Comparative efficacy of different bowel preparations for colonoscopy: A network meta-analysis

BACKGROUND AND AIMS

The quality of a colonoscopy is heavily reliant on the effectiveness of bowel cleansing. Various cleansing solutions are currently available, but their comparative efficacy remains uncertain. This systematic review and network meta-analysis aims to compare the performance of different bowel preparations for colonoscopy.

METHODS

MEDLINE, Embase, Scopus, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing the efficacy of different bowel preparations. The primary outcome was cleansing success (CS), and the secondary outcome was adenoma detection rate (ADR).

RESULTS

On network meta-analysis for CS (22 RCTs, 7179 patients, 14 bowel preparations), 2 L PEG + simethicone (RR = 1.25 [95 %CI = 1.13-1.37]), 2 L PEG + lactulose (RR = 1.22 [95 %CI = 1.10-1.38]) and 1 L PEG + ascorbate (ASC) (RR = 1.03 [95 %CI = 1.01-1.06]) were significantly superior to 2 L PEG + ASC. Overall, 2 L PEG + lactulose resulted as the best product (SUCRA 0.94), followed by 2 L PEG + simethicone (SUCRA 0.93). On network meta-analysis for ADR (17 RCTs, 6639 patients, 11 bowel preparations), only 2 L PEG + simethicone (RR = 1.60 [95 %CI = 1.05-2.43]) resulted significantly superior to 2 L PEG + ASC.

CONCLUSIONS

2 L PEG + simethicone, 2 L PEG + lactulose, and 1 L PEG + ASC seemed to provide high rates of CS, albeit only 2 L PEG + simethicone was associated with significantly higher ADR. Consequently, these products should be preferred for bowel preparation of colonoscopy. Further randomized studies with adequate sample sizes are needed for a more accurate comparison of these products on ADR.

Progress in research of non-coding RNAs in colorectal cancer and their application in early diagnosis

Colorectal cancer is one of the common malignant tumors in the digestive system worldwide, with its incidence and mortality rates ranking high among various diseases. Although certain advancements have been achieved in the diagnosis and treatment techniques of colorectal cancer in recent years, the existing diagnostic means and treatment methods still present numerous limitations, significantly influencing the early detection, precise diagnosis, and individualized treatment of colorectal cancer. With the in-depth research of molecular biology, non-coding RNAs (ncRNAs) have gained increasing attention in the development and prognosis evaluation of colorectal cancer. This paper summarizes some studies related to the expression of different types of ncRNAs in colorectal cancer and selects a portion of ncRNAs that are expected to serve as new diagnostic indicators for this malignancy. The emergence of new biological indicators will contribute to the early diagnosis of colorectal cancer, facilitating its early detection and even prevention.

Diagnostic value of vascular endothelial growth factor (VEGF) levels in gastrointestinal cancers with ascites - A cross sectional study

Objective

Malignant ascites is suggestive of peritoneal carcinomatosis. The distinction between malignant and non-malignant ascites in a patient with malignancy is important, as it alters the management and prognosis. Current diagnostic methods are imaging, cytology, and diagnostic laparoscopy, all of which have low sensitivities. The vascular endothelial growth factor (VEGF) is essential for tumour growth and, hence, ascitic VEGF levels can be a diagnostic method for malignant ascites.

Material and Methods

This cross-sectional study was conducted in patients with gastrointestinal malignancies and ascites. The calculated sample size was 68 patients, who were divided into those who were truly positive or negative for malignant ascites based on a composite gold standard, comprising cytology, contrast enhanced computed tomography, and laparoscopy. The ascitic VEGF levels in these patients were compared.

Results

A total of 84 patients were enrolled, of whom 60.71% were found to have malignant ascites. It was found that the greater the volume of ascites, the greater the statistical likelihood of finding truly malignant ascites. The ascitic VEGF levels had a non-normal distribution, with median values of 783.64 and 41.12 pg/mL for malignant and non-malignant ascites (p<0.001). Using a receiver operating characteristics curve, a cut-off of 83.68 pg/mL was obtained, with a sensitivity of 100% and a specificity of 93.94%.

Conclusion

This study demonstrates that ascitic VEGF levels are significantly elevated in patients with gastrointestinal malignancies and malignant ascites and hence can reliably be used for diagnosing malignant ascites. This study also shows that massive ascites and well-differentiated tumours have a higher rate of peritoneal carcinomatosis.

Astragalin inhibits neuronal excitability and activates neuronal autophagy in the ACC and LH of CFA mice to alleviate inflammatory pain and pain-related emotions

Astragalin (AST), a natural flavonoid, exhibits anti-inflammatory, anti-cancer, and antioxidant properties. However, its effects and molecular mechanisms in inflammatory pain remain unclear. Therefore, this study aims to investigate the impact of AST on a Complete Freund's Adjuvant (CFA)-induced inflammatory pain mouse model and to elucidate its potential mechanisms. We employed behavioral tests, including the paw withdrawal test (PWT) and open field test (OFT), to assess pain thresholds and emotional changes in mice, while ELISA was utilized to measure the expression of inflammatory factors. Western blot analysis was performed to evaluate the expression of autophagy-related proteins, c-Fos, and pathway-related proteins. Additionally, immunofluorescence staining was conducted to assess the co-localization of neurons with autophagy-related factors and c-Fos. Our findings indicate that AST significantly reduces pain sensitivity and anxiety-like behaviors in CFA mice, similar to the analgesic Naproxen (NAP). AST treatment inhibited the expression of c-Fos, a neuronal excitability marker, in the ACC and LH of CFA mice, while upregulating the expression of autophagy-related proteins. Furthermore,AST modulates the expression of proteins associated with the CXCR4-Beclin1/VPS34 signaling pathway. In conclusion, these results suggest that AST inhibits neuronal excitability and enhances autophagy by modulating the CXCR4-Beclin1/VPS34 signaling pathway in the ACC and LH of CFA mice, leading to a reduction in pain sensitivity and anxiety-like behaviors, thereby producing analgesic effects. This study reveals a novel mechanism for the potential use of AST in the treatment of inflammatory pain and pain-related emotions, offering a promising strategy for clinical applications.

Clinical impact of endoscopy in severely thrombocytopenic patients with hematologic malignancy experiencing gastrointestinal bleeding

BACKGROUND

Gastrointestinal bleeding (GIB) is a major cause of hospitalization worldwide. Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction. There is no consensus on the optimal platelet level that would be safe for endoscopic intervention, although a platelet level of > 50 × 109 / L was suggested based on expert opinion. There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.

AIM

To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.

METHODS

This is a single center retrospective study. The data was collected from the electronic health record from 2018 to 2020. Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count ≤ 50 × 109/L were included in the study. Outcomes included mortality, transfusion requirements, length of stay, intensive care unit admission and recurrent bleeding. A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy > 24 hours.

RESULTS

A total of 76 patients were identified. The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm. There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day (P = 0.13) or 1 year (P = 0.78) mortality, recurrent bleeding (P = 0.68), transfusion of red blood cells (P = 0.47), platelets (P = 0.31), or length of stay (P = 0.94). A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality (P = 0.11 and 0.46, respectively) compared to routine endoscopy, but was associated with decreased recurrent bleeding in 30 days (P = 0.01).

CONCLUSION

Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.

USP14 is crucial for proteostasis regulation and α-synuclein degradation in human SH-SY5Y dopaminergic cells

Ubiquitin specific protease-14 (USP14) is critical for controlling proteostasis disturbed in human disorders, including Parkinson's disease (PD). Here we investigated USP14 in the regulation of α-synuclein (α-syn) degradation via the proteasome and autophagy. α-Syn and pS129 α-syn were elevated in USP14 gene-deleted SH-SY5Y dopaminergic cells with decreased proteasome activity. However, autophagy and coordinated lysosomal expression and regulation pathways were elevated in USP14 lacking cells with higher levels of the transcription factor TFEB. There was an increase in reactive oxidative species (ROS) and elongated mitochondria in USP14 deficient cells and counteracting oxidative stress decreased α-syn levels. Phosphoproteomics revealed that USP14 is phosphorylated at residue S143 that reduces its binding to the proteasome. Re-expression of wild-type and phospho-mimetic S143D-USP14 mutant lowered ROS and α-syn levels in USP14 lacking cells. USP14 is a promising factor to consider in PD to target α-syn through its regulation of proteasomes and oxidative stress in dopaminergic neurons.

Clinical and endoscopic characteristics of colorectal traditional serrated adenomas with dysplasia/adenocarcinoma in a Korean population

BACKGROUND

Traditional serrated adenoma (TSA) is a rare and precancerous lesion of colorectal cancer. The clinical and endoscopic differentiations between TSAs without dysplasia or adenocarcinoma (TSAOs) and TSAs with dysplasia or adenocarcinoma (TSADs) remain unclear.

AIM

To evaluate the characteristics of colorectal TSAs and compare the characteristics of TSAOs with those of TSADs.

METHODS

This retrospective study included 193 patients who underwent endoscopic resection and received a pathologic diagnosis of TSA. We reviewed the medical, endoscopic, and histopathologic records of patients who underwent endoscopic resection of TSAs between January 2010 and December 2023.

