Role of gut microbiome in suppression of cancers

The pathogenesis of cancer is closely related to the disruption of homeostasis in the human body. The gut microbiome plays crucial roles in maintaining the homeostasis of its host throughout lifespan. In recent years, a large number of studies have shown that dysbiosis of the gut microbiome is involved in the entire process of cancer initiation, development, and prognosis by influencing the host immune system and metabolism. Some specific intestinal bacteria promote the occurrence and development of cancers under certain conditions. Conversely, some other specific intestinal bacteria suppress the oncogenesis and progression of cancers, including inhibiting the occurrence of cancers, delaying the progression of cancers and boosting the therapeutic effect on cancers. The promoting effects of the gut microbiome on cancers have been comprehensively discussed in the previous review. This article will review the latest advances in the roles and mechanisms of gut microbiome in cancer suppression, providing a new perspective for developing strategies of cancer prevention and treatment.

From chaos to order: optimizing fecal microbiota transplantation for enhanced immune checkpoint inhibitors efficacy

The integration of fecal microbiota transplantation (FMT) with immune checkpoint inhibitors (ICIs) presents a promising approach for enhancing cancer treatment efficacy and overcoming therapeutic resistance. This review critically examines the controversial effects of FMT on ICIs outcomes and elucidates the underlying mechanisms. We investigate how FMT modulates gut microbiota composition, microbial metabolite profiles, and the tumor microenvironment, thereby influencing ICIs effectiveness. Key factors influencing FMT efficacy, including donor selection criteria, recipient characteristics, and administration protocols, are comprehensively discussed. The review delineates strategies for optimizing FMT formulations and systematically monitoring post-transplant microbiome dynamics. Through a comprehensive synthesis of evidence from clinical trials and preclinical studies, we elucidate the potential benefits and challenges of combining FMT with ICIs across diverse cancer types. While some studies report improved outcomes, others indicate no benefit or potential adverse effects, emphasizing the complexity of host-microbiome interactions in cancer immunotherapy. We outline critical research directions, encompassing the need for large-scale, multi-center randomized controlled trials, in-depth microbial ecology studies, and the integration of multi-omics approaches with artificial intelligence. Regulatory and ethical challenges are critically addressed, underscoring the imperative for standardized protocols and rigorous long-term safety assessments. This comprehensive review seeks to guide future research endeavors and clinical applications of FMT-ICIs combination therapy, with the potential to improve cancer patient outcomes while ensuring both safety and efficacy. As this rapidly evolving field advances, maintaining a judicious balance between openness to innovation and cautious scrutiny is crucial for realizing the full potential of microbiome modulation in cancer immunotherapy.

Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis

BACKGROUND

Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the most common modality for tissue acquisition from pancreatic masses. Despite high specificity, sensitivity remains less than 90%. Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically. However, data regarding the same have shown conflicting results.

AIM

To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.

METHODS

The electronic databases of MEDLINE, EMBASE, and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions. A bivariate hierarchical model was used to perform the meta-analysis.

RESULTS

A total of 10 studies were identified. The pooled sensitivity, specificity, and area under the receiver-operated curve (AUROC) for standard EUS-FNA/B were 0.82 (95%CI: 0.79-0.85), 1.00 (95%CI: 0.96-1.00), and 0.97 (95%CI: 0.95-0.98), respectively. The pooled sensitivity, specificity, and AUROC for EUS-FNA/B with auxiliary techniques were 0.86 (95%CI: 0.83-0.89), 1.00 (95%CI: 0.94-1.00), and 0.96 (95%CI: 0.94-0.98), respectively. Comparing the two diagnostic modalities, sensitivity [Risk ratio (RR): 1.04, 95%CI: 0.99-1.09], specificity (RR: 1.00, 95%CI: 0.99-1.01), and diagnostic accuracy (RR: 1.03, 95%CI: 0.98-1.09) were comparable.

CONCLUSION

Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B. Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.

Non-esophageal eosinophilic gastrointestinal disease and chronic abdominal pain in children: A multicenter experience

BACKGROUND

Eosinophilic gastrointestinal (GI) disease (EGID) beyond eosinophilic esophagitis is not commonly reported in the developing world.

AIM

To estimate the prevalence of EGID in a selected group of pediatric patients suffering from non-functional chronic abdominal pain (CAP).

METHODS

A retrospective analysis was conducted on case records of children with CAP. Those exhibiting clinical or laboratory alarming features underwent endoscopic evaluation. Histopathology reports from upper GI endoscopy and ileo-colonoscopy determined the diagnosis of EGID. Subsequent analyses included clinical presentations, presence of atopy in the children or family, hemoglobin, albumin, serum immunoglobulin E (IgE), fecal calprotectin levels, endoscopic appearances, treatment methods, and outcomes.

RESULTS

A total of 368 children with organic CAP were subjected to endoscopic evaluation. Among them, 19 (5.2%) patients with CAP were diagnosed with EGID. The median age of the children was 11.1 years (interquartile range = 8.4-14.4). The estimated prevalence of EGID in children with organic CAP was 520/10000 children over 5 years. Periumbilical pain was the most common site (63%). Family history of atopy, peripheral blood eosinophilia, and elevated serum IgE were the three parameters significantly associated with EGID. Clinical remission was obtained in all children at 6 months. The 47% had microscopic remission and maintained remission until a 1-year follow-up. The 53% had a fluctuating clinical course after 6 months.

CONCLUSION

EGID beyond the esophagus is not an uncommon entity among the children of India. It can contribute significantly to the etiology of pediatric CAP.

Chemerin facilitates placental trophoblast invasion and spiral artery remodeling through the pentose phosphate pathway

AIMS

The invasion of trophoblasts and remodeling of spiral arteries are the requisite processes for successful placentation. A defect of trophoblast invasion is closely associated with pregnancy complications, including miscarriage and preeclampsia. In this study, we investigated the function of chemerin in trophoblast invasion and artery remodeling and explored the underlying mechanism in this process.

MAIN METHODS

Immunostaining was performed to examine chemerin expression in different days of mouse placenta and early stage of human placenta. Chemerin KO and LPS-treated mice, with exogenous chemerin peptide, were used to evaluate trophoblast giant cells (TGC) invasion, artery remodeling, and NK cell infiltration. Chemerin KO and LPS-treated decidua on E8.5 were conducted in metabolites file and measured related enzymes' expression. Chemerin's function was further examined by human trophoblast HTR-8 cell migration and the enzymes expression in the pentose phosphate pathway.

KEY FINDINGS

Chemerin has high expression in mouse-invasive TGC and human extra-villous trophoblast cells. Deficiency of chemerin and LPS treatment in pregnant mice impaired placental TGC invasion, spiral artery remodeling, and NK cell infiltration in decidua, which mainly attributed to the downregulation of metabolites and G6PD and RPIA expression in pentose phosphate pathway (PPP). Chemerin activated the PPP to accelerate HTR-8 cell migration. Exogenous chemerin administration remarkably attenuated the defect of TGC invading and artery remodeling in LPS-treated mice, and promoted NK infiltration and maternal blood perfusion.

SIGNIFICANCE

This study described the indispensable role of chemerin in trophoblast invasion and arterial remodeling, and suggested its potential application in pregnancy complications miscarriage and preeclampsia.

Successful treatment of depressed esophageal squamous papilloma with interferon- alpha 2a: A case report

BACKGROUND

Esophageal squamous papilloma (ESP) is a rare benign tumor of the esophagus, typically characterized by an exophytic and warty appearance, with a diameter of less than 5 mm. Endoscopic resection is considered the most effective treatment for these tumors.

CASE SUMMARY

In this paper, we discussed the pathogenesis, clinical characteristics, and therapeutic options of ESP based on our experience with a case presenting a depressed appearance and treated with interferon-alpha 2a (IFNα2a) injection.

CONCLUSION

This paper reports the first successful clinical case of using the human IFNα2a for the treatment of ESP with a depressed endoscopic appearance. However, the efficacy of interferon treatment requires to validation in a large number of subsequent cases.

Culturally tailored steatotic liver disease management: Latino and Asian community partner perspectives and recommendations

BACKGROUND

Lifestyle modification is the mainstay of treatment for steatotic liver disease (SLD), and recommendations for behavior change require cultural tailoring to enhance their relevance for minority populations. This study aimed to explore community partner perspectives on barriers and facilitators to lifestyle modification and identify ways to improve cultural sensitivity for SLD management.

