Structural or functional abnormality of sphincter of Oddi: an important factor for the recurrence of choledocholithiasis after endoscopic treatment

A high recurrence rate is undesirable after treatment of common bile duct (CBD) stones. A major risk factor identified for recurrence is that invasive techniques, including surgical or endoscopic treatments, will impair the biliary tract system either by direct incision of the CBD or by cutting or dilating the ampulla of Vater. During endoscopic treatment, two main assisted methods for lithotomy, sphincterotomy and papillary balloon dilation, can result in different degrees of damage to the structure and function of the sphincter of Oddi (SO), contributing to slowing of biliary excretion, cholestasis, biliary bacterial infection, and promotion of bile duct stone recurrence. In this review, the relationship between endoscopic lithotomy and structural impairment or functional abnormality of the SO will be summarized, and their relationship with the recurrence of CBD stones will also be analyzed. Further improvement of these endoscopic methods or exploration of some novel methods, such as endoscopic endoclip papilloplasty, temporary insertion of a self-expandable metal stent, and combined application of peroral cholangioscopy, may aid in providing more appropriate treatment for patients with choledocholithiasis, repair or protect the function and structure of SO, reduce or prevent the recurrence of bile duct stones, and improve patient outcomes.

Gut microbiota and microbial metabolites for osteoporosis

Osteoporosis is an age-related bone metabolic disease. As an essential endocrine organ, the skeletal system is intricately connected with extraosseous organs. The crosstalk between bones and other organs supports this view. In recent years, the link between the gut microecology and bone metabolism has become an important research topic, both in preclinical studies and in clinical trials. Many studies have shown that skeletal changes are accompanied by changes in the composition and structure of the gut microbiota (GM). At the same time, natural or artificial interventions targeting the GM can subsequently affect bone metabolism. Moreover, microbiome-related metabolites may have important effects on bone metabolism. We aim to review the relationships among the GM, microbial metabolites, and bone metabolism and to summarize the potential mechanisms involved and the theory of the gut‒bone axis. We also describe existing bottlenecks in laboratory studies, as well as existing challenges in clinical settings, and propose possible future research directions.

AhR Activation Transcriptionally Induces Anti-Microbial Peptide Alpha-Defensin 1 Leading to Reversal of Gut Microbiota Dysbiosis and Colitis

Alpha-defensin 1 is a small antimicrobial peptide that acts as the first line of defense against pathogens. It is induced following microbial cues and inflammatory signals in neutrophils and Paneth cells in the small intestine, which suggests that it plays a role in microbial homeostasis in the gut. The gut microbial products also serve as ligands for the aryl hydrocarbon receptor (AhR), an environmental sensor. In the current study, we investigated if there is any crosstalk between AhR and alpha-defensin 1. Interestingly, we found a positive correlation between AhR and alpha-defensin 1 protein levels in ileal tissues from active Crohn's' (CD) patients and epithelial cells (IECs) from multiple models of murine colitis. In vitro downregulation of AhR led to inhibition of α-defensin 1, while activation of AhR induced α-defensin 1 in IECs. AhR directly targeted the dioxin response element 3 (DRE3) region on the α-defensin 1 promoter in IECs. AhR-mediated induction of α-defensin 1 in colitis mice reversed the gut microbial dysbiosis and alleviated colitis. Our data identify a novel signaling pathway in which AhR acts as a transcription factor for α-defensin 1, leading to regulation of homeostasis between gut microbiota, intestinal mucosa, and mucosal immunity.

Third space endoscopy pulmonary complications and chylothorax post peroral endoscopic myotomy

Third-space endoscopy (TSE) has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors. TSE is based on the concept of working in the submucosa using a mucosal flap valve technique, which is the underlying premise for all TSE procedures; thus, some complications are shared across the spectrum of TSE procedures. Despite the high safety profiles of most TSE procedures, studies have reported various adverse events, including insufflation-related complications, bleeding, perforation, and infection. Although the occurrence rate of those complications is not very high, they sometimes result in critical conditions. No reports of chylous effusion following TSE procedures, particularly per-oral endoscopic myotomy, have been documented previously. We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy. Additionally, we aim to present a comprehensive overview, discuss the existing data, and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures, especially TSE.

Enhanced cancer therapy using modified magnetic α-Fe2O3/Fe3O4nanorods: Dual role in curcumin delivery and ferroptosis induction

Curcumin (CUR) has gained considerable attention in oncology due to its potent anti-tumor, anti-inflammatory, and antioxidant properties. However, its clinical utility was significantly hindered by low bioavailability and rapid metabolic degradation. This work designed a magnetic α-Fe2O3/Fe3O4 heterogeneous nanorod prepared via a urea hydrolysis-calcination process for curcumin delivery. The nanorods were modified with hyaluronic acid (HA), providing a stable matrix for curcumin encapsulation. The zeta potential of α-Fe2O3/Fe3O4/HA/CUR was -3.94 mV, the saturation magnetization was 7.82 emu·g-1, the encapsulation rate and drug loading rate were 10.53 % and 29.64 % respectively. At pH 5.4, 6.5, and 7.4, the release rates were 44.8 %, 40.2 %, and 39.3 %, respectively. Kinetic modeling indicated that release profiles followed the Weibull kinetic model, with an R2 value greater than 0.98. The α-Fe2O3/Fe3O4/HA/CUR exhibited excellent magnetic responsiveness, demonstrating a significant inhibitory effect on human liver cancer (HepG2) cells (inhibition rate greater than 60 %) under a magnetic field. Moreover, they substantially reduced the cytotoxicity of curcumin on normal human (LO2) cells. The α-Fe2O3/Fe3O4/HA/CUR inhibited migration and proliferation of HepG2 cells, induced apoptosis via the Caspase pathway, and synergistically suppressed tumor cell development through ferroptosis. The drug release from the α-Fe2O3/Fe3O4/HA/CUR was stable, significantly enhancing the bioavailability of curcumin. This provided a promising strategy for improving the bioavailability of poorly soluble drugs and enhancing liver cancer treatment outcomes.

An updated and comprehensive review of the health benefits and pharmacological activities of hesperidin

OBJECTIVES

This review aims to comprehensively assess the health benefits and pharmacological activities of hesperidin, a flavonoid commonly found in citrus fruits. It consolidates recent research findings to provide insights into hesperidin's diverse health-promoting effects.

KEY FINDINGS

Hesperidin has gained significant attention recently for its notable pharmacological activities and potential health benefits. Studies reveal its antioxidant properties, protecting cells from oxidative damage, and its anti-inflammatory effects, inhibiting pro-inflammatory cytokines and enzymes. Also, hesperidin shows promise in cardiovascular health by reducing blood pressure and cholesterol levels and enhancing endothelial function. It also exhibits anticancer potential by hindering cell proliferation, inducing apoptosis, and suppressing tumour growth. Moreover, hesperidin demonstrates neuroprotective effects, potentially mitigating neuroinflammation and oxidative stress associated with neurodegenerative diseases. Furthermore, it displays beneficial effects in metabolic disorders such as diabetes, obesity, and fatty liver disease by influencing glucose metabolism, lipid profile, and insulin sensitivity.

SUMMARY

Hesperidin exhibits a wide range of health benefits and pharmacological activities, making it a promising candidate for therapeutic interventions in various diseases. Its antioxidant, anti-inflammatory, cardiovascular, anticancer, neuroprotective, and metabolic effects underscore its potential as a valuable natural compound for promoting health and preventing chronic diseases.

Endoscopic treatment of benign esophageal strictures: Advances and challenges

Benign esophageal stricture is characterized by the narrowing of the digestive tract lumen due to multiple factors. Endoscopic treatment is the first treatment choice and includes endoscopic dilatation, drug injection, stenosis incision, stent implantation, stem cell flap transplantation, etc. However, there are currently no specific clinical standards or guidelines to quantify a series of specific parameters in the treatment of benign esophageal stricture, such as the frequency of drug administration, dosage, dilation inner diameter, and number of treatments. This leads to operator bias in clinical practice and inconsistent treatment outcomes among patients. Therefore, this article reviews the current advances and existing challenges in the endoscopic treatment of benign esophageal stricture, with the aim of exploring the possibility of achieving precision and standardization in the endoscopic treatment of this disease.

Non-coding RNAs as a Critical Player in the Regulation of Inflammasome in Inflammatory Bowel Diseases; Emphasize on lncRNAs

Inflammatory bowel disease (IBD) is an idiopathic disease caused by a dysregulated immune response to host intestinal microflora. A hyperactive inflammatory and immunological response in the gut has been shown to be one of the disease's long-term causes despite the complexity of the clinical pathology of IBD. The innate immune system activator known as human gut inflammasome is thought to be a significant underlying cause of pathology and is closely linked to the development of IBD. It is essential to comprehend the function of inflammasome activation in IBD to treat it effectively. Systemic inflammasome regulation may be a proper therapeutic and clinical strategy to manage IBD symptoms since inflammasomes may have a significant function in IBD. Non-coding RNAs (ncRNAs) are a type of RNA transcript that is incapable of encoding proteins or peptides. In IBD, inflammation develops and worsens as a result of its imbalance. Culminating evidence has been shown that ncRNAs, and particularly long non-coding RNAs (lncRNAs), may play a role in the regulation of NLR family pyrin domain containing 3 (NLRP3) inflammasome activation in IBD. The relationship between IBD and the gut inflammasome, as well as current developments in IBD research and treatment approaches, have been the main topics of this review. We have covered inflammasomes and their constituents, results from in vivo research, inflammasome inhibitors, and advancements in inflammasome-targeted therapeutics for IBD.

