Decoding the role of intratumoral microbiota in gastric cancer

Intratumoral microbiota are increasingly recognized for their impact on gastric cancer, with growing evidence highlighting their complexity and significance. This review synthesizes current knowledge on the origins, heterogeneity, detection, and mechanistic roles of intratumoral microbiota in gastric carcinogenesis. In gastric cancer, intratumoral microbiota can originate from mucosal disruption and may migrate from normal adjacent tissues or be influenced by the TME. It exhibits spatial and functional heterogeneity within gastric cancer. Despite challenges in the detection of intratumoral microbiota, advances in deep sequencing and spatial omics have enhanced our understanding of microbial diversity and functionality. Mechanistically, intratumoral microbiota influence gastric cancer development through genetic and epigenetic alterations, signaling pathway modulation, metabolic reprogramming, and regulation of chronic inflammation and immune responses. These insights underscore the microbiota's dual function in both promoting and hindering tumor advancement. Therapeutically, the microbiota's impact on chemotherapy resistance and immune modulation presents opportunities for novel interventions. Integrating microbiome analysis into cancer research and leveraging microbial therapies may enable more effective, personalized treatment strategies. Future research should further elucidate the intricate microbe-tumor interactions to advance clinical applications and improve outcomes for gastric cancer patients.

Targeting mitochondrial ribosomal protein expression by andrographolide and melatonin for colon cancer treatment

Colospheroids contain colon cancer stem cells (CSCs) that cause colorectal cancer metastasis (mCRC). Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the U.S. Little is known about the role of mitochondria in the survival and metastatic ability of CSCs. In this study, we investigate the effect of andrographolide (AGP) and melatonin (MLT) on mitochondrial dynamics (including fusion and fission) and the expression of mitochondrial ribosomal proteins (MRPs). Our results show that AGP and MLT synergistically reduce the total active mitochondrial mass, downregulate fusion and fission proteins, reduce OXPHOS proteins, and lead to CSC growth inhibition via Nrf2 and KEAP1 signaling. Microarray revealed 4389 differentially expressed mRNAs in the AGP and MLT combination compared to the control. Results exhibiting a three-fold induction/reduction were validated by qRT-PCR and immunoblot. MRPS6, a mitochondrial ribosomal (Mitoribosome) small subunit protein, was dramatically downregulated by AGP + MLT treatment compared to control. MRPS6 inhibition by siRNA reduced mCRC cell viability. Molecular docking-based protein-ligand interactions showed that AGP has direct physical interaction with MRPS6 and increases the binding affinity of MLT to MRPS6. This drug combination downregulated genes in the NRF2 (NFE2L2) pathway in CSCs. MRPS6 may be directly linked to CSC proliferation and could be a therapeutic target for this population. Functionally, MRPS6 knockdown significantly reduced colony formation, with enhanced suppression in AGP + MLT-treated cells. In xenograft models, the AGP-MLT combination synergistically decreased MRPS6 expression and increased apoptosis, as evidenced by TUNEL assays, demonstrating the therapeutic potential of targeting MRPS6 in CRC.

Continuity of Outpatient Care for Patients with an Intestinal Fistula in China

OBJECTIVE

To report on the current state of outpatient nursing care for patients with an intestinal fistula in a stoma clinic in China.

METHODS

This retrospective study included 41 patients with an intestinal fistula who visited the stoma clinic in a tertiary hospital in Shanghai, China, between January 2019 and December 2023. Electronic medical records were selected for analysis of patients' clinical data, fistula diagnosis and treatment process, and outcome regression.

RESULTS

Few patients with an intestinal fistula are referred to the stoma clinic for nursing care (1.29%). At patients' first visit to the stoma clinic, the majority of those with an intestinal fistula (87.80%) had perifistular moisture-associated skin damage (MASD). The mean discolor, erosion, and tissue score was 6.73 ± 4.35, the mean healing time for MASD was 8.77 ± 8.51 days, and the mean number of follow-ups was 3.41 ± 1.92. The majority of patients (87.80%) complained of accompanying pain of different degrees. The mean self-healing time for nonoperative treatment was 301.96 ± 193.95 days. Enterostomal therapists applied the dressings to care for the skin around the fistula and formulated and guided a personalized management method to effectively contain output.

CONCLUSIONS

The quality of outpatient nursing care for patients with an intestinal fistula needs to be optimized. Standardized assessment and individualized precise intervention can reduce the incidence of complications such as MASD and improve the quality of care and prognosis of patients.

TreatmENT of AnastomotiC LeakagE after colon cancer resection: the TENTACLE - Colon study

BACKGROUND

Anastomotic leakage (AL) is a common and severe complication after colon cancer resection, but studies investigating various treatment strategies and factors influencing outcomes are scarce.

OBJECTIVES

(1) To identify predictive factors associated with 90-day mortality and 90-day Clavien-Dindo grade 4-5 complications amongst patients who developed AL following colon cancer resection with subsequent development and validation of prediction models, and (2) to explore and compare the effectiveness of various treatment strategies for AL following colon cancer resection, adjusting for type of index surgery, different leak entities and patient factors.

METHODS

The TENTACLE - Colon is an international multicentre retrospective cohort study. Consecutive patients with AL after colon cancer resection operated between 1 January 2018 and 31 December 2022 from participating centres will be included. The planned sample size is 2000 patients. The primary outcome is 90-day mortality and the co-primary composite endpoint is Clavien-Dindo grade 4-5 complications. Secondary outcomes include: hospital and intensive care unit length of stay, number of radiological and surgical reinterventions within one year after resection, mortality (in-hospital, 30-day, and 1-year), the comprehensive complication index, and 1-year stoma-free survival. For objective 1, regression models will be used to identify predictors associated with 90-day mortality and grade 4-5 complications. For objective 2, comparative analyses of various treatment strategies will be performed for the specified outcomes, adjusting for patient, tumour, resection and leakage characteristics.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov (NCT06528054) since July 30th, 2024.

Significance of serum APE1-AAbs, PTX-3, and miR-486-3p in patients with colorectal cancer undergoing radical surgery

BACKGROUND

Colorectal cancer (CRC) is a common malignant tumor of the digestive tract worldwide, characterized by high incidence and mortality rates.

AIM

To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies (APE1-AAbs), peripheral pentraxin-3 (PTX-3), and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.

METHODS

A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024. Patients were followed for one year postoperatively and divided into an occurrence group (n = 28) and a non-occurrence group (n = 126) based on whether they experienced recurrence or metastasis. The clinical data and the expression levels of APE1-AAbs, PTX-3, and miR-486-3p were compared between the two groups. Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients. The relationship of APE1-AAbs, PTX-3, and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis. Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs, PTX-3, and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.

RESULTS

The occurrence group had significantly higher proportions of patients with an age ≥ 60 years, lymph node metastasis, stage III disease, poor differentiation, tumor diameter > 5 cm, and higher platelet count, carcinoembryonic antigen, and carbohydrate antigen 19-9 levels than the non-occurrence group (P < 0.05). The expression levels of APE1-AAbs, PTX-3, and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group (P < 0.05). Multivariate logistic regression analysis showed that lymph node metastasis, stage III disease, poor differentiation, and elevated levels of APE1-AAbs, PTX-3, and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients (odds ratio > 1, P < 0.05). Spearman correlation analysis revealed that the levels of APE1-AAbs, PTX-3, and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients (r = 0.642, 0.653, and 0.631, respectively, P < 0.05). Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs, PTX-3, and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764, 0.783, 0.806, and 0.875, respectively, with the combination significantly outperforming individual markers (P < 0.05).

CONCLUSION

Serum APE1-AAbs, PTX-3, and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis. These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers. The combined detection of these markers has higher predictive value compared to individual tests.

Therapeutic potential of stem cells in colorectal cancer management: Current trends and future prospects

Colorectal cancer (CRC) ranks among the leading causes of cancer-related morbidity and mortality worldwide. Despite progress in understanding its molecular intricacies, the management of CRC, especially in advanced stages, remains a significant clinical hurdle. This review delves into the evolving landscape of stem cell-based therapeutic strategies in CRC, with a specific focus on the interplay between cancer stem cells (CSCs) and CRC pathogenesis and treatment resistance. Highlighting the pivotal roles of CSCs in tumor initiation, progression, metastasis, and recurrence, the review comprehensively examines their involvement in CRC, ranging from normal colonic tissue to cancer initiation. The potential of stem cells for medicinal purposes in CRC management is explored, encompassing diverse modalities such as transplantation, differentiation therapy, immunotherapy, and gene/cell-based approaches. Challenges and opportunities associated with these strategies are also evaluated, providing insights into their clinical potential and limitations. The review also appraises preclinical investigations contributing to the understanding of CRC and stem cells. Current clinical trials, patient stratification strategies, and regulatory considerations related to stem cell-based therapies in CRC are scrutinized. Furthermore, the review explores emerging trends and future directions, including developments in stem cell technologies and ethical considerations. It highlights the transformative potential of stem cell-based therapeutic strategies in CRC.

