Evaluation of N-NOSE as a surveillance tool for recurrence in gastric and esophageal cancers: a prospective cohort study

OBJECTIVE

Early detection of recurrent gastric and esophageal cancers remains a critical challenge. Innovative and non-invasive cancer screening technologies, such as N-NOSE, can improve early detection. N-NOSE is a urine-based scent test that leverages the olfactory abilities of the nematode C. elegans. For the first time, this prospective study evaluates the efficacy of the N-NOSE chemotaxis index as a novel biomarker for postoperative surveillance and recurrence in patients with upper gastrointestinal cancers.

METHODS

A two-year prospective cohort study was conducted at The University of Tokyo Hospital, involving 40 patients with gastric and esophageal cancers. Urine samples were collected pre- and postoperatively and analysed using the N-NOSE technique.

RESULTS

In cases of recurrence with vascular invasion, the chemotaxis index at 100-fold urine dilution was significantly elevated compared to the non-recurrence group.

CONCLUSION

This study suggests the potential of N-NOSE as an effective follow-up tool for patients with upper gastrointestinal cancer, particularly those with vascular invasion. While N-NOSE has been validated to distinguish between cancer and non-cancer, and its performance compared to traditional markers has been proven, it has not been studied for recurrence. Our data highlights, for the first time, the capability of N-NOSE in the surveillance of cancer recurrence.

Heterojunction Nanozyme Hydrogels Containing Cu-O-Zn Bonds with Strong Charge Transfer for Accelerated Diabetic Wound Healing

The complex microenvironment of persistent inflammation and bacterial infection is a major challenge in chronic diabetic wounds. The development of nanozymes capable of efficiently scavenging reactive oxygen species (ROS) is a promising method to promote diabetic wound healing. However, many nanozymes show rather limited antioxidant activity and ROS-dependent antibacterial effects under certain circumstances, further weakening their ability to scavenge ROS. To meet these challenges, electronically regulated bioheterojunction (E-bio-HJ) nanozyme hydrogels derived from metal-organic frameworks (MOFs) were designed and prepared via an interface engineering strategy. Owing to the electron transfer and redistribution effects of the abundant and highly dispersed Cu-O-Zn sites at the heterogeneous interface, the E-bio-HJ nanozymes exhibited catalase (CAT)-like activity with ultrahigh hydrogen peroxide affinity (Km = 25.76 mM) and sustained ROS consumption. In addition, owing to the enhanced interfacial effect of E-bio-HJ and the good biocompatibility and cell adhesion of the methacryloylated gelatin (Gel) hydrogel, the E-bio-HJ gelatin hydrogel (E-bio-HJ/Gel) further reduced inflammation by inducing macrophage transformation to the M2 phenotype, accompanied by excellent antimicrobial properties and enhanced cell migration, angiogenesis, and collagen deposition, which synergistically promoted diabetic wound healing. This highly effective and comprehensive strategy offers a new approach for the rapid healing of diabetic wounds.

Spatial transcriptome profiling identifies DTX3L and BST2 as key biomarkers in esophageal squamous cell carcinoma tumorigenesis

BACKGROUND

Understanding the stepwise progression of esophageal squamous cell carcinoma (ESCC) is crucial for developing customized strategies for early detection and optimal clinical management. Herein, we aimed to unravel the transcriptional and immunologic alterations occurring during malignant transformation and identify clinically significant biomarkers of ESCC.

METHODS

Digital spatial profiling (DSP) was performed on 11 patients with early-stage ESCC (pT1) to explore the transcriptional alterations in epithelial, immune cell, and non-immune cell stromal compartments across regions of distinct histology, including normal tissues, low- and high-grade dysplasia, and cancerous tissues. Furthermore, single-cell spatial transcriptomics was performed using the CosMx Spatial Molecular Imaging (SMI) system on 4 additional patients with pT1 ESCC. Immunohistochemical (IHC) analysis was performed on consecutive histological sections of 20 pT1 ESCCs. Additionally, public bulk and single-cell RNA-sequencing (scRNA-seq) datasets were analyzed, and in vitro and in vivo functional studies were conducted.

RESULTS

Spatial transcriptional reprogramming and dynamic cell signaling pathways that determined ESCC progression were delineated. Increased infiltration of macrophages from normal tissues through dysplasia to cancerous tissues occurred. Macrophage subtypes were characterized using the scRNA-seq dataset. Cell-cell communication analysis of scRNA-seq and SMI data indicated that the migration inhibitory factor (MIF)-CD74 axis may exhibit pro-tumor interactions between macrophages and epithelial cells. DSP, SMI, and IHC data demonstrated that DTX3L expression in epithelial cells and BST2 expression in stromal cells increased gradually with ESCC progression. Functional studies demonstrated that DTX3L or BST2 knockdown inhibited ESCC proliferation and migration and decreased M2 polarization of tumor-associated macrophages.

CONCLUSIONS

Spatial profiling comprehensively characterized the molecular and immunological hallmarks from normal tissue to ESCC, guiding the way to a deeper understanding of the tumorigenesis and progression of this disease and contributing to the prevention of ESCC. Within this exploration, we uncovered biomarkers that exhibit a robust correlation with ESCC progression, offering potential new avenues for insightful therapeutic approaches.

Halometallate Ionic Liquid Dynamically Regulates Zwitterionic Hydrogels by Synergistic Multiple‐Bond Networks

Improving the compatibility between high concentration metallic ions and zwitterions to controllable construction of coordination bonds is critical and extremely challenging. Here, a facile and effective strategy to fabricate multifunctional hydrogels by randomly copolymerizing halometallate ionic liquids (ILs) and zwitterions through electron beam irradiation is reported. Introducing metal ions into ILs can balance charges and establish moderate and stable cross‐linked networks with zwitterions. The synergistic effect of coordination bonds and multiple interactions with varying strengths endows hydrogel with outstanding stretchability, compressive strength, rapid response, advanced self‐healing ability, and excellent frost resistance. The multifunctional sensor assembled from hydrogels can timely, accurately, and stably monitor human movement, write anti‐counterfeiting and remotely transmit Morse code signals. Multiple hydrogel sensors are also assembled into a flexible sensor array to track the tactile trajectory and detect spatial distribution of force. Moreover, the obtained hydrogel displays high temperature sensitivity with resistance temperature coefficient of −3.85% °C−1 at 25–40 °C, which can detect tiny temperature changes (0.1 °C). Interestingly, the processed hydrogel can effectively modulate the transmissivity through salt triggering to achieve patterning. Considering the structural designability of halometallate ILs, this work provides new insights for the development of multifunctional hydrogels.