RESULTS

TSAs were more frequently located in the rectosigmoid colon. Most TSAs had 0-Ip, 0-Isp, or 0-Is morphologies. The TSAD lesions were larger than TSAO lesions. TSAD lesions more commonly had a red color and an irregular border than TSAO lesions. TSAOs were usually treated using conventional endoscopic mucosal resection, whereas TSADs were treated using conventional endoscopic mucosal resection, endoscopic submucosal dissection, and surgery. Post-polypectomy bleeding was more common with TSADs than with TSAOs. Univariate analysis showed that gastrointestinal bleeding, red color, 0-IIa, irregular border, and lobular mucosal surface were significantly associated with TSADs. Multivariate analysis showed that gastrointestinal bleeding, an irregular border, and a lobular mucosal surface were significantly associated with TSADs.

CONCLUSION

TSAs with gastrointestinal bleeding, an irregular border, and a lobular mucosal surface are associated with an increased risk of dysplasia or adenocarcinoma.

Autophagy-related protein LC3β and its association with clinical-pathological characteristics, mismatch repair proteins and survival in colorectal carcinoma

Introduction

Autophagy is a metabolic process that serves to maintain cellular homeostasis as well as enable the cell to adapt to metabolic stress. In malignant cells, autophagy has been associated with drug resistance, metastasis and poor outcome. Colorectal carcinoma is a leading cause of cancer morbidity and mortality worldwide. The management and outcome are dependent on the tumor clinical and pathological characteristics. Autophagy is a potential therapeutic target as well as prognostic biomarker given its role in cancer pathogenesis. This study aimed at evaluating the autophagy status of colorectal carcinomas for tumors diagnosed at the Aga Khan University Hospital, Nairobi and establish its association with clinical-pathological characteristics including age, tumor location, tumor grade, tumor pathological stage, tumor nodal stage, tumor budding, tumor-infiltrating lymphocytes (TILs), Mismatch repair protein status (MMR), HER2 status and patient survival.

Methods

The study assessed the autophagy status of 114 colorectal carcinoma cases using immunohistochemistry for autophagy related protein LC3β. The clinical-pathological characteristics were determined by examining the medical records and evaluation of hematoxylin and eosin-stained slides. HER2 and MMR status were evaluated using immunohistochemistry. The treatment outcome was determined from the patient's records by checking for date of last visit or death.

Results and discussion

The mean age of patients in our study was 58years. There were more males 61.8% (n = 70) than females 38.6% (n = 44). Most of the patients had high pathological tumor stage of pT3 and pT4. Majority of the tumors showed intermediate tumor budding and weak tumor-infiltrating lymphocytes. The mismatch repair deficiency and HER2 overexpression were found in 14.9% (n = 17) and 2.6% (n = 3) of the cases respectively. LC3β was overexpressed in 36% (n = 41) of the cases and was significantly more common in females (p = 0.013). The LC3β status showed no significant association with age, tumor location, tumor grade, tumor stage, nodal stage, tumor budding, tumor-infiltrating lymphocytes, MMR status, HER2 status or patient survival. Future prospective studies are recommended to further explore the utility of autophagy as a prognostic and predictive biomarker.

LMNA R482L mutation causes impairments in C2C12 myoblasts subpopulations, alterations in metabolic reprogramming during differentiation, and oxidative stress

LMNA mutations causing classical familial partial lipodystrophy of Dunnigan type (FPLD2) usually affect residue R482. FPLD is a severe metabolic disorder that often leads to cardiovascular and skeletal muscle complications. How LMNA mutations affect the functional properties of skeletal muscles is still not well understood. In the present project, we investigated the LMNA-R482L mutation-specific alterations in a transgenic mouse C2C12 cell line of myoblasts. Using single-cell RNA sequencing we have studied transcriptional diversity of cultured in vitro C2C12 cells. The LMNA-R482L mutation induces changes in C2C12 cluster composition and increases the expression of genes related to connective tissue development, oxidative stress, stress defense, and autophagy in a population-specific manner. Bulk RNA-seq confirmed these results and revealed the dysregulation of carbohydrate metabolism in differentiated R482L myotubes that was supported by ATP production profile evaluation. The measurement of reactive oxygen species (ROS) levels and glutathione accumulation in myoblasts and myotubes indicates R482L mutation-related dysregulation in mechanisms that control ROS production and scavenging through antioxidant glutathione system. The increased accumulation of autophagy-related structures in R482L myoblasts was also shown. Overall, our experiments showed a connection between the redox status and metabolic alterations with skeletal muscle pathological phenotypes in cells bearing pathogenic LMNA mutation.

Five-Day Treatment with B. licheniformis Along with Classical Vancomycin Treatment Was Effective in Preserving Gut Microbiota in Patients with Clostridioides difficile Infection

Background/Objectives:Clostridioides difficile infection (CDI) is an important nosocomial diarrheal disease. The benefits of the probiotic Bacillus licheniformis (B. licheniformis) in the preservation of intestinal microbiota have not been studied in patients with CDI to date. Therefore, we aimed to investigate the efficacy of B. licheniformis in preserving the intestinal microbiota in patients with CDI. Methods: A multicenter, randomized, placebo-controlled trial was carried out at six academic centers in Korea. Individuals diagnosed with mild to moderate CDI were included in this trial. CDI was treated with vancomycin 125 mg four times daily for two weeks. Along with vancomycin, B. licheniformis was administered for five days in this study, while a placebo was given to the placebo group. Microbiome analysis was performed before and five days after administering vancomycin and B. licheniformis or placebo, using 16S rRNA amplicon sequencing. Alpha and beta diversity was compared between the two groups. Results: A total of 35 participants were finally included in this study, with 16 in the study group and 19 in the placebo group. The alpha diversity was similar in both groups before CDI treatment. After five days of the administration of vancomycin and B. licheniformis or placebo, alpha diversity did not decrease in the study group (Chao1 index, p = 0.665; observed features, p = 0.692). In contrast, alpha diversity decreased in the placebo group (Chao1 index, p = 0.011; observed features, p = 0.011). Beta diversity did not differ between the two groups. Conclusions: The addition of B. licheniformis to vancomycin was effective in preserving gut microbiota in patients with CDI.

Maackiain induces apoptosis and autophagy via ROS-mediated endoplasmic reticulum stress in endometrial cancer

Endometrial cancer (EC) is a common gynecological cancer, characterized by increasing incidence and mortality rates. Maackiain (MA), a natural flavonoid compound, has multiple biological activities, but little is known about how it affects EC cells. In the present study, CCK-8, EdU, colony formation, and flow cytometry assays were used to evaluate the effects of MA on EC cell proliferation, apoptosis, and reactive oxygen species (ROS) levels. The effect of MA on autophagy in EC cells were examined through the observation of cell morphology and ultrastructure, and cells were transfected with AdPlus-mCherry-GFP-LC3B for further analysis. Transcriptomic and western blot analyses revealed the underlying mechanism. To evaluate the anti-EC effect of MA in vivo, a xenograft model was established. The results demonstrated that MA inhibited KLE and Ishikawa cell growth in a dose-dependent manner. Furthermore, MA significantly suppressed EC xenograft tumor growth in vivo while exhibiting low toxicity. In addition, EC cells treated with MA exhibited pro-apoptotic and pro-autophagic responses, with the latter exhibiting cytoprotective properties. MA also induced the accumulation of ROS, which promoted endoplasmic reticulum (ER) stress. Notably, the use of the N-acetyl-L-cysteine (NAC) ROS scavenger and the 4-phenylbutyric acid (4-PBA) ER stress inhibitor effectively mitigated the autophagy and apoptosis induced by MA. These results collectively implied that MA triggers autophagy and apoptosis in EC cells through ROS-mediated ER stress, highlighting its potential as a therapeutic agent against EC.

Signalling and molecular pathways, overexpressed receptors of colorectal cancer and effective therapeutic targeting using biogenic silver nanoparticles

Increasing morbidity and mortality in CRC is a potential threat to human health. The major challenges for better treatment outcomes are the heterogeneity of CRC cases, complicated molecular pathway cross-talks, the influence of gut dysbiosis in CRC, and the lack of multimodal target-specific drug delivery. The overexpression of many receptors in CRC cells may pave the path for targeting them with multiple ligands. The design of a more target-specific drug-delivery device with multiple ligand-functionalized, green-synthesized silver nanoparticles is highly promising and may also deliver other approved chemotherapeutic agents. This review presents the various aspects of colorectal cancer and over-expressed receptors that can be targeted with appropriate ligands to enhance the specific drug delivery potency of green synthesised silver nanoparticles. This review aims to broaden further research into this multi-ligand functionalised, safer and effective silver nano drug delivery system.

Efficacy of Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors for Gastric Ulcers: Bayesian and Frequentist Network Meta-Analysis With Cross-Inference Through a Quality management System

Purpose

Proton pump inhibitors (PPIs) have been the mainstay treatment for gastric ulcer (GU) for over 30 years. However, since the discovery of a new class of acid suppressants, potassium-competitive acid blockers (P-CABs), the desire for a therapeutic agent has continued and the clinical trials on P-CABs have been conducted. In this regard, we aimed to assess whether P-CABs are noninferior to PPIs in patients with GU in terms of efficacy.

Methods

We performed a systematic review and network meta-analysis (NMA) based on randomized controlled trials (RCTs). Additionally, we used a new methodology of inference concept with the purpose of grouping between P-CABs and PPIs. Moreover, our quality management system was integrated throughout the research to ensure data accuracy.

