Bacterial extracellular vesicles in the initiation, progression and treatment of atherosclerosis

Atherosclerosis is the primary cause of cardiovascular and cerebrovascular diseases. However, current anti-atherosclerosis drugs have shown conflicting therapeutic outcomes, thereby spurring the search for novel and effective treatments. Recent research indicates the crucial involvement of oral and gastrointestinal microbiota in atherosclerosis. While gut microbiota metabolites, such as choline derivatives, have been extensively studied and reviewed, emerging evidence suggests that bacterial extracellular vesicles (BEVs), which are membrane-derived lipid bilayers secreted by bacteria, also play a significant role in this process. However, the role of BEVs in host-microbiota interactions remains insufficiently explored. This review aims to elucidate the complex communication mediated by BEVs along the gut-heart axis. In this review, we summarize current knowledge on BEVs, with a specific focus on how pathogen-derived BEVs contribute to the promotion of atherosclerosis, as well as how BEVs from gut symbionts and probiotics may mitigate its progression. We also explore the potential and challenges associated with engineered BEVs in the prevention and treatment of atherosclerosis. Finally, we discuss the benefits and challenges of using BEVs in atherosclerosis diagnosis and treatment, and propose future research directions to address these issues.

Global, regional and national burden of pancreatitis in children and adolescents, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Pancreatitis poses a significant global health burden, disproportionately affecting children and adolescents. This study uses the global burden of disease (GBD) 2021 dataset to evaluate pancreatitis epidemiology in this demographic, focusing on disparities by age, sex, and region.

OBJECTIVE

To assess global trends in pediatric pancreatitis, identify risk factors, and forecast disease burden to 2035.

METHODS

We analysed GBD 2021 data on deaths and disability-adjusted life years (DALYs) for pancreatitis in individuals under 20. The socio-demographic index (SDI) assessed the link between societal development and health outcomes. Bayesian age-period-cohort (BAPC) modelling and Poisson's linear models were applied to project future burdens and estimate annual percentage changes (EAPCs) in age-standardized rates.

RESULTS

In 2021, pancreatitis caused 1120.09 deaths in children and adolescents, comprising 2% of all pancreatitis-related deaths. Age-standardized death rate (ASDR) and DALYs rate declined from 1990 to 2021 (EAPC -0.92 and -0.86, respectively). Low-middle SDI regions, notably Andean and Central Latin America and Eastern Europe, faced the highest burden. Alcohol was a leading risk factor, accounting for 3.51% of related deaths, and males had higher death and DALYs rate.

CONCLUSIONS

Despite declining pancreatitis-related mortality and DALYs, the disease remains a challenge, particularly in low-middle SDI regions. Alcohol consumption is a key risk factor, underscoring the need for targeted public health interventions. Gender-, age-, and region-specific strategies are essential to mitigate pancreatitis impact in children and adolescents.

Microbial diversity and fitness in the gut-brain axis: influences on developmental risk for Alzheimer's disease

The gut-brain axis (GBA) denotes the dynamic and bidirectional communication system that connects the gastrointestinal tract and the central nervous system (CNS). This review explored this axis, focusing on the role of microbial diversity and fitness in maintaining gastrointestinal health and preventing neurodegeneration, particularly in Alzheimer's disease (AD). Gut dysbiosis, characterized by the imbalance in populations of beneficial and harmful bacteria, has been associated with increased systemic inflammation, neuroinflammation, and the progression of AD through pathogenic mechanisms involving amyloid deposition, tauopathy, and increased blood-brain barrier (BBB) permeability. Emerging evidence highlighted the therapeutic potential of probiotics, dietary interventions, and intermittent fasting in restoring microbial balance, reducing inflammation, and minimizing neurodegenerative risks. Probiotics and synbiotics are promising in helping improve cognitive function and metabolic health, while dietary patterns like the Mediterranean diet were linked to decreased neuroinflammation and enhanced gut-brain communication. Despite significant advancement, further research is needed to elucidate the specific microbial strains, metabolites, and mechanisms influencing brain health. Future studies employing longitudinal designs and advanced omics technologies are essential to developing targeted microbiome-based therapies for managing AD-related disorders.

Investigation of the protein corona and biodistribution profile of polymeric nanoparticles for intra-amniotic delivery

When exposed to the biological environment, nanoparticles (NPs) form a protein corona that influences delivery profile. We present a study of protein corona formation and NP biodistribution in amniotic fluid (AF) for poly(lactic-co-glycolic acid) (PLGA) and poly(lactic-acid) (PLA) NPs, with and without polyethylene glycol (PEG), as well as poly(amine-co-ester)-PEG (PACE-PEG) NPs. The presence of surface PEG and polyvinyl alcohol (PVA) were characterized to investigate surfactant role in determining protein corona formation. The surface density of PEG groups demonstrated an inverse correlation with the total amount of protein surface adsorption. All PEGylated NPs exhibited a dense brush conformation and demonstrated higher levels of stability in AF than non-PEGylated NPs. The protein corona composition varied by core polymer, while the amount of protein adsorption varied by PEGylation status. In A549 cells, in vitro cellular association of each NP type correlated with the amount of albumin that was found in the protein corona. In vivo, only PEGylated NPs were able successfully distribute to fetal organs, likely due to the enhanced stability imparted by PEG. PLGA-PEG and PACE-PEG NPs had both high levels of albumin in the protein corona and high biodistribution to the fetal lung, consistent with the association with lung cells in vitro. PLA-PEG NPs distributed exclusively to the fetal bowel, which we propose is associated with known gastrointestinal targeting keratin proteins. By furthering our understanding of polymeric NP behavior in AF, this novel study provides a basis for optimization of intra-amniotic NP delivery systems targeting congenital pulmonary and gastrointestinal diseases.

Characterization of metabolism associated with outcomes in severe acute pancreatitis: Insights from serum metabolomic analysis

Severe Acute Pancreatitis (SAP) is characterized by an abrupt onset of pancreatic inflammation, which may induce damage to other organs, and is associated with significant morbidity and mortality. Despite the considerable disease burden, specific treatments to stop progression or prevent occurrence are limited. Currently, there is a paucity of comprehensive studies that thoroughly explore metabolic dysregulation in SAP, particularly those that emphasize changes in outcomes. Nuclear magnetic resonance (NMR) based metabolomics coupled with multivariate analysis was applied to serum samples of 20 survivors and 30 non-survivors of SAP to identify metabolic changes linked to different outcomes. The discriminant analysis of serum samples of SAP survivors and non-survivors revealed isoleucine, leucine, valine, arginine, lactate, and 3-hydroxybutyrate as significant metabolites elevated in the non-survivors. These identified metabolites had shown a significant positive correlation with clinical severity scores in the Pearson correlation analysis. Pathway analysis revealed disruptions in amino acid metabolism, driven by protein catabolism to fulfill the patient's energy requirements. This study highlights the importance of metabolomics in unraveling the molecular and physiological mechanisms underlying SAP. These findings offer valuable insights for clinicians to develop treatment strategies that target metabolic pathways in SAP, potentially for improving patient outcomes.

Understanding the risk factors of hemagglutinase-associated hypofibrinogenemia can improve the prognosis of patients

We editorialized on this study published by Zou et al . Gastrointestinal bleeding is a common clinical symptom, and hemocoagulase is frequently used to treat hemorrhagic conditions. However, studies have shown that hemocoagulase treatment may induce acquired hypofibrinogenemia, further aggravating the bleeding. Zou et al retrospectively analyzed 109 gastrointestinal bleeding cases to explore the hazards underlying hypofibrinogenemia induced by hemocoagulase, and identified higher total dose of hemocoagulase and female sex, as well as low baseline fibrinogen levels as significant hazards. Consequently, clinicians should be aware of both intrinsic and extrinsic risk factors when using hemocoagulase among this patient population, and remain vigilant for the potential development of hemocoagulase-induced hypofibrinogenemia.

Unraveling the nutritional challenges in epilepsy: Risks, deficiencies, and management strategies: A systematic review

BACKGROUND

Malnutrition and epilepsy share a complex bidirectional relationship, with malnutrition serving as a potential risk factor for epilepsy development, while epilepsy, in turn, often exerts profound effects on nutritional status. Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.

AIM

To explore the multifaceted associations between malnutrition and epilepsy, structured into three primary sections: (1) Elucidating the impact of malnutrition as a risk factor for epilepsy onset; (2) Examining the reciprocal influence of epilepsy on nutritional status, and (3) Evaluating diverse nutritional interventions in the management of epilepsy.

METHODS

A systematic search was conducted across PubMed, Scopus, and Web of Science databases utilizing defined keywords related to malnutrition, epilepsy, and nutritional interventions. Inclusion criteria encompassed various study types, including clinical trials, animal models, cohort studies, case reports, meta-analyses, systematic reviews, guidelines, editorials, and review articles. Four hundred sixteen pertinent references were identified, with 198 review articles, 153 research studies, 21 case reports, 24 meta-analyses, 14 systematic reviews, 4 guidelines, and 2 editorials meeting the predefined criteria.