Artificial Intelligence-Based Classification of Anatomical Sites in Esophagogastroduodenoscopy Images

Background

A full examination of gastrointestinal tract is an essential prerequisite for effectively detecting gastrointestinal lesions. However, there is a lack of efficient tools to analyze and recognize gastric anatomy locations, preventing the complete portrayal of entire stomach. This study aimed to evaluate the effectiveness of artificial intelligence in identifying gastric anatomy sites by analyzing esophagogastroduodenoscopy images.

Methods

Using endoscopic images, we proposed a system called the Artificial Intelligence of Medicine (AIMED) through convolutional neural networks and MobileNetV3-large. The performance of artificial intelligence in the recognition of anatomic sites in esophagogastroduodenoscopy images was evaluated by considering many cases. Primary outcomes included diagnostic accuracy, sensitivity, and specificity.

Results

A total of 160,308 images from 27 categories of the upper endoscopy anatomy classification were included in this retrospective research. As a test group, 16031 esophagogastroduodenoscopy images with 27 categories were used to evaluate AIMED's performance in identifying gastric anatomy sites. The convolutional neural network's accuracy, sensitivity, and specificity were determined to be 99.40%, 91.85%, and 99.69%, respectively.

Conclusion

The AIMED system achieved high accuracy with regard to recognizing gastric anatomy sites, and it could assist the operator in enhancing the quality control of the used endoscope. Moreover, it could contribute to a more standardized endoscopic performance. Overall, our findings prove that artificial-intelligence-based systems can be indispensable to the endoscopic revolution (Clinical trial registration number: NCT04384575 (12/05/2020)).

Harnessing Nanotechnology for Gout Therapy: Colchicine-Loaded Nanoparticles Regulate Macrophage Polarization and Reduce Inflammation

Gout is a disease caused by hyperuricemia, characterized by inflammation reactions triggered by macrophage polarization. Colchicine is a commonly used drug for gout treatment, but its mechanism of action remains unclear. The aim of this study was to investigate the regulatory effect of colchicine on macrophage polarization to enhance the therapeutic effectiveness against gout inflammation. To accomplish this, a mouse model was established, and peripheral blood mononuclear cell samples were collected. Single-cell RNA sequencing was employed to reveal cellular heterogeneity and identify key genes. Molecular docking and experimental validation were performed to confirm the binding between the key genes and colchicine. Lentiviral intervention and biochemical indicator detection were conducted to assess the impact of key genes on gout mice. Additionally, the therapeutic effect of colchicine incorporated into neutrophil membrane-coated nanoparticles was investigated. The study found that macrophage polarization plays a critical role in gout, and AHNAK was identified as the key gene through which colchicine affects macrophage polarization. Lentiviral intervention to decrease AHNAK expression was shown to alleviate joint swelling in gout mice and regulate macrophage polarization. Colchicine encapsulated in R4F peptide-modified neutrophil membrane-coated Pluronic F127 nanoparticle (R4F-NM@F127) nanocarriers inhibited M1 macrophage polarization, induced M2 macrophage polarization, alleviated gout, and minimized toxicity to normal tissues. Colchicine suppressed M1 macrophage polarization and induced M2 macrophage polarization by binding to AHNAK protein, thereby alleviating gout. Colchicine incorporated into R4F-NM@F127 nanocarriers can serve as a targeted therapeutic drug to regulate macrophage polarization, alleviate gout, and reduce toxicity to normal tissues.

Durable Antibacterial Photothermal Membrane Using Melanin-Inspired Cu-Doped Polynorepinephrine for Water Remediation

Solar-driven interfacial evaporation is an efficient approach to addressing water scarcity due to its environmental sustainability. However, the prolonged use of solar evaporators causes microbial contamination from wastewater. Inspired by the antifouling properties of polydopamine, we develop a series of mono- and dual-metal-loaded poly(norepinephrine) (PNE) nanoparticles by pre-doping multiple metal ions. Metal doping enhances the photothermal conversion efficiency (∼60%) of PNE by reducing the energy bandgap and imparts antimicrobial properties. Cu2+-loaded PNE (Cu-5) combined with laser achieves a 99.72% bactericidal rate against both E. coli and S. aureus. The Cu-5-coated cellulose membrane (Cu-5@CM) realized an evaporation rate of 2.21 kg m-2 h-1 under one sun with an evaporation efficiency of 97.4%. Cu-5@CM exhibits remarkable anti-biofouling properties, maintaining its surface integrity and evaporation performance even after 15 days of immersion in a bacterial environment. Its stable evaporation rate and long-lasting antimicrobial performance offer a promising solution to the biofouling challenges in seawater desalination.

The Impact of Tumor Stage and Histopathology on Survival Outcomes in Esophageal Cancer Patients over the Past Decade

BACKGROUND

Esophageal cancer (EC) is the sixth leading cause of cancer-related mortality worldwide, continuing to be a significant public health concern. The purpose of this study is to assess the impact of staging and histopathology of EC on associated mortality. The study also aims to further investigate clinical characteristics, prognostic factors, and survival outcomes in patients diagnosed with EC between 2010 and 2017. Furthermore, we analyzed the interaction between tumor histology and staging and the risk of mortality.

METHODS

A total of 24,011 patients diagnosed with EC between 2010 and 2017 in the United States were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic parameters, tumor stage, and histologic subtypes were analyzed and associated overall mortality (OM) and cancer-specific mortality (CSM) were measured across all subgroups. Covariates reaching the level of statistical significance, demonstrable by a p-value equal to or less than 0.01, were incorporated into a multivariate Cox proportional hazards model. A hazard ratio greater than 1 was indicative of an increased risk of mortality in the presence of the variable under discussion. Additionally, the study explores the interaction between histology and tumor stage on outcomes.

