Hyperforin-induced gut microbiota metabolite carbocysteine protects against depressive-like behaviors in mice by modulating the colonic mucus barrier

OBJECTIVE

Depression affects millions, and current treatments have limitations, necessitating new approaches. Earlier research confirms Hyperforin's ability to reduce anhedonic behaviors in mice and modulate gut microbiota. This study aims to identify specific metabolic changes induced by Hyperforin that could illuminate its impact on gut microbiome metabolism, possibly uncovering novel metabolites for developing antidepressant therapies.

METHODS

Following the chronic stress model, untargeted metabolomic analysis of fecal samples was conducted to identify metabolic changes induced by Hyperforin. Bioinformatics tools analyzed the origins of differentially expressed metabolites and their correlation with Akkermansia muciniphila and Muribaculum intestinale. The significant metabolite Carbocysteine was further investigated for its antidepressant effects using behavioral assays in a mouse model of depression. Additionally, the response of the colonic mucus barrier was evaluated using Periodic Acid-Schiff (PAS) staining, scanning electron microscopy (SEM), and enzyme-linked immunosorbent assays (ELISA).

RESULTS

Hyperforin significantly altered fecal metabolite profiles in stressed mice, with a notable shift in 239 metabolites mainly associated with co-metabolism pathways and microbiota-specific processes. Among these, Carbocysteine emerged as a key metabolite linked to beneficial bacteria Akkermansia muciniphila and Muribaculum intestinale, with its levels significantly elevated following Hyperforin treatment. Behavioral assessments indicated that Carbocysteine supplementation ameliorated depressive-like behaviors in the chronic restraint stress mouse model. It also enhanced colonic mucus production and integrity.

CONCLUSION

Our research highlights Hyperforin's role in modulating gut microbiota metabolism and identifies Carbocysteine as a potential antidepressant. These findings advance our understanding of the gut-brain axis (GBA) in depression and pave the way for developing new therapeutics.

Metabolic dysfunction-associated steatotic liver disease and malignancies: Unmasking a silent saboteur

Not required for Editorials.

Application of liquid biopsy in differentiating lung cancer from benign pulmonary nodules (Review)

The diagnosis of malignant and benign pulmonary nodules has always been a prominent research topic. Accurately distinguishing between these types of lesions, particularly small or ground glass nodules, is crucial for the early detection and proactive treatment of lung cancer, ultimately leading to improved patient survival. Although various imaging methods and tissue biopsies have advanced the diagnostic efficacy of pulmonary nodules, each approach possesses inherent limitations. In recent years, there has been a growing interest in liquid biopsy as a non‑invasive and easily obtainable alternative. Furthermore, in‑depth investigations into the mechanisms underlying tumor initiation and progression have contributed to the development of circulating biomarkers for monitoring treatment response and efficacy in lung cancer. This review provides a comprehensive overview of the current landscape of pulmonary nodule diagnosis while highlighting the latest advancements in liquid biopsy techniques, such as extracellular vesicles, tumor‑educated platelets, non‑coding RNA, circulating tumor DNA and circulating antibodies.

The role of ICG NIRL fluorescence imaging in the surgical treatment of digestive system tumors (Review)

Indocyanine green (ICG) is a relatively non‑toxic fluorescent dye with a history of safe use, which has fueled the development of new applications for ICG. Research on the use of ICG near‑infrared light (NIRL) fluorescence imaging during oncologic surgery has increased, revealing its role in tumor identification and localization, lymph node navigational resection and blood perfusion assessment. The purpose of the present review was to provide a comprehensive overview of advances in the clinical application of ICG NIRL fluorescence imaging during gastrointestinal tumor surgery. The present review discusses the techniques, outcomes, limitations and key considerations necessary for clinical practice, aiming to provide a valuable resource for professionals in the field.

Novel insights into differences in the whey proteome of porcine and human colostrum and mature milk

Many mothers are unable to exclusively breastfeed for several reasons. Other mammalian milks should be explored as human milk supplements. Pigs and humans are physiologically similar. Therefore, we hypothesized that the whey protein composition and functions of porcine and human milk are similar. This study aimed to compare and analyze the whey proteomes of porcine and human milk during lactation. Totally, 3390, 3275, 3587, and 3463 whey proteins were identified in porcine colostrum, porcine mature milk, human colostrum, and human mature milk, respectively. Complement components and serotransferrin, which are related to the immune system process were highly expressed in porcine milk. Porcine and human whey proteins were enriched in similar Gene Ontology annotations and Kyoto Encyclopedia of Genes and Genomes pathways. These results revealed that the biological functions of porcine and human whey proteins were similar, which contributes to the development of porcine whey proteins.

Ferroptosis meets inflammation: A new frontier in cancer therapy

Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has emerged as a critical player in cancer pathogenesis. Concurrently, inflammation, a key biological response to tissue injury or infection, significantly influences cancer development and progression. The interplay between ferroptosis and inflammation represents a promising yet underexplored area of research. This review synthesizes recent advances in understanding the molecular mechanisms governing their interaction, emphasizing how ferroptosis triggers inflammatory responses and how inflammatory mediators, such as TNF-α, regulate ferroptosis through iron metabolism and lipid peroxidation pathways. Key molecular targets within the ferroptosis-inflammation axis, including GPX4, ACSL4, and the NF-κB signaling pathway, offer therapeutic potential for cancer treatment. By modulating these targets, it may be possible to enhance ferroptosis and fine-tune inflammatory responses, thereby improving therapeutic outcomes. Additionally, this review explores the broader implications of targeting the ferroptosis-inflammation interplay in disease treatment, highlighting opportunities for developing innovative strategies to combat cancer. By bridging the gap in current knowledge, this review provides a comprehensive resource for researchers and clinicians, offering insights into the therapeutic potential of this intricate biological relationship.

Prognostic impact of histopathological features and serum inflammatory markers in patients with gastric cancer undergoing neoadjuvant therapy

BACKGROUND

Neoadjuvant therapies induce tumor regression, resulting in improved surgical resection and pathologic complete response rates, as well as long-term disease-free and overall survival (OS). In addition to the tumor regression score, serum inflammatory markers, including neutrophil, lymphocyte, platelet, and serum albumin levels, are used to determine prognosis.

AIM

To investigate the effect of histological features and serum inflammatory markers on the prognosis of gastric cancer following neoadjuvant treatment.

METHODS

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and serum albumin levels were retrospectively recorded for 177 patients receiving neoadjuvant 5-fluorouracil, leucovorin, oxaliplatin and docetaxel chemotherapy. Disease-free and OS were analyzed based on tumor histopathological features, type of surgery, regression scores, and serum inflammatory markers.

RESULTS

Patients over 65 years of age, those with lymphovascular or perineural invasion, hypoalbuminemia, and those who did not receive adjuvant therapy were found to be at higher risk for shorter recurrence/relapse intervals [hazard ratio (HR): 1.64, P = 0.04; HR: 4.20, P < 0.001; HR: 1.87, P = 0.03; HR: 3.5, P < 0.001; and HR: 2.73, P = 0.01, respectively]. Lymphovascular invasion, R1 resection, lack of adjuvant treatment, and hypoalbuminemia negatively influenced OS (HR: 3.68, P < 0.003; HR: 2.37, P = 0.01; HR: 3.99, P < 0.001; and HR: 2.50, P = 0.01, respectively). No effect of NLR and PLR was observed.

CONCLUSION

Current neoadjuvant therapies prolong disease-free and OS. The practical application of serum inflammatory markers (NLR and PLR) is limited due to the lack of standard cut-off values. Nutritional status, hypoalbuminemia, and incomplete perioperative chemotherapy have been associated with poor prognosis.

Impact of enhanced bowel preparation on complications and prognosis following colonoscopic polypectomy

BACKGROUND

Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer, with its success and safety largely dependent on the quality of bowel preparation. Currently, polyethylene glycol electrolyte solution remains the standard method for bowel preparation, but its use may cause patient discomfort and incomplete cleansing.

AIM

To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.

METHODS

This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024. Patients were divided into the conventional bowel preparation group (n = 65) and enhanced bowel preparation group (n = 65). Primary outcome measures included Boston Bowel Preparation Scale (BBPS) scores, procedure-related parameters, complication rates, and prognosis. Statistical analysis was performed using SPSS version 25.0, with P < 0.05 indicating statistical significance.

