Management of hepatic encephalopathy following transjugular intrahepatic portosystemic shunts: Current strategies and future directions

Transjugular intrahepatic portosystemic shunts (TIPSs) are generally used for the management of complications of portal hypertension in patients with decompensated cirrhosis. However, hepatic encephalopathy (HE), which impairs neuropsychiatric function and motor control, remains the primary adverse effect of TIPS, limiting its utility. Prompt prevention and treatment of post-TIPS HE are critical, as they are strongly associated with readmission rates and poor quality of life. This review focuses on the main pathophysiological mechanisms underlying post-TIPS HE, explores advanced biomarkers and predictive tools, and discusses current management strategies and future directions to prevent or reverse HE following TIPS. These strategies include preoperative patient assessment, individualized shunt diameter optimization, spontaneous portosystemic shunt embolization during the TIPS procedure, postoperative preventive and therapeutic measures such as nutrition management, medical therapy, fecal microbiota transplantation, and stent reduction.

Arachidonate 15-lipoxygenase: A promising therapeutic target for alleviating inflammation in acute pancreatitis

This article discusses the significant findings from the study on the transfection of arachidonate 15-lipoxygenase (ALOX15) and its therapeutic potential in managing acute pancreatitis (AP). The research highlights the role of ALOX15 in attenuating inflammatory responses, apoptosis, and autophagy in a cerulein-induced AP murine model. By using a recombinant lentiviral vector for efficient gene delivery, the study provides compelling evidence for the protective effects of ALOX15 transfection on pancreatic tissue. The authors demonstrate that ALOX15 reduces the expression of key inflammatory markers like interleukin-β and tumor necrosis factor α while promoting apoptosis through caspase-3 activation. Furthermore, the modulation of autophagy and structural preservation of pancreatic acinar cells suggest that ALOX15 could be a promising therapeutic target for AP. The implications of these findings are discussed, emphasizing the potential for future clinical translation and further research to explore the molecular mechanisms and therapeutic applications of ALOX15 in inflammatory diseases.

Readmission Events Following EGD for Upper Gastrointestinal Bleed: An Analysis Using the National Readmission Database

Background: Upper Gastrointestinal Bleed (UGIB) is a common and potentially life-threatening condition with an annual incidence of 80-150 per 100,000 individuals and a mortality rate of 2-10%. Esophagogastroduodenoscopy (EGD) is the gold standard for both diagnosis and treatment, but post-discharge outcomes, including readmissions, remain underexplored. Methods: This study utilized the 2021 National Readmission Database (NRD) to analyze 30-day readmission rates following EGD for UGIB. Adult patients (≥18 years) admitted for UGIB and undergoing EGD were included; those who died during the index hospitalization were excluded. Demographic, clinical, and socioeconomic factors associated with readmission were examined using multivariate logistic regression. Results: Among 34,257 patients admitted for UGIB and undergoing EGD, 11,088 (32.4%) were readmitted within 30 days, with 5423 (49%) due to recurrent UGIB. Readmitted patients had a higher mean age (68.46 vs. 67.63 years) and greater prevalence of cirrhosis (16.71% vs. 13.84%). Hospital resource utilization was significantly higher among readmissions, with increased total hospital charges (USD 82,544.82 vs. USD 61,521.17) and longer hospital stays (5.38 vs. 4.97 days). Mortality was lower among readmitted patients (1.46% vs. 3.53%). Multivariate analysis identified cirrhosis (OR 7.20, 95% CI: 6.45-8.02), untreated H. pylori infection (OR 3.43, 95% CI: 2.15-4.30), atrial fibrillation (OR 1.52, 95% CI: 1.36-1.69), and chronic antithrombotic therapy (OR 1.63, 95% CI: 1.41-1.89) as significant predictors of recurrent UGIB readmission. Lower socioeconomic status was also associated with increased readmission risk (OR 1.15, 95% CI: 1.05-1.25). Conclusions: Readmission following EGD for UGIB is common and driven primarily by recurrent bleeding. Cirrhosis, untreated H. pylori infection, atrial fibrillation, and chronic anticoagulation therapy are key risk factors. These findings highlight the need for targeted interventions, including improved post-discharge management and optimization of anticoagulation strategies, to reduce readmission rates and improve patient outcomes.

Proton pump inhibitors and the risk of gastric cancer: a systematic review, evidence synthesis and life course epidemiology perspective

OBJECTIVES

Since proton pump inhibitors (PPI) have been introduced, many concerns were raised regarding potential gastric carcinogenicity. We aim to summarise and weigh the epidemiological evidence and address possible causality.

DESIGN

Systematic literature review, evidence synthesis and life-course assessment.

DATA SOURCES

PubMed, Web of Science and Cochrane database (from inception up to October 2024), and back- and forward citation tracking (Web of Science).

ELIGIBILITY CRITERIA

Original studies and quantitative evidence syntheses assessing the association between PPIs and gastric cancer in humans, without language restrictions.

DATA EXTRACTION AND SYNTHESIS

Study design, definitions (and participant numbers) of PPI use and gastric cancer, study characteristics (setting, period, follow-up, lag-time), age and sex distribution presented in tables and evidence mapping.

RESULTS

We identified 33 original studies, 21 meta-analyses, three umbrella meta-analyses, one individual patient data meta-analysis and a Markov model (2006-2023). PPIs were consistently associated with an increased gastric cancer risk with 20/21 meta-analyses reporting pooled relative risks between 1.3 and 2.9. Available trials were underpowered. Reverse causation/protopathic bias, residual confounding (by indication) and lag time seem the largest methodological challenges, as well as disentangling the effects of Helicobacter pylori and its' eradication. Insufficient data are available on age and sex-specific risks, with no studies specifically addressing PPIs in young populations. We hypothesise a sensitive-period exposure model, in which PPI use during pregnancy and early life may be particularly damaging regarding long-term cancer risk. An exploration of Swedish cancer incidence data suggests potential cohort effects as overall gastric cancer risk decreased over time (1970-2022). The risk has increased in young (<40 years) men since the early 2000s, ~10 years after the introduction of Helicobacter pylori eradication and PPIs.

CONCLUSION

Although for older individuals with valid indications, the gastric cancer risk related to PPI use may be limited, we do argue for a more rational and evidence-supported use of PPIs in young populations.

Host-encoded DNA methyltransferases modify the epigenome and host tropism of invading phages

Restriction modification (RM) systems are ubiquitous bacterial defense systems; however, some phages evade RM system and adapt to their bacterial hosts. In such cases, phages are thought to stochastically acquire DNA methylation from host-encoded DNA methyltransferases (MTases), facilitating host adaptation. However, no studies have directly compared the methylomes of host bacteria and their infecting phages. Here, we demonstrate the epigenetic landscape of adapted phages with diverse infection histories, focusing on the broad host-range phage KHP30T as its adapts to three Helicobacter pylori strains. Using a multistage infection system, we observed that the adapted phages displayed significantly high titers against the last infected H. pylori strain, suggesting an attendant change in host tropism. Single-molecule real-time sequencing revealed that methylated motifs were predominantly shared between the adapted phages and their most recent host. Our findings enhance our understanding of epigenetic phage-host interactions, which have significant implications for microbial ecology.

The interplay between the myeloperoxidase-hypochlorous acid system, heme oxygenase, and free iron in inflammatory diseases

Accumulated unbound free iron (Fe(II or III)) is a redox engine generating reactive oxygen species (ROS) that promote oxidative stress and inflammation. Iron is implicated in diseases with free radical pathology including cardiovascular, neurodegenerative, reproductive disorders, and some types of cancer. While many studies focus on iron overload disorders, few explore the potential link between the myeloperoxidase-hypochlorous acid (MPO-HOCl) system and localized iron accumulation through heme and iron‑sulfur (FeS) cluster protein destruction. Although inducible heme oxygenase (HO-1), the rate-limiting enzyme in heme catabolism, is frequently associated with these diseases, we hypothesize that HOCl also contributes to the generation of free iron and heme degradation products. Furthermore, HO-1 and HOCl may play a dual role in free iron accumulation by regulating the activity of key iron metabolism proteins. Enzymatic and non-enzymatic modulators, as well as scavengers of HOCl, can help prevent heme destruction and reduce the accumulation of free iron. Given iron's role in disease progression and severity, identifying the primary sources, mechanisms, and mediators involved in free iron generation is crucial for developing effective pharmacological treatments. Further investigation focusing on the specific contributions of the MPO-HOCl system and free iron is necessary to explore novel strategies to mitigate its harmful effects in biological systems.

Association between an energy-adjusted inflammatory diet index and gastroesophageal reflux disease: a retrospective cohort study

PURPOSE

To examine and quantify the association between an inflammatory diet index and gastroesophageal reflux disease (GERD) utilizing extensive data from a large cohort.

