Feasibility and Safety of a Novel Cable-Transmitted Magnetically Controlled Capsule Endoscopy System for Upper Gastrointestinal Examination

Background

To evaluate the feasibility and safety of a novel cable-transmitted magnetically controlled capsule endoscopy (CT-MCE) system for upper gastrointestinal examination.

Methods

Twenty-six participants (19 healthy volunteers and seven patients with gastrointestinal symptoms) willing to undergo upper gastrointestinal endoscopy were recruited. Each participant underwent CT-MCE followed by conventional gastroscopy within 24 h. Maneuverability and visibility of the CT-MCE capsule in the upper gastrointestinal tract, adverse events, and discomfort during the procedure were evaluated. The sensitivity and specificity of CT-MCE for diagnosing upper gastrointestinal lesions were evaluated using conventional gastroscopy findings as the standard.

Results

Maneuverability was graded as "good" for all segments of the esophagus. The percentage of participants in which maneuverability was good according to gastric region was as follows: cardia (100.00%), pylorus (96.15%), angulus (92.31%), antrum (88.46%), fundus (84.62%), and body (73.08%). In the duodenal bulb and descending duodenum, it was good in only 20.83% and 16.67% of participants, respectively. Visibility was graded as "excellent" or "good" in the esophagus, Z line, and duodenal bulb in all participants; excellent/good visibility was achieved in the stomach and descending duodenum in 96.15% and 79.17% of participants, respectively. Forty-one lesions were detected overall. The sensitivity and specificity of CT-MCE in diagnosing upper gastrointestinal lesions were 85.00% and 98.15%, respectively. The CT-MCE capsule was successfully removed through the mouth in all participants. No serious adverse events or capsule retention occurred.

Conclusions

CT-MCE showed good feasibility and safety for upper gastrointestinal examination. The system was effective in examining the esophagus and stomach with no risk of capsule retention.

A review of potential mechanisms and treatments of gastric intestinal metaplasia

Gastric intestinal metaplasia (GIM) is a pathological process where gastric mucosal epithelial cells are replaced by intestinal-type cells, serving as a precursor lesion for gastric cancer. This transformation involves various genetic and environmental factors, affecting key genes and signaling pathways. Recent research has revealed complex mechanisms, including changes in gene expression, abnormal signaling pathway activation, and altered cell behavior. This review summarizes the latest research on GIM, discussing its pathogenesis, current treatment strategies, and potential efficacy of emerging approaches like gene editing, microbiome interventions, and integrative medicine. By exploring these strategies, we aim to provide more effective treatments for GIM and reduce gastric cancer incidence. The review also highlights the importance of interdisciplinary studies in understanding GIM mechanisms and improving treatment strategies.

Artificial Intelligence in Endoscopy Quality Measures

Quality of gastrointestinal endoscopy is a major determinant of its effectiveness. Artificial intelligence (AI) has the potential to enhance quality monitoring and improve endoscopy outcomes. This article reviews the current literature on AI algorithms that have been developed for endoscopy quality assessment.

Role of Artificial Intelligence in the Detection and Management of Premalignant and Malignant Lesions of the Esophagus and Stomach

The advent of artificial intelligence (AI) and deep learning algorithms, particularly convolutional neural networks, promises to address pitfalls, bridging the care for patients at high risk with improved detection (computer-aided detection [CADe]) and characterization (computer-aided diagnosis [CADx]) of lesions. This review describes the available artificial intelligence (AI) technology and the current data on AI tools for screening esophageal squamous cell cancer, Barret's esophagus-related neoplasia, and gastric cancer. These tools outperformed endoscopists in many situations. Recent randomized controlled trials have demonstrated the successful application of AI tools in clinical practice with improved outcomes.

Fusobacterium nucleatum-Derived Outer Membrane Vesicles Promote Immunotherapy Resistance via Changes in Tryptophan Metabolism in Tumour-Associated Macrophages

Only a minority of patients with head and neck squamous cell carcinoma (HNSCC) respond favourably to immunotherapy. The oral oncogenic bacterium Fusobacterium nucleatum (F.nucleatum) was recently observed to suppress the anti-tumour immune response, although the mechanisms remain unclear. In this study, we found that outer membrane vesicles (OMVs) derived from F.nucleatum (F.n-OMVs) promoted HNSCC progression by inducing immunosuppressive phenotypes of tumour-associated macrophages (TAMs), resulting in decreased cytotoxic T lymphocyte infiltration in vivo. Mechanistically, TAMs internalized tryptophanase presented in F.n-OMVs, which activated the tryptophan-2,3-dioxygenase 2/aryl hydrocarbon receptor (TDO2/AHR) pathway and upregulated the transcription of immunosuppressive cytokines and immune checkpoints. TDO2 inhibitor enhanced the therapeutic effect of anti-programmed death-1 in a tumour-bearing mouse model. Both TDO2 and F.nucleatum demonstrated excellent performance in predicting the immunotherapy outcomes in patients with HNSCC. These results indicate that F.n-OMVs induce immunotherapy resistance in HNSCC, providing novel insights into the microbiota-tumour immunity crosstalk.

Functional hydrogels promote chronic infectious wound healing by re-rousing macrophage M1 and inducing bacterial copper-like death

Traditional antibiotics are often ineffective against biofilm-associated infections, and biofilm-induced macrophage immune evasion directly halts the wound healing process. Disrupting biofilms and regulating macrophage immune functions are critical to improving wound healing. In this study, we synthesized g-C3N4 with peroxidase (POD) enzyme activity via thermal polymerization and copper alginate microspheres (CAM) via gas cutting. These were co-encapsulated into GelMA hydrogels to form a functionalized wound repair system (GelMA/CAM@g-C3N4) with both anti-biofilm and local immune microenvironment remodeling capabilities. In vitro, this system exhibited excellent biocompatibility and promoted endothelial cell migration, vascular formation, and CD31 expression. It also polarized macrophages toward the M1 phenotype, restoring their pro-inflammatory functions, upregulating inflammatory cytokines (IL-1, IL-6, TNF-α), and inhibiting Staphylococcus aureus and Escherichia coli. In vivo, the system suppressed S. aureus growth, promoted angiogenesis and collagen deposition, and reshaped the pathological microenvironment to achieve wound repair and regeneration. Conclusions: This system offers a new therapeutic strategy for chronic infectious wounds.

The application of artificial intelligence in upper gastrointestinal cancers

Upper gastrointestinal cancers, mainly comprising esophageal and gastric cancers, are among the most prevalent cancers worldwide. There are many new cases of upper gastrointestinal cancers annually, and the survival rate tends to be low. Therefore, timely screening, precise diagnosis, appropriate treatment strategies, and effective prognosis are crucial for patients with upper gastrointestinal cancers. In recent years, an increasing number of studies suggest that artificial intelligence (AI) technology can effectively address clinical tasks related to upper gastrointestinal cancers. These studies mainly focus on four aspects: screening, diagnosis, treatment, and prognosis. In this review, we focus on the application of AI technology in clinical tasks related to upper gastrointestinal cancers. Firstly, the basic application pipelines of radiomics and deep learning in medical image analysis were introduced. Furthermore, we separately reviewed the application of AI technology in the aforementioned aspects for both esophageal and gastric cancers. Finally, the current limitations and challenges faced in the field of upper gastrointestinal cancers were summarized, and explorations were conducted on the selection of AI algorithms in various scenarios, the popularization of early screening, the clinical applications of AI, and large multimodal models.

Personalized prediction of esophageal cancer risk based on virtually generated alcohol data

BACKGROUND

Esophageal cancer (EC) presents a significant public health challenge globally, particularly in regions with high alcohol consumption. Its etiology is multifactorial, involving both genetic predispositions and lifestyle factors.