METHODS

We conducted semi-structured interviews with 20 community partners (public health professionals, community leaders, and health care workers) from Latino (n=9) and Asian (n=11) communities in San Francisco. Interviews explored community knowledge of SLD, perceived barriers and facilitators to lifestyle changes, and feedback on current education materials. Data were analyzed using thematic analysis.

RESULTS

Across 4 levels of influence (societal, community, interpersonal, and individual), 9 shared barriers and 6 shared facilitators emerged. Barriers included poverty, misinformation, social influences, time constraints, and limited nutrition and SLD knowledge, while facilitators included free outdoor spaces, food assistance programs, healthy cultural habits, and family. The Asian community uniquely cited safety concerns for outdoor activities and preference for Eastern medicine, while the Latino community expressed childcare constraints as barriers. We gathered 9 recommendations to improve the cultural sensitivity of lifestyle modification guidance, including working within traditional dietary frameworks, adapting exercise to activities of daily life, and embracing harm reduction for alcohol cessation.

CONCLUSIONS

Culturally tailored interventions may improve the relevance and sustainability of SLD lifestyle modification recommendations in Latino and Asian communities. Recommendations for interventions include harnessing community-based support, embracing cultural dietary modifications, and promoting feasible physical activity to enhance engagement in these populations.

Targeting the kynurenine pathway in gliomas: Insights into pathogenesis, therapeutic targets, and clinical advances

Gliomas, the most prevalent primary brain tumors, continue to present significant challenges in oncology due to poor patient prognosis despite advances in treatment such as immunotherapy and cancer vaccines. Recent research highlights the potential of targeting tryptophan metabolism, particularly the kynurenine pathway (KP) and combinatorial approaches with immunotherapies, as a promising strategy in cancer research. The key enzymes of the kynurenine pathway, such as IDO1, IDO2, and TDO, and metabolites like kynurenine, kynurenic acid, and quinolinic acid, are implicated in fostering an immunosuppressive tumor microenvironment and promoting glioma cell survival. In glioblastoma, a highly aggressive glioma subtype, elevated IDO and TDO expression correlates with reduced survival rates. KP metabolites, such as kynurenine (KYN), 3-hydroxykynurenine (3-HK), kynurenic acid (KYNA), and quinolinic acid (QUIN), are involved in modulating immune responses, oxidative stress, neuroprotection, and neurotoxicity. This review synthesizes recent findings on the kynurenine pathway involvement in glioma pathogenesis, examining potential therapeutic targets within this pathway and discussing ongoing clinical trials that draw attention to treatments based on this pathway. Furthermore, it highlights novel findings on the post-translational modifications of kynurenine pathway enzymes and their regulatory roles, presenting their potential as therapeutic targets in gliomas.

Comprehensing the role of serum GGT in colorectal carcinoma: cancer risk, prognostic and diagnostic significance

Effective biomarkers are necessary for early diagnosis, prognosis, and therapy monitoring of colorectal cancer (CRC), a disease that continues to be a major worldwide health problem. Due to a potential connection to colorectal cancer, serum gamma-glutamyl transferase (GGT), an important enzyme in metabolism of glutathione and cellular stress response, has drawn attention. GGT is an essential component of the antioxidant system that protects against oxidative stress. It is mostly found in organs such as the liver, kidneys, and biliary tract. Numerous health problems, such as metabolic disorders, liver illnesses, and several types of cancer, are linked to elevated blood GGT levels. This review aims to clarify the function of serum GGT in colorectal cancer by examining clinical research conducted over the past 20 years. A comprehensive analysis of pertinent literature identifies associations between high blood GGT levels and carcinoma of the colon risk, prognosis, and diagnostic potential. Increased GGT and a higher risk of colorectal cancer are positively correlated, according to epidemiological data consistently. The predictive capacity of GGT for colorectal adenomas underscores its use in early identification and preventive approaches. Additional clinical evidence indicates that higher GGT levels in CRC patients are associated with poorer outcomes, such as invasion of lymph nodes, advanced tumour stages, and decreased overall survival. Furthermore, changes in GGT levels after therapy offer information about patient survival and treatment effectiveness, highlighting its importance in therapy monitoring. In summary, this review underscores the multifaceted role of serum GGT in CRC, offering insights into its value as a biomarker for risk assessment, prognosis, and therapeutic monitoring, while emphasizing the need for further research to validate its clinical utility.

Galactia lindenii lectin type-II: Its potential use in thyroid cancer diagnosis

Galactia lindenii lectin type-II (GLL-II) belongs to the group of the legume lectins. The present study investigated the GLL-II staining patterns in histological sections of neoplastic and non-neoplastic thyroid tissues. Besides, hemagglutination assays (HA) using the GLL-II on red blood cells of different glycomic profiles were performed, complementing previous results. The differential staining in Papillary Thyroid Cancer, Invasive Encapsulated Follicular Variant Papillary Thyroid Carcinoma, Hashimoto's thyroiditis, and non-neoplastic thyroid with goiter changes, together with the HA results, allowed us to propose the potential utility of GLL-II as part of lectin platforms used to discriminate between human thyroid pathological samples from normal ones. The present study shed light on potential applications of GLL-II in determining alterations of glycosylation patterns in specific cells, tissues, or body fluids, as well as glycotopes biomarkers of healthy or pathological conditions.

Anti-Inflammatory and Immunomodulatory Effects of Intravenous Lidocaine in Surgery: A Narrative Review

Lidocaine, a widely used local anaesthetic, has been shown to possess anti-inflammatory and immunomodulatory properties with applications in surgery. During a surgical procedure, inflammation is a natural response of the body, triggered by the release of inflammatory mediators and the activation of the immune system. However, an excessive response can lead to serious postoperative complications. Lidocaine modulates inflammation through mechanisms beyond its anaesthetic action. It reduces the activation of neutrophils and macrophages, decreases the release of pro-inflammatory cytokines and prostaglandins, and preserves endothelial integrity, helping to control excessive inflammatory responses. Additionally, its perioperative use has shown benefits such as reduced postoperative pain, lower opioid consumption, and faster intestinal recovery. Furthermore, studies have suggested that lidocaine may have an anti-metastatic effect by inhibiting the migration of tumour cells and the activation of inflammatory pathways related to cancer spread. Although its use in surgery is promising, further research is needed to determine optimal dosages and its long-term clinical impact.

Interaction Between Gut-Heart Axis in Sepsis-Induced Cardiomyopathy

The gut microbiota and its metabolites profoundly influence cardiac function, emerging as critical players in the pathophysiology of Sepsis-Induced Cardiomyopathy (SIC). Conversely, therapeutic interventions for SIC and the resultant cardiac alterations can reciprocally modulate gut microbial composition and function. To systematically elucidate this complex bidirectional relationship during SIC, this review delineates two key aspects: the 'forward gut-heart axis', defined as influences originating from the gut microbiota and its metabolites directed towards the cardiovascular system, and the 'reverse gut-heart axis', encompassing the reciprocal effects of cardiovascular drugs and cardiac factors on the gut microbiota. Furthermore, we explore potential therapeutic strategies for SIC centered on the targeted modulation of this intricate gut-heart interplay.

Optimizing TACE for Hepatocellular Carcinoma: The Impact of Intra-Arterial Contrast Enhanced Ultrasound

Transarterial chemoembolization (TACE) is a well-established treatment for intermediate-stage hepatocellular carcinoma (HCC), shown through randomized trials to improve survival compared to supportive care in patients with large, unresectable tumors who are not candidates for liver transplantation or local ablation. As the most commonly used transarterial intervention, TACE is also employed to downstage advanced HCC, allowing certain patients to become eligible for orthotopic liver transplantation under the Milan criteria. Despite its widespread use, variability in therapeutic outcomes highlights the need for improved procedural guidance. Recent advancements in intra-arterial contrast-enhanced ultrasound (IA CEUS) offer new opportunities to enhance TACE precision with real-time imaging that provides superior visualization of tumor vasculature and chemoembolic agent distribution. This review explores the role of IA CEUS in refining TACE for HCC, emphasizing its potential to increase intraprocedural accuracy and reduce the risk of incomplete tumor embolization. The enhanced spatial resolution of IA CEUS enables real-time tracking of embolic agent dispersion within tumor vessels, which could improve therapeutic efficacy by ensuring complete tumor targeting and minimizing non-target embolization. Additionally, IA CEUS may decrease procedural complications by allowing dynamic adjustment of embolic delivery based on real-time imaging feedback. By reviewing existing evidence on IA CEUS applications in TACE, this article highlights the modality's potential to transform treatment protocols, improve outcomes, and expand the patient population eligible for TACE.

