The Microbiome in Critical Illness

Evidence suggests that the intestinal microbiome may play an important role in the pathogenesis and progression of acute critical illness in humans and other mammals, although evidence in small animal medicine is sparse. Moreover, the intestinal microbiota plays many important metabolic roles (production of short-chain fatty acids, trimethylamine-N-oxide, and normal bile acid metabolism) and is crucial for immunity as well as defense against enteropathogens. The use of probiotics and fecal microbiota transplantation as instruments to modulate the intestinal microbiota seems to be safe and effective in studies on critically ill dogs with acute gastrointestinal diseases.

Perianal Fistulizing Crohn's Disease-Associated Anorectal and Fistula Cancers: Systematic Review and Expert Consensus

BACKGROUND & AIMS

Perianal fistulizing Crohn's disease (PFCD)-associated anorectal and fistula cancers are rare but often devastating diagnoses. However, given the low incidence and consequent lack of data and clinical trials in the field, there is little to no guidance on screening and management of these cancers. To inform clinical practice, we developed consensus guidelines on PFCD-associated anorectal and fistula cancers by multidisciplinary experts from the international TOpClass consortium.

METHODS

We conducted a systematic review by standard methodology, using the Newcastle-Ottawa Scale quality assessment tool. We subsequently developed consensus statements using a Delphi consensus approach.

RESULTS

Of 561 articles identified, 110 were eligible, and 76 articles were included. The overall quality of evidence was low. The TOpClass consortium reached consensus on 6 structured statements addressing screening, risk assessment, and management of PFCD-associated anorectal and fistula cancers. Patients with long-standing (>10 years) PFCD should be considered at small but increased risk of developing perianal cancer, including squamous cell carcinoma of the anus and anorectal carcinoma. Risk factors for squamous cell carcinoma of the anus, notably human papilloma virus, should be considered. New, refractory, or progressive perianal symptoms should prompt evaluation for fistula cancer. There was no consensus on timing or frequency of screening in patients with asymptomatic perianal fistula. Multiple modalities may be required for diagnosis, including an examination under anesthesia with biopsy. Multidisciplinary team efforts were deemed central to the management of fistula cancers.

CONCLUSIONS

Inflammatory bowel disease clinicians should be aware of the risk of PFCD-associated anorectal and fistula cancers in all patients with PFCD. The TOpClass consortium consensus statements outlined herein offer guidance in managing this challenging scenario.

Evaluating the role of kynurenine/tryptophan ratio as an indicator of disease activity in Indian patients with inflammatory bowel disease. A case-control study

BACKGROUND

Tryptophan (T), an essential amino acid, is primarily metabolized (∼90%) to kynurenine (K) by indoleamine 2,3-dioxygenase 1 (IDO1) mainly in intestinal cells. In inflammatory bowel disease (IBD), there is an increase in IDO1 activity which would increase Kynurenine levels and Kynurenine/Tryptophan (K/T) ratio. We hypothesize that alteration in K/T may be an indicator of disease severity in IBD.

METHODS

55 healthy controls (HC), 55 Ulcerative colitis (UC) (35 active and 20 remission) and 30 Crohn's disease (CD) (20 active and 10 remission) were enrolled from November 2020 to March 2023. Plasma Kyn & Trp were simultaneously estimated using ultra-high-pressure liquid chromatography (UPLC). K/T ratio was correlated with disease activity and fecal calprotectin. In 25 patients follow-up samples were also collected with change in disease activity.

RESULTS

Median K/T ratio was significantly higher in patients with active disease as compared to those in remission and HC (p < .0001). A cut-off of ≤41 distinguished remission/healthy controls with a sensitivity of 92.73%, specificity of 76.36%, and an AUC of 0.9 (95% CI: 0.83-0.95, p < .001). The K/T ratio correlated with FC levels at a diagnostic cut-off of 250 µg/g. A significant reduction in K/T ratio with disease activity was noted in 80% of follow-up patients.

CONCLUSION

The K/T ratio with a cut-off of 41, correlated with the disease activity in 82% of patients, suggesting that the K/T ratio alters remarkably with disease activity in IBD patients. These findings can be further assessed for disease marker in a larger cohort of IBD patients.

Extracellular Vesicles From Lactobacillus fermentum Enhance Intestinal Barrier Integrity and Restore Gut Microbial Homeostasis in Experimental Murine Colitis

BACKGROUND

Lactobacillus fermentum has been shown to improve intestinal health and treat colitis; however, its precise efficacy and mechanisms in inflammatory bowel disease remain unclear.

OBJECTIVES

This study aimed to evaluate whether L fermentum and its metabolites, extracellular vesicles, and other components could modulate intestinal barrier function and gut microbiota to alleviate dextran sulfate sodium (DSS)-induced colitis in mice.

METHODS

Forty-eight mice were randomly assigned to 6 groups: control, DSS, L fermentum+DSS group (LF+DSS), heat-inactivated L fermentum+DSS group (LHF+DSS), L fermentum supernatant solution+DSS group (LSF+DSS), and L fermentum extracellular vesicles+DSS group (LEV+DSS). After a 1-wk acclimation, mice were gavaged daily for 3 wk. Fresh cultures, including live (LF+DSS), heat-inactivated (LHF+DSS), supernatant (LSF+DSS), and extracellular vesicles (LEV+DSS), were prepared daily. During the final 7 d, the control group received normal water, and the other groups received 3% DSS. Data were collected daily, followed by sample collection from the mice.

RESULTS

In this study, significant reductions (P < 0.05) in body weight changes, disease activity index, intestinal damage, and histology scores were observed in the treatment groups, especially LEV+DSS and LF+DSS. Additionally, compared with the DSS group, colonic mucus secretion, as well as claudin-1 and occludin expression, increased significantly (P < 0.05) in the LEV+DSS and LF+DSS groups, whereas proinflammatory cytokines IL-1β and TNF-α decreased (P < 0.05) and IL-10 increased (P < 0.05) in the LEV+DSS group. L fermentum and its components significantly regulated gut microbiota α-diversity and β-diversity, affecting overall composition. Linear discriminant analysis effect size analysis revealed an enrichment of beneficial bacteria including Prevotellaceae_UCG-001, Romboutsia, and Ruminococcus species in the LF+DSS group and Akkermansia, Odoribacter, and Marvinbryantia species in the LEV+DSS group. Both L fermentum and its extracellular vesicles significantly downregulated the gene expression of TNF-α and IL-1β, whereas the expression of IL-10 was upregulated, thereby contributing to the alleviation of colitis symptoms.

CONCLUSIONS

This study reveals that L fermentum alleviates colitis through modulation of the gut microbiota and reinforcement of the intestinal mucosal barrier, with its extracellular vesicles potentially playing a key role in this regulatory process.

Imaging of the Small Bowel Tumors

Small bowel tumors are rare gastrointestinal tumors. Neuroendocrine tumors are the most common and demonstrate unique subtypes depending on their location. Adenocarcinomas are most common in the duodenum demonstrating luminal narrowing and irregularity. Gastrointestinal stromal tumors are heterogeneously enhancing lesions with endophytic and/or exophytic growth patterns. Immunotherapy is a unique treatment of these tumors with tumoral response best assessed with both routine computed tomography (CT) and PET/CT. Primary small bowel lymphoma has many imaging patterns, most commonly being aneurysmal dilation and thickening of the small bowel. Metastases are common and may present as polypoid lesions, focal wall thickening, or serosal deposits.

Single-cell landscape of peripheral immune cells in MASLD/MASH

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) progresses to metabolic dysfunction-associated steatohepatitis (MASH) and is a major cause of liver cirrhosis. Although liver inflammation is the hallmark feature of MASH versus MASLD, the involvement of the peripheral immune cell compartments in disease progression is poorly understood, and single-cell profiles of peripheral immune cells in MASLD/MASH are not known.

METHODS

Patients with MASLD/MASH and healthy volunteers have been prospectively enrolled in a cross-sectional study. Patients have been histologically stratified and further characterized by liver bulk RNA sequencing (RNA-Seq). Peripheral immune cells from patients and control blood samples have been comprehensively profiled using bulk and single RNA-Seq.

RESULTS

Twenty-two patients with fibrosis stage less than F3 have been histologically stratified into patients with low, medium, and high disease activity scores (NAFLD activity score [NAS]). In contrast to fibrosis, the NAS group correlated with noninvasive imaging readouts and blood biomarkers of liver damage and inflammation (ALT, AST). The prevalence of type 2 diabetes and obesity increased with the NAS stage. Bulk RNA-seq profiling of patient liver biopsies revealed gene signatures that were positively and negatively associated with NAS. Known marker genes for liver fibrosis where upregulated on RNA level. Blood bulk RNA-seq showed only moderate differences in patients versus healthy controls. In contrast, single-cell analysis of white blood cells revealed multiple alterations of immune (sub-)populations, including an increased abundance of immature B cells and myeloid suppressor cells in patients with MASLD/MASH as compared to healthy controls.

CONCLUSIONS

The study gives new insights into the pathophysiology of MASLD/MASH already manifesting relatively early in peripheral immune cell compartments. This opens new avenues for the development of new biomarker diagnostics and disease therapies.

