Alterations in mucosa branched N-glycans lead to dysbiosis and downregulation of ILC3: a key driver of intestinal inflammation

The perturbation of the symbiotic relationship between microbes and intestinal immune system contributes to gut inflammation and Inflammatory Bowel Disease (IBD) development. The host mucosa glycans (glycocalyx) creates a major biological interface between gut microorganisms and host immunity that remains ill-defined. Glycans are essential players in IBD immunopathogenesis, even years before disease onset. However, how changes in mucosa glycosylation shape microbiome and how this impact gut immune response and inflammation remains to be clarified. Here, we revealed that alterations in the expression of complex branched N-glycans at gut mucosa surface, modeled in glycoengineered mice, resulted in dysbiosis, with a deficiency in Firmicutes bacteria. Concomitantly, this mucosa N-glycan switch was associated with a downregulation of type 3 innate lymphoid cells (ILC3)-mediated immune response, leading to the transition of ILC3 toward an ILC1 proinflammatory phenotype and increased TNFα production. In addition, we demonstrated that the mucosa glycosylation remodeling through prophylactic supplementation with glycans at steady state was able to restore microbial-derived short-chain fatty acids and microbial sensing (by NOD2 expression) alongside the rescue of the expression of ILC3 module, suppressing intestinal inflammation and controlling disease onset. In a complementary approach, we further showed that IBD patients, often displaying dysbiosis, exhibited a tendency of decreased MGAT5 expression at epithelial cells that was accompanied by reduced ILC3 expression in gut mucosa. Altogether, these results unlock the effects of alterations in mucosa glycome composition in the regulation of the bidirectional crosstalk between microbiota and gut immune response, revealing host branched N-glycans/microbiota/ILC3 axis as an essential pathway in gut homeostasis and in preventing health to intestinal inflammation transition.

Refractory Crohn's disease complicated with Guillain-Barré syndrome: A case report

BACKGROUND

Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory gastrointestinal disorders, including Crohn's disease (CD) and ulcerative colitis, with uncertain etiologies. The natural course of IBD can be accompanied by extraintestinal manifestations involving the skin, mucous membranes, musculoskeletal structures, eyes, cardiovascular system and nervous system. Guillain-Barré syndrome (GBS) is a type of peripheral neuropathy. However, the etiology and pathogenesis of IBD combined with GBS are unclear, and only a few clinical cases have been reported. Here, we report a case of refractory CD complicated by GBS and review the previous literature to improve the understanding of these diseases.

CASE SUMMARY

A 34-year-old man had a 9-year history of refractory CD. He became unresponsive to multiple drugs and experienced recurrent intestinal fistulas. After several abdominal surgeries and treatment with ustekinumab, he achieved clinical remission. Unfortunately, he developed GBS during maintenance treatment with ustekinumab. According to previous reports, in some patients with IBD combined with GBS, GBS may be a comorbidity, an extraintestinal manifestation of IBD, or an adverse reaction to IBD therapeutic drugs. After a comprehensive evaluation, we suspected that GBS might have been a comorbidity in this patient. To avoid fatal disease relapse after medication discontinuation, we concluded that ustekinumab should not be withdrawn. On the basis of a joint decision between doctors and the patient, we decided to continue maintenance treatment with ustekinumab along with intravenous immunoglobulin, dexamethasone and traditional Chinese medicine acupuncture, which resulted in a steady improvement in his GBS symptoms and sustained remission of CD.

CONCLUSION

When IBD is complicated by a neurological disease, it is first necessary to analyze the patient's condition and then choose the corresponding treatment strategy. If the neurological disease is a specific comorbidity, treatment of both IBD and the comorbid disease should be considered. For IBD patients with extraintestinal manifestations involving the nervous system, neurological manifestations tend to resolve when the active IBD is controlled. When an adverse drug reaction is suspected, the medication should be discontinued, and symptomatic treatment should be administered.

Diagnostic value of upper gastrointestinal imaging for duodenal webbing in adults: A case report

BACKGROUND

Duodenal web is a rare congenital malformation, exceedingly uncommon in adults, and often misdiagnosed due to the subtle imaging features.

CASE SUMMARY

By analyzing the clinical diagnosis process and various imaging findings of a patient from our institution, this case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs, outlines its typical radiographic features, and provides a literature review on the etiology, clinical presentation, and management of this condition.

CONCLUSION

This case report emphasizes the necessity of upper gastrointestinal series in diagnosing duodenal webs.

Iron deposition in gastric black spots: Clinicopathological insights and NanoSuit-correlative light and electron microscopy analysis

Objectives

Black spots (BSs) are lentiginous findings observed in the gastric body and fundus during upper gastrointestinal endoscopy and are predominantly seen in patients undergoing Helicobacter pylori eradication treatment. However, the detailed patient background and exact composition are poorly understood. This study aims to clarify the clinicopathological features of BSs, examine patient demographics, and use the NanoSuit-correlative light and electron microscopy (CLEM) method combined with scanning electron microscopy-energy dispersive X-ray spectroscopy for elemental analysis.

Methods

Patients who underwent upper gastrointestinal endoscopy between 2017 and 2022 were included. Data on age, medications, blood tests, and H. pylori infection status were retrospectively gathered from medical records. Univariate analysis was conducted to examine BS presence, with results then used in a multivariate model to identify associated risk factors. Additionally, pathological specimens from patients with BSs were analyzed for elemental composition using the NanoSuit-CLEM method combined with scanning electronmicroscopy-energy dispersive X-ray spectroscopy.

Results

An analysis of 6778 cases identified risk factors for BSs, including older age and using proton pump inhibitors, statins, corticosteroids, and antithrombotic drugs. Endoscopically, BSs correlated with higher gastric atrophy and lower active H. pylori infection. Iron deposition at BS sites was specifically identified using NanoSuit-CLEM.

Conclusions

BSs on gastrointestinal endoscopy may indicate an absence of active H. pylori inflammation. The discovery of iron deposition within BSs using the NanoSuit-CLEM method has offered new insights into the possible causative factors and advances our understanding of the etiology of BSs, bringing us closer to unraveling the underlying mechanisms of their formation.

Localized light chain amyloidosis of the stomach that regressed after eradication of Helicobacter pylori over 15 years of follow-up: a case report and new hypothesis

Localized light chain amyloidosis is considered to be a plasmacytic B-cell lymphoproliferative disorder caused by antigenic induction. A hypothesis has been proposed that antigen-induced local plasmacytic B cells produce amyloidogenic proteins that are processed into amyloid fibrils in giant cells leading to amyloid fibril deposition. However, the inciting antigen exposure or immune response that signals plasmacytic B-cell infiltration, activation, and selection, is unknown. A case of localized light chain amyloidosis of the stomach that gradually regressed endoscopically after Helicobacter pylori eradication is presented. Histologically, plasmacytes decreased markedly and macrophages disappeared after eradication, and they are thought to play important roles in amyloid formation. There have been no reports of localized gastric amyloidosis in which the lesion regressed and few reports showing the relationship between localized gastric amyloidosis and Helicobacter pylori infection that evaluated the changes after eradication. Given the review of the latest findings about localized light chain amyloidosis, in addition to circumstantial evidence from the clinical course of this case, we would like to propose a bold new hypothesis that Helicobacter pylori could be one of the antigens inducing localized light chain amyloidosis of the stomach.

Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors: A Two-Center Retrospective Study

OBJECTIVES

Current literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast-enhanced ultrasound (CEUS) features in HIPT and compare them with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI).

METHODS

A total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B-mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi-square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI.

RESULTS

On the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper- or iso-enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash-out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash-out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05).

CONCLUSIONS

The CEUS features of HIPT lesions typically include mildly hyper-enhanced or iso-enhanced in AP, rapid wash-out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash-out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.

