GINS4 silencing mediates hepatocellular cancer cell proliferation, cycle and ferroptosis through POLE2

BACKGROUND

GINS4 has been identified as a regulator associated with multiple types of cancers. However, the effects of GINS4 on hepatocellular carcinoma (HCC) have not been reported.

METHODS

GINS4 expression in HCC was evaluated utilizing UALCAN database. The relationship between the expression of GINS4 and the survival probability of HCC patients was analyzed using Kaplan-Meier Plotter. Cell viability was evaluated by CCK8 assay and EDU assay. qRT-PCR and western blot were performed to examine GINS4 expression. The level of cell cycle was measured by flow cytometry and western blot. Fe2+ level and ferroptosis-related proteins were measured by corresponding kits and western blot. Lipid peroxidation was explored by C11 BODIPY 581/591 probe. STRING database and HDOCK database were performed to predict the binding of GINS4 to POLE2. Immunofluorescence and western blotting was adopted for assessing cell autophagy and mTOR signaling pathway. Ki67 and GPX4 levels were measured by immunohistochemistry. The expression levels of POLE2/PI3K/AKT were assessed by western blot.

RESULTS

The data indicated that GINS4 expression was upregulated in HCC. Knockdown of GINS4 alleviated the proliferation and cycle and promoted ferroptosis of HuH7 cells. GINS4 was proved to bind to POLE2 and the silencing of GINS4 inhibited the expression of POLE2. GINS4 knockdown accelerated ferroptosis in HuH7 cells. POLE2 overexpression reversed the influences of GINS4 silencing on proliferation and cycle, and also ferroptosis. In addition, interference with GINS4 suppressed the activation of PI3K/AKT signaling via POLE2. In vivo experiments illustrated that GINS4 deletion suppressed HCC tumor growth, increased the GPX4 expression and restrained the Ki67 level, as well as reducing POLE2/PI3K/AKT signaling.

CONCLUSION

GINS4 silencing suppressed proliferation and cycle while promoted ferroptosis in HCC cells by regulating PI3K/AKT signaling via binding to POLE2.

Diagnostic value of ultrasonography for post-liver transplant hepatic vein complications

Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success. Despite hepatic vein complications following LT occurring at a relatively low frequency, ranging between 2% to 11%, delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality. Clinical manifestations of hepatic vein complications are often subtle and nonspecific, posing challenges for early diagnosis. Signs may initially present as mild abnormalities in liver function, delayed recovery of liver function, unexplained ascites, lower limb edema, and perineal edema. Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion. Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness. Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging, these findings lack specificity. Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can, however, significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.

An overview of stem cells and cell products involved in trauma injury

Trauma injuries represent a significant public health burden worldwide, often leading to long-term disability and reduced quality of life. This review provides a comprehensive overview of the therapeutic potential of stem cells and cell products for traumatic injuries. The extraordinary characteristics of stem cells, such as self-renewal and transdifferentiation, make them definitive candidates for tissue regeneration. Mesenchymal stem cells (MSCs), neural stem cells (NSCs), and hematopoietic stem cells (HSCs) have been tested in preclinical studies for treating distinct traumatic injuries. Stem cell mechanisms of action are addressed through paracrine signaling, immunomodulation, differentiation, and neuroprotection. Cell products such as conditioned media, exosomes, and secretomes offer cell-free resources, thereby avoiding the risks of live cell transplantation. Clinical trials have reported many effective outcomes; however, variability exists across trauma types. Some challenges include tumorigenicity, standardized protocols, and regulatory issues. Collaboration and interdisciplinary research are being conducted to harness stem cells and products for trauma treatment. This emerging field is promising for improving patient recovery and quality of life after traumatic injuries.

Future prospects of deep learning in esophageal cancer diagnosis and clinical decision support (Review)

Esophageal cancer (EC) is one of the leading causes of cancer-related mortality worldwide, still faces significant challenges in early diagnosis and prognosis. Early EC lesions often present subtle symptoms and current diagnostic methods are limited in accuracy due to tumor heterogeneity, lesion morphology and variable image quality. These limitations are particularly prominent in the early detection of precancerous lesions such as Barrett's esophagus. Traditional diagnostic approaches, such as endoscopic examination, pathological analysis and computed tomography, require improvements in diagnostic precision and staging accuracy. Deep learning (DL), a key branch of artificial intelligence, shows great promise in improving the detection of early EC lesions, distinguishing benign from malignant lesions and aiding cancer staging and prognosis. However, challenges remain, including image quality variability, insufficient data annotation and limited generalization. The present review summarized recent advances in the application of DL to medical images obtained through various imaging techniques for the diagnosis of EC at different stages. It assesses the role of DL in tumor pathology, prognosis prediction and clinical decision support, highlighting its advantages in EC diagnosis and prognosis evaluation. Finally, it provided an objective analysis of the challenges currently facing the field and prospects for future applications.

A nanoplasmonic cell-on-a-chip for in situ monitoring of PD-L1+ exosome-mediated immune modulation

Despite the transformative impact of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 pathway in cancer therapy, up to 80% of patients fail to respond, necessitating reliable predictive biomarkers to guide treatment decisions. Recent studies highlight the critical role of tumor-derived exosomal PD-L1 in immune evasion, and its potential as a diagnostic and prognostic biomarker in cancer immunotherapy. However, significant challenges remain in elucidating the functional roles of PD-L1+ exosomes in immune suppression, as current methods lack the ability to precisely and simultaneously characterize and monitor exosome secretion and the corresponding immune modulation on site. To address this, we developed an integrated microfluidic platform that combines a digital nanoplasmonic immunoassay with a cell-on-a-chip system, enabling in situ monitoring of PD-L1+ exosome secretion and exosome-mediated T cell immune responses. This nanoplasmonic immunoassay integrated cell-on-a-chip (NIIC) creates a localized co-cultured microenvironment that facilitates exosome-mediated cellular interactions without direct contact. The NIIC employs machine-learning assisted signal processing for highly sensitive detection of both exosomes and cytokines, providing spatial and quantitative analysis of immune modulation in situ. Using this system, we demonstrated that PD-L1+ exosomes from cancer cells significantly suppressed IFN-γ and IL-2 secretion in neighboring T cells, offering direct insights into exosome-mediated immune suppression. The NIIC platform represents a powerful tool for advancing the understanding of exosome-driven immune modulation and holds potential for predicting clinical responses to anti-PD-1/PD-L1 therapies, paving the way for more personalized cancer immunotherapy strategies.

Regulatory effect of curcumin on CD40:CD40L interaction and therapeutic implications

Natural compounds have garnered significant attention as potential therapeutic agents due to their inherent properties. Their notable qualities, including safety, efficacy, favorable pharmacokinetic properties, and heightened effectiveness against certain diseases, particularly inflammatory conditions, make them particularly appealing. Among these compounds, curcumin has attracted considerable interest for its unique therapeutic properties and has therefore been extensively studied as a potential therapeutic agent for treating various diseases. Curcumin exhibits diverse anti-inflammatory, antioxidant, and antimicrobial effects. Curcumin's immune system regulatory ability has made it a promising compound for treatment of various inflammatory diseases, such as psoriasis, atherosclerosis, asthma, colitis, IBD, and arthritis. Among the signaling pathways implicated in these conditions, the CD40 receptor together with its ligand, CD40L, are recognized as central players. Studies have demonstrated that the interaction between CD40 and CD40L interaction acts as the primary mediator of the immune response in inflammatory diseases. Numerous studies have explored the impact of curcumin on the CD40:CD40L pathway, highlighting its regulatory effects on this inflammatory pathway and its potential therapeutic use in related inflammatory conditions. In this review, we will consider the evidence concerning curcumin's modulatory effects in inflammatory disease and its potential therapeutic role in regulating the CD40:CD40L pathway.

Association of proteomics with lymph node metastasis in early gastric cancer patients

Surgical decision making for early gastric cancer (EGC) is heavily influenced by its metastasis into the lymph nodes. Currently, the clinicopathological features of EGC cannot be used to accurately distinguish between EGC patients with and without lymph node metastasis. Our retrospective case-matching study included a total of 132 samples from 66 pairs of EGC patients with or without lymph node metastasis and conducted proteomic assays. By comparing the lymph node metastasis group and the nonmetastasis group, we found that two proteins, GABARAPL2 and NAV1, were significantly associated with lymph node metastasis in EGC patients. Our prediction model using protein biomarkers had good prediction accuracy, with an area under the curve (AUC) of 0.87, a sensitivity of 0.78, a specificity of 0.89, and an accuracy of 0.84, which can help distinguish between EGC patients with and without lymph node metastasis and guide the decision-making process for performing tailored surgery.

N6-methyladenosine RNA modification in stomach carcinoma: Novel insights into mechanisms and implications for diagnosis and treatment

N6-methyladenosine (m6A) RNA methylation is crucially involved in the genesis and advancement of gastric cancer (GC) by controlling various pathobiological aspects including gene expression, signal transduction, metabolism, cell death, epithelial-mesenchymal transition, angiogenesis, and exosome function. Despite its importance, the exact mechanisms by which m6A modification influences GC biology remain inadequately explored. This review consolidates the latest advances in uncovering the mechanisms and diverse roles of m6A in GC and proposes new research and translational directions. Key regulators (writers, readers, and erasers) of m6A, such as METTL3/14/16 and WTAP, significantly affect cancer progression, anticancer immune response, and treatment outcomes. m6A modification also impacts immune cell infiltration and the tumor microenvironment, highlighting its potential as a diagnostic and prognostic marker. Interactions between m6A methylation and non-coding RNAs offer further novel insights into GC development and therapeutic targets. Targeting m6A regulators could enhance immunotherapy response, overcome treatment resistance, and improve oncological and clinical outcomes. Models based on m6A can precisely predict treatment response and prognosis in GC. Additional investigation is needed to fully understand the mechanisms of m6A methylation and its potential clinical applications and relevance (e.g., as precise markers for early detection, prediction of outcome, and response to therapy and as therapeutic targets) in GC. Future research should focus on in vivo studies, potential clinical trials, and the examination of m6A modification in other types of cancers.