Atorvastatin and flaxseed dietary treatments improve dyslipidemia and liver injuries in a diet-induced rat model of non-alcoholic fatty liver disease

Objective

Non-alcoholic fatty liver disease (NAFLD) as the most common chronic liver disease is associated with metabolic disorders including dysregulated lipid and glucose metabolism. There is no approved drug treatment for NAFLD; thus, new therapies are needed. We studied the antidyslipidemic effects of atorvastatin and/or possibly hepatoprotective effects of flaxseed/ flaxseed oil in a rat model of NAFLD.

Materials and Methods

Fifty-six male Wistar rats were divided randomly into seven groups: 1) control, 2) high-fructose diet (HFD), 3) HFD +atorvastatin (20 mg/kg), 4) HFD+ flaxseed (40 g/kg), 5) HFD+ flaxseed oil (40 mg/kg), 6) HFD+flaxseed (40 g/kg) + atorvastatin (20 mg/kg) and 7) HFD+flaxseed oil (40 g/kg) +atorvastatin (20 mg/kg). The interventions were done for 23 weeks, after which anthropometric indices, lipid profile, liver enzymes, fasting blood glucose, and kidney indices were analyzed. Scoring of hematoxylin-eosin-stained liver sections was used to assess the severity of NAFLD.

Results

All the treatments reduced mesenteric fat mass, and the amount of fat around the liver, except in HFD+ flaxseed +atorvastatin group. The interventions improved NAFLD activity score, which considers steatosis, lobular inflammation, and hepatocyte ballooning. However, atorvastatin was most efficient in reducing inflammation and hepatocyte ballooning. While atorvastatin reduced only Gamma-glutamyltransferase (GGT) levels, flaxseed or flaxseed oil mono- and combination therapies reduced serum levels of all liver enzymes. The interventions improved the serum lipid profile and all, except atorvastatin decreased fasting blood glucose.

Conclusion

Flaxseed therapies improved NAFLD-associated liver injuries and dyslipidemia, while atorvastatin mostly reduced hepatocyte ballooning and lobular inflammation.

Acute-Onset Disabling Restless Legs Syndrome and Periodic Limb Movements in a Context of Mesenteric Ischemia: Successful Management With Intravenous Iron Supplementation

An 87-year-old woman with a history of multiple cardiovascular conditions, diabetes mellitus, and chronic renal failure developed insomnia and restless leg syndrome (RLS) with periodic limb movements during hospitalization for superior mesenteric artery ischaemia, which was successfully treated by mechanical embolectomy. She was found to be anaemic, with a haemoglobin at 10.5 g/dL (reference range: 11.8 15 g/dL) and serum ferritin at 13μg/L (reference range: 30 400μg/L). Given the severity of her symptoms and iron deficiency, we opted against oral iron supplementation, as its absorption is slower and less efficient. Instead, we administered intravenous iron sucrose as a first-line treatment, resulting in a corrected ferritin level of 90μg/L. Her RLS symptoms regressed within two days after intravenous iron supplementation. This case highlights the importance of considering RLS in patients presenting with insomnia, as effective treatments are available to improve patient outcomes.

Risk of serum circulating environmental chemical residues to esophageal squamous cell carcinoma: a nested case-control metabolome-wide association study

Esophageal squamous cell carcinoma (ESCC) is the primary histological subtype of esophageal carcinoma, yet research on environmental exposure risks and associated metabolic alterations preceding ESCC is limited. In a nested case-control cohort of 396 adults (199 diagnosed with ESCC and 197 healthy controls (HC)), we combined exposomics and metabolomics to assess circulating chemical residues and early serum metabolic changes linked to ESCC risk. A cell experiment further evaluated the proliferative impact of 1H,1H,2H,2H-perfluorooctanesulfonic acid (6:2 FTS), identifying it as a risk factor for ESCC, primarily through lipid metabolism-related chronic inflammation. Significant metabolic disruptions were observed in ESCC cases, characterized by increased carnitines, phosphatidylcholines (PCs), and triglycerides (TGs) alongside reduced lysophosphatidylcholines (LPCs) and ether lysophosphatidylcholines (LPC-Os). An early-warning biomarker panel, including glutamic acid, methionine, choline, LPC-O 18:0, TG (14:0_18:2_20:5), and PC (18:0_20:4)/LPC 18:0, showed improved predictive capacity when combined with 6:2 FTS. Metabolome-exposome-wide association studies largely confirmed 6:2 FTS as a potential ESCC risk factor through lipid mediation. This study offers novel insights for ESCC prevention and early diagnosis through a combined biomarker panel integrating metabolic and environmental risk indicators.

Spanish Working Group in Crohn's Disease and Ulcerative Colitis (GETECCU) position paper on cardiovascular disease in patients with inflammatory bowel disease

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Therefore, it is essential to understand their relationship and prevalence in different diseases that may present specific risk factors for them. The objective of this document is to analyze the specific prevalence of CVD in patients with inflammatory bowel disease (IBD), describing the presence of classical and non-classical cardiovascular risk factors in these patients. Additionally, we will detail the pathophysiology of atherosclerosis in this patient group and the different methods used to assess cardiovascular risk, including the use of risk calculators in clinical practice and different ways to assess subclinical atherosclerosis and endothelial dysfunction. Furthermore, we will describe the potential influence of medication used for managing patients with IBD on cardiovascular risk, as well as the potential influence of commonly used drugs for managing CVD on the course of IBD. The document provides comments and evidence-based recommendations based on available evidence and expert opinion. An interdisciplinary group of gastroenterologists specialized in IBD management, along with a consulting cardiologist for this type of patients, participated in the development of these recommendations by the Spanish Group of Work on Crohn's Disease and Ulcerative Colitis (GETECCU).

Efficacy and Safety of Ileal Bile Acid Transport Inhibitors in Inherited Cholestatic Liver Disorders: A Meta-analysis of Randomized Controlled Trials

Background

Inherited cholestatic liver disorders such as progressive familial intrahepatic cholestasis (PFIC) and Alagille syndrome result in significant pruritus and increased serum bile acids, necessitating liver transplantation. This study aims to evaluate the efficacy and safety of Ileal bile acid transport inhibitors (IBATIs) in children with PFIC and Alagille syndrome.

Methods

We conducted a comprehensive search across the databases to identify relevant randomized controlled trials (RCTs), and Covidence was used to screen eligible articles. All outcomes data were synthesized using risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) in RevMan 5.4. PROSPERO: CRD42024564270.

Results

Four multicenter RCTs involving 215 patients were included. IBATIs were associated with a significant reduction in Itch Observer Reported Outcome (Itch (ObsRo)) score (MD: -0.90, 95% CI [-1.17, -0.63], P < 0.01), serum bile acids (MD: -119.06, 95% CI [-152.37, -85.74], P < 0.01), total bilirubin (MD: -0.73, 95% CI [-1.32, -0.15], P = 0.01), and increased proportion of patients achieving ≥1 score reduction in Itch (ObsRo) score (RR: 2.54, 95% CI [3.83, 1.69], P < 0.01) and bile acid responders (RR: 8.76, 95% CI [2.46, 31.23], P < 0.01) compared with placebo. No differences were observed in any treatment-emergent adverse events (TEAs) (RR: 1.02, 95% CI [1.12, 0.93], P = 0.71), TEAs leading to drug discontinuation (1.03, 95% CI [5.56, 0.19], any serious TEAs, or liver-related TEAs.

Conclusion

IBATIs showed significant improvement in various cholestatic parameters with tolerable safety profile; however, future research on optimal dosage and long-term outcomes is needed.

Role of IL-6, TNF-α and VCAM-1 as predictors of renal impairment in patients with spontaneous bacterial peritonitis

BACKGROUND

Multiple mechanisms may contribute to the occurrence of renal impairment (RI) in patients with spontaneous bacterial peritonitis (SBP). One such mechanism is systemic inflammatory response syndrome, which involves the release of pro-inflammatory cytokines (tumour necrosis factor [TNF]-α, interleukin [IL]-6 and vascular cell adhesion molecule [VCAM]-1). The goal of this research was to evaluate the role of IL-6, TNF-α and VCAM-1 as potential predictors of RI and mortality in cirrhotic patients with SBP.

METHODS

This study included 90 cirrhotic patients with SBP, divided into two equal groups: group A was patients without RI and group B was patients with RI. Based on mortality outcomes, the patients were further categorized into group 1 (recovery, n=70) and group 2 (death, n=20). TNF-α, IL-6 and VCAM-1 serum levels were measured using enzyme-linked immunosorbent assay.

RESULTS

RI occurred in 50% (45/90) of the study population. Among the 90 patients, 10 (11.1%) had elevated IL-6 levels, 8 (8.9%) had elevated TNF-α levels and 6 (6.7%) had elevated VCAM-1 levels. There were no significant variations in cytokine levels between groups A and B. With an area under the curve of 0.5, the three cytokines showed comparable sensitivity and specificity as predictors of RI.

CONCLUSIONS

The use of TNF-α, IL-6 and VCAM-1 as predictive markers for RI and mortality in SBP patients is not recommended, as these biomarkers demonstrated limited diagnostic value.

Bronchoscopic detection of aspiration in patients with bronchiectasis and Mycobacterium avium complex pulmonary infection

RATIONALE

To investigate whether gastroesophageal reflux with laryngopharyngeal reflux and aspiration play a role in the pathogenesis of bronchiectasis and Mycobacterium avium complex (MAC) pulmonary infection.