Ascending colon perforation by a migrated pancreatic spontaneous dislodgment stent: a case report

Here, we report a case of a 74-year-old woman treated for acute cholecystitis. She initially underwent percutaneous transhepatic gallbladder drainage; however, cholecystitis recurred when the drain was clamped. Therefore, endoscopic transpapillary gallbladder drainage (ETGBD) was performed. Endoscopic sphincterotomy was performed, and a transpapillary gallbladder stent was placed. Additionally, a pancreatic spontaneous dislodgment stent (PSDS) was inserted to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. Cholecystitis resolved, and the patient was discharged seven days later. Twenty-five days after ETGBD, she experienced abdominal pain, and computed tomography revealed ascending colon perforation by the migrated PSDS. She underwent laparoscopic surgery, in which the perforation was sutured, and an ileostomy was performed. The postoperative course was uneventful, and colonoscopy performed two months after surgery revealed multiple diverticula in the ascending colon. PSDS-induced gastrointestinal perforations are extremely rare. Previous case reports have suggested that perforation is caused by long-term stent retention in the gastrointestinal tract due to obstructions, such as peritonitis carcinomatosa or postoperative adhesions. We believe that in this case, the PSDS was retained because of multiple colonic diverticula. PSDS should be used with caution in patients with multiple colonic diverticula, peritonitis carcinomatosa, and postoperative adhesions.

Endoscopic findings and outcomes of gastric mucosal changes relating to potassium-competitive acid blocker and proton pump inhibitor therapy

Gastric mucosal changes associated with long-term potassium-competitive acid blocker and proton pump inhibitor (PPI) therapy may raise concern. In contrast to that for PPIs, the evidence concerning the safety of long-term potassium-competitive acid blocker use is scant. Vonoprazan (VPZ) is a representative potassium-competitive acid blocker released in Japan in 2015. In order to shed some comparative light regarding the outcomes of gastric mucosal lesions associated with a long-term acid blockade, we have reviewed six representative gastric mucosal lesions: fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone-like gastric mucosal changes, gastric black spots, and stardust gastric mucosal changes. For these mucosal lesions, we have evaluated the association with the type of acid blockade, patient gender, Helicobacter pylori infection status, the degree of gastric atrophy, and serum gastrin levels. There is no concrete evidence to support a significant relationship between VPZ/PPI use and the development of neuroendocrine tumors. Current data also shows that the risk of gastric mucosal changes is similar for long-term VPZ and PPI use. Serum hypergastrinemia is not correlated with the development of some gastric mucosal lesions. Therefore, serum gastrin level is unhelpful for risk estimation and for decision-making relating to the cessation of these drugs in routine clinical practice. Given the confounding potential neoplastic risk relating to H. pylori infection, this should be eradicated before VPZ/PPI therapy is commenced. The evidence to date does not support the cessation of clinically appropriate VPZ/PPI therapy solely because of the presence of these associated gastric mucosal lesions.

New Scenarios in Liver Transplantation for Hepatocellular Carcinoma

BACKGROUND AND AIMS

Despite liver transplantation (LT) is considered the optimal treatment for hepatocellular carcinoma (HCC), particularly in patients with impaired liver function, the shortage of donors has forced the application of very restrictive criteria for selecting ideal candidates for whom LT can offer the best outcome. With the evolving LT landscape due to the advent of direct-acting antivirals (DAAs) and the steady increase in donors, major efforts have been made to expand the transplant eligibility criteria for HCC. In addition, the emergence of immune checkpoint inhibitors (ICIs) for the treatment of HCC, with demonstrated efficacy in earlier stages, has revolutionized the therapeutic approach for these patients, and their integration in the setting of LT is challenging. Management of immunological compromise from ICIs, including the wash-out period before LT and post-LT immunosuppression adjustments, is crucial to balance the risk of graft rejection against HCC recurrence. Additionally, the effects of increased immunosuppression on non-hepatic complications must be understood to prevent them from becoming obstacles to long-term OS.

METHODS AND RESULTS

In this review, we will evaluate the emerging evidence and its implications for the future of LT in HCC. Addressing these novel challenges and opportunities, while integrating the current clinical evidence with predictive algorithms, would ensure a fair balance between individual patient needs and the overall population benefit in the LT system.

Microsatellite-high intrahepatic cholangiocarcinoma with favorable treatment outcome using pembrolizumab

Intrahepatic cholangiocarcinoma has a poor prognosis. In unresectable cases, the survival period is short despite combination therapy with cytotoxic anticancer agents and immune checkpoint inhibitors. The usefulness of immune checkpoint inhibitors against malignant tumors with microsatellite instability-high (MSI-H) mutations was shown in the KEYNOTE158 study; however, data for intrahepatic cholangiocarcinoma are insufficient. In the present case, a 65-year-old man with intrahepatic cholangiocarcinoma and lymph node metastasis could not be treated with a combination of gemcitabine, CDDP, and S-1. A comprehensive cancer genomic profiling (CGP) test showed MLH1 pathogenic mutation and MSI-H. When pembrolizumab was administered, the tumor shrinkage effect was rapidly observed, which was sustained even after 30 months. No pathogenic mutations were observed in the germline test, and MSI-high was considered to be due to the MLH1 pathogenic mutation occurring sporadically in somatic cells. MSI-H intrahepatic cholangiocarcinoma is extremely rare. However, because pembrolizumab is expected to be effective, CGP testing should be actively performed.

Endoscopic diagnosis and management of eosinophilic esophagitis

Eosinophilic esophagitis is a chronic allergic inflammatory disease, and its incidence and prevalence have recently increased. Eosinophilic esophagitis has not become a rare disease; thus, knowledge for diagnosing it is needed in current clinical practice. The adequate management of endoscopic procedures is particularly important for the diagnosis and evaluation of inflammatory activity and therapeutic responses. The therapeutic options for eosinophilic esophagitis include anti-acid drugs such as proton pump inhibitors, potassium-competitive acid blockers, swallowed topical corticosteroids, biologics, and dietary elimination therapies. Moreover, endoscopic esophageal dilation is a therapeutic option for fibrotic strictures due to eosinophilic esophagitis to improve obstructive symptoms, such as dysphagia and food impaction. In this review, we describe the endoscopic characteristics of eosinophilic esophagitis, including an endoscopic reference score and an optimal biopsy protocol to diagnose and evaluate the therapeutic response. We also describe a current therapeutic management of eosinophilic esophagitis.

Colitis in a patient with familial Mediterranean fever: Is it Crohn's disease or ulcerative colitis?

A 24-year-old woman was referred to our hospital with joint pain, fever, abdominal pain, and diarrhea. A colonoscopy revealed longitudinal ulcers with a cobblestone appearance throughout the entire colon, suggestive of Crohn's disease. However, treatment with 5-aminosalicylic acid, azathioprine, and infliximab failed to achieve clinical remission. A colonoscopy 5 months later revealed a diffusely spreading granular mucosa without visible vasculature, compatible with active ulcerative colitis. Based on these serial changes in colonic lesions, we tested the patient for MEFV gene mutations and found variants E148Q and L110P in exon 2. Administration of colchicine resulted in complete clinical remission. Our experience suggests that drastic changes in the features of colonic inflammation may be a clue to the diagnosis of enterocolitis associated with familial Mediterranean fever.