Findings

We initially screened 438 studies and extracted 10 homogeneous GU RCTs with 6315 participants. The odds ratios (ORs) for the 4-week cure rate in Bayesian + frequentist NMA, tegoprazan 100 mg (OR = 4.14, 95% credible interval [CI] 0.56-26.3) and pantoprazole 40 mg (OR = 4.12, 95% CI 1.90-8.88) were the largest, respectively. The ORs for the 8-week cure rate in Bayesian + frequentist NMA, lansoprazole 30 mg (OR = 8.77, 95% credible interval [CI] 0.95-78.9) and lansoprazole 30 mg (OR = 7.91, 95% CI 2.60-24.03) was the largest, respectively.

Conclusions

The results of the NMA reveal that the cure rates of P-CABs in cases of GU were not inferior to those of PPIs. As the inference by grouping PPIs and P-CABs, the results showed similar trends in terms of effectiveness between the two therapeutic classes.

Surgical risk stratification and outcome analysis of Tenckhoff catheter implantations in paediatric patients: a single-centre experience

This study aimed to assess the risk factors for complications post-Tenckhoff catheter implantation in paediatric patients. All records of children who underwent the procedure from 2002 to 2022 at the University Medical Centre of Hamburg were analyzed. The demographic and anthropometric characteristics were scrutinized, with particular attention given to complications such as catheter leakage, occlusions, and peritonitis. Univariate and multivariate analyses were employed to determine the hazard ratios for complications. In total, 299 implantations were performed in 116 females and 130 males; 67% were under 5 years old, and 85% had renal disease. Fifty-one percent needed an acute catheter insertion, 26% of the patient's required revision, and 24% of the patients experienced peritonitis. Neonates had a 22% mortality rate, and infants had a 37% reimplantation rate. Compared with the other subgroups, a glomerular filtration rate of 15-29 ml/kg/1.7 3m2 was associated with a 10.7-fold higher risk of peritonitis. Male patients had a threefold greater chance of reimplantation or inguinal hernia. Omentectomy revealed no increased risk of peritonitis, and only two catheter occlusions were observed. Patients with inguinal hernias or gastric tubes had higher odds of complications (HR = 3.60, p = 0.003 and OR = 2.47, p = 0.014). Neither the implantation side nor acute insertion was correlated with complications.

CONCLUSION

Infants, male patients with kidney disease, prolonged use of catheter, and those with a GFR of 15-29 ml/kg/1.73 m2 were at increased risk. The presence of peritonitis, inguinal hernia, and gastric tubes were adverse prognostic factors.

WHAT IS KNOWN

• Omentectomy can serve as a protective factor and correlates with a lower incidence of catheter malfunction. • The insertion of gastric tubes is commonly associated with complications but has lower risk of complications if inserted prior to the initiation of peritoneal dialysis.

WHAT IS NEW

• Males have been found to have a 2.14 hazard ratio for revision in both acute and chronic peritoneal dialysis groups. • The incidence of revisions seems to be greater in the first 36 months, while the incidence of peritonitis rises by 7% for each additional year of age.

Efficacy of alternate mucosa-submucosa clip closure in preventing postoperative adverse events for patients with gastric mucosal lesions after endoscopic submucosal dissection: a multicenter retrospective study

BACKGROUND

Endoscopic submucosal dissection (ESD) is the first-line treatment for gastric mucosal lesions. The artificial ulcers caused by ESD can lead to bleeding, perforation, and other adverse events.

OBJECTIVES

This study aimed to evaluate the efficacy of alternate mucosa-submucosa clip in preventing adverse events following ESD for gastric mucosal lesions.

DESIGN

Multicenter retrospective observational study.

METHODS

Data from 924 patients who underwent ESD for gastric mucosal lesions were retrospectively collected and categorized into completely closed and unclosed groups based on postoperative wound management. The incidence of adverse events and postoperative wound healing rate at 1 and 3 months were compared between the groups, and the factors related to delayed bleeding after ESD were analyzed.

RESULTS

The rate of delayed hemorrhage was lower in the completely closed group than in the unclosed group (0.8% vs 7.6%; p < 0.001), and subgroup analysis showed that this effect was consistent across all subgroups. The postoperative abdominal pain score was lower in the completely closed group than in the unclosed group (0 vs 2, p < 0.001). One month postoperatively, the wound healing rate was higher in the completely closed group (77.6% vs 55.1%; p < 0.001). Multivariable analysis showed that the presence of ulcers or scars on the lesion surface, and lesions located in the lower one-third of the stomach were risk factors for postoperative bleeding.

CONCLUSION

Application of alternate mucosa-submucosa clip closing the wound of ESD reduced the risk of postoperative bleeding, alleviated postoperative abdominal pain, and promoted artificial wound healing.

Computational Elucidation of a Monobody Targeting the Phosphatase Domain of SHP2

Src homology 2 (SH2) domain-containing phosphatase 2 (SHP2) is a key regulator in cellular signaling pathways because its dysregulation has been implicated in various pathological conditions, including cancers and developmental disorders. Despite its importance, the molecular basis of SHP2's regulatory mechanism remains poorly understood, hindering the development of effective targeted therapies. In this study, we utilized the high-specificity monobody Mb11 to investigate its interaction with the SHP2 phosphatase domain (PTP) using multiple replica molecular dynamics simulations. Our analyses elucidate the precise mechanisms through which Mb11 achieves selective recognition and stabilization of the SHP2-PTP domain, identifying key residues and interaction networks essential for its high binding specificity and regulatory dynamics. Furthermore, the study highlights the pivotal role of residue C459 in preserving the structural integrity and functional coherence of the complex, acting as a central node within the interaction network and underpinning its stability and efficiency. These findings have significantly advanced the understanding of the mechanisms underlying SHP2's involvement in disease-related signaling and pathology while simultaneously paving the way for the rational design of targeted inhibitors, offering significant implications for therapeutic strategies in SHP2-associated diseases and contributing to the broader scope of precision medicine.

Clinical and imaging predictors for the development of diabetes mellitus following a single episode of acute pancreatitis in youth

BACKGROUND

Acute pancreatitis (AP) increases the risk of diabetes mellitus (DM). Our aim was to identify clinical, laboratory and imaging predictors of preDM/DM in youth post index AP.

METHODS

This was a prospective cohort study of patients ≤21 years-old with an index admission for AP and follow up at 3 and/or 12 months. Clinical laboratory values, imaging findings, admission course, and plasma chemokine and cytokine measures collected at index admission were tested for association with preDM/DM development. A multivariable regression model was used to predict preDM/DM.

RESULTS

Among 187 enrolled participants, 137 (73 %) and 144 (77 %) underwent DM screening at 3 and 12 months respectively, and 137 (73 %) had imaging available. PreDM/DM occurred in 22/137 (16 %; preDM n = 21, DM n = 1) at 3 months and 23/144 (16 %; preDM n = 18, DM n = 5) participants at 12 months. Univariate associations with preDM/DM at 12 months included: severe AP (SAP) (52 % preDM/DM vs. 17 % no DM; p = 0.0008), median [IQR] IL-6 (910 pg/ml [618-3438] vs. 196 pg/ml [71-480], p < 0.05) and CRP (4.16 mg/L [1.67-10.7] vs. 1.55 mg/L [0.4-3.68], p = 0.1) at time of AP attack. The optimal multivariable model to predict preDM/DM included with clinical variables was severe acute pancreatitis (SAP), c reactive protein (CRP), interleukin-6 (IL-6), and age [AUC = 0.80; (0.70, 0.88)]. Including imaging markers, the ideal model included SAP, CRP, IL-6, subcutaneous fat area, age and presence of autoimmune disease with an AUC [0.82 (0.71, 0.90)].

CONCLUSIONS

Development of preDM/DM following an index AP episode can be predicted by baseline AP severity, baseline CRP, IL-6 levels, and subcutaneous fat area.

Influence of Lifestyles on Polyp Burden and Cancer Development in Hereditary Colorectal Cancer Syndromes

BACKGROUND

Whether the progression of precursor lesions or the occurrence of cancer is influenced by lifestyle factors in carriers of genetic mutations has not been fully investigated, especially in Asian patients of hereditary colorectal cancer (CRC) syndrome.

METHODS

Patients at a high risk of hereditary CRC were included. For polyposis CRC syndromes, colorectal polyp burden was measured using at least 60 images per colonoscopy in each patient and classified into five stages using the International Society for Gastrointestinal Hereditary Tumours staging system according to the polyp number and size. Increase in tumor burden stage for polyposis CRC syndrome and the occurrence of CRC or any cancer for Lynch syndrome were analyzed according to lifestyle factors.

RESULTS

Ninety-six patients with suspected hereditary polyposis CRC syndrome and 106 patients with Lynch syndrome were recruited. For polyposis CRC syndromes, multivariate analysis showed that exposure to smoking and > 100 polyps independently predicted a high risk of increased polyp burden (p = 0.008 and p = 0.012, respectively). Significant genetic mutations or phenotype of polyposis syndromes were significantly associated with an increased polyp burden. For Lynch syndrome, smokers showed to be diagnosed with CRC in younger age than never-smokers (42.2 years vs. 49.0 years; p = 0.021), and heavy drinkers had high risk for occurrence of CRC (HR, 2.381, 95% CI, 1.338-4.236; p = 0.003) and any cancer (HR, 2.254; 95% CI, 1.334-3.806; p = 0.002).