METHODS

In this prospective case-control study, subjects included 31 patients with bronchiectasis undergoing bronchoscopy to investigate suspected MAC infection and 9 control subjects undergoing bronchoscopy for alternative reasons. Patients drank 45 mL of FD&C Blue #1 mixed with 200 mL of tap water the night prior to bronchoscopy. During bronchoscopy, the bronchial mucosa was inspected for the presence of blue dye staining. Bronchoalveolar lavage (BAL) samples were obtained from the most affected segments on CT scan and were cultured for mycobacteria and assayed for pepsin and bile acids. Gastric aspirate samples were obtained for mycobacterial culture.

RESULTS

93.8% of patients with confirmed pulmonary MAC infection and 91.7% of patients with evidence of bronchiectasis by CT scan, but negative mycobacterial cultures, had blue dye staining of the bronchial mucosa vs. 11.3% of control patients (p < 0.001). Areas of abnormality on CT correlated with airways demonstrating blue staining by bronchoscopy in 100% of MAC patients and 90.9% of patients with bronchiectasis and negative mycobacterial cultures. MAC patients had higher median BAL pepsin levels compared to combined MAC negative patients (subjects with bronchiectasis and negative mycobacterial cultures and true controls), 5.4 ng/mL vs. 3.4 ng/mL (p = 0.019). 78.6% of MAC patients vs. 26.3% of combined MAC negative patients had BAL bile acid concentrations of >/= 0.493 uM (p = 0.005). There was no significant difference in age, supraglottic index, reflux symptoms, gastric pH, or proton pump inhibitor use between the MAC positive vs. MAC negative patients. 42.8% of patients with growth of MAC on BAL also had growth of MAC in the gastric aspirate.

CONCLUSIONS

Reflux and aspiration of gastric contents into the airways show a strong association with bronchiectasis and may be associated with MAC pulmonary disease. The novel method introduced in this study of drinking blue dye the evening prior to bronchoscopy should be utilized in the evaluation of infectious and inflammatory lung diseases in which aspiration may play a role.

Lead Mediated Lipopolysaccharides Exacerbates Fatty Liver Processes in High-Fat Diets-Induced Mice

Obesity leads to a variety of health risks, and lead, which is ranked second in Agency for Toxic Substances and Disease Registry's priority list of harmful substances, may be more harmful to individuals that are obese. C57BL/6 mice were fed a normal diet or a high-fat diet with or without exposure to 1 g/L lead exposure in drinking water for 8 consecutive weeks. Serum and hepatic biochemistry analysis, histopathological observation, and RT-qPCR were used to explore the potential mechanism of liver damage in obese individuals after Pb exposure, and fecal microbiota transplantation was performed to investigate the role of the gut microbiota in the progression of fatty liver disease. We found that the progression of fatty liver disease induced by high-fat diets was accelerated by chronic lead intake. In addition, the occurrences of liver injury in recipient mice suggested the role of the gut microbiota. These findings indicated that the combination of lead and a HFD exacerbated hepatic lipotoxicity by activating LPS-mediated inflammation, and that gut microbiota disorders and impaired intestinal barrier function play pivotal roles in the progression of fatty liver disease.

Hypophosphatemia as a Predictor of Pancreatic Necrosis in Acute Alcohol-induced Pancreatitis

OBJECTIVE

Pancreatic necrosis is a catastrophic complication of acute pancreatitis and is associated with increased morbidity and mortality. While there is no objective means to predict pancreatic necrosis, recent studies have identified serum phosphate levels as a contributor to the disease process, with worse outcomes noted in patients with low serum phosphates. We aimed to determine if there was a relationship between low serum phosphate levels and the risk of developing pancreatic necrosis in patients with acute alcoholic pancreatitis (AAP).

METHODS

Health care records from patients admitted between January 2017 and December 2022 for acute alcoholic pancreatitis were retrospectively reviewed. These patients were categorized based on their phosphate levels within 48 hours of admission: normal phosphate levels (2.8-4.5 mg/dL) and hypophosphatemia (<2.8 mg/dL). Imaging findings from hospital stays were examined to identify cases of pancreatic necrosis. These cases were then compared across patients with normal and low phosphate levels.

RESULTS

Among the 207 patients admitted for acute alcoholic pancreatitis, 67 met the inclusion and exclusion criteria. Of these, 37 patients exhibited serum phosphate levels below 2.8 mg/dL, while 30 maintained levels between 2.8 and 4.5 mg/dL within the first 48 hours of admission. Of the patients in the hypophosphatemia group, 27.02% were noted to develop pancreatic necrosis during hospital stay compared to only 6.66% in the normal phosphate group ( P value: 0.029). In addition, those who developed necrosis had an overall lower mean phosphate level of 2.13 mg/dL compared to the mean phosphate level of 2.60 mg/dL ( P value: 0.0521) in patients without necrosis. The median duration of hospital stay ( P value: 0.65) and rate of intensive care unit (ICU) admission ( P value: 0.41) were similar in both groups.

CONCLUSIONS

Early hypophosphatemia during admission for AAP was associated with an increased risk of developing pancreatic necrosis; however, it may not affect the overall length of hospital stay or rate of ICU admission.

The insular cortex-nucleus tractus solitarius glutamatergic pathway involved in acute stress-induced gastric mucosal damage in rats

Previous studies have shown that acute stress-induced gastric mucosal damage is linked to excessive activation of parasympathetic nervous system. The Insular Cortex (IC), the higher centers of the parasympathetic nervous system, serves as both the integration site of gastric sensory information and play a crucial role in the regulation of gastric function. However, whether the IC is involved in Restraint water-immersion stress (RWIS)-induced gastric mucosal damage has not been reported. In this study, we examined the expression of neuronal c-Fos, PSD95 and SYN-1 protein expression in IC during RWIS by immunofluorescence and western blot techniques, as well as assessed IC blood oxygenation level dependant (BOLD) through functional MRI. Chemical genetics techniques specifically modulate the activity of IC glutamatergic neurons and IC-nucleus tractus solitary (NTS) glutamatergic pathway to elucidate their contributions to RWIS-induced gastric mucosal damage. The results showed that the expression of c-Fos, PSD95, and SYN-1 protein in IC increased significantly after RWIS, along with a noticeable enhancement in fMRI signal intensity. Furthermore, inhibiting IC glutamatergic neurons and the IC-NTS glutamatergic neural pathway resulted in a significant reduction in gastric mucosal damage, an increase in the expression of Occludin, Claudin-1, and PCNA in the gastric wall, while the expression of nNOS decreased and CHAT increased. These findings suggest that during RWIS, IC glutaminergic neurons are activated, promoting stress-induced gastric mucosal damage through the IC-NTS-vagal nerve pathway.

Lymphangiosis Carcinomatosa of the Liver and Extrahepatic Bile Duct Due to Gastric Cancer: A Case Report and Literature Review

A 78-year-old man was diagnosed with advanced poorly differentiated gastric adenocarcinoma, presenting with jaundice and diffuse thickening of the extrahepatic bile duct. No obstructive biliary sites or liver masses were observed. The serum concentrations of proteins induced by the absence of vitamin K or antagonist-II were markedly high. Samples of the extrahepatic bile duct and liver were obtained by endoscopic examination. The patient was diagnosed with lymphangiosis carcinomatosa of the liver and extrahepatic bile duct but died 28 days after hospitalization. As the disease progresses rapidly with uncharacteristic imaging findings, biopsy samples should be obtained early using several diagnostic tools.

Global genetic diversity of human gut microbiome species is related to geographic location and host health

The human gut harbors thousands of microbial species, each exhibiting significant inter-individual genetic variability. Although many studies have associated microbial relative abundances with human-health-related phenotypes, the substantial intraspecies genetic variability of gut microbes has not yet been comprehensively considered, limiting the potential of linking such genetic traits with host conditions. Here, we analyzed 32,152 metagenomes from 94 microbiome studies across the globe to investigate the human microbiome intraspecies genetic diversity. We reconstructed 583 species-specific phylogenies and linked them to geographic information and species' horizontal transmissibility. We identified 484 microbial-strain-level associations with 241 host phenotypes, encompassing human anthropometric factors, biochemical measurements, diseases, and lifestyle. We observed a higher prevalence of a Ruminococcus gnavus clade in nonagenarians correlated with distinct plasma bile acid profiles and a melanoma and prostate-cancer-associated Collinsella clade. Our large-scale intraspecies genetic analysis highlights the relevance of strain diversity as it relates to human health.