METHODS

This study aimed to develop a personalized risk prediction model for EC by integrating genetic polymorphisms (rs671 and rs1229984) with virtually generated alcohol consumption data, utilizing advanced artificial intelligence and machine learning techniques. We analyzed data from 86,845 individuals, including 763 diagnosed EC patients, sourced from the Taiwan Biobank. Eight machine learning models were employed: Bayesian Network, Decision Tree, Ensemble, Gradient Boosting, Logistic Regression, LASSO, Random Forest, and Support Vector Machines (SVM). A unique aspect of our approach was the virtual generation of alcohol consumption data, allowing us to evaluate risk profiles under both consuming and non-consuming scenarios.

RESULTS

Our analysis revealed that individuals with the genotypes rs671 = AG and rs1229984 = CC exhibited the highest probabilities of developing EC, with values ranging from 0.2041 to 0.9181. Notably, abstaining from alcohol could decrease their risk by approximately 16.29-49.58%. The Ensemble model demonstrated exceptional performance, achieving an area under the curve (AUC) of 0.9577 and a sensitivity of 0.9211. This transition from consumption to abstinence indicated a potential risk reduction of nearly 50% for individuals with high-risk genotypes.

CONCLUSION

Overall, our findings highlight the importance of integrating virtually generated alcohol data for more precise personalized risk assessments for EC.

Latest possible timing for endoscopic-assisted intervention in capsule endoscopy

Background

Delayed upper gastrointestinal transit during small bowel capsule endoscopy (SBCE) can lead to incomplete or failed examinations but can be treated by endoscopic-assisted intervention (EAI). The aim of this study was to investigate the latest possible timing of EAI.

Methods

Patients who underwent SBCE and received EAI between July 2007 and December 2020 were retrospectively reviewed. A novel T-value was developed that accounted for the varied battery life of different generations of PillCam when determining the latest possible timing of EAI, where T is calculated as EAI time/[minimum battery life of the PillCam minus small bowel transit time (6 h)] × 100%. Patients were divided into two groups based on the cut-off value of the receiver operating characteristic curve: early EAI (group A, T < 76.3%) and late EAI (group B, T ≥ 76.3%). The primary outcome was the completion rate (CR), and the secondary outcome was the detection rate. The latest possible timing of EAI (h) was calculated according to the T-value formula and further verified in our recent data set.

Results

This study included 108 patients. The CR was significantly higher in group A than in group B (79.2% vs 58.2%; P = 0.018). Late EAI was an independent predictor of incomplete SBCE (odds ratio = 2.900; 95% confidence interval, 1.193-7.053). The latest possible timing of EAI was 1.5 h and 4.6 h from the start of the examination for PillCam SB1 and PillCam SB2/3, respectively.

Conclusions

Early EAI was associated with higher CR. The latest possible timing of EAI was 1.5 h for PillCam SB1 and 4.6 h for PillCam SB2/3 from the start of the examination.

Human-Specific Organization of Proliferation and Stemness in Squamous Epithelia: A Comparative Study to Elucidate Differences in Stem Cell Organization

The mechanisms that influence human longevity are complex and operate on cellular, tissue, and organismal levels. To better understand the tissue-level mechanisms, we compared the organization of cell proliferation, differentiation, and cytoprotective protein expression in the squamous epithelium of the esophagus between mammals with varying lifespans. Humans are the only species with a quiescent basal stem cell layer that is distinctly physically separated from parabasal transit-amplifying cells. In addition to these stark differences in the organization of proliferation, human squamous epithelial stem cells express DNA repair-related markers, such as MECP2 and XPC, which are absent or low in mouse basal cells. Furthermore, we investigated whether the transition from basal to suprabasal is different between species. In humans, the parabasal cells seem to originate from cells detaching from the basement membrane, and these can already begin to proliferate while delaminating. In most other species, delaminating cells have been rare or their proliferation rate is different from that of their human counterparts, indicating an alternative mode of how stem cells maintain the tissue. In humans, the combination of an elevated cytoprotective signature and novel tissue organization may enhance resistance to aging and prevent cancer. Our results point to enhanced cellular cytoprotection and a tissue architecture which separates stemness and proliferation. These are both potential factors contributing to the increased fitness of human squamous epithelia to support longevity by suppressing tumorigenesis. However, the organization of canine oral mucosa shows some similarities to that of human tissue and may provide a useful model to understand the relationship between tissue architecture, gene expression regulation, tumor suppression, and longevity.

Ligation-assisted endoscopic submucosal resection following the unroofing technique for esophageal lesions

For the treatment method of esophageal subepithelial lesions originating from the muscularis propria, conventional endoscopic resection techniques are time-consuming and lack efficacy for small subepithelial lesions originating from the muscularis propria. Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection, aiming to provide a minimally invasive method for treatment. We discussed and analyzed this study from the aspects of sample screening, clinical pathological characteristics, case-control analysis, and follow-up data.

Unveiling Another Dimension: Advanced Visualization of Cancer Invasion and Metastasis via Micro-CT Imaging

Invasion and metastasis are well-known hallmarks of cancer, with metastatic disease accounting for 60% to 90% of cancer-related deaths [...].

Magnet-assisted diverticuloplasty for treating the symptomatic esophageal diverticulum: a case series (with video)

BACKGROUND

The development of the magnetic compression technique (MCT) for the gastrointestinal (GI) tract has been widely applied in the treatment of biliary strictures, esophageal atresia, and GI anastomoses. Our team combined the MCT and minimally invasive endoscopic operation to propose a novel alternative procedure called magnet-assisted diverticuloplasty (MAD) for treating various esophageal diverticula. This case series aimed to report the effectiveness, safety, and our experience of MAD.

METHODS

This retrospective case series included patients with symptomatic esophageal diverticulum (SED) who underwent MAD between November 2017 and June 2022 in West China Hospital, Sichuan University. The patients' symptomatic scores were accessed by Eckardt symptomatic scores. The telephone follow-up period ended in March 2023. The primary outcome of the study was clinical success. Secondary outcomes included the technical success of MAD, procedure time, hospitalization, recurrence, and adverse events.

RESULTS

We reported 6 patients with SED who underwent MAD (3 with Zenker's, 1 with middle, and 2 with lower esophageal diverticulum). The technical success rate was 100% (6/6) and no adverse events were reported. The median procedural duration was 22.5 min (interquartile range (IQR) 18.5). The mean hospitalization was 2 days (range 1-3). The median time of follow-up endoscopy was on postoperative day 18 (IQR 31), revealing a shortened diverticular septum under endoscopic examination. After a median telephone follow-up of 23 months (IQR 36), the median total symptomatic score decreased significantly from 4.00 (IQR 3.25) to 1.00 (IQR 2.00) (P = 0.015). The clinical success rate was 83.3% (5/6), and only one patient had recurrent symptoms two years after MAD.

CONCLUSION

MAD provided a novel method for treating SED. Our limited experience suggested that MAD could be minimally invasive and effective. More extensive, multicenter prospective studies were needed to assess this technique further.

Validity of the efficacy of the spray flushing cleaning method in flexible endoscope reprocessing

The advancement in endoscopic technology and techniques has increased its use in the diagnosis and treatment of gastrointestinal diseases. Reprocessing of reusable endoscopes remains a challenge. Inadequate reprocessing leads to bacterial contamination of the endoscope, a significant cause of endoscope-related infections. To thoroughly address the complexities of cleaning a flexible endoscope, various cleaning methods have been devised and tested across different studies. This letter evaluates one such method, spray flushing for flexible gastroscopes, developed and tested in a randomized controlled trial by Du et al. Based on the post-processing test results for this method, Du et al conclude that there is improved cleaning efficacy and reduced damage compared to manual brush cleaning. The validity and reliability of the results could be further enhanced by carefully considering the study design and a few underlying concepts that contribute to the reprocessing quality of different types of endoscopes.