RESULTS

The enhanced group demonstrated significant advantages over the conventional group, with higher BBPS total scores (4.2 ± 0.7 vs 3.1 ± 0.8, P < 0.001), higher one-time complete resection rates (95.4% vs 83.1%, P = 0.01), shorter operative times (23.1 ± 4.8 vs 25.4 ± 5.2 min, P = 0.03), and lesser intraoperative blood loss (18.2 ± 4.5 vs 20.3 ± 5.1 mL, P = 0.04). Total complication rates were significantly lower (5.9% vs 16.9%, P = 0.05), particularly for bleeding (1.5% vs 16.9%, P = 0.01) and infection (1.5% vs 7.7%, P = 0.04). The enhanced group also showed lower 6-month recurrence rates (3.1% vs 10.8%, P = 0.05) and higher patient satisfaction (87.7% vs 76.9%, P = 0.04) than did the conventional group.

CONCLUSION

The enhanced bowel preparation protocol demonstrates significant advantages, particularly in improving surgical outcomes, reducing complications, and increasing patient satisfaction, underscoring its importance of its application during colonoscopic polypectomy.

Relationship between prognosis and glucose transporter-1 and Ki-67 expression in obstructive colon cancer pre and post stent placement

BACKGROUND

Self-expandable metallic stent (SEMS) placement is a common intervention for obstructive left-sided colon cancer. However, the long-term prognosis post-SEMS placement remains debated. Mechanical compression within the tumor caused by SEMS may induce vascular compression, leading to tissue ischemia and hypoxia. These alterations in the tumor microenvironment could affect patient prognosis.

AIM

To assess the influence of glucose transporter-1 (GLUT-1) and Ki-67 expression in obstructive colon cancer tissues pre and post SEMS placement on patient prognosis.

METHODS

A retrospective analysis was conducted on clinical and pathological data from 71 patients with obstructive colon cancer who underwent SEMS placement followed by surgery. Paired colon cancer tissue samples were collected from each patient pre and post SEMS placement. Immunohistochemical techniques were employed to evaluate GLUT-1 and Ki-67 expression in the specimens.

RESULTS

The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were 14.1% and 43.7%, respectively (P < 0.001). GLUT-1 expression was associated with vascular invasion post-SEMS placement (P = 0.03). Ki-67 expression showed no significant difference pre and post SEMS placement and was unrelated to clinical pathological characteristics (all P > 0.05). The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were associated with worse recurrence-free interval (pre-SEMS: 40.0% vs 72.3%, P = 0.026; post-SEMS: 45.5% vs 85.7%, P = 0.001). Cox regression analysis revealed that both pre-SEMS placement (HR = 3.490, 95%CI: 1.165-10.453, P = 0.026) and post-SEMS placement (HR = 4.335, 95%CI: 1.539-12.214, P = 0.006) GLUT-1 expression were adverse prognostic factors for patients.

CONCLUSION

Though the precise impact of stent placement on the mechanical compression and biological behavior of tumors is not fully understood, our study found an increase in GLUT-1 expression in tumor tissues after SEMS placement. Tumor GLUT-1 serves as a prognostic biomarker for the survival of patients with obstructive colon cancer treated with SEMS placement.

Quality of life and outcomes in patients undergoing endoscopic papillectomy vs surgical treatment for duodenal papillary adenomas

BACKGROUND

Endoscopic papillectomy (EP) via endoscopic retrograde cholangiopancreatography has emerged as a less invasive alternative to surgery for duodenal papillary adenomas (DPAs), which is traditionally associated with notable postoperative risks.

AIM

To compare quality of life (QoL) and outcomes between DPA patients undergoing EP vs surgical resection, and to assess the influencing factors of QoL and complications.

METHODS

We conducted a retrospective, single-center analysis involving patients treated for DPA at the Drum Tower Hospital of Nanjing University Medical School from 2011 to 2023. The participants completed post-discharge telephone surveys using the 12-item short form survey to assess mental (MCS) and physical component summary (PCS) scores, with norm-based scoring where ≥ 50 denotes normal. Multivariate regression analysis adjusted for confounding variables was used to compare QoL scores.

RESULTS

Compared with EP patients, surgically treated patients had significantly lower PCS [median: 53.0, interquartile range (IQR): 46.0-55.1 vs 54.2, IQR: 51.7-55.9, P = 0.008] and MCS scores (median: 48.6, IQR: 41.8-56.0 vs 55.9, IQR: 51.7-60.7, P < 0.001). These disparities persisted even after adjustments for demographic and medical factors. Long-term follow-up of the EP group revealed that abdominal pain and poor sleep were factors negatively impacting PCS scores, whereas postoperative pancreatitis and hypertension were associated with lower MCS scores.

CONCLUSION

EP has emerged as a QoL-preserving alternative for patients with DPA, conditional upon ensuring equivalent efficacy and safety. QoL outcomes should be considered when choosing interventions for this patient population.

Clinical significance of immune cell and biomarker changes in liver cancer

BACKGROUND

Primary liver cancer (PLC) is characterized by high malignancy, rapid disease progression, and persistent high incidence and mortality rates, posing a significant public health challenge worldwide. Early diagnosis and assessment of PLC are of great significance for guiding clinical treatment and improving patient prognosis. Alpha fetoprotein (AFP) and gamma-glutamyl transpeptidase (GGT) are commonly utilized tumor markers for the clinical diagnosis of PLC. They are ideal indicators for the detection of metastasis and recurrence after LC surgery. Nevertheless, not all patients with PLC secrete large amounts of AFP and GGT, which affects the accuracy of evaluating PLC by monitoring these two tumor markers alone. Cluster of differentiation 3 and 161 double-positive natural killer T (CD3⁺CD161⁺NKT) cell subsets are a class of molecules inextricably related to immune function and tumor occurrence and development. This research seeks to explore the clinical significance of CD3⁺CD161⁺NKT cell subsets combined with tumor markers AFP and GGT in the diagnosis of patients with PLC.

AIM

To probe the clinical significance of CD3⁺CD161⁺NKT cell subsets and AFP and GGT changes in the peripheral blood of individuals with PLC.

METHODS

The PLC group comprised 30 patients diagnosed with PLC who were admitted to our hospital between July 2022 and December 2023, whereas the control group consisted of 30 healthy individuals undergoing routine physical examinations at our hospital. Peripheral blood samples were harvested from both cohorts of patients. The levels of CD4⁺NKT, CD8⁺NKT, CD3⁺CD56⁺NKT, CD8⁺CD56⁺NKT, CD3⁺CD161⁺NKT, and CD3^-CD161⁺NKT were measured by flow cytometry. Serum AFP content was determined using a fully automatic immunoassay analyzer, and serum GGT content was ascertained by a fully automatic biochemical analyzer. The diagnostic value of CD3⁺CD161⁺NKT cell subsets and AFP and GGT level alterations for PLC was evaluated by receiver operating characteristic curve analysis.

RESULTS

No significant disparities were observed in the counts of white blood cells, neutrophils, and platelets, as well as the levels of blood urea nitrogen and serum creatinine between the two groups (P > 0.05). Lymphocytes, red blood cells, hemoglobin, total protein, albumin, and globulin were more attenuated in the PLC group than in the control group, while glutamic-pyruvic transaminase, glutamic oxalacetic transaminase, and carcinoembryonic antigen levels were increased in the PLC cohort compared with the control cohort, with statistical significance (P < 0.05). No substantial difference was discovered in peripheral blood CD4⁺NKT, CD8⁺NKT, and CD3⁺CD56⁺NKT cells between the two cohorts (P > 0.05). The percentage of CD8⁺CD56⁺NKT cells (8.35% ± 1.01%), CD3⁺CD161⁺NKT cells (14.36% ± 1.55%), and CD3^-CD161⁺NKT cells (12.08% ± 1.34%) in the PLC group was higher than that in the control group (P < 0.05). The levels of AFP (335.71 ± 20.89 ng/mL) and GGT (136.87 ± 15.62 U/mL) in the PLC cohort were elevated within the PLC cohort compared with the control cohort (P < 0.05). The sensitivity of CD8⁺CD56⁺NKT, CD3⁺CD161⁺NKT, CD3^-CD161⁺NKT, AFP, and GGT alone for diagnosing PLC was 70.00%, 83.33%, 80.00%, 56.67%, and 53.33%, respectively (P < 0.05), with specificity rates of 66.67%, 80.00%, 76.67%, 76.67%, and 66.67%, respectively (P < 0.05). The area under the curve for combined detection was 0.898, with a sensitivity of 86.67% and a specificity of 80.00% (P < 0.05).

CONCLUSION

The levels of CD8⁺CD56⁺NKT, CD3⁺CD161⁺NKT, CD3^-CD161⁺NKT, AFP, and GGT in the peripheral blood of patients with PLC were markedly elevated. The combined detection of these five indicators can improve the sensitivity and specificity of PLC diagnosis, providing solid evidence for the early clinical diagnosis of PLC.

