Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis

BACKGROUND

Numerous meta-analyses have identified various risk factors for hepatocellular carcinoma (HCC), prompting a comprehensive study to synthesize evidence quality and strength.

METHODS

This umbrella review of meta-analyses was conducted throughout PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. Evidence strength was evaluated according to the evidence categories criteria.

RESULTS

We identified 101 risk factors throughout 175 meta-analyses. 31 risk factors were classified as evidence levels of class I, II, or III. HBV and HCV infections increase HCC risk by 12.5-fold and 11.2-fold, respectively. These risks are moderated by antiviral treatments and virological responses but are exacerbated by higher HBsAg levels, anti-HBc positivity, and co-infection. Smoking, obesity, non-alcoholic fatty liver disease, diabetes, low platelet, elevated liver enzymes and liver fluke infection increase HCC risk, while coffee consumption, a healthy diet, and bariatric surgery lower it. Medications like metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), aspirin, statins, and selective serotonin reuptake inhibitors reduce HCC risk, while acid suppressive agents, particularly proton pump inhibitors, elevate it. Blood type O reduces the risk of HCC, while male gender and older age increase the risk.

CONCLUSIONS

HBV and HCV are major HCC risk factors, with risk mitigation through antiviral treatments. Lifestyle habits such as smoking and alcohol use significantly increase HCC risk, highlighting the importance of cessation. Certain drugs like aspirin, statins, GLP-1 RAs, and metformin may reduce HCC occurrence, but further research is needed to confirm these effects.

L-theanine prevents ulcerative colitis by regulating the CD4+ T cell immune response through the gut microbiota and its metabolites

The disturbance of gut microbiota and its metabolites are considered to be the causes of ulcerative colitis (UC), which leads to immune abnormalities. Diet is the most important regulator of gut microbiota; therefore, it has a beneficial impact on UC. A novel food ingredient, l-theanine, alters the gut microbiota, thereby regulating gut immunity. However, whether l-theanine prevents UC by altering the gut microbiota, as well as the underlying mechanisms, remains unknown. Here, l-theanine was used to optimize the gut microbiota and its metabolites. Furthermore, to explore the mechanism by which l-theanine prevents UC, an l-theanine fecal microbiota solution was used to prevent dextran sulfate sodium-induced UC via fecal microbiota transplantation. Improvements in the colonic structure, colon histology scores, immune factors (IL-10), and inflammatory factors (IL-1β) demonstrated the preventive effect of l-theanine on UC. The 16S rDNA and metabolomic results showed that tryptophan-, short chain fatty acid-, and bile acid-related microbiota, such as Muribaculaceae, Lachnospiraceae, Alloprevotella, and Prevotellaceae were the dominant. Flow cytometry results showed that l-theanine decreased helper T (Th)1 and Th17 immune responses, and increased Th2 and T-regulatory immune responses via regulation of antigen-presenting cell responses, such as dendritic cells and macrophages. Therefore, l-theanine regulated the immune response of colon CD4 + T cells to dendritic cell and macrophage antigen presentation via tryptophan-, short chain fatty acid-, and bile acid-related microbiota, thereby preventing dextran sulfate sodium-induced UC.

Case Report: Macrophage activation syndrome due to multifocal tuberculosis in an immunocompromised patient

Macrophage Activation Syndrome (MAS) is a serious and life-threatening complication defined by excessive immune activation. While it's commonly associated with rheumatic diseases, infections can also trigger MAS, with tuberculosis being a rare but significant cause. This case report discusses a rare occurrence of Macrophage Activation Syndrome (MAS) caused by multifocal tuberculosis in an immunocompromised patient with Crohn's disease receiving immunosuppressive treatment. The patient is a 26-year-old woman with Crohn's disease who is being treated with azathioprine. She arrived at the hospital battling persistent abdominal pain, overwhelming fatigue, and fever. Upon examination, splenomegaly and ascites were noted. A chest X-ray revealed bilateral pleural effusion consistent with tuberculosis. A CT scan confirmed the presence of pleural, pericardial, and intraperitoneal fluid. Blood tests indicated pancytopenia, hyperferritinemia, and hypofibrinogenemia. The analysis of ascitic fluid suggested an exudate. The PCR test of the bone marrow aspirate was positive for tuberculosis without rifampicin resistance, and the smear showed hemophagocytosis images. The patient was diagnosed with Macrophage Activation Syndrome secondary to multifocal tuberculosis. This report delves into the complex relationship between MAS and tuberculosis, emphasizing the challenges in diagnosing MAS in such cases and the potential link to tuberculosis. The complex diagnostic landscape of multifocal tuberculosis, which can often mimic malignancies, underscores the importance of promptly detecting and starting anti-tuberculosis interventions for improved clinical outcomes and the prevention of associated complications.

Development and Validation of Predictive Models for Inflammatory Bowel Disease Diagnosis: A Machine Learning and Nomogram-Based Approach

Background

Inflammatory bowel disease (IBD) is a chronic, incurable gastrointestinal disease without a gold standard for diagnosis. This study aimed to develop predictive models for diagnosing IBD, Crohn's disease (CD), and Ulcerative colitis (UC) by combining two approaches: machine learning (ML) and traditional nomogram models.

Methods

 Cohorts 1 and 2 comprised data from the UK Biobank (UKB), and the First Hospital of Jilin University, respectively, which represented the initial laboratory tests upon admission for 1135 and 237 CD patients, 2192 and 326 UC patients, and 1798 and 298 non-IBD patients. Cohorts 1 and 2 were used to create predictive models. The parameters of the machine learning model established by Cohorts 1 and 2 were merged, and nomogram models were developed using Logistic regression. Cohort 3 collected initial laboratory tests from 117 CD patients, 197 UC patients, and 241 non IBD patients at a tertiary hospital in different regions of China for external testing of three nomogram models.

Results

For Cohort 1, ML-IBD-1, ML-CD-1 and ML-UC-1 models developed using the LightGBM algorithm demonstrated exceptional discrimination (ML-IBD-1: AUC = 0.788; ML-CD-1: AUC = 0.772; ML-UC-1: AUC = 0.841). For Cohort 2, ML-IBD-2, ML-CD-2, and ML-UC-2 models developed using XGBoost and Logistic Regression algorithms demonstrated exceptional discrimination (ML-IBD-2: AUC = 0.894; ML-CD-2: AUC = 0.932; ML-UC-2: AUC = 0.778). The nomogram model exhibits good diagnostic capability (nomogram-IBD: AUC=0.778, 95% CI (0.688-0.868); nomogram-CD: AUC=0.744, 95% CI (0.710-0.778); nomogram-UC, AUC=0.702, 95% CI (0.591-0.814)). The predictive ability of the three models was validated in cohort 3 (nomogram-IBD: AUC=0.758, 95% CI (0.683-0.832); nomogram-CD: AUC=0.791, 95% CI (0.717-0.865); nomogram-UC, AUC=0.817, 95% CI (0.702-0.932)).

Conclusion

This study utilized three cohorts and developed risk prediction models for IBD, CD, and UC with good diagnostic capability, based on conventional laboratory data using ML and nomogram.

Risk factors for enteral nutrition-associated diarrhea in older patients with severe traumatic brain injury: a retrospective cohort study

BACKGROUND

Severe traumatic brain injury (STBI) is one of the major causes of death and disability worldwide. The incidence and risk factors of enteral nutrition (EN)-associated diarrhea in older patients with STBI remain unclear.

METHODS

A cohort of adult STBI patients were retrospectively studied. The patients were stratified into an older group (≥ 65years) and a young group (< 65 years). All patients received EN for at least 48 h. Demographic, clinical and nutritional data were collected for analysis. We utilize multiple logistic regression models to evaluate predictors of diarrhea.

RESULTS

Among 292 patients with STBI aged 60.38 ± 14.89 years (mean ± standard deviation), 114 cases developed diarrhea, with an incidence of 39.04%. Older patients had a higher incidence of diarrhea than young patients (46.77% vs 33.33%, p = 0.020). Three variables were found to be significantly associated with diarrhea in young STBI patients. In contrast, five variables were significantly associated with this complication in older STBI patients, including acute physiology and chronic health evaluation II score (adjusted OR 1.134, 95% CI 1.019-1.272, p = 0.025), high-fat energy (adjusted OR 1.221, 95% CI 1.055-1.789, p = 0.025), EN duration (adjusted OR 1.105, 95% CI 1.005-1.223, p = 0.044), antibiotics total defined daily dose (DDDs) (adjusted OR 1.076, 95% CI 1.029-1.211, p = 0.039) and tube feeding of potassium (adjusted OR 2.525, 95% CI 1.031-6.450, p = 0.046).

CONCLUSIONS

Enteral nutrition-associated diarrhea was prevalent among STBI patients. Older STBI patients had a higher incidence of diarrhea and more risk factors than young patients. Early management of modifiable risk factors may help reduce the incidence of diarrhea.

How Does Inflammatory Bowel Disease Impact Outcomes and Costs of Care Following Primary 1- to 2-level Lumbar Fusion for Degenerative Lumbar Disease?