Inhibitors of Cyclic Dinucleotide Phosphodiesterases and Cyclic Oligonucleotide Ring Nucleases as Potential Drugs for Various Diseases

The phosphodiester linkage is found in DNA, RNA and many signaling molecules, such as cyclic mononucleotide, cyclic dinucleotides (CDNs) and cyclic oligonucleotides (cONs). Enzymes that cleave the phosphodiester linkage (nucleases and phosphodiesterases) play important roles in cell persistence and fitness and have therefore become targets for various diseased states. While various inhibitors have been developed for nucleases and cyclic mononucleotide phosphodiesterases, and some have become clinical successes, there is a paucity of inhibitors of the recently discovered phosphodiesterases or ring nucleases that cleave CDNs and cONs. Inhibitors of bacterial c-di-GMP or c-di-AMP phosphodiesterases have the potential to be used as anti-virulence compounds, while compounds that inhibit the degradation of 3',3'-cGAMP, cA3, cA4, cA6 could serve as antibiotic adjuvants as the accumulation of these second messengers leads to bacterial abortive infection. In humans, 2'3'-cGAMP plays critical roles in antiviral and antitumor responses. ENPP1 (the 2'3'-cGAMP phosphodiesterase) or virally encoded cyclic dinucleotide phosphodiesterases, such as poxin, however, blunt this response. Inhibitors of ENPP1 or poxin-like enzymes have the potential to be used as anticancer and antiviral agents, respectively. This review summarizes efforts made towards the discovery and development of compounds that inhibit CDN phosphodiesterases and cON ring nucleases.

Insights into Modeling Inflammatory Bowel Disease from Stem Cell Derived Intestinal Organoids

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a multifactorial, immune-mediated condition marked by chronic gastrointestinal inflammation. This condition significantly impairs patients' quality of life and represents a major public health challenge globally. Pathogenesis of IBD arises from complex interplay among genetic predisposition, environmental factors, immune dysregulation, and microbial dysbiosis. Although significant strides have been made in unraveling these mechanisms, existing therapeutic options remain inadequate in addressing the full spectrum of clinical needs, underscoring the urgent demand for innovative strategies. Regenerative medicine has emerged as a promising frontier, offering novel tools for therapeutic development. We briefly consolidated current knowledge on IBD pathogenesis and treatments, emphasized the pivotal potential of human intestinal organoids (including adult stem cell-derived organoids and pluripotent stem cell- derived organoids) as a robust platform for mechanistic studies and treatment exploration. Leveraging this technology, we aim to advance personalized and next-generation therapies for IBD.

Autoimmune Pancreatitis: A Review

Autoimmune pancreatitis is a rare condition of pancreatic inflammation with two classic subtypes. The emergence of a third subtype, ICI-induced pancreatitis, highlights the need for knowledge of each type to ensure accurate diagnosis and treatment. Abbreviations: AIP-Autoimmune pancreatitis; AIP-1-Type 1 autoimmune pancreatitis, also known as lymphoplasmacytic sclerosing pancreatitis (LPSP); AIP-2-Type 2 autoimmune pancreatitis, also referred to as idiopathic duct-centric pancreatitis (IDCP); AIP-3-Type 3 autoimmune pancreatitis, also known as immune checkpoint inhibitor (ICI)-induced autoimmune pancreatitis; IgG4-RD-Immunoglobulin G4-related disease.

Advances in application of serum biomarkers for screening and early diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) represents a major global health challenge, with early detection through surveillance of high-risk populations remaining critical for improving clinical outcomes. Serum biomarkers play a crucial role in the early detection of HCC. Currently, commonly used serological markers for HCC include alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin, and the Lens culinaris agglutinin-reactive fraction of AFP. Other potential biomarkers under investigation include glypican-3, osteopontin, alpha-L-fucosidase, Dickkopf-1, heat shock protein 90α, and Golgi protein 73. With the advancement of liquid biopsy technologies, novel markers such as circulating tumor DNA, circulating tumor cells, microRNAs, and long non-coding RNAs have emerged as promising tools for early screening and diagnosis of HCC. This review aims to summarize the research progress and clinical applications of these biomarkers related to liver cancer, providing scientific evidence to enhance early diagnosis rates, improve prognosis, and ultimately reduce HCC-related mortality.

Epigenetic modulation of the NLRP6 inflammasome sensor as a therapeutic modality to reduce necroptosis-driven gastrointestinal mucosal dysfunction in HIV/SIV infection

BACKGROUND

Gastrointestinal (GI) disease/dysfunction persists in people living with HIV (PLWH) receiving suppressive combination anti-retroviral therapy (ART) leading to epithelial barrier breakdown, microbial translocation and systemic inflammation that can drive non-AIDS associated comorbidities. Although epigenetic mechanisms are predicted to drive GI dysfunction, they remain unknown and unaddressed in HIV/SIV infection. The present study investigated genome-wide changes in DNA methylation, and gene expression exclusively in colon epithelial cells (CE) in response to simian immunodeficiency virus infection (SIV) and long-term low-dose delta-9-tetrahydrocannabinol (THC).

METHODS

Using reduced-representation bisulfite sequencing, we characterized DNA methylation changes in colonic epithelium (CE) of uninfected controls (n=5) and SIV-infected rhesus macaques (RMs) administered vehicle (VEH/SIV; n=7) or THC (THC/SIV; n=6). Intact jejunum resection segments (~5cm) were collected from sixteen ART treated SIV-infected RMs [(VEH/SIV/ART; n=8) and (THC/SIV/ART; n=8)] to confirm protein expression data identified in the colon of ART-naïve SIV-infected RMs. Transcriptomics data was used to confirm expression of differentially methylated genes. Protein expression of differentially methylated genes and their downstream targets was assessed using Immunofluorescence followed by HALO quantification.

RESULTS

SIV infection in ART-naïve RMs induced marked hypomethylation throughout promoter-associated CpG islands (paCGIs) in genes related to inflammatory response (NLRP6, cGAS), cellular adhesion (PCDH17, CDH7) and proliferation (WIF1, SFRP1, TERT, and HAND2) in CEs. Moreover, low-dose THC reduced NLRP6 protein expression in CE by hypermethylating the NLRP6 paCGI and blocked polyI:C induced NLRP6 upregulation in vitro. In ART suppressed SIV-infected RMs, significant NLRP6 protein upregulation during acute infection was unaffected by long-term ART administration during chronic infection despite successful plasma and tissue viral suppression. In this group, NLRP6 protein upregulation was associated with significantly increased expression of necroptosis-driving proteins; phosphorylated-RIPK3(Ser199), phosphorylated-MLKL(Thr357/Ser358), and HMGB1. Most strikingly, adding ART to THC-treated SIV-infected RMs effectively reduced NLRP6 and necroptosis-driving protein expression to pre-infection levels.

CONCLUSIONS

We conclude that DNA hypomethylation-assisted NLRP6 upregulation can lead to its constitutively high expression resulting in the activation of necroptosis signaling via the RIPK3/p-MLKL pathway that can eventually drive intestinal epithelial loss/death. From a clinical standpoint, low-dose phytocannabinoids in combination with ART could safely and successfully reduce/reverse persistent GI inflammatory responses via modulating DNA methylation.

Spatial Study of TLR4, TLR5 and TLR9 in Gastric Premalignant Lesions Before and After Helicobacter pylori Eradication

The histological changes in the gastric epithelium are crucial in the progression from premalignant to neoplastic lesions. TLR4, TLR5 and TLR9 have been localized in the gastric epithelium and studied separately using conventional histological techniques without a focus on the protein or cell interactions within the microenvironment. Therefore, we developed a multiplex immunohistochemistry/immunofluorescence (mIHC/IF) technology for the simultaneous detection of TLR4, TLR5 and TLR9 on a single tissue section of human gastric biopsies from 10 paired cases collected in two independent visits, and its correlation with the OLGA/OLGIM scoring and H. pylori status after eradication. The results confirmed that mIHC/IF is useful for simultaneously interrogating six biomarkers and demonstrated that TLR4 and TLR9 are significantly associated with H. pylori infection. However, only TLR9 is positively related to the presence of intestinal metaplasia. TLR5 was mainly present in goblet cells (TFF3+) but did not show any significant association with H. pylori or the presence of intestinal metaplasia. Our results suggest that a more comprehensive strategy to interrogate the tissue microenvironment in premalignant lesions may improve the interpretation of the earned risk of gastric cancer in patients with chronic gastritis and evidence of failure in H. pylori eradication.

Iron Deficiency Treatment in Heart Failure-Challenges and Therapeutic Solutions

Iron deficiency (ID) is a common comorbidity in heart failure (HF), affecting nearly 50% of patients and worsening symptoms, exercise capacity, and prognosis. This review summarizes recent evidence from meta-analyses, clinical trials, and guidelines on the pathophysiology, diagnosis, and treatment of ID in HF. ID in HF results from chronic inflammation, intestinal congestion, and impaired iron metabolism. Diagnosis is based on serum ferritin and transferrin saturation (TSAT) levels. While oral iron therapy has limited efficacy, intravenous iron, particularly ferric carboxymaltose and ferric derisomaltose, improves symptoms and exercise tolerance and reduces hospitalizations. Timely diagnosis and treatment of ID in HF are essential. Intravenous iron is the preferred therapeutic approach, but further research is needed to optimize long-term management.