METHODS

This study included eligible UK Biobank participants recruited between 2006 and 2010 who had no prior history of GERD and no missing data for key covariates. The primary outcome was incident GERD, identified using the "first occurrence" dataset. 27 eligible food/nutrient parameters derived from the 24-h recall questionnaires in the UK Biobank were included to calculate the energy-adjusted dietary inflammation index (E-DII) score. The E-DII score was employed as a continuous variable in restricted cubic spline regression (RCS) analysis. To facilitate analysis, participants were then categorized into four groups based on quartile values in the subsequent Cox regression analysis adjusting varying degrees of confounding factors.

RESULTS

After exclusion, 154,590 participants were included in the primary analysis. Over a mean 12.36-year follow-up, a total of 12, 041(7.79%) participants experienced GERD. The results of multivariable RCS showed that the risk of GERD had a slightly overall increased trend along with E-DII after adjusting the confounding factors. The cumulative incidence of GERD in the four groups was significantly different (P < 0.001) and participants in higher quartiles determined by E-DII had a higher GERD incidence. Results from both univariate and multivariate Cox regression consistently revealed the most pro-inflammatory E-DII group (i.e. the fourth quartile) had a significantly heightened risk of GERD compared to those in the first quartile (crude HR [95% CI] 1.118 [1.063-1.175]; fully adjusted HR [95% CI] 1.136 [1.079-1.196]). Subgroup analyses revealed variations across populations, while sensitivity analyses confirmed the robustness of primary findings.

CONCLUSIONS

The current study revealed that that adherence to a diet with high pro-inflammatory potential might be associated with higher GERD incidence and further randomized controlled trials are needed to provide more conclusive evidence.

Fatal Acute Intestinal Obstruction with Hemophagocytic Lymphohistiocytosis and Multiple Organ Failure in Adult-Onset Still's Disease: A Rare Case Report

Background

Adult-onset Still's disease (AOSD) is a systemic autoinflammatory disorder characterized by unpredictable multi-organ involvement. Although gastrointestinal complications are uncommon in AOSD, they can be life-threatening and present significant diagnostic and management challenges.

Case Summary

We report the case of a 68-year-old man with AOSD who developed acute intestinal obstruction, a rare and critical complication. Imaging revealed significant colonic wall thickening, with a maximum thickness of 2.6 cm on contrast-enhanced computed tomography. The clinical status of the patient deteriorated, further complicated by the onset of hemophagocytic lymphohistiocytosis (HLH) and multi-organ failure, including acute renal dysfunction. Despite receiving intensive care and aggressive treatment, including supportive measures and immunosuppressive therapy, the patient succumbed to his illness.

Conclusion

This case underscores the importance of recognizing rare gastrointestinal and systemic complications in patients with AOSD. Early identification and prompt multidisciplinary management of conditions such as HLH and acute intestinal obstruction are essential for improving outcomes in such critical scenarios.

Non-Invasive Tests as a Replacement for Liver Biopsy in the Assessment of MASLD

Metabolic dysfunction-associated steatotic fatty liver disease (MASLD) is a worsening global health issue, affecting over one-third of the adult population and representing the leading cause of liver-related morbidity and mortality. MASLD is not only a key precursor to chronic liver disease, but also a systemic condition that leads to numerous extrahepatic complications, increasing the risk of cardiovascular diseases, chronic kidney disease, type 2 diabetes, and certain cancers. The primary reference method for assessing liver fibrosis, allowing for precise determination of its location and severity, remains liver biopsy. However, it is an invasive procedure and involves certain risks. In recent years, the importance of MASLD diagnosis using noninvasive diagnostic methods has been increasing, including serological markers, methods based on multi-omics, and imaging techniques such as liver elastography. This review presents data on the diagnosis and evaluation of this disease that may find application in future clinical practice. The focus is on presenting both currently used and newly identified noninvasive diagnostic methods that open up the prospect of gradually replacing biopsy in the diagnosis of MASLD.

Environmental fate of antibiotic resistance genes in livestock farming

As emerging environmental pollutants, antibiotic resistance genes (ARGs) are prevalent in livestock farms and their surrounding environments. Although existing studies have focused on ARGs in specific environmental media, comprehensive research on ARGs within farming environments and their adjacent areas remains scarce. This review explores the sources, pollution status, and transmission pathways of ARGs from farms to the surrounding environment. Drawing on the "One Health" concept, it also discusses the potential risks of ARGs transmission from animals to human pathogens and the resulting impact on human health. Our findings suggest that the emergence of ARGs in livestock farming environments primarily results from intrinsic resistance and genetic mutations, while their spread is largely driven by horizontal gene transfer. The distribution of ARGs varies according to the type of resistance genes, seasonal changes, and the medium in which they are present. ARGs are disseminated into the surrounding environment via pathways such as manure application, wastewater discharge, and aerosol diffusion. They may be absorbed by humans, accumulating in the intestinal microbiota and subsequently affecting human health. The spread of ARGs is influenced by the interplay of microbial communities, antibiotics, heavy metals, emerging pollutants, and environmental factors. Additionally, we have outlined three control strategies: reducing the emergence of ARGs at the source, controlling their spread, and minimizing human exposure. This article provides a theoretical framework and scientific guidance for understanding the cross-media migration of microbial resistance in livestock farming environments.

Effects of Natural Polysaccharides on the Gut Microbiota Related to Human Metabolic Health

Natural polysaccharides (NPs) are sugar chains bound by glycosidic bonds that are composed of at least 10 monosaccharides and have broad biological activity. The human body microbiome is a complex ecosystem that plays a role in host metabolism, immunity, and other important life activities. Numerous studies have demonstrated an obvious relationship between the gut flora and the occurrence of many human diseases. Many studies have reviewed and investigated the effects of polysaccharides on the microbiome, but the underlying mechanisms remain unclear. Most of these studies have focused on the effects of NPs on microbes, as they are important "foods" for the intestinal flora. However, polysaccharides can also affect microbes by improving gut homeostasis. Therefore, the purpose of this review is to introduce recent research that looks at how NPs affect microbiomes by directly acting as fermentation substrates and enhancing gut homeostasis. In addition, this study provides a succinct summary of NP extraction, purification, and structural characteristics, as well as a discussion of their structure‒activity correlations. This study also sheds light on future directions and obstacles in the use of NPs with protective properties, with the aim of providing insights into their potential applications in disease treatment.

Optimizing stress ulcer prophylaxis practices and reducing associated costs in intensive care units: a non-randomized controlled study

Objective

This study evaluated the use of stress ulcer prophylaxis (SUP), assessed the costs associated with inappropriate use, and highlighted the impact of clinical pharmacists on improving adherence to the SUP guidelines.

Method

A prospective, non-randomized controlled study was carried out in two intensive care units (ICUs) of a training and research hospital between 1 June 2023 and 1 December 2023. Routine care services were provided for the observation group (OG) patients. In the guideline group (GG) patients, SUP management and routine care were performed according to ASHP guidelines. The physician and clinical pharmacist jointly evaluated the patients to determine the suitability of their SUP indications. Adherence rates to ASHP guidelines and the costs associated with nonadherence were evaluated.

Results

A total of 196 patients were included in the study: 121 in the OG and 75 in the GG. A total of 54.6% of the patients were male, and the reason for hospitalization was mainly surgery (52.6%). SUP use was higher in OG (100%) than in GG (42.6%) (p < 0.001). The indication rate according to the ASHP guidelines was significantly higher in the GG group (100%) than in the OG group (54.5%) (p < 0.001). Dosage form adherence was significantly lower in the OG (0%) than in the GG (100%) (p < 0.001). The costs associated with proton pump inhibitor use for inappropriate indications and incorrect dosage forms were $60 versus $0 (p < 0.001) and $321 versus $0 (p < 0.001) in OG and GG, respectively. Overall, cost savings of $327 were achieved in the GG group.

Conclusion

Inappropriate SUP use is common in the ICUs. Adequate adherence to guidelines and proactive involvement of clinical pharmacists may reduce inappropriate SUP in ICUs and the associated costs.

Impact of ultra-processed foods on human health: A comprehensive review of genomic instability and molecular mechanisms

In this review the nexus between genomic instability and human health is investigated, emphasizing the rising consumption of ultra-processed foods (UPFs). Introducing the NOVA food classification system, we explore the significant surge in UPF consumption over the past 3 decades and its correlation with heightened mortality rates. This exploration extends to the development of health issues such as obesity, cancer, type 2 diabetes, inflammatory bowel diseases, cardiovascular diseases, and depression. Existing evidence, including studies involving healthy adolescents and older adults, underscores a clear link between increased consumption of UPFs and heightened DNA damage. The primary objective of this review is to offer a comprehensive examination of the repercussions of elevated UPF consumption on human health. With a specific focus on unraveling the intricate relationship between these dietary choices and genomic instability, the review seeks to enhance our understanding. Through a targeted exploration of molecular pathways, the aim is to illuminate how dependence on UPFs may impact physical and mental well-being.

