Global, regional and national burden of pancreatitis in children and adolescents, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Pancreatitis poses a significant global health burden, disproportionately affecting children and adolescents. This study uses the global burden of disease (GBD) 2021 dataset to evaluate pancreatitis epidemiology in this demographic, focusing on disparities by age, sex, and region.

OBJECTIVE

To assess global trends in pediatric pancreatitis, identify risk factors, and forecast disease burden to 2035.

METHODS

We analysed GBD 2021 data on deaths and disability-adjusted life years (DALYs) for pancreatitis in individuals under 20. The socio-demographic index (SDI) assessed the link between societal development and health outcomes. Bayesian age-period-cohort (BAPC) modelling and Poisson's linear models were applied to project future burdens and estimate annual percentage changes (EAPCs) in age-standardized rates.

RESULTS

In 2021, pancreatitis caused 1120.09 deaths in children and adolescents, comprising 2% of all pancreatitis-related deaths. Age-standardized death rate (ASDR) and DALYs rate declined from 1990 to 2021 (EAPC -0.92 and -0.86, respectively). Low-middle SDI regions, notably Andean and Central Latin America and Eastern Europe, faced the highest burden. Alcohol was a leading risk factor, accounting for 3.51% of related deaths, and males had higher death and DALYs rate.

CONCLUSIONS

Despite declining pancreatitis-related mortality and DALYs, the disease remains a challenge, particularly in low-middle SDI regions. Alcohol consumption is a key risk factor, underscoring the need for targeted public health interventions. Gender-, age-, and region-specific strategies are essential to mitigate pancreatitis impact in children and adolescents.

Transoral septotomy versus Z-POEM in the treatment of Zenker diverticulum: a multicenter case-matched comparative study

INTRODUCTION

Transoral septotomy has become the favored treatment of Zenker Diverticulum (ZD), with POEM becoming a mini-invasive option also in ZD. The gold-standard treatment of ZD is still debated. We designed a case-matched comparative study to evaluate whether POEM (Z-POEM) could be as effective as stapler, traction-assisted Transoral Septotomy (TS) as first-line treatment of ZD.

MATERIALS AND METHODS

Consecutive naïve patients between 2015 and 2022 were enrolled in two high-volume centers. Barium-swallow and endoscopy were performed before and after surgery. Symptoms were assessed using a dedicated questionnaire. A control group was generated by matching patients who underwent Z-POEM with those who underwent TS. For matching the patients, a one-to-one nearest neighbor approach was used. Patients were matched for: septum length, symptoms duration, age, and sex.

RESULTS

After matching, 26 patients in each group were enrolled. The procedures were completed successfully in all patients in both groups, and mortality was null. TS required a shorter operative time. One leakage was detected in the Z-POEM group while one mucosal tear was detected in the TS group, both treated conservatively. At a median follow-up of 45 months (IQR: 27-68) for TS and 66 months (IQR: 58-76) for Z-POEM, a successful outcome was achieved in 96.2% in both groups. Post-operative symptom scores decreased in all patients in both groups.

CONCLUSIONS

This is the first study comparing Z-POEM and TS. Both the minimally invasive treatments are effective for naïve Zenker Diverticulum. TS provides a lower rate of intraoperative complications and a shorter operative time.

Nursing strategies for implementing psychosocial interventions to address violence behavior in schizophrenia: a scoping review

BACKGROUND

Psychosocial interventions are crucial in managing violent behavior problems in people with schizophrenia, considering the high risk to self and others. Although drug therapy plays an important role, psychotherapy approaches offer holistic solutions in reducing violent behavior that is complex and often resistant to treatment. Therefore, a comprehensive review of the literature on these psychosocial interventions is necessary to evaluate the various approaches that have been developed.

OBJECTIVE

This study aims to map and synthesize existing literature on psychosocial interventions designed to reduce violent behavior in patients with schizophrenia.

METHODS

A scoping review was carried out by searching for articles from the CINAHL, PubMed, and Scopus databases using the keywords "schizophrenia", "nursing". "psychosocial intervention", and "violence". Inclusion criteria included studies published in English using original research, reporting the results of a nursing intervention, full text, and a publication period of the last five years (2019-2024). Data was extracted using manual tables, and analysis was carried out descriptively qualitatively.

RESULTS

There were 12 articles that met the inclusion criteria and discussed various psychosocial interventions to reduce violent behavior in people with schizophrenia. The results showed that five types of nursing strategies, logotherapy, assertive therapy, forgiveness therapy, cognitive behavioral therapy (CBT) and social skills training (SST), and assertive communication and de-escalation training, consistently resulted in significant reductions in violent behavior.

CONCLUSION

This scoping review underscores the need for a comprehensive approach to managing violent behavior in schizophrenia by utilizing psychosocial interventions that have been proven to be effective. However, the limited number of studies, heterogeneity in intervention methods, and variability in outcome assessments warrant careful interpretation of the results. Nursing implications include improvements in training and support for nurses to implement these interventions in daily clinical practice. Recommendations for future research include the need for more in-depth studies to explore effective intervention mechanisms as well as improvements in methodologically more robust study designs.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Renewable energy reduces domestic depression but increases depression for neighboring countries: evidence of spatial effects from 181 countries worldwide

BACKGROUND

Depression poses a significant global public health challenge, affecting millions of people worldwide. The utilization of renewable energy holds potential for improving mental health by reducing air pollution and promoting green spaces.

PURPOSE

This study aims to investigate the impact of renewable energy use on depression, with a focus on its spatial effects and the mediating roles of air pollution reduction and green space expansion.

METHODS

Data from 181 countries were analyzed using a two-way fixed effects model and the Spatial Durbin Model (SDM). Depression-related metrics, including Disability-Adjusted Life Years (DALYs), Age-Standardized Disability-Adjusted Life Years Rate (ASDR), prevalence, and Age-Standardized Prevalence Rate (ASPR), were evaluated.

RESULTS

Renewable energy use significantly reduces DALYs, ASDR, prevalence, and ASPR within a country, but it also significantly increases the risk of depression in neighboring countries. The impact of renewable energy on depression varies by gender, age, and SDI level, being more pronounced for males and the 50-74 age group. The effect is significant in high and low SDI countries but not in middle SDI countries, indicating a "middle-income trap."

CONCLUSION

Renewable energy can improve mental health by reducing air pollution and promoting green spaces. However, policymakers need to consider spatial effects and tailor policies accordingly to maximize health benefits.

Oral microbiota signature predicts the prognosis of colorectal carcinoma

Emerging evidence links oral-derived gut microbes to colorectal cancer (CRC) development, but CRC prognosis-related microbial alterations in oral remain underexplored. In a retrospective study of 312 CRC patients, we examined the oral microbiota using 16S rRNA gene full-length amplicon sequencing to identify prognostic microbial biomarkers for CRC. Neisseria oralis and Campylobacter gracilis increased CRC progression risk (HR = 2.63 with P = 0.007, HR = 2.27 with P = 0.001, respectively), while Treponema medium showed protective effects (HR = 0.41, P = 0.0002). A microbial risk score (MRS) incorporating these species effectively predicted CRC progression risk (C-index = 0.68, 95% CI = 0.61-0.76). When compared to a model constructed solely from clinical factors, including tumor stage, lymphatic metastasis, and perineural invasion, the predictive accuracy significantly improved with the addition of the MRS, resulting in a C-index rising to 0.77 (P = 2.33 × 10-5). Our findings suggest that oral microbiota biomarkers may contribute to personalized CRC monitoring strategies, their implementation in clinical surveillance necessitates confirmatory studies.

Evolving therapeutic approaches in achalasia: a comprehensive review of peroral endoscopic myotomy (POEM) vs. Heller's myotomy

This comprehensive narrative review thoroughly explores the treatment landscape for achalasia, a rare esophageal motility disorder. Beginning with an introduction outlining the anatomical and clinical aspects of achalasia, the review delves into its historical perspective, tracing the evolution of treatment options from early nonsurgical methods to advanced surgical techniques such as Heller's myotomy and peroral endoscopic myotomy (POEM). Technical perspectives on surgical interventions, including key steps, clinical practice guidelines, and modifications to POEM techniques, are extensively discussed. A comparative analysis between POEM and Heller's myotomy elucidates their indications, contraindications, efficacy, outcomes, and interventions for persistent symptoms or complications. Furthermore, the review explores the adverse events associated with both procedures, highlighting their safety profiles and management strategies. Finally, from a financial perspective, considerations such as operative time, hospital stay length, readmission rates, and quality-adjusted life years are examined, emphasizing the implications for patient decision-making. This review underscores the importance of a multidimensional approach to understanding and managing achalasia, advocating for further research to enhance treatment efficacy and reduce adverse effects.

