Extracellular Vesicle-Based Strategies for Tumor Immunotherapy

Immunotherapy is one of the most promising approaches for cancer management, as it utilizes the intrinsic immune response to target cancer cells. Normally, the human body uses its immune system as a defense mechanism to detect and eliminate foreign objects, including cancer cells. However, cancers develop a 'switch off' mechanism, known as immune checkpoint proteins, to evade immune surveillance and suppress immune activation. Therefore, significant efforts have been made to develop the strategies for stimulating immune responses against cancers. Among these, the use of extracellular vesicles (EVs) to enhance the anti-tumor immune response has emerged as a particularly promising approach in cancer management. EVs possess several unique properties that elevate the potency in modulating immune responses. This review article provides a comprehensive overview of recent advances in this field, focusing on the strategic usage of EVs to overcome tumor-induced immune tolerance. We discuss the biogenesis and characteristics of EVs, as well as their potential applications in medical contexts. The immune mechanisms within the tumor microenvironment and the strategies employed by cancers to evade immune detection are explored. The roles of EVs in regulating the tumor microenvironment and enhancing immune responses for immunotherapy are also highlighted. Additionally, this article addresses the challenges and future directions for the development of EV-based nanomedicine approaches, aiming to improve cancer immunotherapy outcomes with greater precision and efficacy while minimizing off-target effects.

Extracellular vesicles in Helicobacter pylori-mediated diseases: mechanisms and therapeutic potential

Extracellular vesicles (EVs) are relevant elements for cell-to-cell communication and are considered crucial in host-pathogen interactions by transferring molecules between the pathogen and the host during infections. These structures participate in various physiological and pathological processes and are considered promising candidates as disease markers, therapeutic reagents, and drug carriers. Both H. pylori and the host epithelial cells infected by H. pylori secrete EVs, which contribute to inflammation and the development of disease phenotypes. However, many aspects of the cellular and molecular biology of EV functions remain incompletely understood due to methodological challenges in studying these small structures. This review also highlights the roles of EVs derived from H. pylori-infected cells in the pathogenesis of gastric and extragastric diseases. Understanding the specific functions of these EVs during H. pylori infections, whether are advantageous to the host or the pathogen, may help the development new therapeutic approaches to prevent disease.

Low-Dose Docetaxel Is Effective in Reducing Atherogenic Lipids and Atherosclerosis

High-density lipoprotein (HDL) particles form during cellular cholesterol removal, positioning HDL biogenesis as a potential strategy to combat atherosclerosis. We identified desmocollin 1 (DSC1) as a negative regulator of HDL biogenesis and discovered that docetaxel (DTX) effectively inhibits DSC1 activity. This study assessed the efficacy of DTX in reducing atherosclerosis in ApoE-/- mice. After two weeks on a high-fat diet, mice were divided into baseline, vehicle-treated, and DTX-treated groups. Baseline mice were sacrificed at the end of the two weeks, while the other groups received a vehicle or DTX (1 μg/μL) via subcutaneously implanted osmotic pumps delivering 0.15 μL/h for six weeks, with the high-fat diet continued. The controlled drug delivery system maintained stable DTX blood concentrations (2.7-4.3 nM) over six weeks without hematologic toxicity. DTX treatment significantly reduced circulating atherogenic lipids, including triglycerides, non-esterified fatty acids, low-density lipoprotein cholesterol, and total cholesterol, while increasing the HDL cholesterol/total cholesterol ratio. These improvements were associated with significant reductions in atherosclerotic lesions in the aortic sinus and arch. Notably, these effects occurred without altering circulating inflammatory cytokine levels. These results demonstrate that DTX effectively reduces dyslipidemia-induced atherosclerosis. Its HDL-biogenic and anti-atherosclerotic effects establish DTX as a promising candidate for developing HDL-directed therapies for atherosclerosis.