Indigo naturalis‑associated ischemic injury of colorectal mucosa: A case series study

Indigo naturalis, a traditional Chinese herbal medicine characterized by its dark blue hue, is utilized in the treatment of a diverse array of diseases, including ulcerative colitis, psoriasis, oral ulcers, radiation proctitis, chronic myelocytic leukemia and herpes zoster. The common adverse effects associated with indigo naturalis include liver dysfunction, headaches, abdominal pain and nausea. Notably, case reports have documented instances of ischemic injury to the colorectal mucosa attributed to indigo naturalis. The present case series study aimed to elucidate the clinical characteristics of patients that experienced an ischemic injury of the colorectal mucosa due to consuming Chinese patent medicines containing indigo naturalis. The present study included 15 patients (mean age, 61.7±15.1 years; 5 male patients) that were admitted to the Second Affiliated Hospital of Jiaxing University (Jiaxing, China) between March 2013 and February 2016. The patients developed ischemic colonic mucosal injuries after consuming indigo naturalis through Chinese patent medicines, with an incidence rate of 1.3% (15/1,157 patients). Overall, 9/15 patients had idiopathic thrombocytopenic purpura and 6 patients had schistosomal liver fibrosis with hypersplenism but normal myeloproliferative thrombocytopenia. The duration of continuous treatment with indigo naturalis-containing Chinese patent medicines ranged from 12-330 days, with a mean of 98.0±52.3 days. Gastrointestinal symptoms, including abdominal pain, diarrhea and hematochezia, were observed 6-90 days after starting the indigo naturalis-containing Chinese patent medicines, with a mean onset of 28.9±22.2 days. Abdominal computed tomography scans and colonoscopy revealed lesions predominantly in the right hemi-colon and the entire colon, including the rectum. Gastrointestinal symptoms resolved 17.3±12.4 days after discontinuing the treatment with indigo naturalis-containing Chinese patent medicines, and patients had a favorable prognosis and did not experience a recurrence of ischemic colitis. Therefore, individuals taking indigo naturalis orally may be susceptible to developing ischemic injuries of the colorectal mucosa. In cases where colonoscopy indicates a suspected mucosal ischemic injury, it is suggested that endoscopists inquire about the medical history of the patient in order to establish a definitive diagnosis and adjust the dose of the indigo naturalis-containing drug to mitigate the adverse effects.

A high-fat diet changes the interaction of the extracellular matrix, cytokines, and growth factors in gastric ulcer repair

BACKGROUND

Obesity is characterized by persistent low-grade inflammation that alters the gastrointestinal system and healing process. The link between obesity and the prevalence of stomach ulcers has not yet been fully established.

AIMS

We investigated the healing features of gastric lesions in male Swiss mice fed a standard diet (SD) or high-fat diet (HFD) using morphometric, biochemical, and molecular parameters.

METHODS

After 12 weeks on different diets, the animals underwent acetic acid-induced stomach ulcer surgery. To evaluate healing patterns, the stomachs of the animals were studied at five post-induction times, including the early, middle, and late phases of healing (1, 3, 7, 10, and 14 days). Morphometric features, activity of matrix metalloproteinases 2 and 9 (MMP-2 and 9), and measurement of inflammatory and growth factors were investigated using multiplex immunoassays.

RESULTS

Compared with the SD group, the HFD group demonstrated slowing of the early healing process. During the initial phase of the healing process, the SD group had significantly higher levels of EGF, VEGF-A, and VEGF-D than the HFD group. In the intermediate phase, only the SD group showed a 70 % increase in the regeneration area compared with the initial phase of the procedure. In this phase, the SD group also had higher levels of MMP-9, VEGF-D, and HGF than the HFD group.

CONCLUSIONS

HFD can have a negative impact on the healing process of gastric ulcers in animals by delaying repair in gastric tissue when compared with animals consuming SD.

Case series of small bowel adenocarcinoma associated with Crohn's disease

Long-standing Crohn's disease (CD) is well known to be associated with gastrointestinal malignancies. Patients with CD have a higher risk of developing small bowel adenocarcinoma (SBA) compared to healthy individuals. However, CD-associated SBA is not as common as colorectal cancer. While patients with CD often present with complicated stricture lesions in the small intestine, it is difficult to confirm all lesions by endoscopy. There is still no consensus on the surgical treatment of small bowel strictures with suspected CD-associated SBA. We report a case of small bowel high-grade dysplasia and two cases with advanced SBA. Case 1 involved a 53-year-old man whose high-grade dysplastic lesion of the small intestine was discovered incidentally postoperatively and successfully resected curatively. Case 2 was that of a 60-year-old man and Case 3 involved a 69-year-old man. Both patients had multiple small bowel stenotic lesions and were diagnosed with advanced small bowel cancer during follow-up. In conclusion, for patients with long-standing Crohn's disease who are refractory to treatment or have stenotic lesions, surgical resection should be considered as a treatment option with CD-associated SBA in consideration.

Unique endoscopic features of primary biliary diffuse large B-cell lymphoma: A case report with literature review (with video)

A 67-year-old man visited our hospital complaining of dark-colored urine and upper abdominal pain. Magnetic resonance cholangiopancreatography showed stricture of the distal bile duct, and contrast-enhanced computed tomography showed irregular thickening of the distal bile duct wall. However, no enlarged lymph nodes, pancreatic tumors, or other neoplastic lesions were apparent around the bile duct. Endoscopic ultrasonography and intraductal ultrasonography showed irregular thickening of the inner hypoechoic layer without the disappearance of the innermost thin hyperechoic layer. On the basis of these findings, we considered that the bile duct lesion was of non-epithelial origin. Thus, we repeatedly performed bile duct biopsies from the same site under fluoroscopy to obtain a sample of the submucosal tissue. The pathological diagnosis was diffuse large B-cell lymphoma, and the patient received systemic chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). After six courses of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, positron emission tomography-computed tomography showed the disappearance of 18-fluorodeoxyglucose uptake in the bile duct and endoscopic retrograde cholangiography showed improvement of the bile duct stricture. Endoscopic findings and repeated biopsies were useful in making the diagnosis of primary biliary diffuse large B-cell lymphoma.

Dual snare endoscopic extraction of a gastric foreign body using a dual-channel endoscope

Foreign body ingestion, though rare, poses significant health risks, with 10%-20% of cases requiring endoscopic intervention. This article presents a novel case of a 16-year-old female who ingested a cigarette lighter, leading to abdominal pain and radiographic confirmation of a gastric foreign body. Initial attempts at retrieval using grasping forceps and snares were unsuccessful due to the object's size and shape, risking potential complications. We employed a dual-channel endoscope utilizing a push-pull technique with two snares, one capturing the blunt end and the other the sharp edge of the lighter. This method facilitated safe extraction through the gastroesophageal junction without causing trauma. This case highlights the efficacy of dual snares in the endoscopic retrieval of challenging foreign bodies and emphasizes the importance of appropriate techniques in preventing complications during such procedures.

Secondary Sclerosing Cholangitis due to Drugs With a Special Emphasis on Checkpoint Inhibitors

BACKGROUND

Secondary sclerosing cholangitis (SSC), is one of the phenotypes of DILI first described in the 1980s. Check point inhibitors (CPIs) are currently the most frequent cause of SCC.

AIMS

To describe the epidemiology, clinical and biochemical features at presentation, differential diagnoses, pathophysiology, imaging, histological characteristics and management associated with SSC.

MATERIALS AND METHODS

A language and date-unrestricted Medline literature search was conducted to identify case reports and clinical series on SSC with special emphasis on CPIs (2007-2023).

RESULTS

We identified 19 different drugs that have been shown to induce SSC. A total of 64 cases with SSC due to CPIs are presented. This was mostly seen in patients treated with anti-Programmed cell death (PD)-1/PD-L1 inhibitors. The most frequent presenting signs and symptoms were abdominal pain and jaundice. Large-duct cholangitis induced by CPIs is a very rare condition while small-duct cholangitis is more common. Nivolumab and pembrolizumab were the most commonly implicated agents. Biopsies have revealed predominant CD8+ T cell infiltration in biliary strictures. Corticosteroids is linked to a low frequency of success and is the only agent recommended to begin the treatment.

CONCLUSIONS

CPIs-induced SSC seems to affect the entire biliary system. Clinicians should consider and suspect SSC when a probable CPIs-induced hepatitis does not respond to corticosteroids. Additionally, further randomized, controlled trials should prospectively investigate alternative therapies for treatment.