Harnessing the Activity of Lytic Bacteriophages to Foster the Sustainable Development Goals and the "One Health" Strategy

As bacteriophages (phages) are viruses that infect and destroy bacterial cells, they can be considered natural bactericides that can either directly or indirectly contribute to the achievement of the United Nations Sustainable Development Goals (UN SDGs) on health and well-being, food production and food security, as well as environmental protection and climate change mitigation, thus contributing to the success of the European "One Health" strategy to combat antimicrobial resistance in humans, animals, plants, and the environment. The biological activity of lytic bacteriophages can operate in the fields of microbiology and biotechnology for clinical, veterinary, agricultural, and industrial applications, among others, to achieve the proposed goals, mainly because the phages can help increase crop productivity by reducing bacterial diseases; constitute alternative therapies against infections caused by multidrug-resistant bacteria; can reduce populations of pathogenic bacteria that contaminate soil and water, therefore ensuring healthier and safer food production; and they can help reduce environmental pollution caused by the presence of agrochemicals and antibiotics. Phage-based therapies developed through research and innovation have the potential to promote greater global food security and health in a more environmentally friendly and eco-sustainable way.

Self-disassembling nanoparticles as oral nanotherapeutics targeting intestinal microenvironment

Inspired by the survival strategies of pyomelanin-producing microbes, we synthesize pyomelanin nanoparticles (PMNPs) from homogentisic acid- γ-lactone via auto-oxidation and investigate their biomedical potential. PMNPs possess distinct physicochemical properties, including reactive oxygen species scavenging and microenvironment-responsive self-disassembly. Under intestinal conditions, PMNPs self-disassemble and penetrate the nanoscale pores of the mucin layer. In an inflammatory bowel disease model, orally administered PMNPs withstand gastric acidity and, in their solubilized form, interact with macrophages and epithelial cells. They significantly reduce reactive oxygen species levels, exert anti-inflammatory effects, and restore gut microbiota composition. Compared to conventional nanoparticles and 5-aminosalicylic acid, PMNPs exhibit greater therapeutic efficacy. Clinical symptoms and intestinal inflammation are alleviated, and the gut microbiota is restored to near-normal levels. These findings underscore the therapeutic potential of PMNPs for inflammatory bowel disease treatment and suggest broader biomedical applications.

The assessment of thiol-disulfide homeostasis and ıschemia-modified albumin levels in patients with acromegaly

PURPOSE

Data regarding the relationship between acromegaly and oxidative stress (OS) remain limited. Dynamic thiol-disulfide homeostasis (TDH) is vital for antioxidant protection, and ischemia-modified albumin (IMA) serves as a marker of OS. This study aimed to measure serum TDH parameters and IMA levels in acromegaly patients, comparing them with healthy controls.

METHODS

This cross-sectional study consecutively included 81 patients and 55 controls, matched for age, gender, and body mass index. Serum levels of native thiol, total thiol, and disulfide (TDH parameters) were measured using the automated spectrophotometric method developed by Erel and Neselioglu, along with serum IMA levels.

RESULTS

In patients, serum native and total thiol levels were significantly lower (p = 0.005 and p = 0.007), while serum IMA levels were significantly higher (p = 0.001). Disulfide levels were similar. Patients with active disease (N = 32), patients in remission (N = 49), and controls (N = 55) were compared. In post-hoc analyses; serum TDH parameters and IMA levels were similar in remission and active disease patients. Native and total thiol levels were significantly lower in patients in remission compared to controls (p = 0.01 and p = 0.04). IMA levels were significantly higher in patients in remission compared to controls (p = 0.04). Serum thiol levels positively correlated with serum insulin-like growth factor-1 levels and negatively with age and disease duration, while age independently exerted a negative impact on serum thiol levels.

CONCLUSION

Our findings may indicate increased OS in the acromegalic process, which may contribute to the development of acromegaly and its related complications and comorbidities.

Assessment and Impact of Age on the Safety and Efficacy of Etrasimod in Patients With Ulcerative Colitis: A Post Hoc Analysis of Data From the ELEVATE UC Clinical Program

BACKGROUND

Patient age can impact the safety and efficacy of ulcerative colitis (UC) treatments. Etrasimod is an oral, once daily (QD), selective sphingosine 1-phosphate1,4,5 receptor modulator for the treatment of moderately to severely active UC. Here, we evaluate the impact of age on etrasimod safety and efficacy in patients with UC in the phase 3 ELEVATE UC clinical program.

METHODS

Data were pooled from ELEVATE UC 52 and ELEVATE UC 12 in patients receiving etrasimod 2 mg QD or placebo. Proportions and incidence rates (IRs) per 100 patient-years of treatment-emergent adverse events (AEs) were stratified by age (<40, 40-59, and ≥60 years). With the same age stratifications, efficacy was evaluated in patients with baseline Modified Mayo scores of 5-9 and 4-9 for the primary efficacy endpoint (clinical remission) and secondary efficacy endpoints.

RESULTS

Overall, 787 patients were enrolled (<40 years, n = 420 [53.4%]; 40-59 years, n = 276 [35.1%]; and ≥60 years, n = 91 [11.6%]). Arthralgia, fatigue, and hypertension IRs were higher in older patients, irrespective of treatment. Serious AEs and AEs leading to treatment discontinuation were low and consistent across age groups. Significantly more patients receiving etrasimod 2 mg QD vs placebo achieved efficacy endpoints, regardless of age.

CONCLUSIONS

The safety profile of etrasimod 2 mg QD in the ELEVATE UC population was consistent across age groups, with no change in the incidence of AEs. Patients receiving etrasimod vs placebo showed significant clinical benefit, regardless of age.

CLINICALTRIALS.GOV

NCT03945188; NCT03996369.

Diagnosis of small bowel inflammation using small bowel capsule endoscopy combined with abdominal CT scan

Background and study aims

Abdominal computed tomography (CT) scans are simple to perform and widely used in evaluating small bowel inflammation. However, detailed evaluation of small intestinal mucosa is difficult with CT. Conversely, small bowel capsule endoscopy (SBCE) is noninvasive and useful for evaluation of mucosal inflammation. We evaluated presence or absence of mucosal inflammation by SBCE in patients with CT findings of suspected small bowel inflammation and analyzed their backgrounds.

Patients and methods

The Lewis score was determined by SBCE, and scores ≥ 135 placed 65 patients in the enteritis group and scores of < 135 placed 87 patients in the pseudoenteritis group.

Results

Blood tests revealed higher C-reactive protein (CRP) levels in the enteritis group ( P < 0.01). Regarding comorbidities, chronic renal failure ( P < 0.01) and carcinoma ( P = 0.05) were more common in the enteritis group, as was use of proton pump inhibitors ( P = 0.02). Target sign, accordion sign, and fat stranding/centipede sign, which are known findings on CT of small intestinal inflammation, were more frequently observed in the enteritis group ( P < 0.01). Small intestinal wall thickness was greater in the enteritis group (5.3 mm vs 3.4 mm, P < 0.01) and the cut-off value was 4.15 mm.

Conclusions

Backgrounds of patients with inflammatory mucosa included high CRP, use of nonsteroidal anti-inflammatory medications, chronic renal failure, and cancer. If a patient with a thickened small intestinal wall (> 4.15 mm) on CT has these characteristics, it may be worth considering performing SBCE.

Chlorogenic acid alleviates the development of severe acute pancreatitis by inhibiting NLPR3 Inflammasome activation via Nrf2/HO-1 signaling

Severe acute pancreatitis (SAP), marked by profound tissue inflammation within the pancreatic tissue, is an abrupt and intense inflammation of the pancreas. Chlorogenic acid (CGA) is one of the effective pharmacological ingredients components in JinHong Tablet (JHT). The role of CGA in protecting pancreas from severe injury in pancreatitis needs to be studied. The intervention with CGA led to a significant decline in serum amylase and lipase levels in rats with SAP, concurrently mitigating the pathological impairment within the pancreatic tissue. CGA effectively diminishes the levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in SAP rats by inhibiting the activation of NF-κB and the NLRP3 inflammasome. Additionally, in AR42J cells, the application of CGA was found to reduce the inflammatory response induced by caerulein. Mechanically, CGA alleviates the inflammatory response in SAP models by activating the Nrf2/HO-1 pathway. Together, CGA reduces the inflammatory response of SAP by activating the Nrf2/HO-1 pathway, thus alleviating the development of SAP. Our results provide a basis for the treatment of SAP.

