Decentralized worker-centred occupational management in health care: nationwide survey and alpha testing

BACKGROUND

Occupational stress among healthcare workers negatively impacts job satisfaction and patient care quality, jeopardizing healthcare system sustainability. Traditional employer-driven approaches often fail to address these challenges comprehensively, leading to persistent gaps in work condition transparency and well-being.

AIMS

To elucidate the working conditions of health workers and introduce a worker-centred, technology-based strategy moving beyond traditional practices and entrenched medical culture.

METHODS

A nationwide survey of Belgian medical residents evaluated occupational conditions and perceptions of management practices. Additionally, the alpha version of a decentralized mobile application was tested to gather user satisfaction and feedback on its usability. The data were surveyed using Pearson's chi-squared and Kruskal-Wallis rank sum tests to assess associations between categorical and ordinal variables, respectively. Alpha-testing results were evaluated using descriptive statistics.

RESULTS

The nationwide survey, involving 257 participants, revealed significant associations between medical specialty, work choices and compensation. Notably, 91% of participants expressed strong interest in our proposed open, decentralized solution. In the alpha testing phase, 12 testers reported high satisfaction regarding time-tracking accuracy and payroll verification, though challenges related to administrative burden were also identified.

CONCLUSIONS

The findings underscore the need for innovative, worker-centred occupational management solutions. The proposed solution shows promise in improving autonomy and transparency, potentially enhancing healthcare delivery and sustainability.

PTPN2 Regulates Iron Handling Protein Expression in Inflammatory Bowel Disease Patients and Prevents Iron Deficiency in Mice

Anemia is the most common extraintestinal manifestation of inflammatory bowel disease (IBD). Iron deficiency is the most frequent cause of anemia in IBD; however, the mechanisms involved are still poorly understood. Here, we investigated the role of the IBD risk gene, protein tyrosine phosphatase non-receptor type 2 (PTPN2), in regulating iron homeostasis. Proteomic analyses were performed on serum from IBD patients genotyped for the IBD-associated loss-of-function rs1893217 PTPN2 variant. Constitutive Ptpn2 wild type (WT), heterozygous (Het), and knockout (KO) mice were analyzed for iron content, blood parameters, and expression of iron handling proteins. Iron absorption was assessed through radiotracer assays. Serum proteomic analyses revealed that the "iron homeostasis signaling pathway" was the main pathway downregulated in Crohn's disease (CD) patients carrying the PTPN2 risk allele, independent of disease activity. Ptpn2-KO mice showed characteristics of anemia, including reduced hemoglobin concentrations along with serum and tissue iron deficiency and elevated serum hepcidin levels vs. Ptpn2-WT and Het mice. 55Fe absorption via oral gavage was significantly impaired in Ptpn2-KO mice. Correspondingly, Ptpn2-KO mice showed reduced apical membrane expression of the iron transporter DMT1. CD patients with the PTPN2 loss-of-function rs1893217 variant display alterations in serum iron handling proteins. Loss of Ptpn2 in mice caused features of anemia, including iron deficiency associated with reduced apical membrane expression of DMT1. These findings identify an important role for PTPN2 in regulating systemic iron homeostasis.

Changes in Abdominal Artery Diameter in Patients Treated for Acute Aortic Dissection

BACKGROUND

Mesenteric ischemia significantly increases intraoperative mortality in patients with acute aortic dissection (AAD). The arterial diameter affects both blood flow and arterial resistance. There are no data in the literature on changes in arterial diameter in patients with AAD. It has already been demonstrated that changes in arterial diameter can be observed in patients with non-occlusive intestinal ischemia. The aim of this study was to compare the arterial branches of the abdominal aorta in patients with AAD preoperatively and postoperatively.

METHODS

Preoperative and postoperative contrast-enhanced computed tomography scans of 25 patients who had undergone the frozen elephant trunk procedure for the treatment of AAD were reconstructed and retrospectively analyzed with detailed medical data of the patients.

RESULTS

In patients without AAD at the level of the abdominal aorta, statistically significant differences were observed when comparing the diameter of the superior mesenteric artery (p < 0.001) and the renal arteries (p < 0.001) between preoperative and postoperative scans. Occlusion of the inferior mesenteric artery was more common in patients with AAD involving the abdominal aorta. Statistically significant differences in true and false lumen were observed at each level of the abdominal aorta after a successful frozen elephant trunk procedure.

CONCLUSION

Significant changes in visceral artery diameter were observed at the abdominal aortic level in patients both with and without aortic dissection. Chronic or non-occlusive mesenteric ischemia may be associated with a lack of adjustment in arterial diameter. Patients with AAD of the abdominal aorta are more susceptible to occlusion of the inferior mesenteric artery.

How Does Inflammatory Bowel Disease Impact Outcomes and Costs of Care Following Primary 1- to 2-level Lumbar Fusion for Degenerative Lumbar Disease?

STUDY DESIGN

Retrospective study.

OBJECTIVE

The purpose of this study was to determine whether IBD in patients with degenerative lumbar changes undergoing primary 1-2LF is associated with higher rates of (1) in-hospital length of stay, (2) medical complications, (3) readmissions, and (4) costs of care.

SUMMARY OF BACKGROUND DATA

In the United States, the prevalence of inflammatory bowel disease (IBD) has increased concurrently with an aging population with degenerative disk changes. In these patients, primary 1- to 2-lumbar fusion (1-2LF) is a common procedure to resolve serious complications of the spine. Studies comparing these patient demographics to hospital lengths of stay, postoperative complications, readmission rates, and costs of care are limited in the literature.

METHODS

The inclusion criteria consisted of patients with IBD who underwent 1-2LF, using a 90-day surveillance period, postoperatively. This 90-day surveillance period was used to measure the length of hospital stay, rates of medical complications, rates of readmissions, and overall costs of care. The IBD cohort was matched against a case-matched cohort group.

RESULTS

Patients in the study group had significantly longer in-hospital lengths of stay. In addition, patients in the study group had significantly higher incidence and odds of developing postoperative medical complications within 90 days. Also, study group patients had significantly higher readmission rates. Finally, patients in the study group had significantly higher costs of care than their case-matched cohort.

CONCLUSIONS

This study demonstrated that patients with IBD and degenerative lumbar disease are burdened with longer in-hospital lengths of stay, rates of postoperative medical complications, rates of readmission, and costs of care after undergoing primary 1-2LF.

Proportion and Characteristics of Helicobacter Pylori -Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Systematic Review and Meta-Analysis

INTRODUCTION

While Helicobacter pylori ( H . pylori ) infection is common in patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma, there are still individuals who test negative for it. The proportion and characteristics of these patients remain unclear.

METHODS

We conducted a systematic search of the PubMed, Embase, and Cochrane Library databases for relevant articles. Using a random-effects model, we performed a meta-analysis to assess the pooled proportion of gastric MALT lymphoma patients with negative H. pylori tests. In addition, we compared characteristics between gastric MALT lymphoma patients with and without H. pylori infection to examine clinical features in H. pylori -negative cases.

RESULTS

A total of 50 studies involving 6,033 patients were included. The overall proportion of gastric MALT lymphoma patients with negative H. pylori tests was 20.5% (95% confidence interval: 17.0%-24.6%). This rate exhibited an increasing trend over the years, particularly in non-Asian countries and in studies published after 2013, as well as in cases with sample sizes exceeding 100 patients, in male individuals, and among those with proximal or multiple lesions, nonsuperficial type morphology, submucosal invasion, and advanced clinical staging. Compared with H. pylori -positive patients, those who tested negative were more likely to be male, have proximal lesions, exhibit submucosal invasion, and present with an advanced clinical stage.

DISCUSSION

This study provides comprehensive information on the proportion and characteristics of H. pylori -negative gastric MALT lymphoma cases, highlighting the need for future clinical attention to treatment and surveillance in this patient population.

High-dimensional tissue profiling of immune cell responses in chronic lung allograft dysfunction

PURPOSE

The immunological drivers of chronic lung allograft dysfunction (CLAD), the major barrier to long-term survival after lung transplantation, are poorly understood at a tissue level. Tissue imaging using mass spectrometry with laser ablation of regions of interest offers single-cell resolution of distinct immune cell populations and their spatial relationships and may improve our understanding of CLAD pathophysiology.

METHODS

Lung tissue from 23 lung transplant recipients, 20 with and 3 without CLAD, was sectioned and stained with a 40-plex antibody panel before 81 regions of interest from airways, blood vessels and lung parenchyma were laser ablated.

RESULTS

190,851 individual segmented cells across 41 mm2 tissue were captured before 26 distinct immune and structural cell populations were identified and interrogated across CLAD phenotypes. CLAD was associated with expansion of cytotoxic T cells, γδ T cells and plasma cells and M2 macrophage polarization compared with non-CLAD. Within CLAD, bronchiolitis obliterans syndrome was characterized by more γδ T cells and fewer Th1 cells than restrictive allograft syndrome. Both adaptive and innate immune cells were involved in the temporal evolution of fibrotic remodeling. Although fibrosis seemed to be partially associated with different factors in restrictive allograft syndrome (M2 macrophages, Th1 cells) and in bronchiolitis obliterans syndrome (γδ T cells).

