Cryo-EM reveals mechanisms of natural RNA multivalency

Homo-oligomerization of biological macromolecules leads to functional assemblies that are critical to understanding various cellular processes. However, RNA quaternary structures have rarely been reported. Comparative genomics analysis has identified RNA families containing hundreds of sequences that adopt conserved secondary structures and likely fold into complex three-dimensional structures. In this study, we used cryo-electron microscopy (cryo-EM) to determine structures from four RNA families, including ARRPOF and OLE forming dimers and ROOL and GOLLD forming hexameric, octameric, and dodecameric nanostructures, at 2.6- to 4.6-angstrom resolutions. These homo-oligomeric assemblies reveal a plethora of structural motifs that contribute to RNA multivalency, including kissing-loop, palindromic base-pairing, A-stacking, metal ion coordination, pseudoknot, and minor-groove interactions. These results provide the molecular basis of intermolecular interactions driving RNA multivalency with potential functional relevance.

Periostin acts as an oncogene to promote laryngeal cancer progression by activating decorin

Laryngeal carcinoma (LC) is the second most common malignancy of the head and neck worldwide, with increasing incidence every year. However, the mechanism of its development is not completely clear. Periostin (POSTN) has been reported to be involved in various aspects of tumorigenesis. To determine the influence of POSTN on LC tumorigenesis, we first examined the expression of POSTN in tissues from patients with LC through immunohistochemistry, western blot, and qRT-PCR. Besides, we demonstrated that POSTN promoted LC cell migration, invasion, and proliferation in vitro by CCK-8, colony formation, and Transwell assays, and tumor growth in vivo by immunohistochemistry. Furthermore, the interaction between POSTN and decorin (DCN) was further verified by bioinformatics analysis and immunoprecipitation (IP), finding that POSTN promoted the malignant progression of LC by targeting DCN. Our findings support the idea that the level of POSTN expression and accumulation in tumors correlated with the malignancy degree of LC, suggesting that POSTN may play a potential role in improving laryngeal cancer treatment strategies.

Preparation of pH-enzyme dual-responsive gel microspheres and their treatment of ulcerative colitis

Mesalazine (MSZ), a first-line treatment for ulcerative colitis (UC), was formulated into acid-resistant, colon-targeted gel microspheres to reduce upper gastrointestinal tract (GIT) exposure and extend drug retention in the colon. In this study, we used MSZ/hydroxypropyl-β-cyclodextrin (MSZ/HP-β-CD) as the model drug, dopamine-modified sodium alginate (DA-SA) and konjac glucomannan (KGM) as the carrier matrix, and chitosan (CS) as the coating material. The colon-targeted gel microspheres (MSZ/HP-β-CD/DA-SA/KGM/CS) were prepared using the drop method. These microspheres had a drug loading capacity of 7.9 ± 0.01 % and an encapsulation efficiency of 72.5 ± 0.03 %. The drug primarily released in the colon environment, showing pH and β-mannanase sensitivity. The dried microspheres measured approximately 0.6 mm, suitable for oral administration. In the rat UC model, after oral administration of gel microspheres, the colon length increased, while the DAI score, spleen index, and the expression levels of IL-6, IL-1β, TNF-α, TLR4, MyD88 and NF-κB p65 all decreased. Histopathological examination showed that treated UC rats' colon tissues closely resembled those of healthy controls. These findings indicate that pH-enzyme-responsive coated gel microspheres can effectively target the colon and show potential for UC treatment.

Identification of a Biomarker Panel in Extracellular Vesicles Derived From Non-Small Cell Lung Cancer (NSCLC) Through Proteomic Analysis and Machine Learning

Antigen fingerprint profiling of tumour-derived extracellular vesicles (TDEVs) in the body fluids is a promising strategy for identifying tumour biomarkers. In this study, proteomic and immunological assays reveal significantly higher CD155 levels in plasma extracellular vesicles (EVs) from patients with non-small cell lung cancer (NSCLC) than from healthy individuals. Utilizing CD155 as a bait protein on the EV membrane, CD155+ TDEVs are enriched from NSCLC patient plasma EVs. In the discovery cohort, 281 differentially expressed proteins are identified in TDEVs of the NSCLC group compared with the healthy control group. In the verification cohort, 49 candidate biomarkers are detected using targeted proteomic analysis. Of these, a biomarker panel of seven frequently and stably detected proteins-MVP, GYS1, SERPINA3, HECTD3, SERPING1, TPM4, and APOD-demonstrates good diagnostic performance, achieving an area under the curve (AUC) of 1.0 with 100% sensitivity and specificity in receiver operating characteristic (ROC) curve analysis, and 92.3% sensitivity and 88.9% specificity in confusion matrix analysis. Western blotting results confirm upregulation trends for MVP, GYS1, SERPINA3, HECTD3, SERPING1 and APOD, and TPM4 is downregulated in EVs of NSCLC patients compared with healthy individuals. These findings highlight the potential of this biomarker panel for the clinical diagnosis of NSCLC.

A Bio-Adaptive Janus-Adhesive Dressing with Dynamic Lubrication Overlayer for Prevention of Postoperative Infection and Adhesion

Wound postoperative infection and adhesion are prevalent clinical conditions resulting from surgical trauma. However, integrating intraoperative repair and postoperative management into a dressing suitable for wounds with unpredictable surface shapes and surroundings remains a formidable challenge. Here, we attempt to introduce a dynamic antifouling surface as wound protective covering and report an in situ formation of slippery-adhesive Janus gel (SAJG) by assembling hydrogel (N-hydrosuccinimide ester-activated powders) and elastomer (Silicon oil-infused polydimethylsiloxane). First powders can rapidly absorb interfacial water to gel and bond to tissue based on network entanglement, forming a tough adhesive hydrogel. Then precured organosilicon is applied to hydrogel and bonded together, forming a slippery elastomer. Due to the molecular polarity difference between hydrogel and elastomer, SAJG exhibits anisotropic surface behavior as evidenced by liquid repellency (hydrophilic vs. hydrophobic), and adhesion performance (bioadhesion vs. antiadhesion). Further, in vivo models are constructed and results demonstrated that the SAJG can effectively prevent bacterial infection to promote wound healing and avoid postoperative adhesion. Predictably, the morphologically adaptive SAJG with slippery and adhesive properties will have tremendous potential in addressing complex wound infections and postoperative complications.

Advanced Multiparametric MRI Strategies for Tumor Restaging After Neoadjuvant Therapy in Locally Advanced Gastric Cancer

BACKGROUND

This study tested the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in restaging locally advanced gastric cancer after neoadjuvant therapy (NAT) using pathologic T stage (ypT) and pathologic N stage (ypN) as the reference standard.

METHODS

Between August 2022 and September 2023, the study enrolled a prospective cohort of 70 gastric cancer patients who underwent NAT and subsequent surgical resection. MRI procedures, including DLSB T2-weighted imaging (T2WI), ZOOMit diffusion-weighted imaging (DWI), and XD-VIBE dynamic contrast-enhanced imaging (DCE), were performed after NAT and before surgery. Four abdominal radiologists independently assigned radiologic T stage (yrT) and radiologic N stage (yrN) based on individual and combined sequences. Inter-reader agreement was quantified using Kendall's coefficient. Diagnostic accuracy was determined by comparing MRI assessments and pathologic outcomes, with pairwise comparisons analyzed via the McNemar test. Subgroup analysis evaluated the performance in identifying good responders to NAT.

RESULTS

Inter-reader agreement was almost perfect for T restaging and substantial for N restaging. Diagnostic accuracy for T restaging was 0.432 using DLSB-T2WI, 0.586 using ZOOMit DWI, 0.557 using XD-VIBE DCE, and 0.586 using mpMRI. The accuracy demonstrated by DWI, DCE and mpMRI was superior to that of T2WI (all P < 0.05). For N restaging, the accuracy of the mpMRI protocol was 0.443. Notably, mpMRI achieved an AUC of 0.879 (95% confidence interval 0.835-0.915) for differentiating ypT0-1 tumors.

CONCLUSIONS

Advanced mpMRI strategies can serve as a valuable tool for restaging gastric cancer after NAT. Accurately differentiating good responders to neoadjuvant therapy through mpMRI holds significant clinical implications for personalized treatment strategies and improved patient outcomes.

Intratumoral microbiota: a new force in the development and treatment of esophageal cancer

Esophageal cancer (EC) ranks among the most prevalent cancers worldwide, with a particularly high incidence in the Asian population. Due to the inconspicuous nature of early symptoms, patients with esophageal cancer are typically diagnosed in the middle to late stages, resulting in suboptimal overall treatment outcomes. Consequently, there is an urgent need to explore and refine therapeutic strategies. Microorganisms have been identified in numerous tumor tissues, including EC, and these microorganisms are referred to as the intratumoral microbiome. Intratumoral microbiota and their metabolic byproducts can influence the progression and treatment of esophageal cancer through various mechanisms, such as modulating tumor cell metabolism and local immune responses. Therefore, the intratumoral microbiota may potentially serve as a target for the treatment of esophageal cancer. This review delineates the composition, origin, and diagnostic significance of intratumoral microbiota in esophageal cancer tissue, and discusses the mechanisms by which intratumoral microbiota contribute to the onset of esophageal cancer. In addition, the impact of intratumoral microbiota on the treatment of esophageal cancer and its intervention measures are also addressed.