Capsaicin: pharmacological applications and prospects for drug designing

OBJECTIVES

A primary objective of this review is to summarize the evidence-based pharmacological applications of capsaicin, particularly its use to manage pain and treat various health conditions. A second goal of the review is to research how recent technological advances are improving the bioavailability and therapeutic index of capsaicin, as well as the development of novel capsaicin-mimetics that are able to enhance therapeutic responses in various human diseases.

METHODS

In the review, numerous human clinical trials and preclinical studies are examined to determine how effective, safe, and optimal dosages of capsaicin can be used in pain management and therapeutic applications. Furthermore, it discusses capsaicin's mechanisms of action, specifically its interactions with the transient receptor potential vanilloid 1 (TRPV1) channel. As a result of this review, the potential of nanotechnology systems for bypassing the limits of capsaicin's pungency is discussed. The review takes into account individual factors such as pain tolerance and skin sensitivity.

KEY FINDINGS

For topical applications, capsaicin is typically used in concentrations ranging from 0.025% to 0.1%, with higher concentrations being used under medical supervision for neuropathic pain. The formulation can come in the form of creams, gels, or patches, which provide sustained release over the course of time. A condition such as arthritis or neuropathy can be relieved with capsaicin as it depletes substance P from nerves. Neuropathy and osteoarthritis as well as musculoskeletal disorders have been treated successfully with this herbal medicine. A major mechanism through which capsaicin relieves pain is through activating TRPV1 channels, which induce calcium influx and neurotransmitter release. Additionally, it affects the transcription of genes related to pain modulation and inflammation, particularly when disease conditions or stress are present. There have been recent developments in technology to reduce capsaicin's pungency and improve its bioavailability, including nanotechnology.

CONCLUSIONS

It is proven that capsaicin is effective in pain management as well as a variety of therapeutic conditions because of its ability to deplete substance P and desensitize nerve endings. Although capsaicin is highly pungent and associated with discomfort, advancements in delivery technologies and the development of capsaicin-mimetics promise improved therapeutic outcomes. There is a great deal of complexity in the pharmacological action of capsaicin due to its interaction with TRPV1 channels and its ability to affect gene transcription. There is a need for further research and development in order to optimize capsaicin's clinical applications and to enhance its therapeutic index in a variety of human diseases.

Machine Learning-Based Model Used for Predicting the Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B

Object

Currently, predictive models that effectively stratify the risk levels for hepatocellular carcinoma (HCC) are insufficient. Our study aimed to assess the 10-year cumulative risk of HCC among patients suffering from chronic hepatitis B (CHB) by employing an artificial neural network (ANN).

Methods

This research involved 1717 patients admitted to Beijing Ditan Hospital of Capital Medical University and the People's Liberation Army Fifth Medical Center. The training group included 1309 individuals from Beijing Ditan Hospital of Capital Medical University, whereas the validation group contained 408 individuals from the People's Liberation Army Fifth Medical Center. By performing a univariate analysis, we pinpointed factors that had an independent impact on the development of HCC, which were subsequently employed to create the ANN model. To evaluate the ANN model, we analyzed its predictive accuracy, discriminative performance, and clinical net benefit through measures including the area under the receiver operating characteristic curve (AUC), concordance index (C-index), and calibration curves.

Results

The cumulative incidence rates of HCC over a decade were observed to be 3.59% in the training cohort and 4.41% in the validation cohort. We incorporated nine distinct independent risk factors into the ANN model's development. Notably, in the training group, the area under the receiver operating characteristic (AUROC) curve for the ANN model was reported as 0.929 (95% CI 0.910-0.948), and the C-index was 0.917 (95% CI 0.907-0.927). These results were significantly superior to those of the mREACHE-B(0.700, 95% CI 0.639-0.761), mPAGE-B(0.800, 95% CI 0.757-0.844), HCC-RESCUE(0.787, 95% CI 0.732-0.837), CAMD(0.760, 95% CI 0.708-0.812), REAL-B(0.767, 95% CI 0.719-0.816), and PAGE-B(0.760, 95% CI 0.712-0.808) models (p < 0.001). The ANN model proficiently categorized patients into low-risk and high-risk groups based on their 10-year projections. In the training cohort, the positive predictive value (PPV) for the incidence of liver cancer in low-risk individuals was 92.5% (95% CI 0.921-0.939), whereas the negative predictive value (NPV) stood at 88.2% (95% CI 0.870-0.894). Among high-risk patients, the PPV reached 94.6% (95% CI 0.936-0.956) and the NPV was 90.2% (95% CI 0.897-0.917). These results were also confirmed in the independent validation cohort.

Conclusion

The model utilizing artificial neural networks demonstrates strong performance in personalized predictions and could assist in assessing the likelihood of a 10-year risk of HCC in patients suffering from CHB.

Optimizing phage therapy for carbapenem-resistant Enterobacter cloacae bacteremia: insights into dose and timing

The increase in multidrug-resistant (MDR) Enterobacter cloacae complex (ECC) infections, particularly those resistant to carbapenems, underscores the urgent need for alternative therapies. Phage therapy, with its specific bactericidal action, offers a promising solution. However, there remains a shortage of well-characterized ECC-targeting phages, and dosing and timing optimization for ECC-specific phage cocktails is largely unexplored. In this study, we isolated and characterized three novel lytic phages with diverse genome sizes and host ranges. Notably, ФEBU8 demonstrated broad-spectrum activity, lysing both Enterobacter species and Acinetobacter baumannii. ФECL22 displayed stability across a wide temperature range (4-50°C), pH tolerance (6-10), and a burst size of 19 PFU/cell, with OmpA identified as its receptor. Our formulated phage cocktail, comprising ФEBU8, ФECL22, and ФECL30, effectively rescued mice with E. cloacae bacteremia in a dose-dependent manner, with a mid-dose regimen showing particularly strong efficacy. Immediate phage administration achieved full survival, whereas a combined prophylactic and therapeutic regimen ("-24 + 6") also resulted in 100% survival. These findings highlight the critical roles of dosing and timing in optimizing phage therapy for carbapenem-resistant Enterobacter infections, with prophylactic use providing a valuable window for delayed treatment and a promising strategy for combating severe bacterial infections.

Trends in Proton Pump Inhibitor Use in Sweden by Sex and Age: A Drug Utilisation Study

BACKGROUND

Proton pump inhibitors (PPIs) are among the most popular drugs worldwide. Yet, there are concerns on long-term safety and poor adherence to prescription guidelines. Off-label use in children and increasing maintenance use in older adults may be particularly worrisome.

OBJECTIVES

To assess differences in PPI use by age, sex calendar year and PPI type, and to explore potential underlying indications (ulcerogenic drugs, and indications) in Sweden.

METHODS

Proton pump inhibitor drug utilisation study based on the Swedish nationwide prescribed drug (2006-2023) and patient registries (2006-2022).

RESULTS

Proton pump inhibitors were used by 14.4% (women) and 10.5% (men) of adults; and 1.0-1.5% of children and adolescents (aged < 20 years). Proton pump inhibitor use was higher in women in all age-groups except small children (aged < 5 years). Proton pump inhibitor use has increased in all age groups, especially in young children (aged < 10 years) and the oldest groups (aged > 65 years). Proton pump inhibitor users aged > 85 years filled most prescriptions with an annual average of 9.5 (men), 11.6 (women) prescriptions. Most prescriptions were for omeprazole and esomeprazole: 63.7% and 23.5% in adults; 23.5% and 44.7% in children (2023). Prescriptions for other drugs for peptic ulcers/reflux became rare, with 99% of prescriptions in this category being PPIs by 2023. Gastro-intestinal diagnoses were predominantly recorded in men, became less prevalent and only explained part of PPI use, while ulcerogenic drugs were common (particularly in women), suggesting PPIs are regularly used for gastroprotection.

CONCLUSION

Proton pump inhibitor use has doubled in children and increased 50% in adults over the study period, in both sexes, while recorded gastrointestinal indications decreased. Alternative therapies were rarely prescribed in Sweden.

Proton beam therapy in the management of hepatocellular carcinoma

INTRODUCTION

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Photon radiotherapy shows efficacy in treating HCC but carries risks of high exit dose and radiation-induced liver disease. Additionally, HCCs with portal vein tumor thrombosis (PVTT) have a poor prognosis and are associated with higher risk of death. In recent years, proton beam therapy (PBT) has emerged as a novel treatment with the ability to downstage HCC for liver transplant (LT).