Identification of Common miRNAs Differentially Expressed in Periodontitis and Pancreatic Cancer

BACKGROUND/AIM

Periodontitis is a prevalent multifactorial, oral infectious disease and is considered a high-risk factor for pancreatic cancer. Nevertheless, there is limited understanding of the underlying epigenetic mechanisms governing this relationship. The aim of this study was to identify dysregulated miRNAs associated with periodontitis and pancreatic cancer, along with their related genes, signaling pathways, and compounds.

MATERIALS AND METHODS

miRNA expression datasets for tissues affected by periodontitis and pancreatic cancer were obtained from the Gene Expression Omnibus database. miRNAs differentially expressed relative to normal tissues were detected, and those common to both datasets were determined. Further bioinformatics approaches were used to explore the association of common differentially expressed miRNAs with periodontitis and pancreatic cancer.

RESULTS

Twenty shared, differentially expressed miRNAs were identified; 14 exhibited similar expression patterns in both diseases. Among these common differentially expressed miRNAs, 10 were found to be overexpressed. hsa-miR-155, hsa-miR-186, hsa-miR-765, hsa-miR-211 and hsa-miR-375 were the top miRNA nodes in the gene network, with hsa-mir-155 being the sole miRNA node in the transcription factor network. Top candidate miRNA-dysregulated genes included superoxide dismutase 2 (SOD2), nuclear FMR1 interacting protein 2 (NUFIP2), SFT2 domain-containing 2 (SFT2D2), thioredoxin-interacting protein (TXNIP), and cyclin D1 (CCND1), while top dysregulated transcription factors were Argonaute RISC catalytic component 2 (AGO2), AKT serine/threonine kinase 1 (AKT1), BCL6 transcription repressor (BCL6), breakpoint cluster region (BCR), and BRCA1 DNA repair associated (BRCA1). Relevant compounds for targeting these emerged, including 5-fluorouracil, gemcitabine, doxorubicin, ascorbate, diethylstilbestrol, and temozolomide.

CONCLUSION

Our study suggests candidate molecular mechanisms linking periodontitis to pancreatic cancer, highlighting potential compounds that may target both diseases. These findings provide a foundation for guiding future fundamental and clinical research.

Bibliometric analysis in Scopus of scientific production on the relationship between periodontitis and gastrointestinal cancer (2014 - 2023)

BACKGROUND

Recent studies have suggested that some opportunistic periodontal pathobionts have oncogenic properties. However, few bibliometric studies investigate the relationship between periodontitis and gastrointestinal cancer. This bibliometric study aimed to analyze these epidemiological studies conducted between 2014 and 2023 to guide future research.

MATERIAL AND METHODS

In March 2024, the Scopus database was explored. The articles selected were subjected to a bibliometric analysis of study designs, trends in annual scientific production, and networks of collaboration among countries. Furthermore, the most outstanding countries, academic institutions, authors and journals with the most significant number of publications and the top most cited articles were analyzed. For this purpose, Microsoft Excel, SPSS and VOSviewer 1.6.20 were used.

RESULTS

A total of 123 documents were included for analysis. China contributed the most significant number of publications (33 articles) and the United States had the most significant number of citations (2709). Weimin Ye (h-index:81) and Dominique Michaud (h-index:73) were the most prolific authors (5 articles); Dominique Michaud also had the most citations (470). International Journal of Cancer was the journal with the highest number of articles published (6), in addition to being the publication that had the most citations of these articles (409). Tufts University in the United States had the highest number of citations.

CONCLUSIONS

Between 2014 and 2023, 123 articles on the relationship between periodontitis and gastrointestinal cancer were published. The largest scientific production was found in China, and the most cited articles were those from the United States. Likewise, the research design most commonly used was the cross-sectional type.

Is there consensus on diagnostics and treatment in colonic diverticulitis? Results of international survey

BACKGROUND

Clinical guidelines (CGs) developed by expert communities benefit both the patient and the clinician. Meanwhile a considerable proportion of specialists are not familiar with or follow them in their daily practice. Colonic diverticulitis (CD) is the third most common cause of hospitalization among patients with gastrointestinal diseases and common indication for colon resection. Actual tactics for diagnosis and treatment of CD, as well as data on what influences its choice and how the decisions made agree with the existing CGs can be identified by anonymous surveys.

METHODS

An anonymous internet survey of surgeons and coloproctologists was conducted. Groups of questions included demographics of the respondents; self-esteem score; sources of guidance in decision-making; classification systems for CD; preferable diagnostic tests; management of CD; indications for elective surgery; and outcomes of surgical treatment and others (n = 17). The study was conducted in accordance with the CHERRIES criteria. The required minimum sample size was calculated as 377 participants.

RESULTS

The study involved 401 respondents from 9 countries: 76.1% were general surgeons and 14.5% were colorectal surgeons. Excellent or good knowledge of the problem was claimed by 82.8% of the colorectal vs 66.2% of the general surgeons (p = 0.013). In decision-making respondents were largely guided by their professional experience, methods adopted in their clinic and domestic CGs. General Surgeons more often chose tactics inconsistent with CGs than coloproctologists. The largest differences between subgroups were noted for awareness of the reversal of Hartmann's procedure, most common postoperative complications and indications for elective surgery.

CONCLUSION

Adherence to the existing CGs was poor, which entails significant variation in the approaches practiced by the respondents from different cohorts. There is no consensus on the aspects that are not yet covered in the CGs. Further research is needed to elucidate these gaps and update the guidelines accordingly.

Gender and age differences in the global burden of peptic ulcers: an analysis based on GBD data from 1990 to 2021

Background

Peptic ulcer (PU) is one of the most common gastrointestinal diseases worldwide. With advances in medical technology, the global disease burden of PU has been effectively controlled. However, the most recent evidence regarding the global burden of PU remains limited.

Methods

Using publicly available data from the Global Burden of Disease (GBD) study from 1990 to 2021, we analyzed the characteristics of the global burden of PU, including trends in incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). We employed Joinpoint regression, age-period-cohort (APC) analysis, decomposition analysis, and autoregressive integrated moving average (ARIMA) modeling to evaluate changes and influencing factors for each indicator.

Results

The global number of PU cases increased from 2,570,413 in 1990 (95% CI: 2,161,831-2,997,880) to 2,854,370 in 2021 (95% CI: 2,438,231-3,264,252), representing a cumulative growth of 11.05%. However, the age-standardized incidence rate (ASIR) decreased from 57.14 (95% CI: 48.61-66.73) per 100,000 population in 1990 to 34.10 (95% CI: 29.13-38.97) per 100,000 population in 2021. The global number of deaths due to PU decreased from 273,872 in 1990 (95% CI: 247,312-299,718) to 230,217 in 2021 (95% CI: 193,005-270,858). Significant gender differences were observed, with the disease burden consistently higher in males than in females. After controlling for period and cohort effects, the onset of PU tended to occur at younger ages, and the number of cases declined across most age groups from 1990 to 2021. The highest incidence of PU was concentrated in individuals aged 90 years and older. In terms of future trends, the global incidence of PU is projected to continue decreasing over the next 15 years. The global prevalence is expected to improve, while PU-related mortality is likely to plateau without significant increases or decreases.

Conclusion

The global burden of PU has declined significantly over the past three decades. However, elderly individuals and males remain at higher risk and require continued attention in prevention and management efforts.

Electrochemical immunosensor based on poly(5-aminoindole) for cancer biomarker pentraxin-3 detection

Pentraxin-3 (PTX-3) plays a critical role in regulating inflammation, immune response, angiogenesis, and tissue remodeling. As a serum biomarker, it holds a potential in cancer diagnostics and monitoring. Elevated expression of PTX-3 has been found in various cancers, namely lung, prostate, gastric, breast, and hepatic cancers. Here, a PTX-3 immunosensor was fabricated by utilizing poly(5-aminoindole) (P5AIn) to increase the current response and the electroactive surface area (ESA). (3-Aminopropyl)triethoxysilane (APTES) was used as a linker and as an electron transfer enhancer. The developed PTX-3 immunosensor (BSA/anti-PTX-3/APTES/P5AIn/SPCE) shows excellent performance for PTX-3 detection in a wide concentration range from 0.0001 to 2000 ng/mL with the LOD of 0.012 pg/mL. Furthermore, the sensor possessed good reproducibility (%RSD = 0.78), a long shelf-life of at least 4 weeks (% RSD = 0.89), and high specificity to PTX-3. The fabricated PTX-3 immunosensor was demonstrated in the measurement of PTX-3 concentrations in real blood serums from gastric patients. It has been shown as a potentially promising portable sensor for cancer diagnostics and monitoring for cancer patients in remote areas with a low cost.

Feasibility and preliminary findings of a bacterial diversity study in periodontitis: a pilot investigation from the Western Cape

Introduction

Periodontitis is a significant health challenge caused by a complex interaction between bacterial infection, host immune response, and environmental factors, leading to tooth loss, bone loss, and potential associations with major systemic diseases and conditions. While the determinants of periodontitis have been extensively investigated in other populations, such studies are lacking in South Africa, which represents a high-risk population. Therefore, this study was conducted to characterize the subgingival bacterial biodiversity in the periodontal pockets of patients with periodontitis in a Western Cape population.