STUDY DESIGN

Retrospective study.

OBJECTIVE

The purpose of this study was to determine whether IBD in patients with degenerative lumbar changes undergoing primary 1-2LF is associated with higher rates of (1) in-hospital length of stay, (2) medical complications, (3) readmissions, and (4) costs of care.

SUMMARY OF BACKGROUND DATA

In the United States, the prevalence of inflammatory bowel disease (IBD) has increased concurrently with an aging population with degenerative disk changes. In these patients, primary 1- to 2-lumbar fusion (1-2LF) is a common procedure to resolve serious complications of the spine. Studies comparing these patient demographics to hospital lengths of stay, postoperative complications, readmission rates, and costs of care are limited in the literature.

METHODS

The inclusion criteria consisted of patients with IBD who underwent 1-2LF, using a 90-day surveillance period, postoperatively. This 90-day surveillance period was used to measure the length of hospital stay, rates of medical complications, rates of readmissions, and overall costs of care. The IBD cohort was matched against a case-matched cohort group.

RESULTS

Patients in the study group had significantly longer in-hospital lengths of stay. In addition, patients in the study group had significantly higher incidence and odds of developing postoperative medical complications within 90 days. Also, study group patients had significantly higher readmission rates. Finally, patients in the study group had significantly higher costs of care than their case-matched cohort.

CONCLUSIONS

This study demonstrated that patients with IBD and degenerative lumbar disease are burdened with longer in-hospital lengths of stay, rates of postoperative medical complications, rates of readmission, and costs of care after undergoing primary 1-2LF.

Association of Dietary Inflammation Index with sarcopenia in adult women with nonalcoholic fatty liver disease: based on the National Health and Nutrition Examination Survey Database

BACKGROUND

A higher Dietary Inflammatory Index (DII) is linked with an elevated risk of sarcopenia, but the relationship between the two in adult female patients with nonalcoholic fatty liver disease (NAFLD) remains uncertain.

OBJECTIVE

The project was designed to probe into the relationship between DII and the risk of sarcopenia in adult female NAFLD patients.

METHODS

As a cross-sectional study, this study used NAFLD data for adult women from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES) Database, with DII as the independent variable and sarcopenia as the dependent variable. The relationship between DII and sarcopenia was examined by utilizing weighted logistic regression. Restricted cubic splines (RCS) and threshold effect models were further employed to explore the nonlinear relationship between the two.

RESULTS

We included 469 NAFLD patients, of whom 65 (10.2%) were sarcopenic. In adult female NAFLD patients, a great positive correlation of DII with the risk of sarcopenia was observed in the weighted logistics regression model [odds ratio (OR): 1.459, 95% confidence interval (CI): 1.013-2.103, P  = 0.045]. The RCS curve manifested a linear correlation between the two ( Pnonlinear  = 0.751). The threshold analysis demonstrated that when DII > 0, DII was positively linked with an elevated risk of sarcopenia (OR: 1.328, 95% CI: 1.030-1.722, P  = 0.030).

CONCLUSION

In adult female NAFLD patients, DII is positively linked with the risk of sarcopenia. Future research should further explore the mechanism of influence of DII on sarcopenia in NAFLD patients and evaluate whether improving eating habits can effectively reduce the occurrence of sarcopenia in women with NAFLD.

Prevention and management of enteral nutrition-related diarrhea among adult inpatients: a best practice implementation project

INTRODUCTION

Diarrhea, the most common complication for patients during enteral nut. rition, poses a range of risks and care burdens. Medical staff are aware of the importance of proactively preventing and managing enteral nutrition-related diarrhea. However, clinical prevention and management methods are not standardized, and the scientific basis and effectiveness of these methods need to be further verified.

OBJECTIVES

This project aimed to promote evidence-based practices for the prevention and management of enteral nutrition-related diarrhea among adult inpatients in a public tertiary hospital in China.

METHODS

This project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tools. Twelve audit criteria were developed to conduct a baseline audit to measure compliance with best practices. A barrier analysis was conducted, and strategies were implemented to overcome the barriers. The project was finalized with a follow-up audit to determine any changes in compliance with best practices.

RESULTS

The overall compliance rate for the audit criteria increased from 27.37% at baseline to 89.62% in the follow-up audit, with six criteria achieving a compliance rate of 100%.

CONCLUSIONS

The implementation of evidence-based practices can effectively narrow the gap between current practice and best practice. This project improved the ability of medical staff to prevent and manage enteral nutrition-related diarrhea, as well as promoting evidence-based practice in the hospital.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A168.

Disentangling the nutrition-microbiota liaison in inflammatory bowel disease

Inflammatory Bowel Disease (IBD) is a set of chronic intestinal inflammatory disorders affecting the gastrointestinal (GI) tract. Beside compromised intestinal barrier function and immune hyperactivation, a common IBD feature is dysbiosis, characterized by a reduction of some strains of Firmicutes, Bacteroidetes, Actinobacteria and an increase in Proteobacteria and pathobionts. Emerging evidence points to diet and nutrition-dependent gut microbiota (GM) modulation, as etiopathogenetic factors and adjuvant therapies in IBD. Currently, no nutritional regimen shows universal efficacy, and advice are controversial, especially those involving restrictive diets potentially resulting in malnutrition. This review provides an overview of the role of macronutrients, dietary protocols and GM modulation in IBD patients. A Western-like diet contributes to an aberrant mucosal immune response to commensal bacteria and impairment of the intestinal barrier integrity, thereby triggering intestinal inflammation. Conversely, a Mediterranean nutritional pattern appears to be one of the most beneficial dietetic regimens able to restore the host intestinal physiology, by promoting eubiosis and preserving the intestinal barrier and immune function, which in turn create a virtuous cycle improving patient adherence to the pattern. Further clinical studies are warranted, to corroborate current IBD nutritional guidelines, and develop more accurate models to move forward precision nutrition and ameliorate patients' quality of life.

Perspectives in clinical research on Azathioprine for steroid-dependent ulcerative colitis

This study explores the application of Azathioprine in the treatment of ulcerative colitis (UC) and the challenges associated with its long-term use. While short-term studies demonstrate the efficacy of Azathioprine in steroid-dependent UC, long-term data on its risks, including malignancies, infections, and chronic toxicity, remain insufficient. Furthermore, the impact of Azathioprine on patients' quality of life over extended periods is still unclear. The research highlights the importance of optimizing Azathioprine dosing based on genomic data, particularly through TPMT and NUDT15 genotyping, to minimize adverse effects. However, further research is needed to develop individualized treatment strategies that can improve efficacy and reduce toxicity. The identification of predictive biomarkers, through genomics and proteomics, is likely to play a crucial role in improving treatment precision by identifying patients who are most likely to benefit from Azathioprine therapy. Additionally, combining Azathioprine with biologic therapies (such as anti-TNF agents or integrin inhibitors) and interventions targeting the gut microbiome may enhance the drug's effectiveness while reducing reliance on steroids. Overall, large-scale clinical trials are urgently needed to evaluate the benefits and risks of these emerging therapies, ultimately supporting more personalized treatment approaches for steroid-dependent UC patients.

Current and emerging strategies for the prevention of hepatocellular carcinoma

Liver cancer is the third leading cause of cancer-related deaths globally, with incident cases expected to rise from 905,700 in 2020 to 1.4 million by 2040. Hepatocellular carcinoma (HCC) accounts for about 80% of all primary liver cancers. Viral hepatitis and chronic excessive alcohol consumption are major risk factors for HCC, but metabolic dysfunction-associated steatotic liver disease is also becoming a dominant cause. The increasing numbers of cases of HCC and changes in risk factors highlight the urgent need for updated and targeted prevention strategies. Preventive interventions encompass strategies to decrease the burden of chronic liver diseases and their progression to HCC. These strategies include nutritional interventions and medications that have shown promise in preclinical models. Although prevailing approaches focus on treating chronic liver disease, leveraging a wider range of interventions represents a promising area to safeguard at-risk populations. In this Review, we explore existing evidence for preventive strategies by highlighting established and potential paths to reducing HCC risk effectively and safely, especially in individuals with chronic liver diseases. We categorize the preventive strategies by the mechanism of action, including anti-inflammatory, antihyperglycaemic, lipid-lowering, nutrition and dietary, antiviral, and antifibrotic pathways. For each category, we discuss the efficacy and safety information derived from mechanistic, translational, observational and clinical trial data, pinpointing knowledge gaps and directions for future research.

Exploring the potential active components and mechanisms of Tetrastigma hemsleyanum against ulcerative colitis based on network pharmacology in LPS-induced RAW264.7 cells

ETHNOPHARMACOLOGICAL RELEVANCE

Ulcerative colitis (UC) is a chronic form of inflammatory bowel disease, which current treatments often show limited effectiveness. Ferroptosis, a newly recognized form of programmed cell death has been implicated in UC pathogenesis, suggesting that it may be viable therapeutic target. Tetrastigma hemsleyanum (TH) has shown potential anti-UC effects, though it is unclear whether its therapeutic benefits are mediated by ferroptosis.