CONCLUSION

Imaging mass cytometry enables in-depth analyses of immune cell phenotypes in their local microenvironment. Using this approach, we identified major differences in cell populations in CLAD versus non-CLAD and in BOS versus RAS, with novel insights into the fibrotic progression of CLAD.

Systemic inflammation is associated with gut microbiota diversity in post-stroke patients

BACKGROUND

There is growing interest in gut microbiota and health outcomes. However, the relationship between systemic inflammation and gut microbiota diversity in hospitalized patients remains unclear. This study aimed to investigate the association in post-stroke rehabilitation patients.

METHODS

A cross-sectional study was conducted on post-stroke patients admitted to a rehabilitation hospital. Systemic inflammation was assessed using the modified Glasgow Prognostic Score (mGPS). Gut microbiota diversity was evaluated using three indices: Shannon index, Operational Taxonomic Unit (OTU) richness, and Faith's Phylogenetic Diversity (PD). Multiple linear regression analyses were performed to examine the relationship between mGPS and gut microbiota diversity indices, adjusting for potential confounders.

RESULTS

A total of 156 patients (mean age 78.4 years; 55.7% men) were analyzed. The median mGPS was 0 (interquartile range: 0-1), with GPS distribution: 61.8% scored 0, 25.7% scored 1, and 12.5% scored 2. After adjusting for confounders, mGPS was significantly and negatively associated with the Shannon index (B = -0.143, 95% CI -0.288 to -0.002, β = -0.177) and OTU richness (B = -17.832, 95% CI -24.349 to -3.951, β = -0.208). However, no significant association was observed between mGPS and Faith's PD (B = -1.155, 95% CI -2.464 to 0.189, β = -0.155).

CONCLUSION

This study demonstrates a significant negative association between systemic inflammation and both quantitative and qualitative gut microbiota diversity in post-stroke patients.

Recurrence rates and risk factors in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding (OGIB), defined in 2010, involves bleeding from the GI tract that remains unexplained after standard diagnostic procedures. OGIB, which accounts for about 5% of all GI bleeds, poses diagnostic and management challenges, particularly due to the anatomical features of the small intestine. Advances in capsule endoscopy (CE) and balloon-assisted endoscopy have improved the diagnostic and therapeutic landscape for small intestinal lesions.

Objective

To determine the recurrence rate and identify risk factors for recurrence following diagnostic and therapeutic interventions using CE and balloon-assisted endoscopy in patients with OGIB.

Methods

A retrospective cohort study at Gifu University Hospital analyzed CE procedures for patients with OGIB from 2008 to 2022. Patients underwent CE with subsequent treatments based on the findings. Statistical analyses, including Kaplan-Meier and Cox proportional hazards models, were used to estimate cumulative recurrence rates and identify recurrence risk factors.

Results

Out of 417 patients, 65.2% had positive CE findings, leading to therapeutic interventions in 16.3% of cases. The cumulative recurrence rates at 12, 24, and 36 months were 4.3%, 9.0%, and 13.9%, respectively. Liver cirrhosis (hazard rate: 4.15, 95% confidence interval 1.88-9.18, p < 0.01) was identified as a significant risk factor for recurrence.

Conclusions

A significant recurrence rate in OGIB patients, with liver cirrhosis being a major risk factor. Despite diagnostic and therapeutic advances, a comprehensive approach including careful follow-up and consideration of risk factors is essential for management.

Natural xanthones as modulators of the Nrf2/ARE signaling pathway and potential gastroprotective agents

Oxidative stress is implicated in the initiation, pathogenesis, and progression of various gastric inflammatory diseases (GID). The prevalence of these diseases remains a concern along with the increasing risks of adverse effects in current clinical interventions. Hence, new gastroprotective agents capable of inhibiting oxidative stress by modulating cellular defense systems such as the nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway are critically needed to address these issues. A candidate to solve the present issue is xanthone, a natural compound that reportedly exerts gastroprotective effects via antioxidant, anti-inflammatory, and cytoprotective mechanisms. Moreover, xanthone derivatives were shown to modulate the Nrf2/ARE signaling pathway to counter oxidative stress in both in vitro and in vivo models. Thirteen natural xanthones have demonstrated the ability to modulate the Nrf2/ARE signaling pathway and have high potential as lead compounds for GID as indicated by their in vivo gastroprotective action-particularly mangiferin (2), α-mangostin (3), and γ-mangostin (4). Further studies on these compounds are recommended to validate the Nrf2 modulatory ability in relation to their gastroprotective action.

Posterior Epistaxis Presenting as Upper GI Bleeding in A Healthy 21-Year-Old Patient: A Case Report

A 21-year-old Palestinian woman experienced recurrent hematemesis and melena over 7 months, requiring multiple hospital admissions and blood transfusions. Despite extensive investigations, the bleeding source remained undetermined until a posterior nasal bleed was suspected. Flexible rhinoscopy revealed a dilated sphenopalatine artery, and she was successfully treated with endovascular intervention. It is important for the Gastroenterologists to consider nasal endoscopy for patients with unexplained UGIB.

Environmental and Clinical Factors Concerning Gastrointestinal Bleeding: An Umbrella Review of Meta-Analyses

OBJECTIVES

Gastrointestinal bleeding, an emergency and critical disease, is affected by multiple factors. This study aims to systematically summarize and appraise various factors associated with gastrointestinal bleeding.

DESIGN

Umbrella review.

SETTING AND PARTICIPANTS

Meta-analyses that evaluated environmental and clinical factors concerning gastrointestinal bleeding.

METHODS

We conducted a systematic search to identify eligible meta-analyses. For each included study, the risk estimates, heterogeneity estimates, small-study effects, excess significance tests, and publication biases were recalculated and appraised. Furthermore, we considered the methodologic quality and classified the evidence.

RESULTS

In this study, 51 beneficial and 44 harmful associations were found. This study found that preemptive transjugular intrahepatic portosystemic shunt was the most reliable treatment to reduce gastroesophageal variceal bleeding and mortality risk, followed by antibiotics. For gastroduodenal ulcer bleeding, Yunnan Baiyao and proton pump inhibitors (PPIs) were relatively dependable treatment drugs, and the comparatively reliable prophylactic drugs comprised PPIs and H2-receptor antagonists. Patients with hemodynamic instability and larger ulcers had a higher risk of rebleeding. Both weekend admissions and the combination of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs were high-risk factors for upper gastrointestinal bleeding and mortality. We also found that tranexamic acid was a credible drug for overall gastrointestinal bleeding. Meanwhile, aspirin, warfarin, diabetes, and renal failure were all high-risk factors.

CONCLUSIONS AND IMPLICATIONS

Altogether, many factors can substantially influence gastrointestinal bleeding. Therefore, in daily life and clinical practice, we should not only remain cautious in prescribing and taking some drugs but also pay attention to the management of lifestyle and underlying diseases. If necessary, protective drugs should be properly supplemented.

Profile and methodology of ancillary protective measures employed during percutaneous renal cryoablation in a single high-volume centre

OBJECTIVES

To evaluate the at-risk organs that require protection during percutaneous cryoablation (PCA) of renal tumours and the correlation with patient and target lesion characteristics, type of protective measure used and postoperative outcomes.

MATERIALS AND METHODS

Single-centre retrospective review of patients with renal tumours who underwent PCA between 2008 and 2020. Final analysis included 374 tumours. Patient, tumour, and procedure technical details were extracted and analysed. At-risk organs were classified according to tumour location relative to kidney side, pyelic axis, and polar lines.

RESULTS

There were 171 (46.0%) tumours in the left kidney, and 194 (52.0%) in the right. Cryoprotection was required for 272 (272/374; 73.0%) tumours, with hydrodissection (216/374; 58.0%) being the most common technique. Protective measures were used for 82 (82/93; 88.0%) tumours in under/normal-weight patients and 143 (143/196; 73.0%) in overweight/obese ones (P = 0.004). In the left kidney, colon was the most common at-risk organ (63/171; 37.0%), followed by spleen (21/171; 12.3%), small bowel (21/171; 12.3%), ureter (19/171; 11.1%), abdominal wall (15/171; 8.8%), psoas muscle (10/171; 5.8%), and pancreas (9/171; 5.3%). In the right kidney, common at-risk organs were the colon (67/194; 35.0%), liver (50/194; 25.7%), ureter (15/194; 15.5%), diaphragm (16/194; 8.2%), abdominal wall (14/194; 7.2%), and duodenum (12/194; 6.1%). No cryoinjuries to at-risk organs occurred.

CONCLUSION

Hydrodissection is the most common cryoprotective measure used for renal tumour PCA. Under/normal-weight patients are more likely to require cryoprotection. The colon is the most common adjacent at-risk organ requiring protection for both right- and left-sided tumours.

Metastatic neuroendocrine carcinoma of the small intestine presenting as temporomandibular disorder

BACKGROUND

Neuroendocrine carcinomas (NECs) are rare tumors from hormone-secreting neuroendocrine cells, often within the gastrointestinal tract. The authors report what is, to their best knowledge, the first case of a small intestine NEC metastasizing to the temporomandibular joint (TMJ).

CASE DESCRIPTION

A 60-year-old man came to the oral medicine, oncology, and orofacial pain clinic with a chief concern of left-sided jaw pain. Clinical examination revealed left TMJ arthralgia and deep masseter myalgia, and results of imaging showed both osteoblastic and osteolytic changes in the left TMJ. A comprehensive diagnostic approach, including detailed history, clinical evaluation, and advanced imaging techniques, such as positron emission tomography computed tomography, was used to establish an accurate diagnosis.