CONCLUSIONS

The lifestyle factors (smoking and alcohol consumption) were associated with increasing precursor lesions and occurrence of cancer in patients with hereditary CRC syndrome. Lifestyle modifications may reduce the risk of hereditary CRC in carriers.

A decade of advances in human gut microbiome-derived biotherapeutics

Microbiome science has evolved rapidly in the past decade, with high-profile publications suggesting that the gut microbiome is a causal determinant of human health. This has led to the emergence of microbiome-focused biotechnology companies and pharmaceutical company investment in the research and development of gut-derived therapeutics. Despite the early promise of this field, the first generation of microbiome-derived therapeutics (faecal microbiota products) have only recently been approved for clinical use. Next-generation therapies based on readily culturable and as-yet-unculturable colonic bacterial species (with the latter estimated to comprise 63% of all detected species) have not yet progressed to pivotal phase 3 trials. This reflects the many challenges involved in developing a new class of drugs in an evolving field. Here we discuss the evolution of the live biotherapeutics field over the past decade, from the development of first-generation products to the emergence of rationally designed second- and third-generation live biotherapeutics. Finally, we present our outlook for the future of this field.

PTB Regulates Keloid Fibroblast Migration and Proliferation Through Autophagy

BACKGROUND

Keloid disease is a chronic fibroproliferative disease that occurs after tissue injury, and the currently available treatments are unsatisfactory.

OBJECTIVES

We aimed to explore the level of autophagy in keloid fibroblasts (KFbs) and adjacent normal fibroblasts (NFbs). In addition, whether polypyrimidine tract-binding protein (PTB) regulates the biological functions of KFbs via autophagy was also investigated.

METHODS

The morphology of fibroblasts in normal skin and keloids was observed transmission electron microscopy. We silenced PTB with PTB-specific siRNA to determine whether PTB-regulated KFb proliferation. Acridine orange and LysoTracker Red staining was performed to label acidic compartments. Interestingly, when autophagy was inhibited by wortmannin, the PTB knockdown-mediated decrease in KFb migration and proliferation was abolished, while the collagen I and III levels were not altered; these results indicated that PTB regulated the migration and proliferation of KFbs via autophagy, while collagen synthesis occurred independently of PTB regulation.

RESULTS

Many activities related to the survival and function of KFbs are controlled by PTB. Transmission electron microscopy revealed more autophagosomes and autolysosomes in KFbs than in NFbs. PTB induced autophagy in KFbs, as demonstrated by the significantly greater number of autophagosomes in KFbs after PTB knockdown, which was revealed by acridine orange and LysoTracker staining.

CONCLUSIONS

Our study is the first to show that PTB regulates the migration and proliferation of KFbs via autophagy and that PTB regulates collagen synthesis in KFbs in an autophagy-independent manner.

NO LEVEL ASSIGNED

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Optimal bowel preparation for colonoscopy

There is robust evidence to indicate a strong correlation between the bowel preparation status and adenoma detection rate (ADR), which directly impacts the incidence and mortality rate of postcolonoscopy colorectal cancer. Therefore, improving bowel preparation has been of increasing interest. In Japan, commercially available bowel preparation agents include polyethylene glycol, oral sodium sulfate, sodium picosulfate-magnesium citrate, magnesium citrate, and oral sodium phosphate; each has its own strengths and limitations. The timing of administration can also influence the efficacy of bowel preparation and patient tolerability. Furthermore, meta-analyses have suggested predictive factors for inadequate bowel preparation. A detailed understanding of these factors could contribute to reducing the need for repeat colonoscopy within 1 year, as recommended for patients with inadequate bowel preparation. Recent advancements, such as oral sulfate tablets, present promising alternatives with higher patient satisfaction and ADRs than traditional methods. Achieving optimal bowel preparation requires enhanced instructions, individualized regimens, and a comprehensive understanding of patient backgrounds and the characteristics of various bowel preparation agents. This article provides a concise overview of the current status and advancements in bowel preparation for enhancing the quality and safety of colonoscopy.

Additional Stem Resection for Control of Massive Bleeding After Polypectomy for a Pedunculated Colonic Polyp

Background

Polypectomy-associated bleeding is the most frequent complication of colorectal polypectomy.

Case Presentation

An 82-year-old woman underwent polypectomy after an endoloop was placed in a pedunculated polyp in the sigmoid colon. However, the endoloop dislodged, causing massive bleeding from the stem surface. Furthermore, the bleeding vessel could not be identified because of the narrow resection surface and the presence of thrombus and hemorrhage. Therefore, several clips were removed, and polypectomy was performed again on the resection stem to open the resection surface wider and identify the bleeding vessels. Finally, the responsible arterial vessel appeared, leading to complete hemostasis.

Conclusion

The additional stem resection may be a novel method for detecting uncontrolled bleeding after polypectomy for colorectal pedunculated polyps.

Staphylococcus aureus regulates Th17 cells and autophagy via STING in chronic eosinophilic rhinosinusitis with nasal polyps

PURPOSE

As a common pathogen of rhinosinusitis, the role of Staphylococcus aureus in modulating autophagy through STING activation and Th17 cell differentiation in CRSwNP remains unexplored. This study aims to investigate how S. aureus regulates Th17 cell differentiation and the occurrence and development of autophagy in CRS by inducing STING expression.

METHODS

Immunoblotting and flow cytometry were employed to assess the expression levels of STING, RORγt, LC3B, and MUC5AC, as well as Th17 markers in cells. HNECs were co-cultured with S. aureus in vitro to explore its regulatory effects.

RESULTS

STING expression was found to be decreased in CRSwNP tissues, while RORγt, LC3B, and MUC5AC levels were elevated. S. aureus was shown to induce Th17 differentiation via STING regulation. STING activators reduced Th17 inflammation, while autophagy activators increased autophagosomes and MUC5AC levels.

CONCLUSION

The STING system may play a protective role in the inflammatory response of nasal epithelial cells. S. aureus inhibits STING, not only by promoting the differentiation of pathogenic Th17 cells but also by increasing autophagy levels in nasal epithelial cells. Both mechanisms contribute to the enhanced expression of MUC5AC, facilitating the progression of CRSwNP.

Bradykinin attenuates NiSO4-induced autophagy in MIN6 cells and protects islet function in mice by regulating the PI3K/AKT/mTOR signaling pathway

Previous studies have shown that nickel sulfate (NiSO4) increases autophagy in thyroid cells and tissues. As an important organ of the endocrine system, the pancreas not only contributes to the exocrine function of digestion but also has the endocrine function of regulating blood sugar. However, it remains unknown whether NiSO4 increases pancreatic autophagy. Bradykinin (BK) is an important component of the kallikrein-kinin system (KKS) and has many biological functions, such as reducing autophagy. The purpose of the present study was to explore the effects of BK on NiSO4-induced changes in pancreatic endocrine function. The present results demonstrate that NiSO4 increases fasting blood glucose (FBG) within a certain range and decreases insulin levels in mice. Moreover, NiSO4 triggers incomplete autophagy in MIN6 cells by upregulating microtubule-associated protein 1 light chain 3-II (LC3II) and Beclin 1 but downregulating p62. Mechanistically, NiSO4 leads to abnormal activation of autophagy by inhibiting the PI3K/AKT/mTOR signaling pathway. Moreover, BK decreases FBG and increases insulin secretion in mice exposed to NiSO4. Light microscopy and transmission electron microscopy (TEM) analyses revealed that BK pretreatment partially restores MIN6 cell viability and decreases the number of autophagic bodies. BK significantly upregulates the protein levels of LC3II and Beclin1 but downregulates p62 in NiSO4-induced MIN6 cells. In addition, BK increases the levels of phosphorylated phosphatidylinositol 3-kinase (P-PI3K), phosphorylated protein kinase B (P-AKT) and mammalian target of rapamycin (mTOR). Most of these effects of BK are reversed by treatment with the HOE140 B2R inhibitor. The present results suggested that BK ameliorates NiSO4-induced pancreatic β-cell dysfunction through B2R-mediated activation of the PI3K/AKT/mTOR signaling pathway and inhibition of autophagy.

Predictive modeling for the germline pathogenic variant of the APC gene in patients with adenomatous polyposis: proposing a new APC score

BACKGROUND

The precise diagnosis and medical management of patients with suspected familial adenomatous polyposis should be based on genetic testing, which may not always be available. Therefore, establishing a new model for predicting the likelihood of a germline pathogenic variant (GPV) of APC based on its clinical manifestations could prove to be useful in clinical practice.

METHODS

The presence of GPVs of APC gene was investigated in 162 patients with adenomatous polyposis (≥ 10 polyps) using a multigene panel or single-gene testing. To generate a predictive model for GPV of the APC gene, a logistic regression analysis was performed using the clinicopathological variables available at the time of the diagnosis of adenomatous polyposis.

RESULTS

Ninety (55.6%) patients had GPV of the APC gene. According to a multivariate logistic regression analysis, age < 40 years, polyps ≥ 100, fundic gland polyposis, and a family history of colorectal polyposis were found to be independent predictors of the GPV of APC and were used to establish a formula for predicting the GPV of APC using the four predictors. The prediction model had an area under the curve of 0.91 (0.86-0.96) according to a receiver operating characteristic analysis.