Effects of gastrointestinal motility therapy combined with acupuncture on gastrointestinal function in patients after laparoscopic radical surgery

BACKGROUND

Gastrointestinal (GI) dysfunction is common after laparoscopic radical gastrectomy for gastric cancer and affects rehabilitation. While conventional treatments can alleviate symptoms to a certain extent, they often fail to fully address the issue of insufficient GI motility. The GI motility therapeutic apparatus promotes dynamic recovery by simulating GI electric waves, whereas acupuncture regulates zang-fu qi movement, both offering effective interventions. However, there are few clinical studies investigating the combined use of GI motility therapy and acupuncture to promote GI function recovery in patients after GI laparoscopic radical surgery.

AIM

To evaluate the effects of combining GI motility therapy devices with acupuncture on GI function in patients undergoing radical laparoscopic surgery.

METHODS

This retrospective study included 196 patients who underwent radical GI endoscopic surgery at the Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, from June 2022 to May 2024. Patients were classified into a normal group (conventional treatment, n = 96) and an integrated group (conventional + GI motility therapy device + acupuncture, n = 100). The effects on GI function, hormone levels pre- and post-treatment, GI symptoms, immune function, adverse reactions, and patient satisfaction in both groups were assessed.

RESULTS

Compared with the normal group, the integrated group demonstrated significantly better overall effectiveness (93.00% vs 84.3%; P < 0.05) and shorter durations for first exhaust, feeding, defecation, and hospital stay (P < 0.05). Post-treatment, the integrated group had lower gastrin and GI symptom rating scale scores and higher motilin, vasoactive intestinal peptide, and immune marker (CD3+, CD4+, CD4+/CD8+, and natural killer cells) levels (P < 0.05). The integrated group, compared to the normal group, also reported fewer adverse reactions (5.00% vs 14.58%) and higher patient satisfaction (97.00% vs 84.38%), both statistically significant (P < 0.05).

CONCLUSION

The combination of a GI motility therapy device and acupuncture promotes GI function recovery after radical gastrectomy, regulates GI hormones and immune function, and is safe and effective.

Analysis of risk factors for post-operative infection following drug-eluting trans arterial chemo embolization in hepatocellular carcinoma: A retrospective study

BACKGROUND

Post-operative infection is a common and serious complication following drug-eluting trans arterial chemo embolization (D-TACE) in patients with hepatocellular carcinoma (HCC), potentially compromising treatment efficacy and increasing morbidity.

AIM

To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE, and to provide evidence for clinical prevention and targeted intervention strategies.

METHODS

Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed. Patient demographics, laboratory test results, tumor characteristics, and surgery-related parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.

RESULTS

Post-operative infection occurred in 20 cases (25.97%) among the 77 patients. Univariate analysis showed that age ≥ 65 years, Child-Pugh grade B, tumor diameter ≥ 5 cm, operation time ≥ 120 minutes, preoperative albumin < 35 g/L, and comorbid diabetes were significantly associated with post-operative infection (P < 0.05). Multivariate logistic regression analysis identified Child-Pugh grade B (OR = 2.851, 95%CI: 1.426-5.698), operation time ≥ 120 minutes (OR = 2.367, 95%CI: 1.238-4.523), and preoperative albumin < 35 g/L (OR = 2.156, 95%CI: 1.147-4.052) as independent risk factors for post-operative infection.

CONCLUSION

Liver function status, operation time, and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE. For high-risk patients, enhanced perioperative management, appropriate timing of surgery, and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.

Simultaneous combined surgery for hepatic-renal double organ alveolar or cystic echinococcosis: A retrospective study

BACKGROUND

Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections, leading to alveolar echinococcosis (AE) or cystic echinococcosis (CE), respectively. No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.

AIM

To investigate the feasibility and efficacy of simultaneous combined surgery (SCS) as a comprehensive treatment approach for patients with hepatorenal echinococcosis.

METHODS

Clinical datasets of hepatorenal AE (n = 10) and CE (n = 11) patients were retrospectively collected and systematically analyzed. The SCS approach was introduced, and surgical outcomes, complications, and prognoses were documented in detail.

RESULTS

The SCS approach incorporated hybridized techniques, including partial hepatectomy, partial or total nephrectomy, ex vivo liver resection and autotransplantation, and total or subtotal cystectomy with endocystectomy. Radical SCS was achieved in 100% of AE patients and 63.6% of CE patients. All surgeries were completed without intraoperative complications. The short-term complication rate was 28.6% (Clavien-Dindo classification: AE-1 IIIb, 3 IIIa; CE-2 II), while the long-term complication rate was 4.8% (Clavien-Dindo classification: AE-1 IIIb). Patients were followed up for a median of 37 months (AE: 6-81 months; CE: 34-123 months), with no reported deaths or disease relapses.

CONCLUSION

CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE. It fulfills the management criteria for advanced AE or CE cases, aiming to maximize patient benefits.

Incidence, risk factors and outcomes for post-hepatectomy portal vein thrombosis: A retrospective study

BACKGROUND

Post-hepatectomy portal vein thrombosis (PH-PVT) is a life-threatening complication; however, the available literature on this topic is limited.

AIM

To examine the incidence, risk factors, and outcomes associated with PH-PVT.

METHODS

Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University (Beijing, China) were retrospectively reviewed. The patients were divided into a PH-PVT group and a non-PH-PVT group. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.

RESULTS

A total of 1064 patients were included in the study cohort, and the incidence and mortality rates of PH-PVT were 3.9% and 35.7%, respectively. The median time from hepatectomy to the diagnosis of PH-PVT was 6 days. Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy (HPD) [odds ratio (OR) = 7.627 (1.390-41.842), P = 0.019], portal vein reconstruction [OR = 6.119 (2.636-14.203), P < 0.001] and a postoperative portal vein angle < 100° [OR = 2.457 (1.131-5.348), P = 0.023] were independent risk factors for PH-PVT. Age ≥ 60 years [OR = 8.688 (1.774-42.539), P = 0.008] and portal vein reconstruction [OR = 6.182 (1.246-30.687), P = 0.026] were independent risk factors for mortality in PH-PVT patients.

CONCLUSION

Portal vein reconstruction, a postoperative portal vein angle < 100° and HPD were independent risk factors for PH-PVT. Age ≥ 60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.

Antiphospholipid IgG Certified Reference Material ERM®-DA477/IFCC: a tool for aPL harmonization?

OBJECTIVES

The Certified Reference Material (CRM) ERM®-DA477/IFCC is a new polyclonal IgG anti-beta2-glycoprotein I (anti-β2GPI) material for the harmonization of the laboratory diagnosis of antiphospholipid syndrome (APS). We evaluated CRM's ability to represent the heterogeneity of APS patient anti-β2GPI antibodies and to calibrate IgG anti-β2GPI methods.

METHODS

We characterized CRM for its reactivity against domain-1, using the QUANTA Flash® β2GPI-domain-1 assay, and against domains-4-5 of β2GPI, and single-domain-deleted β2GPI molecules using in-house ELISAs. We used QUANTA Lite® ELISA, QUANTA Flash® CLIA, and EliA™ FEIA methods to evaluate the CRM's anti-Cardiolipin (anti-CL) activity. Four anti-β2GPI IgG methods (in-house and QUANTA Lite® ELISA, QUANTA Flash® CLIA, and EliA™ FEIA) were also used to evaluate the CRM's calibration efficacy, alongside 133 clinical samples (CSs) and 99 controls.

RESULTS

The CRM showed high anti-domain-1 activity and no anti-domain-4-5 activity at the recommended assay dilution. The domain-dependent-β2GPI reactivity profiles were comparable with full-blown APS. There was acceptable dilution linearity for anti-CL assays with R2 ranging from 0.957 to 0.997. For the four anti-β2GPI IgG assays, calibration with the CRM led to a good comparability of the average result of CSs for two of the assays. New cut-offs calculated from this work improved comparability in quantitative results between three of the assays: 85 % concordance with CRM compared to 66 % concordance with assay-specific-calibration.

CONCLUSIONS

The CRM is representative of patient anti-β2GPI/CL heterogeneity and should improve anti-β2GPI IgG method harmonization. However, the level of achievable method harmonization is affected by differences in the selectivity among the assays.