Multifunctional Carbon Quantum Dots for Monitoring and Therapy of Bacterial Infected Wounds

Bacterial infections in wounds and bacteremia present significant global health challenges, driving the urgent need for innovative alternatives to traditional antibiotics. Here, the development of PEI-EDTA-2Na carbon quantum dots (PECDs) synthesized via a hydrothermal method is reported. Synthesis conditions affect PECDs' antibacterial efficacy; those at 180 °C have optimal -NH2 functionalization for better adhesion and activity. PECDs are pH - responsive, eradicating bacteria in weakly acidic conditions by disrupting DNA and proteins. Following the resolution of infection, PECDs adapt to neutral and alkaline environments, where they scavenge reactive oxygen species (ROS), reduce inflammation, promote macrophage polarization, and accelerate wound healing. Furthermore, PECDs significantly improve survival in bacteremia models. Their intrinsic fluorescence enables real-time pH monitoring of wounds, offering a non-invasive diagnostic tool. Genomic and transcriptomic analyses reveal that PECDs disrupt bacterial metabolism and resistance pathways, while simultaneously supporting antibacterial and anti-inflammatory responses during tissue repair. This dual functionality-combining therapeutic efficacy in wound healing with antimicrobial and anti-inflammatory properties in bacteremia-positions PECDs as a versatile platform for smart wound management and an emerging candidate for advanced biomedical applications.

Macrophage biology in the pathogenesis of Helicobacter pylori infection

Infection with H. pylori induces chronic gastric inflammation, progressing to peptic ulcer and stomach adenocarcinoma. Macrophages function as innate immune cells and play a vital role in host immune defense against bacterial infection. However, the distinctive mechanism by which H. pylori evades phagocytosis allows it to colonize the stomach and further aggravate gastric preneoplastic pathology. H. pylori exacerbates gastric inflammation by promoting oxidative stress, resisting macrophage phagocytosis, and inducing M1 macrophage polarization. M2 macrophages facilitate the proliferation, invasion, and migration of gastric cancer cells. Various molecular mechanisms governing macrophage function in the pathogenesis of H. pylori infection have been identified. In this review, we summarize recent findings of macrophage interactions with H. pylori infection, with an emphasis on the regulatory mechanisms that determine the clinical outcome of bacterial infection.

Identification of a novel FOXO3‑associated prognostic model in hepatocellular carcinoma

Although numerous molecular classifications are available to predict the prognosis of patients with hepatocellular carcinoma (HCC), they are still unsatisfactory. Forkhead box O3 (FOXO3) has been widely reported as a transcription factor involved in human cancers, but its role in HCC remains controversial. The present study aimed to explore the role of FOXO3 in HCC, as well as to identify biomarkers and construct prognostic models based on FOXO3. FOXO3 was highly expressed in HCC and was closely associated with poor prognosis in The Cancer Genome Atlas (the training set) and International Cancer Genome Consortium (the validation set). Subsequently, a co-expression network indicated that the red modules were closely related to FOXO3. Five key FOXO3-related genes [DEAD-box helicase 55 (DDX55), RAB10, member RAS oncogene family (RAB10), RAB7A, TATA-box binding protein associated factor, RNA polymerase I subunit B (TAF1B) and TAF3] were obtained using Cox-least absolute shrinkage and selection operator analyses. The 5-gene signature successfully predicted the prognosis of patients with HCC in both the training and validation sets. Enrichment analysis suggested marked differences in AKT and cell cycle-related (E2F targets and G2/M checkpoints) pathways between HCC subgroups. Furthermore, the tumor microenvironment analysis suggested that the difference in the distribution of M2 macrophages among various subgroups may contribute to the poor prognosis using the CIBERSORTx framework. Furthermore, the mRNA and protein expressions of DDX55, RAB10, RAB7A, TAF1B and TAF3 were found to be higher in HCC tissues compared with paracancerous tissues using RT-qPCR and western blotting. Additionally, knockdown of RAB10, RAB7A and TAF3 inhibited proliferation of Huh7 cells, assessed by a Cell Counting Kit-8 assay. In conclusion, a novel FOXO3-related model was constructed and revealed that RAB10, RAB7A and TAF3 may be potential molecular targets or biomarkers for HCC.

Double Band Ligation-Assisted Endoscopic Submucosal Resection for Rectal Neuroendocrine Tumors: Comparison With Conventional Endoscopic Mucosal Resection With Ligation (With Video)

INTRODUCTION

Based on endoscopic mucosal resection with ligation (EMR-L), we developed double band ligation-assisted endoscopic submucosal resection (ESR) for complete resection of small submucosal rectal neuroendocrine tumors (NETs). Both procedures use a multiband device to perform resection, with the only difference being that ESR adds an additional band to obtain deeper resection margin. The aim of this retrospective study was to validate its feasibility, safety, and effectiveness compared with EMR-L.

METHODS

This retrospective study included consecutive patients with small (≤10 mm) suspected submucosal rectal NETs who underwent ESR (n = 45) or EMR-L (n = 26) between June 2018 and October 2023 at West China Hospital. En bloc resection rate, complete resection rate, procedure time, margin distance, and adverse events were compared between 2 groups.

RESULTS

En bloc resections were achieved in all patients. The complete resection rate of ESR was higher than EMR-L (100% vs 88.5%, P = 0.045). The vertical margin distance and lateral margin distance were significantly longer in ESR group than EMR-L group (vertical margin distance 782.31 ± 359.45 μm vs 363.84 ± 222.78 μm, P < 0.001; and lateral margin distance 4,205.75 ± 2,167.43 μm vs 3,162.94 ± 1,419.22 μm, P = 0.008, respectively). There were no significant differences in procedure time, adverse events, postprocedural hospital stay, or medical cost between 2 groups. In addition, there was no evidence of recurrence or metastasis during the follow-up.

DISCUSSION

ESR seems to be safe and effective for complete resection of small submucosal rectal NETs. Larger, multicenter, prospective studies are needed to further assess this technique.

Ultrafast self-gelling, superabsorbent, and adhesive chitosan-based hemostatic powders for rapid hemostasis and wound healing

Hemostatic powders are widely used for managing bleeding from wounds with various irregular shapes. However, their limited liquid absorption capacity and difficulty in removal after application remain significant clinical challenges. Herein, we introduce a multifunctional hemostatic powder composed of dually crosslinked poly([2-(methacryloyloxy)ethyl]trimethylammonium chloride-co-acrylic acid) (pMATC-co-AA) and N-[(2-hydroxy-3-trimethylammonium)propyl] chitosan chloride (HTCC), which are integrated via electrostatic interactions and hydrogen bonding. This hemostatic powder exhibits superb liquid-absorbing capacity (94.5 times its own weight in water and 9.1 times in blood), sufficient adhesive properties (5.9 kPa on pig skin), and on-demand removability. It significantly reduces the number of viable Escherichia coli and Staphylococcus aureus by 4.61 and 4.04 orders of magnitude, respectively, thus providing an effective microbiological barrier for the wound. Furthermore, a series of in vivo and in vitro experiments confirm the powder's excellent hemostatic properties. The hydrogel formed on the wound after hemostasis can be removed by saline rinsing on demand, due to its superb liquid-absorbing capacity. Notably, the powder demonstrates good in vivo biocompatibility, with minimal risk of impeding wound healing, and it facilitates the healing process during the later stages. In sum, the hemostatic powder offers a promising solution for trauma bleeding control and acute wound treatment.

Cavernous Hemangioma of the Anal Canal Mimicking a Neoplasm: A Rare Cause of Lower Gastrointestinal Bleeding Successfully Treated With Transanal Excision

Cavernous hemangiomas of the anal canal are exceptionally rare vascular malformations that may present with chronic rectal bleeding and are often misdiagnosed as hemorrhoids or neoplastic lesions. We report the case of a 75-year-old female patient with a one-year history of painless rectal bleeding and a soft polypoid lesion located 2 cm from the anal verge, within the anterior wall of the anal canal. Magnetic resonance imaging (MRI) revealed a hyperintense pseudonodular lesion consistent with a vascular malformation. Histopathological examination after biopsy confirmed the diagnosis of cavernous hemangioma. Definitive treatment was achieved through transanal full-thickness excision, with complete resolution of symptoms and no recurrence at the three-month follow-up. This case highlights the importance of including vascular lesions in the differential diagnosis of anorectal bleeding and illustrates the utility of MRI and organ-preserving surgery in the management of anal canal hemangiomas.