Polysaccharides from Cistanche deserticola mitigate inflammatory bowel disease via modulating intestinal microbiota and SRC/EGFR/PI3K/AKT signaling pathways

Polysaccharides of Cistanche deserticola Ma (CDPS), with high safety and low toxicity have been reported to possess anti-inflammatory, immunomodulatory, antioxidant, anti-aging, anti-osteoporosis, antidepressant, intestinal flora regulatory and hepatoprotective properties. Nevertheless, the effects of CDPS on inflammatory bowel disease (IBD) and its underlying mechanisms have never been reported. To estimate its therapeutic potential on IBD, the extracted CDPS were characterized via utilizing a series of chemical, spectroscopic, and instrumental analyses, and the protective effects and mechanisms of CDPS in colitis mice was investigated. Our results indicated that CDPS were identified as acidic heteropolysaccharides. CDPS alleviated dextran sodium sulfate-induced IBD mice characterized by decreasing disease activity index, improving colon length and body weight, restoring histopathological lesions, inhibiting the expression of pro-inflammatory cytokine (IL-6, IL-1β, TNF-α) and MPO activity, elevating the expression of anti-inflammatory cytokine (IL-10) in colon tissue. The findings manifested CDPS could mitigate the inflammation of colon. Simultaneously, CDPS inhibited the expression of genes and proteins associated with SRC/EGFR/PI3K/AKT signaling pathways, and reduced the diversity and abundance of harmful gut microbiota, including Helicobacter, Bacteroides and Colidextribacter, while descending the relative abundance of Lachnospiraceae_NK4A136_group at genus level. In summary, this work elucidated that CDPS alleviates IBD symptoms via mitigating the inflammation of colon, and modulating intestinal microbiota and SRC/EGFR/PI3K/AKT signaling pathways. It underscores the promise of CDPS as a functional food ingredient or preventive drugs for IBD.

Per-oral endoscopic myotomy versus laparoscopic Heller's myotomy plus Dor fundoplication in patients with idiopathic achalasia: 5-year follow-up of a multicentre, randomised, open-label, non-inferiority trial

BACKGROUND

In this trial, we previously showed per-oral endoscopic myotomy (POEM) to be non-inferior to laparoscopic Heller's myotomy (LHM) plus Dor fundoplication in managing symptoms in patients with idiopathic achalasia 2 years post-procedure. However, post-procedural gastro-oesophageal reflux was more common after POEM at 2 years. Here we report 5-year follow-up data.

METHODS

This study is a multicentre, randomised, open-label, non-inferiority trial performed at eight centres in six European countries (Germany, Italy, Czech Republic, Sweden, the Netherlands, and Belgium). Patients with symptomatic primary achalasia were eligible for inclusion if they were older than 18 years and had an Eckardt symptom score higher than 3. Patients were randomly assigned (1:1; randomly permuted blocks of sizes 4, 8, or 12) to undergo either POEM or LHM plus Dor fundoplication. The primary endpoint was clinical success, defined by an Eckardt symptom score of 3 or less without the use of additional treatments, at 2 years, and was reported previously. Prespecified secondary endpoints at 5 years were clinical success; Eckardt symptom score; Gastrointestinal Quality of Life Index score; lower oesophageal sphincter function by high-resolution manometry; and parameters of post-procedural reflux (reflux oesophagitis according to the Los Angeles classification; pH-metry, and DeMeester clinical score). We hypothesised that POEM would be non-inferior (with a non-inferiority margin of -12·5 percentage points) to LHM plus Dor fundoplication with regards to clinical success. All analyses were performed on a modified intention-to-treat (mITT) population, which included all patients who underwent the assigned procedure. This study is registered with ClinicalTrials.gov (NCT01601678) and is complete.

FINDINGS

Between Dec 7, 2012, and Oct 9, 2015, 241 patients were randomly assigned (120 to POEM and 121 to LHM) and 221 had the assigned treatment (112 POEM and 109 LHM; mITT). 5-year follow up data were available for 90 (80%) patients in the POEM group and 87 (80%) patients in the LHM group. Clinical success rate at 5 years was 75·0% (95% CI 66·2 to 82·1) after POEM and 70·8% (61·7 to 78·5) after LHM (difference 4·2 percentage points [95% CI -7·4 to 15·7]). The mean Eckardt symptom score decreased from baseline to 5 years in both groups and the overall difference in mean scores was -0·29 (95% CI -0·62 to 0·05). Change in Gastrointestinal Quality of Life Index scores, as well as in integrated relaxation pressure on manometry, from baseline to 5 years, did not differ significantly between the groups. At 5 years, 26 (41%) of 63 patients after POEM and 18 (31%) of 58 patients after LHM had reflux oesophagitis (difference 10·2 percentage points [95% CI -7·0 to 26·8]). Significant oesophagitis (Los Angeles classification grade B, C, or D) was observed in nine (14%) of 63 patients after POEM and in four (7%) of 58 patients after LHM. pH-metry was performed in 81 (37%) of 221 patients, with higher mean acid exposure time for POEM (10·2% [95% CI 7·6 to 14·2]) than for LHM (5·5% [3·1 to 11·8]). Significantly more patients in the POEM than in the LHM group had abnormal acid exposure time at 5 years (>4·5%; 28 [62%] of 45 vs 11 [31%] of 36; difference 31·7 percentage points [95% CI 9·8 to 50·5]). The presence of reflux symptoms at 5 years was similar in both groups, with a mean DeMeester clinical score of 1·3 (95% CI 1·0 to 1·6) after POEM and 1·1 (0·9 to 1·4) after LHM. The complications of peptic stricture, Barrett's oesophagus, and oesophageal adenocarcinoma were not reported.

INTERPRETATION

Our long-term results support the role of POEM as a less invasive myotomy approach that is non-inferior to LHM in controlling symptoms of achalasia. Gastro-oesophageal reflux was common in both groups, but with a tendency towards higher rates in the POEM group. Thus, patients should be provided with the advantages and disadvantages of each approach in decision making.

FUNDING

European Clinical Research Infrastructure Network, Hamburgische Stiftung für Wissenschaften, Entwicklung und Kultur Helmut und Hannelore Greve, Dr med Carl-August Skröder Stiftung, Dr Gerhard Büchtemann Stiftung, Agnes-Graefe Stiftung, Georg und Jürgen Rickertsen Stiftung, Reinhard Frank Stiftung, Johann Max Böttcher Stiftung, Richard und Annemarie Wolf Stiftung, Olympus Europa, German Society for Gastroenterology and Metabolism and Olympus Europe Foundation, United European Gastroenterology Week, Olympus EuroNOTES Research Fund Program, Harvard Catalyst, the Harvard Clinical and Translational Science Center, and Harvard University and its affiliated academic health-care centres.

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

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

Oral and intestinal flora translocation and tumor development

ABSTRACT

Cancer metastasis is the leading cause of death in patients. In recent years, there has been a growing recognition of the role of tumor-associated microflora in tumor metastasis. The connection between oral and gut microflora and the tumor microenvironment has also been extensively studied. The migration of oral and gut microflora is closely associated with tumor development. Although there is awareness regarding the significant impact of microbial communities on human health, the focus on their relationship with host organisms, particularly those related to tumor-associated microflora, remains inadequate. As an integral part of the body, the host microflora is crucial for regulating the cancer risk and preventing tumor recurrence. The oral-gut axis plays an indispensable role in human immunity, and many types of cancers, such as colorectal, pancreatic, and breast, are significantly influenced by their internal microbial communities. However, further exploration into the mechanisms underlying the role of the intratumoral microflora in cancer is necessary to achieve a comprehensive understanding. We have summarized and analyzed related articles in PubMed. This article reviews the impact of the oral-gut axis on the human immune system, explores the relationship between the translocation of the oral and intestinal flora and the tumor microenvironment, analyzes the specific mechanisms involved in the translocation of the oral and intestinal microflora during the evolution and progression of tumors, and elaborates on the correlations between the occurrence and development of tumors and the changes in the microflora. Finally, a summary of these abovementioned points is provided.

Submucosal Tunneling Endoscopic Resection for Upper Gastrointestinal Subepithelial Lesions: A Systematic Review and Meta-Analysis

AIM

Submucosal tunneling endoscopic resection (STER) is an advanced endoscopic technique used for the minimally invasive removal of subepithelial lesions of the gastrointestinal (GI) tract. The aim of this study was to evaluate the safety and efficacy of STER for upper gastrointestinal subepithelial lesions.

METHODS

A comprehensive search of major scholar databases (until December 15, 2023) was performed. Complete resection rate was considered the primary outcome. En bloc resection, operation duration, length of stay (LOS), local recurrence, and periprocedural complications were considered secondary outcomes. Random-effects (RE) and fixed-effects (FE) models were used to generate the outcome estimates.

RESULTS

A total of 37 studies and 3795 patients were included. Pooled proportion of complete resection was 99% (95% CI 98.4-99.6%, p < 0.001). En bloc resection was achieved at 87.7% of cases. Overall mean operation duration was 64.2 min, while mean LOS was estimated at 4.93 days. The local recurrence rate was 0.1%. The two most common complications associated with STER were subcutaneous emphysema (5.5%) and pneumothorax (3%).

CONCLUSION

STER is a highly feasible and safe treatment modality for upper GI subepithelial lesions.

Visualizing global progress and challenges in esophagogastric variceal bleeding

BACKGROUND

Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension, most commonly caused by cirrhosis of various etiologies. Although a considerable body of research has been conducted in this area, the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings, insufficient information, and a lack of systematic investigation. Bibliometric analysis can help clarify research trends, identify core topics, and reveal potential future directions. Therefore, this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field, with the expectation of providing new insights for both clinical practice and scientific research.

AIM

To evaluate research trends and advancements in esophagogastric variceal bleeding (EGVB) over the past twenty years.

METHODS

Relevant publications on EGVB were retrieved from the Web of Science Core Collection. VOSviewer, Pajek, CiteSpace, and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume, countries, institutions, journals, authors, keywords, and citation counts.