RESULTS

The review revealed the intricate interplay between malnutrition and epilepsy, highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies. Findings underscored the importance of nutritional interventions in managing epilepsy, showing their impact on seizure frequency, neuronal function, and overall brain health.

CONCLUSION

This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment. The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.

Prevalence of osteoporosis in chronic diseases: an umbrella review of 283 observational studies from 13 systematic reviews

INTRODUCTION

Osteoporosis is a disease characterized by decreased bone mineral density and deterioration of bone microarchitecture, which increases fracture risk. In the context of various chronic pathologies, this condition may present an even higher prevalence, impacting morbidity, mortality, and healthcare burden.

OBJECTIVE

To synthesize and compare available evidence from systematic reviews on the prevalence of osteoporosis across different chronic diseases.

METHODOLOGY

An umbrella review following PRISMA guidelines was conducted, focusing on systematic reviews (with or without meta-analysis) reporting prevalence data of osteoporosis in adults with at least one chronic disease. Databases, including PubMed/MEDLINE, Scopus, Web of Science, and EMBASE, were searched, covering publications between 2009 and 2023, without language restrictions. Two independent reviewers performed study selection and data extraction, resolving discrepancies through consensus. A risk of bias assessment was conducted using the ROBIS tool. Prevalence estimates reported in each review were analyzed, classifying diseases according to the magnitude of the percentages found.

RESULTS

Thirteen systematic reviews were evaluated (twelve included meta-analyses). The highest prevalence of osteoporosis was observed in patients with Chronic Obstructive Pulmonary Disease (up to 36.8%) and diabetes mellitus (approximately 27.7%). Other conditions, such as rheumatoid arthritis, multiple sclerosis, liver cirrhosis, and celiac disease, showed variable prevalence but were equally relevant in clinical terms. Methodological heterogeneity, both in diagnostic criteria and populations, was a notable factor.

CONCLUSIONS

The results highlight the need for systematic assessment of bone health in patients with chronic diseases, particularly those with a higher prevalence of osteoporosis. These findings underscore the importance of timely screening strategies and multidisciplinary approaches to prevent fractures and optimize comprehensive care.

CLINICAL TRIAL NUMBER

Not applicable.

Adjuvant treatment of gastrointestinal stromal tumor: State of the art in 2025

The management of gastrointestinal stromal tumors (GISTs) has been revolutionized by the discovery of their sensitivity to imatinib. Most localized GISTs can be cured by surgery alone. The present overview aims to discuss the results of four recent randomized trials or updates assessing adjuvant imatinib. The duration of adjuvant treatments varied in these 4 trials (1 year versus zero, 2 years versus zero, 3 years versus 1 year and 6 years versus 3 years). All these trials showed that adjuvant imatinib improves disease/relapse-free survival in patients at high-risk of GIST relapse. Nevertheless, only one trial showed an overall survival improvement, in favor of 3-year treatment compared to 1-year treatment. But these randomized trials did not assess KIT or PDGFRA mutational status at study entry. Moreover, the definition of high-risk GIST differed across these trials. So, the patient subset that benefits the most from adjuvant imatinib therapy remains undetermined. The optimal duration of adjuvant imatinib therapy remain unclear.

Experimental datasets on the extraction of functional ingredients from seaweeds for controlling bacterial infection

Seaweeds are gaining significant attention for their bioactive compounds, which hold great potential for use in food, cosmetics, and pharmaceuticals [1]. To avoid the use of toxic substances in the extraction process, there is a need for innovative and eco-friendly methods to exploit the highly potent raw seaweed biomass. Described herein are the datasets of how the particle size reduction of seaweeds positively enhanced the efficacy of green extraction in boosting the extraction yields of seaweed bioactive compounds. Different green extraction approaches were used to accumulate different seaweed particle sizes that were collected via grinding and sieving [2]. The total yields of carbohydrates, glucuronic acids, proteins, phenolics and flavonoids were quantified to evaluate the efficacy of the extraction strategies. The efficacy and safety usages of the extracts were assessed using different pathogenic bacterial strains and human cell lines, respectively.

Management of metabolic dysfunction-associated steatotic liver disease (MASLD)-An expert consensus statement from Indian diabetologists' perspective

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high-risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high-risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non-invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well-planned study design that could enhance the scientific value of these statements.

Could the Therapeutic Effect of Physical Activity on Irritable Bowel Syndrome Be Mediated Through Changes to the Gut Microbiome? A Narrative and Hypothesis Generating Review

BACKGROUND

Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal (GI) disorders worldwide. Defined as a disorder of gut-brain interaction, its pathophysiology is still not completely clear. Consequently, current treatments primarily target symptoms rather than addressing the cause of the condition. The gut microbiome is increasingly acknowledged as central to IBS pathophysiology and, thus, may have therapeutic potential. Several national treatment guidelines recommend increasing physical activity for IBS management.

AIMS

This review summarises the evidence about the relationship between physical activity, IBS symptoms, and the gut microbiome, investigating the hypothesis that physical activity's therapeutic effects on IBS may be explained via modulation of the gut microbiome.

RESULTS

This review revealed that routine exercise was associated with a 15%-66% reduction in symptom severity and up to 41% enhanced QoL in IBS participants, and modulates the gut microbiome in healthy controls.

DISCUSSION

This review generates the hypothesis that routine physical activity may favorably alter gut microbiome composition in IBS to improve IBS symptomology. While a plausible hypothesis, research needs to confirm whether gut microbiome modulation is involved in physical activity associated IBS symptom relief.

CONCLUSION

Furthermore, the establishment of the most effective mode, duration, and intensity of physical activity for each sex and IBS-subtype is needed, with patient input during this process crucial to successfully translate science into practice.

Metagenomic profiling of hospital wastewater: A comprehensive national scale analysis of antimicrobial resistance genes and opportunistic pathogens

BACKGROUND

Healthcare settings are recognised as potential hotspots for the emergence and spread of antimicrobial resistance (AMR).

METHOD

Metagenomic sequencing was conducted on a national scale using wastewater from hospitals across Wales to screen for antimicrobial resistance genes (ARGs) and opportunistic pathogens.

RESULTS

The total abundance and diversity of ARGs varied significantly across the hospitals. Genes conferring resistance to aminoglycosides, beta-lactams, and Macrolide-Lincosamide-Streptogramin-class antibiotics were predominant, with distinct resistome patterns emerging spatially. OXA-type beta-lactamases were the dominant ARG types. Spatial variability was observed in the distribution of the "big five" carbapenemases (KPC, IMP, VIM, NDM, OXA-48-like) and mcr genes, as well as WHO-listed fungal priority pathogens and Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli (ESKAPEE) pathogens. Furthermore, antibiotic concentrations in the effluents often exceeded risk quotients, posing a substantial risk for AMR emergence.

CONCLUSIONS

Overall, the study highlights the effectiveness of combining wastewater-based epidemiology with metagenomics to gain critical insights into the distinct resistome and microbiome profiles in hospital settings. Tailored strategies are essential to mitigate the spread of antibiotics, clinically relevant ARGs and pathogens in these settings. This study underscores the necessity of implementing pre-treatment processes for hospital effluents before release into community sewers and environmental waters to curb the spread of these micro-pollutants.

Probiotic Lactiplantibacillus plantarum Lb41 alleviates high-fat diet-induced nonalcoholic fatty liver disease in mice

OBJECTIVE

Nonalcoholic fatty liver disease (NAFLD) is mainly related to genetics, obesity, insulin resistance, and type 2 diabetes. Probiotic Lactiplantibacillus plantarum Lb41 (Lb41) has not been reported to have hepatoprotective effects. Therefore, the aim of this study is to investigate the preventive effects of Lb41 against NAFLD in high-fat diet (HFD)-fed mice for preventing NAFLD.

METHOD

To induce fatty liver, the mice were given HFD for 5 weeks, followed by silymarin (200 mg/kg) or Lb41 (108 or 109 colony forming units/day) with the HFD for 7 weeks. After 12 weeks, body weight, histological change, serum and hepatic lipid profiles, etc. was performed compared to control and silymarin.

RESULTS

Lb41 had significantly reduced body weight (4.87 g) and serum lipids (triglycerides (77.64%), total cholesterol (67.53%), and low-density lipoprotein (40.50%) compared with the HFD group (P < 0.05). Lb41 significantly relieved HFD-associated hepatic injury by reducing aspartate transaminase (0.49-0.57 fold), alanine transaminase (0.49-0.51 fold), and alkaline phosphatase (0.76-0.90 fold) (P < 0.05). Additionally, they had decreased expression levels of peroxisome proliferator-activated receptor (PPAR) γ and sterol regulatory element-binding protein 1c and increased the expression levels of acyl-CoA oxidase, PPARα, carnitine palmitoyltransferase 1, acetyl CoA carboxylase 1, and fatty acid synthase in liver cells. Insulin and leptin levels decreased in the Lb41 treatment group compared with those in the HFD group. Meanwhile, adiponectin levels increased, similar to those in the normal diet group.

CONCLUSION

Based on these findings, Lb41 probiotics have possible hepatoprotective effects and could be used as functional food materials.