RESULTS

The majority of patients were male (80.13%) and non-Hispanic white (77.87%), with a predominant age at diagnosis of between 60 and 79 years (59.86%). Adenocarcinoma was the most common tumor subtype (68.17%), and most patients were diagnosed at a distant stage (41.29%). Multivariate analysis revealed higher mortality risks for males, older patients, unmarried individuals, and those with advanced-stage tumors. Higher income, receiving radiation or chemotherapy, and undergoing surgery were associated with lower mortality. Tumor subtype significantly influenced mortality, with squamous cell carcinoma and neuroendocrine tumors showing higher hazard ratios compared to adenocarcinoma. Adenocarcinoma is linked to a poorer prognosis at advanced stages, whereas the opposite trend is observed for SCC.

CONCLUSIONS

The study identifies significant demographic and clinicopathologic factors influencing mortality in esophageal cancer patients, highlighting the importance of early diagnosis and treatment intervention. Future research should focus on tailored treatment strategies to improve survival outcomes in high-risk groups and to understand the interaction between tumor histology and tumor stage.

Influence of DPYD gene polymorphisms on 5-Fluorouracil toxicities in Thai colorectal cancer patients

DPYD polymorphisms have been widely found to be related to 5-FU-induced toxicities. The aim of this study was to establish significant associations between five single-nucleotide polymorphisms of DPYD and 5-FU hematological toxicities in Thai colorectal cancer patients. The toxicities were analyzed at the first and second cycles of 5-FU administration in 75 patients. Genotyping was performed using TaqMan real-time PCR. The genotype frequencies of DPYD*2A,1905 + 1 G > A and DPYD 1774 C > T were all wild type. The frequencies of genetic testing for DPYD*5, 1627 A > G, DPYD 1896T > C, and DPYD*9A, 85 A > G were 37.30% (AG; 34.60%, GG; 2.70%), 32.00% (TC; 25.30%, CC; 6.70%), and 13.40% (AG; 10.70%, GG; 2.70%), respectively. The results reveal significant findings with neutropenia occurring in 100% (2/2) of the patients with homozygous variant DPYD*9A (GG) from the first cycle of treatment for both Grade 1-4 and Grade 3-4 toxicities (P = 0.003 and P < 0.001 respectively). DPYD *9A was related to Grade 1-4 leukopenia (P = 0.001) and both Grade 1-4 and severe thrombocytopenia (P < 0.001 and P < 0.001) in the first cycle. In the second cycle, DPYD*5 was shown to be closely associated with no Grade 1-4 toxicity (P = 0.02). However, we found that 100% (2/2) of patients carrying the homozygous variant (GG) DPYD*5, presented no significant toxicity, so, DPYD*5 may be a predictive marker of neutropenia in patients treated with 5-FU. These outcomes suggest that there may be an increased risk of developing 5-FU-induced neutropenia in patients carrying the DPYD*9A, which should be considered as part of the standard procedure.

Is Lactococcus lactis a Suitable Candidate for Use as a Vaccine Delivery System Against Helicobacter pylori?

Helicobacter pylori was described in 1979. This bacterium, which thrives in the harsh conditions of the stomach, is typically acquired during childhood and can remain colonized for life. Approximately, 90% of the global population is affected, and H. pylori is linked to various conditions, including gastritis, peptic ulcers, lymphoproliferative gastric lymphoma, and even gastric cancer. Currently, antibiotics are the primary treatment method, but the associated challenges of antibiotic use have led to the consideration of oral vaccination as a viable preventive measure against this infection. However, the stomach's harsh environment characterized by its acidic conditions and numerous proteolytic enzymes poses significant obstacles to the development and effectiveness of oral vaccines. To address these challenges, researchers have proposed and evaluated several delivery systems. One of the most promising options is the use of probiotics. Among the various probiotics, Lactococcus lactis stands out as a suitable candidate for oral vaccine delivery against H. pylori due to the advancements in genetic engineering that have been applied to it. This review article discusses the limitations of current treatment strategies and rationalizes the shift toward vaccination, particularly oral vaccination for this infection. It also explores the advantages and challenges of using probiotic bacteria, with a focus on L. lactis as a delivery system. Ultimately, despite the existing challenges, L. lactis continues to be recognized as a promising delivery system. Nonetheless, further research is essential to fully assess its effectiveness and address the challenges associated with this approach.

Dual peptide-coordinated dynamic hydrogel with antibacterial and proangiogenic activities for infected skin wounds

Infected skin wounds represent a class of significant clinical challenges due to their complexity and the risk of delayed healing. Developing an effective wound dressing capable of promoting tissue regeneration while addressing infections is crucial. In this study, we designed a dual peptide-coordinated dynamic hydrogel with both antibacterial and proangiogenic properties, specifically tailored for treating infected skin wounds. The dynamic hydrogel was constructed using gelatin, a natural biomacromolecule with high biocompatibility, as the base material. Two functional peptides, the antibacterial melittin and angiogenic peptide, were incorporated to enhance both infection control and tissue repair. Hydrogelation was achieved through coordination interactions between gold (Au) ions and sulfhydryl groups, endowing the hydrogel with dynamic properties. The excellent biocompatibility, antibacterial efficacy and angiogenic capability of hydrogel allow it to provide structural support for wound healing while promoting cell proliferation and migration. By eradicating bacteria and stimulating new blood vessel formation, it accelerates the healing of infected wounds. Additionally, its injectability and self-healing properties make it suitable for treating irregularly shaped and deep wounds. This dual-functional hydrogel may offer a promising and minimally invasive treatment option for infected skin wounds, combining high biological safety with simplified surgical procedures.