Granulocytic sarcoma as an initial manifestation of acute promyelocytic leukemia: A case report with literature review

RATIONALE

Granulocytic sarcoma (GS) is a rare tumor consisting of myeloid blasts with or without maturation and occurs in sites other than the bone marrow. Due to its low prevalence, clinical cases and pathogenesis need to be studied. Therefore, we present a rare case of humerus GS occurring simultaneously with acute promyelocytic leukemia (APL) and studied a retrospective analysis of clinical characteristics and related treatment strategies, hoping that it could help to standardize the early diagnosis and treatment of APL/GS.

PATIENT CONCERNS

We present a case of humerus GS complicated with APL in a 22-year-old woman who experienced pain in right clavicle and shoulder for 6 months without any cause. While the aggravated pain were persistent for 2 months, causing limited movement of her right upper arm.

DIAGNOSES

The presence of tumor in her right proximal humerus and end of clavicle was revealed by positron emission tomography-computed tomography. Subsequently, the mass collected during the operation was confirmed to be GS by the pathological immunohistochemical examination. Further progression to APL was based on marrow smears, flow cytometry, fluorescence in situ hybridization, and PML/RARα gene detection.

INTERVENTIONS AND OUTCOMES

The patient underwent the tumorectomy, and then received 28-day induction therapy with all-trans retinoic acid (ATRA) (25 mg/m2/d) and arsenic trioxide. The posttreatment bone marrow smear and flow cytometry showed that she was in a complete remission. Consolidation treatment was performed with ATRA 25 mg/m2 PO BID for 2 weeks every 4 weeks and arsenic trioxide 0.16 mg/kg IV 5 days a week for 4 weeks every 8 weeks for a total of 6 cycles. Currently, the patient was routinely followed-up at an outpatient clinic, and has been maintained complete remission for 15 months.

LESSONS

We present an uncommon case of a humeral APL/GS, and conducted a comprehensive analysis of 28 cases of APL/GS. Despite the rarity of APL/GS, it should be diagnosed at an early stage. Furthermore, ATRA are recommended in the treatment plan of APL/GS.

Global Epidemiology and Geographic Variations of Pediatric-Onset Inflammatory Bowel Disease: A Comprehensive Analysis of the Global Burden of Disease Study 1990 to 2019

BACKGROUND

An increasing incidence of pediatric-onset inflammatory bowel disease (PIBD) has been reported in many countries. However, the global burden and distribution of this disease remain less understood. We aimed to examine the global epidemiology and trends of PIBD from 1990 to 2019.

METHODS

Data from the 2019 Global Burden of Disease Study, covering 204 countries, were analyzed. We assessed key measures like incidence, prevalence, mortality, and disability-adjusted life years (DALYs) using linear regression to calculate annual percentage changes and assess trends.

RESULTS

Between 1990 and 2019, the PIBD incidence rate increased and the DALY rate and mortality rate declined. The incidence rate was notably elevated in the high Socio-demographic Index (SDI) quintile, reaching 6.3 per 100 000 person-years, corresponding to 13 914 new cases in 2019. Incidence and prevalence of PIBD positively correlated with the SDI, while higher death and DALY burdens were observed in lower-SDI countries. In 2019, the top 5 countries with the highest PIBD incidence rates were Canada (19.9 per 100 000 population), Denmark (12.4 per 100 000 population), Hungary (8.5 per 100 000 population), Austria (8.1 per 100 000 population), and the United States (7.4 per 100 000 population). Several countries experienced significant increases in incidence rates from 1990 to 2019, led by Taiwan (annual percent change 4.2%), followed by China (2.8%), Japan (2.1%), Australia (1.8%), and Hungary (1.6%).

DISCUSSION

PIBD incidence has significantly increased since 1990. High-SDI countries face higher incidence, while lower-SDI countries experience higher mortality and DALY burdens. The study underscores the need for ongoing monitoring and research to address this emerging public health issue.