The artificial intelligence revolution in gastric cancer management: clinical applications

Nowadays, gastric cancer has become a significant issue in the global cancer burden, and its impact cannot be ignored. The rapid development of artificial intelligence technology is attempting to address this situation, aiming to change the clinical management landscape of gastric cancer fundamentally. In this transformative change, machine learning and deep learning, as two core technologies, play a pivotal role, bringing unprecedented innovations and breakthroughs in the diagnosis, treatment, and prognosis evaluation of gastric cancer. This article comprehensively reviews the latest research status and application of artificial intelligence algorithms in gastric cancer, covering multiple dimensions such as image recognition, pathological analysis, personalized treatment, and prognosis risk assessment. These applications not only significantly improve the sensitivity of gastric cancer risk monitoring, the accuracy of diagnosis, and the precision of survival prognosis but also provide robust data support and a scientific basis for clinical decision-making. The integration of artificial intelligence, from optimizing the diagnosis process and enhancing diagnostic efficiency to promoting the practice of precision medicine, demonstrates its promising prospects for reshaping the treatment model of gastric cancer. Although most of the current AI-based models have not been widely used in clinical practice, with the continuous deepening and expansion of precision medicine, we have reason to believe that a new era of AI-driven gastric cancer care is approaching.

The current status of care for families with Lynch syndrome in China

Lynch syndrome is one of the most common hereditary cancer predisposition syndromes, which is caused by germline pathogenic variants in mismatch repair genes. It is associated with increased risks of colorectal cancer, endometrial cancer and various other types of cancer. With the rapid development in economy, medicine and genetic tests technology in recent decades, China had achieved significant advancements in the screening, diagnosis and treatment of Lynch syndrome. However, there are still a lot of challenges remaining unresolved. The major challenges include inconsistent access to genetic tests and counseling, regional disparities in healthcare quality, and limited implementation of clinical guidelines. This review will focus on the Chinese current status in the screening of Lynch syndrome, cancer surveillance, preventive measures, patients' willingness to take genetic tests and share genetic information, insurance coverage of medical cost, and national collaboration. At the end, we also summarize the major current research themes in Lynch syndrome in China.

Amphiphilic lysine-based glycopeptides exert antibacterial effects on Pseudomonas aeruginosa

The development of new antibiotics with novel antimicrobial mechanisms and strategies has attracted considerable interest. Herein, three amphiphilic lysine-based glycopeptides (SA-l-Gal, OA-l-Gal and LOA-l-Gal) were developed, and their antibacterial activity and inhibition effects on biofilm formation on P. aeruginosa were studied. SA-l-Gal with a stearic acid group modification exhibited better antibacterial effects than the other lysine-based glycopeptides by damaging the bacterial membrane. Furthermore, SA-l-Gal could effectively reduce inflammation factor expression, enhance the formation of new blood vessels, and promote the healing of P. aeruginosa-infected mouse wounds. This result provides insights into the development of glycomimetic drugs against P. aeruginosa infection.

Attention-Enhanced Multi-Task Deep Learning Model for Classification and Segmentation of Esophageal Lesions

Accurate detection and segmentation of esophageal lesions are crucial for diagnosing and treating gastrointestinal diseases. However, early detection of esophageal cancer remains challenging, contributing to a reduced five-year survival rate among patients. This paper introduces a novel multitask deep learning model for automatic diagnosis that integrates classification and segmentation tasks to assist endoscopists effectively. Our approach leverages the MobileNetV2 deep learning architecture enhanced with a mutual attention module, significantly improving the model's performance in determining the locations of esophageal lesions. Unlike traditional models, the proposed model is designed not to replace endoscopists but to empower them to correct false predictions when provided with additional Supporting Information. We evaluated the proposed model on three well-known data sets: Early Esophageal Cancer (EEC), CVC-ClinicDB, and KVASIR. The experimental results demonstrate promising performance, achieving high classification accuracies of 98.72% (F1-score: 98.08%) on CVC-ClinicDB, 98.95% (F1-score: 98.32%) on KVASIR, and 99.12% (F1-score: 99.00%) on our generated EEC data set. Compared to state-of-the-art models, our classification results show significant improvement. For the segmentation task, the model attained a Dice coefficient of 92.73% and an Intersection over Union (IoU) of 91.54%. These findings suggest that the proposed multitask deep learning model can effectively assist endoscopists in evaluating esophageal lesions, thereby alleviating their workload and enhancing diagnostic precision.

Deep Learning-Based Semantic Segmentation for Objective Colonoscopy Quality Assessment

Background: This study aims to objectively evaluate the overall quality of colonoscopies using a specially trained deep learning-based semantic segmentation neural network. This represents a modern and valuable approach for the analysis of colonoscopy frames. Methods: We collected thousands of colonoscopy frames extracted from a set of video colonoscopy files. A color-based image processing method was used to extract color features from specific regions of each colonoscopy frame, namely, the intestinal mucosa, residues, artifacts, and lumen. With these features, we automatically annotated all the colonoscopy frames and then selected the best of them to train a semantic segmentation network. This trained network was used to classify the four region types in a different set of test colonoscopy frames and extract pixel statistics that are relevant to quality evaluation. The test colonoscopies were also evaluated by colonoscopy experts using the Boston scale. Results: The deep learning semantic segmentation method obtained good results, in terms of classifying the four key regions in colonoscopy frames, and produced pixel statistics that are efficient in terms of objective quality assessment. The Spearman correlation results were as follows: BBPS vs. pixel scores: 0.69; BBPS vs. mucosa pixel percentage: 0.63; BBPS vs. residue pixel percentage: -0.47; BBPS vs. Artifact Pixel Percentage: -0.65. The agreement analysis using Cohen's Kappa yielded a value of 0.28. The colonoscopy evaluation based on the extracted pixel statistics showed a fair level of compatibility with the experts' evaluations. Conclusions: Our proposed deep learning semantic segmentation approach is shown to be a promising tool for evaluating the overall quality of colonoscopies and goes beyond the Boston Bowel Preparation Scale in terms of assessing colonoscopy quality. In particular, while the Boston scale focuses solely on the amount of residual content, our method can identify and quantify the percentage of colonic mucosa, residues, and artifacts, providing a more comprehensive and objective evaluation.

Chronic Inflammation to Cancer: The Impact of Oxidative Stress on DNA Methylation

The genomic landscape of cancer cells is complex and heterogeneous, with aberrant DNA methylation being a common observation. Growing evidence indicates that oxidants produced from immune cells may interact with epigenetic processes, and this may represent a mechanism for the initiation of altered epigenetic patterns observed in both precancerous and cancerous cells. Around 20% of cancers are linked to chronic inflammatory conditions, yet the precise mechanisms connecting inflammation with cancer progression remain unclear. During chronic inflammation, immune cells release oxidants in response to stimuli, which, in high concentrations, can cause cytotoxic effects. Oxidants are known to damage DNA and proteins and disrupt normal signalling pathways, potentially initiating a sequence of events that drives carcinogenesis. While research on the impact of immune cell-derived oxidants on DNA methylation remains limited, this mechanism may represent a crucial link between chronic inflammation and cancer development. This review examines current evidence on inflammation-associated DNA methylation changes in cancers related to chronic inflammation.