RESULTS

The analysis focused on original research articles and review papers. From 2004 to 2023, a total of 2097 records on EGVB were retrieved. The number of relevant publications has increased significantly over the past two decades, especially in China and the United States. The leading contributors in this field, in terms of countries, institutions, authors, and journals, were China, Assistance Publique-Hôpitaux de Paris, Bosch Jaime, and World Journal of Gastroenterology, respectively. Core keywords in this field include portal hypertension, management, liver cirrhosis, risk, prevention, and diagnosis. Future research directions may focus on optimizing diagnostic methods, personalized treatment, and multidisciplinary collaboration.

CONCLUSION

Using bibliometric methods, this study reveals the developmental trajectory and trends in research on EGVB, underscoring risk assessment and diagnostic optimization as the core areas of current focus. The study provides an innovative and systematic perspective for this field, indicating that future research could center on multidisciplinary collaboration, personalized treatment approaches, and the development of new diagnostic tools. Moreover, this work offers practical research directions for both the academic community and clinical practice, driving continued advancement in this domain.

Probiotics as technological innovations in psychiatric disorders: patents and research reviews

Probiotics have shown promising results in treating anxiety and depression by modulating the gut-brain-microbiota axis using probiotics, which has motivated increasing commercial and academic interest in innovations and the probiotic market. This work explored innovation trends in the use of probiotics in the management of anxiety and depression, through a patent search performed in the Espacenet patent database. To expand the discussion, an additional search was performed on ClinicalTrials.gov and ScienceDirect. Recently probiotic innovations developed were deposited as pharmaceutical products (24.1%), functional foods (20.4%), or both (51.8%). Probiotic strains showed anxiolytic, antidepressant or both effects related to one or more mechanisms including modulation of neurotransmitters (61.1%), neuroendocrine mediators (35.2%) or neuroinflammation and oxidative stress (20.3%). The effects mainly were related to strains of the Lactobacillus (48.1%) and Bifidobacterium (38.9%) genera. In an additional search, 1,945 scientific publications and 11 clinical trials were found. Despite the efficacy observed in preclinical and clinical studies, transitioning from academic discoveries to patented innovations is not always straightforward. This review provides evidence for therapeutic applications of novel probiotic technologies in treating psychiatric disorders. It supports further studies exploring their benefits and highlights the need for greater investment in innovation in this area.

The effects of physical activity on the mental health of typically developing children and adolescents: a systematic review and meta-analysis

BACKGROUND

Physical activity has gained attention in recent years as a promising intervention for improving the mental health of children and adolescents. However, evidence supporting the effectiveness of physical activity interventions for the mental health of typically developing children and adolescents remains limited.

METHODS

This study conducted a comprehensive search across five electronic databases up to July 2024. Studies were eligible for inclusion if they involved an intervention with a control group that examined the effects of physical activity on the mental health of typically developing children and adolescents. Articles focusing on participants with developmental, behavioral, or psychiatric disorders were excluded. A random-effects meta-analysis was conducted using Stata 18.0. The quality of evidence and risk of bias were assessed using the GRADE framework and the PEDro scale.

RESULTS

The initial search yielded 27,527 articles, of which 30 met the inclusion criteria. Meta-regression analysis indicated that country and intervention frequency were significant sources of heterogeneity. Physical activity interventions were significantly more effective than the control group in improving mental health (SMD = 0.37, 95% CI: 0.20 to 0.53). These interventions showed particularly strong effects on stress reduction (SMD = 0.86, 95% CI: 0.15 to 1.56) and social competence enhancement (SMD = 0.56, 95% CI: 0.07 to 1.06). Moreover, physical activity interventions were notably more effective for male adolescents (SMD = 1.11, 95% CI: 0.34 to 1.88) and those at the secondary school level (SMD = 0.45, 95% CI: 0.23 to 1.69).

CONCLUSIONS

Physical activity is beneficial in improving various aspects of mental health, including anxiety, depression, stress, self-esteem, and social competence in typically developing children and adolescents. However, the quality of evidence in this study is low due to methodological limitations of the studies included in this review. More high-quality randomized controlled trials are needed to validate these findings. Teachers and community workers can leverage physical activity as a preventive strategy to promote the mental health of children and adolescents. Future research should also investigate how factors like socioeconomic status and the sporting environment impact the effectiveness of these interventions.

TRIAL REGISTRATION

PROSPERO, CRD42024567153.

Efficacy and safety of mesenchymal stem cell therapy in acute on chronic liver failure: a systematic review and meta-analysis of randomized controlled clinical trials

BACKGROUND

Acute-on-chronic liver failure has become a serious global health burden, which is characterized by an acute deterioration of liver function, rapidly evolving organ failure, and high short-term mortality in patients with chronic liver disease. The pathogenesis includes extensive hepatic necrosis, which is related to intense systemic inflammation and subsequently causes the inflammatory cytokine storm, resulting in portal hypertension, organ dysfunction, and organ failure. Mesenchymal stem cells can function as seed cells to remodel and repair damaged liver tissues, thus showing potential therapeutic alternatives for patients with chronic liver disease. However, standard treatment protocols for mesenchymal stem cells in acute-on-chronic liver failure patients have not been established.

METHODS

We conducted a detailed search from PubMed/Medline, Web of Science, EMBASE, and Cochrane Library to find randomized controlled trials published before October 23, 2021. We formulated criteria for the literature screening according to the PICOS principle (Population, Intervention, Comparison, Outcome, Study design). Subsequently, the bias risk assessment tool was used to assess the quality of all enrolled studies. Finally, outcome measurements including the model of end-stage liver disease score, albumin, total bilirubin, coagulation function, and aminotransferase were extracted for statistical analysis.

RESULTS

A total of 7 clinical trials were included. The results of enrolled studies indicated that patients with acute-on-chronic liver failure who received mesenchymal stem cells inoculation showed a decreased MELD score in 4 weeks and 24 weeks, compared with counterparts who received conventional treatment. Reciprocally, mesenchymal stem cells inoculation improved the ALB levels in 4 weeks and 24 weeks. For secondary indicators, mesenchymal stem cells treatment significantly reduced INR levels and ALT levels, compared with the control group. Our results showed no significant differences in the incidence of adverse reactions or serious adverse events monitored in patients after mesenchymal stem cells inoculation.

CONCLUSION

This meta-analysis indicated that mesenchymal stem cell infusion is effective and safe in the treatment of patients with acute-on-chronic liver failure. Without increasing the incidence of adverse events or serious adverse events, MSC treatment improved liver function including a decrease in MELD score and an increase in ALB levels in patients with acute-on-chronic liver failure. However, large-cohort randomized controlled trials with longer follow-up periods are required to further confirm our conclusions.

Enriched pathways in gut microbiome predict response to immune checkpoint inhibitor treatment across demographic regions and various cancer types

Understanding the effect of gut microbiota function on immune checkpoint inhibitor (ICI) responses is urgently needed. Here, we integrated 821 fecal metagenomes from 12 datasets to identify differentially abundant genes and construct random forest models to predict ICI response. Gene markers demonstrated excellent predictive performance, with an average area under the curve (AUC) of 0.810. Pathway analyses revealed that quorum sensing (QS), ABC transporters, flagellar assembly, and amino acid biosynthesis pathways were enriched between responders (R) and non-responders (NRs) across 12 datasets. Furthermore, luxS, manA, fliC, and trpB exhibited consistent changes between R and NR across 12 datasets. Follow-up microbiota transplant experiments showed that inter-species signaling by different QS autoinducer-2 (AI-2) molecules (synthesized by luxS) can act on overall community function to promote the colonization of Akkermansia muciniphila, which is associated with superior ICI responses. Together, our data highlight the role of gut microbiota function in modulating the microbiome and antitumor immunity.

Risk of and factors influencing the progression from acute to recurrent acute to chronic pancreatitis

OBJECTIVES & AIMS

Acute pancreatitis (AP) recurrence rates range from 11 to 36 % yet accurately predicting recurrent acute pancreatitis (RAP) and its progression to chronic pancreatitis (CP) after an initial episode remains challenging. Thus, this study explored the risk factors contributing to RAP and its progression to CP.

METHODS

This retrospective study included patients with AP from three tertiary medical centers between January 2010 and December 2017. The patients were followed up for up to 60 months. The primary endpoint was the incidence of RAP and CP; risk factors influencing these outcomes were also identified.

RESULTS

Overall, 501 patients were included, of which 164 (32.7 %) experienced RAP, and 71 (14.2 %) progressed to CP. The leading causes of AP were alcohol consumption (43.1 %), gallstones (41.5 %) and hypertriglyceridemia (4.4 %). Multivariate Cox regression analysis revealed that smoking (HR, 4.09; 95 % CI, 2.752-6.078, p < 0.001), and organ failure after 48 h of hospitalization (HR, 3.52; 95 % CI, 1.22-10.19, p < 0.02) were significant risk factors for RAP. Significant risk factors for progression to CP included age over 60 years (HR, 5.29; 95 % CI, 1.25-22.47, p = 0.024), smoking (HR, 2.50; 95 % CI, 1.04-6.01, p = 0.04), alcohol consumption (HR, 8.79; 95 % CI, 2.06-37.43, p = 0.003), computed tomography severity index (CTSI) (HR, 1.22; 95 % CI, 1.04-1.44, p = 0.015), and recurrence of AP (HR, 70.69; 95 % CI, 2.61-1914.86, p = 0.011). In alcohol-induced RAP patients, ≥3 recurrences (HR, 4.18; 95 % CI, 1.75-9.98, p = 0.001) was significant risk factor for progression to CP.