AGTR1 potentiates the chemotherapeutic efficacy of cisplatin in esophageal carcinoma through elevation of intracellular Ca2+ and induction of apoptosis

Cisplatin is one of the principal chemotherapeutic agents used for esophageal cancer (EC) treatment; however, EC mortality remains high. It is therefore imperative to find new therapeutic targets and approaches to potentiate the chemotherapeutic efficacy of cisplatin. Angiotensin II receptor type 1 (AGTR1) is a potential therapeutic target in multiple cancer types. In the present study, RNA‑sequencing analysis of EC and normal esophageal tissues was performed and AGTR1 was identified as a differentially expressed gene that is markedly downregulated in recurrent and metastasized EC. AGTR1 upregulation in the esophageal squamous cell carcinoma cell lines, KYSE‑150 and EC109, promoted their chemosensitivity to cisplatin both in vitro and in vivo. Additionally, AGTR1 suppressed the metastasis‑relevant traits of EC cells, as evidenced by the reduced migration, invasion and wound healing of EC cells with higher AGTR1 expression levels. Moreover, AGTR1 overexpression in EC cells upregulated intracellular Ca2+ levels, reduced ATP levels and mitochondrial membrane potentials, which was accompanied by enhanced mitochondrial pathway apoptosis. Notably, either AGTR1 overexpression or treatments with the calcium channel blocker, fendiline, caused Ca2+ influx and promoted mitochondria‑dependent apoptosis in KYSE‑150 cells in vitro. These effects were augmented when both AGTR1 overexpression and fendiline stimulation were imposed in the absence or presence of cisplatin treatments. Furthermore, fendiline administration enhanced the chemosensitivity of cisplatin in an EC xenograft mouse model. Collectively, these findings offer an alternative treatment option and provide mechanistic insights into using fendiline to potentiate the chemotherapy efficacy of cisplatin in treating EC.

Profound gastric mucosal changes and severe rebound acid hypersecretion after long-term Vonoprazan use: A case report

Vonoprazan is a novel acid blocker with greater potency than proton pump inhibitors. A Japanese study reported no significant safety concerns over 5 years of Vonoprazan use; however, elevated serum gastrin and increased parietal cell and foveolar hyperplasia were observed, and long-term safety data beyond 5 years are limited. We report a case that used Vonoprazan for 6 years, complicated by significant gastric epithelial changes during treatment and acute duodenal mucosal lesions following its discontinuation. A 76-year-old, treated with proton pump inhibitors for over 10 years, was switched to Vonoprazan due to his worsening symptoms. After its use, hemorrhagic hyperplastic polyps became prominent. Given concerns about Vonoprazan's effect on the gastric epithelium, the medication was changed to high-dose H2 blocker therapy. Two months later, the patient complained of vomiting and black tarry stools. Esophagogastroduodenoscopy revealed a significant reduction of gastric polyps but multiple erosions and ulcers in the duodenum. This case indicates the potent effects of Vonoprazan on the gastric mucosa and the risk of severe rebound acid hypersecretion after its long-term use.

Clinicopathological analysis of lymphoepithelioma-like intrahepatic cholangiocarcinoma

We aimed to identify the clinicopathological features of lymphoepithelioma-like intrahepatic cholangiocarcinoma (LEL-ICC), and EBV latency pattern and sequence variations of EBV-associated LEL-ICC. The clinical and pathological information of nine cases of LEL-ICC diagnosed in Department of Pathology, the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to October 2022 were collected. EBV latency pattern and sequence variations of EBV-associated LEL-ICC were investigated. There were 3 males and 6 females with a median age of 47 years in our cases. The morphological feature was the poorly differentiated or undifferentiated tumor cells surrounded by densely tumor infiltrating lymphocytes. Immunohistochemical staining showed the tumor cells were positive for CK7 and/or CK19, negative for HepPar-1 and Arginase-1. Eight cases showed positive nuclear signal in tumor cells by in situ hybridization of EBER. Five surgical specimens of EBV-associated LEL-ICC were positive for EBNA1 and negative for EBNA2, LMP1 and ZEBRA by immunohistochemestry. The type A strain, type f, type I, and del-LMP1 variants were found in EBV-associated LEL-ICC patients. LEL-ICC is a rare subtype of ICC and the accurate diagnosis mainly depends on typical histopathology, immunohistochemistry and in situ hybridization for EBER. The latency pattern in EBV-associated LEL-ICC patients was probably latency type I, the mainly EBV genotypes were perhaps type A strain, type f, type I and del-LMP1 variants.

Advances in Palmitoylation: A key Regulator of liver cancer development and therapeutic targets

Liver cancer ranks as the second leading cause of cancer-related deaths globally, which remains a significant public health concern. The development of liver cancer is associated with several signaling pathways, particularly metabolic reprogramming. Protein S-palmitoylation, a type of lipid post-translational modification (PTM), involves the reversible attachment of palmitic acid to a cysteine residue through a thioester bond. This modification is found in a wide range of proteins, including enzymes, cancer promoters, tumor suppressors, and transcription factors. The palmitoylation process is catalyzed by the zinc finger DHHC-type containing (ZDHHC) protein family, while the reverse process, depalmitoylation, is facilitated by palmitoyl-protein thioesterases (PPTs). Dysregulation of palmitoylation has been linked to various cancer hallmark functions, cancer metabolism, and tumor microenvironment regulation. Currently, membrane palmitoylated protein (MPP) and PPT1 have been identified as prognostic markers and potential therapeutic targets in liver cancer. In this review, we summarize recent advances in understanding the effects of palmitoylation on liver cancer development, metastasis, and prognosis prediction, and explore potential therapeutic strategies for managing liver cancer.

Operative Management of Small and Large Bowel Crohn's Disease

The majority of patients with Crohn's disease, despite an ever-increasing number of advanced therapies, require abdominal surgery during their lifetime. In this review article, the authors provide a comprehensive overview of abdominal surgery for Crohn's disease, with an evidence-based focus on surgery for upper gastrointestinal Crohn's disease, bowel-preserving surgery with strictureplasties, selection of ileocolic anastomotic technique for terminal ileal Crohn's disease, extended resections and proctectomy for Crohn's proctocolitis, intentional ileoanal pouch for Crohn's disease, and several "hot topics" including early surgery for ileocolic Crohn's disease, and surgical approaches that target the mesentery including the Kono-S anastomosis and extended mesenteric excision.

Mixed neuroendocrine-non-neuroendocrine neoplasm of the colon treated with laparoscopic resection and adjuvant chemotherapy: a case report

Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) of the colon is rare with a poor prognosis. Since the first description of a mixed neoplasm 100 years ago, the nomenclature has evolved, most recently with the 2022 World Health Organization (WHO) classification system. We describe our experience of a case of locoregionally advanced MiNEN of the descending colon treated with curative laparoscopic resection and adjuvant chemotherapy. The patient is a 72 year old woman who presented with haematochezia. Initial clinical diagnosis was poorly differentiated adenocarcinoma of the descending colon, cT2N0M0, cStage I. Laparoscopic partial colectomy of the descending colon with D3 lymph node dissection and intracorporeal overlap anastomosis was performed. The pathological diagnosis however, returned mixed adenocarcinoma-neuroendocrine carcinoma (MANEC) of the descending colon, pT4aN1bM0, pStage IIIB, a subgroup of MiNEN: 70% was neuroendocrine carcinoma (NEC), whilst poorly differentiated mucinous carcinoma constituted 30% of the tumour. She completed 4 courses of irinotecan plus cisplatin (IP) adjuvant chemotherapy and is currently recurrence-free at postoperative year 2. The clinical course of MiNEN depends on the biology of the two components, both of which must be pathologically characterised. Even quantitatively discrete components should be carefully subtyped as their prognostic relevance is undetermined.