CONCLUSION

The model for predicting the GPV of APC will help patients with adenomatous polyposis and physicians make decisions about genetic testing.

Visceral adipose tissue area predicts major adverse kidney events in patients with acute necrotizing pancreatitis

BACKGROUND

Given the previously reported harmful effects of abdominal fat burden on kidney function, we aim to investigate the relationship between major adverse kidney events within 30 days (MAKE30) and abdominal obesity in acute necrotizing pancreatitis (ANP) patients and explore the underlying risk factors.

METHODS

A retrospective cohort study of all patients admitted within 72 h after the first episode of ANP to a tertiary center between June 2015 and June 2019 was conducted. Automatic image analysis software was used to calculate the area of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and skeletal muscle from computed tomography scans at the umbilical level. The potential risk factors of MAKE30 were analyzed by logistic regression.

RESULTS

A total of 208 eligible ANP patients were enrolled, with an incidence of 23% for MAKE30. VAT area was more closely associated with the development of MAKE30, with an area under the ROC curve of 0.69 (cutoff value 200 cm2, 63.8% sensitivity and 66.7% specificity). Multivariate logistic regression analysis demonstrated that VAT area [OR 1.01 (1.01-1.02); p < 0.001] was an independent risk factor in predicting MAKE30. Patients with a VAT area > 200 cm2 had more requirements of renal replacement therapy (32% vs. 12%, P < 0.001), and a significantly higher incidence of other poor clinical outcomes (all p < 0.05).

CONCLUSION

Early assessment of the VAT area may help identify ANP patients at high risk of MAKE30, suggesting that it could be a potential indicator for adverse kidney events.

Early Detection and Quality Indicators: Assessing the Clinical Impact and Effectiveness of Lowering the Colorectal Cancer Screening Age

Objective With colorectal cancer (CRC) being a leading cause of cancer-related deaths globally, early detection through screening is critical for improving survival rates. Recent guidelines recommend lowering the initial screening age from 50 to 45 years based on increasing CRC incidence among younger adults. Methodology This retrospective study evaluates the impact of this adjustment on adenoma detection rates (ADR), a validated quality indicator of screening colonoscopies. We conducted a retrospective analysis of 2,792 patients who underwent colonoscopy screening at a major healthcare institution. Patients were categorized into three age groups: 45-49, 50-59, and 60-75 years. We compared ADR across these groups with a focus on evaluating the consistency of ADR in the newly included younger age group against established benchmarks. Result The ADRs for the 45-49 age group were 51.2% (105/205) in male patients and 38.5% (116/301) in female patients, closely mirroring those of the 50-59 age group at 51.08% (188/368) in male patients and 34.80% (133/382) in female patients, with no significant reduction in detection rates. Gender-specific analysis revealed higher ADR in male patients across all age groups. These findings were statistically significant when comparing procedure type with age group and gender (p < 0.05). Conclusion The study supports maintaining the already established ADR for the new age group of 45-49 as the ADR was comparable to those in the older groups. Similar polyp biopsy +/- removal rates in the 45-49-year-old age group (43.6%; 221/506) compared to the older age group (42.7%; 320/750) is also an indirect measure of the effectiveness of early screening for colon cancer.

The role of suppressor of cytokine signaling 3 in inflammatory bowel disease and its associated colorectal cancer

Inflammatory bowel disease (IBD) and colorectal cancer (CRC), as two of the major human intestinal diseases, provide challenges for the medical field. Suppressor of cytokine signaling 3 (SOCS3), a protein molecule that negatively regulates cytokine signaling through multiple pathways, is involved in the regulation of various inflammatory diseases and tumors. In IBD, SOCS3 acts on a variety of cells to repair mucosal damage and balance the immune response, including epithelial cells, macrophages, dendritic cells, neutrophils, and T cells. In CRC, SOCS3 is inextricably linked to tumor cell proliferation, invasion, metastasis, and drug resistance. Therefore, it is crucial to systematically investigate the pathogenic involvement of SOCS3 in IBD and CRC. This article reviews the mechanisms and pathways by which SOCS3 is involved in the inhibition of IBD and the mitigation of CRC, and details the therapeutic options for targeting SOCS3.

Enhanced apoptosis and inflammation allied with autophagic and apoptotic Leishmania amastigotes in the seemingly undamaged ear skin of clinically affected dogs with canine visceral Leishmaniasis

Programmed cell death plays a relevant role in the pathogenesis of visceral Leishmaniasis. Apoptosis selects suitable parasites, regulating parasite density, whereas autophagy eliminates pathogens. This study aimed to assess the inflammation and apoptosis in inflammatory cells and presents a unique description of the presence of autophagic and apoptotic Leishmania amastigotes in naturally Leishmania-infected dogs. Fragments from seemingly undamaged ear skin of sixteen Leishmania-infected dogs and seven uninfected dogs were evaluated through histomorphometry, ultrastructural, immunohistochemical and transmission electron microscopy (TEM) analyses. Leishmania amastigotes were present on seemingly undamaged ear skin only in clinically affected dogs. Parasite load, morphometrical parameters of inflammation and apoptotic index of inflammatory cells were higher in clinically affected animals and were related to clinical manifestations. Apoptotic index and morphometric parameters of the inflammatory infiltrate in undamaged ear skin were positively correlated with parasite load. Apoptotic and non-apoptotic Leishmania amastigotes were observed within neutrophils and macrophages. Leishmania amastigotes were positive for Bax, a marker for apoptosis, by immunohistochemistry. Morphological characteristics of apoptosis and autophagy in Leishmania amastigotes were observed only in phagocytes of clinically affected dogs. Positive correlations were found between histomorphometry and clinical manifestations. Our results showed that apoptosis and autophagy in Leishmania amastigotes may be related to both the increase in parasite load and apoptotic index in inflammatory cells, and with the intensity of the inflammatory response in clinically affected dogs. Thus, our study suggests that apoptotic and autophagy Leishmania within phagocytes may have facilitate the survival of the parasite and it appears to play an important role in the process of Leishmania infection.

Periodontopathogen-Related Cell Autophagy-A Double-Edged Sword

The periodontium is a highly organized ecosystem, and the imbalance between oral microorganisms and host defense leads to periodontal diseases. The periodontal pathogens, mainly Gram-negative anaerobic bacteria, colonize the periodontal niches or enter the blood circulation, resulting in periodontal tissue destruction and distal organ damage. This phenomenon links periodontitis with various systemic conditions, including cardiovascular diseases, malignant tumors, steatohepatitis, and Alzheimer's disease. Autophagy is an evolutionarily conserved cellular self-degradation process essential for eliminating internalized pathogens. Nowadays, increasing studies have been carried out in cells derived from periodontal tissues, immune system, and distant organs to investigate the relationship between periodontal pathogen infection and autophagy-related activities. On one hand, as a vital part of innate and adaptive immunity, autophagy actively participates in host resistance to periodontal bacterial infection. On the other, certain periodontal pathogens exploit autophagic vesicles or pathways to evade immune surveillance, therefore achieving survival within host cells. This review provides an overview of the autophagy process and focuses on periodontopathogen-related autophagy and their involvements in cells of different tissue origins, so as to comprehensively understand the role of autophagy in the occurrence and development of periodontal diseases and various periodontitis-associated systemic illnesses.

Portrait of WWP1: the current state in human cancer

WWP1, a member of the C2-WW-HECT E3 ligase family, is an E3 ubiquitin-protein ligase containing WW domains. This enzyme plays a critical role in regulating diverse cellular processes. Its expression is modulated by various factors and non-coding RNAs, resulting in ubiquitination that affects substrate protein degradation. WWP1 demonstrates a dual function, acting predominantly as an oncogene in tumors but occasionally as a tumor suppressor. This review summarizes WWP1's biological roles, therapeutic potential in oncology, upstream regulatory factors, and downstream substrates. It aims to promote research on WWP1's antitumor effects, improve understanding of its role in tumorigenesis, and support the development of targeted therapies.

Risk Factors for Clostridium difficile Infection in Inpatients: A Four-Year (2017-2020) Retrospective Study

BACKGROUND

Clostridium difficile infection (CDI) impact on healthcare systems is concerning due to high treatment cost and increased hospitalization time. We found that the incidence rate of CDI increased annually at Taipei Medical University Hospital (TMUH). The study aimed to establish monitoring indicators for hospitalized patients receiving antibiotics to prevent CDI occurrences.

METHODS

A case-control study was conducted to identify the risk factors of CDI among patients who were admitted to TMUH and tested for C. difficile. Patient demographics, patient history, and laboratory data were collected and analyzed.

RESULTS

Nutrition Risk Screening 2002 score (NRS 2002) in CDI patients was significantly lower than in non-CDI patients (3.1 ± 1.7 vs. 3.5 ± 1.6). The percentage of tube feeding in CDI patients was significantly lower than in non-CDI patients (23.0% vs. 36.7%), whereas parenteral nutrition was higher (8.8% vs. 3.8%). Age (OR = 1.03, p = 0.00), NRS 2002 score (OR =0.86, p = 0.05), comorbidity with cardiovascular disease (OR = 1.73, p = 0.03) or pulmonary disease (OR = 3.72, p = 0.00), patients with tube feeding (OR = 2.02, p = 0.01), and the number of medications (OR = 1.15, p < 0.01) were significant predictors of CDI.