Investigating accumulation of budesonide and tacrolimus in an ex vivo porcine oesophageal model: Translational potential for local application of drugs to treat eosinophilic oesophagitis

Eosinophilic oesophagitis (EoE) is a chronic inflammatory disease afflicting the oesophagus and causing lifelong morbidity. Over the last few decades, EoE has significantly increased in prevalence with oral corticosteroids, such as budesonide, being the current mainstay of therapy. Tacrolimus is an immunomodulatory drug with anti-inflammation properties that is not on the conventional therapeutic regimen for EoE but offers a promising alternative non-steroidal treatment for patients who do not respond to diet elimination, proton pump inhibitors (PPIs), or corticosteroids. This study aims to investigate and compare the accumulation between locally delivered budesonide and tacrolimus, using an ex vivo porcine oesophageal model of EoE, over a range of contact times up to 30 min. Budesonide and tacrolimus were solubilised in a cosolvent and surfactant formulation to maintain solvation capacity in artificial saliva. Injured and non-injured (control) porcine oesophageal mucosa were used as surrogates to represent EoE and healthy oesophageal mucosa in humans, respectively, due to the highly similar physiological architecture of the oesophagus. EoE-mimicking oesophageal damage was chemically induced by pancreatic enzymes and bile salts known to dilate intercellular spaces typically observed in EoE pathophysiology where tight junction damage was represented by an irreversible drop in transepithelial electrical resistance (TEER). Whole tissue and basolateral accumulation of budesonide and tacrolimus were quantified after 30 min using liquid chromatography tandem mass spectrometry (LC-MS/MS). Tacrolimus yielded a significant increase (p < 0.05) in injured tissue accumulation (approximately two-fold) in comparison to non-injured tissue, while budesonide yielded no significant difference (p > 0.05) in tissue accumulation between the two. Considering the significant accumulation of tacrolimus in this ex vivo porcine model of EoE, using injury-induced porcine oesophageal mucosa, this study suggests the use of tacrolimus as a targeted local therapy for the treatment of EoE.

Updated Review of Radiologic Imaging and Intervention for Acute Pancreatitis and Its Complications

This is a current update on radiologic imaging and intervention of acute pancreatitis and its complications. In this review, we define the various complications of acute pancreatitis, discuss the imaging findings, as well as the timing of when these complications occur. The various classification and scoring systems of acute pancreatitis are summarized. Advantages and disadvantages of the 3 primary radiologic imaging modalities are compared. We then discuss radiologic interventions for acute pancreatitis. These include diagnostic aspiration as well as percutaneous catheter drainage of fluid collections, abscesses, pseudocysts, and necrosis. Recommendations for when these interventions should be considered, as well as situations in which they are contraindicated are discussed. Fortunately, acute pancreatitis usually is mild; however, serious complications occur in 20%, and admission of patients to the intensive care unit (ICU) occurs in over 10%. In this paper, we will focus on the imaging and interventional radiologic aspects for the serious complications and patients admitted to the ICU.

G-protein coupled receptors in metabolic reprogramming and cancer

G-protein coupled receptors (GPCR) are one of the frequently investigated drug targets. GPCRs are involved in many human pathophysiologies that lead to various disease conditions, such as cancer, diabetes, and obesity. GPCR receptor activates multiple signaling pathways depending on the ligand and tissue type. However, this review will be limited to the GPCR-mediated metabolic modulations and the activation of relevant signaling pathways in cancer therapy. Cancer cells often have reprogrammed cell metabolism to support tumor growth and metastatic plasticity. Many aggressive cancer cells maintain a hybrid metabolic status, using both glycolysis and mitochondrial metabolism for better metabolic plasticity. In addition to glucose and glutamine pathways, fatty acid is a key mitochondrial energy source in some cancer subtypes. Recently, targeting alternative energy pathways like fatty acid beta-oxidation (FAO) has attracted great interest in cancer therapy. Several in vitro and in vivo experiments in different cancer models reported encouraging responses to FAO inhibitors. However, due to the potential liver toxicity of FAO inhibitors in clinical trials, new approaches to indirectly target metabolic reprogramming are necessary for in vivo targeting of cancer cells. This review specifically focused on free fatty acid receptors (FFAR) and β-adrenergic receptors (β-AR) because of their reported significance in mitochondrial metabolism and cancer. Further understanding the pharmacology of GPCRs and their role in cancer metabolism will help repurpose GPCR-targeting drugs for cancer therapy and develop novel drug discovery strategies to combine them with standard cancer therapy to increase anticancer potential and overcome drug resistance.

New insights into phytochemicals via protein glycosylation focused on aging and diabetes

BACKGROUND

Protein glycosylation as a common post-translational modification that has significant impacts on protein folding, enzymatic activity, and interfering with receptor functioning. In recent years, with the rapid development of glycopeptide enrichment and analysis technology and the deepening of glycosylation research, glycosylation has gradually become a sign of disease occurrence and development. Multiple investigations suggest that protein glycosylation affect the advances of diabetes and aging.

PURPOSE AND METHODS

This review was focused on the action mechanisms of glycosylated proteins production, permanent abnormalities in extracellular matrix component function, inflammatory and reactive oxygen species production, as well as the glycosylated characterizations of diabetes and aging. Further, advances in glycosylation analysis and detection methods are presented for the first time, highlighting for needed future developments. All literatures were gathered from PubMed and Google Scholar.

RESULTS

Herein, we review how protein glycosylation impacts the progression of diabetes and aging. Specifically, we focus on various types of glycosylation, including N-linked glycosylation, O-linked glycosylation, C-glycosylation, S-glycosylation, and glycophosphatidylinositol (GPI) anchors. N-linked glycosylation and O-linked glycosylation are commonly observed glycosylation forms, wherein O-GlcNAcylation plays a significant role in diabetes, while N-glycan could serve as biomarkers for identifying inflammation and aging.

CONCLUSIONS

Protein glycosylation produces a vastly larger number of core glycan structures through utilizing at least 173 glycosyltransferases and repeated common scaffolds. Single protein may contain multiple glycosylation sites, and the structure and occupancy of glycan at each site may be different, resulting in the macro heterogeneity of protein glycosylation. This review will contribute to how protein glycosylation impacts the life progress of cells and its association with diseases.

Current Understanding of Optimal Prevention of Helicobacter pylori-Induced Cancer

Gastric cancer is the fifth most common cancer and the fifth most common cause of cancer-related death globally. The key to improving outcomes lies in effective prevention and early detection, which are critical for successful curative interventions. Helicobacter pylori is the strongest known risk factor for gastric cancer, and eradication of this pathogen is critical for reducing cancer risk. By synthesizing current evidence and exploring the advanced therapeutic approaches, this review provides a comprehensive overview of best practices for mitigating gastric cancer through targeted bacterial intervention.

Sepsis and high-density lipoproteins: Pathophysiology and potential new therapeutic targets

In 2020, sepsis has been defined a worldwide health major issue (World Health Organization). Lung, urinary tract and abdominal cavity are the preferred sites of sepsis-linked infection. Research has highlighted that the advancement of sepsis is not only related to the presence of inflammation or microbial or host pattern recognition. Clinicians and researchers now recognized that a severe immunosuppression is also a common feature found in patients with sepsis, increasing the susceptibility to secondary infections. Lipopolysaccharides (LPS) are expressed on the cell surface of Gram-negative, whereas Gram-positive bacteria express peptidoglycan (PGN) and lipoteichoic acid (LTA). The main mechanism by which LPS trigger host innate immune responses is binding to TLR4-MD2 (toll-like receptor4-myeloid differentiation factor 2), whereas, PGN and LTA are exogenous ligands of TLR2. Nucleotide-binding oligomerization domain (NOD)-like receptors are the most well-characterized cytosolic pattern recognition receptors, which bind microbial molecules, endogenous by-products and environmental triggers. It has been demonstrated that high-density lipoproteins (HDL), besides their major role in promoting cholesterol efflux, possess diverse pleiotropic properties, ranging from a modulation of the immune system to anti-inflammatory, anti-apoptotic, and anti-oxidant functions. In addition, HDL are able at i) binding LPS, preventing the activating of TLR4, and ii) inducing the expression of ATF3 (Activating transcription factor 3), a negative regulator of the TLR signalling pathways, contributing at justifying their capacity to hamper infection-based illnesses. Therefore, reconstituted HDL (rHDL), constituted by apolipoprotein A-I/apolipoprotein A-IMilano complexed with phospholipids, may be considered as a new therapeutic tool for the management of sepsis.

The association between hepatic steatosis, vitamin D status, and insulin resistance in adolescents with obesity

Introduction

Epidemiological studies suggest an inverse relationship between circulating 25-hydroxy-vitamin D [25(OH)D] levels and insulin resistance (IR), yet interventional studies have yielded inconsistent findings. This study examined the relationship between changes in vitamin D status and markers of IR in adolescents, with a focus on the modifying effect of liver fat.