Malignant Esophageal Glomus Tumor With CARMN::NOTCH2 Fusion: An Additional Tumor Underscoring the Frequent Tendency of Esophageal Glomus Tumors for Aggressive Behavior

Malignant glomus tumors are rare tumors of pericytic origin with a propensity to develop in the upper gastrointestinal tract. Hereby we demonstrate a tumor of a 20-year-old man, who presented with dysphagia and an exophytic esophageal mass. Histologic examination of the resected mass revealed a multinodular tumor in the esophageal wall composed of epithelioid cells showing nesting and monomorphic atypia, staghorn vessels and scanty stroma. Immunohistochemically, the neoplastic cells were positive for SMA, and H-caldesmon, while desmin was negative. Collagen IV and laminin decorated a dense intercellular basal membrane meshwork. RNA-sequencing using TruSight RNA Pan-Cancer Panel revealed a CARMN::NOTCH2 fusion, that is a recurrent, frequently described and so far specific genetic alteration in glomus tumors. In spite of the adjuvant chemotherapy regimens, the patient died of disseminated metastatic disease 2 years after the diagnosis. Our patient presentation and the previous reports in the literature highlight the frequently aggressive behavior of glomus tumors arising in the esophagus.

Comprehensive review of therapeutic procedures for delayed gastric conduit emptying after esophagectomy

BACKGROUND

Delayed gastric conduit emptying (DGCE) is a common functional complication after esophagectomy that significantly impairs the quality of life. Despite its clinical burden, standardized management protocols are lacking, and treatment approaches often rely on individual surgeon preference. This review aimed to evaluate the evidence on procedural interventions for established late DGCE to inform clinical decision-making.

METHODS

A systematic review was conducted across 5 databases, identifying 26 studies on DGCE interventions. Studies were assessed for quality using the Newcastle-Ottawa Scale, emphasizing the inclusion criteria that focused on procedural efficacy and outcome reporting.

RESULTS

A total of 26 studies encompassing diverse treatment modalities were included. Endoscopic approaches, such as botulinum toxin injection and balloon dilatation, have emerged as preferred first-line interventions, with success rates ranging from 50.0% to 100.0%. A hybrid approach combining both modalities demonstrated enhanced efficacy and lower recurrence, with success rates reaching 100.0%. Gastric peroral endoscopic myotomy showed promise for treatment-resistant DGCE, with experienced centers reporting success in 77.2% of refractory cases. Surgical options for gastric conduit revision were reserved for cases of DGCE with structural abnormalities, although the surgical options were associated with higher risks and complications. Significant heterogeneity in outcome definitions and reporting limited the comparability between studies.

CONCLUSION

This comprehensive evaluation provides valuable insights to assist clinicians in navigating current management strategies for DGCE. High-quality comparative studies are essential to refine treatment protocols and improve long-term patient outcomes.

Rutin-Associated Hepatoprotection: A Review of Mechanisms and Therapeutic Prospects

BACKGROUND

Liver disorders pose a considerable global health challenge, accompanied by rising mortality rates. Current therapeutic strategies, though effective, often face limitations due to adverse effects and therapeutic resistance, prompting the exploration of alternative treatments, particularly safer natural compounds. Rutin, a widely available bioflavonoid, has emerged as a promising candidate owing to its varied pharmacological properties.

METHODS

We conducted a comprehensive search on PubMed and Web of Science using the following keywords: 'rutin', 'liver diseases', 'hepatoprotection', 'clinical observations', 'mechanisms, pharmacology' and various combinations of these terms.

RESULTS

This review systematically examines rutin's therapeutic potential in hepatic disorders, focusing on its molecular mechanisms, particularly its effects on inflammatory pathways, oxidative stress and hepatocellular protection.

CONCLUSION

We analyse existing evidence supporting rutin's hepatoprotective efficacy, identify its cellular and molecular targets and evaluate its potential applications in various liver diseases. Our systematic analysis provides theoretical support for developing rutin-based therapies in hepatic disease management and identifies future research directions and clinical applications.

Effect of duodenal papilla morphology on biliary cannulation and complications in patients with common bile duct stones

BACKGROUND

The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications. This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct (CBD) stones.

METHODS

This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022. Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae (types I-IV). Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

RESULTS

A total of 596 patients with CBD stones were enrolled. The proportion of patients with type I papilla was the highest (n = 231, 38.8%), followed by type III papilla (n = 175, 29.4%), type IV papilla (n = 101, 16.9%) and type II papilla (n = 89, 14.9%). Difficult cannulation occurred in 188 of 596 patients (31.5%), with most cases occurring in those with type III papilla (71/175, 40.6%, P = 0.020). Multivariate logistic analysis revealed that age [odds ratio (OR) = 1.034, 95% confidence interval (CI): 1.021-1.047, P < 0.001], type III papilla (OR = 2.255, 95% CI: 1.439-3.535, P < 0.001), gallbladder in situ (OR = 2.486, 95% CI: 1.346-4.590, P = 0.004), and CBD diameter < 10 mm (OR = 1.600, 95% CI: 1.049-2.441, P = 0.029) were risk factors for difficult cannulation. The total incidence of PEP was 10.9%. Compared with the other types of papillae, the rate of PEP was the highest in those with type I papilla (15.2%, P = 0.030). Multivariate analysis demonstrated that PEP was associated with difficult cannulation (OR = 1.811, 95% CI: 1.044-3.143, P = 0.035) and white blood cells (WBCs) < 10 × 109/L (OR = 2.199, 95% CI: 1.051-4.600, P = 0.036).

CONCLUSIONS

The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes. Type III papilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.

Exploration of Active Substances and Its Potential Mechanism of Gancao Fuzi Decoction on Inflammatory Based on Metabolomics and Network Pharmacology

Gancao Fuzi decoction (GCFZT) is a traditional Chinese formula, which has been commonly used in clinical practice to treat inflammatory diseases. However, the active substance of GCFZT in the treatment of inflammation is not fully clarified. In this study, we used orthogonal experiments to design different GCFZT formulations, resulting in a total of 16 GCFZT formulations. Subsequently, UPLC-Q-TOF-MS/MS was used to analyze the chemical composition of different formulations, and the anti-inflammatory activity differences of these formulations were evaluated through an LPS-induced RAW264.7 inflammatory cell model. Combined with machine learning algorithms such as PLS-DA and RF, four main active substances in GCFZT were screened. Finally, network pharmacology techniques were used to investigate the potential anti-inflammatory mechanisms of these main active substances, and the results showed that GCFZT mainly regulates the expression of core targets such as ALOX5, NFKB1, and TLR4 through main active substances such as chlorogenic acid, riboflavin, and formononetin, thereby affecting the NF kappa B signaling pathway, the Toll-like receptor signaling pathway, and the Th17 cell differentiation. This study provides a reference for the anti-inflammatory mechanism of GCFZT and a scientific basis for its clinical application.

Metal-phenolic network coatings delivering stem cells from apical papilla derived nanovesicles for bone defect regeneration

Bone defects have a broad impact, with over four million patients globally needing bone defect reconstruction every year due to various causes. Extracellular vesicle-functionalized scaffolds have recently emerged as a novel therapeutic approach for enhancing bone tissue regeneration. However, the clinical application of exosomes is limited by their low yield and rapid in vivo clearance. To address these challenges, we prepared nanovesicles (SCAPs-NVs) from stem cells of the apical papilla (SCAPs) using the extrusion method and loaded them into a tannic acid-Fe3+ network modified decellularized diaphragmatic tendon matrix. SCAPs can be abundantly obtained directly from extracted immature permanent teeth, are more readily available than other stem cells and also have the potential for multi-lineage differentiation. The strong interaction between tannic acid (TA) and the phospholipid bilayer of SCAPs-NVs enabled the controlled release of SCAPs-NVs. In our study, under the same conditions, the yield of SCAPs-NVs was approximately 23-fold higher than that of exosomes obtained by ultracentrifugation, highlighting the efficiency of the extrusion method. Moreover, MicroRNA sequencing of SCAPs-NVs reveals that they are enriched in angiogenic and osteogenic miRNAs. In vitro results showed that the composite scaffold loaded with SCAPs-NVs stimulated osteogenic differentiation of mesenchymal stem cells and promoted angiogenic activity of human umbilical vein endothelial cells. Micro-CT and histological evaluation confirmed the efficacy of the NVs-functionalized scaffold in promoting bone regeneration within a rat cranial defect model. This study provides novel insights into the therapeutic potential of nanovesicles, particularly SCAPs-NV, for clinical translation in bone regeneration.

Myogenic nano-adjuvant for orthopedic-related sarcopenia via mitochondrial homeostasis modulation in macrophage-myosatellite metabolic crosstalk

The decline in skeletal muscle mass and muscle strength linked to aging, also known as sarcopenia, is strongly associated with disability, traumatic injury, and metabolic disease in patients. Meanwhile, sarcopenia increases the risk of adverse orthopedic perioperative complications including implant dislocation, infection, loosening, and poor wound healing. Mitochondrial dyshomeostasis in the immune-myosatellite metabolic crosstalk is one of the major pathological factors in sarcopenia. To reduce the incidence of orthopedic perioperative complications in patients, we designed and developed a nano-adjuvant based on two-dimensional layer double hydroxide (LDH) for sustained improvement of systemic and orthopedic-related sarcopenia. Construction of MgAlCo-LDH@UA (MACL@UA) nano-adjuvant was performed by introducing cobalt in magnesium-aluminum LDH and further loading urolithin A (UA). The release of magnesium ions and UA promoted myocyte proliferation, angiogenesis and improved mitochondrial homeostasis. Al acted as an immunomodulatory adjuvant to enhance the metabolic crosstalk between macrophages and myosatellite cells, and prompted macrophage-derived glutamine nourishment. Animal experiments confirmed that vaccination with MACL@UA in systemic sarcopenia and intensive orthopedic perioperative vaccination with MACL@UA significantly enhanced quadriceps muscle mass in rats. This nano-adjuvant offers a solution for long-term improvement of sarcopenia and short-term significant reduction of orthopedic perioperative complications in patients, with promising prospects for clinical application and commercial translation.