Position statement of the World Endoscopy Organization: Role of endoscopy in screening, diagnosis, and treatment of esophageal superficial squamous neoplasiaia

Esophageal squamous cell carcinoma (ESCC) remains a significant global health challenge, being the sixth leading cause of cancer mortality with pronounced geographic variability. The incidence rates range from 125 per 100,000 in northern China to 1-1.5 per 100,000 in the United States, driven by environmental and lifestyle factors such as tobacco and alcohol use, dietary habits, and pollution. Major modifiable risk factors include tobacco and alcohol consumption, with a synergistic risk increase when combined. Nonmodifiable risk factors include previous diagnoses of head and neck squamous cell carcinoma (H&N SCC), achalasia, and prior radiotherapy. Prevention strategies must be tailored to specific regional burdens to efficiently allocate medical and financial resources. Gastrointestinal endoscopy is crucial in reducing ESCC burden through early detection and characterization of neoplastic changes, such as high-grade dysplasia. Early diagnosis significantly improves survival rates, while endoscopic resection of noninvasive dysplasia can prevent ESCC onset, reducing treatment burden for advanced disease. Postresection surveillance can detect high-risk metachronous lesions. Despite these benefits, endoscopic prevention faces challenges, including the lack of high-level evidence supporting its efficacy, opportunity costs, the need for specialized training and techniques, and the requirement for advanced technology investments. This Position Statement from the World Endoscopy Organization (WEO) aims to address these challenges, supplying recommendations for the exploitation of endoscopic resources regarding the possible role of screening, quality, and training for the detection, characterization, resection, and surveillance of ESCC.

Defect-Rich MoO3-X@CuO2 Nanosheets Mediated Ultrasound-Enhanced Cuproptosis Antibacterial Activity and M2 Macrophage Reprogramming for Optimizing Diabetic Wound Repairment

Diabetic wounds are often plagued by persistent bacterial infections, which exacerbate inflammation and impair healing processes such as collagen deposition and fibroblast migration. Conventional antibiotic therapies frequently prove ineffective and can even hinder wound repair. To address these challenges, biodegradable MoO3-x@CuO2 ion disruptors (MCO IDs) that for comprehensive diabetic wound treatment is developed. The MCO IDs generate a burst of multimodal reactive oxygen species (ROS) that effectively penetrate bacterial defenses and disrupt redox homeostasis. Released copper ions induce proteotoxic stress-like bacterial death by targeting lipoylated and iron-sulfur cluster proteins. Transcriptomic and metabolomic analyses reveal that this mechanism systematically inhibits bacterial energy metabolism and gene expression, effectively suppressing proliferation. Following bacterial eradication, the released copper ions promote macrophage repolarization to the M2 phenotype, mitigating chronic inflammation and stimulating wound healing. Furthermore, to enhance wound management, a portable wound dressing (PVA-MCO) is fabricated by electrospinning polyvinyl alcohol (PVA) incorporating the MCO IDs. In vivo studies demonstrate that the PVA-MCO dressing effectively eliminates pathogenic bacteria and promotes collagen deposition, angiogenesis, and epithelialization, thereby accelerating diabetic wound healing. This multifaceted therapeutic strategy offers a promising solution for managing persistent infections and promoting diabetic wound repair.

High-Resolution Manometry With Solid Provocative Test in Patients With Mid-Thoracic and Epiphrenic Esophageal Diverticula

BACKGROUND

The number of studies exploring esophageal motility disorders using high-resolution manometry (HRM) in patients with esophageal diverticula (ED) is limited. The goal of this study was to describe motility disorders using HRM in patients with ED and assess the added value of provocative testing in these patients.

METHODS

Patients with ED who underwent HRM between 2010 and 2022 were retrospectively included. HRM findings were compared based on single water swallows (SWS), and provocative testing with solid food swallows in the upright seated position, using both ManoView and Medical Measurement Systems software. We also calculated median pressure slopes during the compartmentalization phase.

KEY RESULTS

Sixteen of the 39 included patients had mid-ED and 23 had lower ED. Twenty (51.3%) patients had motility disorders based on SWS, including 7 (18%) with achalasia and 3 (7.7%) with esophagogastric junction obstruction. No significant differences in esophageal motility disorders were observed in relation to the location of the ED. Solid food swallows were performed in 29 (74%) patients leading to a change in the HRM diagnosis in 7 (24.1%), all of whom showed elevated IRP. Median pressure slopes during the compartmentalization phase (n = 30) were elevated in patients both with and without motility disorders.

CONCLUSION AND INFERENCES

Half of the patients with mid- or lower ED had motility disorders on HRM. Adding solid food swallows during HRM in patients with ED improves the manometric diagnosis. Results suggest abnormal distensibility in these patients, indicated by elevated pressure slope, regardless of the presence of associated motility disorders.

Interplay and cooperation between GLI2 and master transcription factors promote progression of esophageal squamous cell carcinoma

The establishment of gene expression programs that drive cell identity is governed by tightly regulated transcription factors (TFs) that engage in auto- and cross-regulation in a feedforward manner, forming core regulatory circuitries (CRCs). Here, we identify and validate an important interconnected CRC formed by three master TFs-GLI2, TP63, and RUNX1-in esophageal squamous cell carcinoma (ESCC). Furthermore, master TFs co-bind to their own and each other's super-enhancers, forming an interconnected auto-regulatory loop. Mechanistically, these master TFs occupy the majority of ESCC super-enhancers and cooperatively orchestrate the ESCC transcription program. Functionally, GLI2, a master TF, is essential for ESCC viability, migration, invasion, and the growth of xenograft tumors. Moreover, the overexpression of GLI2 is significantly associated with shorter overall survival of patients with ESCC. Downstream, this CRC apparatus coordinately regulates gene expression networks in ESCC, controlling important cancer-promoting pathways, including Hedgehog, glycolysis, and epidermal growth factor receptor signaling pathways. Together, these findings offer significant mechanistic insights into the transcriptional dysregulation in ESCC and recognize GLI2 as a potential therapeutic target and prognostic marker for ESCC. More importantly, CRC-downstream genes and signaling pathways may contain potential therapeutic targets for this malignancy.

Fe/Se nanocomposite-loaded chitosan/alginate films for wound healing

Infectious wounds pose a major challenge to the healthcare sector, with numerous barriers, infections, dysregulated inflammation, and impaired cellular functions as well as complex healing mechanisms. To overcome these challenges, we report the fabrication of disulfide crosslinked chitosan/alginate (CAT)-based film loaded with iron oxide/selenium nanocomposite (SeIO) and ursodeoxycholic acid drug (UDC). Loading of SeIO and UDC in UDC/SeIO/CAT film leads to ⁓47 % increment in tensile strength as compared to CAT film. UDC/SeIO/CAT film shows the porosity of ∼70 % and swelling ratios of around 800 % at physiological pH 7.4, which can aid in the enhanced drug release and efficient wound healing. UDC/SeIO/CAT films exhibit a controlled degradation profile, and prolonged drug release of 92 % and 86 % at pH 7.4 and pH 8.5, respectively, over 110 h. It shows 99 % drug release at pH 5.5 over 74 h. Film displays 90 % antioxidant activity along with antibacterial activity of 86 % against E. coli and 89 % against S. aureus. Additionally, UDC/SeIO/CAT film is hemocompatible and exhibits good hemostatic behavior. It shows 130 % cell viability in murine fibroblast L929 cells, thus corroborating its cytocompatibility. Quantitative analysis of wound healing by scratch assay reveals 91 % decrease in wounded area on treatment with UDC/SeIO/CAT films.

MTHFD2 promotes esophageal squamous cell carcinoma progression via m6A modification‑mediated upregulation and modulation of the PEBP1‑RAF1 interaction

One‑carbon metabolism plays an important role in cancer progression. Methylenetetrahydrofolate dehydrogenase 2 (MTHFD2), a mitochondrial enzyme in one‑carbon metabolism, is dysregulated in several cancer types. However, the precise role and mechanisms of MTHFD2 in esophageal squamous cell carcinoma (ESCC) remain unclear. The present study unravels the multifaceted mechanisms by which MTHFD2 contributes to ESCC pathogenesis. Bioinformatics analyses revealed significant upregulation of MTHFD2 in ESCC tumor tissues, which was associated with advanced disease stage and poor patient prognosis. Validating these findings in clinical samples, MTHFD2 overexpression was confirmed through immunohistochemistry, Reverse transcription‑quantitative PCR and western blotting. Knockdown of MTHFD2 inhibited ESCC cell viability, colony formation, invasion, and tumor growth in vivo, indicating its oncogenic potential. Mechanistically, the present study elucidated a novel regulatory axis involving N6‑methyladenosine modification and MTHFD2 mRNA stability. Specifically, methyltransferase‑like 3 (METTL3) and insulin‑like growth factor 2 mRNA binding protein 2 (IGF2BP2) were identified as key mediators of m6A‑dependent stabilization of MTHFD2 mRNA, contributing to its elevated expression in ESCC. Furthermore, MTHFD2 was found to activate PI3K/AKT and ERK signaling pathways by modulating interaction between phosphatidylethanolamine‑binding protein 1 (PEBP1) and raf‑1 proto‑oncogene (RAF1). This modulation was achieved through direct binding of MTHFD2 to PEBP1, disrupting the inhibitory effect of PEBP1 on RAF1 and promoting downstream pathway activation. The oncogenic functions of MTHFD2 were attenuated upon PEBP1 knockdown, underscoring the role of the MTHFD2‑PEBP1 axis in ESCC progression. In summary, the present study uncovers a novel regulatory mechanism involving m6A modification and the MTHFD2‑PEBP1 axis, unveiling potential therapeutic avenues for targeting MTHFD2 in ESCC.