Unexpected contralateral axillary lymph node metastasis without ipsilateral involvement in triple-negative breast cancer: A case report and review of literature

BACKGROUND

Breast cancer is a leading cause of cancer-related mortality among women worldwide, with invasive ductal carcinoma (IDC) being the most prevalent subtype. Lymph node metastasis is the primary prognostic indicator, typically evaluated via biopsy of the ipsilateral sentinel or axillary lymph nodes. Contralateral axillary metastasis (CAM) without ipsilateral involvement is exceedingly rare, particularly in early-stage breast cancer. This report presents a case of CAM in a patient with triple-negative breast cancer (TNBC), underscoring diagnostic and therapeutic complexities.

CASE SUMMARY

A 73-year-old female presented with left-sided early-stage IDC in February 2023. Despite a modified radical mastectomy and pathologically negative ipsilateral lymph nodes, a postoperative positron emission tomography (PET) scan detected fluorodeoxyglucose-avid nodes in the contralateral axilla. Biopsy confirmed metastatic ductal carcinoma with triple-negative status, resulting in an upstaged diagnosis of metastatic breast cancer, stage IV, M1. The patient underwent six cycles of adjuvant chemotherapy, with follow-up PET imaging showing regression of the contralateral lesion. This case highlights the importance of advanced imaging in TNBC for precise staging and treatment optimization.

CONCLUSION

This case highlights the aggressive nature of TNBC and the need for advanced imaging to ensure accurate staging and effective management.

Advances in the pathophysiology and treatment of focal segmental glomerulosclerosis: The importance of a timely and tailored approach

Focal segmental glomerulosclerosis (FSGS) is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease. Its incidence is rising globally, necessitating timely and personalized management strategies. This paper aims to provide an updated overview of the pathophysiology, diagnosis, and therapeutic strategies for FSGS, emphasizing the importance of early interventions and tailored treatments. This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS. Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients. Advances include novel biomarkers, genetic testing, and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS. Effective management of FSGS requires a combination of timely diagnosis, evidence-based therapeutic strategies, and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.

Changes Over 10 Years in Peripheral Nerve Function in People With Well-Controlled Type 2 Diabetes and Those With Normal Glucose Tolerance

BACKGROUND AND OBJECTIVES

There is a lack of knowledge on the changes in peripheral nerve function in people with well-controlled, recently diagnosed type 2 diabetes compared with those with normal glucose tolerance (NGT). In this study, we aimed to investigate the natural course of the function of lower extremity small and large nerve fibers in people with NGT and its decline in those with well-controlled type 2 diabetes.

METHODS

This prospective observational study assessed changes in nerve function in participants of the German Diabetes Study with recently diagnosed (≤1 year) type 2 diabetes and age-matched and sex-matched individuals with NGT after 5 years and in a larger group of participants with type 2 diabetes after 5 and 10 years. Reference tests of lower extremity peripheral nerve function included peroneal motor nerve conduction velocity (MNCV) and sural sensory nerve conduction velocity (SNCV), sural sensory nerve action potential (SNAP), malleolar vibration perception threshold (VPT), and thermal detection thresholds (TDTs). Data were analyzed using multiple linear or logistic regression analyses.

RESULTS

At baseline, all 5 nerve function measures showed impairment in the 52 individuals in the diabetes group (33% female, median age 51.7 years) compared with the 52 individuals in the matched NGT group (33% female, median age 51.4 years). After 5 years, 2 nerve indices declined in the diabetes group (peroneal MNCV and VPT) and 3 in the NGT group (peroneal MNCV, VPT, and TDT for cold), with similar 5-year declines observed in both groups after adjustment for baseline values and pairwise matching. In addition, the Neuropathy Disability Score increased in the NGT group but not in the diabetes group. Comparable patterns of decline after 5 and 10 years were found in the larger diabetes cohort of 141 individuals (39% female, median baseline age 53.6 years). The observed 10-year prevalence of abnormal NCVs closely matched estimates based on natural aging-related decline (14.2% vs 12.8% for peroneal MNCV and 30.2% vs 31.0% for sural SNCV).

DISCUSSION

These findings suggest that nerve function deterioration in well-controlled type 2 diabetes is primarily influenced by nerve function status at diagnosis and physiologic aging, rather than diabetes-related progression.

Fecal microbiota transplantation in allergic diseases

Microorganisms such as bacteria, fungi, viruses, parasites living in the human intestine constitute the human intestinal microbiota. Dysbiosis refers to compositional and quantitative changes that negatively affect healthy gut microbiota. In recent years, with the demonstration that many diseases are associated with dysbiosis, treatment strategies targeting the correction of dysbiosis in the treatment of these diseases have begun to be investigated. Faecal microbiota transplantation (FMT) is the process of transferring faeces from a healthy donor to another recipient in order to restore the gut microbiota and provide a therapeutic benefit. FMT studies have gained popularity after probiotic, prebiotic, symbiotic studies in the treatment of dysbiosis and related diseases. FMT has emerged as a potential new therapy in the treatment of allergic diseases as it is associated with the maintenance of intestinal microbiota and immunological balance (T helper 1/T helper 2 cells) and thus suppression of allergic responses. In this article, the definition, application, safety and use of FMT in allergic diseases will be discussed with current data.

Advancements in diabetic retinopathy: Insights and future directions

This editorial discusses recent advancements and ongoing challenges in diabetic retinopathy, as reviewed by Morya et al in their comprehensive analysis. In their review, Morya et al discussed the pathophysiology of diabetic retinopathy and explored novel treatment modalities. This editorial highlights the importance of these advancements and emphasizes the need for continued research and innovation for the enhanced management of diabetic retinopathy. It also reflects upon the implications of the authors’ review findings for clinical practice and future research directions, underscoring the potential of emerging therapies for improving patient outcomes and providing a deeper understanding of disease mechanisms.

Closer look at the cardiovascular and metabolic predictors of postpartum depression

Postpartum depression (PPD) is a severe mental health disorder affecting 10% to 15% of postpartum women worldwide. Pre-eclampsia is a hypertensive disorder of pregnancy that has been identified as a significant factor for PPD due to its vascular dysfunction, systemic inflammation and neurobiological alterations. The neuroinflammatory mechanisms common to both pre-eclampsia and PPD, that contribute to depressive symptoms include elevated proinflammatory cytokines (interleukin-6, tumor necrosis factor-alpha), activation of the kynurenine pathway, and oxidative stress. To critically evaluate Wu et al's study, which investigates blood pressure variability (BPV) and gestational body mass index (BMI) as independent predictors of PPD. To integrate recent findings on the metabolic and cardiovascular links between depression, pre-eclampsia, and postpartum mental health outcomes. Pre-pregnancy BMI is found to be a stronger predictor of PPD than gestational weight gain. A vascular-neuropsychiatric connection has been indicated in pre-eclamptic women, indicating a significant correlation between BPV and depressive postpartum symptoms. There is increased susceptibility to depression due to neuroinflammation contributed by blood pressure fluctuations and metabolic dysregulation. The incidence of PPD could be reduced by early identification and intervention for BP fluctuations. Early detection and intervention in high-risk pregnancies should be conducted through public health strategies that prioritize awareness, education, and accessibility to mental health care.

Diagnostic value of ultrasonography for post-liver transplant hepatic vein complications

Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success. Despite hepatic vein complications following LT occurring at a relatively low frequency, ranging between 2% to 11%, delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality. Clinical manifestations of hepatic vein complications are often subtle and nonspecific, posing challenges for early diagnosis. Signs may initially present as mild abnormalities in liver function, delayed recovery of liver function, unexplained ascites, lower limb edema, and perineal edema. Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion. Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness. Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging, these findings lack specificity. Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can, however, significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.

Bioactive peptides PIISVYWK and FSVVPSPK improve glucose homeostasis by targeting DPP-IV and glucose transport in type 2 diabetic mice

Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder characterized by chronic hyperglycemia, insulin resistance, and progressive β-cell dysfunction, often exacerbated by inflammation and oxidative stress. Effective management requires multi-targeted approaches, including modulation of glucose metabolism, suppression of inflammatory pathways, and pancreatic protection. This study investigates the antidiabetic and immunomodulatory potential of PIISVYWK (P1) and FSVVPSPK (P2), bioactive peptides from blue mussel, Mytilus edulis, in regulating these pathways. In vitro, P1 and P2 were assessed for their ability to inhibit α-glucosidase and DPP-IV activity in Caco-2 cells, alongside glucose uptake and transporter protein expression (SGLT-1 and GLUT2). In vivo, HFD/STZ-induced diabetic mice were administered P1 or P2 (1 mg/kg or 10 mg/kg) or metformin (200 mg/kg) for four weeks. Peptide treatment significantly improved glycemic control by inhibiting α-glucosidase and DPP-IV, increasing GLP-1 levels, and reducing intestinal glucose uptake. Additionally, P1 and P2 exhibited strong anti-inflammatory effects by suppressing NF-κB activation and reducing circulating IL-6, TNF-α, and IL-1β levels. Enhanced antioxidant enzyme activity (SOD, GPx, CAT) further mitigated oxidative stress, preventing pancreatic damage. Peptides also preserved β-cell function by enhancing insulin secretion and regulating glucagon levels. These findings suggest that P1 and P2 peptides exert antidiabetic effects through multi-targeted mechanisms, including immunomodulation, making them promising therapeutic candidates for T2DM management.