Effect of water extract of bay laurel (Laurus nobilis L.) on non-alcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) involves lipid accumulation in liver without consumption of alcohol and affects many people worldwide. NAFLD is associated with metabolic syndrome disease such as obesity, insulin resistance, hyperlipidemia, and diabetes. However, there are no pharmacologic therapies for NAFLD. Recently, there are increasing reports that several natural plants can inhibit lipid accumulation in hepatocytes. Bay laurel (Laurus nobilis L.) leaves have been used in traditional medicine for rheumatism, stomach ache, emetic, skin rashes, and earaches. Our objective was to investigate the effect of bay laurel leaves water extract (BLW) on free fatty acid (FFA) treated hepatocyte and high fructose, high fat (HFHF) diet in a mouse model of NAFLD. In vitro, lipid accumulation increased only in the FFA treated group, while BLW reduced lipid accumulation to a level comparable to that only in the FFA treated group. Cellular antioxidants were increased in the BLW compared to the only FFA-treated group, but cellular MDA levels were decreased in the BLW compared to the only FFA treated group. Cellular lipid accumulation, inflammation, and apoptosis were reduced in the BLW compared to the only FFA treated group. In vivo, serum ALT, AST, and GGT levels in the BLW supplementation group were significantly decreased compared with the HFHF group. Hepatic TC, TG, and MDA levels were significantly decreased in the HFHF+100 and HFHF+200 groups compared to the HFHF group. The hepatic antioxidant activities in the BLW supplementation groups were significantly increased compared to the HFHF group. The expression of proteins related to hepatic inflammation and apoptosis was reduced in the BLW supplementation groups compared to the HFHF group. These results suggest that BLW could be potentially useful in the treatment of NAFLD due to its inhibitory effects on hepatic lipogenesis, hepatic inflammation, and hepatic apoptosis.

Gut microbiota diversity in obese rats treated with intermittent fasting, probiotic-fermented camel milk with or without dates and their combinations

Dietary alternatives help effectively in obesity management. The present study examines the gut microbiota diversity in obesity-induced rats treated with intermittent fasting, fermented camel milk (FCM), and FCM-incorporated Sukkari date or their combinations. The metagenomic analysis of the gut microbiome through 16 S rRNA revealed 226 families, 499 genera, and 879 bacterial species. In the taxonomy distributions and heatmap analysis, Bacteroidota (i.e., Prevotella) had the uppermost relative abundance in groups before treatments (Before_Groups, most samples clustered in one sub-cluster) reached 80.50% in sample S11 (Before_G2), whereas Firmicutes (i.e., Lactobacillus) presented the dominant in groups after treatments (After_Groups, generality samples grouped in another sub-cluster) and counted 70.86% in sample S88 (After_G6), reflecting potential short-chain fatty acids production. The alpha and beta diversity explored by Shannon and PCoA indices presented high diversity in most groups after treatment. Deferribacterota and Fusobacteriota, in addition to Stenotrophomonas and Listeria, were the key phylotypes in the treated groups at the Phylum and genus levels, respectively. The proposed functional pathways involving mannan, rhamnose I, glucose, and xylose degradation were the most supported pathways in After_Groups with potential carbohydrate degradation. Eventually, intermittent fasting and probiotic fermented camel milk increased microbiome diversity and accelerated weight loss, preventing health issues.

Delayed endoscopic retrograde cholangiopancreatography: a game-changer for acute cholangitis patients in a resource-limited setting

Background

Acute cholangitis (AC) is a critical biliary infection caused by gallstones that can progress to systemic inflammation, sepsis, and organ failure. The 2018 Tokyo Guidelines advocate for early endoscopic retrograde cholangiopancreatography (ERCP) in moderate-to-severe AC, but its timing in resource-limited settings remains debated. In Vietnam, where healthcare resources may be limited, the timing of ERCP in patients with AC caused by gallstones has not been extensively studied.

Objectives

To compare outcomes of early ERCP (eERCP, ⩽48 h) versus delayed ERCP (dERCP, >48 h) in managing stone-induced AC.

Design

This was a retrospective cohort study analyzing outcomes of early versus dERCP in 708 patients with stone-induced AC. The study aimed to evaluate procedural efficacy, complications, and long-term outcomes, particularly in a resource-limited setting. Patients were stratified based on ERCP timing (⩽48 h for eERCP and >48 h for dERCP) to enable direct comparisons.

Methods

Data on demographics, clinical features, laboratory findings, and procedural outcomes were analyzed.

Results

The eERCP group exhibited higher rates of severe cholangitis and elevated inflammatory markers compared to the dERCP group. Intensive care unit admission rates were also higher in the eERCP group (3.1% vs 0.8%, p = 0.02). Perforation complications occurred more frequently in the dERCP group (1.2% vs 0%, p = 0.01), while stone treatment outcomes were comparable between the two groups. The eERCP group had a shorter hospital stay (6.5 vs 9.3 days, p < 0.05), although there were no significant differences in readmission or 1-year mortality rates. For patients with severe cholangitis, the treatment outcomes for stones, complications after intervention, and the 1-year mortality and readmission rates are similar between the two groups.

Conclusion

In resource-limited settings, dERCP following resuscitation provides outcomes comparable to eERCP, offering a viable alternative when resources are constrained.

A type 1 immune-stromal cell network mediates disease tolerance against intestinal infection

Type 1 immunity mediates host defense through pathogen elimination, but whether this pathway also impacts tissue function is unknown. Here, we demonstrate that rapid induction of interferon γ (IFNγ) signaling coordinates a multicellular response that is critical to limit tissue damage and maintain gut motility following infection of mice with a tissue-invasive helminth. IFNγ production is initiated by antigen-independent activation of lamina propria CD8+ T cells following MyD88-dependent recognition of the microbiota during helminth-induced barrier invasion. IFNγ acted directly on intestinal stromal cells to recruit neutrophils that limited parasite-induced tissue injury. IFNγ sensing also limited the expansion of smooth muscle actin-expressing cells to prevent pathological gut dysmotility. Importantly, this tissue-protective response did not impact parasite burden, indicating that IFNγ supports a disease tolerance defense strategy. Our results have important implications for managing the pathophysiological sequelae of post-infectious gut dysfunction and chronic inflammatory diseases associated with stromal remodeling.

IL-22BP Modulates Injury in Acute Pancreatitis but Delays Tissue Recovery in Chronic Pancreatitis

BACKGROUND & AIMS

In acute pancreatitis, interleukin (IL)-22 signaling is increased, whereas overall expression of the cytokine paradoxically drops, suggesting an additional level of control. Here, we investigate the regulation of IL-22 signaling by its soluble neutralizing receptor interleukin-22 binding protein (IL-22BP) in the context of both acute and chronic pancreatitis.

METHODS

Cerulein was used to induce acute and chronic pancreatitis in both wild-type mice and IL-22BP knockout mice. Histology, multiplex immunofluorescence and flow cytometry were performed to compare differences in tissue injury, recovery, fibrosis, and inflammation at various times of recovery.

RESULTS

Loss of IL-22BP resulted in increased canonical IL-22 signaling and the expression of the anti-autophagy protein Bcl-XL. This was associated with decreased severity of acute pancreatitis, as evidenced by lower serum amylase and tissue injury. In chronic pancreatitis, IL-22BP expression was induced in the inflammatory and recovery phases and genetic deletion resulted in unchecked IL-22 signaling, as demonstrated by persistent p-Stat3 signaling and proliferation of both epithelial cells and fibroblasts. Loss of IL-22BP increased myeloid cell infiltration, which persisted throughout recovery. Mechanistically, IL-22 activity forced persistent acinar to ductal metaplasia and delayed tissue recovery.

CONCLUSIONS

IL-22BP plays an important role in modulating IL-22 activity during tissue injury and recovery after pancreatitis. Loss of IL-22BP attenuated acute pancreatitis but promoted chronic fibrosis and inflammation through uncontrolled IL-22 signaling and subsequent deleterious effects on epithelial cells, fibroblasts, and immune infiltration.

Glycodeoxycholic acid alleviates central precocious puberty by modulating gut microbiota and metabolites in high-fat diet-fed female rats

OBJECTIVE

Central precocious puberty (CPP) is a common pediatric endocrine disorder and a significant global public health concern. Emerging evidence suggests an association between bile acids (BAs) and CPP, although their regulatory roles and underlying mechanisms remain poorly understood.

METHODS

We conducted untargeted metabolomics and targeted BA analysis on serum samples from female rats with high-fat diet-induced CPP to identify metabolites potentially involved in regulating puberty through modulation of Sirt1 and Kiss1 expression in the hypothalamus. Identified BAs were then administered via gavage to female rats with CPP to assess their effects. To explore the mechanisms by which these BAs affect the development of CPP, gut microbiota and their metabolites were analyzed using 16S rRNA sequencing and untargeted metabolomics.

RESULTS

Our findings revealed significant reductions in glycodeoxycholic acid (GDCA) and glycoursodeoxycholic acid (GUDCA) levels in female rats with CPP. GDCA treatment delayed the onset of puberty, accompanied by alterations in the gut microbiota functions and metabolic pathways related to oxidative stress (OS) and fatty acid metabolism. Mediation analysis suggested that OS-related metabolites, including gamma-glutamylcysteine and malonic acid, which increased with the abundance of Lachnospiraceae UCG-001, facilitated the reduction of Sirt1 expression. Additionally, pregnenolone appeared to suppress the beneficial effect of Parasutterella in enhancing Sirt1 expression.

CONCLUSION

This study demonstrates that GDCA exhibits a potential therapeutic effect on CPP through a unique mechanism that involves gut microbiota modulation, alterations in serum metabolites, and changes in the expression of key regulatory factors Sirt1.