AIM OF THE STUDY

This study investigated the involvement of ferroptosis in the therapeutic effects of TH and identified key active components and pathways of TH against UC.

MATERIALS AND METHODS

The ethyl acetate extract of TH (TH_E) was found to be the most effective anti-inflammatory extract compared with the petroleum ether extract (TH_P), n-butanol extract (TH_N), and water-soluble extract (TH_W). TH_E's components were identified using UHPLC-MS/MS, ADME parameters, and network pharmacology. Additionally, TH_E's effects on ferroptosis were evaluated in an LPS-induced RAW264.7 cell model.

RESULTS

TH_E exhibited the strongest anti-inflammatory activity among four extracts. 10 compounds (Linolenic acid; Apigenin; Protocatechualdehyde; Asiatic acid; Quercetin; Isorhamnetin; Kaempferol; Azelaic acid; Oleic Acid; Palmitic acid) were selected from SwissADME database. Then a total of 281 targets for these 10 compounds and 1330 UC-related targets were identified from different database. Isorhamnetin was selected as the most promising anti-inflammatory component among 10 components. Furthermore, enrichment analysis revealed that ferroptosis was involved in UC development, with both TH_E and isorhamnetin exhibited inhibition of ferroptosis. Finally, isorhamnetin's anti-ferroptosis effects were linked to the Keap1/Nrf2/HO-1 pathway.

CONCLUSIONS

The results demonstrate that TH_E and isorhamnetin alleviate LPS-induced UC through restraining ferroptosis. Moreover, isorhamnetin's anti-UC properties are mediated by inhibiting ferroptosis via activation of the Keap1/Nrf2/HO-1 axis.

A cross-sectional study of risk factors associated with sarcopenia in patients with metabolic dysfunction-associated steatotic liver disease

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic liver disease linked to several adverse health consequences that include metabolic disturbances affecting skeletal muscle. Sarcopenia, characterized by skeletal muscle loss, is commonly observed in individuals with MASLD. Our study aimed to identify modifiable lifestyle factors associated with sarcopenia in patients with MASLD.

Methods

This study was a cross-sectional study that was conducted in three clinics in Nablus. A total of 162 adults diagnosed with MASLD were recruited for the study. The patients were interviewed and instructed to provide the necessary information, such as sociodemographic factors, medical and surgical history, lifestyle information, MASLD-related data, and nutritional and functional status. Sarcopenia was defined using the Foundation for the National Institutes of Health (FNIH) criteria, which includes the weight-adjusted skeletal muscle index (wSMI) with the cut-off scores (male subjects: 35.7% and female subjects: 30.7%). Statistical analysis was conducted using SPSS v.21. A chi-squared or independent samples t-test was utilized to identify the factors linked to sarcopenia in the study sample.

Results

Our data found that 44% of MASLD patients had sarcopenia. This condition was significantly associated with female gender (p < 0.0001), older age (p < 0.0001), presence of chronic diseases (p < 0.035), and medication use (p < 0.05). Regarding nutritional factors, sarcopenia had a significant association with obesity, a higher body fat percentage, a high waist-to-hip ratio, a low mid-upper arm circumference, and a reduced calf circumference (p < 0.001). Sarcopenic individuals often exhibit reduced handgrip strength. Lifestyle factors such as a history of smoking and the type of smoking were found to be positively associated with sarcopenia (p < 0.0001).

Conclusion

Sarcopenia was prevalent in the study population and was linked to modifiable risk factors that can be managed to reduce its progression. Future research using different study designs, such as longitudinal design, is recommended to identify the determinants of sarcopenia. Intervention studies are also required to improve the nutritional and functional status of MASLD patients.

Network pharmacology and experimental verification in vivo reveal the mechanism of Zhushao Granules against ulcerative colitis

BACKGROUND

Zhushao Granules (ZSG) had exhibited beneficial effects in the treatment of ulcerative colitis (UC) as an effective herbal prescription in Traditional Chinese Medicine. However, the underlying anti-inflammatory mechanism of ZSG remains unclear. This study aimed to decipher the mechanism of ZSG against UC combining network pharmacology and animal-based experiments.

METHODS

Network pharmacology was employed to identify active components and therapeutic targets of ZSG against UC. The protein-protein interaction (PPI) network was constructed among the therapeutic targets using the STRING database, and GO and pathway analyses were carried out using DAVID. Then, the "herb-component-target-pathway" network based on therapeutic targets was established and the topological parameters were subsequently calculated to identify hub active components, targets and pathways by Cytoscape. Finally, the therapeutic function and the special pathway of ZSG against UC were validated using a TNBS-induced UC model in BABL/c mice.

RESULTS

Ninety-four active components of ZSG and 460 potential targets were acquired from the Encyclopedia of Traditional Chinese Medicine and Tradition Chinese Medicine Systems Pharmacology Database and Analysis Platform. 884 potential targets of UC were obtained from OMIM and HINT. Sixty-two overlapping potential targets were identified as therapeutic targets of ZSG against UC. PPI network filtered out 61 therapeutic targets. GO and pathway analyses extracted 48, 25, and 98 terms corresponding to biological processes, molecular functions and Reactome pathways, respectively. Enrichment analysis suggested that the therapeutic targets were mainly involved in immune regulation, especially RIP-mediated NF-κB activation via ZBP1. Topological analysis of the "herb-component-target-pathway" network recognized 9 hub components, 20 hub targets and 18 hub pathways. The animal-based experiments revealed that ZSG ameliorated symptoms and histological changes in TNBS-induced colitis by significantly inhibiting the ZBP1/RIP/NF-κB pathway.

CONCLUSIONS

ZSG might alleviate the mucosal damage and ameliorate colitis via targeting ZBP1/RIP/NF-κB pathway, which laid the theoretical foundation for the clinical application and further study of ZSG and provided new insights into UC treatment.

Prospective Evaluation of Serum Free Thiols in Inflammatory Bowel Disease: A Candidate to Replace C-Reactive Protein for Disease Activity Assessment?

BACKGROUND

Serum free thiols (SFTs) reflecting oxidative stress appear to correlate with inflammatory bowel disease (IBD) activity. We aimed to evaluate the performance of SFTs concentrations vs endoscopic and histological activity, compare SFTs with established biomarkers, and identify clinical and laboratory parameters independently associated with SFT levels in IBD patients.

METHODS

Patients with confirmed IBD undergoing routine ileocolonoscopy for activity assessment were prospectively recruited, with serum samples obtained concurrently for SFTs and routine bloods, plus fecal calprotectin and immunochemical tests were collected ±30 days from ileocolonoscopy. Endoscopic activity was assessed via established indices and histological activity graded as inactive/mild/moderate. Receiver-operating characteristic curve analyses were utilized to assess performance of SFTs vs endoscopic activity, and multiple regression analysis was used to identify factors associated with SFT levels.

RESULTS

A total of 141 (80 Crohn's disease, 61 ulcerative colitis) patients were recruited. Median SFTs were significantly lower in moderate vs inactive/mild endoscopic activity (309 µM vs 433/471 µM, respectively; P < .01). There was no significant difference in median SFTs across inactive/mild/moderate histological activity. SFTs achieved higher sensitivity than C-reactive protein in predicting moderate, endoscopically active disease (89% vs 78%; area under the curve, 0.80 each) yet was outperformed by fecal calprotectin (100%; area under the curve, 0.93). Advancing age and increasing albumin levels were independently associated with SFT levels, and thus are possible confounders.

CONCLUSIONS

This prospective study has demonstrated the potential of SFTs as a serum biomarker in IBD. It was more sensitive than C-reactive protein, yet less sensitive than fecal biomarkers for prediction of endoscopically active IBD.

US National Estimates of Contemporary Mortality Rates in Patients With Ulcerative Colitis Undergoing Colectomy

INTRODUCTION

Despite a growing armamentarium of medical therapies for ulcerative colitis, colectomy remains an important therapeutic option. To better inform shared decision-making about surgery, we estimated the contemporary risk of mortality after colectomy.

METHODS

Mortality rates were estimated using the National Inpatient Sample (2016-2020). Factors associated with postcolectomy death were evaluated in multivariable regression.

RESULTS

Postcolectomy mortality occurred in 1.2% (95% CI: 0.8%, 1.9%) of hospitalizations. Comorbidity burden, emergent laparotomy, and delays to surgery >5 days after admission were associated with mortality.

DISCUSSION

Colectomy may be associated with mortality; however, this risk is heterogeneous based on patient- and procedural-related factors.

Fasting in combination with the cocktail Sorafenib:Metformin blunts cellular plasticity and promotes liver cancer cell death via poly-metabolic exhaustion

PURPOSE

Dual-Interventions targeting glucose and oxidative metabolism are receiving increasing attention in cancer therapy. Sorafenib (S) and Metformin (M), two gold-standards in liver cancer, are known for their mitochondrial inhibitory capacity. Fasting, a glucose-limiting strategy, is also emerging as chemotherapy adjuvant. Herein, we explore the anti-carcinogenic response of nutrient restriction in combination with sorafenib:metformin (NR-S:M).