Materials & methods

Pooled subgingival plaque samples were collected from the deepest pocket/crevices of five periodontitis cases and five controls using sterile paper points. Illumina MiSeq paired-end sequencing and QIIME2 software were employed for sequence filtration and analysis. Several alpha and beta-diversity metrics assessed biodiversity within-sample and population structure between different microbiota datasets, respectively. Statistical significance for alpha diversity was tested using the Kruskal-Wallis H test (p < 0.05), and beta diversity differences were evaluated using PERMANOVA. Data visualization, including beta diversity plots, was conducted with the Phyloseq package in R.

Results

Beta-diversity measures revealed significant differences between periodontitis cases and controls (p-value = 0.04), whereas alpha-diversity was higher in cases, though without statistical significance (p-value ≥ 0.05). Cases group showed high relative abundance of Fusobacterium (16%), Porphyromonas (10%), and Treponema (9%), while the periodontally healthy controls were dominated by Streptococcus (20%), Fusobacterium (15%), and Veillonella (10%), with g_Streptococcus showing a significant difference (p-value = 0.008). Differential abundance analysis revealed distinct bacterial genera enriched in cases (Bulleidia, Peptoanaerobacter, Phocaeiola, W5053) and controls (Abiotrophia, Haemophilus, Lautropia, Rothia, Streptococcus). Sample-specific variations included higher levels of Porphyromonas (15%) in grade B and Fusobacterium (20%) in grade C.

Conclusion

This exploratory study highlights distinct bacterial communities associated with periodontitis in a South African population. The findings emphasize the need for larger, population-based cohorts to validate these results and lay a foundation for future research into region-specific microbial profiles and their implications for personalized treatment strategies.

Development of Multicenter Deep Learning Models for Predicting Surgical Complexity and Surgical Site Infection in Abdominal Wall Reconstruction, a Pilot Study

Objective

Hernia recurrence and surgical site infection (SSI) are grave complications in Abdominal Wall Reconstruction (AWR). This study aimed to develop multicenter deep learning models (DLMs) developed for predicting surgical complexity, using Component Separation Technique (CST) as a surrogate, and the risk of surgical site infections (SSI) in AWR, using preoperative computed tomography (CT) images.

Methods

Multicenter models were created using deidentified CT images from two tertiary AWR centers. The models were developed with ResNet-18 architecture. Model performance was reported as accuracy and AUC.

Results

The CST model underperformed with an AUC of 0.569, while the SSI model exhibited strong performance with an AUC of 0.898.

Conclusion

The study demonstrated the successful development of a multicenter DLM for SSI prediction in AWR, highlighting the impact of patient factors over surgical practice variability in predicting SSIs with DLMs. The CST model's prediction remained challenging, which we hypothesize reflects the subjective nature of surgical decisions and varying institutional practices. Our findings underscore the potential of AI-enhanced surgical risk calculators to risk stratify patients and potentially improve patient outcomes.

The association of advanced lung cancer inflammation index with non-alcoholic fatty liver disease in NHANES 2017-2020

Background

The advanced lung cancer inflammation index (ALI) is a composite index that combines inflammation and nutritional status, and non-alcoholic fatty liver disease (NAFLD) is associated with inflammation, nutritional status, and obesity. This study aimed to investigate the possible relationship between ALI and NAFLD.

Methods

We extracted cohort datasets from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) for the study. Weighted analyses and multivariate linear regression models were applied to assess the association between ALI and NAFLD. Fitted curves and threshold effects analyses were used to characterize nonlinear relationships.

Results

A total of 6,595 adults aged 18-80 years were included in this study. In multivariate linear regression analysis, there was a significant positive association between ALI and NAFLD [OR: 1.02, 95% CI (1.01, 1.02)]. In subgroup analyses, this positive association was maintained in females [OR: 1.02, 95% CI (1.01, 1.02)] and not in males. In addition, we found that the association between ALI and NAFLD was nonlinear, with an L-shaped relationship and an inflection point of 32.47. ALI showed a U-shaped association with NAFLD in the male population, with an inflection point of 40.65, and an L-shaped association in the female population, with an inflection point of 30.61.

Conclusion

Our study suggests that there is a significant positive association between high ALI levels and NAFLD prevalence in the US adult population. However, more clinical cohort studies are needed to confirm this finding.

Association Between Pentraxins and Obesity in Prediabetes and Newly Diagnosed Type 2 Diabetes Mellitus Patients

Systemic inflammation has an important role in the prognosis and progression of many chronic diseases, including diabetes (T2DM). This retrospective study aimed to evaluate inflammatory status by determining the serum inflammatory biomarkers (PTX3, hs-CRP, TNF-α, and IL-6) and new indices, like the mean corpuscular volume (MCV) to lymphocyte ratio (MCVL) and cumulative inflammatory index (IIC), in a cohort of patients with prediabetes (PreDM) and newly diagnosed T2DM. We also wanted to assess the association with clinical parameters and different obesity-related indices, to identify possible correlations and to evaluate the diagnostic accuracy of the biomarkers using ROC curve analysis. In this study, we included 60 patients diagnosed with T2DM and 30 patients with PreDM. The ELISA method was applied. Elevated PTX3, hs-CRP, TNF-α, and IL-6 levels were found in T2DM patients compared to preDM patients. An independent relationship was found between PTX3, hs-CRP, and different obesity-related indices in patients with preDM and T2DM. The MCVL index exhibited an inverse trend proportional to the rising levels of HbA1c in the T2DM group. Spearman's analysis revealed in the T2DM group that the PTX3 values correlated much better with IIC (rho = 0.445, p-value = 0.014) and MCVL (rho = 0.338, p-value = 0.048). Hs-CRP values expressed moderate-to-weak correlations with IIC and MCVL in both groups. Additionally, ROC analysis showed that the PTX3 (AUC was 0.720; p = 0.003; cut-off value 1888.00 pg/mL, with 67.60% sensitivity and 73.30% specificity) and MCVL index (AUC was 0.677; p = 0.047; cut-off value 39.60, with 63.30% sensitivity and 66.70% specificity) have a good, accurate diagnosis compared with IL-6 (AUC was 0.866; p < 0.0001; cut-off value 40.30 pg/mL, with 100.00% sensitivity and 60.00% specificity). IIC showed 61.70% sensitivity and 60.00% specificity, with an AUC of 0.572, p = 0.027 and a cut-off value of 2.35. PTX3 and MCVL can serve as independent predictor factors in the inflammatory status in preDM and T2DM patients, supporting their potential as biomarkers for T2DM management and future research.

Snare-assisted submucosal tunneling for resection of esophageal schwannomas: Case Report

Esophageal schwannoma is a rare type of esophageal tumor that presents significant challenges in resection, particularly when large and irregularly shaped. This case report highlights the successful removal of a large esophageal schwannoma using a novel technique that combines submucosal tunneling endoscopic resection (STER) with modified snare-assisted external traction. A 68-year-old male with dysphagia was diagnosed with a 35 mm × 20 mm × 15 mm esophageal schwannoma. Due to the tumor's size and consistency, traditional resection methods proved difficult. The snare-assisted traction technique, applied within the submucosal tunnel, provided optimal tension and improved visualization, enabling en bloc resection. The patient recovered well postoperatively, and follow-up endoscopy confirmed complete healing. This novel traction technique is safe and effective for the resection of large esophageal submucosal tumors (SMTs), offering enhanced procedural efficiency and better outcomes in complex cases. However, the clinical utility of this technique requires confirmation through prospective studies with adequate sample sizes and long-term outcome assessments.

Pentraxin-3 as a Biomarker in Diabetes Mellitus: Insights into Inflammation, Vascular Complications, and Modulation by Antidiabetic Medications

Diabetes mellitus (DM) is a multifactorial metabolic disorder associated with systemic inflammation and vascular complications. Pentraxin-3 (PTX3) has emerged as a key biomarker of inflammation and endothelial dysfunction in DM. We aimed to examine the role of PTX3 in DM and assesses the impact of pharmacological interventions on its expression. The review included studies analyzing PTX3 modulation by antidiabetic therapies, such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i), glucagon-like peptide-1 agonists (GLP-1a), and dipeptidyl peptidase-4 inhibitors (DPP-4i), as well as the effects of lifestyle interventions. Clinical and experimental studies demonstrated a strong correlation between PTX3 levels and DM progression. Elevated PTX3 levels were associated with diabetic complications, including nephropathy, retinopathy, and cardiovascular diseases. Antidiabetic drugs showed differential effects on PTX3 expression, with GLP-1a and DPP-4i significantly reducing PTX3 levels, while SGLT-2i displayed a paradoxical increase. Lifestyle interventions, including dietary modifications and weight loss, yielded inconsistent effects, suggesting genetic and metabolic factors influence PTX3 regulation. While pharmacological therapies, particularly GLP-1a and DPP-4i, demonstrate anti-inflammatory effects, further research is needed to standardize PTX3 measurement and explore its potential as a therapeutic target. Personalized treatment strategies incorporating genetic profiling may optimize inflammation control and disease management in DM patients.