SUMOylation of RAD51 upregulates GOLPH3 expression and promotes cisplatin resistance in colon cancer cells by Sp1 transcriptional activity

Platinum-based chemotherapy is a first-line treatment for colon cancer. Previous studies have shown that Golgi phosphoprotein 3 (GOLPH3) overexpression drives platinum resistance in colon cancer and is associated with DNA damage repair (DDR). However, the mechanism by which DDR induces GOLPH3 expression remains unclear. This study investigates how RAD51 recombinase (RAD51) SUMOylation upregulates GOLPH3 expression and promotes platinum resistance in colon cancer. In DDP-resistant colon adenocarcinoma (COAD) cells, Specificity protein 1 (Sp1) and GOLPH3 were overexpressed, while N-myc downstream regulated 1 (NDRG1) was downregulated. Knockdown of Sp1 or GOLPH3 increased NDRG1 expression, inhibited COAD cell proliferation, promoted cell apoptosis, and enhanced cell sensitivity to cisplatin (DDP). Immunohistochemistry (IHC) and bioinformatics analyses of COAD tissues revealed a positive correlation between RAD51, SUMO1 and Sp1 expression. Sp1 was found to increase DDP resistance by transcriptionally activating GOLPH3 expression. RAD51 was SUMOylated by SUMO1 at the K57 site, and this modification decreased COAD cell sensitivity to DDP by enhancing Sp1 transcriptional activity. Furthermore, RAD51 overexpression led to upregulation of GOLPH3 and downregulation of NDRG1, promoting cell proliferation, inhibiting apoptosis, and increasing resistance to DDP. Conversely, the RAD51 mutant did not affect GOLPH3 expression or platinum resistance in vivo and in vitro. In conclusion, RAD51 SUMOylation at the K57 site enhances Sp1 transcriptional activity, thereby reducing colon cancer cell sensitivity to DDP by regulating GOLPH3 and NDRG1 expression. This discovery elucidates the molecular mechanism of DDR-induced GOLPH3 upregulation, offering a new perspective for overcoming DDP resistance in colon cancer.

Role of SMYD2 in gastrointestinal cancer progression (Review)

Gastrointestinal cancer is one of the most prevalent malignancies in humans and is often associated with a poor prognosis. Understanding the molecular mechanisms underlying cancer progression and severity is essential for the development of effective cancer therapies. Abnormal protein methylation is associated with the occurrence and advancement of cancer, highlighting the importance of protein methyltransferase research. SET and MYND domain-containing protein 2 (SMYD2), a lysine methyltransferase, has emerged as a promising small molecule target for cancer treatment. Notably, SMYD2 is implicated in the pathogenesis of several diseases, including gastrointestinal cancer. SMYD2 is closely associated with the tumorigenesis, proliferation, migration and other biological processes of gastrointestinal cancer, indicating its potential as a novel therapeutic target. The present review offers an in-depth analysis of SMYD2, covering its structural characteristics, regulatory pathways and functional significance. By assessing the biological roles and therapeutic potential of SMYD2, the current review presents fresh insights and perspectives for advancing research in different types of gastrointestinal cancer.

m6A-mediated regulation of CPSF6 by METTL3 promotes oxaliplatin resistance in colorectal cancer through enhanced glycolysis

Oxaliplatin resistance poses a significant challenge in colorectal cancer (CRC) treatment. Recent studies have implicated CPSF6 in cancer progression and drug resistance, although its role in chemotherapy resistance and regulatory mechanisms is unclear. This study investigates CPSF6's involvement in oxaliplatin resistance in CRC and its regulation via m6A methylation by METTL3. We assessed CPSF6 expression in oxaliplatin-resistant (OxR) CRC cell lines (HT29-OxR and HCT116-OxR) compared to sensitive counterparts using qRT-PCR and Western blotting. CPSF6 was significantly upregulated in OxR cells, and its knockdown reduced cell viability, colony formation, and glycolytic activity while increasing apoptosis. m6A modification of CPSF6 mRNA was elevated in OxR cells, correlating with increased METTL3 expression. METTL3 knockdown decreased CPSF6 levels and m6A enrichment, enhancing mRNA degradation, while its overexpression stabilized CPSF6 mRNA, promoting resistance. Xenograft experiments showed that CPSF6 knockdown suppressed tumor growth and glycolysis. Thus, CPSF6 is identified as a mediator of oxaliplatin resistance in CRC, regulated by the METTL3/m6A axis, suggesting potential therapeutic targets to overcome resistance.

Bibliometric and graphical analysis of ferroptosis and aging research: Trends, gaps, and future directions

Over the past 12 years, a significant body of evidence derived from extensive research has underscored the pivotal involvement of ferroptosis in the mechanisms underlying aging. Despite the growing body of literature on this topic, there remains a paucity of analytical and descriptive studies that explore its trajectory, key research directions, current trends, primary focal points, and future outlooks. This research endeavors to provide an exhaustive overview of the advancements in understanding the relationship between ferroptosis and aging over the past 12 years. The dataset utilized in this study was extracted from the Web of Science, encompassing records from January 1, 2012, through June 19, 2024. We conducted comprehensive bibliometric and visual analyses using advanced analytical tools. The results highlight China's dominant contribution, which accounts for 48.52 % of total publications, positioning it as a key player in this research area. Leading institutions, including Columbia University, Southern Medical University, and the Salk Institute for Biological Studies, demonstrate high research productivity. Pamela Maher and Gu Wei are identified as the most prolific researchers in this field. Free Radical Biology and Medicine is the leading journal, publishing the most articles in this field. This study identifies mitochondrial diseases, arrhythmias, Parkinson's disease, hepatocellular carcinoma, and iron-refractory iron deficiency anemia as the key diseases investigated in this field. This bibliometric evaluation offers critical perspectives for both experienced scholars and early-career researchers, enabling the identification of novel ideas and advancements within this domain.

Hesperetin induces apoptosis in lung squamous carcinoma cells via G2/M cycle arrest, inhibition of the Notch1 pathway and activation of endoplasmic reticulum stress

Hesperetin (HST), a natural flavonoid, has potent antitumor effects on lung adenocarcinoma; however, its effects on lung squamous cell carcinoma (LUSC) are currently unknown. The present study aimed to investigate the anticancer effects of HST on LUSC cells. The influence of 37.5, 75 and 150 µM HST on the H1703 cell line, and of 75, 150 and 300 µM HST on the H226 cell line was determined using the Cell Counting Kit‑8 method, cell cycle assay, JC‑1 mitochondrial membrane potential assay and Annexin V‑FITC/PI staining. DMSO‑treated cells were used as the control group. Western blotting was performed to detect the protein expression levels of cyclin B1, CDK1, Bcl‑2, Bax, caspase‑3, cleaved caspase‑3, phosphorylated‑eIF2α, eIF2α, glucose‑regulated protein 78, CHOP, Notch1 and Hes‑1. The relationship between endoplasmic reticulum stress (ERS), Notch1 signaling and apoptosis was examined using the ERS‑inhibitor 4‑phenylbutyric acid (4‑PBA; 500 µM) and the Notch1 signaling activator Jagged‑1 (4 µM). In vivo, mice were divided into control, HST (30, 60 and 90 mg/kg/q2d) and cisplatin (2 mg/kg/q2d) groups to evaluate the anti‑LUSC effects of HST. The results revealed that HST inhibited the viability of H226 and H1703 cells, leading to cell cycle arrest at the G2/M phase and the induction of cell apoptosis. In addition, HST downregulated the Notch1 signaling pathway and increased ERS. In H1703 cells, 4‑PBA and Jagged‑1 reduced the expression of apoptosis‑related proteins, and Jagged‑1 also reduced the expression of ERS‑related proteins. In vivo, HST reduced tumor growth without any apparent toxic side effects. In conclusion, HST may exert its antitumor effects by inducing G2/M cell cycle arrest and inhibiting the Notch1 signaling pathway to activate ERS‑induced apoptosis, making it a promising agent for treating LUSC.

Dissecting Tumor Size Underestimation in Pancreatic Cancer: A Comparative Analysis of Preoperative Treatments

BACKGROUND

Tumor size (TS) in pancreatic ductal adenocarcinoma (PDAC) is one of the most important prognostic factors. However, discrepancies between TS on preoperative images (TSi) and pathological specimens (TSp) have been reported. This study aims to evaluate the factors associated with the differences between TSi and TSp.

PATIENTS AND METHODS

We retrospectively analyzed patients with PDAC who underwent surgery at our institution between January 2010 and November 2023. TS discrepancy (TSD[%]) was defined as ([TSp - TSi]/TSp) × 100. Using logistic regression, we generated a receiver operating characteristic (ROC) curve to define the cutoff for TSi underestimation predicting clinical tumor (T) stage migration. Univariate and multivariate analyses were performed to evaluate predictors of TSi underestimation.