Starfish-Inspired Synergistic Reinforced Hydrogel Wound Dressing: Dual Responsiveness and Enhanced Bioactive Compound Delivery for Advanced Skin Regeneration and Management

Effective wound management demands advanced dressings that protect while actively supporting healing. Traditional wound dressings often fall short of meeting the complex needs of skin repair. Inspired by the regenerative abilities of starfish, we developed a bionically engineered hydrogel designed to enhance wound healing. The hydrogel is synthesized through the coassembly of dopamine-modified cellulose nanofibers, chitosan, (3-aminobenzeneboronic acid)-grafted oxidized dextran, and poly(vinyl alcohol), utilizing dynamic Schiff base and boronic ester linkages. This innovative design imparts multifunctional properties, including injectability, 3D printability, antibacterial activity, self-adhesion, self-healing, antioxidant protection, and hemostasis, which emulate the defense mechanisms and regenerative processes of starfish. These characteristics work synergistically to reduce infection and oxidative stress and improve healing efficiency. Additionally, the hydrogel incorporates mangiferin and Vitamin C, which are released in a controlled manner in response to the wound's microenvironment (pH and reactive oxygen species), promoting tissue regeneration and reducing inflammation. In vitro tests confirmed its dual responsiveness, while finite element modeling validated the controlled release of bioactive compounds. In vivo testing on a rat full-thickness wound model showed a 100% healing rate by day 13, significantly outperforming commercial alternatives. The hydrogel's nontoxicity and advanced healing capabilities make it a promising solution for patients with critical healing needs, offering a comprehensive integration of natural biological processes and cutting-edge engineering.

An adhesive and self-healing ROS-scavenging hydrogel loading with hMSC-derived exosomes for diabetic wound healing

Diabetic wounds have garnered significant attention due to excessive reactive oxygen species (ROS), persistent inflammation, and vascular and neural impairments that hinder effective healing. ROS-scavenging hydrogels with phenylborate bonds possess inherent anti-ROS and anti-inflammatory properties, while human mesenchymal stem cell-derived exosomes (hMSC-exos) offer additional anti-inflammatory, pro-angiogenic, and neurogenic benefits, presenting a promising strategy to address these challenges. This study introduces a novel ROS-scavenging hydrogel loaded with hMSC-exos, which exhibits strong adhesion and self-healing capabilities. Upon application to the wound, it interacts with ROS to produce an anti-inflammatory response, concurrently allowing a sustained release of hMSC-exos. In vitro and in vivo experiments have demonstrated that this hydrogel effectively reduces ROS levels, mitigates inflammation, and promotes angiogenesis and neurogenesis, thus enhancing functional skin restoration and accelerating wound healing. In summary, we propose an innovative therapeutic approach for diabetic wound healing by combining ROS-scavenging hydrogels with hMSC-exos, with the potential to significantly benefit patients.

Advances and global trends of precancerous lesions of gastric cancer: A bibliometric analysis

BACKGROUND

Precancerous lesions of gastric cancer (PLGC) represent a critical pathological stage in the development of intestinal gastric cancer. Early detection and diagnosis are key to reducing the incidence of gastric cancer. Substantial advancements have been made in PLGC research in recent years, making it necessary to provide updated reviews using bibliometric methods. We hypothesize that this review will identify emerging trends, key research areas, and gaps in PLGC research, providing insights that could guide future studies and enhance prevention strategies.

AIM

To comprehensively review the current state of research on PLGC, examining development trends and research hotspots.

METHODS

We conducted a bibliometric analysis of PLGC-related studies published between 2004 and 2023 using the Web of Science Core Collection database. We employed Software, including VOSviewer, CiteSpace, R software, and SCImago Graphica, to map scientific networks and visualize knowledge trends in terms of publication volume, countries/regions, institutions, journals, authors, and keywords.

RESULTS

A total of 4097 articles were included, and overall publication volume showed an increasing trend. Over the past two decades, China published the most articles, followed by the United States, Japan, South Korea, and Italy. Among the top 10 contributors, the United States ranked highest in institutions, authors, and citations and demonstrated the strongest international collaboration. Research keywords in this field were clustered into three main categories: Risk factors, pathogenesis, and diagnosis and treatment. Pathogenesis and molecular biomarkers remain key areas of focus. Future research should explore the mechanisms of gut microbiota, immune microenvironment, metabolic reprogramming, and epigenetics. Advanced technologies, including single-cell sequencing, spatially resolved analysis, multi-omics approaches, artificial intelligence, and machine learning, will likely accelerate in-depth investigations of PLGC.

CONCLUSION

PLGC research has rapidly developed in recent years, gaining considerable attention. This bibliometric analysis reveals research state and emerging trends over the past 20 years, providing insights for future studies.

Effect of computer aided detection system on esophageal neoplasm diagnosis in varied levels of endoscopists

A computer-aided detection (CAD) system for early esophagus carcinoma identification during endoscopy with narrow-band imaging (NBI) was evaluated in a large-scale, prospective, tandem, randomized controlled trial to assess its effectiveness. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2100050654, 2021/09/01). Involving 3400 patients were randomly assigned to either routine (routine-first) or CAD-assisted (CAD-first) NBI endoscopy, followed by the other procedure, with targeted biopsies taken at the end of the second examination. The primary outcome was the diagnosis of 1 or more neoplastic lesion of esophagus during the first examination. The CAD-first group demonstrated a significantly higher neoplastic lesion detection rate (3.12%) compared to the routine-first group (1.59%) with a relative detection ratio of 1.96 (P = 0.0047). Subgroup analysis revealed a higher detection rate in junior endoscopists using CAD-first, while no significant difference was observed for senior endoscopists. The CAD system significantly improved esophageal neoplasm detection, particularly benefiting junior endoscopists.

Material Design, Fabrication Strategies, and the Development of Multifunctional Hydrogel Composites Dressings for Skin Wound Management

The skin is fragile, making it very vulnerable to damage and injury. Untreated skin wounds can pose a serious threat to human health. Three-dimensional polymer network hydrogels have broad application prospects in skin wound dressings due to their unique properties and structure. The therapeutic effect of traditional hydrogels is limited, while multifunctional composite hydrogels show greater potential. Multifunctional hydrogels can regulate wound moisture through formula adjustment. Moreover, hydrogels can be combined with bioactive ingredients to improve their performance in wound healing applications. Stimulus-responsive hydrogels can respond specifically to the wound environment and meet the needs of different wound healing stages. This review summarizes the material types, structure, properties, design considerations, and formulation strategies for multifunctional hydrogel composite dressings used in wound healing. We discuss various types of recently developed hydrogel dressings, highlights the importance of tailoring their physicochemical properties, and addresses potential challenges in preparing multifunctional hydrogel wound dressings.

Current Role of Artificial Intelligence in the Management of Esophageal Cancer

Background/Objectives: Esophageal cancer (EC) represents a major global contributor to cancer-related mortality. The advent of artificial intelligence (AI), including machine learning, deep learning, and radiomics, holds promise for enhancing treatment decisions and predicting outcomes. The aim of this review is to present an overview of the current landscape and future perspectives of AI in the management of EC. Methods: A literature search was performed on MEDLINE using the following keywords: "Artificial Intelligence", "Esophageal cancer", "Barrett's esophagus", "Esophageal Adenocarcinoma", and "Esophageal Squamous cell carcinoma". All titles and abstracts were screened; the results included 41 studies. Results: Over the past five years, the number of studies focusing on the application of AI to the treatment and prognosis of EC has surged, leveraging increasingly larger datasets with external validation. The simultaneous incorporation in AI models of clinical factors and features from several imaging modalities displays improved predictive performance, which may enhance patient outcomes, based on direct personalized therapeutic options. However, clinicians and researchers must address existing limitations, conduct randomized controlled trials, and consider the ethical and legal aspects that arise to establish AI as a standard decision-support tool. Conclusions: AI applications may result in substantial advances in EC management, heralding a new era. Considering the complexity of EC as a clinical entity, the evolving potential of AI is anticipated to ameliorate patients' quality of life and survival rates.