Clinical Significance of Blood Cell-Derived Inflammation Markers in Assessing Potential Early and Late Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review

Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor influencing cancer progression and postoperative outcomes. This systematic review evaluates the clinical significance of blood cell-derived inflammatory markers in predicting early and late postoperative complications in CRC patients. Methods: We included studies involving adult patients (≥18 years) with histologically confirmed colorectal cancer, for whom elective radical surgery was performed, as well as at least one of the considered blood-based inflammatory biomarkers (NLR, PLR, SII, or LMR) documented in relation to outcomes. Results: After removing duplicates, 19 studies published between 2016 and 2025 were included in the qualitative analysis. A total of 7023 patients who underwent elective curative surgery for colorectal cancer were analyzed, with mean age varying widely between 47.3 and 74.6 years. Preoperative NLR values were significantly correlated with severe complications, IAI, AL, and overall complications in 13 out of 19 studies (68.4%), with a cutoff value between 2.21 and 4, while early postoperative NLR values were predictive for AL. Late postoperative complications, such as recurrence and overall survival, were also associated with elevated preoperative NLR and PLR values. However, variability in study designs, patient populations, and cutoff values for these indices contributed to inconsistent findings. Conclusions: Blood cell-derived inflammatory markers offer a valuable, non-invasive tool for assessing postoperative risks in patients with CRC. New design nomograms or risk scores that include, beside blood cell-derived inflammation markers, other relevant data, could ensure an optimal predictive value that could be easily used in clinical practice for personalized risk management in patients with colorectal cancer.

Where lung cancer and tuberculosis intersect: recent advances

Lung cancer (LC) and tuberculosis (TB) represent two major global public health issues. Prior evidence has suggested a link between TB infection and an increased risk of LC. As advancements in LC treatment have led to extended survival rates for LC patients, the co-occurrence of TB and LC has grown more prevalent and poses novel clinical challenges. The intricate molecular mechanisms connecting TB and LC are closely intertwined and many issues remain to be addressed. This review focuses on resemblance between the immunosuppression in tumor and granuloma microenvironments, exploring immunometabolism, cell plasticity, inflammatory signaling pathways, microbiomics, and up-to-date information derived from spatial multi-omics between TB and LC. Furthermore, we outline immunization-related molecular mechanisms underlying these two diseases and propose future research directions. By discussing recent advances and potential targets, this review aims to establish a foundation for developing future therapeutic strategies targeting LC with concurrent TB infection.

FATP1-mediated fatty acid uptake in renal tubular cells as a countermeasure for hypothermia

Hypothermia is a condition in which body temperature falls below 35 °C, resulting from exposure to low environmental temperatures or underlying medical conditions. Postmortem examinations have revealed increased levels of fatty acids in blood and lipid droplet formation in renal tubules during hypothermia. However, the causes and implications of these findings are unclear. This study aimed to analyze the biological significance of these phenomena through lipidomics and transcriptomics analyses of specimens from emergency hypothermia patients and mouse hypothermia models. Both human hypothermia patients and murine models exhibited elevated plasma concentrations of fatty acids and their derivatives compared with controls. Hypothermic mouse kidneys displayed lipid droplet formation, with gene expression analysis revealing enhanced fatty acid uptake and β-oxidation in renal tubular cells. In primary cultured mouse renal proximal tubular cells, low temperatures increased the expression levels of Fatty acid transport protein 1 (FATP1), a fatty acid transporter, and boosted oxygen consumption via β-oxidation. Mice treated with FATP1 inhibitors showed a more rapid decrease in body temperature upon exposure to low temperatures compared with untreated mice. In conclusion, increased fatty acid uptake mediated by FATP1 in renal tubular cells plays a protective role during hypothermia. KEY MESSAGES: Low temperatures increase FATP1 expression and fatty acid uptake in renal proximal tubular cells, resulting in enhanced β-oxidation. Renal proximal tubular cells play an important role in the resistance to hypothermia via lipid uptake. Maintaining renal lipid metabolism is essential for cold stress adaptation.

The structural organisation of pentraxin-3 and its interactions with heavy chains of inter-α-inhibitor regulate crosslinking of the hyaluronan matrix

Pentraxin-3 (PTX3) is an octameric protein, comprised of eight identical protomers, that has diverse functions in reproductive biology, innate immunity and cancer. PTX3 interacts with the large polysaccharide hyaluronan (HA) to which heavy chains (HCs) of the inter-α-inhibitor (IαI) family of proteoglycans are covalently attached, playing a key role in the (non-covalent) crosslinking of HC•HA complexes. These interactions stabilise the cumulus matrix, essential for ovulation and fertilisation in mammals, and are also implicated in the formation of pathogenic matrices in the context of viral lung infections. To better understand the physiological and pathological roles of PTX3 we have analysed how its quaternary structure underpins HA crosslinking via its interactions with HCs. A combination of X-ray crystallography, cryo-electron microscopy (cryo-EM) and AlphaFold predictive modelling revealed that the C-terminal pentraxin domains of the PTX3 octamer are arranged in a central cube, with two long extensions on either side, each formed from four protomers assembled into tetrameric coiled-coil regions, essentially as described by (Noone et al., 2022; doi:10.1073/pnas.2208144119). From crystallography and cryo-EM data, we identified a network of inter-protomer salt bridges that facilitate the assembly of the octamer. Small angle X-ray scattering (SAXS) validated our model for the octameric protein, including the analysis of two PTX3 constructs: a tetrameric 'Half-PTX3' and a construct missing the 24 N-terminal residues (Δ1-24_PTX3). SAXS determined a length of ∼520 Å for PTX3 and, combined with 3D variability analysis of cryo-EM data, defined the flexibility of the N-terminal extensions. Biophysical analyses revealed that the prototypical heavy chain HC1 does not interact with PTX3 at pH 7.4, consistent with our previous studies showing that, at this pH, PTX3 only associates with HC•HA complexes if they are formed in its presence. However, PTX3 binds to HC1 at acidic pH, and can also be incorporated into pre-formed HC•HA complexes under these conditions. This provides a novel mechanism for the regulation of PTX3-mediated HA crosslinking (e.g., during inflammation), likely mediated by a pH-dependent conformational change in HC1. The PTX3 octamer was found to associate simultaneously with up to eight HC1 molecules and, thus, has the potential to form a major crosslinking node within HC•HA matrices, i.e., where the physical and biochemical properties of resulting matrices could be tuned by the HC/PTX3 composition.

Innovative Therapeutic Approach Targeting Colon Cancer Stem Cells: Transitional Cold Atmospheric Plasma

Transitional cold atmospheric plasma (TCAP) represents a novel technique for generating plasma remotely from a primary source. It consists of a partially nonthermal ionized gas mixture containing charged and neutral particles, photons, and free radicals. In recent years, TCAP has attracted considerable attention in biomedical applications. In order to evaluate colon cancer stem cells' (CCSCs) proliferation, apoptotic induction, inflammatory response, and survival, TCAP was utilized both directly and indirectly in this study. Using argon and helium gases, TCAP was continuously delivered in two stages during the experiment. For direct state, TCAP was irradiated onto CCSCs for 3 and 5 min. In the indirect technique, Matrigel was treated with TCAP for 5 min before the introduction of cells. In vitro assays demonstrated that TCAP exposure significantly reduced the viability of CCSCs; helium gas and direct application had greater impacts than argon. Numerous investigations confirmed the induction of apoptosis, showing that the treated groups had more apoptotic cells and altered cellular structures than controls (****p < 0.0001). A substantial increase in the Bax/Bcl-2 ratio was found by analyzing the expression of the Bax and Bcl-2 genes, indicating increased susceptibility to apoptosis (*p = 0.0177 and ***p = 0.0004). The higher efficacy of the direct helium mode was further highlighted by inflammatory marker analysis, which showed a significant reduction in interleukin-6 and interleukin-8 expression in cells directly treated with TCAP-helium compared to TCAP-argon (**p = 0.0015 and ***p = 0.0007). Lastly, the proliferation test, which relies on K i-67 expression, demonstrated a noteworthy decline in all TCAP-treated groups, with the direct helium group exhibiting the most robust impact (**p = 0.0014). Overall, the findings highlight the potential of TCAP, particularly with helium, as a promising approach for selectively targeting CCSCs and providing insights into its therapeutic mechanisms for cancer treatment. TCAP, therefore, emerges as a unique therapeutic strategy with potential applications in cancer stem cell-targeted therapies.

Retrospective Clinical Study on Early Prediction of Anastomotic Leak After Esophageal Cancer Resection Based on the Combination of Platelet Count and Neutrophil-to-Lymphocyte Ratio

OBJECTIVE

 The systemic inflammatory response may influence the occurrence of postoperative complications. This study aimed to evaluate the predictive potential of combining platelet count and neutrophil-to-lymphocyte ratio (COP-NLR) for esophagogastric anastomotic leak (AL) following esophageal cancer surgery.

METHODS

 We enrolled patients who developed AL after radical surgery for esophageal cancer and those who did not develop AL after the surgery at the First Affiliated Hospital of Chongqing Medical University, China, from June 2019 to February 2022. We analyzed the correlation between AL and several risk factors, including COP-NLR. Patients were categorized as COP-NLR 2 if both platelet count and neutrophil-to-lymphocyte ratio (NLR) were elevated, COP-NLR 1 if either parameter was elevated, and COP-NLR 0 if neither parameter showed elevation.