Microbial Trojan Horses: Virulence Factors as Key Players in Neurodegenerative Diseases

Changes in population demographics indicate that the elderly population will reach 2.1 billion worldwide by 2050. In parallel, there will be an increase in neurodegenerative diseases such as Alzheimer's and Parkinson's. This review explores dysbiosis occurring in these pathologies and how virulence factors contribute to the worsening or development of clinical conditions, and it summarizes existing and potential ways to combat microorganisms related to these diseases. Microbiota imbalances can contribute to the progression of neurodegenerative diseases by increasing intestinal permeability, exchanging information through innervation, and even acting as a Trojan horse affecting immune cells. The microorganisms of the microbiota produce virulence factors to protect themselves from host defenses, many of which contribute to neurodegenerative diseases. These virulence factors are expressed according to the genetic composition of each microorganism, leading to a wide range of factors to be considered. Among the main virulence factors are LPS, urease, curli proteins, amyloidogenic proteins, VacA, and CagA. These factors can also be packed into bacterial outer membrane vesicles, which transport proteins, RNA, and DNA, enabling distal communication that impacts various diseases, including Alzheimer's and Parkinson's.

Orally administrated acetate inhibits atherosclerosis progression through AMPK activation via GPR43 in plaque macrophages

BACKGROUND AND AIMS

Oral administration of acetic acid, a short-chain fatty acid, has been shown to efficiently reduce obesity and insulin resistance in both experimental animals and humans. The anti-atherosclerotic effect of acetate is expected owing to its anti-inflammatory and anti-oxidative stress characteristics; however, this remains to be fully understood.

METHODS

For 12 weeks, apolipoprotein E-deficient mice were administered 0.6 % sodium acetate water or vehicle water. Plaque formation and progression were investigated using histological analysis of dissected aortic root sections. Flow cytometry and gene expression analyses were employed to assess plaque macrophage characteristics and functional states. In vitro tests were performed on mouse peritoneal primary macrophages and bone marrow-derived macrophages isolated from wild-type or GPR43-deficient mice.

RESULTS

Atherosclerotic plaque formation was inhibited in acetate-treated ApoE-deficient mice, and AMPK activation was directly validated in plaque macrophages. Acetate inhibited macrophage proliferation, reactive oxygen species production, and pro-inflammatory molecule expression, all of which were reversed by AMPK inhibition. Bone marrow transplantation study revealed the role of GPR43-mediated AMPK activation by acetic acid in anti-atherosclerotic effect.

CONCLUSIONS

Oral acetate administration suppressed arteriosclerosis formation and progression in ApoE-deficient mice. Acetate inhibited macrophage proliferation, inflammatory cytokine release, and reactive oxygen species production via GPR43-mediated AMPK activation in macrophages, ameliorating plaque formation and progression.

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis

OBJECTIVES

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States.

METHODS

The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups.

RESULTS

Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile.

CONCLUSIONS

Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Comparison of index and reoperative bowel resections in Crohn's disease

BACKGROUND

There is a scarcity of literature describing outcomes of reoperative Crohn's disease. An in-depth knowledge of these outcomes is critical for managing patient expectations and optimal perioperative planning. We sought to examine outcomes in patients undergoing reoperative surgeries for Crohn's disease compared to index operations.

METHODS

A retrospective chart review of surgeries performed from 2018-2023 at a single tertiary care academic institution was performed. A subgroup analysis of index vs. reoperative ileocolic resections was performed to minimize confounding due to the heterogeneity of operations between the index and reoperative groups.

RESULTS

Out of 119 patients, 70 (59%) underwent index operations, and 49 (41%) were reoperations. Overall complication rates (24.28% vs. 34.69%, P=0.224), EBL (189.5 vs. 193.4 mL, P=0.94), operative time (209 vs. 236 min, P=0.091), length of stay (mean: 7.24 vs. 10.08 days, P=0.0142), utilization of laparoscopy (92.85% vs. 65.3%, P=0.0002) and conversion to open technique (4.61% vs. 9.37%, P=0.392) favored index cases. The laparoscopic approach narrowed the gap in length of stay between the index and reoperative groups from 2.83 to 0.6 days. Subgroup analysis of ileocolic resections (Index: 50, reoperations: 26) also favored the index operations.