Efficacy and safety of immediate vs. delayed endoscopic retrieval of large or multiple common bile duct stones in high-risk elderly patients: a prospective, randomized comparative study

INTRODUCTION

Elderly patients with common bile duct (CBD) stones often present with large or multiple stones, making endoscopic retrograde cholangiopancreatography (ERCP)-guided extraction a technically complex and potentially high-risk procedure.

AIM

This study aimed to compare the efficacy and safety of a staged approach-biliary stenting followed by delayed stone extraction-versus immediate stone removal during the initial ERCP in frail elderly patients with large or multiple CBD stones.

METHODS

This prospective study included high-risk elderly patients with large or multiple CBD stones, defined as either a single stone ≥ 15 mm in diameter or three or more stones, each ≥ 10 mm in diameter. Participants were randomly assigned to two equal groups: Group A underwent initial biliary stenting with elective stone retrieval after 8-12 weeks, while Group B underwent immediate stone extraction during the first ERCP.

RESULTS

A total of 400 patients were included, with 200 in each group. Baseline characteristics and stone extraction methodologies were comparable between the two groups. In Group A, stone size and number significantly decreased after stenting (mean size: 1.42 ± 0.28 cm before vs. 0.98 ± 0.19 cm after stenting; P < 0.001). The overall stone clearance rate was significantly higher in Group A compared to Group B (94% vs. 80%, P < 0.001). Post-ERCP hospital stay was significantly shorter in Group A (6.41 ± 1.27 days vs. 11.3 ± 1.86 days, P < 0.001). Group B had higher rates of complications, including cholangitis (1% vs. 7%, P < 0.05) and pneumonia (2% vs. 11%, P < 0.05).

CONCLUSION

In high-risk elderly patients with large or multiple CBD stones, temporary placement of biliary plastic stents followed by elective endoscopic stone removal effectively reduces stone size, simplifies the removal process, enhances stone clearance rates, and decreases ERCP-related complications.

Rectal and Rectosigmoid Endoscopy to Assess Endoscopic and Histological Remission in Ulcerative Colitis: A Prospective Study

BACKGROUND AND AIMS

Despite increasing interest in endoscopic and histological remission as a treatment target in ulcerative colitis (UC), the accuracy of endoscopic and histological findings in the left colon and/or rectum to detect pancolonic remission is poorly known. We aimed to compare the diagnostic accuracy of rectosigmoidoscopy (RS) and rectoscopy for detecting endoscopic and histological healing elsewhere in the colon.

METHODS

Consecutive UC patients who underwent colonoscopy were prospectively included. Endoscopic healing was defined by a Mayo endoscopic score (MES) = 0 on all explored segments and histological healing was defined by a Nancy index ≤ 1 (2 biopsies/segments). The agreement between colonoscopy, RS, and rectoscopy for endoscopic and histological healing was assessed using Cohen's kappa coefficient.

RESULTS

Eighty patients were included. Thirty-four had an MES = 0 by RS and colonoscopy. The agreement between colonoscopy and RS was almost perfect, with a к index of 0.95 (%-agree 97.5) for Mayo 0, and к of 0.95 for Mayo 0-1 (%-agree 97.5, P < .0001). The agreement between RS and colonoscopy was also almost perfect (к = 0.877, (%-agree 91.7, P < .001) for the assessment of histological healing. The agreement between rectoscopy and colonoscopy for the evaluation of endoscopic (Mayo 0) and histological healing was almost perfect as well (к = 0.83 (%-agree 91.2, P < .001) and к = 0.80 (%-agree 91.7, P < .001)).

CONCLUSION

For UC patients undergoing treat-to-target interventions, endoscopic and histological findings in the rectum alone provide good accuracy for determining pancolonic endoscopic and histological remission. Rectal examination could be an alternative to RS for monitoring UC patients.

Aaptamine Alters Vimentin Expression and Migration Capability of Triple-Negative Breast Cancer Cells

Purpose

This study aimed to explore the effect of Aaptamine, an alkaloid derived from marine sponges, on the vimentin expression in both mRNA and protein levels and the migration capacity of breast cancer cells.

Methods

The triple-negative breast cancer cell line MDA-MB-231 was used for in vitro experiments. Low-cytotoxicity concentrations of Aaptamine (12.5 to 50 μM) were given to MDA-MB-231 cells. The vimentin mRNA and protein expression were evaluated using RT-qPCR and immunofluorescence, respectively, 72 h after Aaptamine treatment. The migration scratch assay was conducted for 48 hours.

Results

Aaptamine treatment in three different doses did not affect the expression of vimentin at the mRNA level while significantly lowering vimentin protein expression at the concentration of 12.5 µM. In addition, Aaptamine significantly inhibited breast cancer cell migration in a dose-dependent manner.

Conclusion

Aaptamine inhibits vimentin protein expression and demonstrates anti-migration activity in the sub-cytotoxic dose.

Development of a Quality Evaluation Index System for the Management of Automated Endoscope Reprocessors: Based on the Structure-Process-Outcome Model

BACKGROUND

The increasing reliance on Automated Endoscope Reprocessors (AERs) for endoscope reprocessing has highlighted gaps in management systems. This study aimed to develop a comprehensive quality evaluation index system to optimize AERs management.

METHODS

Guided by the Structure-Process-Outcome (SPO) model, the Delphi method was employed across two consultation rounds involving 17 experts. Indicators were developed and refined through literature reviews, hospital data analysis, and consensus-building.

RESULTS

Hospital data analysis identified key AERs management challenges: human errors (54.5%)-primarily improper leak detector installation (78.8% of human errors)-and component malfunctions (45.5%). The final system comprised 3 primary, 13 secondary, and 58 tertiary indicators. Expert consensus was robust (response rate: 100%; authority coefficient >0.9; Kendall's W: P<0.001). Outcome indicators linked reprocessing efficacy to clinical impacts, including microbiological pass rates and malfunction frequency.

DISCUSSION

The SPO-driven system integrates structural, procedural, and outcome standards, providing actionable benchmarks to mitigate risks and enhance reliability. While validated through expert consensus, further real-world validation is needed to assess long-term applicability across diverse settings.

CONCLUSION

This comprehensive quality evaluation index system offers a standardized framework for AERs management and optimization of endoscope reprocessing workflows.

Weizmannia Coagulans BC99 Prevents Loperamide-Induced Functional Constipation in Mice Through Increased Intestinal Peristalsis and Modulation of Gut Microbiota Dysbiosis

Objectives: Constipation is one of the most prevalent gastrointestinal disorders worldwide. Recent studies have demonstrated that probiotics may alleviate constipation by restoring gut microbiota balance. Methods: This study investigated the effects of Weizmannia coagulans BC99 (formerly Bacillus coagulans BC99) on gut microbiota and intestinal function in a loperamide-induced mouse model of functional constipation. BALB/c mice were randomly divided into six groups: control, model, phenolphthalein, BC99-L (2 × 107 CFU/day), BC99-M (2 × 108 CFU/day), and BC99-H (2 × 109 CFU/day). After 14 days of supplementation, constipation was induced in mice via loperamide administration. Results: BC99 significantly increased fecal water content, gastrointestinal transit rate, microbial metabolic activity, and butyric acid production, while decreasing the abundance of inflammation-related metabolic pathways. Moreover, BC99 improved levels of gastrointestinal regulatory peptides, including motilin and somatostatin. The Firmicutes-to-Bacteroidetes ratio was elevated in the BC99-M and the BC99-H group compared to the model group, indicating that BC99 effectively modulated gut microbiota composition and host biosynthetic pathways. Conclusions:Weizmannia coagulans BC99 alleviated and prevented loperamide-induced functional constipation in mice by enhancing intestinal peristalsis and restoring gut microbial homeostasis.