RESULTS

 A total of 190 patients were included in this study. The incidence of AL after esophageal cancer surgery was 14.7%. The critical values of preoperative NLR and preoperative platelet count were 2.41 (sensitivity 48.8%, specificity 92.9%, and area under the curve (AUC) 0.728) and 186 × 109/L (sensitivity 45.3%, specificity 78.9%, and AUC 0.667), respectively. According to multivariate analysis, COP-NLR was identified as an independent risk factor for AL (COP-NLR 1 vs. COP-NLR 0: odds ratio (OR) 4.98, 95% confidence interval (CI) 1.05-23.61; COP-NLR 2 vs. COP-NLR 0: OR 11.12, 95% CI 2.31-53.41).

CONCLUSION

 COP-NLR is a new predictor for AL after esophageal cancer resection.

The value of perioperative neutrophil-to-lymphocyte ratio combined with the prognostic nutritional index for predicting anastomotic leakage after minimally invasive esophagectomy

Background

Across the world, esophageal cancer is one of the most common malignant tumors of the digestive system. Anastomotic leakage is a severe complication after minimally invasive esophagectomy (MIE) for esophageal cancer. Research indicates that inflammation and immune system and nutritional status are linked to anastomotic leakage. Neutrophil-to-lymphocyte ratio (NLR) and prognostic nutrition index (PNI) reflect the inflammatory and nutritional status of the human body. The aim of this study is to investigate the value of perioperative NLR combined with the PNI to predict anastomotic leakage after MIE.

Methods

A retrospective analysis was conducted on 232 patients who underwent MIE in The Affiliated Lihuili Hospital of Ningbo University from January 2019 to May 2023. Patients were divided into two groups based on the presence or absence of anastomotic leakage. Clinicopathological data and perioperative peripheral blood indices of the patients were collected, and the factors associated with postoperative anastomotic leakage were analyzed via univariate and multivariate logistic regression. Moreover, the value of NLR and PNI for predicting anastomotic leakage were evaluated using receiver operating characteristic (ROC) curves.

Results

Anastomotic leakage occurred in 35 (15%) of 232 patients who underwent MIE. Multivariate logistic regression analysis identified a history of diabetes, higher NLR levels on postoperative days 3 and 5, and a lower PNI score on postoperative day 3 as independent risk factors of anastomotic leakage. ROC curve analysis indicated that NLR combined with PNI on postoperative day 3 had the best predictive value for anastomotic leakage, with an area under the curve (AUC) of 0.826, a sensitivity of 82.9%, and a specificity of 78.2%.

Conclusions

Persistently high NLR levels and persistently low PNI levels in the postoperative period correlated with the development of anastomotic leakage after MIE, and NLR combined with the PNI on postoperative day 3 had the best predictive value for anastomotic leakage after MIE.

Next-Generation Sequencing in Oncology-A Guiding Compass for Targeted Therapy and Emerging Applications

Multigene sequencing technologies provide a foundation for targeted therapy and precision oncology by identifying actionable alterations and enabling the development of treatments that substantially improve clinical outcomes. This review emphasizes the importance of having a molecular compass guiding treatment decision-making through the multitude of alterations and genetic mutations, showcasing why NGS plays a pivotal role in modern oncology.

Presepsin: An Emerging Biomarker in the Management of Cardiometabolic Disorders

Background/Objectives: Systemic and tissue inflammation play a crucial role in the pathophysiology of cardiometabolic disorders. Presepsin is a newly discovered marker of acute phase inflammation that is produced by monocytes or macrophages in response to bacterial infection and is a soluble fraction of the lipopolysaccharide (LPS) receptor. LPS is an endotoxin that, through the breakdown of the intestinal barrier, penetrates the systemic circulation and is an important bacterial mediator in the pathogenesis of sepsis and septic shock. Methods: A narrative review of the existing literature. Results: A growing body of evidence demonstrates that intestinal dysbiosis is involved in the pathogenesis of diabetes mellitus (DM) and cardiovascular (CV) disease, leading to increased circulating LPS concentrations in people with cardiometabolic disorders, even in the absence of infection. These data provide the theoretical background for a link between presepsin, DM, and CV pathology. Preliminary studies suggest that presepsin levels are downregulated in patients with well-controlled type 2 DM and correlate with continuous glucose monitoring metrics in infection-free individuals with type 1 DM. However, prospective data on the association between presepsin and the risk of diabetic complications are currently lacking. Presepsin has also been found to be elevated in infection-free individuals with myocardial infarction, heart failure, and myocarditis compared to controls and has been shown to correlate with mortality risk in subjects at high CV risk. Conclusions: The clinical utility of presepsin in the monitoring of patients with cardiometabolic disorders warrants further investigation by future studies.

Advanced Assessment of Oxidative Stress and Inflammation in Military Personnel: Development of a Novel IIRPM Score Using Artificial Intelligence

Background/Objectives: The health of military personnel in modern operational settings is critical for sustaining defense readiness. Extended exposure to extreme conditions can cause oxidative stress and systemic inflammation, potentially affecting performance. To address this problem, we developed an innovative diagnostic tool, the Post-Mission Integrated Risk Index (IIRPM), which integrates hematologic markers with key clinical variables. A novel aspect of the approach is the incorporation of ΔNLR, thus quantifying the change in the neutrophil-to-lymphocyte ratio measured before and after deployment, thereby providing a sensitive indicator of the inflammatory impact of operational stress. Methods: In this retrospective study, we analyzed comprehensive clinical and biological data from 443 military personnel over a ten-year period, with measurements taken before and after missions. We applied robust statistical techniques, including paired t-tests and Pearson correlation analyses, to assess variations in hematologic and metabolic parameters. Data segmentation was performed using Gaussian mixture models, and the predictive performance of the resulting model was validated with a multi-layer perceptron (MLP) neural network. Results: The analysis revealed significant post-mission increases in both the baseline NLR and ΔNLR, accompanied by notable shifts in metabolic markers. Data segmentation identified three distinct profiles: a reference profile characterized by stable immunologic parameters, an acute inflammatory response profile, and a proinflammatory metabolic profile marked by elevated cholesterol levels and higher mean age. Remarkably, the MLP model achieved 100% accuracy on the test set, with an average cross-validation accuracy of 97%. Conclusions: The IIRPM-which incorporates ΔNLR, age, mission duration, and cholesterol levels-offers a novel strategy to assess inflammatory risk among military personnel, thus facilitating personalized preventive interventions. Further validation in multicenter and longitudinal studies is anticipated to consolidate the clinical utility of this tool, ultimately fostering a more adaptive approach in military medicine to address the complex challenges of modern operational theaters.

Predicting mortality in geriatric patients with peptic ulcer bleeding: a retrospective comparative study of four scoring systems

Background

Peptic ulcer bleeding (PUB) is a significant cause of morbidity and mortality, especially in geriatric patients. Risk stratification tools such as AIMS65, Glasgow Blatchford Score (GBS), T-score, and Age, Blood tests, and Comorbidities (ABC) score are frequently used to predict outcomes in PUB patients. This study aims to compare the predictive performance of these four scoring systems in geriatric patients with PUB.

Methods

This retrospective cohort study included patients aged 65 years and older who were diagnosed with PUB between January 1, 2019, and January 1, 2024, in a tertiary care hospital. Data collected included demographic information, clinical presentation, laboratory results, and comorbidities. AIMS65, GBS, T-Score, and ABC score were calculated for each patient. The primary outcome was in-hospital mortality.

Results

A total of 315 patients were included in the study, with an overall in-hospital mortality rate of 7.9%. AIMS65 had the highest area under the curve (area under the receiver operating characteristic curve (AUROC): 0.829), followed by the ABC score (AUROC: 0.775). The GBS (AUROC: 0.694) and T-score (AUROC: 0.526) demonstrated lower predictive performance. Pairwise comparisons showed a statistically significant difference between the AIMS65 and GBS (p = 0.0214). AIMS65 was the most accurate predictor of in-hospital mortality in geriatric PUB patients.

Conclusion

The AIMS65 and ABC scoring systems are more effective in predicting in-hospital mortality in geriatric patients with PUB compared to the GBS and T-Score. Implementing these tools in clinical practice could improve risk stratification and decision-making processes in managing high-risk elderly patients.

The Diagnostic and Prognostic Role of Inflammatory Markers, Including the New Cumulative Inflammatory Index (IIC) and Mean Corpuscular Volume/Lymphocyte (MCVL), in Colorectal Adenocarcinoma

Background: Colorectal cancer affects a large number of patients worldwide, with numerous factors being involved in its etiopathogenesis and chronic inflammation playing an essential role in tumor development. In this study, we analyzed and compared several markers of inflammation that are relatively easy to obtain for a rapid and accurate diagnosis and prognosis. Methods: This study included 219 patients diagnosed with colorectal cancer, analyzing the inflammation scores derived from their blood cells and inflammatory circulating proteins. These inflammatory markers are neutrophil-to-lymphocyte ratio-NLR; platelet-to-lymphocyte ratio-PLR; lymphocyte-to-monocyte ratio-LMR; systemic immune inflammation index-SII; systemic inflammatory response index-SIRI; aggregate index of systemic inflammation-AISI; derived neutrophil-to-lymphocyte ratio-dNLR; C-reactive protein-to-albumin ratio-CAR; and fibrinogen-to-albumin ratio-FAR. In the analysis of patients with colorectal cancer, we have also introduced two new recently developed inflammatory markers: the cumulative inflammatory index (IIC) and the ratio between the mean corpuscular volume and lymphocytes (MCVL). This study aimed to correlate the inflammatory markers' levels with the colorectal cancer diagnostic stage, the tumor and clinical characteristics of the colorectal cancer patients, and 36 months' survival time and to evaluate the diagnostic and prognostic capacity and accuracy of these inflammatory markers in this type of cancer. Results: We showed that the levels of the analyzed inflammation markers correlate with the TNM stage, the tumor pathological differentiation grade, the age and gender of the patients, and overall survival, with their increased levels being associated with a lower survival rate. Conclusions: The analyzed markers, which are easy to perform right from the patient's admission, can be helpful both in diagnosis and, mostly, in prognosis, sustaining the role of inflammation in cancer. By comparing them, we showed which one can be useful for increased sensitivity and specificity in the diagnosis and prognosis of colorectal cancer patients.