New insights into therapeutic strategies for targeting hepatic macrophages to alleviate liver fibrosis

Liver fibrosis is a wound-healing response induced by persistent liver damage, resulting from complex multicellular interactions and multifactorial networks. Without intervention, it can progress to cirrhosis and even liver cancer. Current understanding suggests that liver fibrosis is reversible, making it crucial to explore effective therapeutic strategies for its alleviation. Chronic inflammation serves as the primary driver of liver fibrosis, with hepatic macrophages playing a dual role depending on their polarization state. This review summarizes various prevention and therapeutic strategies targeting hepatic macrophages in the context of liver fibrosis. These strategies include inhibition of macrophage recruitment, modulation of macrophage activation and polarization, regulation of macrophage metabolism, and induction of phagocytosis and autophagy in hepatic macrophages. Additionally, we discuss the communication between hepatic macrophages, hepatocytes, and hepatic stellate cells (HSCs), as well as the current clinical application of anti-fibrotic drugs targeting macrophages. The goal is to identify effective therapeutic targets at each stage of macrophage participation in liver fibrosis development, with the aim of using hepatic macrophages as a target for liver fibrosis treatment.

Diagnostic value of serum pepsinogen, gastrin, and carbohydrate antigens in gastric ulcer and gastric cancer

BACKGROUND

Emerging evidence suggests that serum levels of pepsinogen (PG), gastrin-17 (G17), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and CA72-4 may aid in distinguishing gastric cancer (GC) from gastric ulcer (GU).

AIM

To assess serum PG, G17, CEA, CA19-9, and CA72-4 in diagnosing GU and optimizing GC detection.

METHODS

A retrospective analysis was conducted from 263 patients treated at the Third People’s Hospital of Hefei, who were classified into three groups: Chronic non-atrophic gastritis (CG), GU, and GC. Fasting serum levels of PG, G17, CEA, CA19-9, and CA72-4 were measured and compared across the groups.

RESULTS

Serum levels of PGII and G17 were significantly elevated in both the GU and GC groups compared to the CG group (P < 0.01), whereas the PGI/PGII ratio was markedly decreased (P < 0.01). Levels of CEA, CA19-9, and CA72-4 were significantly higher in the GC group than in the CG and GU groups (P < 0.01). Receiver operating characteristic curve analysis identified the optimal diagnostic cut-off values for GU and GC as follows: PGI (169.855 pmol/L), PGII (30.555 μg/L), PGI/PGII ratio (16.529), G17 (6.435 pmol/L), CEA (2.005 ng/mL), CA19-9 (16.65 U/mL), and CA72-4 (2.075 U/mL). The area under the curve for combined detection was 0.826 (P < 0.001), indicating good diagnostic performance.

CONCLUSION

Serological biomarkers effectively distinguish GC from GU, with combined detection of PGII, PGI/PGII ratio, G17, and tumor markers enhancing diagnostic accuracy.

Utility of liver stiffness for the classification of portopulmonary hypertension in precapillary pulmonary hypertension

BACKGROUND

Invasive right heart catheterization plays a central role in identifying pulmonary hypertension (PH) disorders. However, non-invasive biomarkers of portopulmonary hypertension (PoPH) are required. Liver stiffness evaluated by FibroScan® is useful for the assessment of liver fibrosis in patients with chronic liver diseases. This study sought to investigate the utility of liver stiffness for the classification of PoPH among precapillary PH patients.

METHODS

A total of 46 patients [38 females, median (interquartile range) age 63.0 (50.8-72.0) years old] with precapillary PH were divided into a PoPH group (N = 6) and a non-PoPH group (N = 40) based on the presence of portosystemic shunts and/or portal hypertension with hepatic venous pressure gradient >5 mmHg.

RESULTS

The PoPH group showed higher cardiac index and lower pulmonary vascular resistance than the non-PoPH group. Other hemodynamic variables and liver fibrosis biomarkers such as fibrosis-4 index and albumin-bilirubin score were comparable between the 2 groups. Liver stiffness measurements in the PoPH group were significantly higher than those in the non-PoPH group [12.8 kPa (9.4-17.3 kPa) vs 4.15 kPa (3.30-5.50 kPa), p < 0.001]. The cut-off value for the classification of PoPH was 8.50 kPa from the receiver operating characteristic curve (area under curve 0.979, 95 % Confidence interval 8.50 kPa - 11.00 kPa).

CONCLUSIONS

Liver stiffness evaluated by transient elastography may be a non-invasive biomarker to detect the liver status that caused PoPH among precapillary PH patients.

Lipid metabolism of Acetobacter pasteurianus and its main components with hypoglycemic effects

BACKGROUND

Probiotic Acetobacter pasteurianus is used to treat diabetes, but its specific hypoglycemic substances and mechanisms remain unclear.

AIM

To investigate the components for lipid metabolism of A. pasteurianus and its hypoglycemic effects, providing a basis for its broader application.

METHODS

The lipid metabolism of A. pasteurianus under different growth conditions was analyzed using lipidomics. Neutral lipid staining in A. pasteurianus cells and the formation of lipid droplet-like structures were observed using a confocal laser scanning microscope. The neutral lipid components were also analyzed using thin layer chromatography. A diabetic mouse model was established to evaluate the hypoglycemic effects of the main lipid components of A. pasteurianus and their role in repairing tissues such as the pancreas.

RESULTS

After comparing the effects of three culture media, namely, brain heart infusion (BHI) medium with 2% glucose, chromium-rich and zinc-rich medium, and mineral salt medium, A. pasteurianus grew well in BHI containing 2% glucose and produced the most lipids. A total of 583 lipid metabolic products was identified, with higher levels of coenzyme Q9 (CoQ9), oleic acid (OA), and wax ester, but no triacylglycerol was observed. It was found that the components that affected lipid metabolism in A. pasteurianus were mainly CoQ9 and OA. They exhibited hypoglycemic effects comparable to metformin in diabetic mice, repaired damaged pancreatic tissues, and did not cause damage to the liver and spleen.

CONCLUSION

Under high-nutrient growth conditions, A. pasteurianus contains abundant lipid components, such as CoQ9 and OA, with good hypoglycemic effects.

Electrochemical biosensors for hepatocellular carcinoma

The current review analyzes progress in electrochemical detection techniques for hepatocellular carcinoma biosignatures, highlighting their potential to enhance the timely detection and management of hepatocellular carcinoma. In this study, the authors explore the present state of hepatocellular carcinoma biosignatures, encompassing conventional proteins such as alpha-fetoprotein and promising biosignatures like non-coding RNAs and circulatory tumor DNA (ctDNA). This text analyzes the principles of electrochemical biosensing and explores sophisticated sensor designs employing surface modification techniques, innovative recognition elements, and nanomaterials. Particular focus is directed towards aptamer-based sensors, microfluidic technologies, and label-free methodologies. Herein, recent advancements in enhancing sensitivity and specificity are discussed, with some platforms reaching a threshold at the femtogram scale. The discussion also encompasses the progress achieved in point-of-care applications and the obstacles faced in transitioning experimental paradigms to medical applications. The prospective influence of these methodologies on medical results is under evaluation, emphasizing early detection and tailored treatment approaches. Future research should focus on creating advanced, integrated detection systems and conducting comprehensive clinical validation studies to assess the real-world effectiveness of electrochemical biosensors.

Clinical implications of a machine learning model predicting colorectal polyp recurrence after endoscopic mucosal resection

The machine learning model developed by Shi et al for predicting colorectal polyp recurrence after endoscopic mucosal resection represents a significant advancement in the field of clinical gastroenterology. By integrating patient-specific factors, such as age, smoking history, and Helicobacter pylori infection, the eXtreme Gradient Boosting algorithm enables precise personalised colonoscopy follow-up planning and risk assessment. This predictive tool offers substantial benefits by optimising surveillance intervals and directing healthcare resources more efficiently toward high-risk individuals. However, real-world implementation requires consideration of the generalisability of our findings across diverse patient populations and clinician training backgrounds.