PRACTICAL IMPLICATIONS

This case highlights the importance of considering metastasis in differential diagnosis of TMJ pain in patients with NEC, underscoring collaboration between oncology and orofacial pain specialists for accurate diagnosis and effective management.

Emerging Technologies in Inflammatory Bowel Disease: A Minireview on Future Treatment Modalities

Inflammatory bowel disease (IBD) can present as either Crohn's disease or ulcerative colitis. Both phenotypes are inflammatory conditions of the gastrointestinal tract. Despite scientific advances, the overall incidence and morbidity of IBD continues to increase worldwide. Fortunately, we continue to develop novel therapies, in hopes of providing safer, more effective treatment options. Such therapies include cell therapy, exosome therapy, hyperbaric oxygen therapy, and central nerve stimulation. The aim of this review is to briefly highlight each of these novel therapeutic interventions as they relate to the treatment of IBD.

European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management

INTRODUCTION

Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.

METHODS

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.

RESULTS

Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.

CONCLUSION

These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

PNPLA3 Polymorphism Is Inversely Correlated with Aortic Stiffness in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease Without Fibrosis

Metabolic dysfunction-associated steatotic liver disease (MASLD) corresponds to the condition of increased hepatic fat levels, which is the leading cause of hepatic failure and carcinoma. It is also an independent risk factor for cardiovascular disease (CVD) and mortality. MASLD can be due to obesity with insulin resistance and/or genetic predisposition, i.e., polymorphism in the patatin-like phospholipase domain-containing 3 (PNPLA3) gene. PNPLA3 polymorphism has been associated with increased hepatic fat levels, fibrosis, cirrhosis, and hepatocellular carcinoma, while its association with CVD remains to be fully understood. The aim of the current study was to examine whether the vascular phenotype of patients with MASLD differed between carriers and noncarriers of the PNPLA3 polymorphism. Adult patients with MASLD underwent clinical assessment, PNPLA3 genotyping, arterial tonometry for aortic stiffness measurement, and ultrasound examination of carotid arteries. In total, 117 patients with MASLD and no fibrosis (median hepatic stiffness was 4.71 kPa) were recruited. Carriers of the PNPLA3 polymorphism were younger and exhibited higher levels of ALT and APRI, as compared to wild-type subjects. On the other hand, carriers of the PNPLA3 polymorphism had not only a better metabolic profile (i.e., lower glucose and glycated hemoglobin) but also lower blood pressure, carotid intima-media thickness (IMT), and cardiovascular risk. In addition, PNPLA3 polymorphism was negatively correlated with aortic stiffness, which is a marker of arteriolosclerosis and vascular ageing. Our data are consistent with previous observations that in case of genetically-driven MASLD, there is an inverse association with common predictors of CVD. Our data support the view that the main contributors to CVD risk in patients with MASLD remain conventional cardiometabolic risk factors (i.e., age, glucose) that are more likely to be found in metabolic syndrome-related MASLD rather than genetically-driven MASLD, at least in the first stages of the disease.

Inhibition of hedgehog signaling ameliorates severity of chronic pancreatitis in experimental mouse models

Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas with no specific cure. Research highlighting the pathogenesis and especially the therapeutic aspect remains limited. Aberrant activation of developmental pathways in adults has been implicated in several diseases. Hedgehog pathway is a notable embryonic signaling pathway, known to promote fibrosis of various organs when overactivated. The aim of this study is to explore the role of the hedgehog pathway in the progression of CP and evaluate its inhibition as a novel therapeutic strategy against CP. CP was induced in mice by repeated injections of l-arginine or caerulein in two separate models. Mice were administered with the FDA-approved pharmacological hedgehog pathway inhibitor, vismodegib during or after establishing the disease condition to inhibit hedgehog signaling. Various parameters of CP were analyzed to determine the effect of hedgehog pathway inhibition on the severity and progression of the disease. Our study shows that hedgehog signaling was overactivated during CP and its inhibition was effective in improving the histopathological parameters associated with CP. Vismodegib administration not only halted the progression of CP but was also able to resolve already-established fibrosis. In addition, inhibition of hedgehog signaling resulted in the reversal of pancreatic stellate cell activation ex vivo. Findings from our study justify conducting clinical trials using vismodegib against CP and, thus, could lead to the development of a novel therapeutic strategy for the treatment of CP.NEW & NOTEWORTHY Hedgehog signaling is activated in human and experimental models of CP. Inhibition of hedgehog signaling using an FDA-approved inhibitor, vismodegib, leads to the resolution of fibrosis and improves CP. This study has immense and immediate translational benefits.

Retroduodenal lymphangiomyoma: A rare cause of abdominal pain - A case report

BACKGROUND

Lymphangiomyomas are rare benign tumors arising from the lymphatic system, most commonly found in the retroperitoneum. Retroduodenal lymphangiomyomas are exceedingly rare and present significant diagnostic challenges due to their nonspecific symptoms and overlapping features with other retroperitoneal and gastrointestinal pathologies.

CASE PRESENTATION

We report a 48-year-old man with persistent abdominal pain lasting several weeks. Clinical examination and laboratory investigations were unremarkable. Gastroscopy revealed no abnormalities. Contrast-enhanced computed tomography (CT) identified a well-demarcated, non-enhancing retroduodenal soft tissue lesion measuring 36 mm × 30 mm with punctate calcifications, suggestive of a benign process. Endosonography confirmed the lesion's location between the aorta and inferior vena cava. A fine-needle biopsy was avoided due to the lesion's vascular nature. Surgical excision was performed, and histopathological analysis revealed anastomosing vascular channels with smooth muscle proliferation, confirming the diagnosis of lymphangiomyoma. Postoperative recovery was uneventful, and follow-up imaging showed no recurrence.

DISCUSSION

This case underscores the importance of a multidisciplinary approach involving radiology, surgery, and pathology in the diagnosis and management of retroduodenal lymphangiomyomas. Contrast-enhanced CT and histopathology are critical in distinguishing lymphangiomyomas from other retroperitoneal masses. Complete surgical excision remains the definitive treatment to prevent recurrence.

CONCLUSION

Although rare, retroduodenal lymphangiomyomas should be considered in the differential diagnosis of retroperitoneal masses with nonspecific symptoms.

Pancreatic β-cell Function is Higher in Morning Versus Intermediate Chronotypes With Obesity

Objectives

People with later chronotypes are at greater T2D risk, yet it is unknown if β-cell function differs among chronotypes. Thus we, assessed β-cell function in morning (MORN) and intermediate (INT) chronotypes with obesity.

Methods

Adults (n = 41, 9M, 55 ± 1.7 y, 36.8 ± 1.0 kg/m2) were grouped as MORN or INT per the Morningness-Eveningness Questionnaire. Glucose, insulin, C-peptide, GIP, and GLP-1(active) were collected every 30 min during a 120 min 75g-OGTT. Insulin secretion rates (ISR) were calculated (regularized deconvolution) to assess early (total area under the curve; tAUC0-30min) and total-phase (tAUC0-120min) glucose-stimulated insulin secretion (GSIS:ISR/Glucose). Skeletal muscle (glucose infusion rate/steady-state insulin) insulin sensitivity and hepatic (HOMA-IR) as well as adipose (Adipose-IR) insulin resistance were assessed during a 120 min euglycemic hyperinsulinemic clamp (40mU/m2/min, 90 mg/dL). β-cell function (disposition index (DI): GSIS adjusted insulin sensitivity) was determined. Body composition (DXA) and fitness (VO2max) were also measured.

Results

Age, body composition and VO2max were similar between groups, but INT had reduced muscle insulin sensitivity and higher hepatic and adipose IR (p < 0.05). INT had higher C-peptide tAUC0-30min (p = 0.04) and lower hepatic DI (tAUC0-30min p = 0.05 and tAUC0-120min p = 0.07, respectively). Early phase hepatic DI correlated with GLP-1 tAUC0-30min (r = 0.35, p < 0.02) and tAUC0-120min (r = -0.40, p = 0.04).

Conclusions

β-cell function was higher in MORN versus INT chronotypes. Further work is warranted to discern how chronotype impacts insulin secretion.

Trial Registration

NCT03355469.

Evaluating the adherent perinephric fat risk score in East Asian populations and its correlation with non-alcoholic fatty liver disease

BACKGROUND AND AIMS

This study evaluated the predictive value of the APF risk score in East Asian patients undergoing open nephrectomy and its correlation with hypertension and NAFLD.

METHODS AND RESULTS

A retrospective study used the clinical data of 82 patients who underwent ON between January 2010 and December 2022. Per their APF score, patients were categorized into groups A (0-2 points) and B (3-4 points). Logistic regression analyses were used to compare the overall clinical data between the two groups and identify potential risk factors. Intraoperative APF prevalence was significantly higher in group B compared to group A (P < 0.001). Group B patients were older (63.06 ± 8.88 vs. 53.69 ± 15.21 years) and had higher incidences of hypertension (P < 0.001), diabetes (P = 0.002), and NAFLD (P < 0.001). Preoperative CT scans showed significant differences in posterior (P = 0.009) and lateral perinephric fat thickness (P < 0.001), and perinephric stranding (P < 0.001). Group B also had a higher proportion of malignant tumors (P = 0.039). Multivariate logistic regression revealed that NAFLD (OR = 9.053, P = 0.010) and hypertension (OR = 5.181, P = 0.025) were highly correlated with APF risk scores.