RESULTS

Our data demonstrates that, independently of liver cancer aggressiveness, fasting synergistically boosts the anti-proliferative effects of S:M co-treatment. Metabolic and Cellular plasticity was determined by the examination of mitochondrial and glycolytic activity, cell cycle modulation, activation of cellular apoptosis, and regulation of key signaling and metabolic enzymes. Under NR-S:M conditions, early apoptotic events and the pro-apoptotic Bcl-xS/Bcl-xL ratio were found increased. NR-S:M induced the highest retention in cellular SubG1 phase, consistent with the presence of DNA fragments from cellular apoptosis. Mitochondrial functionality, Mitochondrial ATP-linked respiration, Maximal respiration and Spare respiratory capacity, were all found blunted under NR-S:M conditions. Basal Glycolysis, Glycolytic reserve, and glycolytic capacity, together with the expression of glycogenic (PKM), gluconeogenic (PCK1 and G6PC3), and glycogenolytic enzymes (PYGL, PGM1, and G6PC3), were also negatively impacted by NR-S:M. Lastly, a TMT-proteomic approach corroborated the synchronization of liver cancer metabolic reprogramming with the activation of molecular pathways to drive a quiescent-like status of energetic-collapse and cellular death.

CONCLUSION

Altogether, we show that the energy-based polytherapy NR-S:M blunts cellular, metabolic and molecular plasticity of liver cancer. Notwithstanding the in vitro design of this study, it holds a promising therapeutic tool worthy of exploration for this tumor pathology.

Intestinal mucus barrier: A potential therapeutic target for IBD

Intestinal mucus, a viscoelastic medium with mucin2 (MUC2) as its main component, covers the surface of intestinal epithelial cells and protects the intestine from invasion, forming the first barrier of the intestinal tract. Unlike the small intestine, where the mucus layer is a single layer, the colonic mucus layer can be divided into a sterile inner layer and an outer layer with bacterial colonization. Many of the substances in the mucus layer have beneficial effects on the intestinal epithelium, but the mucus layer is often affected by a variety of factors, mainly microbiological, dietary, and immunological. Inflammatory bowel disease (IBD) is a disease of increasing morbidity worldwide, with a complex etiology and a high relapse rate. In recent years, the mucus barrier in IBD has received increasing attention and is considered a key factor in the pathogenesis of IBD. Loss of goblet cells (GCs) and changes in the composition and properties of the mucus layer material are commonly found in the colon of IBD patients. Damage to the mucus layer may make it easier for microorganisms to access the intestinal epithelium and cause inflammation. There are currently a number of herbs and other therapies that can be used to treat IBD and repair the damaged mucus barrier. This review highlights the important role of the mucus layer in IBD and the therapies that target the mucus layer in IBD.

Inadequate Therapy Response on Advanced Therapy in Ulcerative Colitis Adult Patients: A Retrospective Analysis of German Health Claims Data

BACKGROUND

The treatment landscape for active ulcerative colitis is rapidly evolving and current real-world evidence on response to advanced therapy is limited. This study aimed to determine indicators of inadequate therapeutic response among patients with ulcerative colitis in Germany initiating advanced therapy.

METHODS

This retrospective analysis used German claims data (2015-2022) from adult patients (≥ 18 years). The prevalence and incidence of ulcerative colitis (ICD-10-GM: K51.X) were estimated. Inadequate response to therapy was evaluated in patients initiating advanced therapy based on eight predefined indicators observed for 12 months following dispensation of index treatment.

RESULTS

Mean ulcerative colitis patient age in 2016-2022 ranged from 49.6 to 51.5 years, 47.6%-48.3% were female. Administrative prevalence ranged from 0.45% in 2016 to 0.53% in 2022. The number of patients initiating advanced treatment ranged from 157 to 347 across the study years (3.2%-4.9% of overall treated study population). On average from 2016-2021, 78.8% had inadequate response in the 12 months following index treatment. Common indicators included prolonged use of corticosteroids (46.2%) and augmentation with conventional therapies (43.9%).

CONCLUSIONS

Adult ulcerative colitis patients showed a high prevalence of inadequate response to advanced therapies. Our findings reveal a need for improved UC advanced therapy options, providing insight into inadequate response patterns. This may help identify patients who could benefit from a change in therapy to improve long-term outcomes.

Is There Any Association Between Fat Body Mass and Bone Mineral Density in Patients with Crohn's Disease and Ulcerative Colitis?

Background: The study aimed to investigate the association between fat body mass and bone mineral density (BMD) of the lumbar spine (L1-L4), femoral neck, and total body. Methods: We studied 95 patients with Crohn's disease (CD), 68 with ulcerative colitis (UC), and 40 healthy adults (control group-CG) aged 18-50 years old. The BMD of lumbar spine and femoral neck was assessed as well as body composition. Results: A lower fat mass percentage was observed in about 8% of CD, 13% of UC, and 3% of CG. An increased percentage of fat mass was common, and occurred above 50% of CD, 40% of UC, and about 60% of CG. Body fat mass and fat mass percentage were significantly lower among UC compared with the CG (p-value < 0.001) and CD (p-value < 0.01) in women. Body fat mass correlated positively with the BMD and T-score of L1-L4 and total body mass in men with UC. We found a positive correlation between the fat body mass and BMD and T-score of L1-L4, femoral neck, and total body in women with IBD. Among CG, positive correlations occurred between the fat body mass and BMD of L1-L4, BMD of total body, and T-score of total body, but only in men. CRP (C-reactive protein) correlated negatively with fat body mass only in men with CD. Conclusions: A higher fat mass percentage is common among IBD patients and healthy adults despite a normal body mass index. Body fat mass is a predictor of nutritional status and likely influences the course of the disease, as it correlated positively with BMD, T-score, and Z-score. The association between fat tissue and bone health appears to be stronger in women. Further studies are needed to investigate additional factors that may affect bone health in IBD.

A Parasite That Should not be Neglected in Patients with Ulcerative Colitis: Entamoeba histolytica

Objective

To determine the prevalence of amoebiasis, which has been neglected in recent years according to the World Health Organization, in ulcerative colitis patients and investigate the relationship between amoebiasis and ulcerative colitis.

Methods

The study included 150 individuals, including 100 ulcerative colitis patients and 50 healthy individuals without gastrointestinal complaints. The samples collected were first analyzed macroscopically and then using native-Lugol, trichrome staining, and enzyme-linked immunosorbent assay (ELISA).

Results

In the microscopic examination, Entamoeba spp. cysts were found in 22% of the ulcerative colitis patients and 2% of those in the control group. Entamoeba histolytica (E. histolytica) adhesin antigen was detected by ELISA in 31% of the ulcerative colitis patients and 4% of those in the control group. A significant correlation was found between the incidence of E. histolytica and ulcerative colitis in the statistical evaluation.

Conclusion

E. histolytica should not be neglected in ulcerative colitis patients and should be investigated in the presence of diarrhea, bloody diarrhea, and abdominal pain.

Review Article: Green Management of IBD-New Paradigms for an Eco-Friendly Approach

BACKGROUND

The worldwide prevalence of inflammatory bowel disease (IBD) is increasing, with its potential evolution as a global disease and a consequent increase in its burden on healthcare systems. These estimates do not factor in the 'real' price of IBD, which, beyond curbing career aspirations, instilling social stigma, and impairing the quality of life in patients, could also significantly affect the environment.

AIM

To highlight potential areas for intervention and develop management strategies aimed at minimising environmental impacts in the field of IBD over time.

METHODS

Various aspects of IBD care (organisation of IBD centres, diagnostics and therapeutics) are examined from an environmental sustainability perspective.

RESULTS

Each stage, from the patient's means of transport to the hospital to the physician's diagnostic and therapeutic decisions, contribute to CO2 and waste production. Strategies to contain the environmental impact are feasible. Some are easy to implement, such as ensuring the appropriateness of the diagnostic and therapeutic pathway for patients; others need to be implemented in synergy with healthcare providers' policies and pharmaceutical companies.

CONCLUSIONS

With an inevitable increase in the number of patient visits, endoscopies, laboratory testing, and long-term therapeutic strategies for IBD, the clinical community should be aware of environmental concerns and investigate possible strategies to reduce the environmental impact of IBD care.

Hepatobiliary manifestations of inflammatory bowel disease in Saudi Arabia: A retrospective analysis

OBJECTIVES

To evaluate the features and frequency of hepatobiliary diseases in individuals with Inflammatory bowel disease (IBD).

METHODS

This retrospective study included all IBD patients at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. The primary focus was on the prevalence of hepatobiliary diseases, such as primary sclerosing cholangitis (PSC), non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis (AIH), and others. The secondary focus was identifying predictors of these hepatobiliary manifestations in IBD patients. Associations were analyzed using simple and multiple logistic regression analyses.