Liver-specific inactivation of Cideb improves metabolic profiles and ameliorates steatohepatitis and fibrosis in animal models for MASH

Germline mutations of CIDEB, a lipid droplets (LDs)-associated protein, confer protection against various liver diseases in humans. It remains to be determined whether liver-specific inhibition of CIDEB will bring clinical benefits. We aim to establish pharmacological proof of concept by testing GalNAc-conjugated Cideb surrogate siRNAs in respective animal models of obesity and MASH and to develop siRNA drug candidates for clinical investigations. Surrogate siRNAs targeting mouse Cideb were designed and evaluated via a panel of assays. Concurrently, humanized CIDEB knock-in mice were generated as a research tool to facilitate human therapeutic siRNA discovery. In vivo administration of the surrogate siRNAs was conducted in the diet-induced obesity (DIO) model and CDAA-HFD model of MASH. In the DIO model, Cideb knockdown led to significant reductions of serum total cholesterol (TC) and triglyceride (TG) levels, a significant decrease in hepatic macro-steatosis and notable weight loss. In the CDAA-HFD model, Cideb siRNA treatment significantly reduced liver TC and TG levels. Furthermore, remarkable reductions of hepatic steatosis and the composite NAS score were observed with a concomitant amelioration of liver fibrosis. Transcriptome analyses revealed that integrin pathways may contribute to the major pharmacological activities upon Cideb inactivation beyond lipid metabolism. CIDEB exhibits significant potential as a therapeutic target for the treatment of MASH. Liver-targeting siRNA candidates are under development for therapeutic hypothesis testing in humans.

Enhanced activity of autoimmune gastritis following Helicobacter pylori eradication therapy

The relationship between autoimmune gastritis (AIG) and Helicobacter pylori (H. pylori) gastritis remains unclear, particularly whether there is any interaction. Herein, we report a case of early-stage AIG diagnosed in an elderly patient with highly active H. pylori gastritis, who subsequently underwent eradication therapy. We were able to follow the changes in these two types of gastritis immediately before and after eradication therapy, through observation over a period of 5 years and 5 months. Despite the previous state of predominant H. pylori gastritis, eradication therapy led to rapid exacerbation of atrophic changes, which was especially evident in endoscopic findings. In addition, the anti-parietal cell antibody titer increased constantly from 1:320 to 1:1280. We concluded that AIG activity was enhanced compared to that before eradication therapy. This course suggests the following two possibilities: early-stage AIG may have progressed steadily regardless of H. pylori gastritis status, or its activity may have been suppressed until the time of eradication therapy.

Detection of multiple signet ring cell carcinomas using texture and color enhancement imaging led to a diagnosis of hereditary diffuse gastric cancer

Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant cancer caused by CDH1 mutation. HDGC causes multiple signet ring cell carcinomas (SRCCs) throughout the stomach. Few reports exist on the endoscopic findings during screening endoscopy, leading to the diagnosis of HDGC in its early stages. Recently, a new image-enhancement endoscopy technique, texture and color enhancement imaging (TXI), has been developed to improve the visibility of early gastric cancer. To the best of our knowledge, the use of TXI leading to HDGC diagnosis has not been reported. In this report, TXI contributed to the diagnosis of HDGC, and the patient was treated with total gastrectomy. A 27-year-old woman with a family history of gastric cancer underwent esophagogastroduodenoscopy, which revealed two pale lesions in the lower body of the stomach. Histological examination of the biopsy specimen revealed SRCC and the patient was referred to our hospital for treatment. Multiple lesions were found in the lower body using TXI, and a targeted biopsy confirmed other SRCCs. We suspected her disease to be HDGC, and the patient underwent a total gastrectomy. Histopathology showed multiple SRCCs (>60), but no lymph node metastases. Genetic testing revealed CDH1 mutations. The final pathological stage of the tumor was pT1a(m) N0M0 Stage I. TXI may be helpful in detecting multiple SRCCs in patients with HDGC. Endoscopists should be aware of HDGC, and careful investigation of the entire stomach is required for patients with diffuse-type gastric cancer before treatment.

Non-exposed endoscopic wall-inversion surgery for an early gastric cancer arising from heterotopic submucosal gastric glands: A case report

A 74-year-old man, who was scheduled for surgery against the main duct-type intraductal papillary mucinous neoplasm of the pancreas, was found to have a subepithelial lesion of the stomach under esophagogastroduodenoscopy. Endoscopic ultrasound-guided fine needle aspiration for the gastric lesion revealed adenocarcinoma cells. We thus considered carcinomas arising from heterotopic submucosal gastric glands and metastases from the pancreatic lesion as differential diagnoses. We first non-exposed endoscopic wall-inversion surgery to the lesion as a total biopsy. The gastric lesion was diagnosed as early gastric cancer originating from heterotopic submucosal gastric glands. The patient subsequently underwent a pylorus-preserving pancreatoduodenectomy for the intraductal papillary mucinous neoplasm. Our experience suggests non-exposed endoscopic wall-inversion surgery is a useful and minimally invasive option for the diagnosis and treatment of gastric submucosal lesions, which are presumed to be malignant in nature.

Pathological complete response after chemotherapy in initially unresectable distal cholangiocarcinoma

Surgical resection is the only curative treatment for cholangiocarcinoma, but it is often diagnosed at advanced stages, making surgical resection infeasible. Recently, the concept of conversion surgery has expanded the indications for surgical treatment, thanks to advancements in both perioperative management and chemotherapy. However, it remains unclear which patients benefit most from this treatment strategy. We present a case of initially unresectable cholangiocarcinoma in which a pathologic complete response was achieved following chemotherapy. A man in his seventies presented with jaundice and was referred to our hospital. Abdominal computed tomography revealed dilation of the intrahepatic bile ducts and thickening of the common bile duct, suggestive of distal cholangiocarcinoma. The tumor was initially unresectable due to metastatic para-aortic lymph nodes, and chemotherapy with gemcitabine and cisplatin was initiated. After six courses of chemotherapy, the lymph nodes showed a partial response, and tumor markers returned to normal levels. However, further chemotherapy was intolerable due to thrombocytopenia. Our cancer board then decided to perform a pancreaticoduodenectomy. Pathologic examination of the resected specimen showed complete disappearance of the primary tumor, but viable cancer cells were found in the resected lymph nodes. Seven months post-surgery, recurrence in the para-aortic nodes was detected through imaging and elevated tumor markers. Despite this, the patient remains alive 16 months post-surgery with normal tumor marker levels, following additional chemotherapy. Pathologic complete response of the primary tumor is rarely observed in patients with initially unresectable distal cholangiocarcinoma, and a multidisciplinary approach, including conversion surgery, may be effective in such cases.

Familial Mediterranean fever with sigmoid colon stricture

We describe a case of familial Mediterranean fever (FMF) with sigmoid colon stricture. The patient, a woman in her 30 s, had a 12-year history of ileocolitis-type Crohn's disease. The colonoscope could not pass because of the sigmoid colon stricture, and the patient was referred to our hospital with complaints of abdominal pain and fever. At 2-month postreferral, the patient presented with severe abdominal pain and fever. Computed tomography and intestinal ultrasonography revealed no bowel obstruction, whereas wall thickening was observed in the sigmoid colon and small bowel. Our medical interview revealed a cyclical nature to the symptoms. We diagnosed FMF and initiated colchicine. Subsequently, for more than 2 years, the patient remained asymptomatic, and the sigmoid colon stricture improved. FMF should be considered in patients with inflammatory bowel disease with periodic abdominal pain and fever.

Successful management of bleeding ectopic small bowel varices secondary to portal hypertension: A retrospective study

BACKGROUND

Bleeding ectopic varices located in the small bowel (BEV-SB) caused by portal hypertension (PH) are rare and life-threatening clinical scenarios. The current management of BEV-SB is unsatisfactory. This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy (EIS) and subsequent interventional radiology (IR).

AIM

To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.