TJ0113 attenuates fibrosis in metabolic dysfunction-associated steatohepatitis by inducing mitophagy

BACKGROUND

Metabolic dysfunction-associated steatohepatitis (MASH) fibrosis is a liver disease accompanied by inflammatory cell infiltration. There is growing evidence that insufficient mitophagy can exacerbate inflammation and liver fibrosis (LF). TJ0113 is a novel mitophagy inducer. The study aimed to explore the role of TJ0113 in ameliorating fibrosis in MASH and its mechanisms.

METHODS

A high-fat diet (HFD)-induced MASH mice model and a transforming growth factor (TGF)-β1-induced LX-2 cells model were used, and then they were treated with TJ0113. Changes in hepatocyte damage were observed using electron microscopy. Expression of key molecules related to mitophagy, mitochondrial damage and inflammation in liver was detected by immunofluorescence staining (IF), immunohistochemistry (IHC) and western blotting (WB).

RESULT

TJ0113 induces mitophagy through parkin/PINK1 and ATG5 signaling pathways and reduces lipid accumulation, inflammation and fibrosis in the liver of MASH mice. TJ0113 attenuated hepatic injury and lowered serum ALT, AST, TC and TG levels. TJ0113 reduced pro-inflammatory factors (IL-1β, IL-6, TNF-α), TGF-β1/Smad pathway activation and typical fibrosis-related molecules (α-SMA, Collagen-1) expression. In addition, NF-κB/NLRP3 signaling pathway activation after MASH was significantly attenuated by enhanced Mitophagy. We found that TJ0113 was able to effectively and safely induce mitophagy in vitro and reduce TGF-β1/Smad signaling and downstream pro-fibrotic responses in TGF-β1-treated LX-2 cells.

CONCLUSION

TJ0113 enhances mitophagy to inhibit lipid accumulation, inflammation and fibrosis formation in MASH, and is a candidate for MASH treatment.

AhR-Dependent Induction of β-Defensin 1 in Colonic Epithelial Cells Regulates Cross-Talk between Gut Microbiota and Immune Response Leading to Attenuation of Colitis

The aryl hydrocarbon receptor (AhR) acts as a critical signaling hub that connects immune cells, food and environmental cues, and microbiota to regulate intestinal homeostasis. In the current study, the role of AhR in the regulation of an antimicrobial peptide, β-defensin1 (BD-1) is investigated to control colitis. Human patients with ulcerative colitis (UC) and Crohn's disease (CD), and mice with three different models of colitis, express a significant decrease in the expression of BD-1 in colonic epithelial cells (CECs). Dietary and environmental AhR ligands induce the expression of BD-1 in CECs through the activation of two dioxin-responsive elements (DREs) expressed on its promoter. AhR ligands attenuate colitis in wild-type (WT) mice while inducing BD-1. However, AhR ligands fail to induce BD-1 and protect mice from colitis when there is an intestinal epithelial cell (IEC)-specific deletion of AhR. Blocking BD1 in vivo using antibodies prevents the ability of AhR ligands to ameliorate colitis, restore dysbiosis, and attenuate colonic inflammation. The current study identifies a novel pathway involving dietary, environmental, and endogenous AhR ligands to induce the antimicrobial peptide BD-1 in IECs, which in turn, plays a critical role in the regulation of intestinal homeostasis.

The positive role of Chinese herbal medicine as an adjunctive therapy for refractory gastroesophageal reflux disease: A systematic review and network meta-analysis

BACKGROUND

Proton pump inhibitors are currently the primary treatment option for refractory gastroesophageal reflux disease (rGERD), yet they have limitations, including poor efficacy and potential adverse events. Chinese herbal medicine (CHM) may offer an effective and safe adjunctive therapy.

METHODS

This network meta-analysis investigate the adjunctive therapeutic effect and safety of CHM on rGERD. Randomized controlled trials (RCTs) of CHM combined with conventional Western medicine in the treatment of rGERD added to 8 online databases from its inception to January 2024 were systematically searched. Review Manager 5.3 and and Stata 14.0 software were used to conduct pairwise meta-analysis and network meta-analysis of RCTs that met the inclusion criteria. In addition, the methodological quality of RCTs was analyzed using the Cochrane Collaboration Risk of Bias ROB 2.0 assessment tool. This study was registered in PROSPERO (International Prospective Register of Systematic Reviews) (CRD42024532264).

RESULTS

This study included a total of 19 RCTs, comparing 16 CHMs. Pairwise meta-analysis indicated that CHM combined with conventional Western medicine outperformed the latter in terms of overall clinical efficacy, recurrence rate, and symptom improvement. Network meta-analysis suggested that Shugan Jieyu Capsule may significantly enhance overall clinical efficacy, while Buzhongyiqi Granules may significantly reduce the recurrence rate, Sanji Powders may significantly improve symptoms of acid reflux, Shugan Jieyu Capsule may significantly improve symptoms of heartburn, and Shugan Jianpi Hewei Decoction may significantly improve symptoms of esophageal chest pain, Qingweishu Granules may significantly improve the frequency scale for the symptoms of GERD score. No serious adverse events were reported in any of the RCTs.

CONCLUSION

The findings of this study indicate that CHM offers a positive adjunctive therapeutic benefit for rGERD; however, it is imperative to enhance the quality of future RCTs to validate these preliminary findings.

Comparative study on the pathogenesis of Crohn’s disease and ulcerative colitis

Inflammatory bowel disease (IBD) is an incurable disease of the digestive system; however, the therapeutic methods for IBD remain limited. The pathogenesis of IBD was systematically discussed and compared in this paper, primarily comprising Crohn’s disease and ulcerative colitis. This paper focused on six common aspects: (1) Dysregulated immune responses; (2) Gene function changes; (3) Intestinal microbes disorder and imbalance; (4) Microbial infections; (5) Associations between IBD and other inflammatory diseases; and (6) Other factors. In addition, the pathogenesis differences between these two forms of IBD were unraveled and clearly distinguished. These unique aspects of pathogenesis provide crucial insights for the precise treatment of both Crohn’s disease and ulcerative colitis. This paper illustrates the root causes and beneficial factors of resistance to IBD, which provides novel insights on early prevention, development of new therapeutic agents, and treatment options of this disease.

Dehydroepiandrosterone (DHEA)-induced autophagy protects against lipotoxicity in hepatic cells

Dehydroepiandrosterone (DHEA), a precursor of sex hormones, has been implicated in the pathogenesis of non-alcoholic steatohepatitis (NASH) or metabolic dysfunction-associated steatohepatitis (MASH), with studies suggesting a strong correlation between DHEA levels and disease severity. In this study, we demonstrated that DHEA alleviated lipotoxicity-induced hepatic damage by promoting autophagy. Our findings demonstrate that DHEA-induced autophagy is mediated by estrogen receptor alpha (ER-α) and androgen receptor (AR) activation and protects hepatic cells against palmitate-induced apoptosis, steatosis, and inflammasome activation. DHEA treatment in a murine NASH model induced significant autophagy in the liver, further supporting the hepatoprotective role of DHEA. Collectively, our results identified DHEA as a pro-autophagic hormone with therapeutic potential for the treatment of lipotoxicity in NASH.

Apoptotic Bodies Restore NAD and Mitochondrial Homeostasis in Fibroblasts

Fibrotic skin diseases are characterized by excessive fibroblast proliferation and pathological extracellular matrix deposition. As a pivotal coenzyme in cellular energetics, NAD homeostasis perturbation is implicated in fibrosis. Multiple studies have demonstrated the therapeutic potential of mesenchymal stem cells (MSCs) against cutaneous fibrosis, while the specific mechanism remains elusive. Herein, this work finds that although almost all MSCs undergo in situ apoptosis within 24 h post-subcutaneous administration, MSC-derived apoptotic bodies (ABs) mediated potent anti-fibrotic effects. Mechanistically, ABs can restore NAD and mitochondrial homeostasis through NAMPT transfer, FOXO1 deacetylation enhancement, and PINK1/PARKIN-dependent mitophagy activation. To achieve penetration into the hard matrix of fibrotic skin, permeable apoptotic bodies (pABs) are constructed via metabolic glycoengineering and copper-free click chemistry techniques. In both keloid xenograft and scleroderma murine models, pABs can significantly penetrate collagen matrix and reduce skin fibrosis. In summary, this research establishes a highly promising strategy for reversing skin fibrosis with hard fibrotic matrix.

Hyaluronan-decorated-phloroglucinol-loaded mesoporous silica nanoparticles downregulate GLI1 and SMO genes of hedgehog signaling pathway in gastrointestinal cancer stem-like cells

Cancer stem-like cells (CSCs), a small subset of cells within the tumor microenvironment, favor tumor relapse and remain a major obstacle in cancer therapy. Hence, hyaluronan-based mesoporous silica nano-formulation with phloroglucinol (MSN-PG-HA) was employed in our study to address the cancer relapse by targeting CD44. Various in vitro cellular assays were conducted to assess the nano-formulation's effect on suppressing CSC characteristics in AGS, HCT-116 and SW-620. The CUA assay indicated increased uptake of FITC-labeled MSN-PG-HA by all GI cancer cell lines and no uptake by CD44- (3T3) cell line confirming the receptor-mediated endocytosis. Moreover, MSN-PG-HA nano-formulation has shown a significantly higher efficacy than free PG in other cellular assays by controlling cell migration, colony and spheroid formation, inducing apoptosis and suppressing the elevated MMP levels, for all the three GI cell lines with p ≤ 0.05, highlighting the nano-formulation's ability to target CSC. Further, the gene and protein expression analyses of hedgehog signaling pathway components, such as GLI1 and SMO, showed a 0.7 to 0.8-fold decrease in expression with MSN-PG-HA treated groups, proving that our nano-formulation could significantly target CSC-related proteins. Furthermore, the expression analysis utilizing inhibitors such as GANT-61 (GLI1 inhibitor) and Sonidegib (SMO inhibitor) have demonstrated that the MSN-PG-HA has shown a significant level of inhibition as that of GANT-61, indicating a similarity in their mechanism of action in inhibiting the cancer cell proliferation. Thus, our findings conclude that MSN-PG-HA could serve as a potential drug for targeting GI cancer stem cells.