CONCLUSION

This study revealed that nutritional factors, including NRS 2002 scores and feeding routes, were associated with CDI, emphasizing the importance of nutritional factors as key predictors in managing and preventing CDI.

Research progress on the performance of expandable systems for long-term gastric retention

Gastroretentive systems have gained attention due to their prolonged retention time in the human body, and they have the potential to improve treatment effects, simplify treatment regimens, and improve patient compliance. Among these systems, expandable gastroretentive systems (EGRSs) have emerged as an important type of carrier that can reside in the stomach for a desired period through on-demand expansion for drug delivery, obesity intervention, and medical diagnosis. As the physiological environment significantly influences the performance of EGRSs, here, the physiological factors such as the stomach's physiological structure and activity pattern, and the character of gastric juice are summarized. Following this, the research progress of EGRSs from ingestion to removal for long-term gastric retention is discussed with respect to the influencing factors and reinforcement strategies in mechanics. Additionally, as the duration of gastric retention increases, safety concerns arise. As such, safety issues in terms of removal after retention or in an emergency are also analyzed. Finally, the biomedical application of EGRSs as diagnostic and therapeutic tools and the potential direction for further research are discussed. STATEMENT OF SIGNIFICANCE: Expandable gastroretentive systems (EGRSs) resist gastric emptying due to their size exceeding the pylorus diameter, offering promising advantages for obesity intervention, drug delivery, and carrying sensors. However, a long gastroretentive time only by such a size mismatch is hard to be achieved due to the uninterrupted stomach contraction and gastric juice erosion. Recent studies indicate that the retention time and stability of EGRSs can be regulated by adjusting their mechanical properties. Hence, this review summarizes the state-of-art progress of EGRSs for long-term gastric retention from a mechanical perspective for the first time, focuses on material components and synthesis methods, and the reinforcement strategies, and suggests the required mechanical property parameters of EGRSs.

Trehalose activates autophagy to alleviate cisplatin-induced chronic kidney injury by targeting the mTOR-dependent TFEB signaling pathway

Rationale: Cisplatin is a potent chemotherapeutic agent limited by significant nephrotoxicity. Multiple cycles of cisplatin administration are necessary to confer chronic disease. Autophagy is a lysosomal degradation pathway that enables the clearance and reuse of cytoplasmic components and is essential for maintaining the integrity and normal physiological function of tissues and organs. However, the precise role of autophagy in renal fibrosis has been controversial. Trehalose, a well-known autophagy inducer, plays a cytoprotective role under various stress conditions, such as oxidative damage, dehydration, and temperature changes. In this study, we established a model of cisplatin-induced chronic kidney disease (CKD) and human renal tubular epithelial cells (HK2) injury to investigate the nephroprotective effects of trehalose on cisplatin-induced CKD and the underlying mechanisms involved. Methods: Firstly, we measured the role of autophagy in cisplatin-induced injury models both in vivo and in vitro by western blot and immunofluorescence staining, combined with transcriptomics. Then, biomedical, cellular, and molecular approaches were utilized to evaluate the potential protective effect of trehalose intervention in regulating autophagy. Mechanistically, we performed this study using proximal tubular epithelial cells-specific transcription factor EB (TFEB) knockout mice and TFEB small-interfering RNA technology to determine whether TFEB deficiency affects the pharmacological effected of trehalose in cisplatin-induced injury models. Results: Due to the activation of autophagy, trehalose inhibited mitochondrial dysfunction (mitochondrial fragmentation, depolarization, reactive oxygen species) and cellular senescence induced by cisplatin both in vitro and in vivo. Moreover, renal dysfunction, pathological changes and fibrosis were alleviated in CKD mice after trehalose treatment. Mechanistic investigations revealed that trehalose accumulated in lysosomes and inhibited mTORC1 activity, which triggered TFEB and TFEB-mediated autophagy. In addition, siRNA-mediated knockdown of TFEB in HK2 cells or renal proximal tubular epithelial cells-specific (TECs-specific) TFEB deficiency in mice markedly abolished the beneficial effects of trehalose. Conclusion: Our findings suggested that trehalose induced autophagy to alleviate cisplatin-induced chronic kidney injury by targeting the mTOR-dependent TFEB signaling pathway.

The Interplay Between Gut Microbiota, Adipose Tissue, and Migraine: A Narrative Review

BACKGROUND

Migraine, a prevalent neurovascular disorder, affects millions globally and is associated with significant morbidity. Emerging evidence suggests a crucial role of the gut microbiota and adipose tissue in the modulation of migraine pathophysiology, particularly through mechanisms involving neuroinflammation and metabolic regulation.

MATERIAL AND METHODS

A narrative review of the literature from 2000 to 2024 was conducted using the PubMed database. Studies addressing the relationships between microbiota, adipose tissue, and migraine-including dietary interventions and their impact-were analyzed.

RESULTS

The findings highlight a bidirectional gut-brain axis, with gut microbiota influencing neuroinflammation via metabolites such as short-chain fatty acids (SCFAs). Obesity exacerbates migraine severity through chronic inflammation and the dysregulation of adipocytokines like leptin and adiponectin. Dietary patterns, such as low glycemic index diets and Mediterranean diets, and the use of prebiotics, probiotics, and postbiotics show potential in migraine management.

CONCLUSIONS

This review underscores the need for integrative approaches targeting the microbiota-gut-brain axis and adipose tissue in migraine therapy. Future studies should explore longitudinal effects and personalized interventions to optimize outcomes.

Helicobacter pylori reduces METTL14-mediated VAMP3 m6A modification and promotes the development of gastric cancer by regulating LC3C-mediated c-Met recycling

Helicobacter pylori (H. pylori) plays an important role in the malignant transformation of the gastric mucosa from chronic inflammation to cancer. However, the mechanisms underlying the epigenetic regulation of gastric carcinogenesis mediated by H. pylori remain unclear. Here, we uncover that H. pylori inhibits METTL14 by upregulating ATF3. METTL14 inhibits gastric cancer (GC) cell proliferation and metastasis in vitro and in vivo. Downregulation of METTL14 inhibits Vesicle-associated membrane protein-3 (VAMP3) by reducing the m6A modification level of VAMP3 mRNA and the stability of IGF2BP2-dependent mRNA. H. pylori also accelerates the malignant progression of GC by regulating VAMP3/LC3C-mediated c-Met recycling. Moreover, the expression of METTL14 and VAMP3 in Hp+ chronic gastritis tissues is much lower than that in Hp- chronic gastritis tissues. METTL14 and VAMP3 expression levels are downregulated notably in cancerous tissues of patients with GC. Therefore, our results show a novel METTL14-VAMP3-LC3C-c-Met signalling axis in the GC development mediated by H. pylori infection, which reveals a novel m6A epigenetic modification mechanism for GC and provides potential prognostic biomarkers for GC progression.

Comparing 1-L and 2-L Polyethylene Glycol with Ascorbic Acid for Small Bowel Capsule Endoscopy: A Randomized Controlled Trial

Background/Aims

Small bowel capsule endoscopy (SBCE) has become the standard for initial evaluation in the diagnosis of small bowel lesions. Although optimal visualization of the mucosa is important, patients experience difficulty in consuming a large volume of bowel preparation agents. This study aimed to compare the efficacy and safety of 1-L polyethylene glycol (PEG) with ascorbic acid (AA) and 2-L PEG with AA.

Methods

In this prospective, multicenter, non-inferiority study, patients who received SBCE were randomly assigned to consume 1-L PEG with AA or 2-L PEG with AA for small bowel preparation. The primary outcome was adequate small bowel visibility quality (SBVQ). The secondary outcomes included diagnostic yield, cecal complete rate, and adverse events.

Results

One hundred and forty patients were enrolled in this study, 70 patients per group. In the per-protocol analysis, there were no significant differences in the adequate SBVQ rate (94.0% vs 94.3%; risk difference, -0.3; 95% confidence interval, -8.1 to 7.6; p=1.000), diagnostic yield rate (49.3% vs 48.6%, p=0.936), or cecal complete rate (88.1% vs 92.9%, p=0.338) between the 1-L PEG with AA group and 2-L PEG with AA group. The incidence of adverse events did not differ significantly between the groups (12.9% vs 11.9%, p=0.871).

Conclusions

One liter-PEG with AA is not inferior to 2-L PEG with AA in terms of adequate SBVQ for SBCE. One liter-PEG with AA can be recommended as the standard method for bowel cleansing for SBCE.

Survey of the Actual Practices Used for Endoscopic Removal of Colon Polyps in Korea: A Comparison with the Current Guidelines

Background/Aims

We investigated the clinical practice patterns of Korean endoscopists for the endoscopic resection of colorectal polyps.

Methods

From September to November 2021, an online survey was conducted regarding the preferred resection methods for colorectal polyps, and responses were compared with the international guidelines.