CONCLUSIONS

The current study provides valuable insight into managing patient expectations and optimal perioperative planning for reoperative Crohn's disease. Reoperations were associated with longer stays, lower utilization of laparoscopic platforms, and a trend toward higher overall complication rates. Laparoscopy reduces the gap in length of stay between index and reoperations; however, it is associated with a higher reoperation conversion rate.

Surgical Therapy of Gastric Ulcer Disease

Medical advancements, including Helicobacter pylori eradication and antisecretory agents, have reduced peptic ulcer disease (PUD)-associated hospital admissions, mortality, and surgical interventions over the past 30 years. Surgery plays an important role in the treatment of life-threatening complications of PUD, such as bleeding, perforation, and gastric outlet obstruction, as well as for disease that is refractory to medical management. The article highlights the critical role of surgery in cases where medical therapy is insufficient or in the event of emergency complications arising from PUD.

The alcohol exposome

Science is now in a new era of exposome research that strives to build a more all-inclusive, panoramic view in the quest for answers; this is especially true in the field of toxicology. Alcohol exposure researchers have been examining the multivariate co-exposures that may either exacerbate or initiate alcohol-related tissue/organ injuries. This manuscript presents selected key variables that represent the Alcohol Exposome. The primary variables that make up the Alcohol Exposome can include comorbidities such as cigarettes, poor diet, occupational hazards, environmental hazards, infectious agents, and aging. In addition to representing multiple factors, the Alcohol Exposome examines the various types of intercellular communications that are carried from one organ system to another and may greatly impact the types of injuries and metabolites caused by alcohol exposure. The intent of defining the Alcohol Exposome is to bring the newly expanded definition of Exposomics, meaning the study of the exposome, to the field of alcohol research and to emphasize the need for examining research results in a non-isolated environment representing a more relevant manner in which all human physiology exists.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

Anatomizing causal relationships between gut microbiota, plasma metabolites, and epilepsy: A mendelian randomization study

BACKGROUND

Epilepsy causes a heavy disease burden, and the gut microbiota (GM) influences the progression of epilepsy, while plasma metabolites directly or indirectly associated with GM may play a mediating role. However, the causal relationships between epilepsy, GM, and potential metabolite mediators are lack of investigation.

METHODS

Mendelian randomization (MR) analysis was applied to estimate the effects of GM and plasma metabolites on epilepsy. Genetic instruments were obtained from large-scale genome-wide meta-analysis of GM (n = 5959), plasma metabolites (n = 136,016), and epilepsy (Cases/controls = 12891/312803) of European ancestry. Epilepsy phenotypes included all epilepsy, generalized epilepsy and focal epilepsy from the Finn Gen R10 database. And two-step MR (TSMR) to discover the potential mediating metabolites.

RESULTS

In total, we found 19 gut microbial taxa to be causally associated with the risk of epilepsy, among which Omnitrophota phylum had the strongest association (OR, 2.3; P = 0.009) with promoting effect. We also identified 21 plasma metabolites associated with epilepsy, the strongest ones of which are eastotal fatty acids (OR, 1.12; P = 0.001) that exhibited a facilitating effect. We observed indirect effects of free cholesterol to total lipids ratio in large LDL in associations between Fournierella massiliensis species and epilepsy, with a mediated proportion of -3.64% (95%CI, -7.22%∼-0.06%; P = 0.046).

CONCLUSION

This study supports a causal link between Fournierella massiliensis species, free cholesterol to total lipids ratio in large LDL and epilepsy, as well as a mediating effect of free cholesterol to total lipids ratio in large LDL in epilepsy.

Long-term effects of Nε-carboxymethyllysine intake on intestinal barrier permeability: Associations with gut microbiota and bile acids