CONCLUSIONS

In this study, we found that the newly developed APF risk score had significant value in predicting APF in East Asian patients undergoing open nephrectomy. Additionally, NAFLD and hypertension were highly correlated with elevated APF risk scores.

Diagnostic Value of Postsurgical Endoscopy

Background

In the last 3 decades, we have witnessed a significant shift from traditional surgical approaches to minimally invasive and robotic surgery for treating gastrointestinal (GI) conditions minimalizing the associated morbidity and mortality. Meanwhile, endoscopy has continually evolved, reshaping the landscape of both diagnostic and therapeutic procedures. The implementation of postsurgical endoscopy as a critical diagnostic tool is primarily due to its capabilities in early complication detection and providing a prompt therapy possibility, assessment of healing, management of symptoms, and surveillance for recurrence in malignancy cases.

Summary

This review will first delve into the history of endoscopic developments, explore the various available postoperative diagnostic tools, focusing particularly on endoscopy and showing some real-life examples.

Key Messages

As an essential diagnostic tool, postsurgical endoscopy plays a crucial role in the management of patients undergoing upper and lower GI surgeries. It is indispensable for ensuring an optimal postoperative result. The continuous advancements in endoscopic technology and techniques have significantly enhanced the diagnostic and therapeutic capabilities of this modality, solidifying its role in modern GI surgery. Integrating postsurgical endoscopy into routine clinical practice and learning curriculum for surgical residents is vital and essential for optimizing the postoperative care to ensure the best possible outcome for patients.

Exploring the link between celiac disease and obesity: a potential role of gut microbiome

BACKGROUND/AIMS

In today's age, celiac disease (CD) is no longer solely characterized by chronic diarrhea in a malnourished child. Obesity is gradually being acknowledged as part of CD's clinical course. Both conditions have been linked to alterations of gut microbiome. Given the difficulty of strict gluten-free diet adherence, there is a need for less restrictive adjunctive therapies. We aimed to investigate the prevalence of obesity in patients diagnosed with CD with the goal of developing new therapeutic approaches.

METHODS

Baseline data from the National Institute of Health's All of Us Research Program, was used to evaluate the relationship between CD and obesity. A retrospective cohort study was conducted where groups of individuals with CD and without CD were matched by age range and health surveys. Statistical analysis with odds ratios (OR) with 95% confidence intervals (CI) were reported.

RESULTS

The prevalence of obesity was 32.6% in the CD group compared to 18.4% in the control group (OR, 2.111; 95% CI, 1.914-2.328; P< 0.0001). Women accounted for a greater population of patients with CD and obesity. The largest percentage of patients with CD and obesity were older than 65 years. The highest percentage of individuals in both the experimental and control groups were white, followed by African Americans.

CONCLUSIONS

Our data shows a significant association between CD and increased prevalence of obesity. These results warrant further investigation into microbial changes and dietary exposures that affect the pathogenesis of both diseases.

Adherence to a gluten-free diet, depression, and nutrient distribution in participants with celiac disease

BACKGROUND

Celiac disease (CD) presents formidable challenges, requiring rigorous adherence to a gluten-free diet (GFD) AIM: In this study we probed the impact of GFD on depression in people with CD, analyzing depression prevalence across diverse backgrounds and scrutinizing the distribution of macro- and micronutrients.

METHODS

Comprehensive data spanning National Health and Nutrition Examination Survey cycles (2009-2014) encompassed 70 CD participants and 271 individuals reporting general gluten issues. Employing SAS v9.4, merged cycles were scrutinized using unique identifiers, bolstered by sample weight and study design that reduced bias.

RESULTS

While linear regression uncovered no significant depression, CD/GFD link and ethnicity exhibited notable significance. CD prevalence registered at 0.12 in Whites, a striking 3 to 6 times higher compared to other ethnic groups, with females encountering twice the prevalence. Nutritional deficits surfaced within both CD and GFD contexts, inclusive of negative correlations between carbohydrate intake and CD/GFD. The GFD cohort displayed reduced PUFA consumption, while deficiencies in essential micronutrients, encompassing Vitamins B1, D, and E, as well as calcium, also emerged prominently with the GDF group.

CONCLUSION

This study delved into the intricate interplay of dietary, mental health, and CD factors, furnishing comprehensive insights and a holistic framework for optimal management strategies for CD patients.

The Association Between Obesity and Malignant Progression of Barrett's Esophagus: A Systematic Review and Dose-Response Meta-Analysis

BACKGROUND AND AIMS

Obesity is a risk factor for both Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). However, it is unclear whether obesity drives the malignant progression of BE. We aimed to assess whether obesity is associated with high-grade dysplasia (HGD) or cancer in patients with BE.

METHODS

We searched MEDLINE and EMBASE from inception through April 2024 for studies reporting the effect of body mass index (BMI) on the progression of nondysplastic BE or low-grade dysplasia (LGD) to HGD or EAC. A 2-stage dose-response meta-analysis was performed to estimate the dose-response relationship between BMI with malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale.

RESULTS

Twenty studies reported data on 38,565 patients (74.4% male) in total, of whom 1684 patients were diagnosed with HGD/cancer. Nineteen studies were considered moderate to high quality. Eight cohort studies reported data on 6647 male patients with baseline nondysplastic BE/LGD, of whom 555 progressed to HGD/EAC (pooled annual rate of progression, 0.02%; 95% confidence interval [CI], 0.01%-0.03%), and 1992 female patients with baseline nondysplastic BE/LGD, with 110 progressors (pooled annual rate of progression, 0.01%; 95% CI, 0.01%-0.02%). There was no significant difference in pooled annual rate of progression between males and females (P = .15). Each 5-kg/m2 increase in BMI was associated with a 6% increase in the risk of malignant progression (adjusted odds ratio, 1.06; 95% CI, 1.02-1.10; P < .001; I2= 0%).

CONCLUSION

Our meta-analysis provides some evidence that obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship. This finding requires confirmation in future high-quality cohort studies. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BE. PROSPERO, Number: CRD42017051046.

Toll-like receptor 4 deficiency ameliorates experimental ileitis and enteric neuropathy: Involvement of nitrergic and 5-hydroxytryptaminergic neurotransmission

BACKGROUND AND PURPOSE

Inflammatory bowel disease (IBD) patients display genetic polymorphisms in toll-like receptor 4 (TLR4) genes, contributing to dysregulate enteric nervous system (ENS) circuits with increased levels of 5-HT and alteration of the neuroimmune crosstalk. In this study, we investigated the impact of TLR4 signalling on mouse ENS dysfunction caused by dextran sulphate sodium (DSS)-induced ileitis.

EXPERIMENTAL APPROACH

Male C57BL/6J (wild-type [WT]) and TLR4-/- mice (10 ± 2 weeks old) received 2% DSS in drinking water for 5 days and then were switched to 3-day regular drinking water. Histological analysis and proinflammatory cytokine mRNA levels were assessed in ileal samples. Gut motility was evaluated by changes in transit of a fluorescent-labelled marker and isometric neuromuscular responses of ileal full-thickness segments to receptor and non-receptor-mediated stimuli. Alterations in ENS architecture were assessed by confocal immunohistochemistry in longitudinal muscle-myenteric plexus whole-mount preparations.

KEY RESULTS

In WT mice, DSS treatment caused delayed gastrointestinal transit, ileal myenteric neurodegeneration, reactive gliosis and release of proinflammatory cytokines. Enhanced cholinergic and tachykinergic excitatory tone, increased inducible nitric oxide synthase (iNOS)-mediated relaxation, and changes in 5-HT2A and 5-HT3 receptor-mediated responses were observed during ileitis in WT mice. TLR4 deficiency reversed most of the functional and morphological abnormalities.

CONCLUSION AND IMPLICATIONS

Our results demonstrate that TLR4 activity influences the severity of ileitis, neuroglial plasticity, gut motility, and nitrergic and 5-HTergic neurotransmissions. The neuroimmune interaction between TLR4 and 5-HT observed in our study appears to be a potential pharmacological target to treat ENS dysfunction implicated in IBD onset/progression.

Percutaneous biliary drainage: a superior option in select cases of acute cholangitis: a case report

Acute cholangitis is a severe, potentially life-threatening condition, frequently occurring post-ERCP. While endoscopic drainage is the preferred first-line treatment, percutaneous biliary drainage (PTBD) is a crucial alternative in select cases. We present a 55-year-old patient with prior left hemicolectomy and liver metastasis treatment developed acute cholangitis following failed ERCP stent placement, leading to rapid deterioration. Due to high anesthetic risk, ultrasound-guided PTBD with an 8 Fr pigtail catheter was performed under local anesthesia, resulting in significant clinical improvement. Broad-spectrum antibiotics targeted Escherichia coli. The misplaced stent was subsequently replaced, and the patient was discharged on postoperative Day 9 with normalized bilirubin and coagulation. Follow-up confirmed good drain tolerance and recovery. This case underscores PTBD's critical role when endoscopic drainage fails. A multidisciplinary approach and early intervention are essential to improving outcomes in acute cholangitis management.