RESULTS

Of the 231 patients, 99 (42%) patients received preoperative chemotherapy. The ROC curve determined a TSD underestimation cutoff of 25.9%. The number of TSp > TSi cases was 185 (80%), and TSi underestimation was present in 117 (51%) patients. T stage migration rates were 76%, 26%, and 50% in clinical stage (c) T1, cT2, cT3, respectively, among the patients with chemotherapy, and 93%, 33%, and 14%, respectively, in those without chemotherapy. Multivariate analyses revealed that independent predictors of TSi underestimation were posterior surface invasion in the patients with preoperative chemotherapy and anterior surface invasion in those without chemotherapy.

CONCLUSIONS

TS was more commonly underestimated than overestimated, and cT1 rarely corresponded to pathological (p)T1. The factors contributing to TSi underestimation differed between patients with and without preoperative chemotherapy. Therefore, these two groups should be considered separately for accurate TSi evaluation.

Quality of Life and Functional Outcomes in Patients With Locally Advanced Rectal Cancer Receiving Total Neoadjuvant Therapy Versus Concurrent Chemoradiation Therapy: An Analysis of the STELLAR Trial

PURPOSE

To explore differences in the effects of total neoadjuvant therapy (TNT) and preoperative concurrent chemoradiation therapy (CRT) on quality of life and functional outcomes in patients with locally advanced rectal cancer.

METHODS AND MATERIALS

In the study, 591 patients with distal or middle-third, clinical primary tumor stage cT3 to 4 and/or regional lymph node-positive rectal cancer were randomly assigned (1:1) to receive short-term radiation therapy (25 Gy in 5 fractions) followed by 4 cycles of CAPOX (TNT group, n = 297) or standard CRT (50 Gy in 25 fractions concurrently with oral capecitabine) (CRT group, n = 294) before surgery. After a 6-year follow-up, the surviving patients were sent surveys, including the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30, EORTC QLQ-CR29, and Wexner incontinence score questionnaires. Differences between the 2 groups were compared, and baseline data from the general population who completed the EORTC QLQ-C30 were also compared.

RESULTS

The median follow-up was 77.38 (59.07-103.20) months, with 196 out of 414 surviving patients (47.3%) completing the questionnaire. Patients in the TNT group had better emotional function (94.16 ± 10.19 vs 90.17 ± 14.63, P = .031) but more severe diarrhea (12.46 ± 21.73 vs 6.74 ± 16.03, P = .036) than did those in the CRT group. However, the mean differences between the 2 groups were <5 points, which is not clinically significant, and there were no significant differences in other quality of life items. The Wexner incontinence scores were 5 (0-6) and 3 (0-6) for the TNT and CRT groups, respectively, with no significant difference between the groups (P = .357). Compared to the general population data from the completed EORTC QLQ-C30 assessment, the patients did not exhibit differences >5 points in terms of worse function or more severe symptoms.

CONCLUSIONS

There were no significant differences in quality of life or anal function between patients receiving TNT and those receiving CRT. After 6 years, patients were able to maintain stability.

Immune checkpoint inhibitor-related CNS vasculitis - A systematic review and report of 6 cases

BACKGROUND

Immune checkpoint inhibitors (ICI) represent an important new class of immunotherapy used in cancer treatment. Though effective, immune-related adverse events (irAE) are reported, including cerebral vasculitis (nirVasculitis). In this systematic review, we aim to identify clinical and laboratory features of nirVasculitis and exemplify these in six local clinical cases.

OBSERVATIONS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent researchers searched, identified, and extracted data from both PubMed and Embase to identify reports on nirVasculitis. Based on current criteria for diagnostic certainty patients were categorized as having definite, probable, or possible nirVasculitis. 20 cases described relevant symptomatology and met our inclusion criteria. Non-small-cell lung cancer (55 %) was the most frequent cancer type. Most cases (95 %) received a programmed death-1 (PD-1) inhibitor. One patient had definite vasculitis, seven probable vasculitis, and twelve possible vasculitis. Signs and symptoms included aphasia (n = 5), loss of consciousness (n = 7), confusion (n = 8), unilateral sensory or motor dysfunction (n = 5), and fever or headache (n = 9). All patients had brain imaging and seventeen underwent a lumbar puncture. Of these, 64.7 % had pleocytosis and 52.9 % elevated protein in cerebrospinal fluid. Nineteen patients received corticosteroids. Eight patients fully or partially recovered. Eight patients died due to nirVasculitis, three to advanced cancer, and one lost to follow-up.

CONCLUSIONS

There are few clinical reports of nirVasculitis which may be due to underreporting or rarity of complications. Guidelines for diagnostics and reporting may improve awareness and early recognition to initiate important immunosuppressive treatment.

Risk prediction criteria for the primary hepatic perivascular epithelioid cell tumour family, including angiomyolipoma: analysis of 132 cases with a literature review

AIMS

The hepatic perivascular epithelioid cell tumour (PEComa), including angiomyolipoma, exhibits diverse morphology and clinical behaviour; however, its prognostic features remain undefined. This study aimed to investigate its histological features and prognostic factors.

METHODS AND RESULTS

In total, 132 patients were included. Clinical data and histopathological slides were assessed along with the p53 and Ki-67 immunohistochemistry. Targeted next-generation sequencing was performed in three cases. Based on the histologic subtypes, 7 (10%), 36 (51%), 13 (18%), and 15 (21%) patients were classified as inflammatory angiomyolipoma, conventional angiomyolipoma, epithelioid angiomyolipoma, and PEComa not otherwise specified (NOS), respectively, among 71 patients who underwent surgical resection. We proposed the risk prediction criteria after defining primary tumour size ≥7 cm, infiltrative border, mitotic rate >1/10 mm2, necrosis, vascular invasion, and PEComa NOS as worrisome features, as follows: high-risk: ≥3 worrisome features; intermediate-risk: 1-2 features; low-risk: none of the features. Applying these criteria, 4 (6%), 31 (44%), and 36 (51%) patients were classified into high-, intermediate-, and low-risk groups, respectively. One patient each in the high-risk (25%) and intermediate-risk (3%) groups developed peritoneal metastases and intrahepatic recurrence, respectively, whereas none in the low-risk group showed disease progression. A literature review of clinically malignant hepatic PEComa family tumours was conducted, and upon application of our criteria, 62% (16/26) of the patients were classified as high-risk and 35% (9/26) as intermediate- or high-risk.

CONCLUSION

Our risk prediction criteria can effectively predict the clinical outcomes in primary hepatic PEComa.

Exogenous α-Synuclein Induces Oxidative Damage to Dopaminergic Neurons Through p-NMDAR2B/Nur77

Alpha-synuclein (α-syn) is a major pathological marker of Parkinson's disease (PD), and its abnormal expression and aggregation lead to dopaminergic neuron degeneration, in which oxidative stress plays an important role. However, the exact molecular mechanism by which α-syn causes PD remains unclear. In this study, exogenous α-syn, also known as α-syn preformed fibrils (α-syn PFFs), was used to construct in vivo and in vitro models of PD. Behavioral, Western blotting, biochemical, immunofluorescence, flow cytometry, electron microscopy, etc. were used to investigate the pathological mechanism of PD induced by α-syn. We found that 6 months after striatum injection of α-syn PFFs, mice exhibited motor deficits. Meanwhile, the protein expression of pS129-α-syn (p-α-syn) and α-syn oligomer significantly increased, while the expression of TH significantly decreased, and the oxidative stress in the substantia nigra was aggravated. In addition, we found an increase in the protein expression of NMDAR2B and p-Tyr1472-NMDAR2B (p-NMDAR2B) and a decrease in the protein expression of Nur77. However, in α-syn PFFs-induced SH-SY5Y cells, we found that inhibiting p-NMDAR2B increased the protein expression of Nur77, while overexpression of Nur77 did not affect the expression of p-NMDAR2B. Inhibition of p-NMDAR2B and overexpression of Nur77 reversed α-syn PFF-induced oxidative stress, thus reducing mitochondrial damage and cytotoxicity. Therefore, we speculate that α-syn PFF-induced oxidative stress in dopaminergic neurons may be mediated by p-NMDAR2B/Nur77. Our study provides novel insights into the pathology mechanism underlying α-syn-induced PD.

Mechanism of arsenic regulation of mitochondrial damage and autophagy induced synaptic damage through SIRT1 and protective effect of melatonin in HT22 cell

Arsenic (As), a widespread environmental pollutant, can induce severe neurological damage worldwide; however, the underlying mechanisms remain unclear. Sirtuin 1 (SIRT1) has been reported to exert neuroprotective effects against various neurological diseases by resisting mitochondrial damage and autophagy through deacetylation. In this study, we established a model of HT22 cells exposed to NaAsO2 and examined the levels of mitochondrial, autophagy, and synaptic damage in HT22 cells and HT22 cells with high expression of SIRT1 (pre-treated with the agonist SRT1720) 24 h after exposure. Our results suggest that NaAsO2 exposure induces down-regulation of SIRT1, causing mitochondrial damage and activation of autophagy, which in turn leads to synaptic damage. Notably, melatonin (Mel) intervention upregulated SIRT1 and attenuated mitochondrial damage and autophagy, restoring synaptic damage. In conclusion, the results of the present study indicate that As causes neurotoxicity by decreasing SIRT1 production, causing mitochondrial damage and activating autophagy, which provides fundamental data for further study of arsenic neurotoxicity. In addition, blocking this pathway attenuated the synaptic damage of arsenic exposure, which provides a new therapeutic avenue for arsenic neurotoxicity.

Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies

The rising prevalence of pancreatic cystic lesions (PCLs), particularly intraductal papillary neoplasms (IPMNs), has been attributed to increased utilization of advanced imaging techniques. Incidental detection of PCLs is frequent in abdominal CT and MRI scans, with IPMNs representing a significant portion of these lesions. Surveillance of IPMNs is recommended due to their malignant potential; however, their overlapping imaging features with benign entities can lead to misdiagnosis, overtreatment, and overutilization of healthcare resources. This paper aims to highlight and differentiate lesions often mistaken for IPMNs, providing insight into their imaging characteristics, diagnostic challenges, and distinctive features while highlighting the incidence of wrong diagnosis for these lesions. These lesions include serous cystadenomas, cystic pancreatic neuroendocrine tumors, mucinous cystic neoplasms, lymphoepithelial cysts, duodenal diverticula, pancreatic schwannomas, chronic pancreatitis, retention cysts, intrapancreatic accessory spleens, pancreatic lipomas, choledochal cysts, and others. Utilizing various imaging modalities, including contrast-enhanced CT, MRI, and EUS, alongside histological and molecular analyses, can aid in accurate diagnosis and appropriate management. Understanding these mimicry scenarios is crucial to avoid unnecessary surveillance, interventions, and the burden they place on both patients and healthcare systems. Improved recognition of these lesions can lead to better patient outcomes and resource allocation.

Thyroid Tuberculosis Depicted by 18 F-FAPI PET/CT

Thyroid tuberculosis is a rare condition that is difficult to diagnose and may be suspected of being a malignant tumor. We report a case of thyroid tuberculosis in a 54-year-old woman that mimicked thyroid cancer on ultrasound, with a 18 F-FAPI PET/CT scan showing intense 18 F-FAPI uptake in the thyroid lobe, right neck lymph node, and celiac lymph nodes.

Clinical application of fly-thru in diagnosis of biliary obstructive diseases: feasibility, reproducibility, and diagnostic value

PURPOSE

To evaluate the feasibility, reproducibility, and diagnostic value in biliary obstructive diseases using Fly-Thru (FT) technique.

METHODS

In this single-center prospective study, patients with biliary obstruction who underwent both abdominal ultrasound and FT examinations were recruited between January 2013 and January 2023. 3D FT images (3D-FT) were reconstructed with FT volumetric data. Image quality was subjectively assessed by two radiologists independently. 3D-FT was used to determine the degree of biliary obstruction and compared with ultrasound-guided percutaneous transhepatic cholangiography (PTC). Diagnostic confidence level, diagnostic accuracy and diagnostic duration of the two radiologists using 2D-ultrasound (2D-US) alone and 2D-US combined with 3D-FT were recorded respectively and compared.

RESULTS

100 consecutive patients were enrolled (mean age: 59.6 ± 13.2 years; 52 men). All 3D-FT images were successfully reconstructed and most (75% and 66%) 3D-FT images were considered clear and highly useful for diagnosis with a good agreement (Kappa = 0.653). Benign lesions and malignancies presented differently in both 2D-US and 3D-FT imaging. 3D-FT was not inferior to PTC in determining the degree of biliary obstruction (p = 0.101), with the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and positive predictive value as 90.5%, 26.7%, 1.23, 0.36, 77.6%, 50.0% respectively. Combined with 2D-US, 3D-FT significantly increased the diagnostic confidence level and diagnostic accuracy of biliary obstructive diseases (all p < 0.01), especially for radiologists with less experience.

CONCLUSION

Application of 3D-FT in diagnosis of biliary obstructive diseases was considered feasible and reproducible, with satisfactory diagnostic value and clinical importance.

Effect of rapid rehabilitation surgical nursing on patients' gastrointestinal function recovery and sleep quality after laparoscopic appendectomy

BACKGROUND

Appendicitis is a common acute abdominal pain disorder. Laparoscopic appendectomy, a commonly used modality, is associated with less trauma and faster recovery than traditional open appendectomy. However, postoperative recovery remains an important issue that affects rehabilitation quality and surgical results.

AIM

To explore the effects of rapid rehabilitation and surgical nursing care on gastrointestinal function recovery and sleep quality among patients undergoing laparoscopic appendectomy.

METHODS

A total of 120 patients who underwent laparoscopic appendectomy at our hospital between January 2019 and March 2024 and for whom complete clinical data were available were selected. Patients were randomly assigned to two groups (n = 60 each) using the random number table method. The control group received routine nursing care, while the experimental group received rapid rehabilitation surgical nursing care; all patients continued to receive nursing care until discharge. The recovery of gastrointestinal function, length of hospital stay, complications, Pittsburgh sleep quality index, and nursing satisfaction were compared between groups.

RESULTS

Following the implementation of effective nursing measures, the times to bowel sound recovery, first exhaust, first defecation, and first feeding were notably shorter in the study vs control group (P < 0.05). Additionally, the duration of the first postoperative activity and the length of hospital stay were significantly shorter in the study vs control group (P < 0.05). Furthermore, the study group exhibited better sleep quality than the control group (P < 0.05). The postoperative complication rate was significantly lower and the nursing satisfaction rate significantly higher in the study vs control group (P < 0.05).

CONCLUSION

Rapid rehabilitation surgical nursing interventions provided to patients after laparoscopic appendectomy can accelerate their postoperative recovery, reduce the occurrence of complications, and improve their sleep quality and nursing satisfaction.

Temporal evolution and factors influencing visual function and RNFL thickness in ethambutol-associated optic neuropathy

PURPOSE

This study aimed to investigate the temporal evolution and influencing factors of visual function and optic nerve structure in ethambutol-associated optic neuropathy (EON).

METHODS

In this single-center retrospective observational study, we analyzed data from 48 EON patients (26 males and 22 females) with a 12-month follow-up. Comprehensive ophthalmologic assessments, including best corrected visual acuity (BCVA), visual field (VF), optical coherence tomography (OCT), and magnetic resonance imaging (MRI), were conducted to evaluate visual function and optic nerve structure. Statistical analyses including multiple linear regression and comparative analyses (independent t-tests/Mann-Whitney U tests) were performed to identify factors influencing recovery, with effect sizes calculated using Cohen's d.

RESULTS

Significant improvements in best corrected visual acuity and visual field were observed between 3 and 6 months. The mean improvement in BCVA was 0.25 logMAR (from 1.28 ± 0.64 at 3 months to 0.82 ± 0.60 at 6 months, p < 0.0001, Cohen's d = 0.74, 95% CI [0.33, 1.15]), and the mean improvement in VF mean deviation was 2.5 dB (from - 13.85 ± 9.23 dB at 3 months to - 10.33 ± 7.58 dB at 6 months, p = 0.037, Cohen's d = 0.42, 95% CI [0.11, 6.93]), indicating a critical recovery window. Peripapillary retinal nerve fiber layer (pRNFL) thinning was most pronounced between 3 and 9 months, with the temporal quadrant showing the earliest thinning (40.21% reduction by 3 months). Macular ganglion cell-inner plexiform layer (mGCIPL) thickness showed a decreasing trend (73.20 ± 4.76 μm to 55.33 ± 4.16 μm) from 1 month post-onset. Multivariate analysis revealed that disease course was the primary factor influencing VF recovery (β = - 0.31, p = 0.001), while peripapillary retinal nerve fiber layer thinning was associated with gender, ethambutol dosage, and disease duration. Female patients exhibited slower peripapillary retinal nerve fiber layer thinning compared to males.

CONCLUSIONS

This study identifies a critical recovery window for visual function in EON between 3 and 6 months, with peripapillary retinal nerve fiber layer thinning progressing significantly between 3 and 9 months. The temporal quadrant of the peripapillary retinal nerve fiber layer may serve as an early marker for disease progression. These findings provide valuable insights for optimizing monitoring and intervention strategies in EON patients, highlighting that early therapeutic interventions-particularly for patients showing temporal RNFL thinning or high-risk features-may maximize visual recovery potential.

Fish bone migration: complications, diagnostic challenges, and treatment strategies

BACKGROUND

Fish bone impaction in the pharynx is a common otolaryngological emergency. However, if the fish bone perforates the pharyngeal wall or the gastrointestinal wall and migrates to the neck tissues or organs, entering the lungs, mediastinum, heart, liver, biliary tract, spleen, pancreas, or other structures, or damages major blood vessels in the thoracic or abdominal cavities, it can lead to severe complications. This condition is rare and dangerous, potentially resulting in a series of serious complications, including neck abscess, thyroid abscess, thrombosis or air embolism of the cervical vessels, esophageal perforation, rupture of major mediastinal vessels, mediastinitis, aorto-esophageal fistula, lung abscess, spinal injury, sepsis, splenic abscess, hepatic abscess, anal fistula, and it may even be misdiagnosed as a tumor.

OBJECTIVE

This narrative review synthesizes evidence on fish bone translocation complications to (1) identify high-risk clinical presentations, (2) guide site-specific imaging selection, and (3) inform multidisciplinary management strategies.

METHODS

Use the keyword "fishbone" to systematically search articles from PubMed、CNKI and Embase databases from 1972 to 2024. Review all original articles and include them in this review where appropriate. This narrative review synthesizes evidence from case reports and observational studies to explore complications and management of fish bone translocation in uncommon sites. Given the predominance of heterogeneous case reports, a formal systematic review with meta-analysis was not feasible; however, we employed systematic search strategies to minimize selection bias.