A self-assembly enzyme-like hydrogel with ROS scavenging and immunomodulatory capability for microenvironment-responsive wound healing acceleration

On-demand responsive hydrogels are a promising solution for effective wound management as they can adjust their properties in response to changes in the wound environment, allowing them to provide tailored support for the healing process. However, the conventional hydrogels may not fully meet the diverse demands of the intricate healing process. Herein, a novel glycyrrhizic acid (GA) based self-assembly hydrogel coordinated with copper and polyphenol (GCP hydrogel) was developed to exhibit triggered release behavior in response to the microenvironment. The GCP hydrogel coordinated with copper and protocatechuic acid (PA) and self-assembled with GA, also exhibits enzyme-like properties by mimicking the cascade process of superoxide dismutase (SOD) and catalase (CAT), effectively scavenging reactive oxygen species (ROS). Furthermore, the on-demand release of Cu2+ at different stages of the wound healing process can not only enhance the antibacterial ability of methicillin-resistant Staphylococcus aureus (MRSA) but also intelligently promote angiogenesis with outstanding biocompatibility. In addition, the GCP hydrogel effectively modulated the activity of macrophages in response to inflammatory stimuli, exhibiting remarkable anti-inflammatory abilities and promoting tissue regeneration. The multifunctional GCP hydrogel platform has the potential to create a dynamic microenvironment that is conducive to tissue regeneration, making it an ideal candidate for smart wound management.

Multifunctional Bioactive Dual-Layered Nanofibrous Matrix for Effective Breast Cancer Therapy and Enhanced Wound Healing

Surgical resection is the primary treatment for triple-negative breast cancer (TNBC). Post-operative complications, including tumor recurrence and bacterial infections, hinder complete remission and long-term recovery. To address these challenges, a multifunctional bioactive dual-layered nanofibrous matrix (MBDL-NanoMat) featuring adaptive shape control, excellent wound adherence, tunable drug release profiles, and superior biocompatibility for post-surgical applications is developed. The MBDL-NanoMat comprises a hydrophilic (HyPhil) layer and a hydrophobic (HyPhob) layer, offering distinct functionalities. The HyPhil layer, electrospun with gelatin and copper peroxide nanoparticles (Cu NPs), rapidly releases Cu NPs to induce anticancer effects through chemodynamic therapy (CDT), ferroptosis, and cuproptosis along with antibacterial action. Near-infrared laser irradiation enhances therapeutic efficacy through photothermal therapy (PTT). The HyPhob layer ensures prolonged therapeutic effects by releasing therapeutic molecules, such as rapamycin, enabling sustained chemotherapy (CT) and antibacterial activity. This synergistic therapeutic system integrates multiple mechanisms-CT, CDT, PTT, ferroptosis, and cuproptosis-suppressing tumor recurrence and accelerating wound healing. Preclinical results demonstrated enhanced angiogenesis, collagen deposition, and dermal regeneration without systemic safety. In short, the MBDL-NanoMat platform offers a unique advantage in post-surgical TNBC care by simultaneously targeting tumor recurrence and facilitating wound healing. Further investigation of this platform can significantly improve oncological and regenerative medicine strategies.

Artificial intelligence alert system based on intraluminal view for colonoscopy intubation

Mucosal contact of the tip of colonoscopy causes red-out views, and more pressure may result in perforation. There is still a lack of quantitative analysis methods for red-out views. We aimed to develop an artificial intelligence (AI)-based system to assess red-out views during intubation in colonoscopy. Altogether, 479 colonoscopies performed by 34 colonoscopists were analysed using the proposed semi-supervised AI-based system. We compared the AI-based red-out avoiding scores among novice, intermediate, and experienced colonoscopists. The mean AI-based red-out avoiding scores were compared among groups stratified by expert-rated direct observation of procedure or skill (DOPS)-based tip control assessment results. Both the percentage of actual red-out views (p < 0.001) and AI-based red-out avoiding scores (p < 0.001) were significantly different among the novice, intermediate, and experienced groups. Colonoscopists who scored better on the DOPS-based tip control assessment also performed better on the AI-based red-out avoiding skill assessment. AI-based red-out avoiding score was negatively correlated with actual caecal intubation time and actual red-out percentage. Feedback of red-out avoiding score may help remind endoscopists to perform colonoscopy in an effective and safe manner. This system can be used as an auxiliary tool for colonoscopy training.

DOCK9 as a predictive biomarker linked to angiogenesis and immune response in esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) remains a serious health concern due to its high prevalence and mortality rates. Identifying prognostic biomarkers is essential to improving patient outcomes and treatment strategies. DOCK9, a gene implicated in various cellular functions, may play a significant role in ESCC progression and prognosis. We analyzed RNA microarray datasets and single-cell RNA sequencing data to identify survival-associated genes in ESCC. Using protein expression analysis, we examined DOCK9 in ESCC tissues and assessed its functional impact on human umbilical vein endothelial cells to understand its role in angiogenesis. Additionally, we developed a 21-gene prognostic risk model, focusing on the relevance of DOCK9. Our findings revealed that DOCK9 expression is significantly reduced in ESCC tissues and correlates with poor survival outcomes. Functionally, DOCK9 was found to regulate angiogenesis and modulate the tumor-associated fibroblast environment in ESCC. Furthermore, the DOCK9/CD31 ratio emerged as a potential marker to predict immune therapy response in ESCC. DOCK9 serves as a prognostic biomarker in ESCC, influencing both angiogenesis and immune response, and could guide future therapeutic strategies, particularly in immunotherapy. This study highlights DOCK9's relevance in ESCC prognosis, supporting its potential role in tailored therapies aimed at angiogenesis and immune modulation.

Predictive Factors of Post-ERCP Hepatic Decompensation in Patients with Cirrhosis: A Retrospective Case-Control Study

BACKGROUND AND AIM

Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial diagnostic and therapeutic procedure in patients with cirrhosis; however, it carries the risk of post-procedural hepatic decompensation. This study aims to identify predictive factors associated with post-ERCP hepatic decompensation in patients with cirrhosis to better inform clinical decision-making and minimize adverse outcomes.

METHODS

A retrospective analysis was conducted on patients with cirrhosis undergoing ERCP. Clinical, biochemical, and procedural variables were evaluated to determine their association with hepatic decompensation. Multivariate analysis was performed to identify independent predictors.

RESULTS

A total of 277 patients with cirrhosis who underwent an ERCP were included. The cohort had a mean age of 63.4 years, with a male predominance (65.3%) and various etiologies of cirrhosis, including alcohol-related (39.3%) and hepatitis C (11.4%). Post-ERCP complications occurred in 26.7% of patients. The most common complications were hepatic decompensation events (18.4%), sepsis (10.8%), and cholangitis (6.1%). Patients with complications had significantly higher baseline MELD scores, INR, chronic kidney disease (CKD) and history of ascites, hepatic encephalopathy, and hepatorenal syndrome (HRS). A Multivariate analysis revealed that factors such as higher MELD score, ascites, hepatic encephalopathy, and stent placement were associated with post-ERCP complications. Subgroup analyses indicated that patients who developed hepatic decompensation events (ascites, SBP, or HRS) had a more severe liver dysfunction at baseline, as reflected by a higher MELD score and INR, and prior episodes of ascites and hepatic encephalopathy.

CONCLUSION

Pre-procedural liver function parameters and procedural factors are crucial predictors of post-ERCP hepatic decompensation in patients with cirrhosis. Key risk factors include higher MELD score, CKD, history of ascites, and hepatic encephalopathy. Careful pre-procedural evaluation and management are essential to reduce these risks.

FZHWT alleviates chronic atrophic gastritis by inhibiting inflammatory pathways and promoting mucosal repair

BACKGROUND

Chronic atrophic gastritis (CAG) is a prevalent chronic digestive disorder that, through sustained inflammation, can lead to severe mucosal damage and even gastric cancer. Current treatments offer limited efficacy, whereas Fu-Zheng-Huo-Wei Decoction (FZHWT), a traditional Chinese medicine (TCM) formulation, shows promising potential in treating CAG.

PURPOSE

This study aims to identify the key active components of FZHWT and evaluate its therapeutic effects on CAG.

METHODS

UPLC-MS/MS was used to identify the bioactive compounds in FZHWT. A CAG rat model was established to assess its therapeutic effects, and transcriptome sequencing was conducted to identify key targets and mechanisms. A CAG cell model was used for validation of the transcriptomic findings, and histological techniques and molecular biology methods were employed for further validation.

RESULTS

A total of 1362 chemical components were identified in FZHWT, of which 25 are bioavailable compounds. Differential metabolite analysis revealed four key active ingredients: Nicotiflorin, Stachydrine, 5-O-p-Coumaroylquinic acid, and N-(4-oxopentyl)-acetamide. In the CAG rat model, FZHWT significantly reduced inflammation and gastric mucosal damage. Transcriptome sequencing highlighted Sema5a as a key target and revealed the involvement of several inflammatory signaling pathways. In the CAG cell model, FZHWT alleviated CAG by inhibiting inflammation and promoting gastric mucosal repair.