Genetic adjuvants: A paradigm shift in vaccine development and immune modulation

The COVID-19 pandemic underscored the urgency of developing effective vaccines to combat infectious diseases, especially in vulnerable populations such as the elderly and immunocompromised. While recombinant protein vaccines offer safety, their poor immunogenicity highlights the need for advanced vaccination platforms. New genetic/nucleic acid vaccine formulations like plasmid DNA and mRNA showed efficiency and safety in preclinical and clinical studies; however, they demand innovative adjuvants because their mechanism of action differs from traditional protein vaccines. Genetic adjuvants-encoded by nucleic acids within DNA, RNA, or viral vectors-emerge as a promising solution by targeting and modulating specific immune pathways, including antigen presentation, T cell activation, and memory formation. These innovative adjuvants enhance vaccine efficacy by fine-tuning innate and adaptive immune responses, overcoming immune senescence, and addressing the challenges of CD8+ T cell activation in immunocompromised populations. This review explores the potential of genetically encoded adjuvants, including cytokines, chemokines, and other immune modulators. By comparing these adjuvants to traditional formulations, we highlight their capacity to address the limitations of modern vaccines while discussing their integration with emerging technologies like RNA-based vaccines. As genetic adjuvants advance toward clinical application, understanding their mechanisms and optimizing their delivery is pivotal to unlocking next-generation immunization strategies.

Respiratory post COVID sequelae: the role of pulmonary function impairment, fatigue and obesity in dyspnea and the impact of SPA rehabilitation

BACKGROUND

Respiratory COVID-19 post-acute sequelae (PASC) may persist for extended periods following recovery.

METHODS

Patients with PASC who were referred for Salus Per Aquam (SPA) therapy were enrolled in the study.

AIM

To categorize patients based on the presence of dyspnea and fatigue, with a specific focus on obesity, chronic respiratory conditions, and predictors of rehabilitation outcomes.

RESULTS

From July-November 2021, 327 consecutive patients were enrolled at the spa center. Among these, 31% had been previously hospitalized, 5% had required noninvasive or invasive mechanical ventilation. Approximately one-third of the cohort underwent DLCO testing, which was abnormal in 56.3% of cases. Patients with impaired DLCO had significantly higher dyspnea rates compared to those with normal DLCO (88.9% vs. 64.3%, p < 0.0001). Dyspneic patients were more likely to have one or more comorbidities (p < 0.001), be obese (p = 0.005), and have a history of chronic respiratory disease (p = 0.0009). Patients reporting fatigue also had higher rates of dyspnea (91.2% vs. 61.5%, p < 0.0001), were more frequently obese (p = 0.03), had more comorbidities (p = 0.02), and had a greater history of hospitalization (p = 0.02). No improvement in dyspnea/fatigue was observed post-SPA treatment among patients with DLCO impairment and obese. However, patients with chronic respiratory conditions reported benefit.

CONCLUSIONS

Dyspnea in PASC is complex and multifactorial. The findings suggest that SPA rehabilitation may be particularly beneficial for alleviating fatigue and enhancing overall well-being in selected subgroups of patients with PASC.

Protective effects of sinensetin against oxidative stress damage induced by AAPH in the brain-gut

Sinensetin (SIN for short) is one of the most common polymethoxyflavonoids found in citrus fruits. Recently, it has been extensively studied due to its ability to prevent or treat a wide range of diseases, including diabetes, obesity, neurological disorders, and cancer. Oxidative stress is closely related to the pathogenesis of many diseases. Based on literature research and the results of our previous experiments, we found that flavonoids have significant antioxidant effects. This study found that sinensetin alleviated AAPH-induced oxidative stress in zebrafish and alleviated intestinal and brain damage (including brain neurons, vascular development, and blood-brain barrier integrity). This study is of great significance for further study of the relationship between gut-brain changes and oxidative stress. This study provides a practical and convenient tool for real-time tracking of the protective effect of natural products on the in vivo oxidative stress model induced by AAPH. In addition, it paves the way for the discovery of more antioxidants in the future.

Precore G1896A mutation of hepatitis B virus in patients with chronic hepatitis B, hepatic cirrhosis, and hepatocellular carcinoma in Burkina Faso

BACKGROUND

Hepatitis B virus (HBV) infection, which can progress to liver cancer and even death, remains a public health problem. The high variability of HBV leading to the accumulation of mutations influences the natural history of this infection. Mutations in the precore/core region, in particular the G1896A mutation, have been associated with severe forms of liver disease in certain populations around the world. The aim of this study was to determine the molecular epidemiology of the HBV precore G1896A mutation and its relationship to hepatic complications in HBV chronically infected patients.

METHODS

Classical nested PCR was used to amplify the HBV precore region. A total of 97 samples consisting of 53 cases of chronic hepatitis B (CHB), 18 cases of hepatic cirrhosis (HC) and 26 cases of hepatocellular carcinoma (HCC) were amplified. The G1896A mutation was determined by enzymatic digestion on 81 samples using the restriction enzyme Bsu36I. Serological (HBeAg, anti-HBe Ac), biochemical (ALT) and virological (HBV-DNA viral load) tests were performed.

RESULTS

The frequency of the G1896A mutation was 44.44% in our study population. It was 56.82% in CHB cases, 28.57% in HC cases and 30.43% in HCC. The G1896A mutation was found more in subjects with a negative HBeAg status than in those with a positive HBeAg (p = 0.05) in the CHB subgroup. The DNA level was higher in subjects carrying wild-type strains for the G1896A mutation (p > 0.05). ALT levels were lower in subjects carrying the G1896A mutation than in those infected with wild-type strains (p = 0.006) in the HBC subgroup.

CONCLUSION

This study, conducted on patients with chronic hepatitis B, cirrhosis, and hepatocellular carcinoma (HCC), showed that the frequency of the precore G1896A mutation was 44.44%. We found no correlation between this mutation and cirrhosis and HCC. However, it was more found in subjects with chronic hepatitis B and was associated with HBeAg negativity in the latter. It would therefore be involved in the elimination of this protein partly responsible for the persistence of HBV infection and could be a molecular marker for clinicians in the management of patients infected with HBV with negative HBeAg and positive anti-HBe antibodies. However, studies on other mutations of the precore gene would be necessary to obtain more conclusive results in terms of effective treatment.

Effects of a physical activity intervention on sleep among cancer survivors in a randomized controlled trial within the Cancer Prevention Study-3 cohort

PURPOSE

Poor sleep is a long-term sequela of cancer and its treatment. Moderate-to-vigorous physical activity (MVPA) is associated with improved health outcomes among cancer survivors and has been suggested as a nonpharmacological method to improving sleep. We evaluated the efficacy of a MVPA intervention to improve sleep among cancer survivors.

METHODS

We conducted a randomized controlled trial among 415 cancer survivors embedded within the Cancer Prevention Study-3 cohort. Survivors were randomized to a year-long, web-based MVPA program. MVPA was assessed via hip-worn actigraphy at baseline, 3 months, 6 months, and 1 year. We evaluated sleep through the SATED sleep health questionnaire, PROMIS Sleep Disturbance Scale, and device-measured duration and efficiency. An intent-to-treat (ITT) analysis was performed, and secondary analyses were conducted based on measured MVPA levels with generalized additive mixed-effects models.

RESULTS

Survivors reported similar sleep health and patterns to the general US population. We observed no significant changes to sleep between treatment groups in ITT models. Though not statistically significant, there appeared to be heterogeneity based on baseline sleep disturbance (moderate-to-severe sleep disturbance: βSATED = 0.73 (95% CI - 0.09, 1.60) vs mild-to-normal sleep disturbance: βSATED = - 0.26 (95% CI - 0.57, 0.05)). Participants that engaged in more MVPA at the end of the trial reported better sleep health (p-value = 0.04) and less sleep disturbances (p-value = 0.11).

CONCLUSIONS

The MVPA intervention was more effective at improving sleep among survivors with sleep disturbances at baseline. Increasing MVPA improved sleep among cancer survivors IMPLICATIONS FOR CANCER SURVIVORS: Increasing MVPA among cancer survivors with sleep disturbances may be a viable strategy for improving sleep.