CONCLUSION

To avoid severe complications, it is crucial to provide comprehensive information on the management of fish bone impaction. When fish bone removal cannot be achieved using laryngoscopy, prompt and decisive surgical intervention is required to extract the foreign body.

Interpretable machine learning model for predicting delirium in patients with sepsis: a study based on the MIMIC data

OBJECTIVE

The aim of this study was to construct interpretable machine learning models to predict the risk of developing delirium in patients with sepsis and to explore the impact of delirium on the 28-day survival rate of patients.

METHODS

We enrolled 10,321 patients with sepsis older than eighteen years from the MIMIC-IV (Medical Information Mart for Intensive Care) database. Sepsis is defined as the presence or suspected presence of infection, along with a SOFA (Sequential Organ Failure Assessment) score of ≥ 2. Four machine learning models, namely XGBoost (extreme gradient Boost), SVM (support vector machine), Logistic (logistic regression) and RF (random forest), were established for prediction, and the prediction model was constructed.

RESULTS

A total of 10,321 sepsis patients were included, among whom 4,691 (45.45%) developed delirium. The 28-day mortality rate was markedly elevated in the delirium group (log-rank P < 0.001). The XGBoost model has the best performance. Finally, 5 variables were selected to draw a nomogram: hypertension, SOFA score, chlorine, Hb (hemoglobin), creatinine. The receiver operating characteristic (ROC) curve of the predictive delirium model showed better predictive efficiency, with an AUC of 0.767 (95%CI (confidence interval): 0.726-0.798).

CONCLUSION

The nomogram built on the XGBoost model provides clinicians with an easy tool to quickly assess the risk of developing delirium in patients with sepsis. It provides a new idea and direction for the best model to predict delirium in patients with sepsis, so as to promote the development of delirium related research.

Portal vein embolization and subsequent major hepatectomy for hepatocellular carcinoma with insufficient residual liver volume: experience of a tertiary center

Portal vein embolization (PVE) allows for liver regeneration to enhance reduced residual liver volume before resection in hepatocellular carcinoma (HCC) patients with systemic liver disease. A retrospective review of medical records was conducted, including patients who underwent PVE and subsequent major hepatectomy to treat resectable non-metastatic HCC at the University Medical Center in Ho Chi Minh City between 01/2016 and 6/2023. Patient demographics, timing of procedures, surgical interventions, intra- and postoperative complications, pattern of recurrence, and survival were analyzed. A total of 58 patients with HCC were included, and the median length of stay after surgery was 8 days (range 5-24). Post-hepatectomy liver failure (PHLF) occurred with an overall incidence of 31% (18/58 cases). Severe PHLF occurred in 6 cases: grade B in 5 cases (8.6%) and grade C in 1 case (1.7%), resulting in patient death. Postoperative bleeding and bile leak each occurred in 1 case (1.7%). Univariable and multivariable analyses identified portal vein pressure (PVP) after PVE as the only significant preoperative parameter associated with outcomes, correlating with PHLF occurrence (OR 1.27, p = 0.009) at a cut-off of 15 mmHg (p = 0.018). The overall survival at 3, 6, and 12 months was 96%, 94%, and 94%, respectively, with disease-free survival rates of 94%, 90%, and 87%, respectively. Major hepatectomy can be performed safely and effectively in HCC patients who have PVE-induced liver hypertrophy (sFLR ≥ 40%) and preserved liver function (Child-Pugh A) maintaining low morbidity. Multivariate analysis revealed that a post-PVE PVP cutoff of 15 mmHg significantly correlated with perioperative parameters, including operating time, blood loss, and PHLF occurrence.

Clinical value of NT-proBNP, MPO, and NLR combined with echocardiography in prediction of malignant arrhythmia in elderly patients with valvular heart disease

OBJECTIVE

We aimed to probe the clinical value of N-terminus pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), and neutrophil lymphocyte ratio (NLR) combined with echocardiography in the prediction of malignant arrhythmias (MA) in elderly patients with valvular heart disease (VHD).

METHODS

MPO, NT-proBNP, and NLR were detected in blood samples. After 1 year of follow-up, receiver operating characteristic curves were analyzed to determine the clinical value of NT-proBNP, MPO, NLR, and echocardiography for predicting MA in patients with VHD.

RESULTS

MPO, NT-proBNP, and NLR were higher in the VHD group. MPO, NT-proBNP, and NLR were higher with severe cardiac dysfunction. MPO, NT-proBNP, NLR, and LVESV in the MA group were higher. NT-proBNP was an independent factor influencing the occurrence of MA in elderly patients with VHD. The AUC for predicting MA in elderly patients with VHD using NT-proBNP, MPO, NLR, and echocardiography were 0.782 (sensitivity 61.50%, specificity 94.60%, 95% CI 0.630-0.934), 0.759 (sensitivity 69.20%, specificity 81.10%, 95% CI 0.579-0.938), 0.736 (sensitivity 76.90%, specificity 64.90%, 95% CI 0.562-0.910), and 0.782 (sensitivity 76.90%, specificity 75.70%, 95% CI 0.646-0.918), respectively. The AUC for the combined prediction using NT-proBNP, MPO, NLR, and echocardiography was 0.913 (sensitivity 76.90%, specificity 94.60%, 95% CI 0.820-1.000), higher than that of each parameter alone (P < 0.05).

CONCLUSION

The combination of NT-proBNP, MPO, NLR, and echocardiography has a predictive value in detecting MA in elderly VHD patients.

Impact of early versus delayed enteral nutrition on ICU outcomes: a comparative study on mortality, ventilator dependence, and length of stay

BACKGROUND AND OBJECTIVE

The timing of enteral nutrition initiation in critically ill patients in the intensive care unit (ICU) plays a crucial role in clinical outcomes. This study aimed to evaluate the impact of early (within 48 h of ICU admission) versus delayed enteral feeding on 28-day mortality, ventilator dependency, and ICU length of stay.

METHODS

A retrospective cohort study was conducted involving 295 patients across four ICUs in two Tehran hospitals, admitted between 2017 and 2018. Participants were grouped into early (n = 161) and delayed (n = 134) enteral feeding categories. Baseline characteristics were analyzed using the Mann-Whitney and Chi-Square tests. Mortality was assessed using Kaplan-Meier survival analysis and Cox proportional hazards models, while logistic and linear regression models were applied to examine associations with ventilator dependency and ICU length of stay, respectively.

RESULTS

Early enteral feeding (EEF) was significantly associated with reduced 28-day mortality (25.5% vs. 50.0%, p < 0.001), lower incidence of mechanical ventilation (66.5% vs. 80.6%, p = 0.007), and a shorter ICU stay (13.07 ± 16.44 days vs. 16.23 ± 13.57 days, p < 0.001). Kaplan-Meier analysis revealed a higher survival probability at 28 days in the early feeding group (log-rank test, p < 0.001). However, after adjusting for potential confounders (age, gender, BMI, baseline APACHEII, baseline SOFA score, number of comorbid, primary diagnosis and admission category), the relationships between delayed feeding and mortality (HR: 1.49, 95% CI 0.98, 2.26, p = 0.062), ventilator dependency (OR: 1.28, 95% CI 0.59, 2.70, p = 0.558), and ICU length of stay (LOS) (β: 1.96, 95% CI - 1.52, 5.45, p = 0.268) were not statistically significant. Subgroup analyses revealed that delayed enteral feeding was significantly associated with higher mortality risk in surgical patients (adjusted HR: 1.85, 95% CI 1.02, 3.35, p = 0.043) and prolonged ICU stay (β: 3.75, 95% CI 0.27, 7.23, p = 0.035), whereas no significant associations were observed in medical patients.

CONCLUSION

Initiating enteral feeding within 48 h of ICU admission is associated with improved clinical outcomes, although these benefits may be influenced by individual patient factors and disease severity. Future studies should focus on tailoring enteral feeding strategies to optimize outcomes across varied ICU populations.

Mean amplitude of glycemic excursion and mortality in critically ill patients: A retrospective analysis using the MIMIC-IV database

BACKGROUND

Glycemic variability (GV) is increasingly recognised as a critical determinant of outcomes in critically ill patients. However, standardised criteria for assessing GV remain undefined.

OBJECTIVE

This study aimed to evaluate the relationship between the Mean Amplitude of Glycemic Excursion (MAGE) and mortality in intensive care unit (ICU) patients, and to determine optimal MAGE thresholds for distinct patient populations.

METHODS

A retrospective cohort of 13 852 critically ill adults with ICU stays exceeding 24 h was analysed. Patients were stratified into MAGE quartiles, and various GV metrics were compared for their predictive performance on mortality. Multivariable-adjusted models were employed to examine associations between MAGE and mortality outcomes.

RESULTS

Patients in higher MAGE quartiles exhibited significantly elevated mortality risks, with the highest quartile associated with ICU mortality (HR 3.59 [95% CI: 2.99-4.31]), in-hospital mortality (HR: 3.43 [95% CI: 2.92-4.02]) and 28-day mortality (HR 2.04 [95% CI: 1.47-2.82]). The relationship between MAGE and mortality was notably stronger in non-diabetic patients (HR: 3.36 [95% CI: 2.90-3.89]) compared to diabetic patients (HR: 1.59 [95% CI: 1.33-1.91]). Restricted cubic spline analyses identified optimal MAGE thresholds of 44.28 mg/dL for the overall population, 58.97 mg/dL for diabetic patients and 17.11 and 37.72 mg/dL for non-diabetic patients. MAGE demonstrated effective predictive performance for all-cause mortality (AUC: 0.6286 [95% CI: 0.6171-0.6400]) compared to other GV metrics. Incorporating MAGE into prognostic models alongside SAPS II and SOFA scores improved performance for all-cause mortality, with net reclassification improvement (NRI) of 0.238 and integrated discrimination improvement (IDI) of 0.008.