Evaluation of Regeneration Potential of Bone Marrow-Derived Mesenchymal Stem Cells on Induced Damaged Submandibular Salivary Gland in Mice

OBJECTIVES

 The ultimate goal of stem cell (SC) transplantation is the regeneration of salivary gland function by transplanted SCs differentiating into salivary gland cells. Therefore, this study aimed to evaluate the regenerative capacity of bone marrow-derived mesenchymal stem cells (BM-MSCs) transplantation in irradiated mice using the immunohistochemical markers Ki-67 and CD34.

MATERIAL AND METHODS

 Four groups of male mice were included in the study. Group I (normal control) comprised six mice that were not subjected to gamma radiation. Group II comprised six irradiated mice that were not treated with BM-MSCs. Group III comprised 12 irradiated mice that were treated with intraglandular injection of labeled BM-MSCs into their submandibular salivary glands, 24 hours postradiation. Group IV comprised 12 irradiated mice that were treated with intraglandular injection of labeled BM-MSCs into their submandibular salivary glands, on day 11 postradiation.

STATISTICAL ANALYSIS

 Data were presented as mean and standard deviation. The different groups were compared using a one-way analysis of variance (ANOVA).

RESULTS

 The ANOVA test revealed that the difference between all groups was extremely statistically significant (p < 0.003), and Tukey's post hoc test revealed a statistically significant difference between group II and groups I, III, and IV included in the study regarding microvessel density of CD34 immunoexpression in different groups.

CONCLUSION

 BM-MSCs have a regeneration potential on induced damaged submandibular salivary glands in mice; time is an essential factor in the regeneration capacity of BM-MSCs.

Obesity, but Not Overweight, Is Associated with Increased Presepsin Levels in Infection-Free Individuals: An Exploratory Study

Background/Objectives: Intestinal dysbiosis and systemic inflammation are involved in the pathophysiology of obesity and its complications. Presepsin is a recently discovered inflammation marker, being the soluble form of the bacterial lipopolysaccharide (LPS) receptor. Due to the imbalance of the gut flora and subsequent disruption of the intestinal barrier, circulating LPS levels have been found to be elevated in patients with metabolic diseases, even in the absence of infection. However, to date, no studies have evaluated whether obesity is associated with elevated presepsin levels. Methods: The present study included 81 participants (61.7% women, 27 with obesity, 34 with overweight, and 20 controls with normal body mass index), all free of infection and diabetes mellitus. Presepsin was measured in serum by ELISA, and its concentrations were compared between the groups. Results: The obesity group had higher presepsin levels compared to controls (8.09 vs. 4.45 ng/mL, p = 0.06). When participants with a history of cardiovascular disease were excluded from the analysis and adjusting for multiple confounders through a regression model, the obesity group had higher presepsin values than the overweight and control groups (5.84 vs. 3.32 ng/mL, p = 0.016). In contrast, the overweight group had lower concentrations than both the obesity group (p = 0.005) and the controls (p = 0.031). We did not find an association between presepsin and 25-hydroxy vitamin D levels (p = 0.368). Conclusions: Although the cross-sectional character of the study cannot demonstrate causal relationships, the results could potentially suggest that systemic inflammation is implicated in the pathogenesis of obesity through the disruption of the intestinal barrier. However, the findings should only be seen as hypothesis-generating. The reduction in presepsin in the overweight state is an interesting finding that deserves further investigation.

Efficient Differentiation of hiPSCs into hMSC-like Cells under Chemically Defined Conditions on Temperature-Sensitive Micropatterned Surfaces

The fairness of long-term self-renewal and robust cell proliferation limits the applications of human mesenchymal stem cells (hMSCs) in regenerative medicine. Inducing hMSCs from human-induced pluripotent stem cells (hiPSCs), which have the advantages of autogenous and no cell number issues, is highly valuable. However, current induction methods using FBS-containing mesenchymal culture medium have problems, including immunogenicity, microbial contamination, and low efficiency. To solve these problems, we propose a chemically defined induction protocol incorporating transforming growth factor-beta 1 and retinoic acid (RA) additives in serum-free E6 medium for the suspension induction of embryoid bodies in hiPSCs. Additionally, microgroove-patterned polydimethylsiloxane surfaces coated with temperature-sensitive N-isopropylacrylamide (PNIPAAm) were prepared for efficient harvesting and purification of induced hiPSC-derived hMSCs (hiPSC-MSCs). The results showed that both supplementation with RA and patterned microgrooves with a width of 20 μm could accelerate the induction of hiPSC-MSCs, realizing the promising scalable production of homogeneous cells. This study successfully established a chemically defined induction protocol and utilized patterned surfaces to obtain clinically applicable hiPSC-MSCs, which show great promise in tissue engineering, gene therapy, and cell transplantation.

A case of spontaneous reduction of incarcerated inguinal hernia caused by Meckel's diverticulum

Inguinal hernias with a Meckel's diverticulum are called Littre hernias and are rare diseases. In many cases, symptoms of incarceration or intestinal obstruction are present, and emergency surgery is generally required. However, imaging diagnosis and clinical symptoms are similar to those of incarceration of inguinal hernias, making preoperative diagnosis difficult. In most cases, diagnosis is made during emergency surgery. A 54-year-old man with abdominal pain was found to have a right-sided incarcerated inguinal hernia on abdominal computed tomography. The incarceration spontaneously reduced, although a Meckel's diverticulum was discovered during emergency laparoscopic surgery for an inguinal hernia. Mesh repair and Meckel diverticulotomy were performed. In cases of inguinal hernias due to a Meckel's diverticulum, it is difficult to diagnose a Meckel's diverticulum as the cause without exploring the intestine, although laparoscopic hernia repair is useful to investigate this possibility.

Dynamic assessment of the inflammatory response in military personnel: a pilot study on ΔNLR and composite markers in operational environments

In this pilot study, we investigated immune alterations in 178 military personnel exposed to extreme operational stress. We focused on the neutrophil-to-lymphocyte ratio (NLR) and its change (ΔNLR) alongside composite inflammatory indices- Systemic Inflammation Response Index (SIRI), Systemic Immune-Inflammation Index (SII), and Inflammatory Index Cumulative (IIC). Blood analyses performed before and after deployment revealed a significant post-mission increase in NLR (1.9671±±±0.9174 vs. 1.6079±±±0.4973 pre-deployment), yielding an average ΔNLR of 0.3592±±±0.7642 (P < 0.0001). While basophil counts and several biochemical markers remained stable, notable changes in neutrophils and composite indices suggest a complex inflammatory activation. Importantly, correlation analyses confirmed that despite marked shifts in absolute values, the relative relationships between pre- and post-deployment measurements (e.g., NLR: r = 0.5533, P < 0.0001) were maintained. These findings imply that ΔNLR, together with SIRI, SII, and IIC, may serve as valuable biomarkers for dynamically monitoring the inflammatory response in military contexts, thereby enabling early identification of individuals at increased inflammatory risk.

Parathyroid carcinoma: New insights

Parathyroid carcinoma (PC) is a rare malignancy, comprising 1 % of all cases of primary hyperparathyroidism (PHPT). This narrative review explores recent advances in PC management, with a focus on molecular insights, diagnostic advancements, surgical innovations, and emerging targeted therapies. Manuscripts published between 2023 and 2024 were obtained from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The review highlights advances in biochemical markers, such as circulating tumour cells (CTCs), and imaging modalities such as 18F-FDG PET/CT and 4D-CT, which are improving diagnostic accuracy. Surgical resection remains central to localised and metastatic disease management. For patients with widespread metastatic or unresectable disease, newer targeted approaches such as tyrosine kinase inhibitors (TKIs), temozolomide, and immune checkpoint inhibitors (ICIs) may offer clinical benefit to specific patient cohorts. This review identifies future research areas to improve outcomes and recommends that patients with advanced PC continue to be managed in centres of excellence.

Donor age and breed determine mesenchymal stromal cell characteristics

BACKGROUND

Mesenchymal stromal cells (MSCs) hold significant potential for various applications in regenerative medicine and tissue engineering. Initially considered as a single cell type with defined characteristics, MSCs are now known as a heterogeneous cell population with remarkable differences in their properties. No consensus exists on how donor age affects MSC characteristics, like proliferation. Additionally, differences in differentiation capacities and immunophenotype could arise when MSCs are isolated from different animals breeds, which is relevant for experimental and preclinical studies of MSC-based treatments.