AREAS COVERED

This review will provide an overview of dosimetric benefits of PBT, efficacy of PBT in treating HCC, downstaging HCC-PVTT for LT, and a comparison of PBT with other non-surgical techniques. A search of PubMed until 3 September 2024 was conducted using free search and the following keywords: hepatocellular carcinoma, proton beam therapy, portal vein tumor thrombosis, local ablative therapy, trans-arterial chemoembolization, stereotactic body radiotherapy, Y-90 radioembolization.

EXPERT OPINION

Various clinical trials using PBT have shown promising tumor local control and overall survival rates. PBT is mostly safe and efficacious for downstaging HCC-PVTT for LT. PBT has also been shown to be non-inferior to various other treatment modalities. Future research should focus on combinations of PBT with other modalities.

Anti-inflammatory effects of Rhus javanica ethanol extract for pulmonary and colonic disorders

BACKGROUND

Rhus javanica is a traditional medicinal herb widespread in East Asia, including Korea, China, and Japan. Valued for its antidiarrheal, bactericidal, and anti-inflammatory properties, it epitomizes the synergy of traditional wisdom and natural benefits.

PURPOSE

This study aimed to investigate the anti-inflammatory properties of Rhus javanica ethanol extract (Rj-EE) in both in vitro and in vivo models, elucidate the underlying mechanisms, and provide a theoretical foundation for its potential use as a natural therapeutic option for clinical colitis and lung diseases.

STUDY DESIGN

RAW264.7 cells, peritoneal macrophages, HEK293T cells, and mouse models of acute lung injury and acute ulcerative colitis were used to evaluate the anti-inflammatory activity of Rj-EE.

METHODS

In this study, the phytochemical constituents of Rj-EE were identified by GC-MS and LC-MS. Inflammatory targets were sourced from GeneCards and Swiss Target Prediction databases. Gene ontology and KEGG analyses revealed Rj-EE's anti-inflammatory mechanisms. Nitric oxide (NO) production and cell viability were assessed with Griess and MTT assays, respectively. Inflammatory cytokines were measured by RT-PCR, transcription factor activity by luciferase assays, and protein expression through Western blotting. Overexpression and CETSA assays were conducted in HEK293T cells. In vivo model animals with lipopolysaccharide-induced acute lung injury and dextran sulfate sodium-induced acute ulcerative colitis were treated with Rj-EE and then assessed by RT-PCR, hematoxylin and eosin (H&E), cytokine analysis via an enzyme-linked immunosorbent assay, and Western blotting.

RESULTS

KEGG analysis identified the NF-κB pathway as key to Rj-EE's anti-inflammatory effects, with Src as a central target. Molecular docking showed strong binding between Rj-EE's active components and key genes. In vitro, Rj-EE reduced NO production and inflammatory mRNA markers, and inhibited MyD88- and TRIF-induced NF-κB and AP-1 activity. It also targeted Src and Syk. In vivo, Rj-EE alleviated colitis and lung injury.

CONCLUSION

Overall, Our findings lay a foundation for further research into Rj-EE's molecular anti-inflammatory mechanisms and suggest that Rhus javanica could be explored as a potential anti-inflammatory agent targeting Src and Syk for conditions like lung injury and colitis.

Promoting Prevention and Targeting Remission of Asthma: A EUFOREA Consensus Statement on Raising the Bar in Asthma Care

Asthma is a common, multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate for a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.

Severe Polypharmacy Increases Risk of Hospitalization Among Older Adults With Inflammatory Bowel Disease

INTRODUCTION

As the inflammatory bowel disease (IBD) patient population is aging, the prevalence of polypharmacy is rising. However, data exploring the prevalence, risk factors, and clinical outcomes associated with polypharmacy among older adults with IBD are limited. The aim of the study is to determine (i) prevalence of polypharmacy (≥5 medications) and potentially inappropriate medication (PIM) utilization in older adults with IBD, (ii) changes in medications over time, (iii) predictors of polypharmacy, and (iv) the impact of polypharmacy/PIMs on 1-year hospitalization rates.

METHODS

We conducted a retrospective single-center study of older adults with IBD from September 1, 2011, to December 31, 2022. Wilcoxon-signed rank and McNemar tests were used to assess changes in polypharmacy between visits, with ordinal logistic regression and Cox proportional hazards models used to determine risk factors for polypharmacy and time to hospitalization, respectively.

RESULTS

Among 512 older adults with IBD, 74.0% experienced polypharmacy at the initial visit, with 42.6% receiving at least one PIM. In addition, severe polypharmacy (≥10 medications) was present among 28.6% individuals at the index visit and increased to 38.6% by the last visit ( P < 0.01). Multivariable analysis revealed that age ≥70 years, body mass index ≥30.0 kg/m 2 , previous IBD-related surgery, and the presence of comorbidities were associated with polypharmacy. Moreover, severe polypharmacy ( adj hazard ratio 1.95, 95% confidence interval 1.29-2.92), as well as PIM use ( adj hazard ratio 2.16, 95% confidence interval 1.37-3.43) among those with polypharmacy, was significantly associated with all-cause hospitalization within a year of the index visit.

DISCUSSION

Severe polypharmacy was initially present in more than 25% of older adults with IBD and increased to 34% within 4 years of the index visit. Severe polypharmacy, as well as PIM utilization among those with polypharmacy, were also associated with an increased risk of hospitalization at 1 year, highlighting the need for deprescribing efforts in this population.

Gastrointestinal dysmotility in the ICU

PURPOSE OF REVIEW

This review aims to provide a comprehensive overview of gastrointestinal dysmotility, particularly in critically ill patients within the ICU. It highlights the pathophysiology, prevalence, and clinical implications of conditions, such as oesophageal dysmotility, gastroparesis, ileus, and Ogilvie's syndrome. By examining current diagnostic and treatment approaches, the review emphasizes the importance of recognizing and managing gastrointestinal dysmotility to improve patient outcomes.

RECENT FINDING

Recent literature indicates that up to 60% of ICU patients experience some form of gastrointestinal dysmotility, with those on mechanical ventilation being particularly at risk. The review identifies key contributors to gastrointestinal dysmotility, including inflammatory states, electrolyte imbalances, and the effects of certain medications. Nonpharmacological strategies, such as early enteral feeding, correcting electrolyte abnormalities, and mobilization are critical. Prokinetic agents have shown promise in alleviating feeding intolerance and improving gastric emptying, though their effects on overall mortality remain inconclusive.

SUMMARY

Gastrointestinal dysmotility presents a significant challenge in critically ill patients, leading to various complications that hinder recovery. Understanding the underlying pathophysiology, coupled with effective diagnostic and treatment strategies, is essential for enhancing patient care. This review underscores the need for continued research and clinical focus on gastrointestinal motility disorders in the ICU to improve health outcomes for this vulnerable population.

Accidental Trisodium Phosphate [Na3PO4] (TSP) Ingestion in a Child

BACKGROUND

It is not uncommon for a child to present to the hospital due to accidental ingestions, and oftentimes they are the result of a child accessing household cleaning or home improvement products. Typically, the upper gastrointestinal tract is the site of initial tissue insult and prognosis of these cases depends on a variety of factors, including the ingested substance, injury extent, and assessments and treatments rendered. Possible post-ingestion complications that make management difficult may include mediastinitis, hemodynamic instability, gastrointestinal perforation, erosion and scarring.

CASE

In this case, a 13-month-old boy accidently swallowed Trisodium phosphate [Na3PO4] (TSP), a common household all-purpose heavy-duty cleaner. After ingestion, the patient presented to the emergency department where a multi-disciplinary team-initiated care. Work-up included regular vital checks, electrolyte profiles, blood profiles and an esophagogastroduodenoscopy. He was eventually discharged and scheduled to return for follow-up with esophagram, without long term consequences.

CONCLUSIONS

Although the ingestion of TSP has occurred before, the literature regarding consumption of this specific detergent is negligible. This case provides evidence regarding the treatment and outcome of a paediatric patient who accidentally swallowed TSP and offers guidance in the management of their care.

Outcomes of stroke patients undergoing percutaneous endoscopic gastrostomy: a systematic review and meta-analysis

BACKGROUND

Percutaneous endoscopic gastrostomy (P.E.G.) is recommended for stroke patients with dysphagia to sustain oral nutrition.

OBJECTIVE

This study assesses the outcomes of stroke patients undergoing P.E.G. compared with those requiring nasogastric tube (N.G.T) or control group.

METHODS

We performed a thorough search across five electronic databases to gather pertinent studies. Outcomes were analyzed using relative risk (R.R.) for categorical data and mean difference (M.D.) for continuous data, each with 95% confidence intervals (C.I.). The single-arm meta-analysis results were presented as proportions or mean changes, also with 95% C.I.