Predictability of clinical outcomes after external beam radiotherapy for hepatocellular carcinoma according to tumor marker dynamics

Signal changes after high dose irradiation on MRI make it difficult to assess the therapeutic response of hepatocellular carcinoma (HCC). To overcome the limitation of imaging work-up, our study predicted clinical outcomes through tumor marker dynamics in HCC after external beam radiotherapy (EBRT). As a single-center retrospective study, those who underwent conventional fractionated EBRT for viable HCC from 2010 to 2021 were analyzed. Patients with elevated tumor markers of AFP ≥ 10 ng/ml or PIVKA-II ≥ 30 mAU/ml before EBRT were enrolled. Remission of AFP, PIVKA-II, and MoRAL score (=11*√PIVKA-II + 2*√AFP) from pre-EBRT to post-EBRT at 1 month and 3 months was examined. For 1-year and 2-years OS, variables of tumor markers were examined using the receiver operation characteristics (ROC). Multivariate analyses of Cox-regression for OS were conducted. Among 111 patients, 34 patients were estimated to survive more than 2-years. In multivariate analyses for OS, tumor number (P = 0.004), portal vein tumor thrombus (P = 0.004), and Barcelona liver cancer staging (P < 0.001) were found to be significant. For 2-years OS, the degree of AFP remission at 3 months (rAFP_3M) had an AUC of 0.852 (95% CI: 0.758-0.946, P < 0.001), a sensitivity of 85.5%, and a specificity of 82.6% with a cut-off value of 3.7%. MoRAL score at 3 months (MoRAL_3M) had an AUC of 0.814 (95% CI: 0.728-0.900, P = 0.000), a sensitivity of 76.5%, and a specificity of 77.8% with a cut-off value of 111.64. In new multivariate analyses including the above significant factors plus either rAFP_3M or MoRAL_3M, rAFP_3M (P < 0.001) and MoRAL_3M (P < 0.001) were found to be independent prognostic factors in each model. This study confirmed the importance of the changed tumor marker after EBRT rather than the baseline value. Dynamic change of AFP and MoRAL score at post-EBRT 3 months could be recommended as potential indicators for clinical outcomes.

Ameliorative effect of "intestinal-vaginal" probiotics on 5-fluorouracil-induced microbial dysbiosis in colorectal cancer

The interaction between the gut microbiome and cancer chemotherapy has been extensively studied. However, the exact role of the vaginal microbiome in chemotherapy remains unknown. To address this issue, we established a colorectal cancer chemotherapy mouse model. Here, we confirmed that 5-fluorouracil induced dysbiosis in both the vaginal and gut microbiomes, presenting a new challenge for conventional chemotherapy. Therefore, we innovatively propose an "intestinal-vaginal" probiotics administration strategy, which involves the simultaneous delivery of probiotics to both the gut and vagina, aiming to enhance chemotherapy efficacy while alleviating dysbiosis and associated side effects. Our results indicate that, compared to gut-only probiotic intervention, "intestinal-vaginal" probiotics administration significantly enhanced the anticancer efficacy of 5-fluorouracil by upregulating the p53 pathway. Furthermore, regarding gastrointestinal side effects, "intestinal-vaginal" probiotics more effectively reduced the release of vomit-associated neurotransmitters (e.g., 5-HT and SP), while also alleviating mucositis by downregulating the NF-κB pathway. Additionally, "intestinal-vaginal" probiotics outperformed the oral probiotic by increasing beneficial microbiota and reducing pathogenic bacteria. Notably, regarding vaginal side effects, "intestinal-vaginal" probiotics significantly inhibited the NF-κB inflammatory pathway and pro-apoptotic proteins, and improved vaginal dysbiosis compared to vaginal-only probiotics. These findings provide the first evidence of the significant potential of the "intestinal-vaginal" probiotics delivery approach as an adjunctive cancer therapy, which offers a novel perspective on the synergistic interactions between host microbiota communities.

Effect of Helicobacter pylori eradication on remnant stomach neoplasms after curative gastrectomy (HELP-GC): Protocol of a HELP-GC randomized controlled trial

BACKGROUND

Limited research has examined the direct effectiveness of Helicobacter pylori eradication (HPE) on the remnant stomach neoplasms after curative gastrectomy. This study aims to assess whether HPE could prevent the development of gastric neoplasms in the remnant stomach after curative gastrectomy through a double-blinded, randomized controlled trial.

METHODS

After curative gastrectomy, patients with HP infection and pathologically proven stage 1 tumors will be enrolled and randomly assigned to eradication (n = 492) and placebo (n = 492) groups. Patients in the eradication arm will be given the eradication regimen, which will comprise 40 mg of esomeprazole, 1 g of amoxicillin, and 500 mg of clarithromycin twice a day for 14 days. The primary endpoint is the development of gastric neoplasms, including adenoma or adenocarcinoma. The secondary endpoints are the 10-year overall survival, improvement rates of gastric glandular atrophy and/or intestinal metaplasia, and incidence of new-onset hyperplastic polyps among the groups.

SIGNIFICANCE

This research will be the first randomized controlled clinical study in which a thorough long-term follow-up will be needed to evaluate the effectiveness of HPE for remnant stomach neoplasms after curative gastrectomy. Its results will serve as a basis for developing future strategies in the management of patients with HP infection who undergo curative gastrectomy.

TRIAL REGISTRATION

https://cris.nih.go.kr/ KCT0008855. October 10, 2023.

The neuroprotective role of CncC in a Drosophila model of Parkinson's disease

Parkinson's disease (PD) is an incurable neurodegenerative disorder, yet significant advancements have been made in understanding its etiology. Among the risk factors, exposure to neurotoxins plays the greatest role. One of the most dangerous toxins is rotenone, a naturally derived compound that was historically used as an insecticide. This chemical affects mitochondrial function by blocking electron transfer, resulting in increased reactive oxygen species production and accumulation. Recently, the role of the Nrf2 pathway was explored as a possible protective mechanism to minimize the neurotoxic effects leading to Parkinson's disease. Here, we used Drosophila melanogaster as a model to examine the link between the expression or activity levels of CncC (an ortholog of Nrf2) or HO (an ortholog of HO-1) in the brain and the detrimental effects of chronic exposure to rotenone. We found that flies with overexpression of CncC or silencing of ho survived better after exposure to rotenone compared with flies with partially suppressed CncC or upregulated ho expression. These experimental groups exposed to rotenone also exhibited significantly fewer degenerated dopaminergic (DA) neurons than did the wild-type group. Nevertheless, only those in which CncC was overexpressed in glia showed the best survival, the greatest percentage of climbing ability, and no effects on DA neurons. Our findings were supported by data obtained for flies fed with HO inhibitor (SnPPIX) or activator (hemin), as well as with curcumin (Nrf2 activator). The observed effects were connected with changes in autophagy and apoptosis pathways. Our data suggest that possible therapies exploiting Nrf2 activation should include restricting HO upregulation as a neuroprotective strategy against the toxic effects of rotenone.

Endoscopic features differentiating non-Helicobacter pylori Helicobacter-induced gastric mucosa-associated lymphoid tissue lymphoma with a nodular gastritis-like appearance and H. pylori-induced conventional nodular gastritis

OBJECTIVES

Conventional nodular gastritis has been known to be caused by Helicobacter pylori infection. Several cases of gastric mucosa-associated lymphoid tissue (MALT) lymphoma with non-H. pylori Helicobacters (NHPH) exhibit endoscopic findings resembling nodular gastritis. Considering the differences in malignancy, distinguishing between these two conditions is crucial. This study aimed to identify the distinguishing endoscopic features of NHPH-induced gastric MALT lymphoma with nodular gastritis-like appearance (NHPHi-MNG) and H.-induced conventional nodular gastritis (HPi-NG).

METHODS

Between 2011 and 2022, we analyzed 17 patients with NHPHi-MNG and 50 patients with HPi-NG at Hiroshima University Hospital and evaluated nodule morphology and distribution patterns.