CONCLUSIONS

FZHWT demonstrates significant therapeutic potential in treating CAG by modulating inflammatory pathways and promoting mucosal repair. This study provides new insights into the treatment of CAG and supports the modernization of multi-component TCM formulas.

Endoscopic Delivery of a Double-Umbrella-Shaped Hydrogel Occluder with Instant Mechanical Interlock and Robust Wet Adhesion for Gastric Perforation Repair

Achieving robust adhesion of bioadhesives on wet tissues to block gastric perforation remains a challenge due to the gradually deteriorated adhesive-tissue interactions by interfacial acidity and multienzyme gastric fluids, thus accompanying failure shedding and life-threatening risks. Here, we report a biocompatible double-umbrella-shaped endoscopy-deliverable hydrogel occluder (EHO) made of caffeic acid (CA)-grafted chitosan (CS) and polyacrylamide (PAM) by molding technique, which is capable of the customizable, rapid, robust, and long-term sealing of large gastric perforations. In addition to interfacial physiochemical interactions (e.g., H-bonding, chelation) between the tissues and polymers, efficient sealing also integrates the advantages of fast mechanical interlocking in space and gradual self-expansion over time to tolerant acidic and mechanically dynamic environments. The EHO exhibits favorable biodegradability due to the reducible disulfide cross-linkers and remarkable protective barrier functions to impede the infiltration of gastric acid and digestive pepsin into the wound. To validate EHO's therapeutic efficacy, we further demonstrate the robust in vivo sealing to large gastric tissues via endoscopic delivery to the porcine stomach and monitor of healing process with improved retention of endogenous growth factors. Besides, in views of simple hydrogel fabrication using molding technique, the biodegradable EHO can be facilely tailored with various topologies according to application scenarios in surgical and minimally invasive endoscopic delivery, thus offering a promising alternative for clinical repair of gastrointestinal perforations and other organs.

How Alcohol Induces Human Acute Alcoholic Pancreatitis-Problem Solved?

It has been a puzzle why only a minority of heavy alcohol drinkers develop acute alcoholic pancreatitis. In this review, the sparse data available from published studies were collected and, based on them, a hypothesis was formed. Long-term high alcohol consumption results in lowered cholecystokinin and cholinergic stimulus of the pancreas, and causes concentration and acidification of pancreatic fluid, predisposing to protein secretion. Early during the withdrawal period when returning to a normal or high-fat nonalcoholic diet, there is a relative hyperstimulation of the pancreas, a well-established mechanism that results in experimental acute pancreatitis. Lower, physiological stimulation is enough to start acute pancreatitis, when the secretions cause temporary obstruction in the duct system; the stimulation against temporary obstruction is also well-known to result in experimental acute pancreatitis. The magnitude of alcohol-induced deficits in acinar cell defense mechanisms then finally determines the onset of pancreatitis.

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.

Multifunctional dynamic chitosan-guar gum nanocomposite hydrogels in infection and diabetic wound healing

Traditional wound care methods are less effective for infectious and diabetic wounds, highlighting an urgent need for effective strategies. The study aimed to design a self-healing hydrogel with antibacterial, antioxidant, and photothermal capabilities to treat infectious and diabetic wounds. Silver nanoparticles (AgNPs) were loaded into mesoporous polydopamine (MPDA) nanoparticles to form Ag@MPDA nanoparticles. Ag@MPDA was incorporated into the cationic guar gum-chitosan-boric acid (CCB) hydrogel to obtain the PA-CCB hydrogel. PA-CCB hydrogel exhibited excellent self-healing and adhesive properties, adapting well to the dynamic wound environment. PA-CCB hydrogel combined with photothermal therapy (PTT) could effectively eradicated E. coli (99.9 %) and S. aureus (99.7 %). The PA-CCB hydrogel reduced excessive reactive oxygen species and promoted the migration of fibroblasts in vitro. In the infected mouse wound models, the PA-CCB hydrogel effectively inhibited bacteria. After combining with PTT, the antibacterial ability of the PA-CCB hydrogel was further enhanced. In the diabetic mouse wound models, the PA-CCB hydrogel reduced the inflammatory level of wound tissue. In both models, after combining with PTT, the PA-CCB hydrogel exhibited further improvements in angiogenesis, collagen deposition, and re-epithelialization. By integrating multifunctional hydrogel with PTT, the PA-CCB hydrogel exhibited broad application potential for infectious and diabetic wounds.

Importance of hematological and inflammatory markers in the localization of gastric cancer

BACKGROUND

Gastric cancer is a major global health concern, often diagnosed at advanced stages, leading to poor prognosis. Proximal and distal gastric cancers exhibit distinct clinicopathological features.

AIM

To investigate the diagnostic value of hematological and inflammatory markers in differentiating proximal and distal gastric cancers and to evaluate their association with clinical outcomes.

METHODS

A retrospective cohort study was conducted on 150 patients diagnosed with gastric adenocarcinoma through histopathological analysis. Patients were categorized into proximal gastric cancer and distal gastric cancer groups. Laboratory parameters were analyzed.

RESULTS

Of the 150 patients, 84 had proximal gastric cancer and 66 had distal gastric cancer. Dysphagia was significantly more common in the proximal gastric cancer group, while anemia and higher platelet-to-lymphocyte ratio values were observed in the distal gastric cancer group (P = 0.031). Tumor stage and neutrophil-to-lymphocyte ratio emerged as independent predictors of all-cause mortality. No significant differences were found in other laboratory or biochemical parameters between the groups.

CONCLUSION

Proximal and distal gastric cancers demonstrate distinct clinical and laboratory profiles. The platelet-to-lymphocyte ratio may serve as a valuable marker in differentiating cancer localization, while the neutrophil-to-lymphocyte ratio is a prognostic indicator for mortality. These findings highlight the potential of hematological markers in optimizing diagnosis and treatment strategies for gastric cancer.

Polymer Applied in Hydrogel Wound Dressing for Wound Healing: Modification/Functionalization Method and Design Strategies

Hydrogel wound dressings have emerged as a promising solution for wound healing due to their excellent mechanical and biochemical properties. Over recent years, there has been significant progress in expanding the variety of raw materials used for hydrogel formulation along with the development of advanced modification techniques and design approaches that enhance their performance. However, a comprehensive review encompassing diverse polymer modification strategies and design innovations for hydrogel dressings is still lacking in the literature. This review summarizes the use of natural polymers (e.g., chitosan, gelatin, sodium alginate, hyaluronic acid, and dextran) and synthetic polymers (e.g., poly(vinyl alcohol), polyethylene glycol, Pluronic F-127, poly(N-isopropylacrylamide), polyacrylamide, and polypeptides) in hydrogel wound dressings. We further explore the advantages and limitations of these polymers and discuss various modification strategies, including cationic modification, oxidative modification, double-bond modification, catechol modification, etc. The review also addresses design principles and synthesis methods, aligning polymer modifications with specific requirements in wound healing. Finally, we discuss future challenges and opportunities in the development of advanced hydrogel-based wound dressings.

TPM4 influences the initiation and progression of gastric cancer by modulating ferroptosis via SCD1

Gastric cancer (GC) is a deadly disease with poor prognosis and few treatment options. Tropomyosin 4 (TPM4) is an actin-binding protein that stabilizes the cytoskeleton of cells and has an unclear role in GC. This study aimed to elucidate the role and underlying mechanisms of TPM4 in GC pathogenesis. The expression and diagnostic and prognostic value of TPM4 in GC were analyzed using bioinformatics. A nomogram based on TPM4 expression was created and validated with an external cohort. TPM4-knockdown GC cells and xenograft models in nude mice were used to study the function of TPM4 in vitro and in vivo. Proteomic and rescue experiments confirmed the regulatory effect of TPM4 on stearoyl-CoA desaturase 1 (SCD1) in GC. Immunohistochemistry verified the expression and correlation of the TPM4 and SCD1 proteins in GC tissues. Our study identified TPM4 as an oncogene in GC, suggesting its potential diagnostic and prognostic value. The TPM4-based nomogram showed potential prognostic value for clinical use. TPM4 knockdown inhibited GC cell proliferation, induced ferroptosis, and slowed tumor growth in vivo, which is achieved by inhibiting SCD1 expression. Immunohistochemical analysis of GC tissues revealed elevated expression levels of both TPM4 and SCD1 proteins, with a positive correlation observed between their expression. TPM4 is a promising target for new diagnostic, prognostic, and therapeutic strategies for GC. Downregulation of TPM4 inhibits GC cell growth and induces ferroptosis by suppressing SCD1 expression.