CONCLUSION

MAGE exhibits effective predictive value for mortality in ICU patients, with distinct thresholds for diabetic and non-diabetic populations. These findings underscore the importance of tailored GV management strategies in critical care settings and support the adoption of MAGE as a standardised metric for GV assessment in ICU settings.

Development and external validation of nomogram associated with gastroparesis syndrome after subtotal gastrectomy depending on random forest and traditional model: does robotic surgery have advantages?

Postsurgical gastroparesis syndrome (PGS) significantly diminishes the quality of life for patients following surgery. With the evolution of robotic surgery, there is a debate on whether it can offer a novel treatment modality for gastric cancer and reduce the incidence of gastric paralysis syndrome. This study utilizes machine learning techniques and traditional logistic regression to construct and validate predictive models, with the aim of providing guidance for clinical practitioners. This study included two cohorts from one medical centers based on the surgical timing for division (Cohort 1: n = 619 for model building and internal validation; Cohort 2: n = 312 for external validation). In Cohort 1, a 3:1 ratio was used for training and validation in random forest and a 7:3 ratio for logistic regression. After analyzing the Receiver Operating Characteristic curves (ROC), we chose classical logistic regression to build the prediction model followed by evaluation with calibration and decision curve analysis (DCA). Finally, we performed external validation on Cohort 2. The model incorporated 7 factors including: Pre-operative TBIL (OR = 2.99), Pre-operative DBIL (OR = 2.35), Pre-operative potassium (OR = 6.8), Surgical type (OR = 3.76), Gastric tube removal time (OR = 3.48), Reconstruction mode (OR = 4.63) and Operative time (OR = 2.21). The model performed well in ROC, with AUC values of 0.892 in the training set, 0.858 in the inner validation set (Cohort 1), and 0.849 in the exterior validation set (Cohort 2). All three datasets' calibration curves revealed a high level of agreement between projected and actual probability. DCA suggested that the model had great clinical usefulness. We have established a more reliable predictive model for PGS which can provide guidance for clinical practitioners. Robotic surgery is also considered to be one of the factors that can reduce the occurrence of PGS.

Lipidated SNAPP-Stars Target and Kill Multidrug-Resistant Bacteria within Minutes

The fast emergence of bacteria resistance has already threatened global health, and immediate action is required before the emergence of another global pandemic. Despite substantial progress in the chemical synthesis of novel antimicrobial compounds and advancements in understanding antimicrobial resistance, there has been only a handful of new antibiotics coming to the market. Structurally Nanoengineered Antimicrobial Peptide Polymers (SNAPP-stars) are a new class of antimicrobials. Here, we show that lipidation of lysine-valine 16-armed SNAPP-star, S16 (lipo-SNAPP-star) where the N-terminal arms are conjugated with different fatty acids (caproic, C6, lauric, C12, and stearic acid, C18) enhanced the antimicrobial activity toward S. aureus and MRSA. Lipidation enhanced activity by targeting the SNAPP-stars to the bacterial surface by binding to peptidoglycan, leading to greater inner membrane disruption and depolarization. Lipo-SNAPP-stars killed bacteria in under a minute, whereas vancomycin took >16 h. Lipo-SNAPP-stars were found to preferentially target and kill MRSA rather than S. aureus in a mixed bacteria model. Lipid chain length affected activity, with C6-S16 having greater activity compared to C12-S16 > C18-S16. Lauric and stearic acid enhanced SNAPP-star binding to the bacterial surface and membrane depolarization but impeded SNAPP-stars' ability to transit through the peptidoglycan layer to disrupt the inner membrane. Microbial flow cytometry showed that lipidation aided binding to bacteria via lipoteichoic acid and specifically to peptidoglycan. Further, lipid length enhanced bacterial binding with C18-S16 > C12-S16 > C6-S16 = S16, which contrasts the activity order of C6-S16 > S16 ≫ C12-S16 ≫ C18-S16. Our data demonstrate that lipidation enhances antimicrobial activity by targeting and binding an antimicrobial to peptidoglycan, but increasing lipid length reduces activity by retaining the antimicrobial in the outer layer. Lipidation of SNAPP-stars did not increase cytotoxicity, with C6-S16 having an improved therapeutic index compared to S16. Our data show how lipidation of SNAPP-stars enhances its antimicrobial activity, resulting in a highly biocompatible antimicrobial that targets and kills the "superbug" MRSA within minutes.

Korea, Japan, Europe, and the United States: Why are guidelines for gastric cancer different?

As a global health concern, gastric cancer management has been systematized by individual countries and regions into regimented guidelines. To explore international differences, we examined the guidelines of Korea, Japan, Europe, and the United States. Guidelines are created by experts in the field, focusing on evidence-based recommendations to standardize and improve patient care, but the methodology for guideline creation, incorporation of new innovations, and review differs significantly. National and regional differences within the guidelines are apparent, stemming from various factors including local incidence, stage, presentation, patient preferences, and governmental influences. Differences include the use of neoadjuvant chemotherapy, criteria for endoscopic resection, and extent of lymphadenectomy. Nonetheless, fundamental treatment principles remain universal, and the goals of national guidelines are uniform: standardizing patient care, providing the highest quality treatments, incorporating cutting-edge clinical trial results, and consensus in guidelines to help formulate governmental policies. This review highlights how the guidelines are constructed, the unique elements of each guideline, how they differ, and why they differ.

Advancements in the diagnosis of biliopancreatic diseases: A comparative review and study on future insights

Owing to the complex and often asymptomatic presentations, the diagnosis of biliopancreatic diseases, including pancreatic and biliary malignancies, remains challenging. Recent technological advancements have remarkably improved the diagnostic accuracy and patient outcomes in these diseases. This review explores key advancements in diagnostic modalities, including biomarkers, imaging techniques, and artificial intelligence (AI)-based technologies. Biomarkers, such as cancer antigen 19-9, KRAS mutations, and inflammatory markers, provide crucial insights into disease progression and treatment responses. Advanced imaging modalities include enhanced computed tomography (CT), positron emission tomography-CT, magnetic resonance cholangiopancreatography, and endoscopic ultrasound. AI integration in imaging and pathology has enhanced diagnostic precision through deep learning algorithms that analyze medical images, automate routine diagnostic tasks, and provide predictive analytics for personalized treatment strategies. The applications of these technologies are diverse, ranging from early cancer detection to therapeutic guidance and real-time imaging. Biomarker-based liquid biopsies and AI-assisted imaging tools are essential for non-invasive diagnostics and individualized patient management. Furthermore, AI-driven models are transforming disease stratification, thus enhancing risk assessment and decision-making. Future studies should explore standardizing biomarker validation, improving AI-driven diagnostics, and expanding the accessibility of advanced imaging technologies in resource-limited settings. The continued development of non-invasive diagnostic techniques and precision medicine approaches is crucial for optimizing the detection and management of biliopancreatic diseases. Collaborative efforts between clinicians, researchers, and industry stakeholders will be pivotal in applying these advancements in clinical practice.

Obsessive-compulsive symptoms in individuals with a history of eating disorders

BACKGROUND

OCD symptoms are well documented in anorexia nervosa (AN) and to a lesser extent in bulimia nervosa (BN), yet remain virtually unstudied in binge-eating disorder (BED).

METHODS

In this cross-sectional observational study, 5927 participants with lifetime eating disorders (EDs) (i.e., past or current) were categorized into five groups based on their diagnostic histories: AN only (n = 2330), BN only (n = 740), BED only (n = 665), AN and another ED diagnosis (AN Mixed) (n = 1293), and BN and BED (BN-BED) (n = 899). Obsessive-Compulsive Inventory-12 scores were compared across these groups and with OCD (n = 1040), anxiety-related disorders (ANX) (n = 423), and non-clinical community (NCC) (n = 1194) cohorts.

RESULTS

OCD symptoms were common among individuals with lifetime AN, BN, BED, and multiple EDs, with obsessing being the most prevalent dimension, followed by ordering, checking, and washing. The obsessing scale, which captures general intrusive thoughts rather than traditional OCD obsessions, was notably high. ED groups generally scored higher on the OCI-12 subscales than the ANX and NCC cohorts but lower than the OCD cohort, although ordering severity was higher in some ED groups. Positive correlations were found between ED symptoms and OCI-12 subscales, and gender-diverse individuals and men had greater OCD symptoms than women.

CONCLUSIONS

Clinicians should be vigilant for OCD symptoms in individuals with AN, BN, and BED. These findings call for research on the mechanisms linking EDs and OCD symptoms and support integrated treatment approaches for both conditions.