RESULTS

Compared with the HPi-NG group, the NHPHi-MNG group exhibited significantly larger nodules (2.5 vs. 2.0 mm, P < 0.05) with protruded morphology (protruded/superficial, elevated: 14/3 vs. 8/42, P < 0.05), most prominently in the gastric angulus. The variability in nodule size was significantly higher in the NHPHi-MNG group than in the HPi-NG group (0.85 vs. 0.37 mm, P < 0.05), reflecting nodule heterogeneity. The distance from the gastric angulus to the proximal end of the nodular lesions was significantly greater in the NHPHi-MNG group than in the HPi-NG group (4.4 vs. 1.7 cm, P < 0.05). The nodules in the HPi-NG group were smaller, superficial, elevated, and most prominent in the gastric antrum compared with those in the NHPHi-MNG group. They were predominantly distributed in the gastric antrum with a homogeneous morphology.

CONCLUSION

NHPHi-MNG and HPi-NG can be endoscopically differentiated according to nodule morphology and distribution. Recognizing these distinguishing features is essential for an accurate diagnosis.

Machine Learning Radiomics for Predicting Response to MR-Guided Radiotherapy in Unresectable Hepatocellular Carcinoma: A Multicenter Cohort Study

Background

This study was conducted to assess the efficacy and safety of magnetic resonance (MR)-guided hypofractionated radiotherapy in patients with unresectable hepatocellular carcinoma (HCC). Machine learning-based radiomics was utilized to predict responses in these patients.

Methods

This retrospective study included 118 hCC patients who received MR-guided hypofractionated radiotherapy. The primary study endpoint was the objective response rate (ORR). Radiomics features were based on the gross tumor volume (GTV). K-means clustering was performed to differentiate cancer subtypes based on radiomics. Nine radiomics-utilizing machine learning models were built and validated internally through 5-fold cross-validation.

Results

The ORR, median progression-free survival (mPFS), and median overall survival (mOS) were 54.4%, 21.7 months, and 40.7 months, respectively. No patient experienced Grade 3/4 adverse events. 1130 radiomics features were extracted from the GTV, of which 7 were included for further analysis. K-means clustering identified 2 subtypes based on the selected features. Subtype 1 had significantly higher response, longer mPFS, and longer mOS than Subtype 2. In both internal and external validations, the multi-layer perceptron (MLP) model demonstrated superior predictive performance for response, achieving a receiver operating characteristic-area under the curve (ROC-AUC) of 0.804 and 0.842, respectively.

Conclusion

MR-guided radiotherapy was proven to be effective and safe for HCC. The machine learning radiomics model developed in this study could accurately predict the response of radiotherapy-treated inoperable HCC.

Eosinophilic gastrointestinal disorders: variations in eosinophilic counts among investigators and staining methods

Objective

Eosinophilic gastrointestinal disorders (EGIDs) are pathologically diagnosed by manually counting the eosinophils in biopsy tissue under microscopy. However, the skill of the individual examiner is considered to influence the accuracy of the resulting eosinophil count (EC). This study aimed to examine the effects of different examiners and histopathological staining types on the EC results of pathological tissues from patients with EGIDs.

Methods

Infiltrating eosinophils in lesion tissues from 10 eosinophilic esophagitis and 28 eosinophilic gastroenteritis cases were counted by three pathologists and one cytotechnologist. The intra- and inter-observer variabilities in ECs related to hematoxylin-eosin (HE), May-Grünwald Giemsa (MG), and direct fast scarlet (DFS) staining were investigated. The effects of examiner expertise and staining method on ECs were analyzed using a linear mixed effects model. The difference in color value (ΔE) for each staining method was obtained using the Commission International de l'Eclairage luminance-a-b model (L*a*b*).

Results

There was no significant intra-observer variability in eosinophil counting. Regarding inter-observer agreement, the examiner with the most EGIDs experience reported higher ECs than the other examiners for all three staining types (P<0.001). ECs were significantly higher with MG and DFS staining than with HE staining, regardless of the examiner (both P<0.001). Additionally, the ΔE values with DFS were higher than those with MG and HE.

Conclusions

DFS staining offered the most selective visualization of eosinophils. ECs may vary depending on both the skill of the examiner and the staining method.

Tristetraprolin affects invasion-associated genes expression and cell motility in triple-negative breast cancer model

Tristetraprolin (TTP) is an RNA-binding protein that negatively regulates its target mRNAs and has been shown to inhibit tumor progression and invasion. Tumor invasion requires precise regulation of cytoskeletal components, and dysregulation of cytoskeleton-associated genes can significantly alter cell motility and invasive capability. Several genes, including SH3PXD2A, SH3PXD2B, CTTN, WIPF1, and WASL, are crucial components of the cytoskeleton reorganization machinery and are essential for adequate cell motility. These genes are also involved in invasion processes, with SH3PXD2A, SH3PXD2B, WIPF1, and CTTN being key components of invadopodia-specialized structures that facilitate invasion. However, the regulation of these genes is not well understood. This study demonstrates that ectopic expression of TTP in MDA-MB-231 cells leads to decreased mRNA levels of CTTN and SH3PXD2A, as well as defects in cell motility and actin filament organization. Additionally, doxorubicin significantly increases TTP expression and reduces the mRNA levels of cytoskeleton-associated genes, enhancing our understanding of how doxorubicin may affect the transcriptional profile of cells. However, doxorubicin affects target mRNAs differently than TTP ectopic expression, suggesting it may not be the primary mechanism of doxorubicin in breast cancer (BC) treatment. High TTP expression is considered as a positive prognostic marker in multiple cancers, including BC. Given that doxorubicin is a commonly used drug for treating triple-negative BC, using TTP as a prognostic marker in this cohort of patients might be limited since it might be challenging to understand if high TTP expression occurred due to the favorable physiological state of the patient or as a consequence of treatment.

Epidemiology and practice patterns of achalasia in Taiwan: A nationwide population-based cohort study

BACKGROUND

Achalasia is a rare disease of gastrointestinal motility characterized by impaired esophageal peristalsis and reduced esophageal sphincter relaxation. However, data on its epidemiology and outcomes in Taiwan are limited. This study aimed to assess the incidence, characteristics, and clinical management of achalasia in Taiwan.

METHODS

Patients who were newly diagnosed with achalasia between 2001 and 2013 were recruited from the Taiwan National Health Insurance Research Database. The study obtained data on the age, sex, urbanization, socioeconomic status, area of residence, diagnostic methods, and interventional management of the patients. Incidence, diagnostic modalities, treatment methods, malignancy, and mortality outcomes were analyzed.

RESULTS

In total, 206 new achalasia cases were identified. The mean annual incidence in Taiwan was 1.64 (95% confidence interval, 1.22-2.05) per 100 000 persons. The mean age of the patients at diagnosis was 51.8 years. The age-specific incidence of achalasia peaked in patients aged between 70 and 80 years and above 80 years. For achalasia diagnosis, endoscopy, computed tomography (CT), barium studies, and manometry were performed in 123 (59.71%), 97 (47.09%), 49 (23.79%), and 11 patients (5.34 %), respectively. During long-term follow-up, seven patients (3.39%) developed esophageal cancer, and 39 patients (18.93%) died. The median survival was 10.65 years after achalasia diagnosis, with a 10-year survival rate of 76.22%.

CONCLUSION

This is the first population-based epidemiological study on achalasia in Taiwan, revealing the incidence of achalasia before the era of high-resolution manometry. Clinicians should be vigilant about the development of esophageal cancer and mortality during long-term follow-ups. There is also room to enhance the utilization of various diagnostic tools for achalasia.

The pentose phosphate pathway (PPP) in the glioma metabolism: A potent enhancer of malignancy

The glioma hallmark includes reprogramming metabolism to support biosynthetic and bioenergetic demands, as well as to maintain their redox equilibrium. It has been suggested that the pentose phosphate pathway (PPP) and glycolysis are directly involved in the dynamics and regulation of glioma cell proliferation and migration. The PPP is implicated in cellular redox homeostasis and the modulation of signaling pathways, which play a fundamental role in the progression of tumors to malignant grades, metastasis, and drug resistance. Several studies have shown that in glioblastoma cells, the activity, expression, and metabolic flux of some PPP enzymes increase, leading to heightened activity of the pathway. This generates higher levels of DNA, lipids, cholesterol, and amino acids, favoring rapid cell proliferation. Due to the crucial role played by the PPP in the development of glioma cells, enzymes from this pathway have been proposed as potential therapeutic targets. This review summarizes and highlights the role that the PPP plays in glioma cells and focuses on the key functions of the enzymes and metabolites generated by this pathway, as well as the regulation of the PPP. The studies described in this article enrich the understanding of the PPP as a therapeutic tool in the search for pharmacological targets for the development of a new generation of drugs to treat glioma.