CONCLUSIONS

Alcohol consumption was the predominant cause of AP and RAP. The severity of the initial AP episode was the key determinant for RAP, and RAP was the most significant risk factor for the progression to CP. Therefore, smoking and alcohol cessation are important to prevent the development of recurrent AP and CP during long-term follow-up.

Evaluating Risk Factors for Early-Onset Colorectal Cancer in a Large, Prospective Cohort

BACKGROUND

Despite the worrisome rise of early-onset colorectal cancer (EOCRC), risk factors have not been definitively established. We use a large, granular database to evaluate risk factors for EOCRC, investigate differences in associations with EOCRC and later-onset CRC (LOCRC), and compare metrics of accelerated aging, a hypothesized driver of EOCRC.

METHODS

This was a case-control analysis within the UK Biobank. Risk factors for each cancer were identified and compared, including aging measures (chronological age, telomere length, PhenoAge, and homeostatic dysregulation).

RESULTS

A total of 31,164 persons were matched. We found an increased risk of EOCRC with PRS (OR 1.53; 95% CI 1.19-1.97; p < 0.001). LOCRC was associated with increasing PRS (OR 1.48; 95% CI 1.44 - 1.53; p < 0.001), increasing waist-to-hip ratio (OR 5.81; 95% CI 3.25 - 10.38; p < 0.001), family history of CRC (OR 1.27; 95% CI 1.16 - 1.40; p < 0.001), and history of smoking (OR 1.11; 95% CI 1.03 - 1.19; p = 0.01). Male sex and prior CRC screening were associated with reduced risk of LOCRC. The inclusion of PhenoAge as the measure of aging demonstrated the best model fit for both EOCRC and LOCRC. For each year that PhenoAge exceeded chronological age, the odds of EOCRC increased by 7%, while odds of LOCRC only increased by 1%.

CONCLUSIONS

Within this study, we find that genetic risk variants are a significant driver of EOCRC risk. Accelerated aging appears to be associated with increased risk of both EOCRC and LOCRC, and measures such as PhenoAge warrant continued study.

Endoscopists and endoscopic assistants' qualifications, but not their biopsy rates, improve gastric precancerous lesions detection rate

BACKGROUND

Detecting gastric precancerous lesions (GPLs) is critical for the early diagnosis and treatment of gastric cancer. Endoscopy combined with tissue examination is an important method for detecting GPLs. However, negative biopsy results often increase patients' risks, economic burdens, and lead to additional healthcare costs. Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.

AIM

To explore the relationships between the endoscopist biopsy rate (EBR), qualifications of endoscopists and endoscopic assistants, and detection rate of GPLs.

METHODS

EBR, endoscopists, and endoscopic assistants were divided into four groups: Low, moderate, high, and very high levels. Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions. Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR, endoscopist or endoscopic assistant qualifications, and the detection rate of positive lesions.

RESULTS

Compared with those in the low EBR group, the odds ratio (OR) values for detecting positive lesions in the moderate, high, and very high EBR groups were 1.12 [95% confidence interval (CI): 1.06-1.19, P < 0.001], 1.22 (95%CI: 1.14-1.31, P < 0.001), and 1.38 (95%CI: 1.29-1.47, P < 0.001), respectively. EBR was positively correlated with the detection rate of gastric precancerous conditions (atrophic gastritis/intestinal metaplasia) (ρ = 0.465, P = 0.004). In contrast, the qualifications of the endoscopists were positively correlated with GPLs detection (ρ = 0.448, P = 0.005). Compared to endoscopists with low qualification levels, those with moderate, high, and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13% (OR = 1.13, 95%CI: 0.98-1.31), 20% (OR = 1.20, 95%CI: 1.03-1.39), and 32% (OR = 1.32, 95%CI: 1.15-1.52), respectively. Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia (ρ = 0.350, P = 0.034), angularis (ρ = 0.396, P = 0.015) and gastric body (ρ = 0.453, P = 0.005) but not in the antrum (ρ = 0.292, P = 0.079). Moreover, the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications (ρ = 0.427, P = 0.015).

CONCLUSION

Endoscopists and endoscopic assistants with high/very high qualifications, but not EBR, can improve the detection rate of GPLs. These results provide reliable evidence for the development of gastroscopic quality control indicators.

A systematic review of the predictive factors for the recurrence of acute pancreatitis

PURPOSE

Acute Pancreatitis (AP) is a prevalent clinical pancreatic disorder characterized by acute inflammation of the pancreas, frequently associated with biliary or alcoholic events. If not treated with cholecystectomy after the first episode, patients may experience a recurrence of AP, with consequent need for emergency surgery and increased risk of death. Analyzing the risk factors that may contribute to the recurrence of Biliary and Alcoholic Pancreatitis (BAP and AAP), future research can be driven toward new solutions for preventing and treating this pancreatic disease.

METHODS

A systematic review was conducted selecting studies from BiomedCentral, PubMed, Scopus and Web of Science by two independent reviewers. Publications were considered only if written in English in the time interval between January 2000 and June 2024 and investigated the risk factors for the recurrence of BAP and AAP. At the end of the selection, a quality assessment phase was conducted using the PROBAST tool.

RESULTS

In this systematic review, 8 articles were selected out of 6.945, involving a total sample of 11.271 patients of which 38.77% developed recurrence episodes. 37.5% of the included studies focus on recurrent acute biliary pancreatitis (RBAP), while 62.5% are dedicated to recurrent acute alcoholic pancreatitis (RAAP). The risk factors for the recurrence of AP showed a clear differentiation between the alcoholic and biliary etiology. Most of the considered studies adopted a retrospective design, characterized by a susceptibility to potential methodological biases. However, the trend indicated a more recent increase in prospective studies, together with a greater focus on identifying and understanding the possible risk factors associated with the recurrence of acute pancreatitis (RAP). This result highlighted the progress in the scientific approach toward a more rigorous and systematic assessment of the causes and dynamics that influence the recurrence of the disease.

CONCLUSION

Studies highlighted the importance of lifestyle factors, clinical complications, and surgical interventions that can impact the risk of biliary or alcoholic recurrent acute pancreatitis. Increased and systematic adoption of artificial intelligence-based tools could significantly impact future knowledge relating to the risks of recurrence and relative possibilities of prevention.

Burden and Trends of Diet-Related Colorectal Cancer in OECD Countries: Systematic Analysis Based on Global Burden of Disease Study 1990-2021 with Projections to 2050

Background: An unhealthy diet is a major risk factor for colorectal cancer (CRC). This study assessed the diet-related CRC burden from 1990 to 2021 in Organisation for Economic Co-operation and Development (OECD) nations and estimated the burden until 2050. Methods: Data for OECD countries on diet-related CRC disability-adjusted life years (DALYs) and deaths were obtained from the Global Burden of Disease 2021 study. The estimated annual percent change (EAPC) was calculated to analyse the CRC burden attributable to dietary factors. A generalised additive model with a negative binomial distribution was used to predict the future burden of CRC attributable to dietary factors from 2021 to 2050. Results: In 2021, the age-standardised percentages of diet-related CRC DALYs and deaths were 39.1% (95% uncertainty interval (UI): 9.3, 61.3) and 39.0% (95% UI: 9.7, 60.9), respectively, in the OECD countries. Between 1990 and 2021, the age-standardised DALYs decreased from 185 to 129 per 100,000, and deaths decreased from 8 to 6 per 100,000 population for OECD countries. Similarly, the EAPC in the rates showed a downward trend (EAPCdeaths = -1.26 and EAPCDALYs = -1.20). The estimated diet-related CRC DALYs and deaths are projected to increase to 4.1 million DALYs and 0.2 million deaths by 2050. There is a downward trend in CRC deaths (EAPC = 1.33 for both sexes) and in DALYs (-0.90 for males and -1.0 for females) from 1990 to 2050. Conclusions: The diet-related CRC burden remains significant. Implementing nutrition intervention programmes is necessary to promote access to affordable and nutritious foods and raise awareness about the importance of a healthy diet in reducing CRC risk.

Bridging Data Gaps in Emergency Care: The NIGHTINGALE Project and the Future of AI in Mass Casualty Management

In the context of mass casualty incident (MCI) management, artificial intelligence (AI) represents a promising future, offering potential improvements in processes such as triage, decision support, and resource optimization. However, the effectiveness of AI is heavily reliant on the availability of quality data. Currently, MCI data are scarce and difficult to obtain, as critical information regarding patient demographics, vital signs, and treatment responses is often missing or incomplete, particularly in the prehospital setting. Although the NIGHTINGALE (Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies) project is actively addressing these challenges by developing a comprehensive toolkit designed to support first responders and enhance data collection during MCIs, significant work remains to ensure the tools are fully operational and can effectively integrate continuous monitoring and data management. To further advance these efforts, we provide a series of recommendation, advocating for increased European Union funding to facilitate the generation of diverse and high-quality datasets essential for training AI models, including the application of transfer learning and the development of tools supporting data collection during MCIs, while fostering continuous collaboration between end users and technical developers. By securing these resources, we can enhance the efficiency and adaptability of AI applications in emergency care, bridging the current data gaps and ultimately improving outcomes during critical situations.

rTMS ameliorates CUMS-induced anxiety-depression-like behaviour and cognitive dysfunction in rats by modulating the COX-2/PGE2 signalling pathway

BACKGROUND

rTMS is a safe and effective neuromodulation method for treating depression, but the specifics of its antidepressant effects and the underlying mechanisms remain uncertain.