RESULTS

Among a total of 885 patients with IBD patients, 4.3% presented with hepatobiliary manifestations. Of these cases, 31.6% were linked to Crohn's disease (CD). While 65.8% were associated with ulcerative colitis (UC). Primary sclerosing cholangitis (PSC) was most prevalent, especially in females. PSC was linked to specific IBD sites 39.3% of UC patients have the left-sided disease and 10.7% of patients with ileocolonic CD had PSC. The absence of comorbidities was associated with lower odds of developing PSC, while UC diagnosis, adalimumab use, and infliximab use were associated with higher odds of developing PSC.

CONCLUSION

A small percentage of IBD patients experience hepatobiliary complications, with PSC being the most prevalent. The study emphasizes the importance of closely monitoring IBD patients, especially those undergoing anti-TNF therapy.

Primary Biliary Cholangitis Associated with Ulcerative Colitis: Case Series and Literature Review

Purpose: To study the coexistence of ulcerative colitis (UC) and primary biliary cholangitis (PBC). Methods: The Beijing Friendship Hospital patient database was explored to identify patients presenting both UC and PBC from January 2015 to July 2024. By a review of the literature, the characteristics of UC patients who experienced PBC was summarized. Results: We identified 890 UC patients and reported 4 individuals who suffered from UC and PBC. Compared to the general population, UC patients seem to have a higher risk of PBC. Only 28 cases of UC with PBC have been reported so far. Most patients were diagnosed with UC prior to PBC. Once UC patients are complicated with PBC, they might experience more than one extraintestinal manifestation (EIM). Shared susceptibility genes, certain bacterial infections, and common immune-mediated mechanisms may be involved in the pathogenesis of UC patients with PBC. Conclusions: Although the coexistence of UC and PBC is uncommon, PBC should be considered in UC patients with hepatobiliary disorders.

The Health Effects of Dietary Nitrate on Sarcopenia Development: Prospective Evidence from the UK Biobank

Nitrate is abundant in natural foods, especially plant-based foods, having the potential to enhance muscle function. However, its relationship with sarcopenia in the context of daily diet remains unexplored. This cohort study investigated the associations between dietary nitrate intake and sarcopenia, as well as related symptoms, using data including 28,229 participants with a mean follow-up of 9.37 years from the UK Biobank. Dietary nitrate intake was estimated using a comprehensive nitrate food database. Adjusted logistic regression models suggested potential inverse associations between total nitrate intake and risks of sarcopenia plus pre-sarcopenia (Sarc-Presarc), low hand grip strength (HGS), and low walking pace. Similar results were primarily observed for nitrate from plant-based foods. With higher intake, females appeared to have higher HGS and a decreased risk of Sarc-Presarc, while males exhibited a reduced risk of low walking pace. The inverse association between nitrate intake and low skeletal muscle mass index was more evident in individuals aged 65 and above. These associations seemed independent of antioxidants, though higher antioxidants might augment the protective effect against low walking pace. Mediation analyses indicated that protein homeostasis and blood pressure might mediate these associations. These findings suggested that a higher dietary nitrate intake from plant-based foods could contribute to sarcopenia prevention, though further research is needed to confirm these observations.

Diverting hepatic lipid fluxes with lifestyles revision and pharmacological interventions as a strategy to tackle steatotic liver disease (SLD) and hepatocellular carcinoma (HCC)

Steatotic liver disease (SLD) and Hepatocellular Carcinoma (HCC) are characterised by a substantial rewiring of lipid fluxes caused by systemic metabolic unbalances and/or disrupted intracellular metabolic pathways. SLD is a direct consequence of the interaction between genetic predisposition and a chronic positive energy balance affecting whole-body energy homeostasis and the function of metabolically-competent organs. In this review, we discuss how the impairment of the cross-talk between peripheral organs and the liver stalls glucose and lipid metabolism, leading to unbalances in hepatic lipid fluxes that promote hepatic fat accumulation. We also describe how prolonged metabolic stress builds up toxic lipid species in the liver, and how lipotoxicity and metabolic disturbances drive disease progression by promoting a chronic activation of wound healing, leading to fibrosis and HCC. Last, we provide a critical overview of current state of the art (pre-clinical and clinical evidence) regarding mechanisms of action and therapeutic efficacy of candidate SLD treatment options, and their potential to interfere with SLD/HCC pathophysiology by diverting lipids away from the liver therefore improving metabolic health.

Modulation of Inflammation Levels and the Gut Microbiota in Mice with DSS-Induced Colitis by a Balanced Vegetable Protein Diet

Inflammatory bowel disease (IBD) is a nonspecific chronic inflammatory disease of the intestine that is mainly divided into ulcerative colitis and Crohn's disease. Nutrients play important roles in the treatment of IBD. In this study, the effects of vegetable proteins on the regulation of IBD were explored via the amino acid scoring formula. Two diets with different amino acid scores, a balanced one and an imbalanced one, were assessed for their effects on acute colitis induced by dextran sodium sulfate (DSS). Pathological symptoms were evaluated by the disease activity index (DAI) and hematoxylin-eosin (H&E) staining, the expression of inflammatory factors and barrier proteins was determined via qPCR and western blotting, and the intestinal microbiota was examined via 16 S rRNA sequencing. The results indicated that the balanced vegetable protein diet (BVPD) relieved colitis by reducing the colonic histological score, inhibiting the expression of proinflammatory factors such as IL-1β, IL-6, and TNF-α and promoting the expression of tight junction proteins. Analysis of gut microbes revealed that the BVPD altered the structural composition of the intestinal flora in animals with DSS-induced colitis by increasing the abundance of beneficial bacteria (Lactobacillus, Bifidobacterium, etc.). In conclusion, a BVPD effectively relieves colitis and may be a promising adjuvant strategy for the treatment of IBD.

Integrating single-cell RNA-Seq and machine learning to dissect tryptophan metabolism in ulcerative colitis

BACKGROUND

Ulcerative colitis (UC) is a persistent inflammatory bowels disease (IBD) characterized by immune response dysregulation and metabolic disruptions. Tryptophan metabolism has been believed as a significant factor in UC pathogenesis, with specific metabolites influencing immune modulation and gut microbiota interactions. However, the precise regulatory mechanisms and key genes involved remain unclear.

METHODS

AUCell, Ucell, and other functional enrichment algorithms were utilized to determine the activation patterns of tryptophan metabolism at the UC cell level. Differential analysis identified key genes associated with tryptophan metabolism. Five machine learning algorithms, including Random Forest, Boruta algorithm, LASSO, SVM-RFE, and GBM were integrated to identify and categorize disease-specific characteristic genes.

RESULTS

We observed significant heterogeneity in tryptophan metabolism activity across cell types in UC, with the highest activity levels in macrophages and fibroblasts. Among the key tryptophan metabolism-related genes, CTSS, S100A11, and TUBB were predominantly expressed in macrophages and significantly upregulated in UC, highlighting their involvement in immune dysregulation and inflammation. Cross-analysis with bulk RNA data confirmed the consistent upregulation of these genes in UC samples, highly indicating their relevance in UC pathology and potential as targets for therapeutic intervention.

CONCLUSIONS

This study is the first to reveal the heterogeneity of tryptophan metabolism at the single-cell level in UC, with macrophages emerging as key contributors to inflammatory processes. The identification of CTSS, S100A11, and TUBB as key regulators of tryptophan metabolism in UC underscores their potential as biomarkers and therapeutic targets.

Small Intestinal Bacterial Overgrowth and Childhood Malnutrition: A Comprehensive Review of Available Evidence

The gut microbiome is essential for children's normal growth and development, with its formation aligning closely with key stages of growth. Factors like birth method, feeding practices, and antibiotic exposure significantly shape the composition and functionality of the infant gut microbiome. Small intestinal bacterial overgrowth (SIBO) involves an abnormal increase in bacteria within the small intestine. This overgrowth can interfere with digestion, impair nutrient absorption, and lead to both local and systemic inflammation, potentially contributing to malnutrition. In this review, we provide a comprehensive overview of the current understanding of the relationship between SIBO and malnutrition, with a particular focus on the pediatric population. SIBO seems to play an important role in nutrient malabsorption through the gut microbiome imbalance, local inflammation, and disruption of the mucosal intestinal barrier. Additionally, SIBO is more prevalent in digestive disorders linked to malabsorption and malnutrition. Different therapeutic strategies for addressing malnutrition-related SIBO have been proposed. While antibiotics are the primary treatment for SIBO, their effectiveness in promoting weight gain among malnourished children remains uncertain. Hence, future research directed at the impact of microbiome imbalance on nutrient intake and absorption could bring to light new strategies for the effective prevention and treatment of malnutrition.

Burden of liver steatosis and liver fibrosis in a large cohort of people living with HIV

BACKGROUND

Liver steatosis (LS) and liver fibrosis (LF) can increase the risk of cardiovascular disease in people with HIV, but their prevalence and associated factors are poorly understood. This study aimed to assess the prevalence of and factors associated with LS and LF in a large cohort of people with HIV.