Melatonin and the nervous system: nanomedicine perspectives

The mechanism of action of melatonin on the nervous system, sleep, cognitive deficits, and aging is not fully understood. Neurodegenerative diseases (ND) are one of the leading causes of disability and mortality worldwide. Sleeping and cognitive impairments also represent common and serious public health problems, particularly deteriorating with the aging process. Melatonin, as a neuromodulatory hormone, regulates circadian rhythms and the sleep-wake cycle, with functions extending to antioxidant, anti-inflammatory, neuroprotective, and anti-aging properties. However, melatonin is a hydrophobic compound with relatively low water solubility and a short half-life. While melatonin can cross the blood-brain barrier, exogenous melatonin administered orally or intravenously has poor bioavailability, undergoes rapid metabolism in the circulation, and shows limited brain accumulation, ultimately compromising its therapeutic efficacy. In recent years, the convergence of melatonin research with nanomedicine ensures safe therapeutic uses, limited drug degradation, and perspectives for targeted drug delivery to the central nervous system. Here we outline the promising neurotherapeutic properties of nanomaterials as carriers loaded with melatonin drug alone or in combinations with other active molecules.

Patient with Atezolizumab-induced Encephalitis in Hepatocellular Carcinoma

A 65-year-old man treated with atezolizumab plus bevacizumab for hepatocellular carcinoma was admitted to our hospital with a fever, difficulty in moving, and aphasia. The patient became comatose immediately after admission. Imaging and cerebral fluid tests revealed no evidence of malignancy or infection. A diagnosis of atezolizumab-induced encephalitis was made, and steroid pulse therapy was initiated on admission, immediately after which the patient regained consciousness and was able to talk and walk. He was discharged with slight paralysis of his legs and was able to resume chemotherapy. An early diagnosis and treatment are required to improve the prognosis of encephalitis.

Non-invasive liquid biopsy based on transcriptomic profiling for early diagnosis of occult peritoneal metastases in locally advanced gastric cancer

This study proposes a novel non-invasive diagnostic approach utilizing transcriptomic profiling of liquid biopsy samples for the early detection of occult peritoneal metastases in locally advanced gastric cancer (LAGC). By analyzing RNA expression patterns of cancer cells, this method identifies specific gene signatures associated with peritoneal spread, potentially offering a more sensitive and comprehensive diagnostic tool compared to conventional imaging techniques. A 4-mRNA panel (BUB1, SPC25, CT83, MMP3) integrated with clinical features was developed into a Risk Stratification Assessment (RSA) model, demonstrating superior predictive accuracy in multiple cohorts with an area under the curve (AUC) of 0.836 in training and 0.882 in validation. This approach offers a promising alternative for early diagnosis, improving treatment decisions and clinical outcomes for gastric cancer patients, while enabling a shift from tissue-based testing to non-invasive blood-based diagnostics.

Precision risk stratification of primary gastric cancer after eradication of H. pylori by a DNA methylation marker: a multicentre prospective study

BACKGROUND

Precision cancer risk stratification for gastric cancer is urgently needed for the growing number of healthy people after Helicobacter pylori eradication. The epimutation burden in non-malignant tissues has been associated with cancer risk in multiple cross-sectional studies.

OBJECTIVE

To confirm the clinical usefulness of a DNA methylation marker for epimutation burden, and to identify a cut-off methylation level for a super-high-risk population.

DESIGN

Healthy people after H. pylori eradication with open-type atrophy were prospectively recruited. DNA methylation levels of a marker gene, RIMS1, were measured in biopsy specimens from gastric antrum and body. The primary endpoint was the incidence rate of gastric cancer in quartiles of the methylation levels.

RESULTS

1624 participants had at least one endoscopic follow-up with a median follow-up of 4.05 years, and a primary gastric cancer developed in 27 participants. The highest quartile of RIMS1 methylation levels had a higher incidence rate (972.8 per 100 000 person-years) than the lowest quartile (127.1). Cox regression analysis revealed a univariate HR of 7.7 (95% CI 1.8-33.7) and an age- and sex-adjusted HR of 5.7 (95% CI 1.3-25.5). As a secondary objective, a cut-off methylation level of 25.7% (95% CI 1.7-7.7) was obtained to identify a population with a super-high risk based on the number needed to screen of 1000.

CONCLUSION

A DNA methylation marker can risk-stratify healthy people after H. pylori eradication even though all of them have clinically high risk. Individuals with super-high risk will need more frequent gastric cancer screening than currently recommended.

TRIAL REGISTRATION NUMBER

UMIN-CTR000016894.

HDCA alleviates Parkinson's disease symptoms by promoting autophagic degradation of α-synuclein in enteric neurons

INTRODUCTION

Bile acids (BAs) are emerging as key modulators of Parkinson's disease (PD) through gut-brain interactions, yet their therapeutic potential remains underutilized. While BA imbalances contribute to PD pathogenesis, the specific subspecies regulating α-synuclein (α-syn) homeostasis and their mechanisms in enteric neurons-critical sites for PD initiation-require systematic investigation.

OBJECTIVE

To investigate whether hyodeoxycholic acid (HDCA), a secondary BA with documented neuroprotective properties but unproven efficacy in synucleinopathy, modulates α-syn clearance through enteric neuronal autophagy to mitigate PD progression.

METHODS

A53T transgenic mice underwent behavioral assessments for PD phenotyping. State-of-the-art UPLC/MS-based metabolomics quantified BA profiles. Pharmacological interventions using target-specific inhibitors (Gly-MCA, T0070907, VER-155,008) dissected the FXR-PPARγ-HSPA8 pathway. Multiscale analyses spanning immunofluorescence, western blotting, and LC3B autophagy flux reporter assays elucidated α-syn aggregation and autophagic dynamics in primary enteric neurons.

RESULTS

HDCA decline correlated with PD severity, positioning it as a novel biomarker for gut-brain axis dysfunction in PD. HDCA supplementation not only alleviated motor/non-motor deficits but also conferred dual neuroprotection-reducing colonic α-syn oligomers and preserving nigral dopaminergic neurons. Mechanistic decoding revealed HDCA's unparalleled capacity to activate enteric neuronal autophagy via FXR-PPARγ-HSPA8 signaling, a pathway previously unrecognized in PD therapeutics.

CONCLUSION

Our study reveals a novel gut-brain axis where HDCA depletion drives PD pathogenesis via FXR-PPARγ-HSPA8-mediated autophagic dysfunction in enteric neurons. PD-associated HDCA deficiency directly impairs α-syn clearance, identifying HDCA as both a gut-derived synucleinopathy biomarker and a therapeutic target.

Synchronous Portal Vein Embolization of Terminal Branches with Transcatheter Arterial Chemoembolization Prior to Planned Major Hepatectomy for Hepatitis B Virus-Related Hepatocellular Carcinoma: A Single Center Retrospective Cohort Study

BACKGROUND

Terminal branches portal vein embolization (TBPVE) is a novel technical modification. The clinical impact of synchronous TBPVE with transcatheter arterial chemoembolization (TACE) before planned major hepatectomy in hepatitis B virus (HBV) related HCC is still unknown.

METHOD

From November 2016 to December 2021, the study enrolled 115 patients with HBV-related HCC who were scheduled for major hepatectomy but had insufficient FLR. Patients were grouped according to whether they received TBPVE combined with TACE (the TBPVE group, n = 62) or PVE combined with TACE (the PVE group, n = 53). We compared the outcomes of the procedures and the perioperative and long-term outcomes of patients who subsequently underwent major hepatectomy between the groups.

RESULTS

FLR volume increment and degree of hypertrophy were significantly higher in the TBPVE group than in the PVE group (P≤0.003). FLR proliferation was pronounced remarkably within the first two weeks after TBPVE synchronous with TACE, the kinetic growth rates were 17.4 (12.7-21.9) mL/day and 6.9 (4.1-11.1) mL/day respectively. 54 patients in the TBPVE group and 41 patients in the PVE group finally underwent major hepatectomies. Pringle's maneuver time, intraoperative blood loss, transfusion, and postoperative hospital stays were less in the TBPVE group (P<0.05). Disease-free survival (DFS) rates were better in the TBPVE group than in the PVE group (P=0.042).

CONCLUSION

TBPVE synchronous with TACE induced safe and rapid FLR hypertrophy with satisfactory efficacy in initially unresectable HBV-related HCC patients improved the planned major hepatectomy resectability rate and has better DFS.

Rare Malignant Liver Tumors: Current Insights and Imaging Challenges

Rare malignant liver tumors (RMLTs) comprise a diverse group of neoplasms with distinct imaging features and significant diagnostic challenges due to their low prevalence and overlap with more common hepatic lesions. This review highlights the main radiologic characteristics of selected RMLTs-including fibrolamellar hepatocellular carcinoma, hepatic lymphoma, hepatocellular carcinoma in non-cirrhotic liver, mucinous cystic neoplasm, intraductal papillary neoplasm of the bile duct, epithelioid hemangioendothelioma, angiosarcoma, malignant hepatic adenoma, neuroendocrine tumor, hepatocholangiocarcinoma, hepatoblastoma, undifferentiated embryonal sarcoma, and infantile hepatic hemangioendothelioma-focusing on their presentation in CT and MRI. Recognizing specific imaging findings, such as arterial hyperenhancement, biliary communication, target and lollipop signs, and tumor morphology, can help narrow differential diagnoses and guide appropriate clinical management. Despite advancements in imaging, histopathologic confirmation is often required due to nonspecific features. Improved radiologic awareness of these rare entities is essential to facilitate early diagnosis and individualized treatment planning.

A Novel Clip Device for Safer and Faster Suturing in Endoscopic Papillectomy: A Retrospective Study of 241 Procedures

BACKGROUND AND AIM

Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary neoplasms. However, traditional endoscopic clips used for hemostasis and suturing during EP are often difficult to manipulate because of limitations in maneuverability. To address this issue, the efficacy of a novel clip was evaluated for its potential to improve suturing and reduce procedure difficulty after EP.