Targeting the IL-23 Receptor Gene: A Promising Approach in Inflammatory Bowel Disease Treatment

Inflammatory bowel disease (IBD), which includes Crohn's Disease (CD) and ulcerative colitis (UC), is characterized by chronic inflammation of the gastrointestinal tract. A key component of the inflammatory pathway in IBD is interleukin 23 (IL-23), which promotes the differentiation and maintenance of Th17 cells. These cells are major contributors to intestinal inflammation and the release of pro-inflammatory cytokines. A dysregulated IL-23/Th17 axis can lead to excessive gut inflammation. Notably, IL-23 affects Th17 cell responses differently in UC and CD, fostering IL-17 production in UC and interferon-gamma (IFN-γ) production in CD. Genetic studies have pinpointed specific variants of the IL-23 receptor (IL23R) gene that confer protection against IBD. The R381Q (rs11209026) variant has been linked to a reduced risk of developing both CD and UC. Additionally, other variants, such as G149R (rs76418789) and V362I (rs41313262), inhibit IL23R function by disrupting intracellular trafficking and protein stability. This disruption results in decreased phosphorylation of downstream signal transducers, such as STAT3 and STAT4, and reduced IL23R expression on the cell surface, ultimately dampening the activation of pro-inflammatory pathways. The protective effects of these genetic variants underscore the IL-23/IL23R pathway as a significant therapeutic target in IBD management. Therapies designed to modulate this pathway have the potential to reduce pro-inflammatory cytokine production and enhance anti-inflammatory mechanisms. Ongoing research into the IL23R gene and its variants continues to provide valuable insights, paving the way for more targeted and effective treatments for IBD patients.

Integrating Proteomics and GWAS to Identify Key Tissues and Genes Underlying Human Complex Diseases

BACKGROUND

The tissues of origin and molecular mechanisms underlying human complex diseases remain incompletely understood. Previous studies have leveraged transcriptomic data to interpret genome-wide association studies (GWASs) for identifying disease-relevant tissues and fine-mapping causal genes. However, according to the central dogma, proteins more directly reflect cellular molecular activities than RNA. Therefore, in this study, we integrated proteomic data with GWAS to identify disease-associated tissues and genes.

METHODS

We compiled proteomic and paired transcriptomic data for 12,229 genes across 32 human tissues from the GTEx project. Using three tissue inference approaches-S-LDSC, MAGMA, and DESE-we analyzed GWAS data for six representative complex diseases (bipolar disorder, schizophrenia, coronary artery disease, Crohn's disease, rheumatoid arthritis, and type 2 diabetes), with an average sample size of 260 K. We systematically compared disease-associated tissues and genes identified using proteomic versus transcriptomic data.

RESULTS

Tissue-specific protein abundance showed a moderate correlation with RNA expression (mean correlation coefficient = 0.46, 95% CI: 0.42-0.49). Proteomic data accurately identified disease-relevant tissues, such as the association between brain regions and schizophrenia and between coronary arteries and coronary artery disease. Compared to GWAS-based gene association estimates alone, incorporating proteomic data significantly improved gene association detection (AUC difference test, p = 0.0028). Furthermore, proteomic data revealed unique disease-associated genes that were not identified using transcriptomic data, such as the association between bipolar disorder and CREB1.

CONCLUSIONS

Integrating proteomic data enables accurate identification of disease-associated tissues and provides irreplaceable advantages in fine-mapping genes for complex diseases.

Endoscopic balloon dilation with steroid injection versus radial incision and cutting with steroid injection for refractory esophageal anastomotic stricture: a randomized study

Esophageal stricture causes severe distress to patients; however, there are no established treatments for esophageal anastomotic strictures refractory to endoscopic balloon dilation (EBD). Steroid injection added to EBD and radial incision and cutting (RIC) are effective for such strictures, but it is unclear which is more effective. The objective of this study was to investigate the safety and efficacy of RIC plus steroid injection compared with EBD plus steroid injection for patients with refractory anastomotic strictures after esophagectomy.This was a multicenter, randomized phase II/III trial. Patients with esophageal anastomotic strictures refractory to three or more dilations were eligible. The primary endpoint in phase II was the proportion of predefined grade 3/4 adverse events (AEs). The co-primary endpoints in phase III were restricture-free survival and number of EBDs in the 24 weeks after treatment.130 patients were enrolled, with a dysphagia score of grade 2 in 104 patients (80.0%). The median number of dilations before registration was five in each arm. Predefined grade 3/4 AEs occurred in two patients (3.1%) in each arm. Restricture-free survival was 10.6 weeks (95%CI 6.9-20.1 weeks) with EBD and 8.7 weeks (95%CI 7.1-10.9 weeks) with RIC (one-sided P=0.82). The median number of EBDs in the 24 weeks after initial treatment was one (interquartile range [IQR] 0-2) for EBD and two (IQR 0-3) for RIC (one-sided P=0.99).EBD combined with steroid injection is the standard treatment for refractory anastomotic stricture after esophagectomy.

Trends, patterns, and risk factors of esophageal cancer mortality in China, 2008-2021: A National Mortality Surveillance System data analysis

INTRODUCTION

According to the International Agency for Research on Cancer, China had the highest mortality burden of esophageal cancer (EC) globally in 2022.

OBJECTIVES

This study aims to analyze the national and provincial trends, patterns, and risk factors of EC deaths in China.

METHODS

Data from the National Mortality Surveillance System were used to estimate national and provincial deaths, age-standardized mortality rates (ASMRs), and years of life lost (YLL). An age-period-cohort-based Nordpred model was used to predict trends until 2030. Multilevel Poisson and logistic regression were conductedto assess factors influencing EC mortality and the place of death.

RESULTS

From 2008 to 2021, EC deaths and YLLs decreased from 227,677 to 167,529 and from 5.32 million to 3.50 million, respectively. Meanwhile, the ASMR and age-standardized YLL rate decreased from 24.34 to 11.01 per 100,000 and from 535.91 to 231.08 per 100,000, respectively. By 2030, EC deaths and ASMR are predicted to decline to 150,768 and 7.85 per 100,000, respectively. Nationwide, the average age at death increased from 68.46 to 72.45 years, with an increasing proportion of YLLs in the 65-69 age group. Overall premature mortality was observed to decrease, except for an increase in YLLs among urban populations aged ≥60 years. Higher burdens were observed in rural areas compared to urban areas and among males compared to females. Nationwide, individuals with agriculture-related occupations and lower educational levels exhibited significantly higher risks of EC death. Regions with higher prevalences of smoking and harmful drinking, and lower educational, economic, and medical levels were significantly associated with high mortality. Home was the leading place of EC deaths (80.02 %).

CONCLUSION

The EC mortality burden in China is decreasing but remains a significant threat to public health. Promoting education, occupational prevention, healthy lifestyles, and medical treatment for targeted populations and regions is essential.

Anlotinib mediates intrinsic drug resistance in hepatoblastoma through the GAD1/GABA pathway

BACKGROUND

Intrinsic resistance reduces the effectiveness of many anticancer therapies. Anlotinib, a small-molecule multi-targeted tyrosine kinase inhibitor, has shown potential in treating hepatoblastoma. This study investigates the role of γ-aminobutyric acid (GABA) in anlotinib resistance using in vivo and in vitro models.

METHODS

HuH-6 hepatoblastoma cells were implanted into nude mice to assess the effects of anlotinib on tumor growth. Neurotransmitter-targeted metabolomics was performed to analyze neurotransmitter metabolism in xenograft tumor tissues. In vitro, HuH-6 and HepG2 cells were treated with anlotinib to evaluate changes in GABA synthesis, degradation, and associated protein expression.

RESULTS

Anlotinib significantly inhibited HuH-6 tumor growth but was less effective than cisplatin. Neurotransmitter-targeted metabolomics showed tumors treated with anlotinib exhibited increased GABA levels. Anlotinib treatment also upregulated the protein expression of GAD1, a key enzyme in GABA synthesis. In vitro, anlotinib treatment enhanced GABA release and GAD1 expression in hepatoblastoma cells. Exogenous GABA stimulation promoted cell proliferation in vitro and tumor growth in vivo. Notably, GAD1 knockdown enhanced anlotinib's inhibitory effects on hepatoblastoma in vitro and in vivo.

CONCLUSION

Anlotinib induces intrinsic resistance in hepatoblastoma by upregulating GAD1 and increasing GABA accumulation. Targeting GAD1 may enhance anlotinib's therapeutic efficacy and help overcome resistance.

IMPACT

Anlotinib upregulates GAD1 to enhance GABA synthesis, driving intrinsic resistance in hepatoblastoma by activating tumor-promoting GABA signaling in the tumor microenvironment. First identification of the GAD1/GABA axis as a critical mediator of anlotinib resistance, expanding understanding of neurotransmitter-driven drug tolerance in pediatric cancers. GAD1 knockdown synergizes with anlotinib to overcome resistance, establishing a combinatorial strategy to enhance antitumor efficacy in preclinical models. Proposes targeting GABA metabolism to optimize anlotinib-based therapies, addressing unmet needs in refractory hepatoblastoma treatment.

Anlotinib in combination with docetaxel for advanced nonsmall cell lung cancer after failure of platinum-based treatment: A phase 1/2 trial

BACKGROUND

The combination of anlotinib with chemotherapy has demonstrated encouraging efficacy in the treatment of nonsmall cell lung cancer (NSCLC). The objective of this phase 1/2 trial was to establish the maximum tolerated dose of anlotinib in combination with docetaxel and to assess the efficacy and safety of this regimen in patients with advanced NSCLC who had progressed after platinum-based chemotherapy.