Helicobacter pylori in the Philippines: Social and Ecological Determinants of Seropositivity and Lack of Association With Systemic Inflammation

Helicobacter pylori (H. pylori) is a bacterium that infects the stomach and is associated with various gastrointestinal outcomes and increased cardiovascular disease risk. We examined the role of sex in and the social and ecological factors associated with H. pylori seropositivity (n = 124) and the relationship between seropositivity and systemic inflammation (n = 116) among adults in Metro Cebu, Philippines. Data were drawn from the Cebu Longitudinal Health and Nutrition Survey when participants were 21 years old. Anti-H. pylori antibody concentrations and C-reactive protein (CRP) concentrations were analyzed in dried blood spots and plasma, respectively. The seroprevalence of H. pylori in this sample was 32.3%. In logistic regression analyses adjusting for sex, higher socioeconomic status (i.e., asset index) was associated with decreased likelihood of H. pylori seropositivity (OR = 0.723, p = 0.015). Higher assets (OR = 0.688, p = 0.002) and higher hygiene (OR = 0.754, p = 0.026) were associated with decreased odds of H. pylori seropositivity. Any level of excrement near the household, relative to no excrement (low excrement OR = 3.45, p = 0.036; high excrement OR = 3.96, p = 0.021), was associated with increased odds of seropositivity. Sex was not associated with seropositivity. Seropositivity was not associated with CRP concentrations (p = 0.52). Our results support the role of both socioeconomic and hygienic determinants of H. pylori infection risk. These findings provide new insight into factors associated with H. pylori seropositivity in a population with no previously identified infection risk factors.

Advances in research on the intestinal microbiota in the mechanism and prevention of colorectal cancer (Review)

The intestinal microbiota represents a diverse population that serves a key role in colorectal cancer (CRC) and its treatment outcomes. Advancements in sequencing have revealed notable shifts in microbial composition and diversity among individuals with CRC. Concurrently, animal models have elucidated the involvement of specific microbes such as Lactobacillus fragilis, Escherichia coli and Fusobacterium nucleatum in the progression of CRC. The present review aimed to highlight contributions of intestinal microbiota to the pathogenesis of CRC, the effects of traditional treatments on intestinal microbiota and the potential for microbiota modulation as a therapeutic strategy for CRC.

Increased risk of colorectal adenoma and benign colorectal polyp associated with Helicobacter pylori infection: a systematic review and meta-analysis

Background

Although the association between Helicobacter pylori (H. pylori) infection and the risk of colorectal adenomas (CRAs) is suggested, specific analysis of the histological subtype of CRA is limited. The aim of the study was to conduct a meta-analysis on the risk of histological classifications of CRA as benign colorectal polyp (BCP), CRA, and advanced CRA to investigate the effects of H. pylori.

Methods

A comprehensive literature searches of the PubMed, Embase, and Cochrane databases through January 2024. Meta-regression analysis was conducted to identify potential moderators (e.g., histological subtype and ethnic groups).

Results

Among the 503,365 participants across 40 studies, H. pylori was consistently associated with increased probabilities of BCP, CRA, and advanced CRA. In BCP, H. pylori positive was found to be associated with an increase [odds ratio (OR), 1.430; 95% confidence interval (CI): 1.292-1.583]. In CRA and advanced CRA, H. pylori positive was found to be associated with an increase (OR, 1.711; 95% CI: 1.408-2.080). In subgroup analysis by ethnicity, Western group had lower OR compared to Asian, with a statistically significant difference observed (Western OR, 1.369; 95% CI: 1.222-1.535 vs. Asian OR, 1.990; 95% CI: 1.416-2.796, P=0.04).

Conclusions

This systematic review and meta-analysis findings revealed a significant association between H. pylori infection and BCP, CRA, and advanced CRA. In particular, meta-regression analysis confirmed that ethnicity acts as a risk factor in both BCP and CRA.

Expansion of a bacterial operon during cancer treatment ameliorates fluoropyrimidine toxicity

Dose-limiting toxicities remain a major barrier to drug development and therapy, revealing the limited predictive power of human genetics. Here, we demonstrate the utility of a more comprehensive approach to studying drug toxicity through longitudinal profiling of the human gut microbiome during colorectal cancer (CRC) treatment (NCT04054908) coupled to cell culture and mouse experiments. Substantial shifts in gut microbial community structure during oral fluoropyrimidine treatment across multiple patient cohorts, in mouse small and large intestinal contents, and in patient-derived ex vivo communities were revealed by 16S rRNA gene sequencing. Metagenomic sequencing revealed marked shifts in pyrimidine-related gene abundance during oral fluoropyrimidine treatment, including enrichment of the preTA operon, which was sufficient for the inactivation of active metabolite 5-fluorouracil (5-FU). preTA+ bacteria depleted 5-FU in gut microbiota grown ex vivo and in the mouse distal gut. Germ-free and antibiotic-treated mice experienced increased fluoropyrimidine toxicity, which was rescued by colonization with the mouse gut microbiota, preTA+ Escherichia coli, or preTA-high stool from patients with CRC. Last, preTA abundance was negatively associated with fluoropyrimidine toxicity in patients. Together, these data support a causal, clinically relevant interaction between a human gut bacterial operon and the dose-limiting side effects of cancer treatment. Our approach may be generalizable to other drugs, including cancer immunotherapies, and provides valuable insights into host-microbiome interactions in the context of disease.

Epigastric pain of unknown origin, esophageal and gastric involvement: a Henoch-Schönlein Purpura case report

Henoch-Schönlein Purpura (HSP) is an acute systemic vasculitis that primarily affects the skin, gastrointestinal tract, kidneys and joints. It predominantly occurs in children but can occur at any age. We report a case of 48-year-old male patient suffering from unexplained epigastric pain alternating between relapses and remissions. The patient's initial clinical manifestation was atypical, starting with severe epigastric pain, without cutaneous purpura, and with normal rheumatologic and immunologic markers, making diagnosis difficult. The patient was eventually diagnosed with HSP. This case highlights the importance of considering this diagnosis in patients with unexplained abdominal pain and emphasize the role of endoscopy in diagnosing complex cases.

Prevalence and Distribution of Gastric Endoscopy Findings in Non-eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases: Influence of Atrophic Gastritis

Objective The impact of Helicobacter pylori infection on gastric endoscopic findings in non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) remains unclear. This study investigated the influence of H. pylori infection on the prevalence and distribution of gastric lesions. Methods The details of 75 patients diagnosed with non-EoE EGIDs were retrospectively reviewed. Of the 56 patients with a definitive diagnosis according to the Japanese criteria (any GI tract; ≥20 eosinophils/high-power field), 25 patients with pathologic gastric eosinophilic infiltration (EI) (gastric EI; ≥30 eosinophils/high power field) were investigated in detail. The prevalence and distribution of gastric endoscopy findings were assessed according to the gastric mucosal atrophy status, an indicator of H. pylori infection. Results Erythema (76%) was the most common finding in the gastric EI-positive group, followed by erosions (36%), ulcers (28%), ulcer scars (28%), and edema (24%). None of these lesions differed significantly in frequency between the patients with and without gastric atrophy. When erosions, ulcers, and ulcer scars were unified, they were slightly more common in the gastric bodies of patients with gastric atrophy than those without gastric atrophy; however, no preferential site was found in those without gastric atrophy. We identified six patients with active gastric ulcers, and half had large, deep ulcers with marginal swelling/irregularity. Conclusion Gastric endoscopy findings in non-EoE EGIDs with gastric EI were evenly observed in the stomach, with no specific trend in frequency or distribution depending on atrophic gastritis, an indicator of H. pylori infection. Gastric ulcers in patients with non-EoE EGIDs should be considered in the differential diagnosis of idiopathic peptic ulcers.