METHODS

Male SD rats were randomly divided into four groups: control group, CUMS group, CUMS + rTMS (10 Hz) group, and CUMS + celecoxib (25 mg/kg, as a positive control) group. Depression-like behavior was assessed by weight change, SPT, and FST; anxiety by OFT and EPM; and cognitive function by the Y-maze. WB, IF, ELISA, and qPCR were used to observe changes in COX-2/PGE2 signaling pathway-related proteins, inflammatory factors, and the activation of astrocytes and microglia in the hippocampus of rats.

RESULTS

Compared to the control group, rats in the CUMS group exhibited significant anxiety-depression-like behavior and cognitive dysfunction. Compared to the CUMS group, rTMS and celecoxib interventions improved anxiety-depression-like behavior and cognitive dysfunction, reduced the expression of microglia and astrocytes, reversed the upregulation of pro-inflammatory factors (IL-1β, IL-6, TNF-α), and downregulated the expression of proteins related to the COX-2/PGE2 signaling pathway in CUMS-induced rats.

CONCLUSIONS

The study demonstrated that rTMS could improve anxiety-depression-like behavior and cognitive dysfunction in rats by modulating the COX-2/PGE2 pathway.

Curriculum for training in peroral endoscopic myotomy (POEM) in Europe (Part I): European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

Peroral endoscopic myotomy (POEM) is an advanced endoscopic procedure that has become a first-line treatment for esophageal achalasia and other esophageal spastic disorders. Structured training is essential to optimize the outcomes of this technique. The European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in POEM. This Position Statement presents the results of a systematic review of the literature and a formal Delphi process, providing recommendations for an optimal training program in POEM that aims to produce endoscopists competent in this procedure. In a separate document (POEM curriculum Part II), we provide technical guidance on how to perform the POEM procedure based on the best available evidence. 1: POEM trainees should acquire a comprehensive theoretical knowledge of achalasia and other esophageal motility disorders that encompasses pathophysiology, diagnostic tool proficiency, clinical outcome assessment, potential adverse events, and periprocedural management. 2: Experience in advanced endoscopic procedures (endoscopic mucosal resection and/or endoscopic submucosal dissection [ESD]) is encouraged as a beneficial prerequisite for POEM training. 3: ESGE suggests that POEM trainees without ESD experience should perform an indicative minimum number of 20 cases on ex vivo or animal models before advancing to human POEM cases with an experienced trainer. 4: ESGE recommends that the trainee should observe an indicative minimum number of 20 live cases at expert centers before starting to perform POEM in humans. 5: The trainee should undertake an indicative minimum number of 10 cases under expert supervision for the initial human POEM procedures, ensuring that trainees can complete all POEM steps independently. 6: ESGE recommends avoiding complex POEM cases during the early training phase. 7: POEM competence should reflect the technical success rate, both the short- and long-term clinical success rates, and the rate of true adverse events. 8: A POEM center should maintain a prospective registry of all procedures performed, including patient work-up and outcomes, procedural techniques, and adverse events.

Noninvasive prediction of esophagogastric varices in hepatitis B: An extreme gradient boosting model based on ultrasound and serology

BACKGROUND

Severe esophagogastric varices (EGVs) significantly affect prognosis of patients with hepatitis B because of the risk of life-threatening hemorrhage. Endoscopy is the gold standard for EGV detection but it is invasive, costly and carries risks. Noninvasive predictive models using ultrasound and serological markers are essential for identifying high-risk patients and optimizing endoscopy utilization. Machine learning (ML) offers a powerful approach to analyze complex clinical data and improve predictive accuracy. This study hypothesized that ML models, utilizing noninvasive ultrasound and serological markers, can accurately predict the risk of EGVs in hepatitis B patients, thereby improving clinical decision-making.

AIM

To construct and validate a noninvasive predictive model using ML for EGVs in hepatitis B patients.

METHODS

We retrospectively collected ultrasound and serological data from 310 eligible cases, randomly dividing them into training (80%) and validation (20%) groups. Eleven ML algorithms were used to build predictive models. The performance of the models was evaluated using the area under the curve and decision curve analysis. The best-performing model was further analyzed using SHapley Additive exPlanation to interpret feature importance.

RESULTS

Among the 310 patients, 124 were identified as high-risk for EGVs. The extreme gradient boosting model demonstrated the best performance, achieving an area under the curve of 0.96 in the validation set. The model also exhibited high sensitivity (78%), specificity (94%), positive predictive value (84%), negative predictive value (88%), F1 score (83%), and overall accuracy (86%). The top four predictive variables were albumin, prothrombin time, portal vein flow velocity and spleen stiffness. A web-based version of the model was developed for clinical use, providing real-time predictions for high-risk patients.

CONCLUSION

We identified an efficient noninvasive predictive model using extreme gradient boosting for EGVs among hepatitis B patients. The model, presented as a web application, has potential for screening high-risk EGV patients and can aid clinicians in optimizing the use of endoscopy.

Roles of the gut microbiota in hepatocellular carcinoma: from the gut dysbiosis to the intratumoral microbiota

Hepatocellular carcinoma (HCC) is closely linked to alterations in the gut microbiota. This dysbiosis is characterized by significant changes in the microbial population, which correlate with the progression of HCC. Gut dysbiosis ultimately promotes HCC development in several ways: it damages the integrity of the gut-vascular barrier (GVB), alters the tumor microenvironment (TME), and even affects the intratumoral microbiota. Subsequently, intratumoral microbiota present a characteristic profile and play an essential role in HCC progression mainly by causing DNA damage, mediating tumor-related signaling pathways, altering the TME, promoting HCC metastasis, or through other mechanisms. Both gut microbiota and intratumoral microbiota have dual effects on HCC progression; a comprehensive understanding of their complex biological roles will provide a theoretical foundation for potential clinical applications in HCC treatment.

The role of Fusobacterium nucleatum in macrophage M2 polarization and NF-κB pathway activation in colorectal cancer

Fusobacterium nucleatum is strongly linked to colorectal cancer (CRC) progression, but its mechanisms for influencing macrophage polarization and tumor development are not well understood. We established an in vitro model of F. nucleatum infection in RAW264.7 macrophages to investigate these processes. Macrophage polarization was evaluated using scanning electron microscopy (SEM), real-time quantitative PCR (RT-qPCR), and immunofluorescence staining. RNA sequencing (RNA-Seq) identified differentially expressed genes (DEGs) and enriched pathways, focusing on the role of the NF-κB signaling pathway in macrophage polarization. F. nucleatum infection induced M2 polarization in RAW264.7 macrophages, as confirmed by SEM analysis and RT-qPCR validation. A total of 2,029 DEGs were identified after F. nucleatum infection, with 763 upregulated and 1,266 downregulated. GO and KEGG enrichment analysis showed that cytokine-cytokine receptor interaction, TNF signaling, and NF-κB signaling pathways are upregulated in macrophages after F. nucleatum infection, indicating enhanced cytokine activity and immune response. Key genes (Nfkb1, Nfkb2, Malt, Lta, Ltb, Tnf) and proteins (P50, P100) in the NF-κB pathway are upregulated, indicating the crucial role of the NF-κB pathway in M2 macrophage polarization. This study offers crucial evidence regarding the role of the NF-κB signaling pathway in modulating F. nucleatum-induced macrophage M2 polarization, underscoring its significance in the progression of colorectal cancer.

Treatment outcomes and esophageal cancer incidence by disease type in achalasia patients undergoing peroral endoscopic myotomy: Retrospective study

OBJECTIVES

This retrospective study aimed to compare treatment outcomes and postoperative courses, including the incidence of esophageal cancer (EC), according to disease types, in 450 achalasia patients who underwent peroral endoscopic myotomy (POEM).

METHODS

Data from consecutive POEM procedures performed from September 2011 to January 2023 at a single institution were reviewed. Achalasia was classified into straight (St), sigmoid (S1), and advanced sigmoid (S2) types using esophagography findings. Regarding efficacy, POEM was considered successful if the Eckardt score was ≤3. A statistical examination of the incidence and trend of EC occurrence across the disease type of achalasia was conducted using propensity score matching.

RESULTS

Of the 450 patients, 349 were diagnosed with St, 80 with S1, and 21 with S2. POEM efficacy was 97.9% at 1 year and 94.2% at 2 years postprocedure, with no statistical difference between disease types. Using propensity score matching, the incidence of EC in each disease type was as follows: St, 1% (1/98); S1, 2.5% (2/77); S2, 10% (2/18). While no statistical significance was observed between St (1.0%: 1/98) and all sigmoid types (4.0%, 4/95; P = 0.3686). However, a trend test revealed a tendency for EC to occur more frequently in the order of S2, S1, and St type with a statistically significant difference (P = 0.0413).

CONCLUSIONS

Outcomes of POEM are favorable for all disease types. After POEM, it is important not only to monitor the improvement of achalasia symptoms but also to pay attention to the occurrence of EC, especially in patients with sigmoid-type achalasia.