METHODS

In the phase 1 trial, eight patients were enrolled to determine the maximum tolerated dose, which was identified as 10 mg for anlotinib in combination with docetaxel. In the phase 2 trial, in total, 88 patients were randomized, with 57 receiving anlotinib at the established maximum tolerated dose alongside docetaxel and 31 receiving docetaxel monotherapy. Tumor response was evaluated in 88 patients.

RESULTS

In the phase 2 study, the combination of anlotinib and docetaxel demonstrated a significant improvement in progression-free survival compared with docetaxel monotherapy (median, 5.39 vs. 2.56 months; hazard ratio, 0.36; 95% confidence interval, 0.21-0.63; p = .0002). The objective response rate was also superior in the combination group (26.32% vs. 6.45%). The median overall survival was 16.82 months for the combination group versus 9.86 months for the monotherapy group (hazard ratio, 0.89; 95% confidence interval, 0.47-1.66; p = .7114). Safety analysis included 96 patients, and the most frequent treatment-emergent adverse events were decreased neutrophil count and decreased white blood cell count.

CONCLUSIONS

The addition of anlotinib to docetaxel was characterized by a manageable safety profile and also resulted in a significant improvement in progression-free survival among patients with advanced NSCLC who had previously failed platinum-based chemotherapy (ClinicalTrials.gov identifier NCT03726736).

Pyloric Dysfunction: A Review of the Mechanisms, Diagnosis, and Treatment

Pyloric dysfunction is defined as hypertonia or spasm of the pyloric sphincter. The pylorus plays a key role in gastric emptying, but its function remains incompletely understood. Most studies have focused on gastroparesis regardless of the underlying pathophysiology. Few studies have reported pyloric dysfunction in patients with gastroparesis, and the diagnostic and treatment modalities for pyloric dysfunction are not well established. Recently developed diagnostic modalities assessing pyloric function, such as high-resolution antroduodenal manometry and endoluminal functional lumen imaging, are currently being evaluated. A variety of therapeutic interventions targeting the pylorus, including pharmacologic agents, intrapyloric botulinum injection, endoscopic balloon dilation, stent insertion, surgical pyloroplasty, and gastric peroral endoscopic pyloromyotomy, have been proposed. Among these, gastric peroral endoscopic pyloromyotomy has emerged as a novel, minimally invasive therapy with demonstrated efficacy and safety for refractory gastroparesis. This article reviews the pathophysiology of pyloric dysfunction and the potential diagnostic and therapeutic modalities based on the latest literature.

Predictive Modeling of Acute Respiratory Distress Syndrome Using Machine Learning: Systematic Review and Meta-Analysis

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a critical condition commonly encountered in the intensive care unit (ICU), characterized by a high incidence and substantial mortality rate. Early detection and accurate prediction of ARDS can significantly improve patient outcomes. While machine learning (ML) models are increasingly being used for ARDS prediction, there is a lack of consensus on the most effective model or methodology. This study is the first to systematically evaluate the performance of ARDS prediction models based on multiple quantitative data sources. We compare the effectiveness of ML models via a meta-analysis, revealing factors affecting performance and suggesting strategies to enhance generalization and prediction accuracy.

OBJECTIVE

This study aims to evaluate the performance of existing ARDS prediction models through a systematic review and meta-analysis, using metrics such as area under the receiver operating characteristic curve, sensitivity, specificity, and other relevant indicators. The findings will provide evidence-based insights to support the development of more accurate and effective ARDS prediction tools.

METHODS

We performed a search across 6 electronic databases for studies developing ML predictive models for ARDS, with a cutoff date of December 29, 2024. The risk of bias in these models was evaluated using the Prediction model Risk of Bias Assessment Tool. Meta-analyses and investigations into heterogeneity were carried out using Meta-DiSc software (version 1.4), developed by the Ramón y Cajal Hospital's Clinical Biostatistics team in Madrid, Spain. Furthermore, sensitivity, subgroup, and meta-regression analyses were used to explore the sources of heterogeneity more comprehensively.

RESULTS

ML models achieved a pooled area under the receiver operating characteristic curve of 0.7407 for ARDS. The additional metrics were as follows: sensitivity was 0.67 (95% CI 0.66-0.67; P<.001; I²=97.1%), specificity was 0.68 (95% CI 0.67-0.68; P<.001; I²=98.5%), the diagnostic odds ratio was 6.26 (95% CI 4.93-7.94; P<.001; I²=95.3%), the positive likelihood ratio was 2.80 (95% CI 2.46-3.19; P<.001; I²=97.3%), and the negative likelihood ratio was 0.51 (95% CI 0.46-0.57; P<.001; I²=93.6%).

CONCLUSIONS

This study evaluates prediction models constructed using various ML algorithms, with results showing that ML demonstrates high performance in ARDS prediction. However, many of the existing models still have limitations. During model development, it is essential to focus on model quality, including reducing bias risk, designing appropriate sample sizes, conducting external validation, and ensuring model interpretability. Additionally, challenges such as physician trust and the need for prospective validation must also be addressed. Future research should standardize model development, optimize model performance, and explore how to better integrate predictive models into clinical practice to improve ARDS diagnosis and risk stratification.

TRIAL REGISTRATION

PROSPERO CRD42024529403; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024529403.

Anlotinib for the treatment of pulmonary epithelioid inflammatory myofibroblastic sarcoma: a case report

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare subtype of inflammatory myofibrosarcoma. Anlotinib has demonstrated efficacy in the treatment of sarcoma. Nevertheless, to our knowledge, its use in EIMS has not been reported. Herein, we present a case of pulmonary EIMS. The patient underwent two courses of chemotherapy with doxorubicin combined with ifosfamide; however, the treatment was switched to anlotinib due to leukocytopenia. After 11 months of treatment with anlotinib, the tumor was in partial remission. Subsequently, the patient developed an acute myocardial infarction, which resulted in the discontinuation of anlotinib. Four months after discontinuation, the tumor progressed and anlotinib therapy was resumed. Following treatment for 5 months, tumor assessment indicated partial remission until March 2024. During this period, the patient experienced an adverse effect (i.e. ostealgia), which led to two reductions in the dosage of anlotinib. This case report provides a novel strategy for treating EIMS.

Cholestasis in Alcohol-Associated Liver Disease

Alcohol-associated liver disease (ALD) is a leading cause of liver-related morbidity and mortality. ALD covers a spectrum of diseases, ranging from mild and reversible hepatic steatosis to the development of fibrosis, cirrhosis, and alcohol-associated hepatitis (AH). AH is marked by a rapid onset of jaundice and elevated serum levels of aspartate aminotransferase in individuals with heavy alcohol use. It can progress to acute-on-chronic liver failure, with a mortality rate of approximately 30% within the first month. Unfortunately, treatment options for AH are still limited. Cholestasis refers to an impairment in bile formation or flow, leading to clinical symptoms, such as fatigue, pruritus, and jaundice. Cholestasis and biliary dysfunction are commonly seen in patients with AH and can significantly worsen the prognosis. However, the mechanisms and roles of cholestasis in ALD are not yet fully understood. In this review, we will summarize recent findings and explore the potential roles and mechanisms of cholestasis in the progression of ALD.

Effect of sex on the outcomes of peroral endoscopic myotomy for the treatment of achalasia

BACKGROUND

Peroral endoscopic myotomy (POEM) has emerged as the first-line therapy for achalasia. However, large-scale studies which examine sex-related differences in symptoms and outcomes remain limited.

AIM

To evaluate the impact of sex on achalasia symptoms, diagnostic findings, and postoperative improvement following POEM.

METHODS

We conducted a retrospective review of achalasia patients who underwent POEM at a large center between 2010 and 2020, analyzing demographics and variables collected before, during, and after the procedure for both female and male cases.

RESULTS

Our study included 526 cases in total, with the female group experiencing more severe chest pain (P = 0.008). After stratifying age, we found that women aged 40 to 60 showed higher chest pain scores compared to their male counterparts. In female cases, the severity of dysphagia before POEM was lowest among those aged 60 and older (P = 0.033). Preoperatively, the integrated relaxation pressure (IRP) and resting lower esophageal sphincter pressure (LESP) were higher in the female group compared to the male group (P < 0.001 and P = 0.001, respectively). However, no differences in postoperative IRP and LESP were observed between two groups. The overall efficiency of POEM was 96.52%, with a significant improvement in chest pain scores noted in female cases (P = 0.043).

CONCLUSION

Sex may influence the severity and frequency of chest pain, with female cases exhibiting higher LESP and IRP compared to male cases. POEM is proven to be a safe and effective procedure for both sexes, with female cases potentially experiencing greater benefits.

Comparison of 12- and 15-mm endoscopic papillary large balloon dilation combined with a limited endoscopic sphincterotomy for large bile duct stones: A propensity score-matched analysis

BACKGROUND AND STUDY AIMS

Endoscopic papillary large balloon dilation (EPLBD) combined with endoscopic sphincterotomy (EST) has been increasingly used to remove large common bile duct (CBD) stones. However, the clinical outcomes of stone extraction have rarely been investigated in regard to the size of the balloon. The aim of this study was to assess the short- and long-term outcomes of 12- and 15-mm EPLBD with a limited EST for large CBD stones.

PATIENTS AND METHODS

Patients without prior endoscopic retrograde cholangiopancreatography (ERCP) who received 12- or 15-mm EPLBD in combination with a limited EST for large CBD stones at our center between January 2013 and December 2020 were recruited. Matched pairs with 12- and 15-mm EPLBD were generated.

RESULTS

A total of 161 patients were included, with 50 patients successfully matched in each group. The total procedure time (36.8 min vs. 47.3 min, p = 0.003) and the tone removal time (30.5 min vs. 39.2 min, p = 0.008) were significantly lower in the matched 15-mm EPLBD group, while the initial and overall stone removal success rates were comparable between the two groups (p > 0.05). The matched 15-mm EPLBD group had a lower incidence of post-ERCP pancreatitis (PEP) compared to the matched 12-mm EPLBD group (2.0 % vs. 16.0 %, p = 0.031). The cumulative long-term biliary complications were not statistically different between the two groups (log-rank test p = 0.612).