Primary choledocholithiasis after cholecystectomy without hyperbilirubinaemia in a child with sickle cell disease

Children with sickle cell disease (SCD) may have hepatobiliary pathology secondary to chronic haemolysis and intrahepatic sickling during vaso-occlusive crisis. Choledocholithiasis in children with SCD is usually secondary to cholelithiasis but, less commonly, can be due to primary choledocholithiasis. A known history of cholecystectomy may lead to a delay in diagnosis of biliary tract pathology in sickle cell patients presenting with abdominal pain. Normal conjugated bilirubin levels may further stray healthcare providers away from considering biliary disease in these patients. Here, we report an unusual case of primary choledocholithiasis in a child with SCD after cholecystectomy with normal conjugated bilirubin at the time of presentation.

Innovative approaches for beetroot (Beta Vulgaris L.) aqueous extraction by cyclodextrins and its use to alleviate ethanol induced gastric ulcer in rats

One of the most common chronic conditions of peptic ulcer is gastric ulcer (GU), which is recognized as a high-risk illness in the present-day lifestyle. Originating from Asia and Europe, Beetroot (Beta vulgaris L.) is packed with high amounts of bioactive compounds like betanin and phenolics. These contribute to its nutritional value and overall health benefits. In this work, varying concentrations (0.5% to 7% w/v) of beta-cyclodextrin (β-CD) and hydroxypropyl-beta-cyclodextrin (HP-β-CD) were used to improve the efficiency of extracting beetroot components with water, using both stirring and ultrasound techniques. The presence of 5% (w/v) HP-β-CD during extraction appeared the maximum values of total phenolic compounds and betanin (3.1 mcg/mL and 3.01 mg/mL, respectively). The extraction recoveries of betanin at 5% (w/v) HP-β-CD emerging with magnetic stirring were 73%, 36% and 50% against water, ethanol and β-CD, respectively. The reproducibility of extraction procedure was found to be 0.86% relative standard deviation (RSD) indicating the highest precision of the beetroot modified HP-β-CD extraction procedure. Then, rats that had been treated with either HP-β-CD-modified aqueous extract of beetroot, omeprazole (20 mg/kg, orally administered) or both were studied to assess whether they helped reduce ethanol-induced GU. The combined treatment of HP-β-CD modified beetroot extract with omeprazole brought a significant decrease in the increased levels of serum oxidative stress malonaldehyde and nitric oxide, inflammatory markers myeloperoxidase, interleukin-10, interleukin-6 and tumor necrosis factor-α. It also restored the decreased levels of antioxidant glutathione and cyclo-protective prostaglandin E2 in comparison to the positive control. Furthermore, the proposed combination of beetroot-modified aqueous extract and omeprazole exhibited less severe histopathological damage in comparison to the positive control. Therefore, a novel synergistic pharmaceutical treatment using HP-β-CD modified aqueous extract of beetroot and omeprazole was presented to enhance GU healing.

Gut Microbiota Metabolites and Chronic Diseases: Interactions, Mechanisms, and Therapeutic Strategies

The gut microbiota, shaped by factors such as diet, lifestyle, and genetics, plays a pivotal role in regulating host metabolism, immune function, and overall health. The diversity and balance of the gut microbiota are closely linked to the onset and progression of various chronic diseases. A growing body of evidence has demonstrated that alterations in the composition, function, and metabolites of the gut microbiota are significantly associated with cardiovascular diseases, including hypertension, atherosclerosis, and heart failure; metabolic disorders such as obesity, type 2 diabetes, and metabolic dysfunction-associated steatotic liver disease; and gastrointestinal conditions like inflammatory bowel disease and colorectal cancer. Despite substantial advances in microbiome research, challenges remain in fully elucidating the causal relationships between the gut microbiota and disease, as well as in translating these insights into clinical applications. This review aims to investigate the regulatory pathways via which the gut microbiota affects cardiovascular health, metabolic function, and gastrointestinal disease. Additionally, it highlights emerging strategies for the prevention and treatment of these chronic conditions, focusing on microbiota-targeted therapies and personalized dietary interventions as promising approaches for improving health outcomes.

Drug-induced pancreatitis: a real-world analysis of the FDA Adverse Event Reporting System and network pharmacology

Background

Drug-induced pancreatitis is a rare disease but frequently reported, owing to the vast number of medications.

Aim

To summarize potential drugs causing pancreatitis and to speculate on underlying mechanisms.

Methods

We extracted more than 60,000 reports of pancreatitis submitted to the U.S. Food and Drug Administration Adverse Event Reporting System (January 2004 to March 2023). Data on patient age, sex, weight, time to onset, and outcome (death et al.) were collected. Disproportionality analysis was used in data mining to identify associations between drugs and pancreatitis events. Seven databases, commonly used for network pharmacology analysis, were searched to identify potential targets.

Results

Of 867 drugs with 3 or more reports, 101 drugs met all criteria using disproportionality analysis and indicated a potential risk of pancreatitis. The risk of 40 drugs had not been previously noted in "UpToDate" database. Patients taking the drugs had a similar sex distribution, were mostly 45-64 years old, and were heavier (median, 88 kg; P < 0.0001). The median time to onset was 199 days (interquartile range, 27-731.5). Ponatinib (16.48%), tigecycline (14.12%) and valproic acid (13.41%) had higher fatality rates. Potential targets related to pancreatitis were identified in 50 of the 101 drugs.

Conclusion

Clinicians providing the 101 drugs for treatment should stay vigilant to detect pancreatitis early.

Fecal profiling reveals a common microbial signature for pancreatic cancer in Finnish and Iranian cohorts

BACKGROUND

Pancreatic cancer (PC) presents a significant challenge in oncology because of its late-stage diagnosis and limited treatment options. The inadequacy of current screening methods has prompted investigations into stool-based assays and microbial classifiers as potential early detection markers. The gut microbiota composition of PC patients may be influenced by population differences, thereby impacting the accuracy of disease prediction. However, comprehensive profiling of the PC gut microbiota and analysis of these cofactors remain limited. Therefore, we analyzed the stool microbiota of 33 Finnish and 50 Iranian PC patients along with 35 Finnish and 34 Iranian healthy controls using 16S rRNA gene sequencing. We assessed similarities and differences of PC gut microbiota in both populations while considering sociocultural impacts and generated a statistical model for disease prediction based on microbial classifiers. Our aim was to expand the current understanding of the PC gut microbiota, discuss the impact of population differences, and contribute to the development of early PC diagnosis through microbial biomarkers.

RESULTS

Compared with healthy controls, PC patients presented reduced microbial diversity, with discernible microbial profiles influenced by factors such as ethnicity, demographics, and lifestyle. PC was marked by significantly higher abundances of facultative pathogens including Enterobacteriaceae, Enterococcaceae, and Fusobacteriaceae, and significantly lower abundances of beneficial bacteria. In particular, bacteria belonging to the Clostridia class, such as butyrate-producing Lachnospiraceae, Butyricicoccaceae, and Ruminococcaceae, were depleted. A microbial classifier for the prediction of pancreatic ductal adenocarcinoma (PDAC) was developed in the Iranian cohort and evaluated in the Finnish cohort, where it yielded a respectable AUC of 0.88 (95% CI 0.78, 0.97).

CONCLUSIONS

This study highlights the potential of gut microbes as biomarkers for noninvasive PC screening and the development of targeted therapies, emphasizing the need for further research to validate these findings in diverse populations. A comprehensive understanding of the role of the gut microbiome in PC could significantly enhance early detection efforts and improve patient outcomes.

Untargeted metabolomic profiling for identifying systemic signatures of helicobacter pylori infection in a guinea pig model

Infections caused by the Gram-negative bacterium Helicobacter pylori (H. pylori) can lead to gastritis, gastric or duodenal ulcers, and even gastric cancer in humans. Investigating quantitative changes in soluble biomarkers associated with H. pylori infection offers a promising method for monitoring the progression of the infection, inflammatory response and potentially systemic consequences. This study aimed to identify, using an experimental model of H. pylori infection in guinea pigs, the specific metabolomic biomarkers in the serum of H. pylori-infected (32) versus uninfected (32) animals. The H. pylori status was confirmed through histological, molecular, and serological examinations. Metabolomic profiling was conducted using UPLC-QTOF/MS methods. The metabolomic biomarkers significantly associated with H. pylori infection were selected based on volcano plots and traditional univariate receiver operating characteristics (ROC). This study identified 12 unique metabolites significantly differentiating H. pylori-infected guinea pigs from uninfected ones. In summary, the metabolomic profiling of serum samples, in combination with ROC characteristics of the data, enhances the monitoring of H. pylori infection and related inflammatory responses in guinea pigs experimentally infected with these bacteria, with potential applications in humans for prediction the infection course and its systemic effects.

Insight inTo Stress and POOping on work TIME (ITS POO TIME): an online and cross-sectional study protocol

BACKGROUND

Long occupational working hours and shift work are common in high, middle, and lower-income economies. Bowel movement frequency and stool form in occupational settings may be important markers of stressful working conditions as well as diurnal gut microbiota action, gastrointestinal discomfort, and disorders of gut-brain interaction (DGBI). Characterizing DGBI in shift and non-shift workers could help identify the impact of diurnal work patterns on worker's physical and mental health, including anxiety related to bowel movements.