Exploring the intricate relationship between peptic ulcers and immunohematological responses: A narrative review

Peptic ulcers have long been a focus of medical research due to their significant impact on public health worldwide. Traditionally attributed to factors such as Helicobacter pylori infection and excessive gastric acid secretion, recent scientific endeavors have increasingly unveiled the pivotal role of immunohematological responses in the pathogenesis and clinical course of peptic ulcers. This review aims to synthesize and analyze the intricate relationship between peptic ulcers and immunohematological responses, shedding light on the complex interplay between the immune system and ulcer development, progression, and healing. Immunological factors, encompassing inflammatory mediators, immune cells, and the host response to H pylori, play a substantial role in the multifaceted landscape of peptic ulcers. Inflammation orchestrated by cytokines and chemokines derived from immune cells intricately contributes to mucosal damage and repair processes. Moreover, the chronic nature of H pylori infection triggers a cascade of immune responses, involving both innate and adaptive immunity, which significantly influences the course of ulceration. This paper consolidates current knowledge while highlighting the need for further research elucidating the intricate immunological pathways involved in peptic ulcer pathogenesis. The integration of immunology into the broader context of peptic ulcer disease presents opportunities for innovative therapeutic interventions aimed at modulating immune responses for improved clinical outcomes and enhanced patient care. Ultimately, unraveling the intricate relationship between peptic ulcers and immunohematological responses holds significant promise in advancing the understanding and management of this prevalent gastrointestinal disorder.

Regulatory T Cell Infiltration-Driven Single-Cell Transcriptomic Analysis Identifies SAP18 as a Prognostic Marker for Esophageal Squamous Cell Carcinoma

BACKGROUND

Advanced esophageal squamous cell carcinoma (ESCC) is characterized by molecular heterogeneity and distinct patterns of immune cell infiltration. Regulatory T cells (Tregs), in particular, play a critical role in shaping an immunosuppressive tumor microenvironment (TME), which is associated with poor clinical outcomes.

METHODS

We developed a prognostic model by integrating GEO-derived bulk RNA sequencing data and single-cell transcriptome. Model predictions were confirmed through RT-qPCR, Western blot, and immunohistochemistry on clinical specimens, while in vitro assays (CCK8, transwell invasion, scratch, colony formation, and immunofluorescence) validated the function of SAP18 in cell proliferation, invasion, and ECM remodeling.

RESULTS

Expression patterns of the 5 Tregs-associated genes in clinical specimens aligned with model predictions, underscoring the model's robustness. The high-risk subgroup was associated with upregulated extracellular matrix (ECM) remodeling, an abundance of immune-suppressive cells, higher TP53 mutation rate, and limited benefit from immunotherapy. In contrast, the low-risk subgroup exhibited anti-tumor immunity. Cell-cell communication analysis also implicated the collagen pathway in Tregs-mediated immune evasion in ESCC. Functional assays indicated that SAP18 in the prognostic model significantly promotes proliferation, invasion, and ECM reconstruction, further highlighting its potential as a therapeutic target.

CONCLUSION

Our findings elucidate the role of Tregs in the TME, underscoring significant potential of SAP18, which is essential for assessing patient prognosis and may facilitate the development of personalized therapies for ESCC.

Sero-salivary detection of H. pylori immunoglobulins and parasitic infection among healthcare individuals suffering from gastrointestinal disorders with correlation to personal hygiene

BACKGROUND

Gastrointestinal microbial infections among healthcare individuals (HCIs) are common due to several risk factors, including poor personal hygiene and socio-economic lifestyle.

OBJECTIVES

This is the first cross-sectional study that stratifies HCIs to correlate personal hygiene and socio-economic lifestyle with gastrointestinal microbial infections. Additionally, it compares serum and saliva levels of H. pylori-IgG and IgA to assess the potential of saliva as a non-invasive alternative to serum.

METHODS

Based on Fisher's formula, 200 HCIs suffering from gastritis-including hospital workers, employees, nursing students, nurses, and doctors-were enrolled. Blood, saliva, and stool samples were collected for microbial infection investigations. Personal hygiene and socio-economic factors were scored based on WHO guidelines. Parasitic infections were identified microscopically, while H. pylori antigen and antibodies were detected via ELISA, with diagnostic significance determined by ROC curve analysis.

RESULTS

A high prevalence of intestinal microbial infections was observed among HCIs. Blastocystis spp. was the most common pathogen (72%), followed by Cryptosporidium spp. (59.5%). Cases of single, double, and multiple infections were detected. H. pylori antigen was present in 36 (18%) cases, often as a co-infection with intestinal parasites. Infection rates were highest among workers and nurses (100%), followed by employees (97.4%) and nursing students (81.7%), with doctors having the lowest rate (50%). Poor personal hygiene and socio-economic lifestyle were directly linked to increased infection risk. Additionally, H. pylori-IgG was positive in 14 cases and negative in 186 cases, while H. pylori-IgA was positive in 2 cases and negative in 198 cases in both serum and saliva. These findings indicate consistency between serum and saliva levels of H. pylori immunoglobulins.

CONCLUSIONS

Poor personal hygiene and socio-economic lifestyle significantly increase the risk of gastrointestinal microbial infections among HCIs. Salivary immunoglobulins show consistency with serum levels, suggesting saliva as a viable non-invasive alternative for detecting H. pylori infection.

Comparing underwater and conventional cold snare polypectomy for colorectal adenomas: Prospective randomized controlled trial

Background and study aims

In this study, we aimed to evaluate efficacy and safety of underwater cold snare polypectomy (UCSP) for treating colorectal adenoma.

Patients and methods

This single-center, prospective, randomized controlled trial screened patients with colorectal adenomas measuring 4 to 9 mm in diameter that were identified through colonoscopies at the Department of Gastroenterology in Jianyang People's Hospital between April 2022 and October 2023. Patients were randomly assigned to undergo UCSP or cold snare polypectomy (CSP). Both groups underwent narrow-band imaging to determine international colorectal endoscopic morphology of type 2 noncancerous lesions. Following polyp removal, biopsy specimens were collected from the base and margins to assess the completeness of resection.

Results

The study included 227 polyps from 172 patients; median sizes in the UCSP (n = 122) and CSP groups (n=105) were 5 mm and 6 mm, respectively. The R0 (96.7% vs. 86.7%; P =0.005) and muscularis mucosa resection rates (68.9% vs. 43.8%; P <0.0001) were significantly higher in the UCSP group than in the CSP group. However, operative time for the UCSP group (109.5 s; 86.8-134.3 vs. 110.0 s; 83.5-143.5 P =0.890) was not significantly longer than that for the CSP group. Neither group exhibited delayed bleeding or perforations.

Conclusions

UCSP has a high R0 rate for colorectal adenomas measuring 4 to 9 mm.

T-cell receptor dynamics in digestive system cancers: a multi-layer machine learning approach for tumor diagnosis and staging

Background

T-cell receptor (TCR) repertoires provide insights into tumor immunology, yet their variations across digestive system cancers are not well understood. Characterizing TCR differences between colorectal cancer (CRC) and gastric cancer (GC), as well as developing machine learning models to distinguish cancer types, metastatic status, and disease stages are crucial for guiding clinical practices.

Methods

A cohort study of 143 tumor patients (96 CRC, 47 GC) was conducted. High-throughput TCR sequencing was performed to capture TCR beta (TRB), delta (TRD), and gamma (TRG) chain data. Tissue-specific patterns in TCR repertoire features, such as V-J gene recombination, complementarity-determining region 3 (CDR3) sequences, and motif distributions, were analyzed. Multi-layer machine learning-based diagnostic models were developed by leveraging motif-based feature and deep learning-based feature extraction using ProteinBERT from the 100 most abundant CDR3 sequences per sample. These models were used to differentiate CRC from GC, distinguish between primary and metastatic CRC lesions, and predict disease stages in CRC.

Results

Tissue-specific differences in TCR repertoires were observed across CRC, GC, and between primary and metastatic lesions, as well as across disease stages in CRC. Distinct V-J gene recombination patterns were identified, with CRC showing enrichment in TRBV*-TRBJ* combinations, while GC exhibited higher levels of γδT-cell-related recombination. Primary and metastatic lesions of CRC patients displayed distinct V-J recombination preferences (e.g., TRBV7-9/TRBJ2-1 higher in metastatic; TRBV20-1/TRBJ1-2 higher in primary) and CDR3 sequence differences, with metastatic having shorter TRG CDR3 lengths (p-value = 0.019). Across CRC stages, later stages (III-IV) showed higher clonal diversity (p-value < 0.05) and stage-specific V-J patterns, alongside distinct CDR3 amino acid preferences at N-terminal (positions 1-2) and central positions (positions 5-12). Multi-dimensional machine learning models demonstrated exceptional diagnostic performance across all classification tasks. For distinguishing CRC from GC, the model achieved an accuracy of 97.9% and an area under the curve (AUC) of 0.996. For differentiating primary from metastatic CRC, the model achieved 100% accuracy with an AUC of 1.000. In predicting CRC disease stages, the model attained an accuracy of 96.9% and an AUC of 0.993. Extensive validation using simulated and publicly available datasets, confirmed the robustness and reliability of the models, demonstrating consistent performance across diverse datasets and experimental conditions.

Conclusions

Our investigation provides novel insights into TCR repertoire variations in digestive system tumors, and highlight the potential of immune repertoire features as powerful diagnostic tools for understanding cancer progression and potentially improving clinical decision-making.

Artificial intelligence-aided optical biopsy improves the diagnosis of esophageal squamous neoplasm

BACKGROUND

Early detection of esophageal squamous neoplasms (ESN) is essential for improving patient prognosis. Optical diagnosis of ESN remains challenging. Probe-based confocal laser endomicroscopy (pCLE) enables accurate in vivo histological observation and optical biopsy of ESN. However, interpretation of pCLE images requires histopathological expertise and extensive training. Artificial intelligence (AI) has been widely applied in digestive endoscopy; however, AI for pCLE diagnosis of ESN has not been reported.