METHODS

We conducted a cross-sectional study of consecutive people with HIV attending the Clinic of Barcelona from September 2022 to September 2023, excluding those with chronic B or/and C hepatitis virus coinfection. LS was assessed using the Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI), and LF was assessed using the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), Fibrosis-4 score (FIB-4), and the European AIDS Clinical Society (EACS) algorithm in both the whole cohort (cohort 1) and in a specific cohort more susceptible to liver disease (cohort 2). We identified independent variables associated with LS and LF using logistic regression.

RESULTS

Cohort 1 included 4664 people with HIV; 76% and 37% of them had available HSI and FLI data, LS was present in 28% and 19%, respectively. LF risk was present in 1%, 2%, and 1% of people with HIV according to NFS, FIB-4, and EACS algorithm scores, respectively. Cohort 2 included 1345 people with HIV; 60% and 30% of them had available HSI and FLI data, LS affected 55% and 43% and LF 2%, 5%, or 3%, respectively. Factors associated with LS included current CD4 cell count, diabetes, and hypertension, whereas LF was associated with previous exposure to dideoxynucleoside drugs and current CD4 to LF. Current integrase strand transfer inhibitor (INSTI) therapy appeared protective for LF in cohort 1.

CONCLUSIONS

In this study, one in four people with HIV had LS, and the prevalence rose to one in two in those with cardiovascular risk factors. The prevalence of LF was low, but it should be considered in older people with HIV with low CD4 counts or high aspartate transaminase levels. A possible protective effect from INSTIs deserves further investigation.

Liposomal nano-carriers mediated targeting of liver disorders: mechanisms and applications

Liver disorders present a significant global health challenge, necessitating the exploration of innovative treatment modalities. Liposomal nanocarriers have emerged as promising candidates for targeted drug delivery to the liver. This review offers a comprehensive examination of the mechanisms and applications of liposomal nanocarriers in addressing various liver disorders. Firstly discussing the liver disorders and the conventional treatment approaches, the review delves into the liposomal structure and composition. Moreover, it tackles the different mechanisms of liposomal targeting including both passive and active strategies. After that, the review moves on to explore the therapeutic potentials of liposomal nanocarriers in treating liver cirrhosis, fibrosis, viral hepatitis, and hepatocellular carcinoma. Through discussing recent advancements and envisioning future perspectives, this review highlights the role of liposomal nanocarriers in enhancing the effectiveness and the safety of liver disorders and consequently improving patient outcomes and enhances life quality.

The anticancer effect of metformin targets VDAC1 via ER-mitochondria interactions-mediated autophagy in HCC

Metformin (MetF) is used worldwide as a first-line therapy for type 2 diabetes. Recently, interest in the pleiotropic effects of MetF, such as its anticancer and antiaging properties, has increased. However, the molecular target of MetF and the detailed mechanism underlying its ability to inhibit cell growth through autophagy induction remain incompletely understood. In this study, using an innovative label-free drug affinity responsive target stability (DARTS)-LC-MS/MS method, we discovered that mitochondrial voltage-dependent anion channel 1 (VDAC1) is a novel binding protein involved in the induction of autophagy-related cell death by high-dose MetF in hepatocellular carcinoma (HCC). Computational alanine scanning mutagenesis revealed that MetF and VDAC1 (D9, E203) interact electrostatically. MetF disrupts the IP3R-GRP75-VDAC1 complex, which plays a key role in stabilizing mitochondria-associated ER membranes (MAMs), by binding to VDAC1. This disruption leads to increased cytosolic calcium levels, thereby contributing to autophagy induction. MetF also decreased the AMP/ATP ratio and activated the AMPK pathway. Cells with genetic knockdown of VDAC1 mimicked the activity of MetF. In conclusion, this study provides new insights into the involvement of MetF in ionic interactions with VDAC1, contributing to its anticancer effects in HCC. These findings help elucidate the diverse biological and pharmacological effects of MetF, particularly its influence on autophagy, as well as the potential of MetF as a therapeutic agent for diseases characterized by VDAC1 overexpression.

Assessment of Serum Dynamic Thiol/Disulfide Homeostasis and Oxidative/Nitrosative Stress in Patients with Crohn's Disease

Background/Aims

Crohn's disease (CD) is a major subtype of chronic relapsing inflammatory gastrointestinal disorders. In this study, we assessed the possible contributions of serum oxidative/nitrosative stress and dynamic thiol/disulfide homeostasis to CD pathogenesis.

Materials and Methods

Patients with active CD (A-CD) at onset (n = 38), CD patients in the remission (R-CD) (n = 38), and healthy controls (n = 38) were prospectively included in this study. Serum oxidative/nitrosative parameters as well as total thiol and native thiol levels were analyzed.

Results

We observed significant augmentation in nitric oxide (NO) levels in both A-CD and R-CD patients compared to healthy controls. We detected marked reductions in the 3-nitrotyrosine levels in the patient groups. Glutathione, glutathione peroxidase, and myeloperoxidase levels were observed to be significantly lower in both the active and remission groups (P < .001). In the A-CD group, native thiol (P < .001) and total thiol (P < .01) levels were lower, and disulfide levels were higher than those of the control group (P < .01), while the native thiol/total thiol ratio was reduced and disulfide/total thiol (P < .001) and disulfide/native thiol (P < .001) ratios were elevated. Remarkably, no change in dynamic thiol/disulfide homeostasis was found in the R-CD group.

Conclusion

Our results showed increased serum NO levels and decreased antioxidant enzymes, particularly during the active phase of CD. Determination of thiol/disulfide homeostasis could help differentiate between the active and remission phases of the disease. Thiol/ disulfide parameters can be used as biomarkers for A-CD.

Predictive factors for recording the death of women of childbearing age in the Hospital Information System (SIH/SUS), Brazil, 2012-2020

OBJECTIVE

To estimate the death registration coverage of women of childbearing age (WCA) in the Hospital Information System (SIH), according to the hospital of occurrence and to verify the predictors associated with coverage.

METHODS

Descriptive ecological study with public data from SIH, Mortality Information System (SIM) and National Registry of Health Establishments (CNES), 2012-2020. Deaths in WCA hospitalizations in SIH were compared to those in SIM. Coverage was calculated by the proportion of deaths in SIH in relation to SIM. Supervised classification models - decision tree and random forest - were used to identify hospital characteristics related to coverage.

RESULTS

WCA death registration coverage was estimated at 78.0 and 71.8% after excluding hospitals with >100% coverage. Lower coverage was observed in the North region (67.7%) and higher in the South (76.9%). There was an increase in coverage from 69.0% to 74.4% in the period examined. The main factors predicting coverage were urgency/emergency facility, administrative management level, hospital complexity, proportion of adult beds covered by SUS and teaching activity, with lower coverage in those with an urgency/emergency facility and greater coverage in those of higher complexity, in federal hospitals, those with teaching activity and higher proportion of adult beds covered by SUS. Flaws in the CNES registration were identified in SIM.

CONCLUSION

The coverage of WCA death registration in SIH in the country is high and growing. Regional differences reinforce the need for strategies to improve the quality of information systems.

Prevalence, Risk Factors and Association with Clinical Outcomes of Malnutrition and Sarcopenia in Inflammatory Bowel Disease: A Prospective Study

INTRODUCTION

The prevalences of malnutrition and sarcopenia in patients with IBD are not precisely known, and nutritional assessment is not standardized. We assessed the prevalence and risk factors of these conditions in outpatients and their impact on clinical outcomes.

METHODS

This prospective longitudinal study considered patients who had IBD for at least one year, were attending a tertiary IBD center, and were followed for the subsequent year.

RESULTS

In a sample of 158 consecutive patients (96 with Crohn's disease and 62 with ulcerative colitis), the prevalence of malnutrition, according to GLIM criteria, was 13.3%. For identifying patients at risk of malnutrition, the Malnutrition Universal Screening Tool demonstrated better accuracy, (sensitivity 88.9 (65.3-98.6) and specificity 90.2 (83.8-93.4)) than the SaskIBD-NR questionnaire (sensitivity 69.3 (41.1-86.7) and specificity 60.9 (60.9-76.8)). The prevalence of sarcopenia was 34.2%. Considering clinical outcomes, sarcopenia at baseline was significantly associated with hospital admission within a year (p = 45.2% vs. 20.3%, 0.026).

CONCLUSIONS

Malnutrition and sarcopenia were present in about one-third of IBD patients. Awareness should be raised among physicians caring for IBD patients about the need to evaluate patients' nutritional statuses to help patients achieve a better quality of life.

Microscopic messengers: microbiota-derived bacterial extracellular vesicles in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a persistent and complex condition accomplished by inflammation of the gastrointestinal system, encompassing Crohn's disease (CD) and ulcerative colitis (UC). This condition is caused by the combination of genetic predispositions, environmental triggers, and dysregulated immunological responses, which complicates diagnosis and treatment. The latest developments in gastroenterology have revealed the critical significance of the gut microbiota in the pathogenesis of IBD. Extracellular vesicles (EVs) are a type of microbial component that potentially regulate intestinal inflammation. The impact of microbiota-derived bacterial EVs (bEVs) on intestinal inflammation is mediated through several methods. They can intensify inflammation or stimulate defensive responses by delivering immunomodulatory cargo. Improved comprehension could enhance inventive diagnostic and treatment strategies for IBD. This study aimed to explore the relationship between microbiota-derived bEVs and the complex nature of IBD. We performed a thorough analysis of the formation, composition, mechanisms of action, diagnostic possibilities, therapeutic implications, and future prospects of these microbiota-derived bEVs.