Endoscopic management of complete colorectal anastomotic occlusion: Where do we stand?

We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology. In this article, the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes, one for radial electrical incision and the other serving as a guide light. However, this technique can be applied only in selected cases. Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction, by reviewing the available literature, we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.

The potential of Sijunzi decoction in the fight against gastrointestinal disorders: a review

Sijunzi Decoction (SJZD) is a traditional Chinese medicine formula widely used in the treatment of gastrointestinal disorders. Clinical studies have substantiated the efficacy of SJZD in managing conditions such as functional dyspepsia, chronic gastritis, gastric cancer, irritable bowel syndrome, colorectal cancer, and ulcerative colitis. Despite its proven effectiveness, the precise mechanisms by which SJZD operates remain incompletely understood. In this study, we undertake a systematic review of both the clinical applications and the mechanistic underpinnings of SJZD in the context of gastrointestinal disease treatment. Research indicates that SJZD functions through a spectrum of mechanisms including the regulation of intestinal flora, alleviation of inflammation, modulation of immune responses, and facilitation of mucosal repair in the treatment of gastrointestinal ailments. This comprehensive analysis aims to provide a clearer understanding of how SJZD benefits patients with gastrointestinal disorders.

Artificial Intelligence Applications in Image-Based Diagnosis of Early Esophageal and Gastric Neoplasms

Artificial intelligence (AI) holds the potential to transform the management of upper gastrointestinal (GI) conditions, such as Barrett's esophagus, esophageal squamous cell cancer, and early gastric cancer. Advancements in deep learning and convolutional neural networks offer improved diagnostic accuracy and reduced diagnostic variability across different clinical settings, particularly where human error or fatigue may impair diagnostic precision. Deep learning models have shown the potential to improve early cancer detection and lesion characterization, predict invasion depth, and delineate lesion margins with remarkable accuracy, all contributing to effective treatment planning. Several challenges, however, limit the broad application of AI in GI endoscopy, particularly in the upper GI tract. Subtle lesion morphology and restricted diversity in training datasets, which are often sourced from specialized centers, may constrain the generalizability of AI models in various clinical settings. Furthermore, the "black box" nature of some AI systems can impede explainability and clinician trust. To address these issues, efforts are underway to incorporate multimodal data, such as combining endoscopic and histopathologic imaging, to bolster model robustness and transparency. In the future, AI promises substantial advancements in automated real-time endoscopic guidance, personalized risk assessment, and optimized biopsy decision making. As it evolves, it would substantially impact not only early diagnosis and prognosis, but also the cost-effectiveness of managing upper GI diseases, ultimately leading to improved patient outcomes and more efficient health care delivery.

Subcutaneous implantation of tooth germ stem cells over the masseter muscle in mice: An in vivo pilot study

Objectives

This study aimed to explore the potential of tooth germ stem cells for regenerating tooth-like structures by subcutaneously implanting first molar tooth germ stem cells over the masseter muscle in mice.

Methods

Five pairs of house mice, Mus musculus, were selected for mating. At gestational day 14 (E14), the fetuses were extracted, and the first molar tooth germ at the cap stage was isolated. Tooth germ stem cells were prepared into a suspension and seeded onto scaffolds, which were then implanted subcutaneously over the masseter muscle in male mice. The control group (n = 5 male mice) received acellular scaffolds implanted at the same site. After 20 days, the regenerated tissues were resected and analyzed histologically using hematoxylin and eosin (H & E) staining, Masson's trichrome staining, and immunohistochemical (IHC) staining for cytokeratin (CK) and vimentin markers.

Results

H & E staining showed the formation of integrated oval structures at the implant site in all samples. Masson's trichrome staining identified dispersed accumulations of cellular mineralized matrix within the connective tissue. IHC staining was positive for vimentin, confirming the mesenchymal origin of the loose tissue at the center, indicating future dental pulp development. Positive CK staining indicated the ectodermal origin of dense peripheral tissues, suggesting the future formation of inner enamel epithelium. The combined immunohistochemical results for vimentin and CK confirmed the ecto-mesenchymal origin of the regenerated tissue, which resembled a late bell-stage tooth germ observed around gestational days 17.5-18 and showed early indications of dentin formation (D0).

Conclusion

The study indicates that tooth germ stem cells may have the potential to produce dense, tooth-like structures when implanted subcutaneously in mice. These findings provide preliminary insights into the possible applications of tooth germ stem cells in regenerative dental tissue engineering.

Effectiveness and safety of full-thickness versus circular muscle myotomy in peroral endoscopic myotomy: a retrospective single-center analysis of 152 patients

BACKGROUND

Achalasia is a primary esophageal motility disorder, which shows impaired relaxation of the lower esophageal sphincter (LES) and the absence of peristalsis, leading to dysphagia, weight loss, and chest pain. In recent years, peroral endoscopic myotomy (POEM) has become a popular method for treating achalasia. However, the effectiveness and safety of full-thickness myotomy (FTM) versus circular muscle myotomy (CMM) in POEM require further investigation.

METHODS

This retrospective single-center analysis studied 152 patients who underwent POEM surgery at the General Hospital of the Western Theater Command from May 2014 to May 2023. Patients were divided into two groups based on the depth of myotomy: the FTM group and the CMM group. Parameters such as surgical success rate, procedure time, and myotomy length were evaluated, and treatment efficacy was assessed based on the Eckardt score. Postoperative complications and efficacy were also monitored.

RESULTS

Technical success was achieved in both groups, with shorter procedure times in the FTM group (P < 0.05). There were no significant differences in postoperative Eckardt scores and symptom improvement between the FTM and CMM groups. The incidence of adverse events was similar in both groups. The incidence of gastroesophageal reflux disease (GERD) seemed to be higher in the FTM group, although this difference was not statistically significant (P = 0.051).

CONCLUSION

For patients with achalasia, there were no significant differences in short-to-medium-term treatment efficacy and safety between FTM and CMM in POEM. Although FTM significantly reduced procedure time, it may lead to a higher incidence of GERD. More cases are needed in the future to explore the more appropriate myotomy for different achalasia subtypes.

Double-Dynamic-Bond Cross-Linked Hydrogel Adhesive with Cohesion-Adhesion Enhancement for Emergency Tissue Closure and Infected Wound Healing

The hydrogel adhesives with strong tissue adhesion and biological characteristics are urgently needed for injury sealing and tissue repair. However, the negative correlation between tissue adhesion and the mechanical strength poses a challenge for their practical application. Herein, a bio-inspired cohesive enhancement strategy is developed to prepare the hydrogel adhesive with simultaneously enhanced mechanical strength and tissue adhesion. The double cross-linked network is achieved through the cooperation between polyacrylic acid grafted with N-hydroxy succinimide crosslinked by tannic acid and cohesion-enhanced ion crosslinking of sodium alginate and Ca2+. Such a unique structure endows the resultant hydrogel adhesive with excellent tissue adhesion strength and mechanical strength. The hydrogel adhesive is capable of sealing various organs in vitro, and exhibits satisfactory on-demand removability, antibacterial, and antioxidant properties. As a proof of concept, the hydrogel adhesive not only effectively halts non-compressible hemorrhages of beating heart and femoral artery injury models in rats, but also accelerates the healing of infected wound by inhibiting bacteria and reducing inflammation. Overall, this advanced hydrogel adhesive is promising as an emergency rescue adhesive that enables robust tissue closure, timely controlling bleeding, and promoting damaged tissue healing.