Helicobacter pylori: Routes of Infection, Antimicrobial Resistance, and Alternative Therapies as a Means to Develop Infection Control

Helicobacter pylori (H. pylori) is a Gram-negative, spiral-shaped bacterium that colonizes the gastric epithelium and is associated with a range of gastrointestinal disorders, exhibiting a global prevalence of approximately 50%. Despite the availability of treatment options, H. pylori frequently reemerges and demonstrates increasing antibiotic resistance, which diminishes the efficacy of conventional therapies. Consequently, it is imperative to explore non-antibiotic treatment alternatives to mitigate the inappropriate use of antibiotics. This review examines H. pylori infection, encompassing transmission pathways, treatment modalities, antibiotic resistance, and eradication strategies. Additionally, it discusses alternative therapeutic approaches such as probiotics, anti-biofilm agents, phytotherapy, phototherapy, phage therapy, lactoferrin therapy, and vaccine development. These strategies aim to reduce antimicrobial resistance and enhance treatment outcomes for H. pylori infections. While alternative therapies can maintain low bacterial levels, they do not achieve complete eradication of H. pylori. These therapies are designed to bolster the immune response, minimize side effects, and provide gastroprotective benefits, rendering them suitable for adjunctive use alongside conventional treatments. Probiotics may serve as adjunctive therapy for H. pylori; however, their effectiveness as a monotherapy is limited. Photodynamic and phage therapies exhibit potential in targeting H. pylori infections, including those caused by drug-resistant strains, without the use of antibiotics. The development of a reliable vaccine is also critical for the eradication of H. pylori. This review identifies candidate antigens such as VacA, CagA, and HspA, along with various vaccine formulations, including vector-based and subunit vaccines. Some vaccines have demonstrated efficacy in clinical trials, while others have shown robust immune protection in preclinical studies. Nevertheless, each of the aforementioned alternative therapies requires thorough preclinical and clinical evaluation to ascertain their efficacy, side effects, cost-effectiveness, and patient compliance.

Computer-aided endoscopic diagnostic system modified with hyperspectral imaging for the classification of esophageal neoplasms

INTRODUCTION

The early detection of esophageal cancer is crucial to enhancing patient survival rates, and endoscopy remains the gold standard for identifying esophageal neoplasms. Despite this fact, accurately diagnosing superficial esophageal neoplasms poses a challenge, even for seasoned endoscopists. Recent advancements in computer-aided diagnostic systems, empowered by artificial intelligence (AI), have shown promising results in elevating the diagnostic precision for early-stage esophageal cancer.

METHODS

In this study, we expanded upon traditional red-green-blue (RGB) imaging by integrating the YOLO neural network algorithm with hyperspectral imaging (HSI) to evaluate the diagnostic efficacy of this innovative AI system for superficial esophageal neoplasms. A total of 1836 endoscopic images were utilized for model training, which included 858 white-light imaging (WLI) and 978 narrow-band imaging (NBI) samples. These images were categorized into three groups, namely, normal esophagus, esophageal squamous dysplasia, and esophageal squamous cell carcinoma (SCC).

RESULTS

An additional set comprising 257 WLI and 267 NBI images served as the validation dataset to assess diagnostic accuracy. Within the RGB dataset, the diagnostic accuracies of the WLI and NBI systems for classifying images into normal, dysplasia, and SCC categories were 0.83 and 0.82, respectively. Conversely, the HSI dataset yielded higher diagnostic accuracies for the WLI and NBI systems, with scores of 0.90 and 0.89, respectively.

CONCLUSION

The HSI dataset outperformed the RGB dataset, demonstrating an overall diagnostic accuracy improvement of 8%. Our findings underscored the advantageous impact of incorporating the HSI dataset in model training. Furthermore, the application of HSI in AI-driven image recognition algorithms significantly enhanced the diagnostic accuracy for early esophageal cancer.

Feasibility and safety of a cable transmission magnetically controlled capsule endoscopy system for examination of the human upper digestive tract

OBJECTIVES

To evaluate the safety and feasibility of the cable-transmitted, magnetically controlled capsule endoscopy (CT-MCCE) system for examining the esophagus and stomach.

METHODS

A pilot study was carried out at the endoscopy facility of Peking University First Hospital; 30 volunteers were enrolled between September and November 2022. All participants were instructed to swallow the CT-MCCE capsule. An external magnetic robot arm was utilized to manipulate the capsule endoscope with string-facilitated control of the endoscope. This study assessed gastric preparation, safety, maneuverability, and mucosal visualization.

RESULTS

The participants exhibited favorable reactions to the gastric preparation and examination, with no reported adverse effects, and the average duration of the gastric examination was 29.5±6.63 minutes. The gastric cavity cleanliness assessment revealed a good rating in 25 participants (83.3%) and a moderate rating in 5 participants (11.8%). TheCT-MCCE demonstrated good maneuverability in all 30 subjects (100%).The analysis of visualization indicated that more than 75% of the gastric mucosa was discerned in 79.4% of the participants (27 individuals), whereas 50% to 75% was visualized in 20.6% of the participants (7 individuals).

CONCLUSION

This study substantiates the feasibility and safety of employing magnetically controlled capsule endoscopy with cable transmission for the evaluation of human stomach and esophagus.

Fungal symbiont transmitted by free-living mice promotes type 2 immunity

The gut mycobiota is crucial for intestinal homeostasis and immune function1. Yet its variability and inconsistent fungal colonization of laboratory mice hinders the study of the evolutionary and immune processes that underpin commensalism2,3. Here, we show that Kazachstania pintolopesii is a fungal commensal in wild urban and rural mice, with an exceptional ability to colonize the mouse gastrointestinal tract and dominate the gut mycobiome. Kazachstania pintolopesii colonization occurs in a bacteria-independent manner, results in enhanced colonization resistance to other fungi and is shielded from host immune surveillance, allowing commensal presence. Following changes in the mucosal environment, K. pintolopesii colonization triggers a type 2 immune response in mice and induces gastrointestinal eosinophilia. Mechanistically, we determined that K. pintolopesii activates type 2 immunity via the induction of epithelial IL-33 and downstream IL-33-ST2 signalling during mucus fluctuations. Kazachstania pintolopesii-induced type 2 immunity enhanced resistance to helminth infections or aggravated gastrointestinal allergy in a context-dependent manner. Our findings indicate that K. pintolopesii is a mouse commensal and serves as a valuable model organism for studying gut fungal commensalism and immunity in its native host. Its unnoticed presence in mouse facilities highlights the need to evaluate its influence on experimental outcomes and phenotypes.