Promising Gastric Cancer Biomarkers-Focus on Tryptophan Metabolism via the Kynurenine Pathway

Currently, gastric cancer treatment remains an enormous challenge and requires a multidisciplinary approach. Globally, the incidence and prevalence of gastric cancer vary, with the highest rates found in East Asia, Central Europe, and Eastern Europe. Early diagnosis is critical for successful surgical removal of gastric cancer, but the disease often develops asymptomatically. Therefore, many cases are diagnosed at an advanced stage, resulting in poor survival. Metastatic gastric cancer also has a poor prognosis. Therefore, it is urgent to identify reliable molecular disease markers and develop an effective medical treatment for advanced stages of the disease. This review summarizes potential prognostic or predictive markers of gastric cancer. Furthermore, the role of tryptophan metabolites from the kynurenine pathway as prognostic, predictive, and diagnostic factors of gastric cancer is discussed, as this metabolic pathway is associated with tumor immune resistance.

Systems biology approach delineates critical pathways associated with papillary thyroid cancer: a multi-omics data analysis

BACKGROUND

Papillary thyroid cancer (PTC) is the most prevalent follicular cell-derived subtype of thyroid cancer. A systems biology approach to PTC can elucidate the mechanism by which molecular components work and interact with one another to decipher a panoramic view of the pathophysiology.

METHODOLOGY

PTC associated genes and transcriptomic data were retrieved from DisGeNET and Gene Expression Omnibus database respectively. Published proteomic and metabolomic datasets in PTC from EMBL-EBI were used. Gene Ontology and pathway analyses were performed with SNPs, differentially expressed genes (DEGs), proteins, and metabolites linked to PTC. The effect of a nucleotide substitution on a protein's function was investigated. Additionally, significant transcription factors (TFs) and kinases were identified. An integrated strategy was used to analyse the multi-omics data to determine the key deregulated pathways in PTC carcinogenesis.

RESULTS

Pathways linked to carbohydrate, protein, and lipid metabolism, along with the immune response, signaling, apoptosis, gene expression, epithelial-mesenchymal transition (EMT), and disease onset, were identified as significant for the clinical and functional aspects of PTC. Glyoxylate and dicarboxylate metabolism and citrate cycle were the most common pathways among the PTC omics datasets. Commonality analysis deciphered five TFs and fifty-seven kinases crucial for PTC genesis and progression. Core deregulated pathways, TFs, and kinases modulate critical biological processes like proliferation, angiogenesis, immune infiltration, invasion, autophagy, EMT, and metastasis in PTC.

CONCLUSION

Identified dysregulated pathways, TFs and kinases are critical in PTC and may help in systems level understanding and device specific experiments, biomarkers, and drug targets for better management of PTC.

Gut microbiome signature in response to neoadjuvant chemoradiotherapy in patients with rectal cancer

Background

Rectal cancer remains a leading cause of cancer-associated mortality, especially in advanced cases with limited treatment options. Emerging evidence suggests that the gut microbiome may influence the therapeutic efficacy of neoadjuvant chemoradiotherapy (CRT).

Objective

This study aimed to explore the dynamic changes in gut microbiome composition and metabolic pathways in rectal cancer patients undergoing CRT.

Methods

Paired fecal samples were collected from rectal cancer patients pre- and post-CRT. 16S rRNA amplicon sequencing and proteomics analysis were conducted to investigate microbial and metabolic alterations.

Results

Significant shifts in the microbiome were observed, with Fusobacterium, Subdoligranulum, Prevotella, Alloprevotella, and Bacteroides being enriched pre-CRT, while Streptococcus, Megamonas, Megasphaera, Escherichia-Shigella, and Olsenella became dominant post-CRT. Metabolic analysis revealed upregulated carbohydrate metabolism and downregulated lipid and energy metabolism.

Conclusion

These findings identify potential microbial biomarkers and metabolic pathways associated with CRT response, offering insights into personalized treatment strategies.

Can the affected intestinal segment visualized on abdominal ultrasound predict gastrointestinal tract bleeding in immunoglobulin A vasculitis?

OBJECTIVES

The study aimed to evaluate immunoglobulin A vasculitis (IgAV) patients with gastrointestinal (GI) tract involvement and to reveal the relationship between the location and extent of the affected intestinal segment detected on the initial abdominal ultrasound and GI tract bleeding.

METHODS

This medical record review study was conducted on 117 IgAV patients with GI tract involvement between January 2016 and June 2023. Patients were divided into two groups: those with (n = 28) and without (n = 89) GI tract bleeding. Predictors of GI tract bleeding were investigated by comparing demographic, clinical characteristics, and laboratory findings.

RESULTS

Gender, age at diagnosis, symptoms at admission, rash distribution, GI tract complaints, and the elapsed time until the development of GI tract symptoms were similar in both groups. There was no difference between small intestinal, large intestinal, or small + large intestinal involvement (P = .89). The ileum was the most commonly affected intestinal segment in patients with and without GI tract bleeding (P = .37). Jejunal wall thickening (P = .04) and the number of affected intestinal segments (P = .008) were higher in patients with GI tract bleeding.

CONCLUSIONS

In IgAV patients, jejunum involvement and affected multiple intestinal segments shown by abdominal ultrasound are associated with GI tract bleeding.

Novel combinational nanomedicines, liposomes, to tackle breast cancer

AIMS

Doxorubicin (DOX), a potent chemotherapeutic, is a commonly prescribed treatment for breast cancer, but is limited by severe organ toxicity. Therefore, more effective therapies are required. This study developed a novel DOX-liposomes (LipDOX-ALA-AA) co-loaded with alpha-lipoic-acid (ALA) and ascorbic-acid (AA) to enhance antineoplastic effect.

METHODS

Liposomes were fabricated using a microfluidic-system with a DSPClipid:Cholesterol ratio of 1:1 and a flow rate ratio of 5:1. Liposomes were investigated using various-techniques such-as dynamic light scattering to measure liposomes' size and charge; and UV-spectroscopy to determine DOX-encapsulation-efficiency, EE. Cytotoxicity assays used various cell-lines.

RESULTS

Data revealed that LipDOX-ALA-AA had diameter of 79.0 ± 0.3 nm, with narrow size distribution, and zeta-potential of -4.0 ± 1.2. DOX-EE exceeded 95%, drug load was 0.5 mg/105.5 mg total content, drug release followed a biphasic pattern. Cytotoxicity assay showed activity (p < 0.05) against breast cancer cell-lines with reduced nephrotoxicity compared to Doxosome.

CONCLUSION

This novel formulation (LipDOX-ALA-AA) offers a promise in breast cancer therapy.

Optimizing bowel preparation quality for colonoscopy: consensus recommendations by the US Multi-Society Task Force on Colorectal Cancer

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

Atorvastatin attenuates intestinal mucositis induced by 5-fluorouracil in mice by modulating the epithelial barrier and inflammatory response

Chemotherapy-induced intestinal mucositis is a major side effect of cancer treatment. Statins are 3-hydroxy-3-methyl glutaryl coenzyme reductase inhibitors used to treat hypercholesterolemia and atherosclerotic diseases. Recent studies have demonstrated that atorvastatin (ATV) has antioxidant, anti-inflammatory, and resulting from the regulation of different molecular pathways. In the present study, we investigated the effects of ATV on intestinal homeostasis in 5-fluorouracil (5-FU)-induced mucositis. Our results showed that ATV protected the intestinal mucosa from epithelial damage caused by 5-FU mainly due to inflammatory infiltrate and intestinal permeability reduction, downregulation of inflammatory markers, such as Tlr4, MyD88, NF-κB, Tnf-a, Il1β, and Il6 dose-dependent. ATV also improved epithelial barrier function by upregulating the mRNA transcript levels of mucin 2 (MUC2), and ZO-1 and occludin tight junction proteins. The results suggest that the ATV anti-inflammatory and protective effects on 5-FU-induced mice mucositis involve the inhibition of the TLR4/MYD88/NPRL3/NF-κB, iNos, and caspase 3.

Individualized tumor-reactive T cells exhibit a potent anti-tumor response in prostate cancer

BACKGROUND

Cellular immunotherapy exhibits promise in treating blood tumors. However, its application for solid tumors is impeded by their heterogeneity and complex microenvironments. The development of individualized multitarget therapy may be the key to overcoming the challenge of tumor heterogeneity.

METHODS

To generate tumor-reactive T cells, we modified the conditional reprogramming primary cell culture method by to establish a primary prostate cancer cell culture approach, refer to as eCR (enhanced conditional reprogramming). Then, Tumor tissue-derived primary cells were physically lysed and loaded into dendric cells, which, in turn, were co-cultured with peripheral blood T cells to induced individualized tumor-reactive T cells.