Myosteatosis Evaluated Based on Intramuscular Adipose Tissue Content Is a Risk Factor for Postoperative Complications in Crohn's Disease

BACKGROUND

Crohn's disease causes acute and chronic inflammation that often make the preoperative evaluation of surgical risks difficult. Myosteatosis is used for the evaluation of muscle quality to assess sarcopenia. However, data on the relationship between myosteatosis and surgical outcomes in patients with Crohn's disease are lacking.

METHODS

Among patients with Crohn's disease who underwent surgery between 2007 and 2022, we investigated the impact of myosteatosis on postoperative complications using intramuscular adipose tissue content (IMAC). Our study included data from 97 patients who underwent analysis for cutoff values and factors associated with IMAC and 72 who underwent analysis for risk factors of postoperative complications.

RESULTS

Body mass index (BMI; P < .001) and visceral adipose tissue/height index (P < .001) were significantly correlated with IMAC. High BMI (P < .001) and a history of abdominal surgery for Crohn's disease (P = .012) were identified as factors affected with high IMAC. Multivariate analysis revealed high IMAC and external fistulas as independent risk factors for postoperative complications (odds ratio [OR], 5.010; 95% CI, 1.300-19.30; P = .019 and OR, 7.850; 95% CI, 1.640-37.50; P = .010, respectively), especially infectious complications.

CONCLUSIONS

This study established IMAC as a valuable marker for sarcopenic obesity and predicting postoperative complications in patients with Crohn's disease. Furthermore, evaluating myosteatosis using IMAC will facilitate the decision of the optimal timing of surgery, prediction of complications, and treatment of sarcopenia in patients with Crohn's disease.

Risk Factors for Gallstones in Crohn's Disease: A Systematic Review and Meta-Analysis

BACKGROUND

Crohn's disease (CD) have an increased risk of gallstone disease. We aimed to systematically evaluate the prevalence rate and relevant risk factors of gallstones in CD patients.

METHODS

A comprehensive search of PubMed, Embase, and Web of Science databases from inception to September 10, 2023, identified studies investigating risk factors for gallstone development among CD patients. Gender, age, body mass index, disease duration, disease site, stenosis, prior surgery, hospitalization times, corticosteroids, immunomodulators, and total parenteral nutrition (TPN) were assessed as potential risk factors. Odds ratios (OR) and confidence intervals (CI) were calculated.

RESULT

Among 1184 articles, 11 observational studies (3588 patients) were included. The prevalence of CD patients with gallstones was approximately 14.7%. Factors significantly associated with increased gallstone risk included Age ≥ 40 years old (OR 3.06, 95% CI 2.09- 4.48), disease duration > 15 years (OR 3.01, 95% CI 2.06-4.42), lifetime surgery(OR 2.50, 95% CI 1.99-3.12), disease located in ileocolon (OR 1.38, 95% CI 1.04-1.83) and ileocecal(OR 1.93, 95% CI 1.16-3.21), multiple hospitalizations(OR 4.26, 95% CI 2.43-7.46), corticosteroid treatments(OR 2.65, 95% CI 1.52-4.63), immunomodulator therapy(OR 1.94, 95% CI 1.12-3.38), and TPN use(OR 2.66, 95% CI 1.29-5.51). Sex, stenosis, overweight, or low weight did not significantly increase the risk of gallstone developing.

CONCLUSION

Age, long disease duration, specific disease locations (ileocolon, ileocecal), surgery, number of hospitalizations, corticosteroids, immunomodulator therapy, and TPN were identified as factors that increased the risk of gallstones in CD patients. About 14.7% of CD patients experience gallstones, so raising awareness and implementing prevention are needed.

REGISTRATION

PROSPERO (CRD42023449299).

Experiences of caregivers of patients with traumatic brain injury during hospitalization in western China: A qualitative study

Family members frequently provide both physical and emotional support to patients. Previous studies have focused primarily on the experiences of patients with traumatic brain injury (TBI) and their caregivers during home care and the transition from hospital care to the community, with less emphasis on their experiences during acute hospital care immediately after TBI. This study aimed to explore the experiences of caregivers of patients with TBI during acute hospitalizations. A qualitative descriptive study using individual semistructured interviews was conducted at the trauma center of a tertiary hospital in western China. A purposive sample of 21 caregivers of patients with TBI were recruited. The interviews were conducted face to face in the inpatient ward from July to September 2023. Conventional content analysis was used to conduct the framework analysis. The experiences of caregivers were identified within three key themes: TBI consequences in patients (physical impairments, psychological distress, and cognitive dysfunctions), challenges of caregivers (physiological/emotional/economic burdens, conflicts, and concerns regarding recovery), and needs of caregivers (health information, medical services, and recovery expectations). This study highlights the experiences of caregivers of patients with TBI during hospital stays in western China. The challenges faced by caregivers and the needs of caregivers are multidimensional. Appropriate support should be provided to alleviate the burden of caregiving.

Waist-to-hip ratio and nonalcoholic fatty liver disease: a clinical observational and Mendelian randomization analysis

Background

Obesity often coincides with non-alcoholic fatty liver disease (NAFLD), yet a significant portion of NAFLD patients exhibit normal body mass index (BMI) but have abdominal obesity. Recognizing this discrepancy, we aimed to delve deeper into this phenomenon through observational studies coupled with two-sample Mendelian randomization (MR) analysis, with waist-to-hip ratio (WHR) serving as the indicator for abdominal obesity. Our objective was to ascertain whether WHR correlates with an increased risk of NAFLD development.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 to examine the association between WHR and NAFLD through weighted multivariate logistic regression models. On this basis, subgroup analyses were performed to further explore the correlation between WHR and NAFLD. Subsequently, a two-sample MR analysis was conducted using genome-wide association studies (GWAS) data to investigate the potential causal relationship between WHR and NAFLD. Sensitivity analyses were also employed to ensure the robustness of our findings.

Results

A total of 3,732 eligible participants were included in the analysis. Weighted multivariable-adjusted logistic regression models revealed a positive association between WHR and the risk of NAFLD (Q2vsQ1: OR = 1.94 [95% CI: 1.55-2.44]; Q3vsQ1: OR = 2.08 [95% CI: 1.51-2.85]; Q4vsQ1: OR = 3.70 [95% CI: 2.13-6.43], p < 0.05). The results of the subgroup analysis suggested that there was an interaction in the correlation between WHR and NAFLD in normal weight, overweight, and obese populations (p < 0.05). The RCS curves indicated that there was a nonlinear relationship between WHR and NAFLD in populations with BMI in the normal versus obese categories. Furthermore, MR analysis provided additional support for the causal relationship between WHR and NAFLD. Using inverse variance weighting (IVW), the MR analysis yielded an OR of 2.062 (95% CI: 1.680-2.531, p<0.05). Consistent results were obtained with the other four MR methods, all supporting the same direction of causality. Sensitivity analyses were performed to assess the robustness of the findings (p > 0.5), further reinforcing the reliability of the observed associations.

Conclusion

WHR elevation heightens the susceptibility to NAFLD.

Sarcopenia as a Risk Factor for Mortality in NAFLD: How Should We Diagnose It?

OBJECTIVES

Sarcopenia increases the risk of nonalcoholic steatohepatitis (NASH) and cirrhosis in patients with nonalcoholic fatty liver disease (NAFLD). Subsequently, poorly managed NAFLD can result in adverse health outcomes. Lifestyle interventions are effective for both NAFLD and sarcopenia; however, diagnosis of sarcopenia in this population is not well defined. This review aimed to examine current methods to diagnose sarcopenia in NAFLD patients.

METHODS

MEDLINE, EMBASE, and CINAHL databases were searched for articles published until July 2023 using the terms "Non-alcoholic fatty liver disease," "NAFLD," "fatty liver," "sarcopenia," and "myoatrophy." Studies were excluded if they included pediatric populations, did not diagnose both sarcopenia and NAFLD, or included patients with alternate causes of liver disease.

RESULTS

Twenty studies, predominantly from Asian countries (14 [70.0%]), involving 68 848 participants (45.5% females) were included. In 15 studies, most participants had a BMI > 25 kg/m2. Heterogeneity in the tools used to diagnose NAFLD was identified, with abdominal ultrasound being the most commonly used. European, Asian, and Australasian Sarcopenia Working Groups had differing diagnostic definitions of sarcopenia. Of the three potential diagnostic elements of sarcopenia (muscle mass, strength, function), all studies measured muscle mass, commonly through bioelectrical impedance analysis (12 [60.0%]). Seven studies (35.0%) measured muscle strength, with the majority (n = 6) utilizing hand grip strength. Four (20.0%) measured muscle function, through gait speed or a timed up-and-go test.