The application of the combination between artificial intelligence and endoscopy in gastrointestinal tumors

Gastrointestinal (GI) tumors have always been a major type of malignant tumor and a leading cause of tumor‐related deaths worldwide. The main principles of modern medicine for GI tumors are early prevention, early diagnosis, and early treatment, with early diagnosis being the most effective measure. Endoscopy, due to its ability to visualize lesions, has been one of the primary modalities for screening, diagnosing, and treating GI tumors. However, a qualified endoscopist often requires long training and extensive experience, which to some extent limits the wider use of endoscopy. With advances in data science, artificial intelligence (AI) has brought a new development direction for the endoscopy of GI tumors. AI can quickly process large quantities of data and images and improve diagnostic accuracy with some training, greatly reducing the workload of endoscopists and assisting them in early diagnosis. Therefore, this review focuses on the combined application of endoscopy and AI in GI tumors in recent years, describing the latest research progress on the main types of tumors and their performance in clinical trials, the application of multimodal AI in endoscopy, the development of endoscopy, and the potential applications of AI within it, with the aim of providing a reference for subsequent research.

Advanced Esophageal Endoscopy

Recent advancements in endoscopy, including high-definition imaging, virtual chromoendoscopy, and optical magnification, have enhanced our ability to visualize and diagnose certain esophageal diseases. Innovative endoscopic tools and procedures have been developed to broaden the scope of therapeutic options for treating patients with various esophageal conditions. This comprehensive review aims to elucidate the esophageal anatomy and major disorders from an endoscopist's perspective and explore recent advances in endoscopic treatment.

Relationships between bacteria and the mucus layer

The mucus layer on epithelial cells is an essential barrier, as well as a nutrient-rich niche for bacteria, forming a dynamic, functional and symbiotic ecosystem and first line of defense against invading pathogens. Particularly bacteria in biofilms are very difficult to eradicate. The extensively O-glycosylated mucins are the main glycoproteins in mucus that interact with microbes. For example, mucins act as adhesion receptors and nutritional substrates for gut bacteria. Mucins also play important roles in immune responses, and they control the composition of the microbiome, primarily due to the abundance of complex O-glycans. In inflammation or infection, the structures of mucin O-glycans can change and thus affect mucin function, impact biofilm formation and the induction of virulence pathways in bacteria. In turn, bacteria can support host cell growth, mucin production and can stimulate changes in the host immune system and responses leading to healthy tissue function. The external polysaccharides of bacteria are critical for controlling adhesion and biofilm formation. It is therefore important to understand the relationships between the mucus layer and microbes, the mechanisms and regulation of the biosynthesis of mucins, of bacterial surface polysaccharides, and adhesins. This knowledge can provide biomarkers, vaccines and help to develop new approaches for improved therapies, including antibiotic treatments.

Multi-modal networks for real-time monitoring of intracranial acoustic field during transcranial focused ultrasound therapy

BACKGROUND AND OBJECTIVE

Transcranial focused ultrasound (tFUS) is an emerging non-invasive therapeutic technology that offers new brain stimulation modality. Precise localization of the acoustic focus to the desired brain target throughout the procedure is needed to ensure the safety and effectiveness of the treatment, but acoustic distortion caused by the skull poses a challenge. Although computational methods can provide the estimated location and shape of the focus, the computation has not reached sufficient speed for real-time inference, which is demanded in real-world clinical situations. Leveraging the advantages of deep learning, we propose multi-modal networks capable of generating intracranial pressure map in real-time.

METHODS

The dataset consisted of free-field pressure maps, intracranial pressure maps, medical images, and transducer placements was obtained from 11 human subjects. The free-field and intracranial pressure maps were computed using the k-space method. We developed network models based on convolutional neural networks and the Swin Transformer, featuring a multi-modal encoder and a decoder.

RESULTS

Evaluations on foreseen data achieved high focal volume conformity of approximately 93% for both computed tomography (CT) and magnetic resonance (MR) data. For unforeseen data, the networks achieved the focal volume conformity of 88% for CT and 82% for MR. The inference time of the proposed networks was under 0.02 s, indicating the feasibility for real-time simulation.

CONCLUSIONS

The results indicate that our networks can effectively and precisely perform real-time simulation of the intracranial pressure map during tFUS applications. Our work will enhance the safety and accuracy of treatments, representing significant progress for low-intensity focused ultrasound (LIFU) therapies.

Emerging strategies to investigate the biology of early cancer

Early detection and intervention of cancer or precancerous lesions hold great promise to improve patient survival. However, the processes of cancer initiation and the normal-precancer-cancer progression within a non-cancerous tissue context remain poorly understood. This is, in part, due to the scarcity of early-stage clinical samples or suitable models to study early cancer. In this Review, we introduce clinical samples and model systems, such as autochthonous mice and organoid-derived or stem cell-derived models that allow longitudinal analysis of early cancer development. We also present the emerging techniques and computational tools that enhance our understanding of cancer initiation and early progression, including direct imaging, lineage tracing, single-cell and spatial multi-omics, and artificial intelligence models. Together, these models and techniques facilitate a more comprehensive understanding of the poorly characterized early malignant transformation cascade, holding great potential to unveil key drivers and early biomarkers for cancer development. Finally, we discuss how these new insights can potentially be translated into mechanism-based strategies for early cancer detection and prevention.