Methods

A post-hoc analysis was performed using data from 44 adolescents participating in a 6-month observational study evaluating biomarkers of hepatosteatosis. Participants were categorized into two groups based on vitamin D status at the end of the observation period: those whose vitamin D levels increased or remained sufficient (VDI, n = 22) and those whose levels decreased or remained insufficient/deficient (VDD, n = 22). Liver fat percentage was measured using magnetic resonance imaging (MRI) fat-fraction, and IR was assessed using the updated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) and the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL).

Results

Across the cohort, liver fat was positively associated with HOMA2-IR (β = 0.08, p = 0.023). The association between changes in vitamin D status and HOMA2-IR trajectories was modified by liver fat but only in Hispanic adolescents (β = -0.18, p < 0.001). Among Hispanic adolescents in the VDD group, HOMA-IR worsened, particularly at higher levels of liver fat. In non-Hispanic adolescents, HOMA-IR increased in the VDD group (β = 0.65, p = 0.033) compared to the VDI group, independent of baseline liver fat. Across the cohort, changes in vitamin D status interacted with liver fat to influence TG/HDL trajectories (β = 0.20, p = 0.034).

Conclusions

The metabolic response to changes in vitamin D status in adolescents with IR may vary based on racial and ethnic differences and liver fat status. These findings underscore the importance of considering liver fat and racial/ethnic background in vitamin D and metabolic health studies. Future research with more extensive and diverse cohorts spanning the fatty liver disease spectrum is needed to clarify these relationships.

IFN-λ: Unleashing Its Potential in Disease Therapies From Acute Inflammation Regulation to Cancer Immunotherapy

Type III interferons (IFN-λ), which include IFN-λ1 (or interleukin [IL]-29), IFN-λ2 (IL-28A), IFN-λ3 (IL-28B) and IFN-λ4, exert their effects through a unique receptor complex composed of interferon lambda receptor 1 (IFNLR1) and IL-10 receptor subunit beta (IL-10R2). Studies have highlighted their critical role in modulating immune response, particularly in the context of autoimmune diseases, viral infections and cancer. Unlike type I IFNs, which are broadly expressed, IFN-λ displays a more tissue-specific expression pattern, predominantly acting on epithelial cells and certain immune cell types, such as neutrophils and B cells. This specificity allows IFN-λ to play a pivotal role in mucosal immunity, particularly at barrier sites, such as the respiratory and gastrointestinal tracts. Emerging evidence suggests that IFN-λ has a dual role in both enhancing antiviral immunity and regulating inflammation, thus offering a promising therapeutic strategy for diseases like systemic lupus erythematosus, rheumatoid arthritis, asthma and various cancers. However, the precise mechanisms by which IFN-λ influence immune modulation and disease progression remain an area of active investigation. This review aims to provide an overview of the structure, function and signalling pathways of IFN-λ, exploring their role in immune-related diseases and discussing potential avenues for therapeutic intervention.

Factors Associated With Delayed Endoscopic Retrograde Cholangiopancreatography Among Patients With Acute Cholangitis

BACKGROUND AND GOALS

Delayed ERCP is associated with increased morbidity and mortality from acute cholangitis (AC). We aimed to identify the factors associated with delayed receipt of early or urgent ERCP among patients with AC.

STUDY

For this retrospective cohort study, we analyzed data from the 2016 to 2020 iterations of the Nationwide Inpatient Sample. We stratified the study population as severe versus nonsevere AC and timing of ERCP as urgent (within 24 h of admission), early (between 24 and 48 h of admission), and late (after 48 h of admission). Using multivariable logistic regression, we examined for the factors associated with delay in urgent or early ERCP overall and delay in urgent ERCP among patients with severe AC.

RESULTS

Of the 12,613 participants included in this study, 3032 (24.0%) had severe AC. Blacks [aOR 1.53; 95% CI (1.27, 1.85)], Asians/Pacific Islanders [aOR 1.22; 95% CI (1.02, 1.46)], those with a history of bariatric surgery [aOR 2.10; 95% CI (1.40, 3.17)] and those with one [aOR 1.33; 95% CI (1.13, 1.58)] or more comorbidities were more likely to have a delay in receiving ERCP within 48 hours of admission when compared with non-Hispanic Whites and those with no comorbidities respectively. Racial disparities were not observed among patients with severe AC.

CONCLUSION

Black/AA and API's presenting with AC are more likely to have a delay in the receipt of ERCP within 48 hours of admission. Assessing the impact of medical comorbidities on procedural risk is important when deciding timing of ERCP.

Zero-inflated models for the evaluation of colorectal polyps in colon cancer screening studies-a value-based biostatistics practice

Background

Colon cancer screening studies are needed for the early detection of colorectal polyps to reduce the risk of colorectal cancer. Unfortunately, the data generated on colon polyps are typically analyzed in their dichotomized form and sometimes with standard count models, which leads to potentially inaccurate findings in research studies. A more appropriate approach for evaluating colon polyps is zero-inflated models, considering undetected existing polyps at colonoscopy screening.

Method

We demonstrated the application of the zero-inflated and hurdle models including zero-inflated Poisson (ZIP), zero-inflated robust Poisson (ZIRP), zero-inflated negative binomial (ZINB), zero-inflated generalized Poisson (ZIGP), zero hurdle Poisson (ZHP), and zero hurdle negative binomial (ZHNB) models, and compared them with standard approaches including logistic regression (LR), Poisson regression (PR), robust Poisson (RP), and negative binomial (NB) regression for the evaluation of colorectal polyps using datasets from two randomized studies and one observational study. We also facilitated a step-by-step approach for selecting appropriate models for analyzing polyp data.

Results

All datasets yielded a significant amount of no polyps and therefore inflated or hurdle models performed best over single distribution models. We showed that cap-assisted colonoscopy yielded significantly more colon polyps (risk ratio [RR] = 1.38; 95% confidence interval [CI] [1.05-1.81]) compared with the standard colonoscopy by using the ZIP analysis. However, these findings were missed by standard analytic methods, including LR (odds ratio [OR] = 0.90; 95% CI [0.59-1.37]), PR (RR = 1.14; 95% CI [0.93-1.41]), and NB (RR = 1.16; 95% CI [0.89-1.51]) for evaluating colon polyps. The standard approaches, such as LR, PR, RP, or NB regressions for analyzing polyp data, produced potentially inaccurate findings compared to zero-inflated models in all example datasets. Furthermore, simulation studies also confirmed the superiority of ZIRP over alternative models in a range of datasets differing from the case studies. ZIRP was found to be the optimal method for analyzing polyp data in randomized studies, while the ZINB/ZHNB model showed a better fit in an observational study.

Conclusion

We suggest colonoscopy studies should jointly use the polyp detection rate and polyp counts as the quality measure. Based on theoretical, empirical, and simulation considerations, we encourage analysts to utilize zero-inflated models for evaluating colorectal polyps in colonoscopy screening studies for proper clinical interpretation of data and accurate reporting of findings. A similar approach can also be used for analyzing other types of polyp counts in colonoscopy studies.

Photoperiod-Dependent Effects of Phenolic-Enriched Fruit Extracts on Postprandial Triacylglyceride Levels and Acute Inflammatory Responses in F344 Rats

This study investigated the photoperiod-dependent effects of eight phenolic-enriched fruit extracts on postprandial blood triacylglyceride (TAG) levels and serum cytokine and CRP levels in F344 rats after an oral lipid tolerance test (OLTT) and lipopolysaccharide (LPS)-induced inflammatory challenge, respectively. Animals were exposed to short (6-h light, L6) or long (18-h light, L18) photoperiods and orally supplemented with fruit extracts (100 mg/kg) for 2 weeks. Extracts were obtained from seasonal fruits (cherries, plums, apricots, strawberries, persimmon kakis, grapes, oranges, and pomegranates). Temporal homeostasis disruption was induced by an OLTT and LPS challenge. No differences in blood postprandial TAG levels were observed in the L6- and L12-control groups. However, in the experimental groups, the postprandial TAG response depended on the photoperiod and fruit extract consumption, mainly cherry and plum extracts in L6 (p < 0.05). In addition, control rats exposed to L6 exhibited higher blood IL-6 and TNF-α levels after inducing LPS-inflammatory response. Notably, winter-fruit and strawberry extracts were the most efficient at lowering proinflammatory cytokines. These findings show the effectiveness of specific fruit extracts in modulating postprandial TAG levels and acute inflammatory responses, being their effects photoperiod-dependent, opening the door to the design of functional ingredients specific for each season.

Serum pro-inflammatory cytokines as potential biomarkers for the diagnosis of gastric carcinoma

BACKGROUND

Multiple lines of evidence have indicated that pro-inflammatory cytokines play a role in the pathophysiology of gastric carcinoma (GC).

AIM

To identify potential serum cytokine-based biomarkers for GC diagnosis.