RESULTS

We included 22 studies consisting of 996,567 patients. Our double-arm meta-analysis (924,134 patients) revealed no significant difference in post-hospitalization or in-hospital mortality between P.E.G. and control groups. However, P.E.G. patients showed a higher risk of aspiration pneumonia than control (R.R. = 11.72[3.75, 36.62], p < 0.00001). A comparison of P.E.G. and N.G.T. in three studies involving 691 patients indicated a non-significant difference in-hospital mortality risk (R.R. = 0.59, 95% C.I. [0.2, 1.72]). The single-arm analysis of stroke patients with P.E.G. identified a 19.8% in-hospital mortality, 13.6% rate of aspiration pneumonia, and 58% rate of pneumonia.

CONCLUSION

Stroke patients undergoing P.E.G remain at high risk for aspiration pneumonia and with an in-hospital mortality suggesting the need for identifying the best candidates and timing for the procedure.

Achievement of duodenal ulcer remission by vedolizumab in children with eosinophilic gastroenteritis

Eosinophilic gastrointestinal disorders (EGIDs) are treated with corticosteroids and food allergen elimination. However, treatment for refractory cases is not standardized. We demonstrate the efficacy of vedolizumab, an anti-α4β7 integrin agent, in 2 children with duodenal ulcers developed by non-eosinophilic esophagitis EGIDs. In both, vedolizumab was used continuously without side effects, and long-term remission has been durable. Duodenal ulcers associated with EGIDs are increasing. Vedolizumab has potential as a treatment for even upper gastrointestinal lesions in refractory EGIDs.

The Gut-Brain Axis in Irritable Bowel Syndrome: Implementing the Role of Microbiota and Neuroimmune Interaction in Personalized Prevention-A Narrative Review

Background and Purpose

Irritable bowel syndrome (IBS) is a disorder characterized by microbiota-neuroimmune interaction resulting in disturbance to the gut-brain axis (GBA). The purpose of this review is to garner an overview of the different pathophysiological mechanisms indicated in the development of IBS and the associated sequalae on gut microbiota alongside its role in the GBA. Moreover, we aim to provide an insight into the possibility of utilizing personalized medicine when managing said affected populations.

Methods

A comprehensive review was performed of the relevant literature pertaining to the current state of GBA alteration implicated in IBS, comprising microbiota-neuroimmune interaction alongside disturbance and activation, respectively. Different search databases were utilized, including PubMed/MEDLINE and ScienceDirect.

Results

The review demonstrated the most evident etiologies of IBS being the imbalance of microbiota and the alteration to the GBA. Furthermore, the interrelation between microbiota and neuroimmunity was discussed. Promising avenues for IBS prevention and management are offered through emerging research on the pathophysiological mechanisms indicated in IBS-associated GBA alteration. This entails a role for the involved interactions between microbiota modification and neuroimmunity activation.

Conclusion

Promising prospects for symptom prevention and management are signaled by the possibility of personalized therapy specifically designed to address the GBA dysfunction indicated in IBS. Policymakers and developers should encourage further study and allocate available resources to aid researchers in the implementation and identification of novel preventive therapeutics. Furthermore, physicians should advocate and integrate the use of personalized medical approaches of IBS to help ensure a better quality of life.

Demystifying Carbohydrate Maldigestion: A Clinical Review

Carbohydrate intolerance is a poorly understood and potentially overlooked cause of unexplained gastrointestinal symptoms, particularly among patients with disorders of gut-brain interaction. Symptoms related to carbohydrate intolerance arise from bacterial fermentation of unabsorbed carbohydrates leading to increased gases and osmotic load within the gastrointestinal tract. This mechanism is shared across various carbohydrates, including lactose, sucrose, maltose, fructose, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Primary forms of carbohydrate maldigestion typically affect one specific type of carbohydrate and result from inherited defects in specific brush-border enzymes or transport mechanisms, whereas secondary, or acquired, forms of carbohydrate maldigestion can arise from conditions that affect the structural integrity or function of the pancreas and small intestine. Although confirmation of a disaccharidase deficiency does not imply clinical relevance, obtaining a careful patient history with appropriate use of breath testing, duodenal disaccharidase assay, and response to dietary modification can help identify patients whose symptoms are associated with carbohydrate maldigestion and who may benefit from treatment. Dietary modification remains the cornerstone of therapy for patients with carbohydrate intolerance and should focus on determining the most liberal diet for patients that allows symptom control. Given the complexity and time-consuming nature of this process, clinicians are encouraged to engage the help of dietitians with expertise in the treatment of disorders of gut-brain interaction where available. Enzyme replacement therapy can also be an important adjunct to dietary management, with sacrosidase improving symptoms in sucrase-isomaltase deficiency and helping patients to liberalize their diet.

Gastrointestinal Dysfunction Bears on the Clinical-Biological Profile of Parkinson's Disease

BACKGROUND

Gastrointestinal dysfunction (GID) accompanies any phase of Parkinson's disease (PD), underlying differential clinical-pathological trajectories.

OBJECTIVE

To investigate associations between GID and peripheral immune or neurodegeneration-related markers in PD.

METHODS

One-hundred-and-fourteen patients (n = 55 de novo, DN; n = 59 middle-advanced, MA) completed the Gastrointestinal Dysfunction Scale for PD (GIDS-PD), and other motor and non-motor scales; paired measurement of amyloid-β42, amyloid-β42β/β40, total-tau, phosphorylated-181-tau, total α-synuclein CSF levels, albumin ratio, and peripheral blood cell count were collected. Group and correlation analyses were performed.

RESULTS

MA patients had greater GID than DN. GIDS-PD scores directly correlated with MDS-UPDRS-III and non-motor scores in both groups, although more in DN. GIDS-PD scores were directly associated with α-synuclein and inversely with lymphocytes only in DN; conversely, they were positively associated with tau proteins and albumin ratio, and negatively with amyloid-β-peptides in both groups.

CONCLUSIONS

The burden of GID increases along the PD course with associated stage-specific clinical-biological patterns.

Novel nanomaterials-based combating strategies against drug-resistant bacteria

Numerous types of contemporary antibiotic treatment regimens have become ineffective with the increasing incidence of drug tolerance. As a result, it is pertinent to seek novel and innovative solutions such as antibacterial nanomaterials (NMs) for the prohibition and treatment of hazardous microbial infections. Unlike traditional antibiotics (e.g., penicillin and tetracycline), the unique physicochemical characteristics (e.g., size dependency) of NMs endow them with bacteriostatic and bactericidal potential. However, it is yet difficult to mechanistically predict or decipher the networks of molecular interaction (e.g., between NMs and the biological systems) and the subsequent immune responses. In light of such research gap, this review outlines various mechanisms accountable for the inception of drug tolerance in bacteria. It also delineates the primary factors governing the NMs-induced molecular mechanisms against microbes, specifically drug-resistant bacteria along with the various NM-based mechanisms of antibacterial activity. The review also explores future directions and prospects for NMs in combating drug-resistant bacteria, while addressing challenges to their commercial viability within the healthcare industry.

Engineered Stem Cell Booster Breaks Pathological Barriers to Treat Chronic Pancreatitis

Chronic pancreatitis (CP) is a long-standing progressive fibrosis and has long been considered incurable, which remains a heavy health burden worldwide. Mesenchymal stem cells (MSCs) with anti-fibrosis properties are currently used in the treatment of fibroinflammatory diseases. However, its therapeutic effect is limited mainly due to two main types of pathological barriers in CP: 1) Fibrotic collagen hinders cell delivery, and 2) Malignant microenvironment attacks cell inactivation. Here, a MSCs-based exogenous nitric oxide (NO) delivery system (MSCs-Lip@RNO) is constructed. In the MSCs-Lip@RNO, NO not only can be a cell booster to regulate collagen fibers, relieve the vascular compression and enhance the accumulation of MSCs in the whole pancreas, but also can form a protective gas layer on the cell surface, which enhances the therapeutic effect of MSCs. In the CP rat model, the pancreatic injury and fibrosis are reduced with 7 days after a single dose administration of this long-acting MSCs. Collectively, this study offers a promising strategy for enhancing the delivery and therapeutic efficacy of MSCs to break pathological barriers in CP treatment.