Results

Among 246 respondents, those with <4 years, 4-9 years, and ≥10 years of experience in colonoscopy practices accounted for 25.6%, 34.1%, and 40.2% of endoscopists, respectively. The most preferred resection methods for non-pedunculated lesions were cold forceps polypectomy for ≤3 mm lesions (81.7%), cold snare polypectomy for 4-5 mm (61.0%) and 6-9 mm (43.5%) lesions, hot endoscopic mucosal resection (EMR) for 10-19 mm lesions (72.0%), precut EMR for 20-25 mm lesions (22.0%), and endoscopic submucosal dissection (ESD) for ≥26 mm lesions (29.3%). Hot EMR was favored for pedunculated lesions with a head size <20 mm and stalk size <10 mm (75.6%) and for those with a head size ≥20 mm or stalk size ≥10 mm (58.5%). For suspected superficial and deep submucosal lesions measuring 10-19 mm and ≥20 mm, ESD (26.0% and 38.6%) and surgery (36.6% and 46.3%) were preferred, respectively. The adherence rate to the guidelines ranged from 11.2% to 96.9%, depending on the size, shape, and histology of the lesions.

Conclusions

Adherence to the guidelines for endoscopic resection techniques varied depending on the characteristics of colorectal polyps. Thus, an individualized approach is required to increase adherence to the guidelines.

Endoscopic closure using a dedicated device following gastric endoscopic submucosal dissection: Multicenter, prospective, observational pilot study

Background and study aims

Development of a simple, optimized closure method for mucosal defects left by gastric endoscopic submucosal dissection (ESD) is warranted. Herein, we developed a novel and dedicated closure device called FLEXLOOP and aimed to assess feasibility and safety of the closure using FLEXLOOP following gastric ESD.

Patients and methods

This multicenter, prospective, observational study enrolled patients clinically diagnosed with gastric neoplasms < 30 mm in size. Following gastric ESD, closure of the mucosal defect was performed using a FLEXLOOP with standard clips. The primary outcome was the complete closure rate. The secondary outcomes were procedure time, number of clips, sustained closure rate on second-look endoscopy on postoperative days (PODs) 5 to 7, and rate of post-ESD bleeding.

Results

Overall, 35 patients were included in this study. The median specimen size was 32 mm. The mucosal defect was completely closed in 31 patients (89%; 95% confidence interval, 73%-99%) and incompletely closed in four patients (11%). Median closure time was 11 minutes and median number of clips was 10. Second-look endoscopy performed on PODs 5 to 7 demonstrated sustained, partially sustained, and unsustained closures in seven (20%), 22 (63%), and six patients (17%), respectively. Post-ESD bleeding and complications related to FLEXLOOP were not observed.

Conclusions

Closure using FLEXLOOP is feasible and safe. Our technique using this new device can be an attractive option for more easily closing mucosal defects. However, further clinical research is warranted to confirm that this technique can prevent delayed complications.

Complement Factor H Is an ICOS Ligand Modulating Tregs in the Glioma Microenvironment

The survival rate of patients with glioma has not significantly increased in recent years despite aggressive treatment and advances in immunotherapy. The limited response to treatments is partially attributed to the immunosuppressive tumor microenvironment, in which regulatory T cells (Treg) play a pivotal role in immunologic tolerance. In this study, we investigated the impact of complement factor H (FH) on Tregs within the glioma microenvironment and found that FH is an ICOS ligand. The binding of FH to this immune checkpoint molecule promoted the survival and function of Tregs and induced the secretion of TGFβ and IL10 while suppressing T-cell proliferation. We further demonstrated that cancer cells in human and mouse gliomas directly produce FH. Database investigations revealed that upregulation of FH expression was associated with the presence of Tregs and correlated with worse prognosis for patients with glioma. We confirmed the effect of FH on glioma development in a mouse model, in which FH knockdown was associated with a decrease in the number of ICOS+ Tregs and demonstrated a tendency of prolonged survival (P = 0.064). Because the accumulation of Tregs represents a promising prognostic and therapeutic target, evaluating FH expression should be considered when assessing the effectiveness of and resistance to immunotherapies against glioma.

Influential articles in autism and gut microbiota: bibliometric profile and research trends

Objective

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder. Increasing evidence suggests that it is potentially related to gut microbiota, but no prior bibliometric analysis has been performed to explore the most influential works in the relationships between ASD and gut microbiota. In this study, we conducted an in-depth analysis of the most-cited articles in this field, aiming to provide insights to the existing body of research and guide future directions.

Methods

A search strategy was constructed and conducted in the Web of Science database to identify the 100 most-cited papers in ASD and gut microbiota. The Biblioshiny package in R was used to analyze and visualize the relevant information, including citation counts, country distributions, authors, journals, and thematic analysis. Correlation and comparison analyses were performed using SPSS software.

Results

The top 100 influential manuscripts were published between 2000 and 2021, with a total citation of 40,662. The average number of citations annually increased over the years and was significantly correlated to the year of publication (r = 0.481, p < 0.01, Spearman's rho test). The United States was involved in the highest number of publications (n = 42). The number of publications in the journal was not significantly related to the journal's latest impact factor (r = 0.016, p > 0.05, Spearman's rho test). Co-occurrence network and thematic analysis identified several important areas, such as microbial metabolites of short-chain fatty acids and overlaps with irritable bowel syndrome.

Conclusion

This bibliometric analysis provides the key information of the most influential studies in the area of ASD and gut microbiota, and suggests the hot topics and future directions. The findings of this study can serve as a valuable reference for researchers and policymakers, guiding the development and implementation of the scientific research strategies in this area.

Rapamycin improves satellite cells' autophagy and muscle regeneration during hypercapnia

Both CO2 retention, or hypercapnia, and skeletal muscle dysfunction predict higher mortality in critically ill patients. Mechanistically, muscle injury and reduced myogenesis contribute to critical illness myopathy, and while hypercapnia causes muscle wasting, no research has been conducted on hypercapnia-driven dysfunctional myogenesis in vivo. Autophagy flux regulates myogenesis by supporting skeletal muscle stem cell - satellite cell - activation, and previous data suggest that hypercapnia inhibits autophagy. We tested whether hypercapnia worsens satellite cell autophagy flux and myogenic potential and if autophagy induction reverses these deficits. Satellite cell transplantation and lineage-tracing experiments showed that hypercapnia undermined satellite cells' activation, replication, and myogenic capacity. Bulk and single-cell sequencing analyses indicated that hypercapnia disrupts autophagy, senescence, and other satellite cell programs. Autophagy activation was reduced in hypercapnic cultured myoblasts, and autophagy genetic knockdown phenocopied these changes in vitro. Rapamycin stimulation led to AMPK activation and downregulation of the mTOR pathway, which are both associated with accelerated autophagy flux and cell replication. Moreover, hypercapnic mice receiving rapamycin showed improved satellite cell autophagy flux, activation, replication rate, and posttransplantation myogenic capacity. In conclusion, we have shown that hypercapnia interferes with satellite cell activation, autophagy flux, and myogenesis, and systemic rapamycin administration improves these outcomes.

Wound Healing After Vaginal Delivery, Episiotomy, and Cesarean Section Delivery Among Women With IBD: Results From the PIANO Registry

BACKGROUND

Women with inflammatory bowel disease (IBD) face complexities of disease management during pregnancy and childbirth. Apprehension regarding vaginal delivery in pregnant individuals with IBD persists due to concern for perianal disease and perineal trauma. The incidence of poor wound healing after obstetric anal sphincter injury is approximately 4% in the general population. In an IBD population, risk of developing and difficulty healing perineal tears and episiotomy is not well described.

METHODS

In a multicenter prospective cohort of pregnant individuals with IBD, we collected demographic information, IBD disease and treatment history, pregnancy and labor history, and reports of delayed wound healing >1 month from episiotomy, vaginal tear, or Cesarean (C-) section. Prospective data were collected using questionnaires that were administered each trimester of pregnancy, at delivery, and in the year postpartum.

RESULTS

There were 743 patients in the PIANO registry who answered questions pertaining to postpartum wound healing, with 330 (44%) reporting a C-section and 413 (56%) reporting a vaginal delivery. Of 119 C-section deliveries assessed for delayed wound healing, only 1 (0.8%) patient reported this complication. Episiotomies were reported in 59 (14%) patients, with 9 (15%) reporting delayed wound healing. Vaginal tears were reported in 252 (64%) patients. Delayed wound healing from vaginal tear was reported in 9% of patients. Use of immunomodulators was associated with delayed wound healing from episiotomy (33% vs 0% for those on no medications, P = .024). No difference was seen in wound healing time for episiotomy with other medications, including corticosteroids, anti-tumor necrosis factor, or anti-integrin use. Delayed wound healing from vaginal tear was not associated with any class of IBD medication.

CONCLUSIONS

Episiotomy was a common occurrence in patients with IBD. Immunomodulator, but not biologic, use was found to be associated with delayed wound healing. This association could reflect a direct medication effect on episiotomy wound healing or inadequate treatment of underlying active disease prior to delivery. Vaginal tears were also common but delayed wound healing was not associated with IBD therapy. C-section occurred at high rates, particularly in Crohn's disease patients, with no reported delays in postpartum wound healing.

Reversal of neuronal tau pathology via adiponectin receptor activation

Changes in brain mitochondrial metabolism are coincident with functional decline; however, direct links between the two have not been established. Here, we show that mitochondrial targeting via the adiponectin receptor activator AdipoRon (AR) clears neurofibrillary tangles (NFTs) and rescues neuronal tauopathy-associated defects. AR reduced levels of phospho-tau and lowered NFT burden by a mechanism involving the energy-sensing kinase AMPK and the growth-sensing kinase GSK3b. The transcriptional response to AR included broad metabolic and functional pathways. Induction of lysosomal pathways involved activation of LC3 and p62, and restoration of neuronal outgrowth required the stress-responsive kinase JNK. Negative consequences of NFTs on mitochondrial activity, ATP production, and lipid stores were corrected. Defects in electrophysiological measures (e.g., resting potential, resistance, spiking profiles) were also corrected. These findings reveal a network linking mitochondrial function, cellular maintenance processes, and electrical aspects of neuronal function that can be targeted via adiponectin receptor activation.