METHODS

This was a single tertiary care center before-after study, including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center. A retrospective review of the medical records was conducted. The management of these four patients involved the utilization of EIS followed by IR. The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches: Phase 1, from the initial occurrence of BEV-SB to the initial EIS; phase 2, from the initial EIS to the initial IR treatment; and phase 3, from the initial IR to December 2023. Descriptive statistics were performed to clarify the blood transfusions in each phase.

RESULTS

Four out of 519 patients diagnosed with PH were identified as having BEV-SB. The management duration of each phase was 20 person-months, 42 person-months, and 77 person-months, respectively. The four patients received a total of eight and five person-times of EIS and IR treatment, respectively. All patients exhibited recurrent gastrointestinal bleeding following the first EIS, while no further instances of gastrointestinal bleeding were observed after IR treatment. The transfusions administered during each phase were 34, 31, and 3.5 units of red blood cells, and 13 units, 14 units, and 1 unit of plasma, respectively.

CONCLUSION

EIS may be effective in achieving hemostasis for BEV-SB, but rebleeding is common, and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.

Untangling immune cell contributions in the progression from GERD to Barrett's esophagus and esophageal cancer: Insights from genetic causal analysis

BACKGROUND

Esophageal adenocarcinoma (EAC) is a rapidly increasing malignancy with significant morbidity and mortality. The progression from gastroesophageal reflux disease (GERD) to Barrett's esophagus (BE) and ultimately to EAC is thought to be influenced by chronic inflammation and immune cell dynamics. Despite the observed correlations in observational studies, the causal relationships between immune cell phenotypes and this disease continuum remain unclear.

METHODS

This study utilized a two-sample Mendelian Randomization (MR) approach to investigate the causal roles of 731 distinct immune cell phenotypes in the GERD-BE-EAC continuum. The analysis leveraged genome-wide association study (GWAS) data for immune phenotypes from a Sardinian cohort and data for GERD, BE, and EAC from the FinnGen and Open GWAS databases. A comprehensive set of MR methods, including inverse variance weighted (IVW), MR-Egger, and weighted median estimators, was employed to assess causality. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy, ensuring the robustness of the findings.

RESULTS

The study revealed complex and multifaceted roles of immune cells across the GERD-BE-EAC continuum. In GERD, 34 immune phenotypes were found to be causally associated with either increased or decreased risk. Protective effects were observed in phenotypes such as Unswitched Memory B cells, while others like CD45RA- CD4+ T cells were linked to an elevated risk. In the context of BE, 28 immune phenotypes demonstrated significant causal associations, with the majority being protective, including Unswitched Memory B cells and CD62L on Granulocytes. Conversely, certain phenotypes, such as CD24 on Transitional B cells, were identified as risk factors for BE. For EAC, 34 immune phenotypes were implicated, with various B cell subsets, particularly those expressing BAFF-R and CD24, associated with an increased risk, while Switched Memory B cells and specific myeloid cell phenotypes showed protective effects.

CONCLUSIONS

This study provides novel insights into the complex role of immune cells in the pathogenesis of EAC, revealing a dynamic interplay where certain immune phenotypes may be protective in early stages but become risk-enhancing in later stages of disease progression. These findings highlight the potential of immune cell phenotypes to serve as biomarkers for early detection and targeted therapeutic interventions across the GERD-BE-EAC continuum. Further research is warranted to validate these findings in diverse populations and to explore the underlying mechanisms driving these immune-mediated effects.

Primary hepatic neuroendocrine tumor with a suspicious pulmonary nodule: A case report and literature review

BACKGROUND

Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare tumors originating from neuroendocrine cells. Due to lack of neuroendocrine symptoms and specific radiographic characteristics, PHNETs are challenging to differentiate from other liver tumors.

CASE SUMMARY

This case involved a 67-year-old male who was admitted with a discovered hepatic mass and a suspicious lung lesion. Primary hepatic carcinoma was initially speculated based on the characteristic magnetic resonance imaging findings. The patient underwent a laparoscopic right partial hepatectomy, and subsequent immunohistochemical examination revealed a HNET. To exclude other potential origins, a positron emission tomography-computed tomography scan and gastrointestinal endoscopy were performed, leading to a final diagnosis of PHNETs. Then we conducted a literature review using the PubMed database, identifying 99 articles and 317 cases related to PHNETs. The characteristics, diagnostic methods, and treatment of PHNETs have been described. Finally, we elaborate on the presumed origins, pathological grades, clinical features, diagnosed methods, and treatments associated with PHNETs.

CONCLUSION

The diagnosis of PHNETs was primarily an exclusionary process. A definitive diagnosis of PHNETs relied mainly on immunohistochemical markers (chromogranin A, synaptophysin, and cluster of differentiation 56) and exclusion of primary foci in other organs. Radical surgery was the preferred treatment for early-stage tumors.

Therapeutic success of factor XIII substitution for IgA vasculitis with gastrointestinal manifestation

A 52-year-old man presented with severe abdominal pain, elevated C-reactive protein (CRP) levels, and characteristic skin findings, leading to a diagnosis of immunoglobulin A (IgA) vasculitis with gastrointestinal (GI) involvement. Initial evaluation, including contrast-enhanced computed tomography (CT) and esophagogastroduodenoscopy (EGD), revealed marked inflammation of the duodenum and a punched-out ulcer, both of which showed partial improvement with conservative treatment. However, the patient developed worsening abdominal pain, arthralgia, and purpura, accompanied by reduced plasma factor XIII activity (47%). Factor XIII substitution therapy was initiated as a monotherapy, resulting in immediate symptom relief and significant endoscopic improvement of the duodenal ulcer. This case highlights the potential of factor XIII monotherapy as an effective treatment option for adult IgA vasculitis with severe GI manifestations.

Target weight at discharge for children receiving their first inpatient treatment for an eating disorder

PURPOSE

There is no consensus regarding the optimal target weight for discharge during the hospitalization of children with eating disorders (EDs). We attempted to identify the ideal discharge weight for children receiving their first inpatient treatment for anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID).

PATIENTS AND METHODS

Sixty children (mean age: 12.8 years) diagnosed with either AN (49 children) or ARFID (11 children) were followed for 1 year after discharge from a psychiatric ward. We analyzed the percent of ideal body weight (%IBW) at discharge, along with physical and social factors, to predict weight outcomes and rehospitalization risk during the first year after discharge. Longitudinal weight trends were assessed, and Cox proportional hazards modeling was used to analyze the time to rehospitalization.

RESULTS

Single and multiple regression analyses identified the %IBW at discharge as the sole significant predictor of %IBW at 1 year. A receiver operating characteristic curve determined that 86.4%IBW at discharge was the optimal predictor of achieving 90%IBW by 1-year post-discharge. Patients who had achieved ≥ 86.4%IBW at discharge showed better weight trajectories compared with those discharged at < 86.4%IBW. A higher discharge %IBW was associated with prolonged time to rehospitalization, indicating a reduced risk of readmission.

CONCLUSIONS

Discharging pediatric patients at a higher weight is associated with improved weight recovery and a reduced risk of rehospitalization. A target discharge weight of 86.4%IBW may serve as an effective criterion for children with EDs.

LEVEL OF EVIDENCE

III, case-control analytic studies.

miR-103 promotes esophageal squamous cell carcinoma metastasis by targeting FOXP1

Esophageal squamous cell carcinoma (ESCC), a prevalent malignancy within the digestive tract, is associated with a significantly high mortality rate. MicroRNAs were already demonstrated to work in a wide range of tumors. The objective of the present research was to elucidate the involvement of miR-103 in the pathogenesis of ESCC and to explore its underlying mechanisms of action. Real-time quantitative polymerase chain reaction was used to detect miR-103 expressions in ESCC tissues and cells. The clinical significance of these expressions was assessed by a series of statistical analyses. Transwell assay was used to study the impact of miR-103 on migration and invasion ability of ESCC cells. Furthermore, a dual luciferase reporter gene method was adopted to study the association of miR-103 with the targeting of forkhead box protein 1 (FOXP1). miR-103 was significantly up-regulation in ESCC tissues and cell lines. Clinically, high miR-103 expression was associated with negative prognosis in ESCC. The low miR-103 expression significantly inhibited cell proliferation, migration and invasion in ESCC cell lines. Furthermore, miR-103 regulated the mechanism of action of ESCC by targeting FOXP1. In this study, we found that miR-103 may serve as a biomarker for ESCC prognosis. miR-103 may promote ESCC cell metastasis by targeting FOXP1. These studies may elucidate the potential of miR-103 as a novel target for the treatment of ESCC.