Clinical relevance of calprotectin in patients with perianal fistulas in Crohn's disease and cryptoglandular fistulas

BACKGROUND AND AIMS

Previous literature suggests that faecal calprotectin (FC) discriminates Crohn's disease perianal fistulas from cryptoglandular fistulas, irrespective of luminal disease. This study aims to prospectively validate this and analyse if increased local fistula calprotectin levels are associated with fistula characteristics.

METHODS

In this prospective study, all consecutive patients with an active perianal fistula undergoing examination under anaesthesia were included. Faecal and fistula tract scraping calprotectin levels were determined. The primary objective was to analyse whether FC levels could be used to differentiate between Crohn's disease and cryptoglandular perianal fistulas. Secondary outcome parameters were the levels of local calprotectin in fistula scrapings and their correlation with fistula characteristics.

RESULTS

Sixty-three patients were included in this study (perianal Crohn's disease; 45, cryptoglandular; 18). Faecal calprotectin levels were significantly higher in Crohn's disease patients compared with cryptoglandular fistula (354.3 [58.8-1076.3] vs. 47.3 [14.6-233.6] μg/g, p = 0.003). Faecal calprotectin could accurately discriminate Crohn's disease patients with active luminal disease from patients without luminal disease (median [interquartile range]) (1167.0 [557.0-2806.3] vs. 93.0 [47.5-571.6] μg/g, p = 0.001). Faecal calprotectin was not related to calprotectin levels in fistula scrapings. No fistula characteristic was found to be correlated to scraping calprotectin, but a correlation was found with the TOpCLASS classification system, which stratifies fistulas according to disease severity and outcome: class 2a (amenable for repair), class 2b (symptom control) and class 2c (gradually debilitating disease): 140[31.0-149.0]) μg/g versus 706[198.5-1936] μg/g versus 4000[1337-5894] μg/g, p < 0.001). Scraping calprotectin was also related to pronounced hyperintensity of the fistula tract on MRI in Crohn's disease patients: (69.0[30.0-821.0] vs. 1284.0[204.3-4185.5]; p = 0.01)) and cryptoglandular patients: (30.0[13.5-80.5] vs. 3012.0 [923.8-5021.0]; p = 0.002).

CONCLUSION

Crohn's disease and cryptoglandular perianal fistulas differ in FC levels. Local fistula calprotectin production did not explain this difference, implying FC reflects the luminal condition. A correlation exists between scraping calprotectin levels and Crohn's disease fistula severity, which could be clinically relevant for prognostic cohorts and tailored treatment.

Understanding the role of nutritional status on the outcomes of nonvariceal upper gastrointestinal bleeding: Findings from a retrospective cohort analysis

BACKGROUND & AIMS

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization worldwide. Malnutrition, on the other hand, varies in prevalence and closely correlates with age and comorbidities. Though malnutrition is linked to poor outcomes generally, its impact on NVUGIB patients remains unexplored.

METHODS

Using the National Readmission Database (NRD) from 2016 to 2020, we employed the International Classification of Diseases, 10th revision, Clinical Modifications (ICD-10-CM) codes to identify adult patients (aged ≥18 years) admitted with a principal diagnosis of NVUGIB. We further stratified NVUGIB hospitalizations based on the presence and severity of malnutrition. Utilizing a multivariate regression model, we assessed the impact of malnutrition on NVUGIB outcomes. STATA 14.2 was utilized for statistical analysis.

RESULTS

Out of the 742,592 adult patients admitted with NVUGIB, 76,603 (10.32 %) had malnutrition, categorized as mild to moderate (3.01 %), severe (4.00 %), and malnutrition of unspecified severity (3.29 %). After adjusting for confounding variables, all-cause in-hospital mortality due to NVUGIB was significantly higher in malnourished patients, corresponding to the severity of malnutrition (adjusted odds ratio [aOR] 1.83 & 3.52 in mild-moderate malnutrition and severe malnutrition respectively; P < 0.01). Similarly, malnutrition was associated with progressively higher odds of acute kidney injury (aOR 1.39 & 1.54 for mild-moderate and severe malnutrition, respectively), septic shock (aOR 2.41 & 5.12), hemorrhagic shock (aOR 1.71 & 2.16), and intensive care unit (ICU) admission (aOR 2.00 & 2.97), all increasing with malnutrition severity (P < 0.01). Procedural analysis showed lower odds of diagnostic EGD (aOR 0.95 & 0.92), EGD within 24 h (aOR 0.75 & 0.67), and overall EGD (aOR 0.80 & 0.66) in malnourished patients, but higher odds of rebleeding requiring repeat EGD (aOR 1.12 & 1.19) and radioembolization (aOR 2.04 & 2.75), both rising with malnutrition severity (P < 0.01). Finally, resource utilization estimated by total hospitalization charges, length of stay, discharge to rehabilitation facilities (aOR 1.99 & 2.66), and 30-day readmission rates (aOR 1.29 & 1.38) were also significantly higher among patients with malnutrition (P < 0.01).

CONCLUSION

Malnutrition exacerbates the outcomes of NVUGIB including higher in-hospital mortality rates, morbidity and resource utilization. Early identification and targeted management of malnutrition in NVUGIB patients are crucial to reducing adverse outcomes and optimizing healthcare resources.

Medical management of acute severe ulcerative colitis in the hospitalized patient

INTRODUCTION

Approximately one in every four patients with ulcerative colitis will develop acute severe ulcerative colitis (ASUC). Historically, this was managed with intravenous steroids and surgery when steroids failed. The use of rescue therapy.

AREAS COVERED

This review summarizes the latest research in the management of hospitalized patients with ASUC. Covering the historical data and success of rescue therapy with cyclosporine and then with infliximab changed outcomes and reduced the risk of colectomy during the hospitalization and at 1 year. More recently, more biologics and small molecules have been approved and more patients present to the hospital with ASUC already failing anti-tumor necrosis factor antagonists. More recent studies have shown some efficacy of rescue therapy with other classes of biologics (e.g. interleukins and anti-integrins). The more recently approved small molecules (i.e. tofacitinib and Upadacitinib) have shown a rapid onset in therapeutic efficacy in as little as 1 day with sustained response at 1 year in reducing the risk of colectomy following ASUC.

EXPERT OPINION

In the expert opinion, we discuss the challenges in the treatment of patients with ASUC. We summarize the data of current biologics and new small molecules and their emerging roles in the management of ASUC.

Immune Basis of Therapeutic Effects of Solanum tuberosum L. Polysaccharide on Chronic Peptic Ulcer Healing

Background/Objectives: Polysaccharides are complex molecules with a wide range of biological activities that can be used in various biomedical applications. In this work, the antiulcer effect and influence on the level of pro- and anti-inflammatory cytokines of Solanum tuberosum L. polysaccharide (STP) were studied. Methods: The antiulcer effect of STP was studied in the Okabe chronic peptic ulcer model by evaluating the influence of STP on the ulcer index in Wistar rats, comparing it to omeprazole and ranitidine. Dose-effect analysis was also carried out. The level of pro- and anti-inflammatory cytokines was studied using ELISA kits. Results: After treatment in the polysaccharide groups, ulcer healing is observed in 60-80% of cases, in the omeprazole group in 50%, and in the ranitidine group in 25%. STP intravenous injections lead to the formation of a more differentiated mucous membrane; no coarse scar tissue is formed, which is typical for control and comparison drugs. Glycan causes a significant acceleration of the healing of experimental peptic ulcers in rats. STP appears to modulate pro- and anti-inflammatory cytokines. On the fourth and tenth days, a significant decrease in the levels of pro-inflammatory cytokines IL-1b and IFN-γ was noted in the polysaccharide group compared to the control group, while the level of anti-inflammatory cytokine IL-4 significantly increased. Conclusions: Intravenous administration of STP leads to the restoration of functionality and effective tissue regeneration. The antiulcer activity of STP is based on the regulation of the pro- and anti-inflammatory balance.

Analysis of the molecular mechanisms of ulcerative colitis and atherosclerosis by microarray data

Adults can develop ulcerative colitis (UC), a chronic inflammatory illness of the colon, while atherosclerosis (AA) is a chronic inflammatory disease of the blood vessels caused by a range of risk factors. Prior research has demonstrated that UC increases the risk of AA, although the underlying pathological mechanisms are not entirely understood. The purpose of this work was to discover differentially expressed genes (DEGs) in UC and AA and investigate their molecular processes using a bioinformatics method. The UC (GSE36807) and AA (GSE28829) datasets were obtained from the Gene Expression Omnibus (GEO) database. Following the identification of genes that are differentially expressed in common with UC and AA, functional annotation, the construction of protein-protein interaction (PPI) networks and modules, the identification of hub genes, and co-expression analysis were carried out. A total of 105 (including 92 up-regulated and 13 down-regulated genes) DEGs were selected for correlation analysis in the above two datasets, and after Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional analysis immune responses, cytokines, and chemokines were found to play crucial roles in both diseases. Finally, a total of 16 hub genes were identified by CytoHubba and MCODE plugins in Cytoscape, including Chemokine (C-C motif) ligand 4(CCL4), Toll-like receptor 2 (TLR2), Integrin Beta 2(ITGB2), Chemokine (C-C motif) Receptor 1(CCR1), Toll-Like Receptor 8 (TLR8), Fc Fragment of IgG Receptor IIa (FCGR2A), Neutrophil Cytosolic Factor 2(NCF2), Leukocyte immunoglobulin-like receptor B2(LILRB2), FGR proto-oncogene, Src family tyrosine kinase(FGR), Intercellular Adhesion Molecule 1 (ICAM1), Caspase 1(CASP1), Matrix Metallopeptidase 9(MMP9), Cluster of Differentiation 163(CD163), Complement Component 5a Receptor 1 (C5AR1), Neutrophil Cytosolic Factor 4 (NCF4), Selectin P (SELP). This study discovered a link between UC and AA, as well as shared hub genes and pathways, which may bring new insights into the processes of UC and AA.