CONCLUSION

15-mm EPLBD combined with a limited EST shortened the procedure time and reduced the incidence of PEP without increasing long-term biliary complications compared to 12-mm EPLBD combined with a limited EST.

The risk factors affecting effect of extracorporeal shock wave lithotripsy for pancreatic duct stones

OBJECTIVES

This study aimed to investigate the factors affecting effect of extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones.

MATERIALS AND METHODS

The data of 160 patients who underwent ESWL for pancreatic duct stones in Department of Gastroenterology, First People's Hospital of Hangzhou, Westlake University School of Medicine, from July 2017 to June 2023, were retrospectively analyzed. The age and sex of the patients were recorded. All patients underwent spiral computed tomography (CT) abdominal plain scan. The placement of the pancreatic duct stent was recorded. The maximum CT value of stones was manually measured. The regions of interest (ROI) was delineated using ITK-SNAP software, and the stone volume was recorded. According to the size of residual stones after lithotripsy, 99 patients were included in the complete lithotripsy group (CL Group) and 61 patients in the incomplete lithotripsy group (ICL Group). SPSS 26.0 software was used for processing and analysis. A P value < 0.05 was considered statistically significant.

RESULTS

The Sex, maximum CT value, and volume of pancreatic duct stones were statistically significant in both groups. Binary logistic regression analysis showed that female sex, maximum CT value, and volume of pancreatic duct stones were independent risk factors affecting incomplete ESWL fragmentation in pancreatic duct stones. ICL group had a higher mean number of treatments and mean number of impacts than CL group.

CONCLUSION

The Sex, maximum CT value, and volume of stones were related to the therapeutic effect of ESWL. Female sex, maximum CT value, and volume of stones were independent risk factors affecting incomplete stone fragmentation.

A novel radio-immunotherapy strategy: Gut microbiota metabolite combined with radioactive hydrogel for the treatment of low rectal cancer

Colorectal cancer (CRC), especially low rectal cancer, often requires surgical resection of the anus, which severely affects the quality of life of patients. This study aims to develop a novel treatment method that can effectively control tumor growth while preserving anal function. We design a radioactive hydrogel (177Lu-RH) based on the cross-linking of metal ions and sodium alginate, which can be directly injected into the tumor to achieve local radiotherapy. In mouse experiments, we observe significant differences in the therapeutic efficacy of 177Lu-RH among treated mice. Through 16S rDNA microbial diversity and targeted metabolomics studies, it has been revealed that the intestinal microbiota, particularly the Rikenella bacteria, and their metabolite propionate, are positively correlated with a favorable treatment response. We subsequently select the genus Rikenella, which exhibit a significantly higher abundance in the near-complete response (nCR) compared to the partial response (PR) group, for further mechanistic investigation. We discover that propionate, a metabolite produced by Rikenella, plays a crucial role in promoting tumor cell apoptosis and may augment the efficacy of tumor immunotherapy. Therefore, we improve the radioactive hydrogel by adding sodium propionate (SP) to form 177Lu-RH@SP. In vivo experiments show that 177Lu-RH@SP combined with anti-programmed death ligand 1 (αPD-L1) not only inhibits tumor growth but also promotes DC maturation and reverses T cell exhaustion, thereby enhancing the efficacy of tumor immunotherapy. Our work provides a new approach for the treatment of low rectal tumors, with the potential to improve the prognosis and quality of life for patients.

Unsedated emergent ERCP is feasible and efficient for acute cholangitis in old patients over 80 years

BACKGROUND

Acute cholangitis in elderly patients poses unique challenges due to comorbidities and frailty, necessitating timely intervention. This study evaluates the feasibility and efficiency of unsedated emergent endoscopic retrograde cholangiopancreatography (ERCP) in patients over 80 years with acute cholangitis.

METHODS

A retrospective analysis of elderly patients (≥ 80 years) presenting with acute cholangitis who underwent unsedated emergent ERCP between January 2020 and December 2023 was conducted. Data of patients' clinical characteristics, procedural success rates, adverse events, hospital stays, 30-day mortality and 6-month recurrence were collected and analyzed.

RESULTS

Out of 138 elderly patients included, 128 (92.7%) underwent successful unsedated emergent ERCP procedures. 6 patients had ERCP aborted due to patients' intolerance. 5 (3.1%) patients developed mild post-ERCP pancreatitis. The hospital stays were significantly shorter in patients with successful ERCP (6 days (4,8.5) VS 8.5 days (8,11), P = 0.022). 2 patients died after successful ERCP. 29 (22.7%) patients had recurrence within 6 months and univariate logistic regression analysis indicated patients who had concurrent pancreatitis and cholecystitis had less recurrence (OR 0.125, 95% CI 0.016-0.971).

CONCLUSION

Unsedated emergent ERCP appears to be a viable option for managing acute cholangitis in elderly patients over 80 years, offering efficient biliary decompression with acceptable safety profiles. Further prospective studies are warranted to validate these findings and optimize management strategies for this vulnerable population.

Interleukin-22 promotes endometrial carcinoma cell proliferation and cycle progression via ERK1/2 and p38 activation

Endometrial carcinoma (EC) is one of the most common gynecological malignant tumors, but its underlying pathogenic mechanisms are largely obscure. Interleukin-22 (IL-22), one cytokine in the tumor immune microenvironment, was reported to be associated with carcinoma progression. Here, we aimed to investigate the regulation of IL-22 in endometrial carcinoma. Enzyme-linked immunosorbent assay (ELISA) analysis of IL-22 was done in 27 controls and 51 patients with EC. We examined the proliferative potential, cycle progression, and signaling pathways modulated by IL-22 in EC cells. Western blot analysis was performed to investigate the expression of proliferative and cycle-related proteins in EC cells. The effect of IL-22 mediated by interleukin-22 receptor alpha 1 (IL-22RA1) was examined using cell transfection with small interfering RNA (siRNA). In addition, a xenograft tumor model was performed to assess the effect of IL-22 in vivo. We demonstrated significant up-regulation of serum IL-22 concentrations in EC patients (42.59 ± 23.72 pg/mL) compared to the control group (27.47 ± 8.29 pg/mL). High levels of IL-22 concentrations appear to correlate with malignant clinicopathological features of EC. Treatment with IL-22 promoted cell proliferation and G1/S phase progression in Ishikawa and HEC-1B cells. Western blot analysis revealed that c-Myc, cyclin E1, cyclin-dependent kinase (CDK)2, cyclin D1, CDK4, CDK6, p-extracellular signal-regulated kinase1/2 (p-ERK1/2), and p-p38 were highly expressed in EC cells exposed to IL-22. Moreover, in the EC mice model, we found that giving exogenous IL-22 increased tumor volume and weight. Immunohistochemistry showed that intra-tumor Ki-67 expression was up-regulated upon IL-22 treatment. The IL-22-mediated changes in cell proliferation, cycle progression, and protein expression can be effectively inhibited by the ERK1/2 inhibitor U0126 and the p38 inhibitor SB202190. In addition, the role of IL-22 in EC is receptor-dependent. Our findings suggest that IL-22 promotes endometrial carcinoma cell proliferation and G1/S phase progression by activating ERK1/2 and p38 signaling. Therefore, IL-22 may represent a potential therapeutic target for the treatment of endometrial carcinoma.

Postmyotomy Esophageal Diverticulum-A Unique Entity Mimicking Achalasia Recurrence

Background: Recurrence of dysphagia following myotomy for achalasia poses clinical and diagnostic challenges. Postmyotomy esophageal diverticula is a rare disorder, usually developing due to inadequate myotomy, resulting in dysphagia. We herein present a new entity of esophageal diverticula developing after successful complete myotomy, which causes dysphagia and mimics recurrence of achalasia. Methods: A review of the prospectively maintained database of all patients with achalasia and diverticula between January 2012 and June 2024 was performed. Demographic, clinical data, diagnosis, treatment, and outcomes were collected and analyzed. Results: A total of 9 patients underwent esophageal diverticulectomy in our institution. Five patients had achalasia and myotomy either by per-oral endoscopic myotomy, laparoscopic Heller myotomy, or pneumatic dilation. All patients suffered from a recurrence of symptoms, with an open lower esophageal sphincter confirmed by manometry or EndoFLIP™. The time from myotomy to diagnosis was 31-117 months. Four were males and 1 was female between the ages of 33 and 58 years, with an average body mass index of 22.4 kg/m2. All patients underwent esophageal diverticulectomy with no additional myotomy. Median preoperative and postoperative Eckardt scores were 5 and 0 respectively, with complete resolution of symptoms. Conclusions: Epiphrenic diverticula is a rare cause of postmyotomy dysphagia in achalasia patients. Previously, this entity was described in the context of insufficient myotomy; however, we present here a case series of patients with epiphrenic diverticula following adequate myotomy with no distal obstruction. Following diverticulectomy, their dysphagia was resolved. We suggest an algorithm for the diagnosis and treatment of dysphagia following myotomy for achalasia.

Pancreatic Cancer Solitary Metastasis to Colon is a Rare Entity

Metastases in pancreatic ductal adenocarcinoma are present in over 50% of cases at the time of diagnosis, with the liver, peritoneum, and lung being some of the most common sites. By contrast, solitary distant metastasis to the colon is a rare entity but clinically significant. We report 2 cases of synchronous pancreatic ductal adenocarcinoma distant metastasis to colon along with a literature review. Our cases demonstrate the utility of colonoscopy to diagnose metastatic disease. Last, as highlighted, palliative stenting can be used in cases of complete obstruction. KEYWORDS: pancreatic cancer; metastasis; obstruction; malignant large bowel obstruction; colonoscopy.