Compositional and Functional Profile of Gut Microbiota in a Cohort of Adult Spanish Patients with Atopic Dermatitis Using Metagenomics: A Cross-Sectional Study

Background: The role of gut dysbiosis in the pathophysiology of atopic dermatitis (AD) through immune system (IS) imbalance is a novel line of investigation currently under discussion. This study aimed to characterize compare the composition and functional profile of the gut microbiota (GM) between adults with AD and healthy individuals. Methods: Observational cross-sectional study, where fecal samples from 70 adults (38 patients and 32 controls) were analyzed using metagenomics and bioinformatics. Results: Differences between the GM of patients with AD and healthy individuals were demonstrated. Reduced microbial diversity was found in subjects with AD. Bacterial species with lower abundance primarily belonged to the families Ruminococcaceae, Akkermansiaceae, and Methanobacteriaceae. Several microbial metabolic pathways were found to be decreased in patients with AD, including amino acid biosynthesis, vitamin biosynthesis, fatty acids and lipids biosynthesis, and energy metabolism. Conclusion: Adults with AD exhibited a distinct GM compared to healthy individuals. Changes were demonstrated both compositionally and functionally. Further investigation is mandatory to elucidate the potential link and causal relationship between gut dysbiosis and AD, which may be crucial for a deeper understanding of the disease's pathophysiology and the development of novel therapeutic approaches.

Benign Pathologies Encountered in the Whipple Pancreatico-Duodenectomy Specimen- 11-Year Experience from a Tertiary Care Center

IntroductionPancreaticoduodenectomy is the standard treatment for resectable pancreatic head malignancies and other ampullary/peri-ampullary lesions. It is also the standard of care for symptomatic relief in chronic pancreatitis. However, despite advancements in diagnostic modalities, some lesions that are clinically suspicious for malignancy may reveal a surprising benign pathology. Thus, various neoplastic and non-neoplastic lesions are encountered in the pancreaticoduodenectomy specimens.MethodsPancreaticoduodenectomy specimens received at our institute over a period of 11 years were retrieved. Only those patients with a final diagnosis of benign neoplastic or non-neoplastic disease were included in the study. The clinical data, age, sex, presenting complaint, relevant imaging, cyst fluid cytology, and preoperative tissue diagnosis wherever available, were recorded. Patients with a preoperative malignant diagnosis for which pancreaticoduodenectomy was performed and subsequently turned out to be benign/non-neoplastic were analyzed for possible preoperative diagnostic pitfalls.ResultsBenign tumors and non-neoplastic lesions together comprised 8% of the total patients. Serous cystic neoplasm was the most common benign tumor while the most common non-neoplastic entity was chronic pancreatitis. Concordance of preoperative fine-needle aspiration cytology diagnosis with the final histopathological diagnosis was noted in 44% patients. Other rare lesions such as choledochocele, arteriovenous malformation, and adenomyomatous hyperplasia of the common bile duct were also encountered.ConclusionIn this study, we highlight the spectrum of benign neoplastic and non-neoplastic lesions encountered in pancreaticoduodenectomy specimens at a tertiary care center, emphasizing on those lesions that were clinically suspicious for malignancy and revealed a surprising benign diagnosis on the final surgical pathology excision specimen.

A retrospective study on endoscopic submucosal dissection for the treatment of ileocecal valve lesions

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) for ileocecal valve (ICV) lesions poses unique technical challenges due to anatomical complexity. The study aimed to evaluate the effectiveness and safety following ESD for lesions at the ICV.

METHODS

From December 2016 to June 2023, we reviewed the clinic characteristics and outcome of ESD on 51 ICV lesions and 84 cecal lesions. Factors related to longer procedure time were analyzed for ESD of ICV lesions.

RESULTS

Baseline characteristics and clinical features of lesions were not significantly different between the groups. The median procedure time of ICV group was significantly longer than that of the cecal group (35min and 24min, respectively; P=0.04). There were no significant differences in en bloc resection rate (92.2% and 97.6%, respectively; P=0.14) between the groups. During the median follow-up of 32 months (range 6-89), there was no case of recurrence in ICV groups. A specimen diameter of ≥25mm and circumferential spread ≥1/2 were factors related to a longer procedure time (OR5.6, 95%CI 1.7 to 18.9, P=0.02; OR 4.4, 95%CI 1.3 to 14.6, P=0.04, respectively).

CONCLUSIONS

ESD for ICV lesions requires a longer procedure duration than for cecal lesions but is safe and effective, making it a challenging and promising therapeutic approach.

Comparative Analysis of Plasmapheresis Versus Plasmapheresis Combined With Continuous Renal Replacement Therapy in Adult Liver Failure: A Retrospective Observational Study

BACKGROUND

Liver failure constitutes a critical medical condition marked by the rapid decline in hepatic functions. Novel therapeutic approaches, including therapeutic plasma exchange (TPE) and continuous venovenous hemodiafiltration (CVVHDF), have emerged as promising modalities for mitigating the effects of this condition by facilitating detoxification and enhancing liver function. The efficacy of these interventions, whether administered individually or in combination, is a prominent area of investigation in the management of liver failure among adult populations. This study aims to evaluate the role and effectiveness of TPE, both as a standalone treatment and in conjunction with CVVHDF, in the management of liver failure in adult patients.

METHODS

This retrospective study was conducted in a Liver Transplant Intensive Care Unit (LTICU), focusing on the medical records of adult patients aged 35 to 62 years. The patient cohort consisted of individuals admitted between January 1, 2021, and June 1, 2024, due to acute liver failure or acute-on-chronic liver failure. The analysis specifically included patients who underwent therapeutic plasma exchange (TPE) or those who received continuous renal replacement therapy in conjunction with TPE. For the statistical analysis, a P-value of less than .05 was deemed indicative of statistical significance. The study encompassed a total of 47 patients with liver failure, comprising 23 males and 24 females. Among these patients, 25 (53.2%) received only TPE, while 22 (46.8%) were treated with a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF).

RESULTS

In the cohort of patients who received only therapeutic plasma exchange (TPE), the median International Normalized Ratio (INR) improved significantly, decreasing from 2 (1.6-2.6) to 1.3 (1.1-1.7). Similarly, alanine aminotransferase levels reduced from 351 (66-1482) to 166 (71-367), while aspartate aminotransferase levels decreased from 259 (132-1392) to 86 (35-160). In the group receiving a combination of TPE and continuous venovenous hemodiafiltration (CVVHDF), notable reductions were also observed: INR decreased from 3 (2.4-4.7) to 1.5 (1.3-2.4), alanine aminotransferase levels dropped from 691 (59-2397) to 162 (70-1060), and aspartate aminotransferase levels fell from 916 (134-1828) to 69 (45-503). These changes were statistically significant, with P-values of less than .05 for each parameter in both treatment groups. Overall, 21 patients achieved survival without requiring a liver transplant, while 7 patients underwent liver transplantation, resulting in a transplant-free survival rate of 44.7%.

CONCLUSION

The findings from our study on the management of liver failure in adults demonstrate that both therapeutic plasma exchange (TPE) administered alone and in conjunction with continuous venovenous hemodiafiltration (CVVHDF) are effective treatment modalities, particularly as a bridging strategy to liver transplantation. The observed transplant-free survival rate of 44.7% underscores the significant clinical advantages of these therapies. However, to enhance the validity of these results and their applicability in broader clinical contexts, additional multicenter studies are essential for further exploration of these treatment approaches in liver failure management.