Diuretics: a review of the pharmacology and effects on glucose homeostasis

Thiazides, thiazide-like and loop diuretics are commonly prescribed to manage hypertension and heart failure. The main mechanism of action of these diuretics involve inhibition of Na+ reabsorption in the kidneys, leading to increased urine production. While effective, diuretics, particularly hydrochlorothiazide, have been linked to altered glucose metabolism and other metabolic issues. These disruptions in fuel homeostasis are not clearly related to their primary action of fluid management, raising concerns for patients with metabolic syndrome, in which high blood pressure coexists with obesity, insulin resistance, glucose intolerance and dyslipidemia. In this review, we conducted an extensive examination of existing literature on these classes of diuretics, covering publications from the late 1950s to the present. Our objective was to investigate the origins, development and current understanding of the widely recognized association between the use of diuretics in general and their potential negative impact on glucose homeostasis. We focused on the clinical and experimental evidence of the most commonly prescribed diuretics: hydrochlorothiazide, chlorthalidone, bumetanide and furosemide. On one hand, the clinical evidence supports the hypothesis that the metabolic effects on glucose homeostasis are primarily linked to hydrochlorothiazide, with little, if any impact observed in other diuretics. In addition, these metabolic effects do not appear to be related to their diuretic action or intended pharmacological targets, raising concerns about the long-term metabolic impact of specific diuretics, particularly in vulnerable populations, including those with metabolic syndrome. On the other hand, the experimental evidence using animal models suggest variable effects of diuretics in insulin secretion and general glucose metabolism. Although the mechanisms involved are not clearly understood, further research is needed to uncover the molecular mechanisms by which certain diuretics disrupt fuel metabolism and contribute to metabolic disturbances.

Early diagnosis of Crohn's disease in patients presenting with a perianal fistula: systematic review and development of a perianal red flags index

BACKGROUND

Delay in diagnosing Crohn's disease (CD) in patients presenting with perianal abscess (PAA) and/or fistula (PAF) is common. The aim of this study was to identify red flags suggestive of CD.

METHODS

A systematic literature review was conducted to identify symptoms associated with CD in patients presenting with PAA/PAF. A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012-2023) at a single non-academic teaching hospital. All patients were asked to recall symptoms/signs experienced during their first PAF.

RESULTS

The systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (n = 2)/PAF (n = 6), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72-0.94]).

CONCLUSIONS

The perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.

Effectiveness of a bioenergy economy program versus mindfulness-based cognitive therapy on the severity and psychological symptoms of irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder causing a great burden on patients' lives due to its physical and psychological symptoms. Mindfulness-based cognitive therapy (MBCT) has previously alleviated IBS symptoms. Bioenergy economy (BEE) is a novel mind-body intervention that has shown moderating effects on many psychological and physical symptoms, particularly in chronic diseases. This research aimed to compare the effectiveness of MBCT and BEE on IBS symptom severity, somatic symptoms, depression, and anxiety.

MATERIALS AND METHODS

This study was conducted using a quasi-experimental method with a pre-test, post-test, and follow-up design with a control group in Isfahan, Iran. Forty-five patients with IBS were divided into two experimental and one control group (15 subjects in each group). The patients were assessed using the ROME III Diagnostic Criteria for IBS, IBS Severity Index (IBS-SI), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory, and Patient Health Questionnaire (PHQ-15) before and after the intervention. Data were analyzed using analysis of covariance, and SPSS-22 software was used.

RESULTS

The findings showed that MBCT and BEE both had significant effects on the IBS symptom severity, somatic symptoms, depression, and anxiety (P < 0.01), but there was no significant difference between the mean scores of the two experimental groups in any of the post-test or the follow-up stages (P > 0.05). This concludes that there was no difference between the effectiveness of MBCT and BEE programs (P > 0.05).

CONCLUSION

Although both interventions had significant results in improving patients' symptoms, the BEE program had a stronger and wider range of effectiveness.

Green-synthesized selenium-hydroxytyrosol nanocomposites attenuate hepatocellular carcinoma in rats by modulating oxidative stress, inflammation, and apoptosis

Hepatocellular carcinoma (HCC) poses a significant health risk and greatly affects global rates of illness and death, highlighting an urgent requirement for new treatment strategies. This study examines the therapeutic effects of selenium-hydroxytyrosol nanocomposites (Se-HTNPs) in a rat model with HCC caused by diethylnitrosamine (DEN). Treatment with Se-HTNPs significantly inhibited serum activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin, while increasing serum albumin and total protein levels. Oxidative stress was alleviated, as evidenced by a marked reduction in hepatic malondialdehyde (MDA) levels and an increase in antioxidant markers, such as reduced glutathione (GSH), superoxide dismutase (SOD), and total antioxidant capacity (TAC). Se-HTNPs also significantly decreased hepatic inflammatory markers, such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), as well as apoptotic markers (p53 and caspase-3) and vascular endothelial growth factor (VEGF). Furthermore, Se-HTNPs suppressed the mRNA expression of c-Jun N-terminal kinase (c-JNK) and nuclear factor kappa B (NF-κB) and improved histopathological alterations brought on by DEN. These findings suggest that Se-HTNPs mitigate DEN-induced HCC in rats through their potent antioxidant, anti-inflammatory, and anti-carcinogenic properties, underscoring their potential as a therapeutic strategy for HCC.

Mesothelin as a Signal Pathways and Epigenetic Target in Cancer Therapy

Mesothelin (MSLN), a glycoprotein-based tumor antigen, is elevated in several malignancies and it is related to a poor prognosis, as it enhances tumor aggression, dissemination and chemotherapy resistance. MSLN plays a crucial role in epigenetic and signal pathway regulation and it can be an important biomarker. MSLN targeting is in particular, associated with CA125/MUC16, which offers the potential to improve lung, pancreatic, colon and ovarian cancer detection as well as therapeutic strategies. MSLNtargeted therapies have shown favorable results, such as CAR NK cells, 227Th conjugate and CAR-T cells, which target mesothelin. Significant advancements can be achieved with novel techniques, such as mesothelin-targeting BiTEs and simultaneous CAR-T cells. Immunotherapies targeting mesothelin have the potential to completely transform the way cancer is therapy in patients with limited options. To fully comprehend the mechanisms of MSLN, more investigation is required to explore its role in cancer for improved patient outcomes. The complex control, cellular functions and clinical significance of MSLN in the advancement of cancer are highlighted in this review.

Zatariamultiflora hydroalcoholic extract: A triple-blind randomized controlled trial on immune genes, inflammation, and ulcerative colitis symptoms

ETHNOPHARMACOLOGICAL RELEVANCE

Zataria multiflora Boiss. (Shirazi thyme) is traditionally used for digestive disorders and inflammatory conditions. Despite its known anti-inflammatory, immunomodulatory, and antioxidant properties, there is limited clinical evidence on its efficacy for ulcerative colitis (UC).

AIM OF THE STUDY

To evaluate the effectiveness of Zataria multiflora Boiss. (Z. multiflora) extract in alleviating UC symptoms, reducing inflammatory markers, and modulating immune-related gene expression.

MATERIALS AND METHODS

In a multicenter, randomized, placebo-controlled, triple-blind trial in Iran, 92 participants received Z. multiflora extract (6 mg/kg/day) or a placebo for two months. Inflammatory markers and gene expression were analyzed from blood samples. Disease activity was assessed using the Partial Mayo Score (p-Mayo) and the Gastrointestinal Symptom Rating Scale (GSRS). Data were analyzed with SPSS software.

RESULTS

The Z. multiflora group showed significant reductions in C-reactive protein (CRP) (p < 0.001), Interleukin-17 (IL-17) (p = 0.001), Interferon-gamma (IFN-γ) (p = 0.002), Nuclear Factor kappa B (NF-κB) (p = 0.002), T-box Transcription Factor T-bet (T-bet) (p = 0.006), and Retinoic Acid-Related Orphan Receptor gamma t (ROR-γt) (p < 0.001). No significant changes were observed in Erythrocyte Sedimentation Rate (ESR) (p = 0.25), GATA Binding Protein 3 (GATA3) (p = 0.09), and Forkhead Box P3 (FOXP3) (p = 0.17). Symptoms such as heartburn, acid reflux, bloating, diarrhea, and fecal urgency improved (p < 0.05). The GSRS score improved (p < 0.001), while the p-Mayo score did not show a significant change (p = 0.24).

CONCLUSION

Z. multiflora extract significantly alleviated UC symptoms and reduced inflammatory markers, indicating its potential as a complementary treatment for UC. However, the study was limited by its short intervention period and the absence of biopsy analysis to assess local tissue effects. Further longitudinal studies are required to validate these findings and determine long-term efficacy.