A new endoscopic tumor grading for rectal neuroendocrine tumors: Correlation of vascular pattern with histopathology

INTRODUCTION

The clinical utility of applying endoscopic vascular patterns in rectal neuroendocrine tumor (NET) remains unknown. The aims of this study were to develop a system for utilizing vascular patterns for tumor grade and submucosal invasion depth.

METHODS

We retrospectively included patients diagnosed as well-differentiated rectal NET between March 2015 and February 2024. The entire dataset was divided into evaluation and validation sets. In the evaluation set, the relationship between endoscopic tumor features and tumor grade was explored using a multivariable regression model. Based on the endoscopic vessel characteristics, vascular patterns were established and classified into V1 and V2 types. In the validation set, 104 lesions were used to assess the diagnostic performance of the vascular patterns.

RESULTS

Multivariate analysis demonstrated good association between tumor grade and vascular pattern (13.65 odds ratio; 95 % confidence interval, 2.06-90.58). Vascular patterns exhibited almost perfect inter- and intra-observer agreement (kappa = 0.957). The sensitivity, positive predictive value and accuracy of V1 for predicting grade 1 were 94.5 %, 97.7 and 93.3 %, respectively. Histopathological analysis revealed significantly deeper submucosal invasion depth for V2 than that for V1 lesions (p < 0.001).

CONCLUSIONS

Vascular patterns can help identify tumor grade and assess submucosal invasion depth.

Development of Deep Learning-Based Virtual Lugol Chromoendoscopy for Superficial Esophageal Squamous Cell Carcinoma

BACKGROUND

Lugol chromoendoscopy has been shown to increase the sensitivity of detection of esophageal squamous cell carcinoma (ESCC). We aimed to develop a deep learning-based virtual lugol chromoendoscopy (V-LCE) method.

METHODS

We developed still V-LCE images for superficial ESCC using a cycle-consistent generative adversarial network (CycleGAN). Six endoscopists graded the detection and margins of ESCCs using white-light endoscopy (WLE), real lugol chromoendoscopy (R-LCE), and V-LCE on a five-point scale ranging from 1 (poor) to 5 (excellent). We also calculated and compared the color differences between cancerous and non-cancerous areas using WLE, R-LCE, and V-LCE.

RESULTS

Scores for the detection and margins were significantly higher with R-LCE than V-LCE (detection, 4.7 vs. 3.8, respectively; p < 0.001; margins, 4.3 vs. 3.0, respectively; p < 0.001). There were nonsignificant trends towards higher scores with V-LCE than WLE (detection, 3.8 vs. 3.3, respectively; p = 0.089; margins, 3.0 vs. 2.7, respectively; p = 0.130). Color differences were significantly greater with V-LCE than WLE (p < 0.001) and with R-LCE than V-LCE (p < 0.001) (39.6 with R-LCE, 29.6 with V-LCE, and 18.3 with WLE).

CONCLUSIONS

Our V-LCE has a middle performance between R-LCE and WLE in terms of lesion detection, margin, and color difference. It suggests that V-LCE potentially improves the endoscopic diagnosis of superficial ESCC.

What Do We Know About Capsicum Volatilome?

The Capsicum genus includes several cultivated species that release complex blends of volatile organic compounds (VOCs) associated with their unique aroma. These VOCs are essential info-chemicals in ecological interactions. In this review, we describe how the volatilomic profiling naturally varies based on specific plant organs and genotypes as well as how non-beneficial organisms affect VOCs biosynthesis and accumulation in pepper plants. Also, we show evidence about VOCs variation under the pressure of different abiotic factors such as water stress, soil type and nutrient availability. The contribution of specific metabolic pathways and gene expression related to the biosynthesis of particular VOCs is addressed. We highlighted the utility of VOCs as chemical markers for quality control in the food industry, breeding programs to generate resistant plants and to improve aroma innovation. Herein we present a database containing 2734 VOCs, revealing 113 as the basic core of the volatilome from five Capsicum species.

Assessment of Helicobacter pylori infection in Lebanon: Endoscopic and histopathological findings

Helicobacter pylori (H. pylori), a pervasive pathobiont, colonizes the gastric mucosa and plays a crucial role in the pathogenesis of several gastroduodenal pathologies ranging from chronic gastritis to more severe disorders including peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. In symptomatic patients, endoscopy and histological examination of the gastric mucosa are the preferred tests for diagnosing H. pylori. Our study aimed to identify the frequency of H. pylori and its association with endoscopic and histopathological findings in adult Lebanese patients. Thus, 332 symptomatic adult patients, attending the Endoscopy unit of Makassed General Hospital in Beirut, were enrolled in this cross-sectional study. Overall, 14.16 % of the patients were infected with H. pylori, with male predominance. The most common endoscopic findings were gastritis and gastropathy. Moreover, H. pylori infection was significantly associated with gastric ulcers and duodenitis. On the other hand, active gastritis and chronic gastritis were the most common histopathological findings. Chronic gastritis was more frequent in H. pylori-positive patients. The association between endoscopic diagnosis and histopathological findings was then assessed. It was shown that gastropathy was significantly associated with chronic gastritis. In addition, gastric ulcer was significantly related to active gastritis and chronic gastritis. In conclusion, this study reported various endoscopic findings in H. pylori-positive patients based on the Kyoto classification. This highlights the importance of invasive diagnosis in symptomatic patients. Therefore, a combination-based approach including endoscopic and histopathological findings remains crucial in clinical practice for a definitive and accurate diagnosis of H. pylori infection and related disorders, especially in resource-limited settings.

Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial

BACKGROUND/AIMS

Small polyps are the most frequently detected lesions during colonoscopy, with an incomplete resection rate of 6.8% to 15.9%. This study aimed to improve small polyp cold snare resection radicality using submucosal contrast dye pre-lifting (PL+CSP).

METHODS

This single-center, prospective, randomized controlled trial compared the standard cold snare polypectomy technique (PL-CSP) with PL+CSP to evaluate endoscopic and histological complete resection rates, adverse events, procedural times, and polyp retrieval failure rates.

RESULTS

In 143 patients consecutively enrolled, 186 small polyps were detected and randomly assigned following a 1:1 ratio to the PL-CSP (n=97, 51.6%) and PL+CSP (n=90, 48.4%) techniques. Endoscopic (p=0.97) and histologic (p=0.23) complete resection rates did not differ significantly even in univariate analysis. The intraprocedural bleeding rate was significantly higher in the PL+CSP group as confirmed by the univariate analysis (35.8% vs. 8.3%, p<0.001). The polyps retrieval failure rates were similar (p=0.83). Procedural time was significantly longer for PL+CSP (median time, 75 vs. 45 seconds; p<0.001), without impacting colonoscopy withdrawal time (p=0.215).

CONCLUSIONS

PL+CSP of small polyps did not improve endoscopic and histological complete resection rates and polyp sample retrieval. PL+CSP had higher rates of intraprocedural bleeding and was "time-consuming".

Innate Immunity in Helicobacter pylori Infection and Gastric Oncogenesis

Helicobacter pylori is an extremely common cause of gastritis that can lead to gastric adenocarcinoma over time. Approximately half of the world's population is infected with H. pylori, making gastric cancer the fourth leading cause of cancer-related deaths worldwide. Innate immunity significantly contributes to systemic and local immune responses, maintains homeostasis, and serves as the vital link to adaptive immunity, and in doing so, mediates H. pylori infection outcomes and consequent cancer risk and development. The gastric innate immune system, composed of gastric epithelial and myeloid cells, is uniquely challenged by its need to interact simultaneously and precisely with commensal microbiota, exogenous pathogens, ingested substances, and endogenous exfoliated cells. Additionally, innate immunity can be detrimental by promoting chronic infection and fibrosis, creating an environment conducive to tumor development. This review summarizes and discusses the complex role of innate immunity in H. pylori infection and subsequent gastric oncogenesis, and in doing so, provides insights into how these pathways can be exploited to improve prevention and treatment.