Establishment of nomogram of early death in elderly pancreatic cancer patients with liver metastasis

BACKGROUND

Many elderly patients with pancreatic cancer (PC) often have liver metastasis (LM), and these patients often have poor prognosis and early death (ED). However, few models can accurately predict ED from elderly PC patients with LM. Therefore, we aim to create nomograms to predict ED in elderly PC patients with LM.

METHODS

All elderly (≥ 60 years old) PC patients with LM from 2010 to 2020 were downloaded from the Surveillance, Epidemiology, and End Result (SEER) database according to the admission criteria. The included data was randomly divided into the training set and the validation set, with a ratio of 7:3. The risk factors for ED in elderly PC patients with LM were determined by univariate and multivariate logistic regression methods, and a nomogram model was established. Lastly, the nomogram is verified by the receiver operating characteristic (ROC) curve, area under the curve (AUC), calibration curve, and decision curve analysis (DCA).

RESULTS

A total of 1,424 elderly PC patients with LM were randomly divided into training set (n = 996) and validation set (n = 428) based on the ratio of 7:3. The independent prognostic factors for ED include T stage, N stage, surgery, chemotherapy, lung metastasis, and other metastases. These variables were used to create nomograms, where the AUC of the training set and the validation set were 0.83 (95% CI 0.80-0.85) and 0.81 (95% CI 0.77-0.85), respectively. Furthermore, the calibration curve shows that the predicted ED is in good agreement with the actual value. DCA also shows good clinical application value.

CONCLUSIONS

The developed nomogram can be used to predict the specific probability of ED in elderly PC patients with LM, which is useful in guiding the early prevention and treatment decision-making of this group of people.

Multiple pseudoprogressions during ongoing immunotherapy-based treatment of advanced gastric neuroendocrine carcinoma: A case report and review of literature

BACKGROUND

Gastric neuroendocrine carcinomas (NECs) exhibit aggressive features, such as rapid growth, higher rate of metastasis, and a generally unfavorable prognosis compared to gastric adenocarcinoma. As a result, therapeutic options for NECs remain limited, contributing to the poor prognosis of patients. Immunotherapy has emerged as a promising treatment strategy and demonstrated the potential to partially improve the survival and prognosis of patients with NECs. Nevertheless, the unique clinical response termed pseudoprogression (PsP) has garnered considerable attention in the context of immunotherapy.

CASE SUMMARY

Presented here is a case of NEC recurrence five and a half months after radical gastric surgery. The 45-year-old male patient underwent combination treatment involving a PD-1 blocker and tyrosine kinase inhibitors and encountered two instances of PsP during treatment. The patient ultimately achieved a durable treatment response without altering his treatment regimens, resulting in a substantial therapeutic benefit.

CONCLUSION

This case report aimed to provide the authors' experience with the diagnosis of PsP and treatment strategies for PsP in ongoing immunotherapy.

A high-quality fluorescence elimination dual-wavelength Raman method for biological detection and its application in cancer diagnosis

Raman-based methods offer a promising approach for in vivo biological detection. However, the fluorescence of biological samples will significantly affect Raman measurement accuracy. Moreover, due to the existence of excitation wavelength-dependent fluorescent molecules in biological tissues, especially porphyrin molecules, the fluorescence also exhibits significant wavelength dependence. To achieve high-quality Raman spectra of biological tissue, in this work we proposed a dual-wavelength Raman method. Two lasers with different wavelengths were used to excite optical signals in the same region, and the ordinary fluorescence and additional wavelength-dependent fluorescence in the biological samples could be eliminated by two-step normalization calibration; thus, the accuracy of Raman measurement was significantly enhanced. We applied this method to early cancer diagnosis and identified several molecules and structures worthy of attention in carcinogenesis for esophageal tissue, such as phenylalanine and the CC bonds of porphyrins. Normal, precancerous, and early cancer samples were successfully identified by the changes in biomolecules with associated degrees of malignancy. Thus, the imaging and diagnosis of indefinite tumors were realized, which verified the potential of the dual-wavelength Raman method in biological detection.

Differences in treatment outcome between translational platforms in developing therapies for gastrointestinal cancers

The variability in translational models profoundly impacts the outcomes and predictive value of preclinical studies for gastrointestinal (GI) cancer treatments. Preclinical models, including 2D cell cultures, 3D organoids, patient-derived xenografts (PDXs), and animal models, provide distinct advantages and limitations in replicating the complex tumor microenvironment (TME) of human cancers. Each model's unique biological and structural differences contribute to discrepancies in treatment responses, challenging the direct translation of experimental results to clinical settings. While 2D cell cultures are cost-effective and suitable for high-throughput screening, they lack the 3D architecture and cellular interactions of the in vivo TME. Organoids offer a more comprehensive 3D structure that better mirrors tumor heterogeneity, yet they still face limitations in fully mimicking in vivo conditions, such as vascularization and immune cell interactions. PDXs, although more representative of human cancers due to their genetic fidelity and TME preservation, are costly and resource-intensive, with human stromal and immune components gradually replaced by murine counterparts over time. This review assesses the strengths and limitations of each model, highlighting recent advancements in translational platforms that incorporate complex TME features. Understanding the influence of model selection on treatment efficacy predictions is essential for enhancing the reliability of preclinical findings and advancing personalized therapeutic strategies for GI cancers.

Autoimmune Gastritis in Korean Patients with Gastric Tumors: Clinicopathologic Correlations and Diagnostic Histological Features

Background/Aims

Autoimmune gastritis (AIG) is a corpus-dominant atrophic gastritis in which patients are positive for antiparietal cell antibody (APCA) and/or anti-intrinsic factor antibody. The risk of developing gastric cancer in patients with AIG remains unclear, and reliable frequency data of AIG in patients with gastric cancer are lacking.

Methods

We included 624 Korean patients with gastric tumors (612 gastric cancers and 12 neuroendocrine tumors) who had APCA results and were available for AIG evaluation. In patients with positive APCA results, endoscopy and histology findings were reviewed to diagnose AIG.

Results

Of the 624 patients, 37 (5.9%) tested positive for APCA, and ultimately, 11 (1.8%) met the diagnostic criteria for AIG (5 both endoscopy and histology findings, 4 endoscopy-only findings, 2 histology-only findings). The frequency of AIG in patients with gastric cancer was 1.3% (8/612), and that in patients with neuroendocrine tumors was 25.0% (3/12). Of the 11 patients with AIG, serum Helicobacter pylori antibody was positive in six patients (54.5%), all of whom had gastric cancer. Histologically, three patients showed pure AIG, four patients exhibited concurrent AIG and H. pylori gastritis, and the findings for four were indefinite for AIG. The pepsinogen (PG) I levels and PG I/II ratio were significantly lower in patients with gastric cancer with AIG than in patients with gastric cancer without AIG (p=0.042 and p=0.016, respectively).

Conclusions

The frequency of AIG in gastric cancer patients was very low compared to that in patients with neuroendocrine tumors. Rather, concurrent AIG and H. pylori gastritis was common in patients with AIG with gastric cancer.

Successful Surgical Resection of Pancreatic Arteriovenous Malformation Complicated by Acute Pancreatitis

A 73-year-old man presented with left hypochondral pain. Dynamic computed tomography (CT) revealed abnormal vessels surrounding the pancreas, leading to a suspected diagnosis of pancreatic arteriovenous malformation (PAVM). At the time of the initial examination, dynamic CT revealed mild acute pancreatitis, and PAVM was diagnosed based on the findings of dynamic CT. Although repeated abdominal pain was observed after the improvement of pancreatitis, distal pancreatectomy was performed. At >1 year after surgery, no recurrence of PAVM was observed. Surgical resection should be considered in patients with symptomatic PAVM.