RdxA-independent mechanism of Helicobacter pylori metronidazole metabolism

Introduction

Metronidazole (MNZ) is widely used to treat Helicobacter pylori infection worldwide. However, due to excessive and repeated use, resistance rates have exceeded 90% in some regions. The mechanisms of MNZ resistance have been extensively studied, and RdxA has been identified as the primary enzyme responsible for MNZ activation. Mutations in RdxA, particularly termination mutations, can lead to high-level MNZ resistance.

Methods

We identified a strain, ICDC15003s, which harbored RdxA termination mutation but remained highly susceptible to MNZ. To explore this phenomenon, we conducted comparative genomic and transcriptomic analyses to define RdxA-independent mechanisms of MNZ metabolism.

Results and discussion

We found missense mutations in genes such as yfkO, acxB, alr1, glk, and cobB. Additionally, the expression of multiple genes, including TonB-dependent receptor and mod, significantly changed in resistant strains. Notably, the sequences and expression levels of known nitroreductases like FrxA and FdxB remained unchanged after induction of MNZ resistance, suggesting they were not responsible for MNZ sensitivity in ICDC15003s. Instead, transcriptional alterations were observed in genes encoding NADH-quinone oxidoreductase subunit (M, J, H and K), suggesting a potential compensatory mechanism for the loss of RdxA activity. We proposed that NADH-quinone oxidoreductase might serve as an RdxA-independent mechanism for MNZ metabolism and resistance through regulation of its expression levels. This discovery could provide new strategies to address MNZ resistance and aid in developing nitroimidazole antibiotics.

Perspectives in clinical research on Azathioprine for steroid-dependent ulcerative colitis

This study explores the application of Azathioprine in the treatment of ulcerative colitis (UC) and the challenges associated with its long-term use. While short-term studies demonstrate the efficacy of Azathioprine in steroid-dependent UC, long-term data on its risks, including malignancies, infections, and chronic toxicity, remain insufficient. Furthermore, the impact of Azathioprine on patients' quality of life over extended periods is still unclear. The research highlights the importance of optimizing Azathioprine dosing based on genomic data, particularly through TPMT and NUDT15 genotyping, to minimize adverse effects. However, further research is needed to develop individualized treatment strategies that can improve efficacy and reduce toxicity. The identification of predictive biomarkers, through genomics and proteomics, is likely to play a crucial role in improving treatment precision by identifying patients who are most likely to benefit from Azathioprine therapy. Additionally, combining Azathioprine with biologic therapies (such as anti-TNF agents or integrin inhibitors) and interventions targeting the gut microbiome may enhance the drug's effectiveness while reducing reliance on steroids. Overall, large-scale clinical trials are urgently needed to evaluate the benefits and risks of these emerging therapies, ultimately supporting more personalized treatment approaches for steroid-dependent UC patients.

Efficacy and safety of Jinghua Weikang capsule combined with amoxicillin-furazolidone triple/quadruple therapies in the rescue treatment of Helicobacter pylori infection

Aim

To evaluate the efficacy and safety of Jinghua Weikang Capsule (JWC) combined with amoxicillin-furazolidone triple/quadruple therapies in the rescue treatment of drug-resistant H. pylori infection.

Methods

Patients who failed H. pylori eradication therapy at least once were enrolled and randomly assigned into four groups (1:1:1:1), as follows: The control group received 20 mg rabeprazole, 1,000 mg amoxicillin, 220 mg bismuth potassium citrate, and 100 mg furazolidone twice daily (b.i.d.) for 14 days; Group A received 240 mg JWC b.i.d. combined with 20 mg rabeprazole, 1,000 mg amoxicillin, and 100 mg furazolidone b.i.d. for 14 days; Group B received the same regimen as Group A for 14 days, followed by an additional 14 days of 240 mg JWC b.i.d.; and Group C received 240 mg JWC b.i.d. combined with 20 mg rabeprazole, 1,000 mg amoxicillin, 220 mg bismuth potassium citrate, and 100 mg furazolidone b.i.d. for 10 days. The primary outcome was H. pylori eradication at 4 weeks after treatment.

Results

Four hundred eighty-eight patients were included in this study. The intention-to-treat (ITT) eradication rates in the four groups were 85.2, 73.8, 78.7 and 75.4% (p = 0.136), while the modified intention-to-treat (MITT) eradication rates were 92.0, 84.9, 88.9 and 86.8% (p = 0.398), respectively. And the per-protocol (PP) eradication rates were 92.5, 85.4, 87.9 and 86.7% (p = 0.405), respectively. The eradication rates were comparable among the four groups. No statistically significant differences in eradication rates were observed between each of the three treatment groups and the control group (all p > 0.05). The eradication rate of H. pylori in group B demonstrated non-inferiority compared with the control group (p = 0.0415; 90% CI, -0.0965 to 0.0336). The four groups exhibited similar frequencies of overall adverse events (9.84, 5.74, 6.56%, 2.46%, p = 0.112).

Conclusion

The eradication rate of the JWC-containing regimen demonstrated no statistically significant difference compared with bismuth-containing quadruple therapy in the rescue treatment of H. pylori infection. The prolonged JWC treatment regimen exhibited non-inferiority in eradication rates. JWC-containing therapies can effectively reduce the incidence of adverse reactions and significantly alleviate certain clinical symptoms.

Clinical trial

https://clinicaltrials.gov/, identifier ChiCTR1800019326.

The role of shock indexes and RDW/albumin ratio in upper gastrointestinal bleeding : Predicting adverse outcomes

OBJECTIVE

Upper gastrointestinal bleeding (UGIB) is a common condition in emergency departments (ED). The aim of this study is to evaluate the effectiveness of the red blood cell distribution width (RDW) to albumin ratio and three types of shock index (SI) as predictors of adverse outcomes in patients with UGIB in the ED.

METHODS

The study was designed as a retrospective, single-center study, and patients were screened using electronic medical records. Glasgow Blatchford, RDW/albumin ratio, SI, modified SI (MSI), and age SI were calculated, and adverse outcomes were defined as ICU admission, red blood cell transfusion, in-hospital mortality, and 30-day mortality. The effectiveness of these parameters in predicting adverse outcomes in UGIB patients admitted to the ED was evaluated.

RESULTS

The study enrolled 174 patients, of whom 17.2% required admission to the ICU, 33.9% received red blood cell transfusions, and 10.3% died within 30 days. Patients with adverse outcomes had significantly higher SI, MSI, age SI, and RDW/albumin ratio values. All four indices were statistically significant predictors of adverse outcomes (area under the curve [AUC] SI: 0.676; AUC MSI: 0.706; AUC age SI: 0.778; AUC RDW/albumin: 0.787). Age SI showed significantly higher prognostic performance in predicting adverse outcomes than SI and MSI.

CONCLUSION

The present study suggests that SI, MSI, age SI, and RDW/albumin ratio may be useful in predicting adverse outcomes in patients with UGIB. The RDW/albumin ratio was effective in predicting mortality, while age SI showed a higher predictive ability for adverse outcomes compared to SI and MSI.

Presenting features and treatment of small intestinal adenomyosis in children: a 10-year retrospective study

Objective

This study aims to analyze and summarize the clinical characteristics of small intestinal adenomyosis.

Methods

A retrospective study was conducted on children with small intestinal adenomyosis at our center from 2014 to 2024. The age of onset, gender, clinical symptoms, auxiliary examination results, treatment plans, and pathological characteristics of the tumors were recorded and analyzed.

Results

Six cases of small intestinal adenomyosis were analyzed. The male-to-female ratio was 5:1. The median age was 19 months, with two-thirds of the affected children being under 2 years old. Two cases were identified in newborns during the treatment of intestinal malrotation. The remaining patients developed symptoms of intussusception. Preoperative ultrasound identified pathological lead points in two cases. Among the six cases, one case's adenomyoma was located in the jejunum, while the rest was located in the ileum, with tumors ranging from 25 to 140 cm from the ileocecal region. All six patients underwent resection of the tumor segments in the small intestine followed by anastomosis; postoperative prognosis was favorable. Of the six pathological results, glandular-like structures were found in five tumors, with three cases lined with cuboidal or columnar epithelium and one case lined with stratified or squamous epithelium.

Conclusions

Small intestinal adenomyosis is observed to be more prevalent in male, with onset ages ranging from six days to four years. It frequently coexists with recurrent intussusception, making reduction with air or water enema challenging. Abdominal ultrasound typically shows tumors at the leading edge of the intussusception, with compromised blood flow signals and multiple small cystic or honeycomb-like anechoic structures. Surgery is the primary treatment and generally results in a favorable prognosis.

Evaluation of biological therapies in autoimmune hepatitis: A case-based systematic review

BACKGROUND

Autoimmune hepatitis (AIH) is typically treated with immunomodulators and steroids. However, some patients are refractory to these treatments, necessitating alternative approaches. Biological therapies have recently been explored for these difficult cases.

AIM

To assess the efficacy and safety of biologics in AIH, focusing on patients unresponsive to standard treatments and evaluating outcomes such as serological markers and histological remission.

METHODS

A case-based systematic review was performed following the PRISMA protocol to evaluate the efficacy and safety of biological therapies in AIH. The primary focus was on serological improvement and histological remission. The secondary focus was on assessing therapy safety and additional outcomes. A standardized search command was applied to MEDLINE, EMBASE, and Cochrane Library databases to identify relevant studies. Inclusion criteria encompassed adult AIH patients treated with biologics. Data were analyzed based on demographics, prior treatments, and therapy-related outcomes. A narrative synthesis was employed to address biases and provide a comprehensive overview of the evidence.