METHODS

In this study, we isolated bovine adipose tissue-derived MSCs from three age categories, i.e. fetal, calf, and adult, and of two different breeds, i.e. Holstein Friesian (HF) and Belgian Blue (BB). MSC characterization included tri-lineage differentiation, proliferation and senescence assays, and immunophenotyping using multi-color flow cytometry.

RESULTS

Especially fetal and calf HF-MSCs showed a high proliferation capacity, where 4 and 6 out of 7 donors, respectively, could surpass 30 population doublings. Adipogenic differentiation potential was higher for fetal and adult HF-MSCs. Furthermore, breed, but not age, affected their osteogenic differentiation potential, with BB-MSCs performing better. Evaluation of cell surface marker expression revealed a breed effect, as calf HF-MSCs showed a higher percentage of Cluster of Differentiation (CD)34+ cells compared to calf BB-MSCs, which was correlated with both osteogenic differentiation and proliferation potential.

CONCLUSIONS

Our findings clearly show the impact of donor characteristics such as age and breed on MSC proliferation, immunophenotype, and differentiation potential, illustrating the importance of selecting the appropriate MSC donor for MSC-based treatments when allogeneic MSCs are considered.

Link between caries, periodontitis, and pregnancy: The role of personalized oral hygiene

Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus. This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women, with particular emphasis on periodontal disease and dental caries. Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight, many pregnant women do not receive adequate dental care. This gap in care is often due to misconceptions about the safety of dental treatments during pregnancy and lack of awareness on the part of healthcare professionals. Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support, have proven effective in improving oral health in this population. Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient, thereby enhancing maternal and fetal health outcomes. Integration of personalized oral hygiene management into maternal health programs and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.

Mechanisms and Strategies to Overcome Drug Resistance in Colorectal Cancer

Colorectal cancer (CRC) is a major cause of cancer-related mortality worldwide, with a significant impact on public health. Current treatment options include surgery, chemotherapy, radiotherapy, molecular-targeted therapy, and immunotherapy. Despite advancements in these therapeutic modalities, resistance remains a significant challenge, often leading to treatment failure, poor progression-free survival, and cancer recurrence. Mechanisms of resistance in CRC are multifaceted, involving genetic mutations, epigenetic alterations, tumor heterogeneity, and the tumor microenvironment. Understanding these mechanisms at the molecular level is crucial for identifying novel therapeutic targets and developing strategies to overcome resistance. This review provides an overview of the diverse mechanisms driving drug resistance in sporadic CRC and discusses strategies currently under investigation to counteract this resistance. Several promising strategies are being explored, including targeting drug transport, key signaling pathways, DNA damage response, cell death pathways, epigenetic modifications, cancer stem cells, and the tumor microenvironment. The integration of emerging therapeutic approaches that target resistance mechanisms aims to enhance the efficacy of current CRC treatments and improve patient outcomes.

Littre hernia in adults: imaging features and clinical implications

Littre hernia is an inguinal or abdominal wall herniation that contains a Meckel's diverticulum alone or with other intestinal loops. The diagnosis is usually made at surgery, but its pre-operative radiological recognition has been a challenge due to inherent difficulties in detecting the Meckel's diverticulum within hernial content. The aim of this article is to present 8 adults in whom a Meckel's diverticulum protruding into their inguinal, umbilical or incisional hernia had been demonstrated by barium examination of the small bowel or colon, or on computed tomography and magnetic resonance imaging of the abdomen and pelvis. This series included 7 men and 1 woman, who ranged in age from 34 to 78 years (mean age:57 years). Seven patients had subsequent hernia repair, when the diverticulum was visualized and resected. This report highlights the imaging features of these 8 Littre hernias since only 5% of published cases had been diagnosed pre-operatively because the Meckel's diverticulum had resulted in complications. It also reviews the pertinent literature regarding the prevalence and clinical implications of this rare entity.

Integrating transcriptomics and scPagwas analysis predicts naïve CD4 T cell-related gene DRAM2 as a potential biomarker and therapeutic target for colorectal cancer

OBJECTIVE

The interaction between T cells, particularly naïve CD4 T cells (CD4Tn), and colorectal cancer (CRC) is highly complex. CD4Tn play a crucial role in modulating immune responses within the tumor microenvironment, yet the precise mechanisms by which they influence tumor progression remain elusive. This study aims to explore the relationship between CRC and CD4Tn, identify biomarkers and therapeutic targets, and focus on the role of CD4Tn in shaping the immune environment of CRC.

METHODS

Single-cell transcriptomics, alongside the scPagwas algorithm, were employed to identify pivotal T cell subsets involved in CRC progression. Bulk transcriptomic data were further analyzed using deconvolution algorithms to elucidate the roles of these key T cell subsets. The abundance of naïve CD4 T cells (CD4Tn) was specifically assessed to gauge patient responses to immunotherapy, alterations in the immune microenvironment, and correlations with genetic mutations. Key genes linked to CD4Tn were identified using weighted gene co-expression network analysis and Pearson correlation scores. The SMR algorithm was subsequently used for validation, with experimental verification following.

RESULTS

Through single-cell transcriptomics and the scPagwas algorithm, CD4Tn was confirmed as a critical cell type in CRC progression. High infiltration of CD4Tn cells in CRC patients was correlated with poorer prognosis and suboptimal responses to immunotherapy. SMR analysis suggested a potential causal link between DRAM2 gene expression and CRC progression. Experimental knockdown of DRAM2 in colorectal cancer cells significantly inhibited tumor growth.

CONCLUSION

The DRAM2 gene, associated with CD4Tn cells, appears to play a pivotal role in the advancement of CRC and may represent a promising therapeutic target for treatment.

Clinical Ascites and Emergency Procedure as Determinants of Surgical Risk in Patients with Advanced Chronic Liver Disease

Background: Liver function and the presence of portal hypertension, as well as the urgency and type of surgery, are prognostic factors in advanced chronic liver disease (ACLD) patients undergoing extrahepatic major surgeries. Emergent surgery in ACLD patients has 4-10 times higher mortality rates than elective surgery. However, perioperative management improvements have been made in recent years. Methods: This is a retrospective, observational, and unicentric study of 482 patients with ACLD who underwent major surgery from 2010 to 2019. We compared baseline characteristics and postoperative mortality according to the presence of ascites, the emergency, and the surgery period. Results: In total, 140 (29%) patients had ascites, and 191 (39.6%) underwent urgent surgeries. The 90-day mortality was 2.8-fold higher in patients with ascites [HR (95%CI) 2.8 (1.6-5.0); p = 0.001] and 3-fold higher in urgent surgeries [3.0 (1.6 - 5.5); p < 0.001)]. Urgent surgeries in patients with ascites revealed the highest mortality risk [6.3 (2.7-14.8); p < 0.001)], which persisted in current (2015-2019) surgeries [12.8 (2.9-56.5); p = 0.001)]. Portal hypertension was meaningful in patients undergoing abdominal surgery. Conclusions: ascites and emergent surgery increase the mortality risk of patients with ACLD despite the recent perioperative improvements.

Risk Factors for Anastomotic Leak in Patients Undergoing Surgery for Rectal Cancer Resection: A Retrospective Analysis

Introduction Anastomotic leakage (AL) is one of the most severe complications following rectal cancer (RC) surgery, with significant implications for morbidity, mortality, and oncological outcomes. Identifying risk factors associated with AL may enhance surgical decision-making and improve patient prognosis. Methods A retrospective cohort study was conducted, including 42 adult patients who underwent RC resection at a hospital in Mexico City between January 2015 and December 2022. Demographic, clinical, pathological, and surgical variables were analyzed to assess their association with AL. Univariate and multivariate statistical analyses were performed to identify independent risk factors. Results The overall incidence of AL was 11.9%, consistent with previous literature. Univariate analysis revealed no significant differences in patient-related factors such as age, BMI, ASA classification, diabetes mellitus, smoking, or biochemical markers (p>0.05). Treatment-related factors such as neoadjuvant therapy and diverting stoma (DS) placement did not show a significant association with AL. However, surgical factors played a crucial role: operative time was significantly longer in patients with AL (349.0 vs. 232.9 minutes, p=0.024), intraoperative blood loss was markedly higher (800.0 vs. 198.6 mL, p<0.001), and transfusion rates were elevated (60.0% vs. 13.5%, p=0.040). Tumor location in the middle rectum was more frequent among AL cases (60.0% vs. 18.9%, p=0.090). Postoperative complications were significantly more severe in patients with AL, with prolonged hospital stays (20.0 vs. 10.2 days, p=0.043) and increased reintervention rates (80.0% vs. 5.6%, p<0.001). In the logistic regression model, none of the analyzed variables reached statistical significance (p>0.99). However, operative time showed an odds ratio (OR) of 1.736 (p=0.997), suggesting that for each additional minute of surgery, the risk of AL could increase by 73.6%. Despite this trend, the wide confidence interval limits its precision and clinical applicability. Age showed an OR of 0.023 (p=0.998), potentially suggesting a 97.7% reduction in leakage risk for each additional year, although this result was not statistically significant and should be interpreted with caution. Conclusion Although no statistically significant risk factors were identified in the multivariate analysis, intraoperative variables such as prolonged surgical time, high blood loss, and transfusion requirement emerged as clinically relevant trends. These findings emphasize the need for optimizing surgical techniques and perioperative management to mitigate AL risk. Further studies with larger sample sizes are necessary to validate these associations and improve risk stratification models.