RESULTS

Our improved culture method could use a small amount of fresh or frozen tumor specimens (including biopsy specimens), which can be amplified in vitro while maintaining their original characteristics, without contamination by heterologous antigens. Furthermore, a series of in vitro and in vivo experiments revealed these tumor-reactive T cells exhibited specific and effective killing of tumor cells through their ability to recognize neoantigens in cancer.

CONCLUSION

In this study, we developed a protocol for the generation of tumor-responsive T cells based on autologous tumor antigens in patients with prostate cancer. This platform is characterized by its multitargeted, individualized, affordability, and minimal adverse effects, holding significant promise in the treatment of prostate cancer as well as other solid tumors.

Factors predicting insufflation-related events in peroral endoscopic myotomy procedures

BACKGROUND

Peroral endoscopic myotomy (POEM) has revolutionized the therapeutic landscape for esophageal achalasia, offering efficacy comparable to that of surgery with the convenience of an endoscopic approach. With the growing popularity of POEM, insufflation-related adverse events (AEs) present unique challenges that have been widely discussed in the literature. This study aimed to investigate the safety profiles and risk factors associated with insufflation-related events in patients undergoing POEM in endoscopy suites.

METHODS

This retrospective analysis included 100 consecutive patients with achalasia treated by POEM at our institute between March 2016 and October 2022. All procedures were performed in an endoscopy suite and employed carbon dioxide insufflation and general anesthesia with endotracheal intubation and positive-pressure ventilation. Variations in cardiopulmonary dynamics, intraprocedural AEs, and postoperative recovery were documented.

RESULTS

All procedures were successfully performed, with an average POEM duration of 92.3 min and an average anesthesia duration of 108.4 min. Of note, 1 major AE involving an esophageal leak and requiring endoscopic stenting was observed, along with a 27% incidence of minor AEs. Insufflation-related events, manifesting as capnoperitoneum, subcutaneous emphysema, or capnomediastinum, were identified in 48% of cases, but none required additional interventions or extended hospitalization. A peak inspiratory pressure increase of ≥20% was identified as the only predictor of insufflation-related events.

CONCLUSION

Performing POEM in an endoscopy suite can generally be considered safe from major AEs related to insufflation. Monitoring peak inspiratory pressure for a ≥20% increase may be an early indicator of other potential insufflation-related events.

Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale: an international reliability and validation study

BACKGROUND

 Mucosal visualization during upper gastrointestinal (UGI) endoscopy can be impaired by the presence of foam, bubbles, and mucus. Some UGI endoscopy visibility scales have been proposed but have not undergone multicenter validation. This study aimed to develop and validate the Gastroscopy RAte of Cleanliness Evaluation (GRACE) scale.

METHODS

 A multicenter, international, cross-sectional study was conducted. The GRACE scale is based on a score from 0 (worst) to 3 (excellent) for esophagus, stomach, and duodenum, for a total ranging from 0 to 9. In phase 1, four expert endoscopists evaluated 60 images twice, with a 2-week interval between rounds; in phase 2, the same 60 images were scored twice by one expert and one nonexpert endoscopist from 27 endoscopy departments worldwide. For reproducibility assessment and real-time validation, the scale was applied to consecutive patients undergoing gastroscopy at each center.

RESULTS

 On internal validation, interobserver agreement was 0.81 (95 %CI 0.73-0.87) and 0.80 (95 %CI 0.72-0.86), with reliability of 0.73 (95 %CI 0.63-0.82) and 0.72 (95 %CI 0.63-0.81), in the two rounds, respectively. On external validation, overall interobserver agreement was 0.85 (95 %CI 0.82-0.88) and reliability was 0.79 (95 %CI 0.73-0.84). In real-time evaluation, the overall proportion of correct classifications was 0.80 (95 %CI 0.77-0.82).

CONCLUSIONS

 The GRACE scale showed good interobserver agreement, reliability, and validity. The widespread use of this scale could enhance quality and standardize the assessment of mucosal cleanliness during UGI endoscopy, pushing endoscopists to strive for excellent visibility and reducing the risk of missed lesions.

Advances in Fecal Microbiota Transplantation for Gut Dysbiosis-Related Diseases

This article provides an overview of the advancements in the application of fecal microbiota transplantation (FMT) in treating diseases related to intestinal dysbiosis. FMT involves the transfer of healthy donor fecal microbiota into the patient's body, aiming to restore the balance of intestinal microbiota and thereby treat a variety of intestinal diseases such as recurrent Clostridioides difficile infection (rCDI), inflammatory bowel disease (IBD), constipation, short bowel syndrome (SBS), and irritable bowel syndrome (IBS). While FMT has shown high efficacy in the treatment of rCDI, further research is needed for its application in other chronic conditions. This article elaborates on the application of FMT in intestinal diseases and the mechanisms of intestinal dysbiosis, as well as discusses key factors influencing the effectiveness of FMT, including donor selection, recipient characteristics, treatment protocols, and methods for assessing microbiota. Additionally, it emphasizes the key to successful FMT. Future research should focus on optimizing the FMT process to ensure long-term safety and explore the potential application of FMT in a broader range of medical conditions.

Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer

This document is an update to the 2014 recommendations for optimizing the adequacy of bowel cleansing for colonoscopy from the US Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy. The US Multi-Society Task Force developed consensus statements and key clinical concepts addressing important aspects of bowel preparation for colonoscopy. The majority of consensus statements focus on individuals at average risk for inadequate bowel preparation. However, statements addressing individuals at risk for inadequate bowel preparation quality are also provided. The quality of a bowel preparation is defined as adequate when standard screening or surveillance intervals can be assigned based on the findings of the colonoscopy. We recommend the use of a split-dose bowel preparation regimen and suggest that a 2 L regimen may be sufficient. A same-day regimen is recommended as an acceptable alternative for individuals undergoing afternoon colonoscopy, but we suggest that a same-day regimen is an inferior alternative for individuals undergoing morning colonoscopy. We recommend limiting dietary restrictions to the day before a colonoscopy, relying on either clear liquids or low-fiber/low-residue diets for the early and midday meals. We suggest the adjunctive use of oral simethicone for bowel preparation before colonoscopy. Routine tracking of the rate of adequate bowel preparations at the level of individual endoscopists and at the level of the endoscopy unit is also recommended, with a target of >90% for both rates.

Blue esophagus as a diagnosis of aortic dissection

A 76-year-old patient, admitted to the department of cardiac surgery, anticoagulated, started with acute dysphagia. An upper endoscopy revealed a blue mucosa from the upper to distal esophagus, with narrowing of the lumen caused by an extrinsic compression. A computed to¬mography (CT) of the thorax was performed, showing a 85x55 mm mediastinal hematoma causing extrinsic compression of the esophagus. Subsequently, a contrast-enhanced CT scan was performed, confirming a contained rupture of descending thoracic aortic dissection as the cause of the hematoma.

Effect of Genetic Ancestry on Phenotypes and Genotypes in Papillary Thyroid Cancer

Thyroid cancer (THCA) is a prevalent health burden, and unpacking its biological and social determinants is a public health priority. Previous studies have reported inconsistent findings regarding the effects of race and ethnicity on the incidence and presentation of THCA. It remains unclear whether racial differences manifest at the molecular level. By harnessing the Cancer Genome Atlas papillary THCA dataset, this study derived genetic ancestry estimates from single nucleotide polymorphism array genotyping and exome sequencing data. Five ancestral groups (Europeans, East Asians, Africans, Native/Latin Americans, and South Asians) were included for analysis. We found a good agreement between genetic ancestry and reported race (Cramer's V = 0.730). Although differences in tumor size and patient age were observed, overall survival, progression-free interval, and disease-free interval were similar across the ancestral groups. Furthermore, the distribution of oncogenic drivers did not significantly differ among these groups. Weighted gene co-expression network analysis identified several ancestry-associated signatures. In conclusion, this study suggests that hereditary ancestral traits likely have little biological significance in papillary THCA. Instead, racial disparities in this type of cancer may be attributed to lifestyle factors, environmental exposures, and social and political power asymmetries in society and healthcare infrastructure.