Two high-precision compact schemes for the dissipative symmetric regular long wave (SRLW) equation by multiple varying bounds integral method

This paper mainly focuses on the numerical study of fourth-order nonlinear dissipative symmetric regular long wave equation. We propose two new methods: the Multiple Varying Bounds Integral (MVBI) method and Taylor Function Fitted (TFF) method. With the multiple varying bounds integral method, all the derivatives in the space direction of the differential equation can be eliminated and we can get different numerical formats by adjusting the integral bound parameters. According to the physical properties of the original differential equation, we can choose an appropriate format from them. Meanwhile, with the Taylor function fitted method, the derivatives of the function at one point, such as first-order and second-order, can be approximated by the original function value at the points around it. Hence, with the MVBI method and TFF method, we can establish two compact and high-precision numerical schemes. In addition, we prove that these numerical schemes are consistent with the original equation on the energy property. Next, the convergence and stability of numerical solution U and P̃ are both proved. Finally, numerical experiments are carried out to verify the effectiveness of numerical schemes.

Artificial Intelligence in Gastrointestinal Endoscopy

Recent advancements in artificial intelligence (AI) have significantly impacted the field of gastrointestinal (GI) endoscopy, with applications spanning a wide range of clinical indications. The central goals for AI in GI endoscopy are to improve endoscopic procedural performance and quality assessment, optimize patient outcomes, and reduce administrative burden. Despite early progress, such as Food and Drug Administration approval of the first computer-aided polyp detection system in 2021, there are numerous important challenges to be faced on the path toward broader adoption of AI algorithms in clinical endoscopic practice.

Isoxazole based nucleosides induce autophagy through the production of ROS and the suppression of the β-catenin pathway in human colorectal carcinoma cells

β-catenin is frequently implicated in signaling pathways that regulate autophagy, and the production of reactive oxygen species (ROS) has been linked to autophagy activation. Isoxazole-based nucleoside compounds have demonstrated anti-cancer properties. In this study, we report the identification of novel isoxazole-nucleosides as anti-tumor agents and their impact on autophagy in human colorectal carcinoma (CRC) cells. Among the ITP series, ITP-7 and ITP-9 (ITP-7/9) exhibited significant cytotoxicity compared to other compounds. Treatment with ITP-7/9 upregulated the expression of key autophagy-related proteins, including LC3 II, Atg7, and phosphorylated Beclin-1. Additionally, ITP-7/9 promoted the formation of LC3 II puncta and increased the number of AO-stained and MDC-stained cells, indicating enhanced autophagy. ROS levels were elevated following ITP-7/9 exposure, and treatment with N-acetyl l-cysteine (NAC), a ROS inhibitor, reduced the ITP-7/9-induced expression of LC3 II. Furthermore, ITP-7/9 inhibited β-catenin's role as a transcription factor, as observed in ICC assays. Moreover, cells with β-catenin gene deletion exhibited stronger autophagy when treated with ITP-7/9 compared to those treated with ITP-7/9 alone. These findings suggest that ITP-7/9 induces autophagy and promotes CRC cell death by downregulating β-catenin.

PARylation of HMGA1 desensitizes esophageal squamous cell carcinoma to olaparib

As a chromatin remodelling factor, high mobility group A1 (HMGA1) plays various roles in both physiological and pathological conditions. However, its role in DNA damage response and DNA damage-based chemotherapy remains largely unexplored. In this study, we report the poly ADP-ribosylation (PARylation) of HMGA1 during DNA damage, leading to desensitization of esophageal squamous cell carcinoma (ESCC) cells to the poly(ADP-ribose) polymerase 1 (PARP1) inhibitor, olaparib. We found that HMGA1 accumulates at sites of DNA damage, where it interacts with PARP1 and undergoes PARylation at residues E47 and E50 in its conserved AT-hook domain. This modification enhances the accumulation of Ku70/Ku80 at the site of DNA damage and activates the DNA-dependent protein kinase catalytic subunit, facilitating nonhomologous end-joining repair. In both subcutaneous tumour models and genetically engineered mouse models of in situ esophageal cancer, HMGA1 interference increased tumour sensitivity to olaparib. Moreover, HMGA1 was highly expressed in ESCC tissues and positively correlated with PARP1 levels as well as poor prognosis in ESCC patients. Taken together, these findings reveal a mechanistic link between HMGA1 and PARP1 in regulating cell responses to DNA damage and suggest that targeting HMGA1 could be a promising strategy to increase cancer cell sensitivity to olaparib.

Advances in Third Space Endoscopy

This article offers a detailed overview of recent advancements in third space endoscopy (TSE), highlighting key procedures and their clinical applications and outcomes. Clinical TSE started as a treatment for achalasia and was named peroral endoscopic myotomy (POEM). Outcome data and comparative data of POEM with other treatments were detailed and discussed. This article also explores the indications and outcomes of other TSE procedures, such as G-POEM, Z-POEM, D-POEM, per-rectal endoscopic myotomy, and STER/POET. This article serves as a valuable resource for endoscopists looking to enhance their understanding and stay updated on these advanced TSE procedures.

Anorectal melanoma: systematic review of the current literature of an aggressive type of melanoma

Anorectal melanoma (ARM) is a rare malignancy often associated with a poor prognosis due to its late diagnosis and aggressive biological behavior. This review aims to comprehensively investigate ARM's diagnosis, management, and treatment, emphasizing its clinical characteristics, laboratory findings, and implications for patient prognosis. A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL databases from inception to 1 July 2024. This review synthesizes existing literature to provide a comprehensive understanding of this rare primary malignancy. A total of 110 articles reporting on 166 patients were included. Gender data were available for 131 cases, comprising 67 females (51.1%) and 64 males (48.9%). The median age was 66 years. The overall median time to diagnosis was 4 months for anal melanoma, 3 months for rectal melanoma, and 4 months for anorectal junction melanoma. The clinical presentation was nodular in 98.2% of cases. Pre-diagnosis symptoms included bleeding in 84.9% of cases, mucous elimination (6%), pain (68.7%), tenesmus (16.9%), and changes in bowel movements (28.5%). Overall survival (OS) was reported in 82 cases, with a median OS of 11 months: 11 months for anal melanoma, 7 months for rectal melanoma, and 12 months for anorectal junction melanoma. ARM is a rare and aggressive melanoma subtype often diagnosed at an advanced stage, leading to a poor prognosis. A female predominance was observed, consistent with other mucosal melanomas. Anal melanoma exhibited better progression-free survival, and OS compared to rectal and anorectal junction melanoma.