Cutting-edge insights into the mechanistic understanding of plant-derived exosome-like nanoparticles: Implications for intestinal homeostasis

Plant-derived exosome-like nanoparticles (PDELNs) are extracted from plants such as ginger, garlic, broccoli, and others, attracting attention for their therapeutic potential due to their availability and capacity for large-scale production. Their unique physicochemical properties position PDELNs as ideal candidates for targeted gut delivery, improving intestinal health by modulating mucosal immunity, gut microbiota, and intestinal barrier integrity, all essential for maintaining intestinal homeostasis. PDELNs regulate intestinal barrier function through their bioactive components (e.g. microRNAs, lipids, and proteins). These vesicles enhance the expression of tight junction proteins and stimulate mucin production. Additionally, they promote intestinal stem cell proliferation and increase the secretion of antimicrobial peptides. PDELNs also modulate inflammatory cytokine levels and immune cell activity, fostering a balanced immune response. Further, they support the growth of beneficial gut microbiota and their metabolites, while suppressing the proliferation of pathogenic bacteria. This review summarizes recent advancements in understanding the roles of PDELNs in regulating intestinal homeostasis, focusing on their impact on mucosal immunity, intestinal barrier function, and gut microbiota composition, along with underlying molecular mechanisms and therapeutic implications. Overall, PDELNs show promise as a novel approach for treating and preventing intestinal diseases, paving the way for effective gut health interventions.

Research Progress of Hyaluronic Acid-Coated Nanocarriers in Targeted Cancer Therapy

Background: Hyaluronic acid (HA), as a critical ingredient of extracellular matrix (ECM) and synovial fluid, has attracted extensive attention in targeted tumor thearpy. The superiority of HA is reflected as its great biocompatibility, biodegradability and special binding ability to CD44 receptor. Moreover, CD44 receptor proteins are overexpressed in many kinds of tumor cells and cancer stem cells (CSCs). Therefore, HA is commonly used as ligands for the surface modification of versatile nanocarriers applied in various tumor therapy approaches. Methods: We reviewed the literature and summarized the unique properties of HA, the rationale for the use of HA as tumor-specific carrier for drug delivery, catabolism of HA coated nanocarriers, and research achievements of frequently-used HA-modified organic and inorganic nanocarries. Results: We concluded the significant applications of HA coated nanocarriers in tumor chemotherapy and chemoresistance, combination therapy and cancer theranostics. Conclusion: The application prospect of HA-coated nanocarriers will be more extensive for various targeting combination therapy and theranostics.

Kurarinone ameliorates intestinal mucosal inflammation via regulating T cell immunity

Background

Inflammatory bowel disease (IBD) has become an increasingly significant global health concern, imposing substantial economic and psychological burdens on society and public health systems. Herbal medicines, which have shown promise in alleviating IBD symptoms and promoting remission through mechanisms such as immune regulation and anti-inflammatory effects, are gaining increasing attention. Kurarinone (KAR) is a major component of the dried roots of Sophora flavescens, which exhibits a range of pharmacological activities, including antioxidant and anti-inflammatory effects. However, research on the therapeutic potential of KAR in IBD, particularly its effect on intestinal mucosal inflammation, remains limited.

Methods

Colitis was induced by trinitrobenzene sulfonic acid (TNBS) in mice and KAR was intraperitoneally given. Hematoxylin and eosin staining, flow cytometry, and immunofluorescence were used for mucosal inflammation evaluation. Changes in gut microbiota were assessed using 16S rRNA sequencing. RNA sequencing was performed to screen for KAR's therapeutic targets, which was verified by in vitro T cell culture.

Results

We demonstrated that administration of KAR resulted in a mitigated colonic tissue damage in mice with TNBS-induced colitis and decreased the infiltration of inflammatory cells, including monocytes/macrophages, neutrophils, and T lymphocytes. Moreover, KAR protected TNBS-insulted mice from colonic goblet cell loss and tight junction destruction. Furthermore, KAR treatment led to the restoration of the gut microbiota to a more normal composition. Mechanistically, KAR suppressed T helper (Th) 17 cell response but facilitated interleukin (IL)-10 production via Blimp-1.

Conclusion

Our study investigated the impact of KAR on mice with TNBS-induced colitis and elucidated its underlying mechanisms, thereby uncovering novel possibilities for clinical interventions in IBD.

LncRNA PVT1 promotes neuroinflammation after intracerebral hemorrhage by regulating the miR-128-3p/TXNIP axis

OBJECTIVE

Intracerebral hemorrhage (ICH) has significant morbidity and mortality. TXNIP and the competing endogenous RNA (ceRNA) regulatory mechanism involved in long non-coding RNA (lncRNA) play roles in ICH. We probed the upstream microRNAs (miRNAs)/lncRNAs that regulated TXNIP expression in the ceRNA mechanism.

METHODS

ICH mouse model was established, and ICH secondary injury was simulated in BV2 microglia by hemin treatment. TXNIP was silenced 48 h before ICH modeling. The ICH mouse brain water content (BWC) and brain lesion volume after ICH were recorded. Neuronal apoptosis and neurological deficits were evaluated by double staining of NeuN and TUNEL/modified Garcia/corner turn/forelimb placement tests. Iba1 + microglia number and tumor necrosis factor-α (TNF-α)/interleukin-1β (IL-1β)/IL-10/TXNIP/PVT1/miR-128-3p levels were assessed by immunohistochemistry, Western blot, ELISA, and RT-qPCR. Cell viability/death of BV2 cells conditioned medium-treated neuron HT22 cells were assessed by CCK-8/LDH assays. miRNA that had a targeted binding relationship with TXNIP was screened. The targeted bindings of miR-128-3p to TXNIP/PVT1 to miR-128-3p were verified by dual-luciferase reporter gene assay.

RESULTS

TXNIP knockdown reduced post-ICH microglial activation/release of pro-inflammatory factors/brain edema/brain lesion volume/neurological deficits in mice and increased releases of anti-inflammatory factors. TXNIP/PVT1 knockdown inhibited hemin-induced inflammatory responses in BV2 cells and protected in vitro co-cultured HT22 cells. PVT1 was a sponge of miR-128-3p to repress TXNIP expression. miR-128-3p knockdown diminished PVT1 knockdown-inhibited hemin-induced BV2 cell inflammatory responses/neurotoxicity.

CONCLUSIONS

PVT1 silencing reduced hemin-induced neuroinflammation and had a protective effect on neurons by increasing the targeted inhibition of TXNIP by miR-128-3p.

Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025

At a population level, the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), and the European Society of Pathology (ESP) suggest endoscopic screening for gastric cancer (and precancerous conditions) in high-risk regions (age-standardized rate [ASR] > 20 per 100 000 person-years) every 2 to 3 years or, if cost-effectiveness has been proven, in intermediate risk regions (ASR 10-20 per 100 000 person-years) every 5 years, but not in low-risk regions (ASR < 10).ESGE/EHMSG/ESP recommend that irrespective of country of origin, individual gastric risk assessment and stratification of precancerous conditions is recommended for first-time gastroscopy. ESGE/EHMSG/ESP suggest that gastric cancer screening or surveillance in asymptomatic individuals over 80 should be discontinued or not started, and that patients' comorbidities should be considered when treatment of superficial lesions is planned.ESGE/EHMSG/ESP recommend that a high quality endoscopy including the use of virtual chromoendoscopy (VCE), after proper training, is performed for screening, diagnosis, and staging of precancerous conditions (atrophy and intestinal metaplasia) and lesions (dysplasia or cancer), as well as after endoscopic therapy. VCE should be used to guide the sampling site for biopsies in the case of suspected neoplastic lesions as well as to guide biopsies for diagnosis and staging of gastric precancerous conditions, with random biopsies to be taken in the absence of endoscopically suspected changes. When there is a suspected early gastric neoplastic lesion, it should be properly described (location, size, Paris classification, vascular and mucosal pattern), photodocumented, and two targeted biopsies taken.ESGE/EHMSG/ESP do not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection unless there are signs of deep submucosal invasion or if the lesion is not considered suitable for endoscopic resection.ESGE/EHMSG/ESP recommend endoscopic submucosal dissection (ESD) for differentiated gastric lesions clinically staged as dysplastic (low grade and high grade) or as intramucosal carcinoma (of any size if not ulcerated or ≤ 30 mm if ulcerated), with EMR being an alternative for Paris 0-IIa lesions of size ≤ 10 mm with low likelihood of malignancy.ESGE/EHMSG/ESP suggest that a decision about ESD can be considered for malignant lesions clinically staged as having minimal submucosal invasion if differentiated and ≤ 30 mm; or for malignant lesions clinically staged as intramucosal, undifferentiated and ≤ 20 mm; and in both cases with no ulcerative findings.ESGE/EHMSG/ESP recommends patient management based on the following histological risk after endoscopic resection: Curative/very low-risk resection (lymph node metastasis [LNM] risk < 0.5 %-1 %): en bloc R0 resection; dysplastic/pT1a, differentiated lesion, no lymphovascular invasion, independent of size if no ulceration and ≤ 30 mm if ulcerated. No further staging procedure or treatment is recommended.Curative/low-risk resection (LNM risk < 3 %): en bloc R0 resection; lesion with no lymphovascular invasion and: a) pT1b, invasion ≤ 500 µm, differentiated, size ≤ 30 mm; or b) pT1a, undifferentiated, size ≤ 20 mm and no ulceration. Staging should be completed, and further treatment is generally not necessary, but a multidisciplinary discussion is required. Local-risk resection (very low risk of LNM but increased risk of local persistence/recurrence): Piecemeal resection or tumor-positive horizontal margin of a lesion otherwise meeting curative/very low-risk criteria (or meeting low-risk criteria provided that there is no submucosal invasive tumor at the resection margin in the case of piecemeal resection or tumor-positive horizontal margin for pT1b lesions [invasion ≤ 500 µm; well-differentiated; size ≤ 30 mm, and VM0]). Endoscopic surveillance/re-treatment is recommended rather than other additional treatment. High-risk resection (noncurative): Any lesion with any of the following: (a) a positive vertical margin (if carcinoma) or lymphovascular invasion or deep submucosal invasion (> 500 µm from the muscularis mucosae); (b) poorly differentiated lesions if ulceration or size > 20 mm; (c) pT1b differentiated lesions with submucosal invasion ≤ 500 µm with size > 30 mm; or (d) intramucosal ulcerative lesion with size > 30 mm. Complete staging and strong consideration for additional treatments (surgery) in multidisciplinary discussion.ESGE/EHMSG/ESP suggest the use of validated endoscopic classifications of atrophy (e. g. Kimura-Takemoto) or intestinal metaplasia (e. g. endoscopic grading of gastric intestinal metaplasia [EGGIM]) to endoscopically stage precancerous conditions and stratify the risk for gastric cancer.ESGE/EHMSG/ESP recommend that biopsies should be taken from at least two topographic sites (2 biopsies from the antrum/incisura and 2 from the corpus, guided by VCE) in two separate, clearly labeled vials. Additional biopsy from the incisura is optional.ESGE/EHMSG/ESP recommend that patients with extensive endoscopic changes (Kimura C3 + or EGGIM 5 +) or advanced histological stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia, or changes in both antrum and corpus, operative link on gastritis assessment/operative link on gastric intestinal metaplasia [OLGA/OLGIM] III/IV) should be followed up with high quality endoscopy every 3 years, irrespective of the individual's country of origin.ESGE/EHMSG/ESP recommend that no surveillance is proposed for patients with mild to moderate atrophy or intestinal metaplasia restricted to the antrum, in the absence of endoscopic signs of extensive lesions or other risk factors (family history, incomplete intestinal metaplasia, persistent H. pylori infection). This group constitutes most individuals found in clinical practice.ESGE/EHMSG/ESP recommend H. pylori eradication for patients with precancerous conditions and after endoscopic or surgical therapy.ESGE/EHMSG/ESP recommend that patients should be advised to stop smoking and low-dose daily aspirin use may be considered for the prevention of gastric cancer in selected individuals with high risk for cardiovascular events.