CRISPR-based genetically modified scaffold-free biomaterials for tissue engineering and regenerative medicine

CRISPR-based genetically modified scaffold-free biomaterials, including extracellular vehicles, cell sheets, cell aggregates, organoids and organs, have attracted significant attention in the fields of regenerative medicine and tissue engineering in recent years. With a wide range of applications in gene therapy, modeling disease, tissue regeneration, organ xenotransplantation, modeling organogenesis as well as gene and drug screening, they are at a critical juncture from clinical trials to therapeutic applications. Xenografts have already been tested on non-human primates and humans. However, we have to admit that a series of obstacles still need to be addressed, such as immune response, viral infection, off-target effects, difficulty in mass production, and ethical issues. Therefore, future research should pay more attention to improving their safety, accuracy of gene editing, flexibility of production, and ethical rationality. This review summarizes various types of CRISPR-based genetically modified scaffold-free biomaterials, including their preparation procedures, applications, and possible improvements.

Exosomes in inflammation and cancer: from bench to bedside applications

Exosomes, lipid bilayer nanovesicles secreted by nearly all cell types, play pivotal roles in intercellular communication by transferring proteins, nucleic acids, and lipids. This review comprehensively summarizes their multiple functions in inflammation and cancer. In inflammation, exosomes exhibit context-dependent pro- or anti-inflammatory effects: they promote acute responses by delivering cytokines and miRNAs to activate immune cells, yet suppress chronic inflammation via immunoregulatory molecules. Two representative inflammatory diseases, namely sepsis and inflammatory bowel disease, were highlighted to elucidate their roles in the acute and chronic inflammatory diseases. In cancer, exosomes orchestrate tumor microenvironment (TME) remodeling by facilitating angiogenesis, metastasis, and immune evasion through interactions with cancer-associated fibroblasts, tumor-associated macrophages, and extracellular matrix components. Furthermore, exosomes can facilitate the transition from inflammation to cancer by impacting pertinent signaling pathways via their transported oncogenic and inflammatory molecules. Tumor-derived exosomes also serve as non-invasive biomarkers correlating with disease progression. Clinically, exosomes demonstrate promise as therapeutic agents and drug carriers, evidenced by ongoing trials targeting inflammatory diseases and cancers. However, challenges in isolation standardization, scalable production, and understanding functional heterogeneity hinder clinical translation. Future research should prioritize elucidating cargo-specific mechanisms, optimizing engineering strategies, and advancing personalized exosome-based therapies. By bridging molecular insights with clinical applications, exosomes hold great potential in precision medicine for inflammation and oncology.

The Antioxidant Tetrapeptide Epitalon Enhances Delayed Wound Healing in an in Vitro Model of Diabetic Retinopathy

Diabetic retinopathy (DR) is the most common complication of diabetes mellitus and a leading cause of vision loss. Short peptides, such as di-, tri-, and tetrapeptides, have various beneficial activities, including antioxidant, antimicrobial, and anti-inflammatory effects. This study aims to test the hypothesis that the antioxidant effect of the synthetic tetrapeptide AEDG (Ala-Glu-Asp-Gly, Epitalon) improves the delayed healing process associated with hyperglycemia in DR, using a high glucose (HG)-injured human retinal pigment epithelial cell line (ARPE-19). We found that HG exposure delayed wound healing in ARPE-19 cells and increased intracellular levels of reactive oxygen species (ROS), while decreasing antioxidant gene expression. HG also induced epithelial-mesenchymal transition (EMT) and upregulated fibrosis-related genes, suggesting that HG-induced EMT contributes to subretinal fibrosis, the end-stage of eye diseases, including proliferative DR. The antioxidant Epitalon restored impaired wound healing in HG-injured ARPE-19 cells by inhibiting hyperglycemia-induced EMT and fibrosis. These findings support using the antioxidant agent Epitalon as a promising therapeutic strategy for DR to improve retinal wound healing compromised by hyperglycemia. More mechanistic investigations are needed to confirm Epitalon's benefits and safety. Developing ophthalmic forms of Epitalon may enhance its delivery directly to the retina, potentially improving its therapeutic efficacy.

Oral Semaglutide and Cardiovascular Outcomes in People With Type 2 Diabetes, According to SGLT2i Use: Prespecified Analyses of the SOUL Randomized Trial

BACKGROUND

Both GLP-1 (glucagon-like peptide-1) receptor agonists and SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2i) improve cardiovascular outcomes in people with type 2 diabetes and cardiovascular or chronic kidney disease. However, there are limited data about the effect of combining these agents on cardiovascular and safety outcomes.

METHODS

The SOUL trial (Semaglutide Cardiovascular Outcomes Trial; NCT03914326) randomized 9650 participants with type 2 diabetes and atherosclerotic cardiovascular disease and/or chronic kidney disease to oral semaglutide or placebo. As prespecified, participants were analyzed according to baseline use of SGLT2i (yes, n=2596; no, n=7054), and subsequently for any use of SGLT2i during the trial (yes, n=4718; no, n=4932). The primary outcome was time to first major adverse cardiovascular event, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Safety was evaluated by comparing the incidence of serious adverse events.

RESULTS

Over a mean follow-up of 47.5±10.9 months, the risk of the primary outcome in the overall trial population was 14% lower for oral semaglutide versus placebo (hazard ratio, 0.86; 95% CI, 0.77-0.96). In those taking SGLT2i at baseline, there were 143 of 1296 (semaglutide) versus 158 of 1300 (placebo) primary outcome events (hazard ratio, 0.89; 95% CI, 0.71-1.11); and 436 of 3529 versus 510 of 3525, respectively, in participants not taking SGLT2i at baseline (hazard ratio, 0.84; 95% CI, 0.74-0.95; P-interaction, 0.66). An analysis of major adverse cardiovascular events by any in-trial SGLT2i use versus no use also showed no evidence of heterogeneity in the effects of oral semaglutide. The adverse event profiles of oral semaglutide with or without concomitant SGLT2i were similar.

CONCLUSIONS

Oral semaglutide reduced major adverse cardiovascular event outcomes independently of concomitant SGLT2i treatment, and this combination appeared to be safe.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03914326.

Gastrointestinal symptoms in the journey of pancreatic cancer patients

INTRODUCTION

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy frequently arising with nonspecific and overlooked gastrointestinal symptoms. Gastroenterologists are typically the first specialists to encounter these patients, positioning them to play a pivotal role not only in early diagnosis, but also in the ongoing management of the disease's complex symptom burden.

AREAS COVERED

This review explored gastrointestinal symptoms in patients with PDAC (ranging from pain and diarrhea to anorexia, jaundice, and nausea) and outlined both tumor- and treatment-related causes. A literature review based on non-systematic PubMed search updated to April 2025 was conducted to summarize current diagnostic strategies, medical, endoscopic therapies, and multidisciplinary management approaches. In addition, we present original data from a single-center cohort, suggesting that the involvement of gastroenterologists leads to more comprehensive management of gastrointestinal symptom control and supportive care.

EXPERT OPINION

Collaboration among specialists is essential for optimizing patient outcomes in the multidisciplinary management of PDAC. Gastroenterologists' 'stewardship' significantly contributes to prompt diagnosis, symptom control, quality of life preservation, and prognosis. Future priorities should focus on strengthening integration within care pathways, fostering interdisciplinary coordination, and implementing shared clinical tools to enhance comprehensive patient care. A well-structured team-based approach is key to advancing holistic PDAC management.

Real-World Long-Term Outcomes of Operated and Non-Operated Rectal Cancer in the Elderly: A 14-Year Retrospective Multicentre Study

OBJECTIVE

Surgical resection is the cornerstone of rectal cancer treatment. Following neoadjuvant chemoradiotherapy (nCRT), many patients undergo surgery. Another group of patients may not undergo surgery for various reasons, regardless of nCRT response. This study investigates the differences in clinical characteristics and long-term oncological outcomes of operated and non-operated elderly rectal cancer patients.

METHODS

This multicentre observational retrospective cohort analysis included 296 elderly patients (169 surgery, 127 non-surgical) treated at three tertiary cancer centres in Turkey between January 2010 and April 2024. Clinicopathologic features and survival outcomes were compared between groups.

RESULTS

Patients in the surgery group were younger (p < 0.000) and had better performance scores (p < 0.000). There were no differences in initial clinical (c) T stages or cM stages; however, cN2 patients were more prevalent in the surgical group and cN1 patients were more prevalent in the non-surgical group (p = 0.010). No differences in radiotherapy treatment schedules were observed among the groups. The surgical group received more concurrent (p = 0.046) and adjuvant (p < 0.000) chemotherapy. Patient refusal (63.8%) was the most common reason among non-surgical patients. The surgery group showed better overall survival (OS) (median, 99 vs. 33 months) (p < 0.000), local recurrence-free survival (LRFS) (97.8% vs. 65.8% at 3 years, p < 0.000), and distant metastasis-free survival (DMFS) (80.3% vs. 73.3% at 3 years, p = 0.022).