Cold sub-mucosal injection versus traditional cold snare polypectomy for diminutive and small colorectal polyps: A systematic review and meta-analysis

BACKGROUND

The guidelines recommend conventional cold snare polypectomy (C-CSP) for diminutive and small colorectal polyps (≤ 10 mm). However, it remains unclear whether CSP with sub-mucosal injection (SI-CSP) achieves comparable efficacy to C-CSP for managing these lesions. This study compares SI-CSP with C-CSP for patients with diminutive and small colorectal polyps.

METHODS

An electronic literature search was conducted to retrieve articles comparing resection outcomes between SI-CSP and C-CSP in diminutive and small colorectal polyps (registration number INPLASY2023100096). Our primary outcomes of interest were the complete resection rate (CRR), complications (namely immediate bleeding, delayed bleeding and perforation) and polypectomy time. Mean differences with 95% confidence intervals (CI) were employed for continuous variables, while odds ratios (OR) with 95% CI were calculated for categorical variables. Data was analyzed using a random effects model and the I2 test was utilized to assess heterogeneity.

RESULTS

Eight studies involving 1470 patients with 2223 polyps were included in our analysis. The CRR was not significantly higher in the SI-CSP group, with an OR of 95% CI 0.50 (0.22, 1.15). The incidences of immediate bleeding (OR 95% CI 0.60 [0.26-1.40]) and delayed bleeding (OR 95% CI 0.88 [0.32-2.42]) did not differ significantly between the two groups. On average, the mean polypectomy time was 64.75 seconds shorter in the C-CSP group (95% CI, - 102.96 to - 26.53). Notably, no perforation events were reported in the included studies.

CONCLUSIONS

The use of SI-CSP was not superior to C-CSP in managing diminutive and small colorectal polyps and the procedure required significantly more time.

Breaking boundaries: laparoscopic and endoscopic collaboration in appendectomy

BACKGROUND

The combination of endoscopy and laparoscopic assistance is gaining attention due to its minimally invasive approach and the potential to improve the safety of surgical treatment for potential malignant tumors at the base of the appendix.

METHODS

Initially, we attempted an endoscopic resection for a patient with a large adenoma in the ileocecal region, with involvement of the appendiceal orifice. However, due to intraabdominal adhesions, a smooth resection was not possible. Therefore, in collaboration with the surgical team, we proceeded with the laparoscopic release of adhesions followed by endoscopic appendectomy. The surgical site was closed using endoscopic purse-string sutures, and intestinal and intraperitoneal dual drainage tubes were placed.

RESULTS

The patient had a favorable recovery following the appendectomy, with no adverse complications. One year later, the follow-up endoscopy revealed excellent closure of the surgical site.

CONCLUSIONS

The integration of internal medicine and surgery has become an inevitable trend in the advancement of medical disciplines. The laparoscopic and endoscopic combined surgery enhances the cooperation between internal medicine and surgery, ultimately benefiting the patients. This significant attempt holds the promise of further supplementation and support from additional clinical data.

Impact of human and artificial intelligence collaboration on workload reduction in medical image interpretation

Clinicians face increasing workloads in medical imaging interpretation, and artificial intelligence (AI) offers potential relief. This meta-analysis evaluates the impact of human-AI collaboration on image interpretation workload. Four databases were searched for studies comparing reading time or quantity for image-based disease detection before and after AI integration. The Quality Assessment of Studies of Diagnostic Accuracy was modified to assess risk of bias. Workload reduction and relative diagnostic performance were pooled using random-effects model. Thirty-six studies were included. AI concurrent assistance reduced reading time by 27.20% (95% confidence interval, 18.22%-36.18%). The reading quantity decreased by 44.47% (40.68%-48.26%) and 61.72% (47.92%-75.52%) when AI served as the second reader and pre-screening, respectively. Overall relative sensitivity and specificity are 1.12 (1.09, 1.14) and 1.00 (1.00, 1.01), respectively. Despite these promising results, caution is warranted due to significant heterogeneity and uneven study quality.

Establishment of a prognostic nomogram based on the clinical and inflammatory parameters as well as acute radiation enteritis for patients with cervical cancer receiving radiotherapy

Objective

Acute radiation enteritis is one of the most common complications of radiotherapy for patients with cervical cancer. This study aims to investigate the effect of acute radiation enteritis on the prognosis of patients with cervical cancer receiving radiotherapy and to establish a nomogram predicting the patients' overall survival (OS).

Methods

The clinical data of 288 patients with cervical cancer who were admitted to our department from 2014 to 2020 were retrospectively analyzed, and the survival of patients were followed up. The Kaplan-Meier method was used to calculate the survival rate and for univariate analysis, and the Cox regression model was used for multivariate prognostic analysis. A nomogram survival prediction model was established based on independent risk factors, and the concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive accuracy of the model. The clinical applicability of the model was assessed by the decision curve. External validation of the nomogram prediction model was performed in 74 patients admitted to our hospital from 2020 to 2021.

Results

60 patients (20.8%) developed grade 2 or higher acute radiation enteritis. The 1-, 3-, and 5-year OS rates were 94.4%, 80.9%, and 77.4%, respectively. Multivariate Cox regression analysis showed that: Age ≥ 60 years, diabetes/hypertension, anemia, FIGO stage III-IV, poor differentiation, pelvic lymph node metastasis, NLR ≥ 2.54 and grade 2 or higher acute radiation enteritis were independent risk factors for OS in cervical cancer patients undergoing radiotherapy (P < 0.05). The C-index of OS nomogram model was 0.815 (95% CI: 0.766-0.864). The AUC of 3-year and 5-year OS were 0.849 (95%CI: 0.789-0.909) and 0.840 (95%CI: 0.782-0.899), respectively. The AUC value of 3-year OS in the external validation set was 0.779 (95%CI: 0.635-0.922). The calibration curve showed that the model was well calibrated, and the decision curve verified the clinical applicability of the constructed nomogram.

Conclusion

This study established an accurate predicting nomogram based on independent prognostic factors in cervical cancer patients receiving radiotherapy, and patients with grade 2 or higher acute radiation enteritis should be paid more attention to in clinical practice.