Randomized controlled trial of an artificial intelligence diagnostic system for the detection of esophageal squamous cell carcinoma in clinical practice

BACKGROUND

Artificial intelligence (AI) has made remarkable progress in image recognition using deep learning systems. It has been used to detect esophageal squamous cell carcinoma (ESCC); however, none of the previous reports were investigations in a clinical setting, being retrospective in design. We therefore conducted this trial to determine how AI can help endoscopists detect ESCC in a clinical setting.

METHODS

This was a prospective, single-center, exploratory, and randomized controlled trial. High risk patients with ESCC undergoing screening or surveillance esophagogastroduodenoscopy were enrolled and randomly assigned to either the AI or control groups. In the AI group, the endoscopists watched both the AI monitor that detected ESCC with annotation and the normal monitor simultaneously; in the control group, the endoscopists watched only the normal monitor. In both groups, the endoscopists observed the esophagus using white-light imaging (WLI), followed by narrow-band imaging (NBI), then iodine staining. The primary end point was the enhanced detection rate of ESCC by nonexperts using AI. The detection rate was defined as the ratio of WLI/NBI-detected ESCCs to all ESCCs detected by iodine staining.

RESULTS

320 patients were included in the analysis. The detection rate of ESCC among nonexperts was 47% in the AI group and 45% in the control group (P = 0.93), with no significant difference, which was similarly found for experts (87% vs. 57%; P = 0.20) and all endoscopists (57% vs. 50%; P = 0.70).

CONCLUSIONS

This study could not demonstrate an improvement in the esophageal cancer detection rate using the AI diagnostic support system for ESCC.

Targeted animal models for preclinical assessment of cellular and gene therapies in pancreatic and liver diseases: regulatory and practical insights

Cellular and gene therapy (CGT) products have emerged as a popular approach in regenerative medicine, showing promise in treating various pancreatic and liver diseases in numerous clinical trials. Before these therapies can be tested in human clinical trials, it is essential to evaluate their safety and efficacy in relevant animal models. Such preclinical testing is often required to obtain regulatory approval for investigational new drugs. However, there is a lack of detailed guidance on selecting appropriate animal models for CGT therapies targeting specific pancreatic and liver conditions, such as pancreatitis and chronic liver diseases. In this review, the gastrointestinal committee for the International Society for Cell and Gene Therapy provides a summary of current recommendations for animal species and disease model selection, as outlined by the US Food and Drug Administration, with references to EU EMA and Japan PMDA. We discuss a range of small and large animal models, as well as humanized models, that are suitable for preclinical testing of CGT products aimed at treating pancreatic and liver diseases. For each model, we cover the associated pathophysiology, commonly used metrics for assessing disease status, the pros and limitations of the models, and the relevance of these models to human conditions. We also summarize the use and application of humanized mouse and other animal models in evaluating the safety and efficacy of CGT products. This review aims to provide comprehensive guidance for selecting appropriate animal species and models to help bridge the gap between the preclinical research and clinical trials using CGT therapies for specific pancreatic and liver diseases.

Multiple primary cancers with gastrointestinal malignant tumors as the first manifestation: Three case reports and review of literature

BACKGROUND

The incidence of malignant gastrointestinal (GI) tumors is increasing, and advancements in medical care have significantly improved patient survival rates. As a result, the number of cases involving multiple primary cancers (MPC) has also increased. The rarity of MPC and the absence of sensitive and specific diagnostic markers often lead to missed or incorrect diagnoses. It is, therefore, of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease. Patients with GI malignancies face a higher relative risk of developing additional primary malignant tumors compared to those with other systemic tumors. Vigilant monitoring and follow-up are crucial, especially for high-risk groups, which include older adults, men, those with addictions to alcohol and tobacco, those with a family history of tumors, and those who have undergone radiotherapy.

CASE SUMMARY

In this article, we report three cases of MPC, each involving malignant tumors of the GI tract as the initial primary carcinoma, offering insights that may aid in effectively managing similar cases.

CONCLUSION

Patients with GI malignancies face a higher MPC risk. Developing screening and follow-up protocols may enhance detection and treatment outcomes.

Deciphering Precursor Cell Dynamics in Esophageal Preneoplasia via Genetic Barcoding and Single-Cell Transcriptomics

Cancer cells exhibit high heterogeneity and lineage plasticity, complicating studies of tumorigenesis and development of therapies. Recently, preneoplastic cells, although histologically normal, have been shown to possess high plasticity and early genetic alterations, yet their origins and lineage trajectories remain unclear. Herein, we introduce a lineage-tracing tool integrating genetic barcoding with single-cell RNA sequencing to map preneoplastic esophageal cell lineages. We identified preneoplastic precursor cells (PNPCs) as a distinct progenitor-like population with unique transcriptional profiles and high plasticity, contributing to proliferative and basal cell populations. To enhance lineage mapping, we developed the eXamined Ridge (XR) score, accurately identifying high-plasticity cells. Nfib and Qk emerged as conserved PNPC markers, peaking in early preneoplasia and declining after malignant transformation. These findings reveal PNPCs as key players in early tumorigenesis and highlight their potential as biomarkers for early cancer detection and therapeutic intervention, offering new strategies for preventing esophageal cancer progression.

Artificial intelligence in endoscopic diagnosis of esophageal squamous cell carcinoma and precancerous lesions

Esophageal squamous cell carcinoma (ESCC) poses a significant global health challenge, necessitating early detection, timely diagnosis, and prompt treatment to improve patient outcomes. Endoscopic examination plays a pivotal role in this regard. However, despite the availability of various endoscopic techniques, certain limitations can result in missed or misdiagnosed ESCCs. Currently, artificial intelligence (AI)-assisted endoscopic diagnosis has made significant strides in addressing these limitations and improving the diagnosis of ESCC and precancerous lesions. In this review, we provide an overview of the current state of AI applications for endoscopic diagnosis of ESCC and precancerous lesions in aspects including lesion characterization, margin delineation, invasion depth estimation, and microvascular subtype classification. Furthermore, we offer insights into the future direction of this field, highlighting potential advancements that can lead to more accurate diagnoses and ultimately better prognoses for patients.

Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review

Although endoscopic resection (ER) is recommended as first-choice treatment for early esophageal neoplasia, patients with esophageal varices are considered a high-risk group owing to an increased risk of bleeding. This systematic review aimed to evaluate the effectiveness and safety of ER in this specific patient category.We searched for studies reporting on clinical outcomes of ER in the presence of esophageal varices, irrespective of study design or follow-up time. End points included the incidence of prophylactic measures to reduce the risk of variceal hemorrhage, radical and curative resection rates, and adverse events.After screening 2371 studies, 42 studies (including our own unpublished cohort) with a total of 186 patients were included in this systematic review. Endoscopic band ligation (72/186; 39%) and endoscopic injection sclerotherapy (22/186; 12%) were the prophylactic measures most widely adopted to eradicate varices prior to ER. Other frequently described prophylactic measures included direct varix coagulation during ER (18/186; 10%) and the placement of a transjugular intrahepatic portosystemic shunt prior to ER (9/186; 5%). While the radical and curative resection rates were high (86% and 72%, respectively), the periprocedural and delayed bleeding risks were reported to be relatively low (6% and 3%, respectively). In all studies, no procedure-related mortality was observed.ER appeared to be a safe and effective treatment option in selected patients with concurrent early esophageal neoplasia and esophageal varices, provided that a tailored approach of adequate prophylactic measures to prevent bleeding is applied.