Concomitant virus infection increases mortality and worsens outcome of acute pancreatitis: A systematic review and meta-analysis

BACKGROUND

Acute pancreatitis (AP) is a major health threat, with a high mortality rate in severe forms. Though alcohol and bile-induced factors are the most common causes, increasing evidence suggests that viral infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) may also trigger AP development. Our study aims to explore this association in greater detail.

METHODS

After the PROSPERO registration, we systematically searched PubMed, Embase, Cochrane Library, China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform in February 2023. We included studies with the following PECO framework: Population: AP patients, Exposure/Comparison: with/without virus infection, Outcome: mortality, severity, and complications of AP. Pooled odds ratios (OR) were calculated with 95 % confidence intervals (CIs).

RESULTS

Altogether, 29 cohorts with 2,295,172 patients were identified for the meta-analysis and 858 cases for the qualitative synthesis. Patients with concurrent SARS-CoV-2 infection and AP exhibited heightened odds of in-hospital mortality (OR: 3.15, CI: 2.08-4.76), and necrosis (OR: 1.83, CI: 1.13-2.97). Mild AP was less prevalent in the SARS-CoV-2 group (OR: 0.37, CI: 0.14-0.97) compared to moderately severe and severe AP together. Contrarily, no evidence was found that concomitant HIV infection elevated in-hospital mortality (OR: 1.12, CI: 0.92-1.37) or sepsis occurrence (OR:1.21, CI: 0.41-3.59).

CONCLUSION

Patients co-diagnosed with AP and SARS-CoV-2 infection require heightened attention due to an increased risk of mortality and complications. No evidence was found that HIV infection elevated the risk of a more severe outcome.

Pancreatic Cystic Lesions in Children: A Comprehensive Scoping Review

OBJECTIVE

Pediatric pancreatic cystic lesions (PPCLs) are uncommon and differ from adult pancreatic cystic lesions. Literature is limited on the etiologies, evaluation, and management of PPCL. A multidisciplinary working group formed to provide a comprehensive description of PPCL and recommend best available evidence-based evaluation and management.

MATERIALS AND METHODS

The PPCL working group performed a scoping review by 2 methods: 1) a targeted literature review to describe PPCL and 2) a systematic literature review for management recommendations for PPCL. The systematic review was completed using a 2-stage sifting approach: title and abstract screening followed by a full text review.

RESULTS

One hundred thirty-one studies were included in the systematic review and an additional 20 were included in the targeted search to complete a comprehensive list of PPCL. Five neoplastic PPCL and 10 nonneoplastic PPCL were identified, and prevalence of different cystic lesions differs widely in adults and children. Recommendations on evaluation and management of PPCL are presented based on best available evidence.

CONCLUSIONS

We present a comprehensive review and evidence-based management recommendations with management algorithms for pediatric pancreatic cystic lesions. Given the rarity of many of these entities, this review also highlights many aspects of PPCL, which are not adequately described in the current literature.

Potential of photodynamic therapy using polycationic photosensitizers in the treatment of lung cancer patients with SARS-CoV-2 infection and bacterial complications: Our recent experience

The problem of treating cancer patients with lung cancer has become more difficult due to the SARS-CoV-2 viral infection and concomitant bacterial lesions. The analysis shows that the photodynamic effect of long-wavelength polycationic photosensitizers suppresses the tumor process (including the destruction of cancer stem cells), SARS-CoV-2 coronavirus infection, Gram-positive and Gram-negative bacteria, including those that can cause pneumonia. Therefore, the photodynamic approach using such photosensitizers is promising for the development of an effective treatment method for patients with lung cancer, including those with SARS-CoV-2 infection and bacterial complications.

Computational Elucidation of Hub Genes and Pathways Correlated with the Development of 5-Fluorouracil Resistance in HCT 116 Colorectal Carcinoma Cell Line

Colorectal cancer (CRC) is the third most deadly cancer diagnosed in both men and women. 5-Fluorouracil (5-FU) treatment frequently causes the CRC cells to become chemoresistance, which has a negative impact on prognosis. Using bioinformatic techniques, this work describes important genes and biological pathways linked to 5-FU resistance in CRC cells. In our studies, a 5-FU-resistant HCT 116 cell line exhibiting elevated TYMS was created and validated using various tests. Bioinformatic studies were conducted to determine which differentially expressed genes (DEGs) were responsible for the establishment of 5-FU resistance in the same cell line. After screening 3949 DEGs from the two public datasets (GSE196900 and GSE153412), 471 overlapping DEGs in 5-FU-resistant HCT 116 cells were chosen. These overlapping DEGs were used to build the PPI network, and a major cluster module containing 21 genes was found. Subsequently, using three topological analysis algorithms, 10 hub genes were identified, which included HLA-DRA, HLA-DRB1, CXCR4, MMP9, CDH1, SMAD3, VIM, SYK, ZEB1, and SELL. Their roles were ascertained by utilizing Gene Ontology keywords and pathway enrichment studies. Our results also demonstrated that the miRNA and transcription factors (TFs) that had the strongest connection with the hub genes were hsa-mir-26a-5p, hsa-mir-30a-5p, RELA, and NFKB1. Ultimately, 84 FDA-approved drugs that target those hub genes were found to potentially treat 5-FU resistance CRC. Our research's findings increase our understanding of the fundamental factors that contribute to the prevalence of 5-FU resistance CRC, which could ultimately assist in the identification of valuable malignancy biomarkers and targeted treatment approaches based on key regulatory pathways.

Lymph Node Yield and Lymph Node Ratio for Prognosis of Long-Term Survival in Gastric Carcinoma

BACKGROUND

Lymphadenectomy is a fundamental part of surgical strategy in patients with gastric cancer. Lymph node (LN) status is a key point in assessment of prognosis in gastric cancer. The LN ratio (LNR)-number of positive LNs/number of sampled LNs-offers a new approach for predicting survival. The aim of the study was to find factors affecting LN yield and the impact of LNR on 5-year survival.

METHODS

Prospective multicenter quality assurance study. Only LN-positive patients were included in the LNR calculations.

RESULTS

4946 patients from 149 hospitals were enrolled. The inclusion criteria were met by 1884 patients. Patients were divided into two groups: Group 1 (<16 LN), 456 patients and Group 2 (≥16 LN), 1428 patients. The multivariate analysis found G2 (OR 1.98; 95%CI 1.11-3.54), G3 (OR 2.15; 95%CI 1.212-3.829), UICC-stage II (OR 1.44; 95%CI 1.01-2.06) and III (OR 1.71; 95%CI 1.14-2.57), age < 70 (OR 1.818 95%CI 1.19-2.78) and female gender (OR 1.37; 95%CI 1.00-1.86) as independent factors of ≥16 LN yield. Patients with a LNR ≥ 0.4 have a lower probability of survival (p = 0.039 and <0.001) than patients with a LNR = 0.1. Patients with UICC-II have a lower probability of survival than UICC-I (p = 0.023). Age 70-80 (p = 0.045) and > 80 years (p = 0.003) were negative prognostic factors for long-term survival.

CONCLUSION

Long-term survival is directly related to adequate lymphadenectomy. LNR could be superior to pN-stage for estimating survival and adds remarkable nuances in prognosis compared to UICC-stage. LNR also appears valid, even in the case of insufficient LN yield.

Telocytes in inflammatory bowel diseases: contributions to pathology and therapeutic potentials

Telocytes, a novel mesenchymal cell population, are characterized by their distinctive long and slender projections known as telopodes and have garnered significant interest since their formal introduction to the literature in 2010. These cells have been identified in various tissues, including the gastrointestinal (GI) tract, where they are suggested to play important roles in maintaining structural integrity, immune modulation, and barrier function. Inflammatory bowel diseases (IBD), which include Crohn's disease (CD) and ulcerative colitis (UC), are characterized by chronic inflammation and fibrosis. While limited information is available on the fate of telocytes in this group of diseases, it has been suggested that loss/plasticity of telocytes can be among the key factors contributing to their pathogenesis. This review focuses on the current understanding of telocytes, their structural features, and their distribution within the GI tract under gut homeostasis and IBD. We also discuss the roles of these cells in immune regulation and intestinal repair. We highlight evidence implicating telocytes in the pathogenesis of IBD and other chronic inflammatory diseases that share similar pathophysiological processes with IBD. Lastly, we discuss the current challenges in gut telocyte biology and the potential therapeutic implications of telocytes in IBD.

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Littré hernia is the rare protrusion of a Meckel's diverticulum (MD) through a hernia sac. We present a rare case of strangulated MD in a woman patient in her 90s, which required a small intestine resection. She presented with 1 day of groin swelling, no features of bowel obstruction and an irreducible hernia on examination. On CT, there were radiological features of strangulation, and the patient was taken for an emergency operation. Findings included a femoral hernia containing strangulated MD with clinical features of ischaemic small bowel. The affected segment was resected, and a side-to-side anastomosis was performed. She recovered well postoperatively. This report emphasises that the clinical diagnosis of Littré hernia can be insidious, and the importance of imaging to aid decision-making.