METHODS

The study cohort comprised 50 patients diagnosed with GC and 50 healthy control subjects. A panel of 7 pro-inflammatory cytokines, including interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-12, tumor necrosis factor-α, and interferon-γ (IFN-γ) were quantified using multiplex Luminex assays. Comparative analyses were conducted to evaluate cytokine levels between the GC patients and healthy controls. The diagnostic potential of serum pro-inflammatory cytokines in differentiating GC patients from healthy individuals was assessed through receiver operating characteristic (ROC) curve analysis. The correlation between serum cytokine levels and disease severity, as classified by the tumor-node-metastasis staging system, was analyzed using Spearman's rank correlation coefficient.

RESULTS

In comparison to the control group, patients with GC demonstrated significantly elevated serum levels of IL-1β (t = -4.089, P < 0.001), IL-6 (t = -3.983, P < 0.001), IL-8 (t = -5.460, P < 0.001), and IFN-γ (t = -2.856, P = 0.005). ROC curve analysis indicated that the area under the curve values for IL-1β, IL-6, and IL-8 exceeded 0.7, effectively distinguishing GC patients from healthy controls. Additionally, serum levels of IL-1β (r = 0.424, P = 0.012) and IL-6 (r = 0.742, P < 0.001) were positively correlated with the T stage in GC patients. Similarly, serum concentrations of IL-1β (r = 0.356, P = 0.039) and IL-6 (r = 0.441, P = 0.008) exhibited a positive association with the N stage in these patients.

CONCLUSION

These findings suggest that circulating pro-inflammatory cytokines, such as IL-1β, IL-6, and IL-8, may serve as potential biomarkers for the diagnosis of GC.

Metabolomic Signature in Men with Central Serous Chorioretinopathy Using UHPLC-MS

Central serous chorioretinopathy (CSCR), the fourth leading cause of retinal disease, tends to affect men and is favored by corticosteroids. Untargeted systemic metabolomics was analyzed in 60 men with CSCR and 60 age-matched controls using UHPLC-MS. The analysis of sera revealed a total of 722 metabolites that differed significantly between the CSCR and control groups, with 592 being downregulated and 130 being upregulated. The metabolic profile exhibited incomplete breakdown products of protein digestion or catabolism, incomplete fatty acid β-oxidation, and alterations in antioxidant metabolism. A substantial upregulation of three primary fatty acid amides was observed, along with a downregulation of long-chain acylcarnitines and kynurenines. The reduction in long- and medium-chain acylcarnitine, sphingosine-1-phosphate (S1P), tryptophan, and kynurenine, all of which are upregulated by glucocorticoids, does not support the hypothesis of excess glucocorticoid in patients with CSCR. In conclusion, we report here that patients with CRSC present a metabolic signature that could be useful as a complement to specific endocrine studies to better understand the relationship between corticoids and the pathology. Repeated cohorts are needed to validate these findings.

Two Birds with One Stone: Empowering Probiotic with Nanoenzyme for the Treatment of Inflammatory and Anemia through Oral Administration

In the context of ulcerative colitis (UC), iron deficiency anemia (IDA) is often presented as a prevalent systemic manifestation. However, there is an absence of an effective strategy for the specific case of UC with IDA. Herein, mendelian randomization (MR) analysis is applied to confirm the causal association between UC and iron-related conditions. Accordingly, we have developed a probiotic-based therapeutic approach that synergistically alleviates inflammation and IDA. Probiotic Escherichia coli Nissle 1917 (EcN) is functionalized by the Fe3O4 nanoenzyme and hyaluronan (HA) through electrostatic layer-by-layer (LBL) adsorption. As expected, the obtained EcN@Fe3O4/HA exhibits excellent properties in vitro, such as gastric acid resistance and ROS-scavenging capability. Upon oral administration, EcN@Fe3O4/HA shows remarkable adhesion in vivo, particularly in inflamed mice. Moreover, EcN@Fe3O4/HA shows a "two birds with one stone" effect in dextran sulfate sodium (DSS)-induced mice. First, it exerts anti-inflammatory effects through promoting the expression of tight junction proteins and regulating the gut microbiota. Second, it addresses the issue of IDA. EcN@Fe3O4/HA effectively ameliorates IDA in DSS-induced mice through iron supplementation, EPO upregulation, and iron homeostasis modulation, resulting in enhanced RBC morphology and elevated cell counts. Therefore, the proposed strategy provides inspiration for future management of diseases and related complications.

Inducible, but not constitutive, pancreatic REG/Reg isoforms are regulated by intestinal microbiota and pancreatic diseases

The REG/Reg gene locus encodes a conserved family of potent antimicrobial but also pancreatitis-associated proteins. Here we investigated whether REG/Reg family members differ in their baseline expression levels and abilities to be regulated in the pancreas and gut upon perturbations. We found, in humans and mice, the pancreas and gut differed in REG/Reg isoform levels and preferences, with the duodenum most resembling the pancreas. Pancreatic acinar cells and intestinal enterocytes were the dominant REG producers. Intestinal symbiotic microbes regulated the expression of the same, select Reg members in gut and pancreas. These Reg members had the most STAT3-binding sites close to the transcription start sites and were partially IL-22 dependent. We thus categorized them as "inducible" and others as "constitutive". Indeed, in pancreatic ductal adenocarcinoma and pancreatitis models, only inducible Reg members were upregulated in the pancreas. While intestinal Reg expression remained unchanged upon pancreatic perturbation, pancreatitis altered the microbial composition of the duodenum and feces shortly after disease onset. Our study reveals differential usage and regulation of REG/Reg isoforms as a mechanism for tissue-specific innate immunity, highlights the intimate connection of pancreas and duodenum, and implies a gut-to-pancreas communication axis resulting in a coordinated Reg response.

Unraveling the complex role of tumor-associated neutrophils within solid tumors

Neutrophils are integral to the frontline defense against pathogenic bacterial and fungal invasions. Beyond their traditional roles, these cells are increasingly recognized for their dualistic contributions to the pathology of autoimmune and inflammatory diseases, as well as their complex involvement in cancer progression. Neutrophils interact with different disease states, highlighting their potential as therapeutic targets. Within tumor microenvironment (TME), tumor-associated neutrophils (TANs) exhibit a functional dichotomy, capable of either fostering or impeding tumor growth and metastasis. This binary functional potential of TANs, under certain conditions, suggests a reversible state that could transition from tumor-promoting to tumor-eradicating phenotypes. Despite the critical implications of such functional plasticity, systematic studies of TAN behavioral shifts in the context of cancer immunotherapy remain scarce. Herein, we review recent advancements in the understanding of TANs within the TME, highlighting their binary regulatory effects on solid tumors. Leveraging the latest insights from experimental and clinical research, this review elucidates the complex roles of TANs in tumor development and explores their molecular interactions as potential therapeutic targets. The elucidation of these mechanisms holds promise for novel cancer treatment strategies, aiming to improve patient outcomes by manipulating the tumor-promoting or -suppressing functions of TANs.

Multiple Succinate Dehydrogenase-Deficient Gastrointestinal Stromal Tumors of the Stomach: A Case Report

BACKGROUND Gastrointestinal stromal tumors (GISTs) are a rare subset of gastrointestinal neoplasms, with approximately 85% of cases being characterized by genetic alterations in either the KIT gene or the platelet-derived growth factor receptor alpha (PDGFRA) gene. In contrast, succinate dehydrogenase-deficient gastrointestinal stromal tumors (SDH-deficient GIST) account for only 5-10% of cases. SDH-deficient GISTs is a rare form of gastrointestinal tumor, predominantly affecting young people and women. It typically presents with multifocal lesions, has a tendency to invade lymph nodes, follows an indolent course, and is poorly responsive to imatinib; sunitinib and regorafenib may be effective against it. For patients with resectable lesions, surgical intervention remains the cornerstone of treatment. CASE REPORT A 26-year-old male patient was admitted with the presenting symptom of melena. Subsequent diagnostic evaluations revealed the presence of multiple gastric neoplasms. He underwent laparoscopic distal gastrectomy for multiple gastric tumors and postoperative pathology was consistent with GIST, SDH-deficient type. Genetic testing for KIT, PDGFRA, KRAS, NRAS, BRAF, SDHA, SDHB, SDHC, SDHD, and NF1 showed no mutations. The patient is still being followed and no evidence of relapse has been found 6 months postoperatively. CONCLUSIONS Although SDH-deficient GISTs generally exhibit indolent biological behavior, clinically significant manifestations such as gastrointestinal bleeding, as observed in this case, occasionally occur. The postoperative resolution of hemorrhagic symptoms in this patient demonstrated the therapeutic efficacy of surgical intervention. This case underscores the importance of timely surgical management while highlighting the need for improved diagnostic precision and optimized treatment algorithms. The present report provides valuable clinical insights for prognostic evaluation and clinical decision-making in SDH-deficient GISTs, while also offering a reference for future investigations into novel targeted therapies.