Vitamin D sensitizes cervical cancer to radiation-induced apoptosis by inhibiting autophagy through degradation of Ambra1

Cervical cancer (CC) is becoming a major health issue globally, and radiotherapy plays a crucial role in its treatment. However, the prognosis of some patients remains poor due to tumor resistance to the therapy. This study aimed to explore whether vitamin D could confer a more radiosensitive phenotype in CC based on our previous findings and detection using the database. We found that vitamin D sensitized vitamin D receptor (VDR)-positive CC cells (Siha and Caski) to the cytotoxic effects of radiation in vivo and in vitro. We examined conventional radiation-induced cell death, such as DNA damage and cell cycle arrest, in vitamin D-treated cells to detect the underlying mechanism, but no association was observed between them. Subsequently, our proteome analysis exhibited that autophagy was reduced in irradiated CCs treated with vitamin D, and apoptosis displayed the opposite effect. Moreover, we confirmed that vitamin D-pretreated irradiated cells displayed reduced autophagy activity mediated by the Ambra1 downregulation, and the elevation of apoptosis was attributed to the activation of caspase 8. Importantly, the pharmacological inhibition of caspases or the Ambra1 overexpression could restore tumor proliferation under the vitamin D and radiation combination treatment. Hence, the aforementioned findings revealed the essential impact of vitamin D in terms of enhancing radiosensitivity in CC meditated by inhibiting autophagy and proposed the addition of vitamin D as a viable strategy to improve the therapeutic efficacy of VDR-positive CC.

Gain-of-function ANXA11 mutation cause late-onset ALS with aberrant protein aggregation, neuroinflammation and autophagy impairment

Mutations in the ANXA11 gene, encoding an RNA-binding protein, have been implicated in the pathogenesis of amyotrophic lateral sclerosis (ALS), but the underlying in vivo mechanisms remain unclear. This study examines the clinical features of ALS patients harboring the ANXA11 hotspot mutation p.P36R, characterized by late-onset motor neuron disease and occasional multi-system involvement. To elucidate the pathogenesis, we developed a knock-in mouse model carrying the p.P36R mutation. In both heterozygous and homozygous mutant mice, ANXA11 protein levels were comparable to those in wild-type. Both groups exhibited late-onset motor dysfunction at approximately 10 months of age, with similar survival rates to wild-type (> 24 months) and no signs of dementia. Pathological analysis revealed early abnormal aggregates in spinal cord motor neurons, cortical neurons, and muscle cells of homozygous mice. From 2 months of age, we observed mislocalized ANXA11 aggregates, SQSTM1/p62-positive inclusions, and cytoplasmic TDP-43 mislocalization, which intensified with disease progression. Importantly, mutant ANXA11 co-aggregated with TDP-43 and SQSTM1/p62-positive inclusions. Electron microscopy of the gastrocnemius muscle uncovered myofibrillar abnormalities, including sarcomeric disorganization, Z-disc dissolution, and subsarcolemmal electron-dense structures within autophagic vacuoles. Autophagic flux, initially intact at 2 months, was impaired by 9 months, as evidenced by decreased Beclin-1 and LC3BII/I levels and increased SQSTM1/p62 expression, coinciding with mTORC1 hyperactivation. Significant motor neuron loss and neuroinflammation were detected by 9 months, with marked muscle dystrophy apparent by 12 months compared to wild-type controls. These findings implicate the gain-of-function ANXA11 mutation drives late-onset motor neuron disease by early presymptomatic proteinopathy, progressive neuronal degeneration, neuroinflammation, and autophagic dysfunction.

Estrogen promotes autophagy in the mammary epithelial cells of dairy sheep via the CXCL12/CXCR4 axis

Mammary gland development and lactation in dairy sheep are regulated by hormones and autophagy; however, the role of estrogen-mediated autophagy remains unclear. This study determined that estrogen enhances autophagy, promotes CXCR4 and CXCL12 gene expression, and increases the number of autolysosomes in sheep mammary epithelial cells. Co-treatment with a CXCR4 overexpression vector and the small-molecule alternative of CXCL12, NUCC-390, significantly upregulated ATG5 and LC3 gene expression, increased the abundance of the autophagy-associated protein ATG5 and the LC3II/I ratio, and increased the consumption of the autophagy substrate P62. These results suggest that CXCR4 and CXCL12 signaling promotes autophagy in mammary epithelial cells. Conversely, co-treatment with a CXCR4-specific blocker and estrogen inhibited autophagic changes in ATG5, P62, and LC3 levels, reducing the number of autophagosomes and autolysosomes. Overall, this study demonstrated that estrogen promotes autophagy in sheep mammary epithelial cells through the CXCL12/CXCR4 signaling axis, revealing the underlying mechanisms behind estrogen-mediated autophagy.

Safety and efficacy of faecal microbiota transplantation in patients with acute uncomplicated diverticulitis: study protocol for a randomised placebo-controlled trial

Background

Little is known about the involvement of gut microbiota in the disease course of diverticulitis and the potential benefits of manipulating the gut milieu. We propose to conduct a randomised placebo-controlled feasibility trial of faecal microbiota transplantation (FMT) given as capsules to patients with acute uncomplicated diverticulitis.

Objectives

The objective is primarily to investigate the feasibility of clinical safety, explore efficacy associated with FMT in this patient population, and examine changes in patient-reported quality of life and the composition and function of the gut microbiota.

Design

Study protocol for a randomised placebo-controlled trial.

Methods and analysis

Participants with acute, uncomplicated diverticulitis, as confirmed by computed tomography (CT) scan, will be recruited from Odense University Hospital (Denmark) and randomly assigned to either the intervention group or the control group. The intervention group will consist of 20 patients who receive encapsulated FMT. The control group will also consist of 20 patients, receiving placebo capsules. Primary safety endpoint: Patient safety is monitored by (a) the number of re-admissions and (b) the number of adverse events within 3 months of FMT/placebo; Primary efficacy endpoint: Reduction in the proportion of patients treated with antibiotics within 3 months following FMT/placebo; Secondary outcome: Change from baseline to 3 months in the GI-QLI questionnaire. Results will be analysed using an intention-to-treat approach. Adverse events or unintended consequences will be reported.

Ethics and discussion

This is the first study to investigate the safety and efficacy of FMT in patients with acute uncomplicated diverticulitis. The project has the potential to broaden the knowledge and literature on the role of the intestinal microbiota in diverticulitis, and we believe it will elevate our understanding of cause and effect.

Trial registration

Informed consent is obtained from all participants. The study is approved by the regional ethics committee (ref. S-20230023) and the Danish Data Protection Agency (ref. 24/2435). The trial was registered on clinicaltrials.gov (NCT06254625) on 10th February 2024.

Capsule Endoscopy in Inflammatory Bowel Disease: Evolving Role and Recent Advances

Capsule endoscopy has been proven as an efficient and accurate tool in the diagnosing and monitoring patients with inflammatory bowel disease, especially Crohn's disease (CD). The current European Crohn's and Colitis Organization guidelines recommend small bowel disease assessment in newly diagnosed CD, wherein small bowel capsule endoscopy (SBCE) is of prime importance. SBCE plays an essential role in assessing mucosal healing in patients with CD, serving as a monitoring tool in a treat to target strategy, and is capable of identifying high-risk patients for future flares.

Niraparib perturbs autophagosome-lysosome fusion in pancreatic ductal adenocarcinoma and exhibits anticancer potential against gemcitabine-resistant PDAC

While poly (adenosine diphosphate-ribose) polymerase inhibitors (PARPi) have achieved specific clinical benefits in a subset of pancreatic ductal adenocarcinoma (PDAC) patients, the potential role of the PARPi niraparib in PDAC necessitates further exploration. In this study, we demonstrated that Niraparib exhibited a pronounced inhibitory effect on autophagy in PDAC both in vitro and in vivo. Mechanistically, this inhibition was primarily attributed to niraparib's ability to disrupt the fusion process between autophagosomes and lysosomes, while potentially exerting a relatively minor impact on the initial stage of autophagy. The blockade effect observed may be mediated via modulation of the ERK signaling pathway, and this effect can be mitigated by the application of an ERK inhibitor (FR180204). Notably, the combined treatment regimen of niraparib and gemcitabine failed to elicit the anticipated synergistic effects in wild-type PANC-1 cells, instead exhibiting pronounced antagonistic interactions. However, in gemcitabine-resistant PANC-1 cells, the combination of niraparib and gemcitabine exhibited modest additive effects. Furthermore, niraparib demonstrated a heightened cytotoxic potency against gemcitabine-resistant PANC-1 cells compared to wild-type PANC-1 cells, both in vitro and in vivo. Our research established that niraparib inhibits late-stage autophagy in PDAC, potentially representing a valuable salvage therapy for gemcitabine-resistant PDAC. Further clinical studies are justified.