Unveiling SSR4: a promising biomarker in esophageal squamous cell carcinoma

Background

Esophageal squamous cell carcinoma (ESCC) represents a frequent cancer with a poor prognosis. Altered glucose metabolism contributes factor to ESCC progression. In our previous study, signal sequence receptor subunit delta (SSR4) was included in an ESCC prognostic model; however, the mechanisms underlying SSR4 implication in ESCC remain ambiguous. Accordingly, we aim to determine the interconnection between SSR4 expression and clinical characteristics of ESCC.

Methods

This differential expression and prognostic significance of SSR4 was performed using bulk RNA-seq data and 110 patients with complete follow-up information. The ESCC cell subsets with the highest gene expression levels were identified with single-cell data. Gene function and enrichment, immune infiltration, cell communication, and molecular docking analyses were performed.

Results

Unlike adjacent non-cancerous tissues, SSR4 was overexpressed in ESCC tissues, validated by both reverse transcription-qPCR and IHC staining. SSR4 expression was related to the N stage, lymph node metastasis, and AJCC TNM classification stage. Patients exhibiting low SSR4 expression had a more favorable prognosis. The highest SSR4 expression was recognized in tumor plasma cells. Continued exploration of immune infiltration highlighted a close association between SSR4 gene expression and the infiltration of immune cells such as plasma cells. On dividing cells into SSR4-positive and -negative groups, CellChat analysis indicated that SSR4 may regulate the interactions that existed between ESCC tumor plasma cells and the tumor microenvironment (TME) by modulating the MIF/CD74/CXCR4 axis.

Conclusion

The SSR4 gene may have significant relevance with clinical pathological factors, and play a critical role in the regulation of tumor microenvironment of ESCC patients. Overall, SSR4 may be a promising ESCC biomarker with prospective applicability in clinical diagnosis as well as the development of targeted treatment approaches in patients of ESCC.

Exploring the Therapeutic Potential of Medicinal Plants in the Context of Gastrointestinal Health: A Review

Medicinal plants represent promising sources for the treatment of gastrointestinal disorders because of their abundance in bioactive compounds with therapeutic properties. Throughout history, various plant species have been used to alleviate digestive ailments, and studies have revealed the presence of metabolites with anti-inflammatory, antibacterial, antiviral, antiparasitic, antidiarrheal, antioxidant, and anticancer activities. The secondary metabolites responsible for these properties include alkaloids, terpenoids, and phenolic compounds, with the latter, particularly flavonoids, being the most associated with their bioactivities. Gastrointestinal diseases, such as gastritis, peptic ulcers, gastroesophageal reflux disease, inflammatory bowel disease, irritable bowel syndrome, and gastrointestinal cancer, are caused primarily by bacteria, parasites, viruses, and the consumption of raw or undercooked foods. These conditions significantly impact human health, necessitating the development of safer and more effective therapeutic alternatives. After an extensive literature review, several plant species with widespread use in the treatment of these disorders were identified, including Matricaria chamomilla, Mentha spicata, Melissa officinalis, Artemisia ludoviciana, Flourensia cernua, Phoradendron californicum, and Turnera difusa. This study revealed that the analyzed plants are rich in bioactive compounds, which confer their medicinal properties. However, many other plants commonly used to treat digestive disorders have been scarcely studied, highlighting the need for further research.

Deep-learning-ready RGB-depth images of seedling development

In the era of machine learning-driven plant imaging, the production of annotated datasets is a very important contribution. In this data paper, a unique annotated dataset of seedling emergence kinetics is proposed. It is composed of almost 70,000 RGB-depth frames and more than 700,000 plant annotations. The dataset is shown valuable for training deep learning models and performing high-throughput phenotyping by imaging. The ability of such models to generalize to several species and outperform the state-of-the-art owing to the delivered dataset is demonstrated. We also discuss how this dataset raises new questions in plant phenotyping.

Helicobacter pylori SlyD stabilizes TPT1 via hnRNPK and enhances OCT1-mediated CDX2 transcriptional activation to drive gastric intestinal metaplasia

BACKGROUND

Gastric intestinal metaplasia (GIM) represents an important precancerous lesion in intestinal-type gastric cancer, triggered by persistent Helicobacter pylori (H. pylori) infection. In a previous study, we unveiled SlyD as a novel virulence factor of H. pylori, establishing its role in GIM induction through TPT1. However, the underlying mechanism remains undetermined.

METHODS

Gastric epithelial cells were stimulated with H. pylori 26695, a SlyD inactivated mutant (ΔSlyD), and purified HpSlyD protein, respectively. Real-time qPCR and western blot were subsequently used to assess the expression levels of hnRNPK, TPT1, OCT1, and GIM markers. RNA sequencing was employed to identify differentially expressed genes associated with H. pylori SlyD infection. Protein stability was evaluated using cycloheximide. Molecular interactions were investigated through co-immunoprecipitation, chromatin immunoprecipitation, and dual-luciferase reporter assays. Additionally, molecular docking was utilized to predict TPT1 inhibitors. Immunohistochemistry staining was conducted to validate hnRNPK, TPT1, OCT1, and CDX2 expression in gastric tissue samples from both human and Mongolian gerbils.

RESULTS

H. pylori SlyD upregulates TPT1 and induces the expression of GIM markers through hnRNPK. The interaction between hnRNPK and TPT1 enhances TPT1 protein stability, with H. pylori SlyD intensifying this association. TPT1 promotes the expression of GIM markers mediated via OCT1, which binds to CDX2 promoter region, thereby modulating its transcriptional activity. Dihydroartemisinin has the potential to target TPT1, inhibiting the H. pylori SlyD-induced expression of GIM markers.

CONCLUSIONS

In vitro and in vivo experiments verified that H. pylori SlyD enhances TPT1 stability through hnRNPK, leading to OCT1-mediated transcriptional activation of CDX2 and the initiation of the GIM process. Our study offers novel perspectives on the pathogenesis of H. pylori-related gastric precancerous conditions.

Novel device for blunt dissection in third space endoscopy: Preliminary animal study (with video)

Background and study aims

Blunt dissection is not commonly performed in flexible endoscopic procedures. We developed a novel blunt dissection device and evaluated its feasibility, safety, and potential effectiveness in third space endoscopy procedures.

Materials and methods

The device consists of a cotton swab and a flexible shaft. To evaluate its functionality, creation of 4-cm submucosal tunnels in live swine stomachs was attempted by either blunt dissection using our device or sharp dissection using a standard monopolar knife. Data on factors such as completion rate, operating time, adverse events, necessity of submucosal injection, and dissected submucosal thickness were collected.

Results

Eighteen submucosal tunnels were successfully created (sharp: 9, blunt: 9) by two experienced endoscopists and one novice endoscopist. Median operating time was significantly shorter in the blunt dissection group (239 vs. 429 s, P = 0.008). In the sharp dissection group, the experienced endoscopists did not cause any muscle layer injuries, but the novice endoscopist caused muscle layer injuries in all cases. In the blunt dissection group, neither experienced nor novice endoscopists caused muscle layer injuries. The blunt dissection group required significantly fewer submucosal injections (0 vs. 5, P < 0.001). Median dissected submucosal thickness was similar between the groups.

Conclusions

Blunt dissection using our device was feasible, safe, and potentially effective in third space endoscopy procedures by shortening operating time, reducing submucosal injections, and potentially minimizing muscle layer injury.