CONCLUSIONS

The lack of standardization in sarcopenia diagnosis for NAFLD patients is concerning. A consistent definition is necessary to prevent this comorbidity from being overlooked, improve care, and outcomes.

Farnesol ameliorates DSS-induced IBD by regulating inflammatory cytokines, repairing the intestinal barrier, reversing the gut microbiota imbalance, and influencing fecal metabolome in C57BL/6 mice

The incidence of inflammatory bowel disease (IBD) is rising globally, increasing interest in food ingredients for its prevention and control. This study evaluated the effect of farnesol (FAR), a key component of pomelo flower volatile oil, on dextran sodium sulfate (DSS)-induced colitis in C57BL/6 mice. FAR significantly alleviated DSS-induced colitis and secondary liver injury, as shown by improved body weight, DAI, colon length, and pathology, as well as liver function and blood lipid indices. The mechanism involves FAR-mediated regulation of inflammatory cytokines, increased expression of tight junction protein genes, and decreased expression of lipid metabolism-related proteins. FAR also enhanced gut microbiota diversity, balancing harmful and probiotic bacteria. Fecal metabolome analysis indicated FAR's role in reversing metabolic disturbances related to inflammation and liver lipid metabolism. These findings support developing functional foods for IBD treatment using pomelo flower volatile oil.

Telomere Length and Biological Aging: The Role of Strength Training in 4814 US Men and Women

Telomere length is an index of cellular aging. Healthy lifestyles are associated with reduced oxidative stress and longer telomeres, whereas unhealthy behaviors are related to shorter telomeres and greater biological aging. This investigation was designed to determine if strength training accounted for differences in telomere length in a random sample of 4814 US adults. Data from the National Health and Nutrition Examination Survey (NHANES) were employed to answer the research questions using a cross-sectional design. Time spent strength training was calculated by multiplying days of strength training per week by minutes per session. Participation in other forms of physical activity was also calculated based on reported involvement in 47 other activities. Weighted multiple regression and partial correlation were used to calculate the mean differences in telomere length across levels of strength training, adjusting for differences in potential confounders. With the demographic covariates controlled, strength training and telomere length were linearly related (F = 14.7, p = 0.0006). Likewise, after adjusting for all the covariates, the linear association remained strong and significant (F = 14.7, p = 0.0006). In this national sample, 90 min per week of strength training was associated with 3.9 years less biological aging, on average. Regular strength training was strongly related to longer telomeres and less biological aging in 4814 US adults.

JAK inhibitors: an evidence-based choice of the most appropriate molecule

Janus kinase inhibitors (JAKis) represent a fundamental therapeutic tool for the treatment of patients with immune-mediated inflammatory diseases. Although JAKis are often considered a homogeneous class of drugs whose members are thought to be largely interchangeable, there are significant differences in their efficacy and safety profiles. This narrative review analyzes the pharmacokinetic and pharmacodynamic differences among JAKIs, highlighting their clinical relevance based on the most recent available evidence. The article aims to provide rheumatologists, gastroenterologists and dermatologists with practical guidance for choosing the most appropriate JAKi for each patient, given the lack of evidence-based recommendations on this topic, to improve clinical outcomes. Due to its preferential action on JAK1, intestinal metabolization and proven absence of impact on male fertility, filgotinib may be characterized by an improved benefit/risk ratio compared with other less selective JAKis.

Development and validation of a risk prediction model for feeding intolerance in neurocritical patients with enteral nutrition

Background

This study collects and analyzes clinical data on enteral nutrition therapy in neurocritical patients, develops and validates a feeding intolerance (FI) risk prediction model, and provides a theoretical basis for screening patients with high risk of feeding intolerance (FI) and delivering personalized care.

Methods

A convenience sampling method was employed to select 300 patients who were admitted to a tertiary hospital in China for early enteral nutrition therapy in the neurointensive care unit between April 2022 and December 2022. Independent risk factors for FI were identified using univariate and logistic regression analyses. A prediction model was established, and the goodness of fit and discriminant validity of the model were evaluated.

Results

The incidence of FI in neurocritical patients receiving enteral nutrition was 71%. Logistic regression analysis identified age, Glasgow Coma Scale (GCS) scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mechanical ventilation, feeding via the nasogastric tube route, hyperglycemia, and low serum albumin as independent risk factors for the development of FI (p < 0.05). The predictive formula for FI risk was established as follows: Logit p = -14.737 + 1.184 × mechanical ventilation +2.309 × feeding route +1.650 × age + 1.336 × GCS tertile (6-8 points) + 1.696 × GCS tertile (3-5 points) + 1.753 × APACHE II score + 1.683 × blood glucose value +1.954 × serum albumin concentration. The Hosmer-Lemeshow test showed χ2  = 9.622, p = 0.293, and the area under the ROC curve was 0.941 (95% confidence interval: 0.912-0.970, p < 0.001). The optimal critical value was 0.767, with a sensitivity of 85.9%, a specificity of 90.8%, and a Youden index of 0.715.

Conclusion

The early enteral nutrition FI risk prediction model developed in this study demonstrated good predictive ability. This model can serve as a valuable reference for effectively assessing the risk of FI in neurocritical patients, thereby enhancing clinical outcomes.

Association between Clinical Characteristics and Sarcopenia or Sarcopenic Obesity in Crohn's Disease

Objective Crohn's disease (CD) is a chronic inflammatory bowel disease that is associated with malnutrition. Sarcopenia is a malnutrition condition characterized by skeletal muscle loss that impairs the physical function. We investigated the clinical characteristics of patients with CD with sarcopenia and sarcopenic obesity (sarcopenic-o). Methods The body composition of patients with CD was evaluated using a bioelectrical impedance analysis. The clinical characteristics of patients with sarcopenia and sarcopenic-o were analyzed, and a predictive model for sarcopenia was developed. Patients: Patients with CD recruited from 2019 to 2021 were included. Results Among the 104 patients, 35 (33.7%) and 10 (9.6%) had sarcopenia and sarcopenic-o, respectively. In the sarcopenia group, the skeletal muscle index (SMI) and body mass index (BMI) were lower than those in the control group (SMI, 6.3 kg/m2 vs. 7.7 kg/m2, p<0.01; BMI, 18.8 kg/m2 vs. 22.6 kg/m2, p<0.01), whereas the Crohn's disease activity index (CDAI) was higher than in the control group (114.2 vs. 42.0, p<0.01). The predictive models of sarcopenia using the BMI and CDAI revealed high performance with areas under the receiver operating characteristic curve (AUC) of 0.87 and 0.72, respectively, and high specificity (0.94) and sensitivity (0.71), respectively. Sarcopenic-o patients could not be screened using the BMI (25 kg/m2), and the SMI and body fat percentage were negatively correlated in patients with sarcopenia (p<0.01). Conclusion Sarcopenia and sarcopenic-o are relatively common conditions among patients with CD. Sarcopenia can be predicted using the clinical parameters of BMI and CDAI. Sarcopenic-o can be a severe form of sarcopenia.

18F-FDG-PET and other imaging modalities in the diagnosis and management of inflammatory bowel disease

Inflammatory bowel disease (IBD), which encompasses ulcerative colitis (UC) and Crohn's disease (CD), is a chronic inflammatory condition of the gastrointestinal (GI) tract that presents complex diagnostic and management challenges. Early detection and treatment of IBD is paramount, as IBD can present with serious complications, including bowel perforation, arthritis, and colorectal cancer. Most forms of diagnosis and therapeutic management, like ileocolonoscopy and upper endoscopy are highly invasive and require extensive preparation at great discomfort to patients. 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) imaging can be a potential solution to the current limitations in imaging for IBD. This review explores the utility and limitations of various imaging modalities used to detect and manage IBD including ileocolonoscopy, magnetic resonance enterography (MRE), gastrointestinal ultrasound (IUS), and 18F-FDG-PET/computed tomography (18F-FDG-PET/CT) and magnetic resonance imaging (18F-FDG-PET/MR). This review has an emphasis on PET imaging and highlights its benefits in detection, management, and monitoring therapeutic response of UC and CD.

The contribution of genetics and epigenetics to MAFLD susceptibility

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver disease worldwide. The risk of developing MAFLD varies among individuals, due to a combination of environmental inherited and acquired genetic factors. Genome-wide association and next-generation sequencing studies are leading to the discovery of the common and rare genetic determinants of MAFLD. Thanks to the great advances in genomic technologies and bioinformatics analysis, genetic and epigenetic factors involved in the disease can be used to develop genetic risk scores specific for liver-related complications, which can improve risk stratification. Genetic and epigenetic factors lead to the identification of specific sub-phenotypes of MAFLD, and predict the individual response to a pharmacological therapy. Moreover, the variant transcripts and protein themselves represent new therapeutic targets. This review will discuss the current status of research into genetic as well as epigenetic modifiers of MAFLD development and progression.