METHODS

This retrospective study included 241 patients who underwent EP at Nagoya University Hospital between December 2004 and April 2024. Patients were divided into two groups: the conventional clip group (n = 184) and the novel clip group (n = 57). We compared the total clipping time, number of clips used, and incidence of adverse events between the two groups.

RESULTS

The total clipping time was significantly shorter in the novel clip group than in the conventional clip group (6.0 vs. 12.7 min, p < 0.01). The novel clip group also required fewer clips for suturing (3.9 vs. 5.0 clips, p < 0.01) and had fewer dislodged clips at the second look endoscopy (0.05 vs. 0.72 clips, p < 0.01). There was no significant difference in the delayed bleeding rate between the two groups (5.3% vs. 8.7%, p = 0.58).

CONCLUSIONS

The novel clip demonstrated superior performance in terms of reducing the procedure time, the number of clips used, and the incidence of clip dislodgement in suturing after EP. This offers a promising solution for improving procedural efficiency. In conclusion, the novel clip should be used in wound suturing after EP.

Chitosan/κ-Carrageenan/Carbon Nitride Hydrogel Adsorbent for Removing Free Hemoglobin from Extracorporeal Circulation

Extracorporeal circulation often causes mechanical damage to erythrocytes, which release hemoglobin into the plasma, resulting in postsurgical hazard, so lowering the free hemoglobin (f-Hb) level in the blood is important. In this study, based on the good biocompatibility of chitosan/κ-carrageenan and the adsorption effect of carbon nitride, a chitosan/κ-carrageenan/carbon nitride (CS/κ-Car/C3N4) hydrogel was prepared through the charge electrostatic interaction between polysaccharides. The incorporation of C3N4 enhanced both the adsorptive capacity and the stability of the hydrogel. Specifically, the CS/κ-Car/C3N4-0.4% hydrogel exhibited an adsorption amount of 185.79 mg/g for human hemoglobin, approximately twice that of the CS/κ-Car hydrogel. The CS/κ-Car/C3N4 hydrogel also showed a significantly lower breakage and degradation rate. In addition, the CS/κ-Car/C3N4 hydrogel did not induce hemolysis, complement activation, or coagulate when in contact with blood and showed good blood compatibility. Furthermore, in vivo studies in rabbits revealed that the CS/κ-Car/C3N4 hydrogel significantly reduced elevated f-Hb levels to near-normal concentrations postcirculation, without inducing any severe adverse effects on the subjects. This investigation has elucidated that the CS/κ-Car/C3N4 hydrogel possesses superior adsorptive efficacy and biocompatibility, effectively clearing f-Hb in vivo. Consequently, the findings of this study offer novel insights into the design paradigm for adsorbents intended for blood circulation applications.

Case Report: Radiological characteristics and pathological correlation analysis of extranodal Rosai-Dorfman disease of liver

Background

Rosai Dorfman disease (RDD), also known as sinus histiocytosis with extensive lymph node involvement, is a rare histiocytosis with unknown etiology. Liver RDD is relatively rare and is often reported in individual cases. Exploring the imaging and pathological features of extrahepatic Rosai Dorfman disease (RDD) and conducting a comprehensive analysis of reported cases in domestic and foreign literature to enhance understanding of this rare disease.

Methods

We collected data from a patient diagnosed with liver RDD in our hospital. In addition, we searched for liver RDD cases through PubMed and conducted a literature review.

Results

Of the patient data used in this study, 1 patient's data was obtained from our hospital records and 16 were retrieved from literature. There were 6 males and 11 females aged between 2-72 years, with an average age of 33.55 ± 19.38 years. Four patients presented with isolated liver nodules without the involvement of lymph nodes or extranodal organs, two patients presented with a case that involved extranodal organs but not lymph nodes, two patients presented with a case involving lymph nodes but not extranodal organs, eight patients presented with a case involving both lymph nodes and extranodal organs and lastly one patient presented with a case that did not involve either lymph nodes or extranodal organs. Four of the patients underwent enhanced scanning. The results revealed that 2 of them showed low enhancement, and the other 2 showed no significant enhancement. Only 1 case underwent PET-CT, and the results indicated a high uptake. Immunohistochemistry was performed on all 17 cases of liver RDD, and the results were positive for CD1a (-), CD68 (+), and S-100 (+).

Conclusions

Liver RDD can manifest at any age. It presents with nonspecific imaging findings and a challenging preoperative diagnosis. Patients with extranodal hepatic RDD present with typical RDD characteristic immunohistochemistry features such as, high uptake on PET-CT, and no to mild enhancement on contrast-enhanced scans. For an early diagnosis, it is beneficial to fully comprehend these traits.

Machine learning-based reconstruction of prognostic staging for gastric cancer patients with different differentiation grades: A multicenter retrospective study

BACKGROUND

The prognosis of gastric cancer (GC) patients is poor, and an accurate prognostic staging system would help assess patients' prognostic status before treatment and determine appropriate treatment strategies.

AIM

To develop positive lymph node ratio (LNR) and machine learning (ML)-based staging systems for GC patients with varying differentiation.

METHODS

This multicenter retrospective cohort study included 11772 GC patients, with 5612 in the training set (Harbin Medical University Cancer Hospital) and 6160 in the validation set (Surveillance, Epidemiology, and End Results Program database). X-tile software identified optimal cutoff values for the positive LNR, and five ML models were developed using pT and LNR staging. Risk scores were divided into seven stages, constructing new staging systems tailored to different tumor differentiation levels.

RESULTS

In both the training and validation sets, regardless of the tumor differentiation level, LNR staging demonstrated superior prognostic stratification compared to pN. Extreme Gradient Boosting exhibited better predictive performance than the other four models. Compared to tumor node metastasis staging, the new staging systems, developed for patients with different degrees of differentiation, showed significantly better predictive performance.

CONCLUSION

The new positive lymph nodes ratio staging and integrated staging systems constructed for GC patients with different differentiation grades exhibited better prognostic stratification capabilities.

Dihydromyricetin restores lysosomal function in Schwann cells to alleviate bortezomib-induced peripheral neuropathy via ERK/TFEB signaling

Bortezomib (BTZ) serves as a first-line drug for multiple myeloma (MM) treatment by reversibly inhibiting of the proteasomes. However, BTZ-induced peripheral neuropathy (BIPN) remains a significant toxicity concern, with its molecular mechanisms not fully elucidated, resulting in limited therapeutic options. Dihydromyricetin (DHM) has been shown to alleviate neuropathic pain, but its potential effect on BIPN has not been investigated. We found that oral administration of DHM (40 mg/kg/day, 200 mg/kg/day) for 2 weeks significantly improved mechanical allodynia, sciatic nerve conduction, and demyelination in a BIPN mouse model (BTZ 1.0 mg/kg, i.v.). BTZ (50 nmol/L) impaired lysosomal function and blocked autophagy flux in both primary cultured rat Schwann cells and RSC96 Schwann cells; these effects were reversed by DHM treatment (3 μmol/L, 10 μmol/L). Mechanistically, DHM facilitated the nuclear translocation of TFEB, a master regulator of lysosomal-related genes, and the protective effects of DHM on Schwann cells were abolished by Tfeb shRNA. Furthermore, BTZ treatment activated ERK signaling, leading to TFEB phosphorylation and impaired nuclear translocation. DHM treatment prevented the BTZ-induced ERK activation, and the protective effects of DHM were compromised by the ERK activator TBHQ. Importantly, DHM did not diminish the efficacy of BTZ against RPMI 8226 myeloma cells. This study demonstrates that DHM mitigates BTZ-induced toxicity on Schwann cells by restoring lysosome-autophagy activity through the ERK-TFEB pathway, highlighting DHM as a promising candidate for improving the adverse reaction of BTZ in the peripheral nervous system.

A systematic review of preoperative radiological factors associated with the development of low anterior resection syndrome (LARS)

The aim of this systematic review is to summarise the available evidence for radiological changes associated with postoperative low anterior resection syndrome (LARS). A literature search was undertaken for all studies focusing on preoperative radiological predictors of postoperative LARS. Articles were selected from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases up to October 2024. Eighty-four articles were screened: eighty-one were excluded and three were included in the analysis. All included studies focused on preoperative Magnetic Resonance Imaging (MRI) already performed as part of the oncological assessments, no study examined ultrasound or defecography. Authors retrospectively selected patients that underwent LAR, screened them with the LARS score, and reviewed preoperative MRI images with specific softwares in order to find radiological characteristics associated with LARS. Results showed that particular anatomical characteristics were present in patients that subsequently developed major LARS: the volume of the pubococcygeal + iliococcygeus muscles in 27 LARS patients out of 46 LAR (odds ratio-OR 14.7, 95% CI 1.7-128.3; p = 0.02), the thickness of the anorectal joint in 136 LARS out of 255 LAR preceded by neoadjuvant chemoradiotherapy (OR 0.653, 95% CI 0.565-0.756; p = 0.001) and the mesorectal/pelvic volumes in 135 LARS out of 236 LAR (Cox Regression analysis, p = 0.0017 and p = 0.0001 respectively). Pelvic floor musculature is a factor, among the others, that contributes to LARS. Future prospective studies need to validate these retrospective results, further delineate its influence, and investigate the potential contribution of other radiologic investigations (ultrasound and defecography) in this setting.