Vegetative and microbial proteins for bioplastics applications - a review in the indian context

The generation of plastic waste is around 400 million tons per year. The non-degradable nature of fossil-derived plastics creates pollution, one of the most concerning environmental challenges faced by society, agencies, and governments today. A promising alternative to plastics is bioplastics. Bioplastics are biopolymer-based plastics derived from biomass or manufactured from the processing of monomers derived from biomass. Proteins are naturally occurring biomolecules that are one of the most suitable natural polymers for making bioplastics. In the form of films, proteins possess various desirable properties such as mechanical strength, gas impermeability, and durability. They are also renewable and easily accessible. Making bioplastics from wasted or unused protein sources is the ideal scenario. This review discusses the opportunities that come along with vegetative and microbial proteins to make bioplastics. It covers various sources for protein extraction, such as gluten, whey, zein, and soy from terrestrial sources and water hyacinth and duckweed from aquatic sources. It also discusses the methods of processing vegetative proteins to make bio-plastic products, the current challenges in employing bioplastics for typical applications, and the prospects to steer us towards a clean and sustainable future.

Diet-pathobiont interplay in health and inflammatory bowel disease

The intestinal microbiota plays a crucial role in maintaining host health by participating in various beneficial functions. However, under certain conditions, it can contribute to the development of inflammatory bowel disease (IBD) and other chronic inflammatory conditions. Importantly, not all commensal microbiota members are drivers of inflammation. A specific subset of commensal bacteria, known as pathobionts, can exhibit pathogenic potential under specific circumstances. Their inflammatory potential is modulated by several factors, including the host's genetic background and the surrounding microbiota. Furthermore, diet has emerged as a critical factor influencing the gut microbiota, with some studies highlighting its role in modulating pathobionts. This review will delve into the role played by pathobionts in chronic intestinal inflammation, in both mouse models as well as in humans, with a focus on the interplay between dietary factors and pathobiont members of the intestinal microbiota. Understanding the complex relationships between diet, pathobionts, and chronic inflammation could pave the way for diet-based therapeutic strategies aimed at managing chronic inflammatory conditions.

Evaluation of Acute Pancreatitis Severity and Prognosis Using the Aggregate Systemic Inflammation Index (AISI) as a New Marker: A Comparison with Other Inflammatory Indices

Background/Objectives: Acute pancreatitis (AP) remains a pressing clinical challenge, largely due to its potential to lead to life-threatening complications and increased mortality. Over the years, numerous tools have been proposed to evaluate the intensity of AP and estimate likely health outcomes. Despite their usefulness, many of these assessment models are complex and rely on a wide array of clinical inputs, making them less practical in everyday healthcare settings. In contrast, the Aggregate Systemic Inflammation Index (AISI), which is calculated using routine blood count parameters, provides a simpler and more inclusive approach to measuring systemic inflammation. This research focuses on examining how effectively AISI can be used to gauge disease severity and project clinical trajectories in individuals affected by pancreatitis. Methods: This retrospective study reviewed the medical records of 412 individuals diagnosed with acute pancreatitis, all of whom received care at the Internal Medicine Clinic of Ankara Bilkent City Hospital between 1 April 2019 and 1 September 2024. The investigation encompassed a thorough analysis of patients' demographic characteristics, lab parameters, and clinical findings, with special attention given to inflammatory markers, including the Aggregate Systemic Inflammation Index (AISI), its revised version, the Platelet-to-Lymphocyte Ratio (PLR), the Neutrophil-to-Lymphocyte Ratio (NLR), and the Systemic Inflammatory Response Index (SIRI). Comparative analyses between groups were performed using independent sample t-tests and one-way ANOVA, complemented by Tukey's post hoc tests where appropriate. Correlations among continuous variables were determined through Pearson's analysis, and the prognostic accuracy of both AISI and its modified form was assessed using Receiver Operating Characteristic (ROC) curve methodology. Results: The mean age among participants was 63.47 ± 17.92 years, while the average AISI value was calculated as 1183.89 ± 1067.42. Both the original and modified versions of the AISI index showed strong positive correlations with several key clinical measures, including prolonged hospitalization, a Glasgow score of 2 or above, BISAP, Ranson scoring, the revised Atlanta classification, and APACHE II. AISI was also significantly linked to the presence of complications and overall mortality (p < 0.01). Analysis through ROC curves demonstrated that an AISI level above 236.626 effectively predicted hospital stays exceeding 10 days, with a sensitivity of 94.40% and a specificity of 91.00%. Moreover, both AISI and its modified form reliably distinguished patients who had a Ranson score of zero, with high diagnostic accuracy. Conclusions: AISI and its modified version demonstrate a strong association with both the intensity and clinical course of acute pancreatitis. Thanks to their simplicity, low cost, and broad usability in healthcare settings, these indices hold considerable promise as practical and dependable tools for assessing the severity and likely outcomes of this increasingly prevalent disease.

Beyond the Basics: Recommended Approach to Severe Acute Pancreatitis Management in the Critical Care Setting

Acute Pancreatitis (AP) poses a significant healthcare burden globally. While most cases present with a mild course, approximately one-fifth progress to severe forms characterized by severe pancreatitis and systemic complications, leading to a mortality rate of up to 40%. Effective management of severe acute pancreatitis necessitates a multidisciplinary approach involving gastroenterologists, interventional radiologists, intensive care teams, and surgeons. The advances in treatment modalities, including early hydration, nutrition, and pain control, have led to a decrease in the morbidity and long-term complications associated with severe acute pancreatitis down to 20%. In this review, we focus on the management challenges and outcomes associated with the difficult condition of severe acute pancreatitis.

Co-Occurrence of Helicobacter pylori and Candida spp. Infections in the Pathogenesis of Gastrointestinal Diseases

Helicobacter pylori and Candida spp. are widespread microorganisms found in the human gastrointestinal tract, often coexisting in the same ecological niche. H. pylori, a Gram-negative bacterium, is a well-known pathogen responsible for gastritis, peptic ulcers, and gastric cancer. In contrast, Candida fungi, often detected in food, particularly Candida albicans, are generally considered commensal organisms, but can become opportunistic pathogens under certain conditions. Recent studies suggest a possible link between these microorganisms, highlighting a new survival strategy of H. pylori, that is, its ability to internalize in Candida vacuoles. This phenomenon, confirmed by various microscopic and molecular techniques, may provide H. pylori with protection against adverse environmental conditions, especially clinically important antibiotic therapy. The basic premise of this theory is the ability of H. pylori to penetrate vacuoles in fungal cells, which then become a reservoir of infection, allowing the infection to recur. Understanding the interaction between H. pylori and Candida may offer new insights into the pathogenesis of gastrointestinal diseases and may lead to the development of treatments targeting both organisms simultaneously. The purpose of this article is to review the literature, considering the first observations on this problem in the literature and the current state of knowledge, and to suggest a direction for further research.

Tapping into Metabolomics for Understanding Host and Rotavirus Group A Interactome

Group A rotavirus continues to be a leading global etiological agent of severe gastroenteritis in young children under 5 years of age. The replication of this virus in the host is associated with the occurrence of Lewis antigens and the secretor condition. Moreover, histo-blood group antigens (HBGAs) act as attachment factors to the outer viral protein of VP4 for rotavirus. Therefore, in this study, we employed a metabolomic approach to reveal potential signature metabolic molecules and metabolic pathways specific to rotavirus P[8] strain infection (VP4 genotype), which is associated with the expression of HBGA combined secretor and Lewis (Le) phenotypes, specifically secretor/Le(a+b+). Further integration of the achieved metabolomics results with lipidomic and proteomics metadata analyses was performed. Saliva samples were collected from children diagnosed as negative or positive for rotavirus P[8] strain infection (VP4 genotype), which is associated with the HBGA combined secretor/Le(a+b+). A total of 22 signature metabolic molecules that were downregulated include butyrate, putrescine, lactic acid, and 7 analytes. The upregulated metabolic molecule was 2,3-Butanediol. Significant pathway alterations were also specifically observed in various metabolism processes, including galactose and butanoate metabolisms. Butyrate played a significant role in viral infection and was revealed to exhibit different reactions with glycerolipids, glycerophospholipids, sphingolipids, sterol lipids, and fatty acyls. Moreover, butyrate might interact with protein receptors of free fatty acid receptor 2 (FFAR2) and free fatty acid receptor 3 (FFAR3). The revealed metabolic pathways and molecule might provide fundamental insight into the status of rotavirus P[8] strain infection for monitoring its effects on humans.

Progress of research on the gut microbiome and its metabolite short-chain fatty acids in postmenopausal osteoporosis: a literature review

Postmenopausal osteoporosis (PMOP) is a systemic metabolic bone disease caused by the decrease in estrogen levels after menopause. It leads to bone loss, microstructural damage, and an increased risk of fractures. Studies have found that the gut microbiota and its metabolites can regulate bone metabolism through the gut-bone axis and the gut-brain axis. As research progresses, PMOP has been found to be associated with gut microbiota dysbiosis and Th17/Treg imbalance. The gut microbiota is closely related to the development and differentiation of Treg and Th17 cells. Among them, the metabolites of the gut microbiota such as short-chain fatty acids (SCFAs) can regulate the differentiation of effector T cells by acting on molecular receptors on immune cells, thereby regulating the bone immune process. The multifaceted relationship among the gut microbiota, SCFAs, Th17/Treg cell-mediated bone immunity, and bone metabolism is eliciting attention from researchers. Through a review of existing literature, we have comprehensively summarized the effects of the gut microbiota and SCFAs on PMOP, especially from the perspective of Th17/Treg balance. Regulating this balance may provide new opportunities for PMOP treatment.