Fusobacterium nucleatum modulates the Wnt/β-catenin pathway in colorectal cancer development

The Wnt/β-catenin signalling pathway normally maintains cellular and tissue homeostasis by regulating cellular differentiation and survival in a controlled manner. An aberrantly regulated Wnt/β-catenin signalling pathway can transform into an oncogenic pathway, which is associated with Colorectal cancer (CRC) as well as other cancers. CRC is one of the most frequently occurring gastrointestinal cancers worldwide. In CRC tissues, deregulation of Wnt/β-catenin pathway is observed, which indicates that this oncogenic pathway directly promotes CRC malignancy, cell migration, angiogenesis, chemoresistance, as well as shorter lifespan of a patient. Growing evidence suggests that human commensal microbes have a strong association with carcinogenesis, particularly the prevalence and high enrichment of Fusobacterium nucleatum in CRC progression. The Wnt/β-catenin pathway is one of the targeted pathways by F. nucleatum in CRC, where Fusobacterium adhesin attaches to E-cadherin to initiate infection. Also, Wnt/β-catenin pathway can be a potential target for the treatment of both CRC and F. nucleatum-positive CRC. Here, we discuss the underlying mechanisms of F. nucleatum-positive CRC development through modulation of Wnt/β-catenin signalling and its possibility for the application in targeted therapy of F. nucleatum-positive CRC.

The first two human infections with Helicobacter zhangjianzhongii, a new Helicobacter closely related to Helicobacter canis

PURPOSE

In 2023, Helicobacter zhangjianzhongii was proposed as a new species in the Helicobacter genus. We here describe two human cases of H. zhangjianzhongii bacteremia.

METHODS

Four clinical strains from the Helicobacter genus isolated from blood culture between 2017 and 2023 were studied. They were initially identified as H. canis by MALDI-TOF and 16S rDNA sequencing. The strains were biochemically characterized and tested at different temperatures and atmospheres. Two databases were used to characterize the isolates: the Bruker® MBT compass Version 4.1.1 database and a in-house spectrum-enriched database. After bacterial DNA extraction the genomes were sequenced on NovaSeq 6000 (Illumina) and analyzed using an in-house pipeline.

RESULTS

Case 1 involved a 58-year-old woman who was hospitalized in a thoracic oncology unit because her general condition deteriorated in a setting of small-cell carcinoma. She presented with abdominal pain associated with significant hepatomegaly. Case 2 involved a 78-year-old woman on rituximab who was hospitalized to treat chest pain, anemia, and inflammatory syndrome. Both strains exhibited very similar microbiological and genomic characteristics, thus growth in a microaerobic atmosphere at 37°C and 42°C, oxidase-positivity, and urease- and catalase-negativity. Both were formally identified by whole-genome sequencing as H. zhangjianzhongii (ANI > 99% and DDH > 94%).

CONCLUSION

This proposed species is associated with bacteremia in humans. It is thus likely to be a novel human pathogen. Dogs may have been the source of infection.

Factors predicting insufflation-related events in peroral endoscopic myotomy procedures

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

ACG Clinical Guideline: Diagnosis and Management of Gastric Premalignant Conditions

Gastric premalignant conditions (GPMC) are common and include atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric epithelial polyps. GPMC have an increased risk of progression to gastric adenocarcinoma. Gastric cancer (GC) in the United States represents an important cancer disparity because incidence rates are 2- to 13-fold greater in non-White individuals, particularly early-generation immigrants from regions of high GC incidence. The US 5-year survival rate for GC is 36%, which falls short of global standards and is driven by the fact that only a small percentage of GC in the US is diagnosed in the early, curable stage. This document represents the first iteration of American College of Gastroenterology guidelines on this topic and encompasses endoscopic surveillance for high-risk patients with GPMC, the performance of high-quality endoscopy and image-enhanced endoscopy for diagnosis and surveillance, GPMC histology criteria and reporting, endoscopic treatment of dysplasia, the role of Helicobacter pylori eradication, general risk reduction measures, and the management of autoimmune gastritis and gastric epithelial polyps. There is insufficient evidence to make a recommendation on upper endoscopic screening for GC/GPMC detection in US populations deemed high-risk for GC. Surveillance endoscopy is recommended for individuals at high risk for GPMC progression, as defined by endoscopic, histologic, and demographic factors, typically every 3 years, but an individualized interval may be warranted. H. pylori testing, treatment, and eradication confirmation are recommended in all individuals with GPMC. Extensive high-quality data from US populations regarding GPMC management are lacking, but continue to accrue, and the quality of evidence for the recommendations presented herein should be interpreted with this dynamic context in mind. The GPMC research and education agendas are broad and include high-quality prospective studies evaluating opportunistic endoscopic screening for GC/GPMC, refined delineation of what constitutes "high-risk" populations, development of novel biomarkers, alignment of best practices, implementation of training programs for improved GPMC/GC detection, and evaluation of the impact of these interventions on GC incidence and mortality in the US.

The Use of Knives With Versus Without Integrated Water-jet Function During Peroral Endoscopic Myotomy for Patients With Achalasia: A Meta-analysis

BACKGROUND

Peroral endoscopic myotomy (POEM) is a well-established endoscopic treatment for achalasia, utilizing an endoscopic knife for dissection. Recently, new knives with an integrated water-jet (WJ) function have been introduced. This study aims to compare the technical, perioperative, and late postoperative outcomes between WJ knives and conventional (C) knives, which lack the WJ function, through a pairwise meta-analysis of published comparative studies.

METHODS

We conducted a systematic literature review following PRISMA guidelines to identify studies directly comparing knives with versus without a WJ function in POEM for achalasia. A random-effects model was employed, using odds ratios for dichotomous data and mean differences for continuous data as effect size metrics.

RESULTS

The use of WJ knives demonstrated statistically significant reductions in the mean number of intraoperative instrument exchanges, mean intraoperative use of coagulation forceps, and operative times compared to the use of C knives. There were no significant differences in terms of the incidence of adverse events, subcutaneous emphysema, or mean hospital length of stay (LOS). Clinical success, defined as a postoperative Eckardt score <3, mean postoperative Eckardt scores, and the incidence of GERD requiring proton pump inhibitors (PPI) also showed no significant differences.

CONCLUSIONS

The use of water-jet (WJ) knives demonstrates comparable efficacy to conventional (C) knives, with superior efficiency reflected in reduced operative time and fewer intraoperative instrument exchanges. In addition, in terms of safety, the lower use of coagulation forceps with WJ knives suggests reduced intraoperative bleeding. However, no significant differences were observed between the groups in terms of length of stay (LOS) and adverse events, despite a trend toward reduction. A larger number of studies with greater sample sizes is required to better assess potential differences in safety between the use of WJ and C knives.

Peroral endoscopic myotomy (POEM) as a treatment for pediatric achalasia: multicenter study and first results

INTRODUCTION

Laparoscopic Heller miotomy of achalasia has been classically recognized as the gold standard management in children. There is increasing experience with the peroral endoscopic miotomy (POEM) approach in pediatrics, although the series published are scarce. The objective of this study was to present our experience in primary or secondary treatment of pediatric achalasia by POEM and its clinical success rate.

METHODS

We performed a retrospective review of pediatric patients with achalasia who underwent POEM in some national centers from October 2016 to January 2023. We evaluated clinical efficacy (Eckardt score ≤3), demographic characteristics, intraoperative, preoperative and postoperative, complications, and follow-up.

RESULTS

Fifteen POEM were performed in fourteen pediatric patients (aged 12 to 18 years) with achalasia. POEM was the first line treatment in 11 patients, but 4 (21.3%) had previous treatment: 1 (7,1%) pneumatic balloon dilation and 2 (14,2%) laparoscopic Heller myotomy and 1 (7,1%) previous POEM. The average age was 15 years (SD±1,9). The baseline Eckardt score was 7,5 (SD:±1,8), with the baseline GERD score being 6 (SD:±2,9). There was a Clavien-Dindo grade 2 postoperative adverse event corresponding to mild pneumonia (7,1%). The postoperative Eckardt and GERD score after 12 months of follow-up were 0.7 (SD±1,2) and 0,5 (SD±0,7). The study has a success rate greater than 93%.

CONCLUSIONS

POEM seems a safe and effective procedure, with a short postoperative period for treatment of pediatric achalasia.

Safety of same day discharge after Zenker's diverticulum peroral endoscopic myotomy

INTRODUCTION

There are limited data on the safety of same-day discharge (SDD) following peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM). Our aim is to assess the frequency and etiology of emergency department (ED) visits or hospital admissions after SDD after Z-POEM.

METHODS

Patients at our institution between 02/2020 and 08/2023 who had SDD after Z-POEM were identified. Criteria for SDD were: 1)no procedure-related serious adverse event; 2)post-POEM esophagram without leak; 3)stable vital signs; 4)ability to take liquids; 5)pain controlled without IV analgesia; 6)social support for transit to ED; 7)ASA class I-III. Relevant post-procedure events, ED visits and hospitalizations within 30 days were reported. A causative relationship between Z-POEM and ED visits and hospitalizations was assigned by consensus.

RESULTS

39 Z-POEMs were performed, and 26 (67 %) patients (58 % male, median age 72 years) had SDD. Mean ZD diameter was 29±14 mm and mean baseline Dakkak and Bennett's score was 2.9 ± 0.9. Within 30 days of Z-POEM, two(7.7 %) ED visits occurred 13 days and 9 days post-procedure for a COPD exacerbation(n = 1) and pneumonia(n = 1), respectively. Both patients were discharged without admission and only the visit for pneumonia was considered related to Z-POEM.

CONCLUSION

Eligible patients who follow and fulfill a strict protocol after Z-POEM may be safely discharged the same day of the procedure.