Diagnostic Challenges of Upper Gastrointestinal Tract Crohn's Disease

Crohn's disease (CD) is a chronic inflammatory disorder that commonly affects the distal small bowel and proximal large bowel. However, it can involve any part of the gastrointestinal tract (GIT), including the upper GIT. However, upper GIT involvement is often overlooked due to the limited use of upper gastrointestinal (UGI) endoscopy and biopsy for diagnosis. We present a case of a 30-year-old male with an 11-year history of symptomatic CD. Despite multiple normal findings on various endoscopic and imaging evaluations, his symptoms persisted, leading to numerous treatment modifications from Pentasa foam enema to various biologics. Despite this, fecal calprotectin remained elevated. A critical diagnosis was made via video capsule endoscopy, revealing duodenitis and aphthous ulcers, and subsequent esophagogastroduodenoscopy (OGD) with histology confirming focal inflammation consistent with upper GIT CD of the stomach and duodenum. Despite aggressive treatment, the patient's symptoms persisted, necessitating comprehensive nutritional management. This case underscores the diagnostic challenges of upper GIT CD and highlights the importance of thorough endoscopic and histological evaluations for accurate diagnosis and effective management. Additionally, it underscores the usefulness of fecal calprotectin as an indication of inflammation and the relevance of nutritional management in controlling symptoms of upper GIT CD.

Early management of acute caustic ingestion in pediatrics

This review is intended to provide an overview of currently available literature related to caustic ingestion in pediatric patients, including initial management considerations in symptomatic versus asymptomatic children, timing and necessity of endoscopic evaluations, and the use of various therapeutic interventions. Further, this review provides management considerations for children presenting for evaluation following caustic ingestion based on the best available evidence. Additional research is needed to develop conclusive pediatric guidelines that meet GRADE criteria for management of caustic ingestion in children.

Identifying phage Lysins through genomic analysis of prophages from Acinetobacter baumannii

Acinetobacter baumannii is a Gram-negative opportunistic pathogen, responsible for nosocomial infections worldwide. In recent years, this microorganism has acquired resistance to various antibiotics, prompting the World Health Organization (WHO) to declare carbapenem-resistant A. baumannii (CRAB) a critical priority microorganism requiring urgent attention and the development of new therapeutic options. Here, we screened for prophages in 158 genomes of A. baumannii, comprising 139 complete genomes from the Bacterial and Viral Bioinformatics Resource Center (BV-BRC), and 19 newly sequenced clinical isolates. Additionally, we conducted phylogenetic analyses of prophages, highlighting their diversity and local clustering. The analyzed genomes harbored at least two prophage regions, resulting in the identification of a total of 950 prophage regions, of which 348 were considered complete prophages through software analysis and manual curation, while the remainder may represent prophage remnants. The complete prophages ranged from 28.6 to 103.9 kbp, with an average GC content of 39%. Based on genomic similarity, only 18 complete prophages were taxonomically classified to the genus Vieuvirus. Among all identified complete prophages, we identified 166 genes encoding for putative lysins, while prophage regions that were not considered complete could also harbor putative lysins. These findings highlight the abundance of prophage-encoded lysins in A. baumannii genomes, which are promising therapeutic agents for combating A. baumannii infections, particularly in the face of rising antibiotic resistance.

Electroacupuncture Improves Ovarian Function in Rats With Tripterygium Glycoside-Induced Diminished Ovarian Reserve by Promoting the Polarization of M2 Macrophages and Inhibiting Inflammatory Responses

Immunoinflammatory responses and macrophage polarisation are crucial for maintaining ovarian function. Moreover, electroacupuncture (EA) has been shown to protect ovarian function. However, the mechanisms by which EA improves ovarian function, including its effects on immunoinflammatory responses and macrophage polarisation, have not been determined. This study aimed to investigate the protective effects of EA on ovarian function in rats with diminished ovarian reserve (DOR) and to elucidate the regulatory mechanisms underlying inflammation and M1 and M2 macrophage polarisation. DOR models were established through the intragastric administration of 50 mg/kg Tripterygium glycoside suspension (TGs) for 14 consecutive days. The EA group received treatment at 2/100 Hz and 1.0 mA for 10 min using acupoints BL23, CV4 and CV12 for 14 days. Following the intervention, we employed various methodologies, including haematoxylin-eosin (H&E) staining, enzyme-linked immunosorbent assay (ELISA), flow cytometry, immunohistochemical (IHC) staining, western blotting and quantitative reverse transcriptase-polymerase chain reaction (PCR), to assess ovarian function, inflammatory factors and the expression levels of M1 and M2 macrophage-related factors. EA intervention reduced the oestrous cycle disorder rate in the rats compared with that in the DOR group, leading to an increase in growing follicles, a reduction in atretic follicles (AFs) and an enhancement of both the capillary (Cap) network and corpus luteum (CL) structure. This intervention also resulted in decreased serum levels of follicle-stimulating hormone (FSH), interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α), along with increased levels of oestradiol (E2), interleukin-4 (IL-4) and interleukin-10 (IL-10). Furthermore, the number of M2 macrophages in the spleen increased, which was accompanied by elevated arginase 1 (Arg1) and decreased inducible nitric oxide synthase (iNOS) expression in the ovarian tissues. In summary, EA can restore the impaired ovarian function caused by TGs by promoting M2 macrophage polarisation and inhibiting inflammatory responses.

Sleep and Respiratory Infections

Sleep disorders that involve circadian rhythm disruption and sleep-disordered breathing (SDB) such as obstructive sleep apnea (OSA) are closely linked to respiratory infections. SDB leads to a proinflammatory state due to intermittent hypoxia, sleep fragmentation, increased oxidative stress, and elevation of inflammatory mediators such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and C-reactive protein (CRP). Furthermore, inflammatory mediator levels correlate with SDB severity, especially in people with OSA. Nocturnal microaspiration, gastroesophageal reflux, and associated comorbidities (e.g., obesity) increase the risk of community-acquired pneumonia, viral infections such as SARS-CoV-2, respiratory complications, and death. OSA has been associated with post-COVID syndrome. It also increases the risk of postoperative complications in both adults and children. Circadian rhythm disorders such as insomnia predispose to immune disorders and increase the risk of infection. Chronic conditions such as bronchiectasis, with or without concomitant cystic fibrosis, can lead to structural sleep changes and increase the risk of OSA due to chronic cough, arousals, aspirations, hypoxia, upper airway edema, and overexpression of proinflammatory cytokines. The protective effect of treatment for sleep disorders against respiratory infection is currently unknown. However, in people presenting with respiratory infection, it is important to test for SDB to prevent complications.

Risk Factors for Glue Extrusion Bleeding After Endoscopic Injection of Cyanoacrylate Glue for Gastric Varices: A Retrospective Study of 269 Patients

BACKGROUND

Glue extrusion bleeding is a major complication of endoscopic cyanoacrylate glue injection for the treatment of gastric varices. However, its risk factors remain unclear.

AIMS

This retrospective study aimed to evaluate the risk factors for bleeding associated with glue extrusion.

METHODS

This study analyzed the medical data of cirrhotic patients who underwent endoscopic obliteration for gastric varices using cyanoacrylate glue between January 2016 and December 2022. The data within 1 year after therapy were carried out with logistic regression. A nomogram model was constructed based on the factors.

RESULTS

269 patients were enrolled. Risk factors associated with glue extrusion bleeding included the volume of the glue (≥ 4 mL)(OR 1.289, 95% CI 1.051-1.580; P = 0.015), massive ascites (OR 5.645, 95% CI 2.260-14.097; P = 0.000), active hemorrhage during endoscopy (OR 2.830, 95% CI 1.284-6.234; P = 0.010), and the use of β-blockers was a protective factor (OR 0.185, 95% CI 0.07-0.485; P = 0.001). The nomogram model had good prediction accuracy, with an area under the curve of 0.74 (95% CI 0.658-0.822; P < 0.001).

CONCLUSION

Massive ascites, active hemorrhage during endoscopy, glue volume ≥ 4 mL, and the use of β-blockers are associated with glue extrusion bleeding. At-risk patients may benefit from controlling the volume of the glue, undergoing endoscopic ultrasound and using β-blockers.

Isolation, characterization, and genomic analysis of three novel Herelleviridae family lytic bacteriophages against uropathogenic isolates of Staphylococcus saprophyticus

BACKGROUND

Staphylococcus saprophyticus (S. saprophyticus) is the second most prevalent etiological agent of urinary tract infections (UTIs) in young women. However, there is a paucity of data regarding its bacteriophage (phage). Therefore, this study was conducted to isolate and identify new lytic phages from municipal wastewater with the objective of increasing knowledge about phages and their genomes.

METHODS

A total of 11 clinical isolates of S. saprophyticus and 30 wastewater samples were used to isolate three lytic phages (vB_SsapH-Golestan-100, vB_SsapH-Golestan101-M, and vB_SsapH-Golestan-105-M). The morphology, behavioral characteristics, and complete DNA genomes of these phages were analyzed.