An Image-Based Model for Assisting in Diagnosing Malignant Esophageal Lesions During Lugol Chromoendoscopic Examination

INTRODUCTION

Image-based diagnostic tools that aid endoscopists to biopsy putative esophageal malignant lesions are essential for ensuring the standardization and quality of Lugol chromoendoscopy. But there is no such model available yet.

METHODS

We developed a diagnostic model using endoscopic Lugol-unstained lesions (LULs) features and baseline data from 1,099 individuals enrolled from a large-scale population-based ESCC screening cohort. Six hundred three participants from a clinical outpatient cohort were included as the external validation set. High-grade intraepithelial neoplasia and above lesions identified at baseline or within 1 year after screening were defined as outcome. The final model was determined using logistic regression analysis by the Akaike information criterion.

RESULTS

The optimal diagnostic model contained the size, irregularity, sharp border of LUL, age, and body mass index of the participant, with the area under the curve of 0.83 (95% confidence interval [CI]: 0.78-0.87) in the development set, 0.81 (95% CI: 0.77-0.86) in the internal validation set, and 0.87 (95% CI: 0.84-0.90) in the external set. This model stratified individuals with LULs into low-risk, moderate-risk, and high-risk groups based on tertiles of predicted probabilities. The high-risk group accounted for <40% participants but enriched 80.8% and 82.7% of high-grade intraepithelial neoplasia and above cases in the development and external validation sets, respectively, achieving detection ratios 16.2 and 11.0 times higher than the low-risk group.

DISCUSSION

Our model can help maintain consistency and accuracy in detecting esophageal malignancy through Lugol chromoendoscopy, particularly in primary healthcare units in high-risk rural areas.

Anlotinib as a Tailored Treatment for Extensive-Stage Small Cell Lung Cancer with Stable Disease after Two Cycles of First Chemotherapy Plus Immunotherapy: A Retrospective Study

Objective: Optimize the treatment of extensive-stage small cell lung cancer (ES-SCLC). Materials and Methods: We collected data on patients with ES-SCLC who had stable disease (SD) after two cycles of first-line chemotherapy combined with immunotherapy (CIO) and subsequently received tailored treatment with anlotinib. The primary endpoints of the study were progression-free survival and overall survival (OS), while secondary endpoints included overall response rate (ORR), disease control rate (DCR), and adverse events (AEs). Results: A total of 45 patients were ultimately enrolled in the study. Preliminary analysis indicated that the integration of anlotinib provides promising efficacy for patients with ES-SCLC who had SD after two cycles of CIO. ORR and DCR were 26.67% and 62.22%, respectively, with median progression-free survival and median OS were 6.0 months and 10.0 months. Furthermore, subgroup analysis results showed that patients who experienced hypertension, proteinuria, and hand-foot syndrome during treatment had better efficacy. In addition, mechanistic analysis suggested that this regimen may activate the immune system by depleting immune suppression, thereby exerting a synergistic antitumor effect. Beyond the promising efficacy, the overall AEs of this regimen were manageable, indicating a potential positive outlook for this treatment model in this patient population. Conclusion: The adaptive treatment with anlotinib can significantly improve outcomes for these patients, with manageable toxicities, suggesting that this treatment model has the potential to become an important option for first-line therapy in ES-SCLC. However, its true clinical value requires further research for validation.

Risk factors associated with Helicobacter pylori infection in the urban population of China: A nationwide, multi-center, cross-sectional study

OBJECTIVES

To assess the risk factors associated with Helicobacter pylori infection in the urban Chinese population.

METHODS

The study was conducted from March to November 2023, including 12,902 urban participants aged 18-60 years across 52 cities distributed over 26 provinces in China. Risk factors included socioeconomic status, lifestyles, and public understanding. Univariate and multivariate logistic regression analysis was used to calculate corrected odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

According to multivariate logistic regression, risk factors associated with significantly higher H. pylori infection rates included residency in developing (OR 1.27, 95% CI 1.13-1.43) and undeveloped cities (OR 1.15, 95% CI 1.02-1.29), obesity (OR 1.37, 95% CI 1.05-1.78), alcohol consumption (OR 1.16, 95% CI 1.05-1.29), tea consumption (OR 1.11, 95% CI 1.01-1.21), and soft drink consumption (OR 1.24, 95% CI 1.09-1.40). Conversely, individuals with moderate awareness (OR 0.79, 95% CI 0.71-0.88) and high awareness (OR 0.57, 95% CI 0.48-0.69) of H. pylori had lower infection rates.

CONCLUSION

Our findings highlight the importance of promoting a healthy lifestyle and improving the understanding of H. pylori in reducing the infection rate of the bacterial pathogen in the urban Chinese population.

Efficacy and safety of anlotinib plus EGFR tyrosine kinase inhibitors in slow- or locally progressing non-small cell lung cancer after adjuvant therapy

Background

Anlotinib, a small-molecule tyrosine kinase inhibitor (TKI), suppresses angiogenesis and tumor progression. As the mechanisms underlying the resistance to epidermal growth factor receptor (EGFR)-TKIs are complex and diverse, further exploration of new treatment strategies is necessary. Combination therapy with EGFR-TKIs and anlotinib targets multiple signaling pathways, enhancing efficacy in patients with EGFR-positive non-small cell lung cancer (NSCLC). This study evaluated the efficacy and safety of anlotinib with EGFR-TKIs in patients with NSCLC who developed resistance to postoperative adjuvant therapy.

Methods

From January 2020 to December 2023, 48 patients at the Department of Thoracic Surgery, the First Affiliated Hospital of Zhejiang University, who developed resistance to adjuvant therapy were included in this retrospective study. All patients received anlotinib (10-12 mg, po, d1-14, q3w) alongside their original EGFR-TKI regimen. The primary endpoint was progression-free survival (PFS), while secondary endpoints included 6- and 12-month PFS rates, overall survival (OS), and safety. PFS was defined as the time from the initiation of anlotinib plus EGFR-TKI to disease progression or death, and OS was defined as the time from the start of anlotinib plus EGFR-TKI to death from any cause.

Results

Among the 48 patients, 23 previously received first- or second-generation EGFR-TKIs, and 25 received third-generation EGFR-TKIs. As of March 25, 2024, the median follow-up duration was 33.3 months [95% confidence interval (CI): 23.2-43.3]. The median PFS was 9.5 months (95% CI: 4.8-14.3), and 6- and 12-month PFS rates were 70.8% and 47.9%, respectively. For patients previously treated with first-/second- and third-generation EGFR-TKIs, the median PFS was 10.3 months (95% CI: 6.1-14.4) and 7.7 months (95% CI: 4.8-10.6), with a 6-month PFS rate of 69.6% and 72.0%, respectively, and a 12-month PFS rate of 47.8% and 48.0%, respectively. The median OS was 31.0 months [95% CI: not reached (NR)-NR], with 6-month and 12-month rates of 91.7% and 85.4%, respectively. For patients previously treated with first-/second- and third-generation EGFR-TKIs, the median OS was NR and 20.3 months (95% CI: 10.7-30.0), respectively; meanwhile, the OS rates were 95.7% and 88.0% at 6 months, and 91.3% and 80.0% at 12 months, respectively. The incidence rates of any grade and grade ≥3 treatment-related adverse events (TRAEs) were 75.0% (36/48) and 10.4% (5/48), respectively. The most common TRAEs included hypertension (17/48, 35.4%), proteinuria (15/48, 31.3%), rash (11/48, 22.9%), fatigue (5/48, 10.4%), and diarrhea (4/48, 8.3%), and no new safety events were observed. Dose reduction and discontinuation of anlotinib were reported in four (8.3%) and five (10.4%) patients previously treated with first-/second- and third-generation EGFR-TKIs, respectively.

Conclusions

Patients with NSCLC who developed resistance to postoperative EGFR-TKIs demonstrated promising efficacy and manageable safety, extending the treatment window and survival opportunities.