Endoscopic submucosal tunneling techniques versus flexible endoscopic septotomy for Zenker's diverticulum: a systematic review and meta-analysis

BACKGROUND AND AIMS

Zenker's diverticulum (ZD) is the most common type of esophageal diverticulum. We conducted a systematic review and meta-analysis to compare the effectiveness and safety of endoscopic submucosal tunneling techniques (ESTTs) and flexible endoscopic septotomy (FES) for treating patients with ZD, including subgroup analyses by follow-up duration (<12 months and ≥12 months), diverticulum size (<2.5 cm and ≥2.5 cm), ESTT used (Zenker's peroral endoscopic myotomy and peroral endoscopic septotomy), and publication format (full text and abstract).

METHODS

We searched PubMed, EMBASE, and Cochrane Library databases until June 20, 2024. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with the I2 statistics.

RESULTS

We included 9 studies (759 patients). Compared with FES, ESTT had a higher probability of clinical success (RR, 1.15; 95% CI, 1.04-1.28). The results were similar in both groups for clinical recurrence (RR, .56; 95% CI, .29-1.07), technical success (RR, .99; 95% CI, .97-1.01), operative time (MD, 7.22 minutes; 95% CI, -.33 to 14.76), hospital stay (MD, .47 days; 95% CI, -1.25 to 2.19), and overall adverse events (RR, 1.19; 95% CI, .44-3.18). Subgroup analyses showed consistent results.

CONCLUSIONS

ESTT demonstrated a higher probability of clinical success and showed a trend toward a lower recurrence rate compared with FES; however, both groups had similar technical success, operative time, length of hospital stay, and overall adverse events. These findings underscore ESTT as an effective and safe method for treating patients with ZD.

Peroral endoscopic myotomy for complex achalasia and the POEM difficulty score: An update

Objectives

We present an update on the (peroral endoscopic myotomy (POEM) difficulty score [PDS] by introducing a novel knife with waterjet functionality.

Methods

This is a retrospective review of patients who underwent POEM between May 2018 and July 2023 at the Kingston Health Sciences Center. Demographic and procedural variables were compared using descriptive and inferential statistics.

Results

One hundred thirty-nine consecutive POEMs were included in the study. Seventy-four (56.7% male; aged 56.7 ± 16.5 years) complex achalasia (CA) and 65 (55.4% female; aged 47.3 ± 20.2 years) non-CA POEM procedures were performed. PDS correlates moderately with procedural efficiency with a correlation coefficient of 0.595 (Spearman's p < 0.001). The mean efficiency for non-CA was 3.3 ± 1.2 min/cm compared to CA as follows: type III 3.3 ± 1.3 min/cm; prior myotomy 5.3 ± 2.3 min/cm; ≧4 prior procedures 4.0 ± 1.7 min/cm; sigmoid type 5.2 ± 2.4 min/cm. The median PDS for non-CA was 1 (1-5). In comparison, the median PDS for CA is as follows: type III 3 (2-4); prior myotomy 4 (3-5); ≧4 prior procedures 3 (1.25-4); sigmoid type 3 (2-4). PDS excluding the presence of spastic contractions correlated better with procedural velocity, with a correlation coefficient of 0.645 (Spearman's p < 0.001).

Conclusions

PDS continues to moderately correlate with procedural efficiency using the novel knife. The presence of spastic contractions correlated poorly with procedural efficiency. Thus, it may be omitted in further studies.

Friends close, enemies closer: the complex role of the microbiome in antitumor immunity

Immunotherapy has achieved remarkable advances in cancer treatment by harnessing the immune system to combat tumors, yet its effectiveness remains inconsistent across patients and tumor types. The microbiota, a diverse assemblage of microorganisms residing at host barrier surfaces, is pivotal in shaping immune responses. This review explores the direct and indirect mechanisms via which the microbiota modulates antitumor immune responses both locally within the tumor microenvironment and systemically by affecting distant tumors. We discuss recent findings linking microbiota-derived metabolites and microbiota-derived antigens with antitumor immunity and immunotherapy response. Additionally, we discuss recent advances in microbiome-based therapies, including fecal microbiota transplantation. We propose the use and development of new analytical techniques to further characterize the complex functions and interactions between the microbiome and immune system. To conclude, we outline recommendations for future research and therapeutic approaches to leverage the microbiome to improve current immunotherapies.

Lumen-apposing metal stents provide early and late clinical benefits for the management of benign gastrointestinal strictures: Is there a role for definitive therapy?

Objectives

This study aimed to characterize the clinical outcomes, safety, and efficacy of lumen-apposing metal stents (LAMS) in treating benign gastrointestinal strictures.

Methods

A single-center retrospective review of all patients who underwent LAMS placement for benign strictures from June 2017 to July 2023. Primary outcomes were technical success, early clinical success, late clinical success (LCS), and sustained post-LAMS clinical success (SPLCS). Secondary outcomes included stent dwell time, stenosis changes, adverse events, reintervention rates, and symptomatology evaluation.

Results

Thirty-five patients underwent placement of 42 LAMS (74% female, mean age: 54.2 ± 11.7 years). Anastomotic strictures accounted for 64% of cases (N = 27, 45% at the gastrojejunal anastomosis). The median STD was 91.0 days (interquartile range [IQR]: 55.0-132.0). Technical success was obtained in all cases. Early clinical successand LCS were achieved in 80% of cases overall. SPLCS was achieved in 45% (n = 15) of cases. The overall reintervention rate was 63%, with a median time to reintervention being 50.5 days (IQR: 24-105). adverse events occurred in 28% (n = 12) overall, with a 24% migration rate (n = 10). Follow-up was completed in 83% of cases with a median duration of 629 days (range: 192.0-1297.0). Overall symptom improvement occurred in 79% (n = 27) during indwelling LAMS versus 58% and 56% at 30- and 60-days post-removal, respectively.

Conclusions

LAMS for benign gastrointestinal strictures are associated with high technical and early clinical success/LCS rates, positive quality-of-life metrics, and a tolerable adverse event rate. Overall, recurrence of symptoms and high reintervention rates post-LAMS removal reinforce the difficulty in managing benign gastrointestinal strictures but also argue for LAMS as a definitive therapy in select cases.

The Burden of Esophageal Cancer in Five East Asian Countries From 1990 to 2021 and Its Prediction Until 2036: An Analysis of the Global Burden of Diseases Study 2021

BACKGROUND

In 2022, esophageal cancer (EC) was the eleventh most frequently diagnosed cancer and the seventh leading cause of cancer-related deaths worldwide. Nonetheless, the prevalence and burden of EC in Asian countries have been little studied. This study investigated the prevalence, incidence, and burden of EC in five East Asian countries from 1990 to 2021.

METHODS

We retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 on the prevalence, incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) associated with EC in five East Asian countries from 1990 to 2021. The epidemiological characteristics of EC were analyzed by joinpoint regression, age-period-cohort analysis, and decomposition analysis. The burden of EC until 2036 was estimated using autoregressive integrated moving average and Bayesian age-period-cohort models.

RESULTS

Among these East Asian countries, China had the highest incidence, prevalence, mortality rates, YLLs, YLDs, and DALYs in 1990 and 2021. China and Mongolia exhibited the highest age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, age-standardized YLDs rate, age-standardized YLLs rate, and age-standardized DALYs rate from 1990 to 2036. The age group with the highest prevalence rate, incidence rate, mortality rate, YLDs rate, YLLs rate, and DALYs rate in these countries was ≥ 55 years. The prevalence and incidence rates in the five countries were influenced by aging and were higher than the global average.

CONCLUSIONS

The burden of EC in five East Asian countries was high over the past three decades, particularly among older adults. EC is a significant public health problem in these countries, particularly because of the large population base and aging demographics.

Combining gut microbiota modulation and immunotherapy: A promising approach for treating microsatellite stable colorectal cancer

Colorectal cancer (CRC) is one of the most prevalent and lethal cancers worldwide, ranking third in incidence and second in mortality. While immunotherapy has shown promise in patients with deficient mismatch repair (dMMR) or high microsatellite instability (MSI-H), its effectiveness in proficient mismatch repair (pMMR) or microsatellite stable (MSS) CRC remains limited. Recent advances highlight the gut microbiota as a potential modulator of anti-tumor immunity. The gut microbiome can significantly influence the efficacy of immune checkpoint inhibitors (ICIs), especially in pMMR/MSS CRC, by modulating immune responses and systemic inflammation. This review explores the role of the gut microbiota in pMMR/MSS CRC, the mechanisms by which it may enhance immunotherapy, and current strategies for microbiota modulation. We discuss the potential benefits of combining microbiota-targeting interventions with immunotherapy to improve treatment outcomes for pMMR/MSS CRC patients.

Psychedelic Drugs in Mental Disorders: Current Clinical Scope and Deep Learning-Based Advanced Perspectives

Mental disorders are a representative type of brain disorder, including anxiety, major depressive depression (MDD), and autism spectrum disorder (ASD), that are caused by multiple etiologies, including genetic heterogeneity, epigenetic dysregulation, and aberrant morphological and biochemical conditions. Psychedelic drugs such as psilocybin and lysergic acid diethylamide (LSD) have been renewed as fascinating treatment options and have gradually demonstrated potential therapeutic effects in mental disorders. However, the multifaceted conditions of psychiatric disorders resulting from individuality, complex genetic interplay, and intricate neural circuits impact the systemic pharmacology of psychedelics, which disturbs the integration of mechanisms that may result in dissimilar medicinal efficiency. The precise prescription of psychedelic drugs remains unclear, and advanced approaches are needed to optimize drug development. Here, recent studies demonstrating the diverse pharmacological effects of psychedelics in mental disorders are reviewed, and emerging perspectives on structural function, the microbiota-gut-brain axis, and the transcriptome are discussed. Moreover, the applicability of deep learning is highlighted for the development of drugs on the basis of big data. These approaches may provide insight into pharmacological mechanisms and interindividual factors to enhance drug discovery and development for advanced precision medicine.