RESULTS

A total of 352 studies were reviewed, with 30 selected for detailed analysis. Key findings revealed that Belimumab led to a favourable response in five out of eight AIH patients across two studies. Rituximab demonstrated high efficacy, with 41 out of 45 patients showing significant improvement across six studies. Basiliximab was assessed in a single study, where the sole patient treated experienced a beneficial outcome. Additionally, a notable number of AIH cases were induced by anti-tumor necrosis factor (TNF) medications, including 16 cases associated with infliximab and four cases with adalimumab. All these cases showed improvement upon withdrawal of the biologic agent.

CONCLUSION

Belimumab and Rituximab show promise as effective alternatives for managing refractory AIH, demonstrating significant improvements in clinical outcomes and liver function. However, the variability in patient responses to different therapies highlights the need for personalized treatment strategies. The risk of AIH induced by anti-TNF therapies underscores the need for vigilant monitoring and prompt symptom recognition. These findings support the incorporation of biologic agents into AIH treatment protocols, particularly for patients who do not respond to conventional therapies.

Genetic factors that predict response and failure of biologic therapy in inflammatory bowel disease

Inflammatory bowel disease (IBD) represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients' quality of life. Effective diagnostic strategies involve clinical assessments, endoscopic evaluations, imaging studies, and biomarker testing, where early diagnosis is essential for effective management and prevention of long-term complications, highlighting the need for continual advancements in diagnostic methods. The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance. Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics. Through an in-depth examination of current literature, this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD. Understanding these genetic actors paves the way for personalized approaches, informing clinicians on predicting, tailoring, and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.

Unlocking the potential of Radix Astragali and its active ingredients in gastric ulcer therapy

We studied the protective effects of Radix Astragali (RA) on gastric ulcer (GU). A literature search was conducted using databases from Web of Science, PubMed, Springer, ScienceDirect, Science Direct Chinese National Knowledge Infrastructure (CNKI), and Wanfang. The inclusion criteria for this study were limited to reports on the effects of RA, AS-IV, cycloastragenol, astragalus polysaccharide (APS), and astragalosides (AST) in the treatment of gastric ulcers. Any studies involving gastric lesions that were precancerous or cancerous were eliminated. The search period was from database inception through June 2024. The results suggested RA hold promiseas potential novel therapeutics for the therapy of GU.

Protective effects of human breast milk-derived exosomes on inflammatory bowel disease through modulation of immune cells

Human breast milk (HBM)-derived exosomes play a crucial role not only in infant nutrition but also in modulating inflammation, immunity, and epithelial cell protection. This study investigated how HBM-derived exosomes regulate immune cell development and function. The exosomes promoted the differentiation of naïve CD4+ T cells into Treg and Th2 cells while suppressing their differentiation into Th17 and Th1 cells. They also enhanced the proliferation of intestinal epithelial Caco-2 cells and reduced apoptosis in dextran sulfate sodium (DSS)-damaged caco-2 cells. In a DSS-induced colitis mouse model, the exosomes significantly alleviated disease severity, as evidenced by improvements in colon length, disease activity index, and histology grades. Furthermore, the exosomes normalized CD4+ T cell subsets in the spleen, mesenteric lymph nodes, and colon, restoring levels comparable to controls. These findings suggest that HBM-derived exosomes hold promise as a potential therapeutic strategy for inflammatory bowel disease by modulating T-cell responses and protecting intestinal epithelial cells.

Diverse Subsets of γδT Cells and Their Specific Functions Across Liver Diseases

γδT cells, a distinct group of T lymphocytes, serve as a link between innate and adaptive immune responses. They are pivotal in the pathogenesis of various liver disorders, such as viral hepatitis, nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), liver fibrosis, autoimmune liver diseases, and hepatocellular carcinoma (HCC). Despite their importance, the functional diversity and regulatory mechanisms of γδT cells remain incompletely understood. Recent advances in high-throughput single-cell sequencing and spatial transcriptomics have revealed significant heterogeneity among γδT cell subsets, particularly Vδ1+ and Vδ2+, which exhibit distinct immunological roles. Vδ1+ T cells are mainly tissue-resident and contribute to tumor immunity and chronic inflammation, while Vδ2+ T cells, predominantly found in peripheral blood, play roles in systemic immune surveillance but may undergo dysfunction in chronic liver diseases. Additionally, γδT17 cells exacerbate inflammation in NAFLD and ALD, whereas IFN-γ-secreting γδT cells contribute to antiviral and antifibrotic responses. These discoveries have laid the foundation for the creation of innovative solutions. γδT cell-based immunotherapeutic approaches, such as adoptive cell transfer, immune checkpoint inhibition, and strategies targeting metabolic pathways. Future research should focus on harnessing γδT cells' therapeutic potential through targeted interventions, offering promising prospects for precision immunotherapy in liver diseases.

Comparative analysis of Parkinson's and inflammatory bowel disease gut microbiomes reveals shared butyrate-producing bacteria depletion

Epidemiological studies reveal that inflammatory bowel disease (IBD) is associated with an increased risk of Parkinson's disease (PD). Gut dysbiosis has been documented in both PD and IBD, however it is currently unknown whether gut dysbiosis underlies the epidemiological association between both diseases. To identify shared and distinct features of the PD and IBD microbiome, we recruited 54 PD, 26 IBD, and 16 healthy control individuals and performed the first joint analysis of gut metagenomes. Larger, publicly available PD and IBD metagenomic datasets were also analyzed to validate and extend our findings. Depletions in short-chain fatty acid (SCFA)-producing bacteria, including Roseburia intestinalis, Faecalibacterium prausnitzii, Anaerostipes hadrus, and Eubacterium rectale, as well depletion in SCFA-synthesis pathways were detected across PD and IBD datasets, suggesting that depletion of these microbes in IBD may influence the risk for PD development.

Risk of progression to high-grade intraepithelial neoplasia and gastric cancer: A multi-center prospective study in Anhui Province, China

BACKGROUND

Gastric cancer is one of the most common cancers worldwide, especially in East Asia.

AIM

To explore the clinical outcomes and progression-related factors of low-grade intraepithelial neoplasia (LGIN) in the gastric mucosa and provide valuable guidance for improving treatment efficacy.

METHODS

A total of 357 patients diagnosed with LGIN based on initial pathological examination in Anhui Provincial Hospital or three other medical consortium units between January 2022 and June 2024 were included. Among them, 296 patients were followed up with endoscopic and biopsy pathology. Logistic regression was utilized to analyze the relevant risk factors for LGIN progression in the gastric mucosa.

RESULTS

The distribution sites of LGIN among the 357 patients were as follows: Gastric antrum (54.6%), gastric cardia (24.1%), gastric angulus (8.7%), gastric body (4.8%), gastric fundus (4.8%), and multiple sites (3.1%). Additionally, of the 357 patients with LGIN, 112 (31.4%) developed ulceration and 59 (16.5%) experienced gastric polyps. Furthermore, 231 of the 357 (64.71%) patients with LGIN tested positive for Helicobacter pylori (H. pylori) infection. The H. pylori infection rates of the patients with LGIN with accompanying atrophy, intestinal metaplasia, and gastric ulcer were 51.95%, 59.31%, and 28.57%, respectively. Multivariate logistic regression analysis showed that age ≥ 60 years [odds ratio (OR) = 3.063, 95% confidence interval (CI): 1.351-6.945, P = 0.007], H. pylori infection (OR = 3.560, 95%CI: 1.158-10.949, P = 0.027), multiple locations (OR = 10.136, 95%CI: 2.045-50.237, P = 0.005), lesion size ≥ 2 cm (OR = 3.921, 95%CI: 1.664-9.237, P = 0.002), and gastric ulcer (OR = 2.730, 95%CI: 1.197-6.223, P = 0.017) were predictive factors for LGIN progression.

CONCLUSION

LGIN progression is closely related to age, H. pylori positivity, multiple locations, lesion size ≥ 2 cm, and gastric ulcer. Thus, actively identifying these risk factors in patients with LGIN may have certain clinical significance in preventing further tumor progression.

Deep representation learning for clustering longitudinal survival data from electronic health records

Precision medicine requires accurate identification of clinically relevant patient subgroups. Electronic health records provide major opportunities for leveraging machine learning approaches to uncover novel patient subgroups. However, many existing approaches fail to adequately capture complex interactions between diagnosis trajectories and disease-relevant risk events, leading to subgroups that can still display great heterogeneity in event risk and underlying molecular mechanisms. To address this challenge, we implemented VaDeSC-EHR, a transformer-based variational autoencoder for clustering longitudinal survival data as extracted from electronic health records. We show that VaDeSC-EHR outperforms baseline methods on both synthetic and real-world benchmark datasets with known ground-truth cluster labels. In an application to Crohn's disease, VaDeSC-EHR successfully identifies four distinct subgroups with divergent diagnosis trajectories and risk profiles, revealing clinically and genetically relevant factors in Crohn's disease. Our results show that VaDeSC-EHR can be a powerful tool for discovering novel patient subgroups in the development of precision medicine approaches.