OBJECTIVE

The paper outlines the Insight inTo Stress and POOping on work TIME (ITS POO TIME) protocol describing a web-based multi-methods research project on DGBI, stool form and frequency, psychological factors, sleep, diet and anxiety related to bowel movements in occupational settings by comparison to residential settings.

METHODS

Study 1 comprises a web-based convenience sampling survey to acquire quantitative data from adults who are engaged in paid employment. We seek to assess occupational characteristics, organizational factors, as well as standardized questionnaires for stool form, DGBI assessed by Rome-IV criteria, sleep, diet, bowel movement anxiety (i.e. parcopresis), and distress. Study 2 is a qualitative study which asks open-ended questions about respondents' attitudes to defecation at work. Analyses for Study 1 will explore rates of DGBI in shift vs. non-shift workers and explore how occupational characteristics are associated with occupational bowel movement stool form and frequency. With regards to distress, and parcopresis, Study 1 will analyse how parcopresis, distress, and contamination fears are associated with stool form and frequency in occupational settings compared with residential settings. Study 1 is designed to have 90% power to detect a 5% difference in DGBI prevalence between groups at α = 0.05 based on the conservative estimate of 15% DGBI prevalence in shift workers and 10% DGBI prevalence in non-shift workers, with a final sample of N=1967 required. Study 2 qualitative data will be analysed using inductive thematic analysis to identify themes concerning feelings and attitudes about bowel movements in occupational settings.

RESULTS

The findings of ITS POO TIME will elicit important information on what factors are associated with bowel movements and stool form and frequency in occupational settings and identify associations pertinent to occupational health. Data collection commenced in January 2019 and finished enrolment in December 2023. Study 1 obtained 1872 responses and fell short of the desired sample size. Study 2 received 337 responses, and the primary results are expected to be published in 2025 and qualitative results published in 2026.

CONCLUSIONS

The results of the research described in this research protocol will have direct implications for industry, employers, and policy makers concerning DGBI, stress, and worker health.

CLINICALTRIAL

Comparative Genomic Analysis of Key Oncogenic Pathways in Hepatocellular Carcinoma Among Diverse Populations

BACKGROUND/OBJECTIVES

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with significant racial and ethnic disparities in incidence, tumor biology, and clinical outcomes. Hispanic/Latino (H/L) patients tend to be diagnosed at younger ages and more advanced stages than Non-Hispanic White (NHW) patients, yet the molecular mechanisms underlying these disparities remain poorly understood. Key oncogenic pathways, including RTK/RAS, TGF-beta, WNT, PI3K, and TP53, play pivotal roles in tumor progression, treatment resistance, and response to targeted therapies. However, ethnicity-specific alterations within these pathways remain largely unexplored. This study aims to compare pathway-specific mutations in HCC between H/L and NHW patients, assess tumor mutation burden, and identify ethnicity-associated oncogenic drivers using publicly available datasets. Findings from this analysis may inform precision medicine strategies for improving early detection and targeted therapies in underrepresented populations.

METHODS

We conducted a bioinformatic analysis using publicly available HCC datasets to assess mutation frequencies in RTK/RAS, TGF-beta, WNT, PI3K, and TP53 pathway genes. This study included 547 patients, consisting of 69 H/L patients and 478 NHW patients. Patients were stratified by ethnicity (H/L vs. NHW) to evaluate differences in mutation prevalence. Chi-squared tests were used to compare mutation frequencies, while Kaplan-Meier survival analysis assessed overall survival differences associated with pathway-specific alterations in both populations.

RESULTS

Significant differences were observed in the RTK/RAS pathway-related genes, particularly in FGFR4 mutations, which were more prevalent in H/L patients compared to NHW patients (4.3% vs. 0.6%, p = 0.02). Additionally, IGF1R mutations exhibited borderline significance (7.2% vs. 2.9%, p = 0.07). In the PI3K pathway, INPP4B alterations were more frequent in H/L patients than in NHW patients (4.3% vs. 1%, p = 0.06), while, in the TGF-beta pathway, TGFBR2 mutations were more common in H/L patients (2.9% vs. 0.4%, p = 0.07), suggesting potential ethnicity-specific variations. Survival analysis revealed no significant differences in overall survival between H/L and NHW patients, indicating that molecular alterations alone may not fully explain survival disparities and suggesting a role for additional factors such as immune response, environmental exposures, or access to targeted therapies.

CONCLUSIONS

This study provides one of the first ethnicity-focused analyses of key oncogenic pathway alterations in HCC, revealing distinct molecular differences between H/L and NHW patients. The findings suggest that RTK/RAS (FGFR4, IGF1R), PI3K (INPP4B), and TGF-beta (TGFBR2) pathway alterations may play a distinct role in HCC among H/L patients, while their prognostic significance in NHW patients remains unclear. These insights emphasize the importance of incorporating ethnicity-specific molecular profiling into precision medicine approaches to improve early detection, targeted therapies, and clinical outcomes in HCC, particularly for underrepresented populations.

Acute Pancreatitis in Children: It's Not Just a Simple Attack

Acute pancreatitis (AP) in children presents unique challenges distinct from adult manifestations, requiring specialized diagnostic and therapeutic approaches. Compared with adults, pediatric AP has lower mortality rates but still carries significant morbidity and potential long-term complications. This review examines current evidence on pediatric AP, highlighting recent advances in diagnosis, risk stratification, and management strategies. Current diagnostic approaches use serum lipase and amylase testing, along with various imaging modalities that have different diagnostic values. Recent research has identified promising biomarkers for predicting severe AP, including blood urea nitrogen, C-reactive protein, and specific cytokine signals. Emerging evidence suggests a role of gut microbiome dysbiosis in disease pathogenesis, opening new therapeutic possibilities targeting the gut-pancreas axis. Genetic factors, specifically pancreatitis risk genes, influence disease progression to recurrent and chronic pancreatitis. In this review, we summarize the consequences of an isolated AP episode in children. Our review highlights for the first time how AP can lead to significant long-term sequelae, including exocrine/nutritional deficiencies, endocrine pancreatic dysfunction, diabetes, recurrent pain, and decreased quality of life compared with healthy population controls. The goal of this review is to summarize advances in understanding of pediatric AP and to emphasize the importance of early recognition, appropriate risk stratification, and comprehensive follow-up after the first pediatric AP episode, while highlighting areas requiring future research to optimize patient outcomes.

Hemostatic Properties of Climbing Chalk: A Comparative Analysis

IntroductionClimbing chalk is widely used by rock climbers and athletes to improve grip. It has been observed that climbers sometimes apply magnesium carbonate chalk to small wounds to stop bleeding, suggesting that climbing chalk may exhibit hemostatic properties useful for small cuts and scrapes. This study aimed to investigate and compare the effects of different types of climbing chalk on prothrombin time (PT) and activated partial thromboplastin time (aPTT).MethodsThree types of climbing chalk were randomly selected for comparative analysis of hemostatic properties, with talcum powder used as a negative control. PT and aPTT testing were conducted on normal plasma samples containing varying concentrations of climbing chalk (from 0.125 mg/mL to 4 mg/mL). Statistical analyses of the results were performed using two-tailed t-tests, Welch's analysis of variance (ANOVA), and Games-Howell post-hoc analysis.ResultsResults indicated that climbing chalk had no significant effect on PT but did significantly reduce aPTT compared to the negative control. Additional analyses revealed significant differences in aPTT results between different types of chalk and between higher and lower concentrations of chalk.ConclusionsMagnesium carbonate-based climbing chalks appear to have a procoagulant effect on hemostasis, likely by affecting the intrinsic pathway of the coagulation cascade. While further research is needed to better understand its coagulative properties, climbing chalk shows potential as a hemostatic agent for minor wounds in wilderness medicine.

The global resistance problem and the clinical antibacterial pipeline

A comprehensive analysis of the clinical antibacterial pipeline demonstrates that there is a limited range of strategies that are primarily focused on modified versions of widely used chemical classes. These modifications aim to circumvent class-specific resistance mechanisms and reduce resistance rates in certain multidrug-resistant pathogens. Owing to the great variation in resistance rates and mechanisms, the clinical success of current approaches varies substantially across different countries, regions, and economic and environmental conditions, which affects the global societal value of these antibiotics that remain vulnerable to cross-resistance. Although there has been some progress in developing urgently needed antibiotics with novel targets and chemical structures, some of which have advanced to phase I/II trials, further breakthroughs are required. Additionally, adjunctive agents designed to enhance the outcome of conventional antibiotic therapies, along with bacteriophages that offer targeted and personalized treatments, are also under investigation. However, the potential of adjunctive therapeutics, such as antivirulence agents, and bacteriophages has yet to be realized in terms of feasibility and global societal impact.

Periodontal diseases, potential mediators and development of liver fat content: a community-based large cohort

Background

A high level of liver fat content (LFC) is a key indicator of steatotic liver disease (SLD), reflecting its pathological essence. Periodontal disease (PD) recognized as a chronic inflammatory condition and cause a widespread adverse health impact. This study aims to investigate the relationship between PD and LFC development.

Methods

In the UK Biobank, PD were gathered through a digital questionnaire, including gum pain, gum bleed, or teeth loose. LFC was measured by Fatty Liver Index (>60 indicates SLD) in cross-sectional analysis and by magnetic resonance imaging (quantified by Proton Density Fat Fraction, PDFF) in longitudinal analysis. Multivariable logistic and linear regression models were conducted to investigate the association of PD and LFC.