Comparison between biliary plastic stents with and without application of silver nanoparticles: an in-vitro study of the biofilm formation

PURPOSE

Plastic biliary stents are a cost-effective treatment for biliary obstruction. Unfortunately, they have low patency, related to intraluminal biofilm formation. Silver nanoparticles (AgNPs) have been increasingly used in biomedicine because of its antibacterial properties. This study aimed to compare biofilm formation on stents with and without silver nanoparticle coatings when in contact with different bacterial culture medium.

METHODS

Different types of silver coatings were tested on plastic biliary stents. Two groups of stents were analyzed: one group with various types of silver nanoparticle coatings, and a negative control group with no coating. The stents were placed in different bacterial culture media and assessed for biofilm formation. Analysis was performed using confocal microscopy and direct colony-forming unit (CFU/cm2).

RESULTS

Quantitative analysis showed promising results with C16 coating, as Escherichia coli ATCC and Pseudomonas aeruginosa ATCC exhibited reduced growth in the AgNP-coated group (p < 0.05). However, when mixed samples, including clinical strains and Staphylococcus aureus, were tested, the AgNP coating did not inhibit bacterial growth.

CONCLUSION

AgNP-coated stents are effective against certain strains, such as E. coli ATCC and P. aeruginosa. Further research is needed to explore potential improvements in the coating mechanism.

Global research trends and emerging hotspots in acute high altitude illness: a bibliometric analysis and review (1937-2024)

INTRODUCTION

Acute High Altitude Illness (AHAI) includes conditions such as Acute Mountain Sickness (AMS), High Altitude Cerebral Edema (HACE), and High Altitude Pulmonary Edema (HAPE), which result from rapid ascent to altitudes exceeding 2,500 m. Although interest in AHAI research has been growing, a systematic and comprehensive analysis of global research trends remains lacking.

CONTENT

A total of 3,214 articles and reviews published from 1937 to 2024 were retrieved from the Web of Science Core Collection. Bibliometric tools, including CiteSpace and VOSviewer, were applied to thoroughly assess publication trends, collaborative networks among authors, institutional contributions, and keyword co-occurrence patterns. The dataset represents the contributions of over 11,758 authors across 86 countries and 3,378 institutions, reflecting the significant growth of this research domain.

SUMMARY AND OUTLOOK

Our findings highlight the increasing scholarly attention to AHAI research, with the United States leading in publication numbers. Emerging research themes include cellular activation, oxidative stress, risk factors, and hypobaric hypoxia. This is the first systematic bibliometric review of AHAI literature, offering a detailed roadmap of research hotspots, potential collaborations, and key future directions. These findings provide a valuable reference for researchers aiming to explore gaps and build on the existing knowledge in high-altitude medicine.

Visualization analysis of breast cancer-related ubiquitination modifications over the past two decades

BACKGROUND

Ubiquitination is a type of post-translational modification, referring to the process in which the small molecular protein ubiquitin covalently binds to target proteins under the catalysis of a series of enzymes. The process of ubiquitination is vital in the onset and progression of breast cancer. The use of the ubiquitin-protease system is expected to be a new way to treat human breast cancer. This research aimed to investigate the evolution patterns, key areas of interest, and future directions of ubiquitination in breast cancer via bibliometric analysis.

METHODS

Research articles on ubiquitination modifications in breast cancer were sourced from the Web of Science Core Collection database and analyzed via Microsoft Excel 2021, Bibliometrix, VOSviewer, and Citespace software for thorough bibliometrics.

RESULTS

From 2005-2024, 1850 English articles published in 405 journals by 1842 institutions/universities from 61 countries were included in the study. Keywords, research fields, co-cited literature and other information were included. Research on ubiquitination modifications has focused on breast cancer, expression, protein, activation, degradation, ubiquitination, phosphorylation, etc. Notably, the keywords that broke out in the past five years have focused on "triple-negative breast cancer", "promotion", and "metabolism". These findings suggest that key areas of current research are metabolism, immunity, survival, and prognosis in triple-negative breast cancer.

CONCLUSIONS

Our findings indicate that research on triple-negative breast cancer, as well as its immunological and metabolic aspects, is a burgeoning and promising area. Our work offers valuable guidance and fresh perspectives on the relationship between breast cancer and ubiquitin modification.

AI and Machine Learning for Precision Medicine in Acute Pancreatitis: A Narrative Review

Acute pancreatitis (AP) presents a significant clinical challenge due to its wide range of severity, from mild cases to life-threatening complications such as severe acute pancreatitis (SAP), necrosis, and multi-organ failure. Traditional scoring systems, such as Ranson and BISAP, offer foundational tools for risk stratification but often lack early precision. This review aims to explore the transformative role of artificial intelligence (AI) and machine learning (ML) in AP management, focusing on their applications in diagnosis, severity prediction, complication management, and treatment optimization. A comprehensive analysis of recent studies was conducted, highlighting ML models such as XGBoost, neural networks, and multimodal approaches. These models integrate clinical, laboratory, and imaging data, including radiomics features, and are useful in diagnostic and prognostic accuracy in AP. Special attention was given to models addressing SAP, complications like acute kidney injury and acute respiratory distress syndrome, mortality, and recurrence. AI-based models achieved higher AUC values than traditional models in predicting acute pancreatitis outcomes. XGBoost reached an AUC of 0.93 for early SAP prediction, higher than BISAP (AUC 0.74) and APACHE II (AUC 0.81). PrismSAP, integrating multimodal data, achieved the highest AUC of 0.916. AI models also demonstrated superior accuracy in mortality prediction (AUC 0.975) and ARDS detection (AUC 0.891) AI and ML represent a transformative advance in AP management, facilitating personalized treatment, early risk stratification, and allowing resource utilization to be optimized. By addressing challenges such as model generalizability, ethical considerations, and clinical adoption, AI has the potential to significantly improve patient outcomes and redefine AP care standards globally.

NELL2 suppresses epithelial-mesenchymal transition and induces ferroptosis via notch signaling pathway in HCC

Although various malignant tumors have been associated with the aberrant expression of Neural Epidermal Growth Factor-Like 2 (NELL2), its involvement in hepatocellular carcinoma (HCC) has not been previously documented. In this study, NELL2, recognized as a crucial tumor-suppressor gene, was found to be infrequently expressed in HCC. In vitro experiments demonstrated that the overexpression of NELL2 significantly inhibited the proliferation, migration, and invasion of liver cancer cells, whereas the suppression of NELL2 markedly enhanced these oncogenic properties. Further investigation revealed that NELL2 impedes epithelial-mesenchymal transition (EMT) via the Notch signaling pathway. Inhibition of the Notch pathway reversed the increased tumor proliferation, migration, and invasion observed following the downregulation of NELL2 expression. Notably, gene enrichment analysis and in vitro studies indicated that NELL2 effectively induced ferroptosis in HCC cells, as evidenced by increased levels of cellular malondialdehyde (MDA), iron, and Reactive Oxygen Species (ROS), alongside decreased glutathione (GSH) levels. The blockade of the Notch signaling pathway substantially diminished NELL2's capacity to induce ferroptosis. In summary, our findings suggest that NELL2 modulates the Notch signaling pathway to inhibit EMT and promote ferroptosis. Consequently, NELL2 may serve as a novel therapeutic target, potentially functioning as a tumor suppressor gene in HCC.

Artificial Intelligence as a Surrogate for Inspection Time to Assess Completeness in Esophagogastroduodenoscopy: A Prospective, Randomized, Noninferiority Study

INTRODUCTION

The completeness of esophagogastroduodenoscopy (EGD) is a prerequisite for detecting lesions. This study aims to explore whether the quality of complete examinations assisted by artificial intelligence (AI) would be comparable with those conducted within the guideline-recommended inspection time.

METHODS

Patients referred for diagnostic, screening, or surveillance EGD were enrolled at Renmin Hospital of Wuhan University. Patients were randomly assigned to 2 groups in a 1:1 ratio. In the AI-assisted group, endoscopists completed observation of the entire upper gastrointestinal tract with AI assistance. In the control group, endoscopists were instructed to spend no less than 7 minutes on each procedure. The primary outcome was the detection rate of neoplastic lesions. Noninferiority was confirmed when the lower bound of the 95% confidence interval (CI) was greater than the margin of -1.5%.

RESULTS

A total of 1,723 patients were prospectively enrolled between July 3, 2023, and April 7, 2024. Seven hundred ninety-six and 763 patients in the AI-assisted and control groups were included in the final analysis, respectively. The detection rates of neoplastic lesions in the AI-assisted and control groups were 3.14% and 2.36%, respectively, resulting in an absolute proportion difference of 0.78% (95% CI -0.58% to 2.14%; odds ratio 1.342 [95% CI 0.726-2.480]). The median inspection time was reduced by 1.5 minutes in the AI-assisted group (6.18 [2.87] vs 7.70 [1.90], P < 0.001).

DISCUSSION

Inspection time of complete EGD can be significantly shortened by AI without compromising its quality. These findings provide crucial evidence to support that AI-assisted procedural completeness serves as an objective and effective quality indicator for EGD.