Kompetitive allele specific PCR (KASP) based genotyping of sickle gene in the selected sub-ethnic tribal population of Gujarat and Madhya Pradesh

BACKGROUND

Indian tribal population is more vulnerable to sickle cell disease (SCD), an autosomal recessive disease caused by a single A>T transversion mutation in the HBB gene. Current study aims to develop a novel Kompetitive allele specific PCR (KASP) assay for genotyping of sickle gene in selected tribal communities of India.

PATIENTS AND METHODS

The study was conducted from 2021 to 2023 involving 583 self-declared healthy individuals from four tribal communities, i.e. Korku, Kol, and Sahariya of Madhya Pradesh and Dongri bhil of Gujarat. The sickle cell genotyping was performed using KASP and PCR-RFLP methods and further validated by Sanger sequencing. Various hematological and biochemical parameters were also studied and compared for their association with identified genotypes.

RESULTS

Prevalence of sickle cell trait (SCT) was observed as 4.67%, 9.33%, and 16.41% in Kol, Korku, and Dongri bhil, respectively. The SCD prevalence of 0.7% was observed in Dongri bhil. The KASP assay reflects as a novel, high-throughput, and cost-effective method for effective screening. RBC, folic acid, fetal Hb (HBF), and bilirubin have shown significant association with sickle gene mutation.

CONCLUSIONS

KASP assay offers a rapid, precise, and cost-effective method for screening in tribal populations, which can help in early identification, management, and elimination of disease.

In vivo and in vitro therapeutic evaluation of bone marrow-derived mesenchymal stem cells in liver cancer treatment

Hepatocellular carcinoma is the seventh most common kind of cancer worldwide and the second largest cause of cancer-related deaths in males, behind lung cancer. Globally, 866,000 people were diagnosed with hepatocellular carcinoma (HCC) in 2022, and nearly 42,240 new cases will be identified in 2025 in the United States. Using stem cells obtained from bone marrow can effectively reduce the number of malignant tumor cells through the induction of an epigenetic impact. We obtained bone marrow-derived mesenchymal stem cells (BM-MSCs) from mice and collected the conditioned medium (CM) from cultured cells with 90% confluency. The effect of the CM was identified using both 2D and 3D sphere cultures of wild-type human liver cancer cell line (HepG2), considering variations in sphere size and percentage. A cell death study was conducted using the cell cytotoxicity (MTT) kit, while the quantity of stem cells was determined by immunohistochemistry and gene expression analysis. The effectiveness of our therapy was demonstrated by an in vivo assessment of BM-MSCs through intravenous injection and the currently available anticancer drug cisplatin. In vitro, the combination treatment resulted in a synergetic effect, leading to 74% cell death in both adherent and spherical cultures when treated with 25 µM of cisplatin and 90%CM. In vivo, the histological study indicated a decrease in tumor size and number following treatment with cisplatin and BM-MSCs. The study lasted 18 weeks and revealed that the body weight of mice improved across all treatment groups, with the combination group exhibiting the most significant improvement. Both in vitro and in vivo studies showed the synergetic effect of cisplatin and isolated conditioned medium. Our study aimed to identify more efficient therapeutic approaches utilizing stem cells and existing marketed medications to minimize adverse effects with better efficacy.

Amniotic fluid: its role in fetal development and beyond

Amniotic fluid is a complex biological medium that surrounds the fetus and offers not only mechanical protection but also provides nutrition and plays a critical role in normal fetal growth, organogenesis, and potentially fetal programming. Despite its importance, the biology of amniotic fluid has been understudied because of ethical and technical challenges in obtaining amniotic fluid samples from healthy human pregnancies, translational limitations of animal models to humans due to species-specific differences. Recent progress in understanding its dynamic physiology, composition, and clinical applications has advanced prenatal care and facilitated improved diagnostic and therapeutic strategies. As research continues to elucidate the complexities and evolutionary function of amniotic fluid, its increasingly recognized role in maternal-fetal medicine and its potential to transform clinical practice will only become more evident. The purpose of this review is to underscore the key roles of amniotic fluid in shaping fetal development and therapeutic potential.

Therapeutic Role of Probiotics for the Treatment of Dyspepsia: A Review of the Literature

BACKGROUND

Dyspepsia is a common condition with a high prevalence in the general population. Patients in whom traditional diagnostic procedures can detect no identifiable explanation for the symptoms are diagnosed as being affected by functional dyspepsia (FD). To date, no etiological therapy for FD is available, and the current management includes general measures, acid-suppressive drugs, prokinetic agents, fundus-relaxing drugs, antidepressants, and psychological interventions. Recent evidence suggests that microbiota imbalance is involved in the development of FD. As a consequence, the modulation of microbiota through the use of probiotics could represent an effective therapeutic strategy. Moreover, Helicobacter pylori (HP) infection is a frequent cause of dyspepsia, and patients diagnosed with HP-associated dyspepsia are treated with HP eradication. In this regard, probiotics supplementation may also be helpful for HP infection to increase the eradication success rate as well as to reduce gastrointestinal adverse events caused by antibiotics.

PURPOSE

This review of the literature aims to summarize and discuss the current evidence on the use of probiotics in the treatment of dyspepsia and as a supplement to HP eradication therapy.

Whole-genome analysis of five Escherichia coli strains isolated from focal duodenal necrosis in laying hens reveals genetic similarities to the E. coli O25:H4 ST131 strain

Focal duodenal necrosis (FDN) is an intestinal disease causing significant economic losses in the table-egg industry due to reduced egg production in laying hens. Its etiology and pathogenesis remain poorly understood. Between 2021 and 2023, 111 Escherichia coli isolates were collected from FDN lesions and screened for the presence of virulence genes using PCR panels. Five strains-FDN-4, FDN-9, FDN-11, FDN-24, and FDN-50-were selected for whole-genome sequencing due to their high virulence gene content. Core-genome analyses found that the five FDN E. coli belong to different phylogroups and strain types (ST), but they all share multiple complete operons involved in key pathogenic functions, including host cell adhesion and invasion, iron acquisition, motility, biofilm formation, and acid resistance. Comparative genomic analyses identified FDN-4 as the most genetically distinct strain, closely resembling EC958, an O25b:H4 ST131 uropathogenic E. coli (UPEC) commonly associated with extended-spectrum beta-lactamase production. FDN-4 and EC958 share unique chromosomal virulence genes absent in the other FDN strains, all located within genomic islands. This study provides the first complete genomic characterization of E. coli isolated from FDN lesions and highlights FDN-4 as a genetically distinct strain with similarities to O25b:H4 ST131 UPEC.IMPORTANCEThis study presents the first complete genomic characterization of Escherichia coli isolated from focal duodenal necrosis (FDN) lesions. Notably, FDN-4 is the first E. coli strain from a poultry disease (FDN) to show significant similarity to O25b:H4 ST131 strains, commonly classified as uropathogenic E. coli and often associated with extended-spectrum beta-lactamase production. However, caution is warranted when attributing direct transmission routes between poultry and humans.

Engineering a three-dimensional liver steatosis model

Liver transplantation is the key treatment for liver failure, yet organ scarcity, exacerbated by high discard rates of steatotic livers, leads to high waitlist mortality. Preclinical models of steatosis are necessary to understand the pathophysiology of the disease and to develop pharmacological interventions to decrease disease burden and liver discard rate. In this paper, we develop an expedited 3D steatotic organoid model containing primary human hepatocytes and non-parenchymal cells. We present our iterative approach as we transition from 2D to 3D models and from immortalized to primary cells to optimize conditions for the development of a 3D human steatosis model. Both primary cell aggregation and steatosis induction time were reduced from the standard, 5-7 days, to 2 days. Our 3D model incorporates human primary hepatocytes from discarded liver tissues, which have not been used in organoids previously due to their rapid loss of phenotype in culture. After optimizing our steatosis induction media there was a mix of macro- and micro-steatosis in these primary hepatocytes which is consistent with the human pathology. Our approach achieves a model reflective of the liver pathology, preserving cellular phenotypes and viability while exhibiting markers of oxidative stress, a key factor contributing to complications in the transplantation of steatotic livers.

Outcomes of abdominal wall closure with fascial bridging using a polyglactin 910 (Vicryl) Mesh following non-trauma laparotomy: a multi-center study

INTRODUCTION

Complete primary fascial closure following midline laparotomy is occasionally unachievable, necessitating abdominal wall closure via fascial bridging with polyglactin 910 (Vicryl) mesh. Despite its frequent use, literature on the outcomes of Vicryl mesh for fascial bridging remains sparse and controversial, with some studies indicating potential associations with enterocutaneous fistulas and bowel obstruction. This study evaluates the outcomes of fascial bridging utilizing Vicryl mesh for non-trauma laparotomies.