Global, regional, and national burden of gastrointestinal cancers among adolescents and young adults from 1990 to 2019, and burden prediction to 2040

BACKGROUND

Gastrointestinal (GI) cancers have heavily burdened public health. Few studies reported GI cancer burden among adolescents and young adults (AYA). To address this gap, we explored the burden of GI cancer among people aged 15-39.

METHODS

We retrieved data from the Global Burden of Disease Study 2019 Data Resources. The average annual percent change (AAPC) of rates was calculated by linear regression analysis of the natural logarithm. Bayesian age-period-cohort model was applied to predict the future burden.

RESULTS

In 2019, there were 171,857 (95% uncertain interval [95% UI]: 157,092-187,974) new GI cancer cases with a rate of 5.79/100,000 (95% UI: 5.29-6.33) and 91,033 (95% UI: 83,156-99,399) deaths at a rate of 3.07/100,000 (95% UI: 2.80-3.35) among AYA. The number of prevalent cases and disability-adjusted life years (DALYs) were 722,573 (95% UI: 660,806-789,476) and 5,151,294 (95% UI: 4,706,065-56,188,77), with rates of 24.35/100,000 (95% UI: 22.27-26.60) and 173.57/100,000 (95% UI: 158.57-189.32) respectively. The overall rates of mortality (AAPC = -1.281, p < 0.001) and DALY (AAPC = -1.283, p < 0.001) of GI cancers declined during the past 30 years, while the incidence rate (AAPC = -0.270, p = 0.074) remained stable and the prevalence rate (AAPC = 1.066, p < 0.001) increased. The burden of colorectal cancer (CRC) and pancreatic cancer increased, while those of stomach cancer (SC) and liver cancer (LC) declined. Among the 21 GBD regions, East Asia exhibited the highest burden, while within the five SDI regions, high-middle SDI locations showed the highest rates across all four indicators. CRC, SC, and LC emerged as the primary culprits, attaining a position within the top ten absolute DALYs for all AYA cancers. There were predicted to be 315,792 new cases and 174,068 deaths of GI cancers among AYA in 2040.

CONCLUSIONS

Despite the decrease in mortality and DALY rates of GI cancers among AYA, they remain prevalent. The burden varied with locations, SDI levels, sexes, and cancer types. Sufficient attention and multi-party cooperation are needed to control the widespread public health issue.

Exosomes and SARS-CoV-2 infection

Exosomes, which are small extracellular vesicles, are of particular interest in studies on SARS-CoV-2 infection because of their crucial role in intercellular communication. These vesicles are released by several cell types and are rich in "cargo" such as proteins, lipids, and nucleic acids, which are vital for regulating immune response and viral pathogenesis. Exosomes have been reported to be involved in viral transmission, immune escape mechanisms, and illness development in SARS-CoV-2 infection. This review examines the current research on the contribution of exosomes to the interplay between the virus and host cells, highlighting their potential as diagnostic biomarkers and therapeutic targets in combating COVID-19.

Developing a potent vaccine against Helicobacter pylori: critical considerations and challenges

Helicobacter pylori (H. pylori) is closely associated with gastric cancer and peptic ulcers. The effectiveness of antibiotic treatment against H. pylori is diminished by the emergence of drug-resistant strains, side effects, high cost and reinfections. Given the circumstances, it is imperative to develop a potent vaccination targeting H. pylori. Understanding H. pylori's pathogenicity and the host's immune response is essential to developing a vaccine. Furthermore, vaccine evaluation necessitates the careful selection of design formulation. This review article aims to provide a concise overview of the considerations involved in selecting the optimal antigen, adjuvant, vaccine delivery system and laboratory animal model for vaccine formulation. Furthermore, we will discuss some significant obstacles in the realm of developing a potent vaccination against H. pylori.

Ionically assembled hemostatic powders with rapid self-gelation, strong acid resistance, and on-demand removability for upper gastrointestinal bleeding

Upper gastrointestinal bleeding (UGIB) is bleeding in the upper part of the gastrointestinal tract with an acidic and dynamic environment that limits the application of conventional hemostatic materials. This study focuses on the development of N-[(2-hydroxy-3-trimethylammonium) propyl] chitosan chloride/phytic acid (HTCC/PA, HP) powders with fast hemostatic capability and strong acid resistance, for potential applications in managing UGIB. Upon contact with liquids within 5 seconds, HP powders rapidly transform into hydrogels, forming ionic networks through electrostatic interactions. The ionic crosslinking process facilitates the HP powders with high blood absorption (3.4 times of self-weight), sufficient tissue adhesion (5.2 and 6.1 kPa on porcine skin and stomach, respectively), and hemostasis (within 15 seconds for in vitro clotting). Interestingly, the PA imparts the HP powders with strong acid resistance (69.8% mass remaining after 10 days of incubation at pH 1) and on-demand removable sealing while HTCC contributes to fast hemostasis and good wet adhesion. Moreover, the HP powders show good biocompatibility and promote wound healing. Therefore, these characteristics highlight the promising clinical potential of HP powders for effectively managing UGIB.

Colonic transendoscopic enteral tubing is revolutionizing intestinal therapeutics, diagnosis, and microbiome research

The intestine, as a crucial organ of the human body, has remained enigmatic despite the remarkable advancements in modern medical technology. Over the past decades, the invention of endoscopic technology has made the noninvasive intervention of the intestine a reality, expanding diagnostic and therapeutic options for diseases. However, due to the single-treatment feature of endoscopic procedures, continuous or repeated medication administration, sampling, and decompression drainage within the intestine have yet to be fulfilled. These limitations persisted until the invention of colonic transendoscopic enteral tubing (TET) in 2014, which realized repeated fecal microbiota transplantation, medication administration, and decompression drainage for the treatment of colon perforation and intestinal obstruction, as well as in situ dynamic sampling. These breakthroughs have not gone unnoticed, gaining global attention and recommendations from guidelines and consensuses. TET has emerged as a novel microbial research tool that offers new paradigms for human microbiome research. This review aims to update the research progress based on TET.