AIM

To develop a pCLE computer-aided diagnostic system for ESN and assess its diagnostic performance and assistant efficiency for nonexpert endoscopists.

METHODS

The intelligent confocal laser endomicroscopy (iCLE) system consists of image recognition (based on inception-ResNet V2), video diagnosis, and quality judgment modules. This system was developed using pCLE images and videos and evaluated through image and prospective video recognition tests. Patients between June 2020 and January 2023 were prospectively enrolled. Expert and non-expert endoscopists and the iCLE independently performed diagnoses for pCLE videos, with histopathology as the gold standard. Thereafter, the non-expert endoscopists performed a second assessment with iCLE assistance.

RESULTS

A total of 25056 images from 2803 patients were selected for iCLE training and validation. Another 2442 images from 226 patients were used for testing. iCLE achieved a high accuracy of 98.3%, sensitivity of 95.3% and specificity of 98.8% for diagnosing ESN images. A total of 2581 patients underwent upper gastrointestinal pCLE examination and were prospectively screened; 54 patients with suspected ESN were enrolled. Overall, 187 videos from 67 lesions were assessed by iCLE, three nonexpert and three expert endoscopists. iCLE achieved a high accuracy, sensitivity and specificity of 90.9%, 92.0%, and 90.2%, respectively. Compared to experts, iCLE showed significantly higher sensitivity (92.0% vs 80.4%; P < 0.001) and negative predictive value (94.4% vs 87.7%; P = 0.003). With iCLE assistance, nonexpert endoscopists showed significant improvements in accuracy (from 83.6% to 88.6%) and sensitivity (from 76.0% to 89.8%).

CONCLUSION

iCLE system demonstrated high diagnostic performance for ESN. It can assist nonexpert endoscopists in improving the diagnostic efficiency of pCLE for ESN and has the potential for reducing unnecessary biopsies.

Integrative analysis and prognostication in gastric cancer: unveiling the role of mitochondrial genomics with the MLRScore model

Gastric cancer, a leading cause of cancer-related mortality globally, presents significant challenges in prognosis and treatment due to its heterogeneity. This study aimed to elucidate the role of mitochondrial-related genes (MRGs) in gastric cancer and develop a prognostic model. We analyzed RNA sequencing data and clinical information of 412 gastric cancer samples from The Cancer Genome Atlas (TCGA). A comprehensive list of 1136 MRGs was curated from the MitoCarta3.0 database, leading to the identification of 110 differentially expressed MRGs between gastric cancer and normal tissues. Using univariate and multivariate Cox regression analyses, we constructed the Mitochondrial-Related Risk Score (MLRScore), a prognostic model incorporating five key MRGs. The model was validated in training and testing cohorts and exhibited promising prognostic capability. Additionally, we investigated the relationship between MLRScore and immune cell infiltration, somatic mutations, tumor mutation burden (TMB), and response to chemotherapy. The MLRScore was found to correlate with distinct immune landscapes and chemotherapeutic sensitivities, suggesting its potential utility in guiding personalized treatment strategies. Our study not only provides a novel tool for prognostic assessment in gastric cancer but also underscores the importance of mitochondrial dynamics in tumor biology and patient stratification.

MiR-3613-5p targets AQP4 to promote the progression of chronic atrophic gastritis to gastric cancer

Introduction: Gastric cancer (GC) exhibits high invasiveness, delayed diagnosis, and poor prognosis. Chronic atrophic gastritis (CAG), an initial stage within the Correa cascade, induces gastric mucosal inflammation and atrophy, promoting genetic and epigenetic alterations. MicroRNAs (miRNAs) dysregulation has been implicated in gastric tumorigenesis, yet their specific roles in CAG progression to GC remain unclear. Methods: Using clinical data from the GEO database, we identified miRNAs differentially expressed in gastric mucosa and serum samples from GC patients. Murine CAG models were established through administration of N-methyl-N-nitrosourea (MNU) and high-salt diet (HSD). In vitro functional assays evaluated proliferation and migration after miRNA modulation in gastric cancer cell lines. MiRNA target validation involved luciferase reporter assays. Results: MiR-3613-5p expression was significantly elevated in gastric mucosal and serum samples of GC patients, mucosal tissues of CAG patients, tumor tissues, and human gastric cancer cell lines. Murine models demonstrated increased miR-3613-5p expression in gastric mucosa following MNU and HSD-induced CAG. Functionally, miR-3613-5p overexpression promoted gastric cancer cell proliferation and migration in vitro, whereas silencing miR-3613-5p alleviated pathological gastric mucosal alterations (atrophy, hyperplasia, inflammatory infiltration) in vivo. Mechanistically, miR-3613-5p inhibited Aquaporin 4 (AQP4) expression by directly targeting its 3'UTR. Discussion: Our findings provide the first evidence that miR-3613-5p facilitates CAG progression toward GC via negative regulation of AQP4. These results highlight miR-3613-5p as a promising biomarker and therapeutic target, suggesting antagomiR-3613-5p as a potential novel strategy to prevent gastric carcinogenesis.

Diagnostic performance of AI-assisted endoscopy diagnosis of digestive system tumors: an umbrella review

The diagnostic performance of artificial intelligence (AI)-assisted endoscopy for digestive tumors remains controversial. The objective of this umbrella review was to summarize the comprehensive evidence for the AI-assisted endoscopic diagnosis of digestive system tumors. We grouped the evidence according to the location of each digestive system tumor and performed separate subgroup analyses on the basis of the method of data collection and form of the data. We also compared the diagnostic performance of AI with that of experts and nonexperts. For early digestive system cancer and precancerous lesions, AI showed a high diagnostic performance in capsule endoscopy and esophageal squamous cell carcinoma. Additionally, AI-assisted endoscopic ultrasonography (EUS) had good diagnostic accuracy for pancreatic cancer. In the subgroup analysis, AI had a better diagnostic performance than experts for most digestive system tumors. However, the diagnostic performance of AI using video data requires improvement.

Clinical features of magnetically controlled capsule endoscopy in children: A large, retrospective cohort study

OBJECTIVE

This study aimed to assess the utility of magnetically controlled capsule endoscopy (MCE) in the diagnosis of pediatric gastrointestinal diseases.

METHODS

A retrospective cohort study was conducted, which collected data from 1040 children (546 males and 494 females; mean age: 11.0 ± 2.6 years) who underwent MCE at Shanghai Children's Hospital between June 2017 and February 2023. Information on gastric visualization, cleanliness, examination times, lesion detection rates, and other parameters were recorded. A 2-week follow-up monitored capsule excretion and adverse reactions.

RESULTS

Of the 1055 patients, 78 had difficulty swallowing the capsule, and 15 could not swallow even with assistance, which led to their exclusion. The small intestine was successfully examined in 94.5% (206 out of 218) of the 218 children who were able to proceed with the procedure. The remaining 822 underwent esophagus and stomach examinations. The average transit time of the endoscopy capsule in the esophagus, stomach, and small intestine was 5 (3, 9) s, 57.0 (29.0, 102.0) min, and 306.0 (234.0, 500.0) min. In the examined cases, complete small bowel visualization was achieved in 94.5% of the patients. The most common symptoms reported by the patients were abdominal pain (77.9%) and nausea with vomiting (13.5%). Lesion detection rates were 38.8% in the stomach, 21.1% in the duodenum, and 43.1% in the jejunoileum. No complications, such as capsule retention or intestinal obstruction, were observed.

CONCLUSION

MCE is a feasible and safe method for examining the gastric cavity and small bowel in pediatric patients.

Short-term clinical and technical outcomes of a modified Zenker's peroral endoscopic myotomy with mucosal flap incision

Zenker's diverticulum peroral endoscopic myotomy (Z-POEM) is an effective treatment for symptomatic Zenker's diverticulum. A modification to Z-POEM involves mucosal flap incision (MFI). We describe the technical and clinical success of patients who underwent Z-POEM with MFI.We included patients who underwent Z-POEM with MFI for Zenker's diverticulum at eight international centers. The primary outcome was the rate of clinical success, assessed by post-procedure Kothari-Haber symptom score (KHSS) without re-treatment. Secondary outcomes included technical success, serious adverse events, and clinical recurrence with need for re-treatment.36 patients (age 69 [SD 9] years; 69% male) underwent Z-POEM with MFI for symptomatic Zenker's diverticulum. Mean diverticulum size was 3.2 (SD 1.4) cm. Clinical success was achieved in 35 patients (97%). Median baseline KHSS was 6 and median post-procedure KHSS was 0 (P < 0.001). Technical success was achieved in all cases. Mean procedure time was 57 (SD 34) minutes and median follow-up time was 196 days (interquartile range 39-499). There was one adverse event (3%), which was treated endoscopically.Z-POEM with MFI had high rates of technical and clinical success. Prospective evaluation is needed to further validate this technique in patients with a large Zenker's diverticulum.