METHODS

We conducted a retrospective analysis of adult patients who underwent abdominal wall closure using Vicryl mesh at Cleveland Clinic centers from January 2018 to April 2023. Data were extracted from the Epic System, focusing on outcomes including fistula formation, the need for interventions for small bowel obstruction, and overall wound and postoperative morbidity, with a minimum follow-up of six months.

RESULTS

Among the 124,536 patients who underwent non-trauma laparotomies, 202 (0.17%) met the inclusion criteria, with a median follow-up of 47 months (SD ± 18.9 months). Postoperative outcomes following abdominal wall closure with Vicryl mesh included a 48.5% rate of surgical site infections, a 27.2% incidence of skin dehiscence, a 9.9% occurrence of soft tissue necrosis, and 2% experienced bowel evisceration secondary to mesh detachment. Enterocutaneous fistulas developed in 8.4% of patients, with no interventions for small bowel obstruction required within the first six months postoperatively. These complication rates are comparable to other abdominal closure techniques in similarly complex cases.

CONCLUSIONS

Fascial bridging with Vicryl mesh is a safe method for abdominal wall closure, with enterocutaneous fistula and small bowel obstruction rates comparable to those seen with other techniques. Nevertheless, primary closure of the linea alba should be prioritized, with mesh implantation minimized whenever feasible.

INCIDENTAL HEPATIC STEATOSIS IDENTIFIED ON ULTRASOUND IN PATIENTS UNDERGOING CHOLECYSTECTOMY: HIGH PREVALENCE AND INSUFFICIENT INVESTIGATIVE AND CLINICAL MANAGEMENT

BACKGROUND

Steatotic liver disease (SLD) affects about 1 billion people globally, making its proper management essential to prevent progression to more severe stages.

OBJECTIVE

The aim of this study was to evaluate medical management concerning hepatic steatosis incidentally identified by ultrasound in patients undergoing elective cholecystectomy.

METHODS

This observational, cross-sectional, and retrospective study included patients aged 18 years or older who underwent elective cholecystectomy at Hospital do Trabalhador, in Curitiba/PR, between 2018 and 2022. Patients with external ultrasound reports or incomplete data in their medical records were excluded. Medical records, laboratory tests, and ultrasound reports were analyzed to evaluate the prevalence of steatosis in these patients.

RESULTS

The study sample consisted of 355 patients, and 103 (29.01%) of them presented steatosis on ultrasound. Older age (P=0.0022), male sex (P=0.03009), higher body mass index (P<0.001), obesity (P<0.001), hypertension (P<0.001), dyslipidemia (P=0.0072), and elevated levels of oxaloacetic and pyruvic aminotransferases (P=0.02112) were associated with the presence of this finding. No action was taken regarding the presence of steatosis in 60.19% of patients. Approximately 39.81% had the finding recorded in their medical records, 6.80% received lifestyle change counseling, and 4.85% were investigated for the stage of steatosis.

CONCLUSION

A significant prevalence of hepatic steatosis was incidentally identified in the ultrasound of patients undergoing cholecystectomy. However, the approach to this finding was insufficient, highlighting the need for substantial improvements on its management and investigation.

CT surveillance for type 1 autoimmune pancreatitis: cumulative radiation dose and diagnostic performance for disease relapse

OBJECTIVES

Long-term follow-up is essential for type 1 autoimmune pancreatitis (AIP) patients due to high relapse rates. The cumulative radiation dose from repeated CT scans during follow-up should not be ignored. We aim to investigate the cumulative radiation dose in AIP patients undergoing CT surveillance and the diagnostic performance of CT in detecting disease relapse. The diagnostic performance of MRI from a secondary cohort during the same period was also investigated.

METHODS

This retrospective single-institutional study included 247 type 1 AIP patients with one or more follow-up CT scans, and 120 patients with MR follow-ups. Four metrics were utilized to report the radiation dose, including the volume computed tomography dose index, the dose length product, size-specific dose estimate and effective dose. The diagnostic performance for AIP relapse was assessed, taking the final clinical diagnosis in retrospect as the reference standard.

RESULTS

With a median 2.3-year follow-up period, AIP patients followed up with CT exhibited a median cumulative radiation dose of 37.5 mSv. 11.3% of patients have accumulated doses exceeding 100 mSv. For the 169 patients followed over a year, 30.8% sustained an average annual radiation dose surpassing 20 mSv. The sensitivity/specificity/accuracy of CT for detecting abdominal organ relapse was 64.1%/99.6%/97.0%. For AIP patients followed up with MRI, the sensitivity for detecting disease relapse was 90.5%.

CONCLUSION

Considering the accumulation of radiation dose in AIP patients and the insufficient sensitivity in detecting disease relapse with CT, safer and more sensitive imaging follow-up strategies should be explored.

KEY POINTS

Question CT, as the primary imaging modality for autoimmune pancreatitis (AIP) follow-up, raises concerns regarding radiation exposure and lacks reported diagnostic performance in detecting AIP relapse. Findings CT in AIP follow-up causes significant cumulative radiation exposure and exhibits insufficient sensitivity in relapse detection. Clinical relevance Type 1 AIP necessitates long-term imaging follow-up, yet current guidelines lack consensus regarding the prioritization of CT or MRI for such follow-up. CT is widely used but has radiation concerns and limited sensitivity, calling for safer, efficient strategies.

Frailty Predicts Mortality and Procedural Performance in Patients With Non-Variceal Upper Gastrointestinal Bleeding

Introduction

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization in the United States, with approximately 400 000 admissions annually and a 5%-10% mortality rate. This study aimed to evaluate frailty's impact on NVUGIB outcomes.

Methods

We utilized the 2019 National Readmission Database (NRD) to identify adult patients (≥ 18 years) admitted with a principal diagnosis of NVUGIB using ICD-10-CM codes. NVUGIB hospitalizations were stratified by frailty using the hospital frailty risk score (HFRS) of 5 or more as the cut-off for frailty. Multivariate regression analyses were conducted to analyze the outcomes. STATA 14.2 was used for statistical testing.

Results

Among 218 647 NVUGIB admissions, 99 892 (45.69%) were frail. Frail patients were older, more often female, and had higher comorbidity burdens. They showed significantly greater in-hospital mortality (adjusted odds ratio [aOR] 5.64, 95% CI 4.94-6.44; p < 0.001), acute kidney injury (5.85), respiratory failure (6.93), septic shock (40.94), hemorrhagic shock (2.64), vasopressor use (4.36), mechanical ventilation (6.04), and ICU admission (5.41). Although frail patients had higher odds of esophagogastroduodenoscopy (EGD) with intervention (1.04; p < 0.001), they were less likely to receive EGD within 24 h (0.75; p < 0.001). They also had higher odds of rebleeding (1.18; p < 0.001) and radioembolization (2.69; p < 0.001). Length of stay increased by 2.30 days, total charges rose by $28 518, discharge to rehabilitation was more frequent (3.12; p < 0.01), and 30-day readmission was higher (15.24% vs. 11.43%, HR 1.16; p < 0.001).

Conclusion

Frailty independently predicts worse clinical outcomes and increased resource use in NVUGIB. Recognizing frailty may improve risk stratification and guide more tailored management strategies for this high-risk population.

Causality Between Irritable Bowel Syndrome and Suicide Attempt: A Mendelian Randomization Study

BACKGROUND

Prior research has indicated a correlation between irritable bowel syndrome (IBS) and suicidal behavior. Nevertheless, it remains uncertain if this correlation implies causation.

METHODS

We used univariate and multivariate Mendelian randomization. The United Kingdom Biobank provided 53,400 European patients and 433,201 European controls for the IBS GWAS. The outcome variable was developed from a genome-wide association analysis of 26,590 suicide attempt cases and 492,022 controls from the International Suicide Genetics Consortium. BioBank Finland GWAS data (9,771 cases and 402,410 controls) was used for SA validation. Primarily employing inverse variance weighting (IVW), we conducted the analysis to establish causality. MR-Egger and weighted median were used as complementary methods to reinforce the robustness and validity of the results. We used the MRlap method to eliminate the effect of sample overlap. We also used a multivariable MR approach to control for the influence of potential confounders. Using a number of approaches, including the Cochran's Q test, the MR-Egger intercept, and the MR-PRESSO methodology, the study examined pleiotropy and heterogeneity.

RESULTS

We discovered evidence for an elevated risk of suicide attempt with IBS (OR = 1.67, 95% CI = 1.21-2.35, P = 5.52E-07). MRlap analyses similarly support this result. We got the same results with the validation data (OR = 1.19, 95% CI = 1.06-1.34, P = 2.46E-03). The relationships between the different sensitivity analysis approaches were similar, and there was no indication that outliers influenced these correlations. The independent causal impact of IBS on suicide attempts was maintained after controlling for anxiety, depression, and abdominal pain. In reverse MR, we found no causal link between suicide attempt and IBS.

CONCLUSION

Our MR analysis indicates a causal relationship between IBS and suicide risk. Early detection and intervention in suicidal ideation in IBS patients reduces their suicide risk. More study is needed to understand the mechanisms that link IBS and suicidal behavior, which may alter or broaden therapy for specific individuals.