RESULTS

The microscopic images of the phages revealed that the sizes of their heads and tail lengths fell within the ranges of 90-111 nm and 234-266 nm, respectively. All phages exhibited high adsorption rates (99.5% in 15 min) and burst sizes (150-210 PFU per infected cell), with a potential for a narrow host range. Genomic analysis of Staphylococcus phages indicated a size of 136,433 base pairs (bp) with a guanine-cytosine (GC) content of 33.7% and 192 open reading frames (ORFs) for vB_SsapH-Golestan-100, 144,081 bp with a GC content of 29.6% and 205 ORFs for vB_SsapH-Golestan101-M, and 142,199 bp with a GC content of 30.6% and 203 ORFs for vB_SsapH-Golestan-105-M. A bioinformatics analysis indicated that all three phages belong to the Twortvirinae subfamily of Herelleviridae. Among the three phages, vB_SsapH-Golestan-100 exhibited the least similarity to previously known phages, with less than 21% similarity with its closest counterparts in genomic databases.

CONCLUSIONS

This study identified new phages that have the ability to destroy a broad range of S. saprophyticus isolates and may potentially be classified as a new genus and species within the Herelleviridae family in future studies.

The outcomes of robotic ileocolic resection in Crohn's disease compared with laparoscopic and open surgery: a meta-analysis and systematic review

BACKGROUND

This is the first review providing insights into the outcomes of robotic ileocolic resection for Crohn's disease, potentially guiding improved surgical decisions and patient outcomes and comparing outcomes with laparoscopic and open approaches.

METHODS

The review was registered prospectively with PROSPERO (CRD42024504839). A comprehensive search of MEDLINE, Embase, Scopus, and Cochrane Central databases for studies on robotic ileocolic resection for Crohn's disease from inception to February 2024 was conducted. Eligible studies included participants over 18 years of age with Crohn's disease undergoing robotic ileocolic resection. Data were extracted according to PRISMA guidelines. For single-arm analyses, the random-effects model was used, while two-arm analyses employed the inverse variance and Mantel-Haenszel methods.

RESULTS

The analysis included eight studies with 5760 patients, among whom 369 underwent robotic ileocolic resection. The mean operative time for robotic procedures was 226 min. Postoperative complications included ileus in 12.50% and wound complications in 7.00%, while reoperations and readmissions occurred in 3.60% and 13.20% of patients, respectively. When compared with laparoscopic procedures, robotic procedures showed shorter length of hospital stay and longer operative times but similar total complication, reoperation, and conversion rates. In contrast, robotic procedures had fewer total postoperative complications compared with open surgeries, despite longer operative times.

CONCLUSIONS

Robotic ileocolic resection for Crohn's disease, while having a longer operative time, results in fewer postoperative complications compared with open surgery and shows comparable outcomes to laparoscopic procedures with shorter hospital stays.

Exploration of Novel Antimicrobial Agents against Foodborne Pathogens via a Deep Learning Approach

The emergence of antibiotic-resistant bacteria poses a severe threat to food safety and human health, necessitating an urgent search for novel antimicrobial agents that can be applied in the food industry. This study utilizes a deep learning approach to establish the optimal models for antibacterial activity against foodborne pathogens, particularly Escherichia coli and Staphylococcus aureus, as well as for predicting carcinogenicity. These optimal models are applied to screen natural products from the COCONUT database, resulting in the identification of 130 compounds with both antibacterial activity and noncarcinogenic properties. Two natural products, bis(hexamethylene)triamine and N-phenethylbiguanide, are selected for experimental validation of their antibacterial activity. The confirmation of antimicrobial properties validates the reliability of the models developed in this study. By providing an innovative approach for identifying antimicrobial agents for foodborne pathogens, this research offers new insights for discovering effective antimicrobials in an efficient manner.

The Role of Blastocystis spp. in the Etiology of Gastrointestinal and Autoimmune Diseases

Blastocystis spp. has been linked to gastrointestinal symptoms, yet its pathogenicity remains uncertain. In addition, the roles of virulence factors, pathogenic potential, and host-specific traits associated with symptomatic infections are still not well understood. The growing number of immunocompromised patients has contributed to an increasing prevalence of Blastocystis spp. infections, which may be implicated in the development of various inflammatory diseases, including irritable bowel syndrome (IBS), colorectal cancer, and autoimmune disorders such as Hashimoto's disease and ulcerative colitis. However, the presence of nonspecific symptoms often complicates diagnosis. This study aimed to present current data on the impact of Blastocystis spp. on the development and progression of gastrointestinal and autoimmune diseases, as well as to explore potential treatment options for Blastocystis spp. infections. A literature review was conducted to analyze the role of Blastocystis spp. in the pathogenesis of specific diseases and to investigate potential mechanisms of its interaction with the host organism. Advances in diagnostic techniques, particularly PCR, allow not only for the detection of Blastocystis spp. but also for the identification of specific subtypes, improving treatment precision. Beyond conventional therapies like metronidazole, there is a growing emphasis on alternative treatments, including the use of medicinal plants and probiotics.

Active Inflammatory Bowel Disease on Intestinal Ultrasound During Pregnancy Is Associated With an Increased Risk of Adverse Pregnancy and Neonatal Outcomes Independent of Clinical and Biochemical Disease Activity

BACKGROUND AND AIMS

Clinically active inflammatory bowel disease (IBD) is associated with an increased risk of adverse pregnancy outcomes. However, the validity of clinical scores to assess antenatal disease activity is questionable. We aimed to assess whether active disease defined by intestinal ultrasound (IUS) may predict adverse pregnancy outcomes.

METHODS

This international prospective cohort study recruited pregnant individuals with IBD from 2017 to 2023 from 3 specialist IBD pregnancy services. Participants underwent clinical assessments and fecal calprotectin (FCP) testing in the first (T1), second (T2), and third (T3) trimesters, and 6 weeks postpartum. IUS was performed in T1 or T2 when referral timing allowed. Univariable and multivariable log-binomial regression analyses were used to estimate the impact of IUS activity on pregnancy outcomes. Cohen's κ coefficients were used to determine agreement between FCP, IUS, and clinical disease activity.

RESULTS

The study recruited 377 participants, 198 with Crohn's disease (CD), and 234 women underwent an IUS during pregnancy. A maximal bowel wall thickness (BWT) >6 mm in T2 was associated with a 4-fold increased risk of prematurity (relative risk [RR], 4.01; 95% confidence interval [CI], 1.26-12.72; P = .018) and 2-fold increased risk of low-birth-weight delivery (RR, 2.19; 95% CI. 1.01-4.72; P = .046). Hyperemia on IUS in T2 was associated with a 3-fold increase in preeclampsia risk (RR, 3.46; 95% CI, 1.03-11.12; P = .046). Each 1-mm increase in BWT in T2 was estimated to increase the risk of gestational diabetes (RR, 1.08; 95% CI, 1.088-1.089; P < .001) Agreement between clinical (Harvey Bradshaw index or Simple Clinical Colitis Activity Index) and IUS/FCP activity during pregnancy was weak, particularly for CD.

CONCLUSIONS

Active IBD on IUS in pregnancy is associated with an increased risk of adverse pregnancy outcomes, independent of clinical activity and FCP. Use of IUS monitoring antenatally should be considered to guide therapeutic decision-making.

The LAMP-CRISPR-Cas13a technique for detecting the CBASS mechanism of phage resistance in bacteria

Introduction

Antimicrobial resistance (AMR) is a major public health threat, driving the need for alternative treatments such as phage therapy. However, bacterial defense mechanisms, often regulated by the quorum sensing (QS) network and encoded in genomic islands (GIs), can generate phage-resistant mutants. Understanding these resistance mechanisms is essential for optimizing phage therapy.

Methods

This study analyzed 48 Klebsiella pneumoniae strains to identify pathogenicity islands (PAIs) containing anti-phage defense (APD) proteins. We constructed a knockout strain lacking the cyclase gene from the type II CBASS defense systems present in PAIs to investigate QS regulation and its role in cell viability. The LAMP-CRISPR-Cas13a technique was used to confirm gene knockout and to detect the main cyclase in type I CBASS systems, i.e., APECO1.

Results

A total of 309 pathogenicity islands (PAIs), containing 22.1% of anti-phage defense (APD) proteins, were identified. Type I and II CBASS APD systems were also detected in the genome of the 48, K. pneumoniae strains, and only two type II CBASS systems were located in PAIs. Alluding to these defense mechanisms, the QS revealed to be involved in the regulation of the type II CBASS systems contained in PAIs. Finally, the LAMP-CRISPR-Cas13a technology successfully detected the main cyclases habored in type I and II CBASS systems, respectively.

Discussion

The study findings highlight the regulatory role of the QS network in APD systems. Notably, this is the first study to develop an innovative biotechnological application for the LAMP-CRISPR-Cas13a rapid-technique (<2 h), thereby helping to optimize phage therapy by detecting bacterial resistance mechanisms and predicting the potential inefficacy of therapeutic phages and thus improving patient prognosis.