Results

In cross-sectional analysis, 164,150 (37.4%) individuals were diagnosed with SLD, and PD showed a significant association with SLD (odds ratio: 1.104, 95% CI: 1.075-1.132). In prospective analysis, a total of 39,656 participants with a median follow-up of 10.3 years were included. PD showed an arithmetic mean difference of 0.091 in PDFF (95% CI: 0.047-0.139), with males exhibiting a stronger association than females (P for interaction <0.05). Significant mediating effects were observed for body mass index (19.58%), C-reactive protein (11.61%), blood glucose (6.70%), and healthy diet score (5.99%) between PD and PDFF (P for all <0.001).

Conclusion

There was a pronounced correlation between PD and LFC, with males predominantly driving this link. This correlation may be partially mediated by body fat, inflammation, dietary habit, and insulin resistance.

Mechanistic Studies on the Role of IL-17/NLRP3 in Arsenic-Induced Activation of Hepatic Stellate Cells Through Hepatocyte Proptosis

Long-term exposure to arsenic, a prevalent environmental contaminant, has been implicated in the pathogenesis of various hepatic conditions. Hepatic stellate cells (HSCs) are central to the development of liver fibrosis. Recently, the involvement of interleukin-17 (IL-17) and the NOD-like receptor protein 3 (NLRP3) inflammasome in hepatic pathologies has attracted significant research interest. Hepatocyte pyroptosis, a form of programmed cell death, is a critical factor in the occurrence of inflammation. The objective of this study was to investigate the specific roles of IL-17 and NLRP3 in the arsenic-induced activation of HSCs through hepatocyte pyroptosis. We pretreated MIHA cells with MCC950 (1 and 5 μM) and secukinumab (10 and 100 nM) for 4 h, then with NaAsO2 (25 μM) for 24 h at 37 °C under 5% CO2. After incubation, the cell-culture supernatant was collected and mixed with serum-free high-glucose DMEM medium in a 1:1 ratio to prepare the conditioned medium, which was subsequently used for the culture of LX-2 cells. The results showed that exposure to NaAsO2 induced hepatocellular pyroptosis, which led to the release of the inflammatory cytokines IL-18 and IL-1β and subsequent activation of HSCs. Treatment with the inhibitors MCC950 and secukinumab significantly reduced the secretion of Extracellular matrix (ECM) components and attenuated HSC activation. These results demonstrate that blocking the IL-17 and NLRP3 signaling pathways significantly reduces HSC activation and attenuates hepatic fibrogenesis. These results provide novel molecular targets for the prevention and treatment of arsenic-related liver fibrosis.

Prevalence of metabolic syndrome in patients with inflammatory bowel disease: a meta-analysis on a global scale

BACKGROUND

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that increase the risk of cardiovascular diseases (CVD). Patients with inflammatory bowel disease (IBD) may be at higher risk of developing MetS due to chronic inflammation, altered adipokine profiles, and the effects of corticosteroid treatment. However, the prevalence of MetS in IBD patients remains inconsistent across studies. This meta-analysis aims to estimate the prevalence of MetS in IBD patients and compare its occurrence between Crohn's disease (CD) and ulcerative colitis (UC).

METHODS

A systematic search was conducted across PubMed, Scopus, Embase, and Web of Science from their inception up to January 19, 2025. Eligible observational studies reporting MetS prevalence in IBD patients were included. Meta-analysis was performed using a random-effects model, with heterogeneity assessed via the I² statistic. Comprehensive Meta-Analysis (CMA) software, version 4.0 was used for analysis.

RESULTS

The pooled prevalence of MetS in IBD patients was 21.8% (95% CI: 14.3-31.6%). The prevalence was higher in UC patients (32.7%, 95% CI: 16.0-55.5%) compared to CD patients (14.1%, 95% CI: 8.6-22.3%). Patients with UC had significantly higher odds of MetS than those with CD (OR = 1.38, 95% CI: 1.03-1.85, P = 0.02). Additionally, IBD patients with MetS were significantly older than those without (MD: 9.89, 95% CI: 5.12-14.67, P < 0.01).

CONCLUSION

In summary, this meta-analysis reveals a notable prevalence of MetS among patients with IBD, particularly in those with UC, where the prevalence is higher than in CD. The analysis also shows that IBD patients with MetS tend to be older, suggesting age as a contributing factor. These findings underscore the need for routine metabolic screening in IBD care, especially in UC and elderly patients.

Sex Differences in Peripheral Vascular Disease: A Scientific Statement From the American Heart Association

Sex differences in the risk factors, diagnosis, treatment, and outcomes of patients with cardiovascular disease have been well described; however, the bulk of the literature has focused on heart disease in women. Data on sex differences in peripheral vascular disease are ill defined, and there is a need to report and understand those sex-related differences to mitigate adverse outcomes related to those disparities. Although peripheral vascular disease is a highly diverse group of disorders affecting the arteries, veins, and lymphatics, this scientific statement focuses on disorders affecting the peripheral arteries to include the aorta and its branch vessels. The purpose of this scientific statement is to report the current status of sex-based differences and disparities in peripheral vascular disease and to provide research priorities to achieve health equity for women with peripheral vascular disease.

Assessment of Non-Cereal Products Gluten Cross-Contamination Exposure Risk in a Polish Female Population of Patients Diagnosed with Coeliac Disease

BACKGROUND/OBJECTIVES

Following gluten-free diet is challenging, due to risk of gluten cross-contamination. The study aimed to assess the non-cereal products gluten cross-contamination exposure risk in patients with coeliac disease.

METHODS

The study was conducted in a population of 699 Polish female members of the Polish Coeliac Society purchasing gluten-free products on-line (445 patients, 254 relatives). Participants were asked about frequency of buying and availability of gluten-free alternatives of non-cereal products characterized by the gluten cross-contamination risk ('hidden' gluten sources).

RESULTS

The most frequently bought non-cereal gluten-free alternatives of the 'hidden' gluten sources were baking powders, spices, side dishes, ice cream, chocolate and chocolate products, snack bars and candies. The caregivers often declared buying 'often' gluten-free baking powder, snack bars, chocolate and chocolate products, candies, ice cream, as well as often declared problems with the availability of gluten-free spices, chocolate and chocolate products, while patients often declared buying 'often' gluten-free beer, as well as often declared problems with its availability. The older respondents often declared buying 'often' gluten-free baking powder, while younger respondents often declared buying 'often' gluten-free chocolate and chocolate products, as well as often declared problems with the availability of gluten-free instant soups, and beer. The respondents living in small towns/villages often declared problems with the availability of gluten-free powder sauces. The respondents not purchasing in hypermarkets often declared buying 'often' gluten-free baking powder, spices, candies. The respondents who most often purchased gluten-free products often declared problems with the availability of gluten-free side dishes, chocolate and chocolate products.

CONCLUSIONS

The majority of patients diagnosed with coeliac disease do not buy a number of gluten-free alternatives of the 'hidden' gluten sources, so they may be prone to gluten exposure, due to non-cereal products' gluten cross-contamination risk.

Small Molecules and Epigenetic Modifiers in Facilitating Pancreatic β-cell Formation: A Comprehensive Insight

Diabetes mellitus, arising due to inadequate insulin release or insulin resistance, can be addressed through β-cell replacement therapy. Given the limited availability of islet cadaveric donors, alternative strategies such as differentiation of stem cells into pancreatic β-cells or direct reprogramming of somatic cells into pancreatic β-cells are emerging as viable options. This chapter elucidates the pivotal role of small molecules and associated signaling pathways in in vivo pancreatic organogenesis, allowing their emulation in vitro to facilitate pancreatic development. Small molecules exhibit distinct advantages, such as cell-permeability and non-immunogenic properties, thereby generating efficient functional β-like cells. Recent investigations highlight alterations in epigenetic marks unique to pancreatic β-cells during cellular reprogramming and diabetes pathogenesis. The study further delineates the distinctive histone modifications and DNA methylation within pancreatic β-cells, underscoring their contributions to pancreas development.

SARCOPENIA AND GASTROINTESTINAL CANCER: NUTRITIONAL APPROACH FOCUSING ON CURCUMIN SUPPLEMENTATION

BACKGROUND

Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass. When associated with cancer, it correlates with poorer clinical outcomes. Cancers of the gastrointestinal tract, prevalent globally and in Brazil, are associated with a greater nutritional risk. Early detection and intervention for nutritional risks are critical in this population. Recent studies on turmeric/curcumin have demonstrated beneficial effects in cancer patients. Specifically, curcumin have shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia. This review aims to elucidate sarcopenia and sarcopenia secondary to cancer, emphasizing nutritional management and the role of curcumin supplementation. Effective cancer management, whether with or without sarcopenia, demands comprehensive public health strategies and multimodal interventions within healthcare institutions. Nutrition is pivotal across the cancer care journey, encompassing screening, guidance, and provision of nutrients that support maintaining or recovering body composition. Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management. Nevertheless, further clinical studies are warranted to substantiate these findings.

BACKGROUND

• Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass.

BACKGROUND

• Sarcopenia when associated with cancer, it correlates with poorer clinical outcomes.

BACKGROUND

• Curcumin has shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia.

BACKGROUND

• Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management.