CONCLUSION

This study shows that elderly rectal cancer patients without surgery had poor survival and tumour control. Surgical resection in rectal cancer is very important and should be strongly recommended for all medically suitable elderly patients.

Deep learning without borders: recent advances in ultrasound image classification for liver diseases diagnosis

INTRODUCTION

Liver diseases are among the top global health burdens. Recently, there has been an increasing significance of diagnostics without discomfort to the patient; among them, ultrasound is the most used. Deep learning, in particular convolutional neural networks, has revolutionized the classification of liver diseases by automatically performing some specific analyses of difficult images.

AREAS COVERED

This review summarizes the progress that has been made in deep learning techniques for the classification of liver diseases using ultrasound imaging. It evaluates various models from CNNs to their hybrid versions, such as CNN-Transformer, for detecting fatty liver, fibrosis, and liver cancer, among others. Several challenges in the generalization of data and models across a different clinical environment are also discussed.

EXPERT OPINION

Deep learning has great prospects for automatic diagnosis of liver diseases. Most of the models have performed with high accuracy in different clinical studies. Despite this promise, challenges relating to generalization have remained. Future hardware developments and access to quality clinical data continue to further improve the performance of these models and ensure their vital role in the diagnosis of liver diseases.

Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders

BACKGROUND

Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.

AIM

To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.

METHODS

A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.

RESULTS

The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children's vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.

CONCLUSION

Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.

Redefining haemostasis: Role of rotational thromboelastometry in critical care settings

Management of patients with acute hemorrhage requires addressing the source of bleeding, replenishing blood volume, and addressing any coagulopathy that may be present. Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges. In these patients, transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality. Moreover, ratio-based concepts do not stop bleeding; instead, they just give physicians more time to identify the bleeding source and plan management strategies. In clinical practice, standard laboratory coagulation tests (SLCT) are frequently used to assess various aspects of blood clotting. However, these tests may not always offer a comprehensive understanding of clinically significant coagulopathy and the severity of blood loss. Furthermore, the SLCT have a considerable turnaround time, which may not be ideal for making prompt clinical decisions. In recent years, there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelastometry, which provide real-time, dynamic information about clot formation and dissolution.

Comprehensive study comparing different machine learning methods in computed tomography imaging

The article written by Zhao et al, which was recently accepted for publication, introduces an innovative method that combines deep learning-based feature extraction with a radiomics nomogram to create a noninvasive procedure for determining perineural invasion status in patients with rectal cancer. This method is an artificial intelligence application in which researchers segment their own datasets, derive features and analyze their weights. It was found that the support vector machine was the most effective model in the arterial and venous phases. A support vector machine is a machine learning algorithm based on a vector space that finds a decision boundary between the two classes furthest from any point in the training data.

Revolutionizing hepatobiliary surgery: Impact of three-dimensional imaging and virtual surgical planning on precision, complications, and patient outcomes

BACKGROUND

Hepatobiliary surgery is complex and requires a thorough understanding of the liver’s anatomy, biliary system, and vasculature. Traditional imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), although helpful, fail to provide three-dimensional (3D) relationships of these structures, which are critical for planning and executing complicated surgeries.

AIM

To explore the use of 3D imaging and virtual surgical planning (VSP) technologies to improve surgical accuracy, reduce complications, and enhance patient recovery in hepatobiliary surgeries.

METHODS

A comprehensive review of studies published between 2017 and 2024 was conducted through PubMed, Scopus, Google Scholar, and Web of Science. Studies selected focused on 3D imaging and VSP applications in hepatobiliary surgery, assessing surgical precision, complications, and patient outcomes. Thirty studies, including randomized controlled trials, cohort studies, and case reports, were included in the final analysis.

RESULTS

Various 3D imaging modalities, including multidetector CT, MRI, and 3D rotational angiography, provide high-resolution views of the liver’s vascular and biliary anatomy. VSP allows surgeons to simulate complex surgeries, improving preoperative planning and reducing complications like bleeding and bile leaks. Several studies have demonstrated improved surgical precision, reduced complications, and faster recovery times when 3D imaging and VSP were used in complex surgeries.

CONCLUSION

3D imaging and VSP technologies significantly enhance the accuracy and outcomes of hepatobiliary surgeries by providing individualized preoperative planning. While promising, further research, particularly randomized controlled trials, is needed to standardize protocols and evaluate long-term efficacy.

Artificial intelligence in gastrointestinal surgery: A minireview of predictive models and clinical applications

BACKGROUND

Artificial intelligence (AI) is playing an increasingly significant role in predicting outcomes of gastrointestinal (GI) surgeries, improving preoperative risk assessment and post-surgical decision-making. AI models, particularly those based on machine learning, have demonstrated potential in predicting surgical complications and recovery trajectories.

AIM

To evaluate the role of AI in predicting outcomes for GI surgeries, focusing on its efficacy in enhancing surgical planning, predicting complications, and optimizing post-operative care.

METHODS

A systematic review of studies published up to March 2025 was conducted across databases such as PubMed, Scopus, and Web of Science. Studies were included if they utilized AI models for predicting surgical outcomes, including morbidity, mortality, and recovery. Data were extracted on the AI techniques, performance metrics, and clinical applicability.

RESULTS

Machine learning models demonstrated significantly better performance than logistic regression models, with an area under the curve difference of 0.07 (95%CI: 0.04–0.09; P < 0.001). Models focusing on variables such as patient demographics, nutritional status, and surgical specifics have shown improved accuracy. AI’s ability to integrate multifaceted data sources, such as imaging and genomics, contributes to its superior predictive power. AI has improved the early detection of gastric cancer, achieving 95% sensitivity in real-world settings.

CONCLUSION

AI has the potential to transform GI surgical practices by offering more accurate and personalized predictions of surgical outcomes. However, challenges related to data quality, model transparency, and clinical integration remain.

Validation of signature molecular profiles of advanced HCV liver disease in hepatocellular carcinoma patients

Our previous transcriptome analysis revealed that hepatitis C virus (HCV) infection in hepatocytes regulates the expression of numerous hepatocellular genes in a liver disease stage-specific manner. Based on the fold changes at different stages and the known relevant function of the cellular genes with respect to hepatocellular carcinoma (HCC) and through comprehensive examination with various in silico assays, such as heatmap and volcano analysis for the differential expression, the Cancer Genome Atlas - Hepatocellular Carcinoma (TCGA-HCC) analysis, and molecular approaches, such as qRT-PCR, immunoblot analyses, we have chosen the two up-regulated genes - aldo-keto reductase family 1 member B10 (AKR1B10) and hexokinase domain containing 1 (HKDC1), and two down-regulated genes - glycine N-methyltransferase (GNMT) and C-type lectin domain family 4, member M (CLEC4M), and validated their differential expressions of the genes at disparate stages of liver disease with respect to the development of potential therapeutic targets against HCV-mediated hepatocellular carcinoma (HCC). These data suggested that the differentially expressed genes at various stages could serve as prognostic and diagnostic markers for liver disease progression and may also be utilized in developing therapeutic drugs.

Reassessing the Routine Histopathological Evaluation of Anastomotic Doughnuts in Colorectal Procedures: A 10-Year Retrospective Study

Anastomotic doughnuts (ATD) are routinely submitted for pathological evaluation during colorectal surgery despite limited evidence supporting its clinical significance. This retrospective study aimed to analyze the pathological findings and cost-effectiveness of examining ATDs. A total of 870 pairs of ATDs from 870 patients who underwent colorectal surgery between 2012 and 2022 were included in the study. Microscopic examination was performed in all cases, and clinical charts and pathology reports were reviewed. The average cost of processing each case was conservatively estimated at US$ 59, with a total cost of US$ 51,185 during the study period. Of the 870 cases, 317 (36.4%) were obtained from surgical procedures for benign conditions, whereas 553 (63.6%) were from procedures related to malignant or neoplastic conditions. In cases of surgery for benign conditions (n=317), no neoplastic or cancerous changes were observed in the ATDs. Among the malignant cases (n=553), only 14 (1.6% of the total 870 cases) showed neoplastic findings, including ovarian/endometrial carcinoma (n=7), tubular adenoma (n=4), colonic mucinous adenocarcinoma (n=1), high-grade squamous intraepithelial lesion (n=1), and low-grade B-cell lymphoma (n=1). However, these findings did not interfere with the postsurgical or clinical management. The results suggest that routine pathological examination of ATDs provides limited clinical benefits and incurs significant costs. Pathology departments and surgeons should consider revising their protocols to limit examinations to a subset of high-risk cases where the results could potentially impact patient outcomes.