Tumor-Associated Lactic Acidosis and Early Death in Patients With Lymphoma

BACKGROUND

Cancer is characterized by accelerated glycolysis with enhanced glucose uptake and lactate production, a phenomenon termed Warburg effect (WE). We studied the incidence and clinical impact of Warburg-driven lactic acidosis in lymphoma.

METHODS

Patients admitted with newly diagnosed or relapsed/refractory lymphoma and documented lactate levels during the first week of admission were included. Patients with lactatemia were classified as secondary (with a recognizable cause for elevated lactate) or none (WE group).

RESULTS

WE and secondary lactatemia were documented in 58 and 44 patients (15% and 12% of evaluable patients, respectively). Both WE and secondary lactatemia were associated with poor short-term survival. WE at presentation correlated with tumor burden, with most patients having aggressive disease, advanced stage, and extranodal involvement. WE was associated with high rates of early death (26% and 43% at 30- and 60-days, respectively). Higher lactate levels correlated with worse survival. Earlier initiation of chemotherapy was associated with a (nonsignificant) trend toward better outcomes, whereas steroid and/or thiamine therapy did not alter patient outcomes. Glucose administration was associated with worse survival.

CONCLUSION

WE-driven lactatemia is associated with high tumor burden and increased short-term mortality in lymphoma. Prompt initiation of anti-lymphoma therapy may improve outcomes.

A deadly taste: linking bitter taste receptors and apoptosis

Humans can perceive five canonical tastes: salty, sour, umami, sweet, and bitter. These tastes are transmitted through the activation of ion channels and receptors. Bitter taste receptors (Taste Family 2 Receptors; T2Rs) are a sub-family of 25 G-protein coupled receptor (GPCR) isoforms that were first identified in type II taste bud cells. T2Rs are activated by a broad array of bitter agonists, which cause an increase in intracellular calcium (Ca2+) and a decrease in cyclic adenosine 3',5'-monophosphate (cAMP). Interestingly, T2Rs are expressed beyond the oral cavity, where they play diverse non-taste roles in cell physiology and disease. Here, we summarize the literature that explores the role of T2Rs in apoptosis. Activation of T2Rs with bitter agonists induces apoptosis in several cancers, the airway epithelia, smooth muscle, and more. In many of these tissues, T2R activation causes mitochondrial Ca2+ overload, a main driver of apoptosis. This response may be a result of T2R cellular localization, nuclear Ca2+ mobilization and/or a remnant of the established immunological roles of T2Rs in other cell types. T2R-induced apoptosis could be pharmacologically leveraged to treat diseases of altered cellular proliferation. Future work must explore additional extra-oral T2R-expressing tissues for apoptotic responses, develop methods for in-vivo studies, and discover high affinity bitter agonists for clinical application.

Past, Present, and Future: A History Lesson in Artificial Intelligence

Over the past 5 decades, artificial intelligence (AI) has evolved rapidly. Moving from basic models to advanced machine learning and deep learning systems, the impact of AI on various fields, including medicine, has been profound. In gastroenterology, AI-driven computer-aided detection and computer-aided diagnosis systems have revolutionized endoscopy, imaging, and pathology detection. The future promises further advancements in diagnostic precision, personalized treatment, and clinical research. However, challenges such as transparency, liability, and ethical concerns must be addressed. By fostering collaboration, robust governance and development of quality metrics, AI can be leveraged to enhance patient care and advance scientific knowledge.

Executive Summary of the American Radium Society Appropriate Use Criteria for Management of Squamous Cell Carcinoma of the Cervical Esophagus: Systematic Review and Guidelines

OBJECTIVES

Cervical esophageal cancer (CEC) is an uncommon malignancy accounting for <5% of all esophageal carcinomas. Treatment of CEC varies and is adapted from established regimens used for squamous cell carcinoma (SCC) or the lower esophageal and head and neck. The present systematic review and guidelines are intended to assist treatment decision making for patients with CEC based on the available evidence.

METHODS

Using the Population, Intervention, Comparator, Outcome, Timing, and Study Design (PICOTS) framework, the evidence regarding treatment outcomes was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective Phase II to III trials and retrospective analyses published between January 1, 2013 and February 23, 2024 in the Ovid Medline database. These references were assessed through the American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. A systematic review PRISMA 2020 checklist confirmed the completion of essential elements. RAND-UCLA consensus methodology was used by the expert panel to rate the appropriateness of the treatment options.

RESULTS

ARS AUC recommendations include (1) larynx preservation using endoscopic resection (EMR or ESD) alone for the typical case with pT1a cN0 cM0 CEC, (2) definitive CRT for the typical case with cT1bN0M0 in patients who cannot undergo endoscopic resection, (3) larynx-preserving using definitive CRT (with or without induction chemotherapy) for the typical case with nonmetastatic locally advanced CEC (advanced T-stage tumors or involved lymph nodes), with surgery reserved for those patients with incomplete response or locoregional recurrence.

CONCLUSIONS

This ARS AUC summary provides guidelines for the management of SCC of the cervical esophagus provides based on available evidence. Topics that warrant further investigation include optimization of (1) patient selection; (2) multimodality therapies including chemotherapy, immunotherapy, and targeted agents; (3) radiation dose, schedule, and treatment volume; and (4) supportive care for patients with CEC. Ongoing trials continue to improve outcomes for patients with CEC.

Immunohistochemical-Based Molecular Typing of ACRG Combined With Immune-Associated PD-L1 Expression Can Predict the Prognosis of Gastric Cancer

BACKGROUND

Gastric cancer (GC) is a molecularly heterogeneous disease with diverse clinical outcomes. Traditional classifications lack predictive accuracy, necessitating alternative molecular subtyping approaches for effective prognosis prediction. The Asian Cancer Research Group (ACRG) molecular subtypes, combined with immune-associated PD-L1 expression, offer a promising framework to predict patient outcomes and potentially guide treatment strategies in GC.

METHODS

This study retrospectively analyzed 1007 primary GC patients who underwent surgical resection between January 2017 and June 2019 at the Fourth Hospital of Hebei Medical University. Comprehensive immunohistochemical and fluorescent PCR-capillary electrophoresis analyses were conducted to determine ACRG molecular subtypes (microsatellite instability [MSI], microsatellite stability with epithelial-mesenchymal transition [MSS/EMT], MSS/TP53+, and MSS/TP53-) and PD-L1 expression. We assessed the relationship between these classifications and various clinicopathological parameters, including survival outcomes, using Cox regression and Kaplan-Meier analysis.

RESULTS

The ACRG subtypes showed significant associations with clinicopathological features, including tumor invasion depth, Lauren classification, and HER2 status. The MSI subtype (6.7% of cases) was associated with higher PD-L1 positivity and a favorable prognosis, whereas the EMT subtype had the lowest 5-year survival rate (34.55%) and was predominantly linked to diffuse-type histology. PD-L1 positivity correlated with worse survival outcomes, with independent predictive value alongside ACRG subtypes (HR for PD-L1 = 1.759, p = 0.001; HR for ACRG = 5.144, p < 0.001).

CONCLUSION

The combination of ACRG molecular subtyping and PD-L1 expression serves as an effective predictor of GC prognosis, facilitating tailored clinical decision-making. The ACRG-PD-L1 classification system offers a practical, cost-effective approach for routine clinical application, providing critical insight into GC heterogeneity. Further multicenter studies are needed to validate these findings and explore the impact of ACRG subtypes on therapy responses, particularly in immunotherapy settings.

Bronchopulmonary malformation of the foregut communicating with the distal Oesophagus in a form of an Epiphrenic diverticulum. An exceptional cause of epiphrenic diverticulum in adults: Case report

INTRODUCTION

Epiphrenic diverticula are rare entities, generally asymptomatic. Most symptomatic ones occur in the form of dysphagia and are related to primary hypertensive oesophageal motor disorders of the distal oesophagus or the lower oesophageal sphincter. Exceptionally, they have been associated with congenital abnormalities in the formation of the primitive foregut.

CASE PRESENTATION

An 85-year-old male patient with symptoms of dysphagia was diagnosed with epiphrenic diverticulum. Functional studies revealed associated oesophageal motility disorders. A transhiatal laparoscopic approach was used to perform a diverticulectomy, myotomy, and partial anterior fundoplication. The histological study of the diverticulectomy specimen was compatible with extralobar pulmonary sequestration communicating with the distal oesophagus.

DISCUSSION

Bronchopulmonary malformations are very rare entities. A complete preoperative study of an epiphrenic diverticulum facilitates a correct differential diagnosis and decision-making. Endoscopy with biopsies can help define its etiology, rule out malignancy, and even change the therapeutic approach. The surgical approach depends on the morphological characteristics of the diverticulum, the surgical technique to be performed, and the surgical team experience. Intraoperative endoscopic resources facilitate surgical manoeuvres and guarantee the safety of the procedure.

CONCLUSION

Bronchopulmonary malformation of the foregut communicating with the distal oesophagus in the form of an epiphrenic diverticulum is an extremely rare condition. However, it should be included in the differential diagnosis of an epiphrenic diverticulum. Transhiatal laparoscopic resection under intraoperative endoscopic control is safe and effective for treating this entity.