Advanced glycation end products (AGEs) in processed foods are closely linked to intestinal injury. However, the long-term effects of exposure to free Nɛ-carboxymethyl lysine (CML), a prevalent AGE molecule, on intestinal barrier integrity have been rarely evaluated. This study investigated the temporal effects of CML exposure on intestinal barrier permeability in C57BL/6N mice at diet-related doses over 12, 14, and 16 weeks. No significant changes were observed at 12 weeks, but CML exposure significantly increased intestinal permeability at 14 and 16 weeks, accompanied by elevated serum LPS levels, colonic histological damage, and reduced tight junction protein expression at 16 weeks. CML exposure also altered gut microbiota composition and intestinal bile acid (BA) profiles, specifically reducing TDCA, GDCA, and GCDCA levels. Given the important role of colonic BA receptor signaling in maintaining the intestinal barrier integrity, the impact of CML on BA receptor signaling was assessed. CML exposure significantly downregulated BA receptor TGR5-YAP signaling in mice, while no significant effects were observed in vitro, suggesting that the changes observed in TGR5-YAP signaling in vivo may not result from the direct effects of CML. Spearman's correlation analysis revealed strong associations between altered gut microbiota, BA levels, TGR5-YAP signaling, and intestinal barrier injury. This study highlighted the chronic health risks of long-term CML intake and provided new insights into the links between CML-induced intestinal toxicity, gut microbiota, BA profiles, and BA receptor signaling.

Dietary quality, perceived health, and psychological status as key risk factors for newly developed metabolic dysfunction-associated steatotic liver disease in a longitudinal study

OBJECTIVES

This study investigated biomarkers in individuals with newly developed metabolic dysfunction-associated steatotic liver disease (ND-MASLD) and examined the interplay between genetic predisposition and environmental factors using a machine learning approach in a large longitudinal study.

METHODS

Participants were classified into four groups based on metabolic dysfunction-associated steatotic liver disease (MASLD) status between the first and second measurements with an approximate 5-y gap. A model was developed to identify early-stage biomarkers of ND-MASLD (n = 1603). Nutrient intake, dietary patterns, genetic variants, and psychosocial factors were compared among the no MASLD (n = 60 081), recovered MASLD (n = 3181), persistent MASLD (n = 670), and ND-MASLD (n = 1603) groups. Their association with ND-MASLD was also predicted using a machine learning approach.

RESULTS

The model incorporating ND-MASLD status, age, sex, dietary inflammatory index, and metabolic syndrome (MetS), especially low high-density lipoprotein cholesterol and hypertriglyceridemia, at the second measurement demonstrated an optimal fit. High carbohydrate intake with a high glycemic index was associated with elevated ND-MADSLD risk. Fatty liver index was lower in persistent MASLD followed by ND-MASLD, recovered MASLD, and no MASLD. Participants in the ND-MASLD group had lower vitamin D and total isoflavonoid intake and a lower modified healthy eating index, indicating unhealthy diets. The XGBoost and deep neural network models identified age, sex, MetS components, dietary antioxidants, self-rated health, psychological well-being indexes, and serum liver enzyme levels at the second measurement as significant predictors of ND-MASLD. However, polygenic risk scores were not included.

CONCLUSIONS

Early-stage biomarkers of ND-MASLD were closely linked to MetS incidence. Dietary quality, perceived health status, and psychological stress emerged as potential targets for MASLD prevention strategies, with lifestyle modifications potentially overriding genetic predispositions. The results indicate that preventive strategies about lifestyle modification should be developed for MASLD.

Social and natural environmental factors cause the birth-cohort phenomenon of peptic ulcers by superposition mechanism

The widely believed Helicobacter pylori infection has never explained the birth-cohort phenomenon of peptic ulcers. Although numerous studies have observed that environmental factors are associated with peptic ulcers, their role in the disease has yet to be identified. A new etiological theory proposed that environmental factors cause peptic ulcers via inducing psychological stress. Starting from this etiology, an integration of the mortality rates caused by social and natural environmental factors reproduced a representative fluctuation curve in the birth-cohort phenomenon, where a causal role of environmental factors in peptic ulcers was hidden. The reproduced fluctuation curve revealed that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism, and the causal role of each individual environmental factor surfaced if the fluctuation curves in the birth-cohort phenomenon were properly differentiated. A full understanding of the birth-cohort phenomenon highlights the importance of environmental management in improving clinical outcomes, and suggests that the Superposition Mechanism is an indispensable methodological concept for life science and medicine.

Efficacy of probiotics regimens for Helicobacter pylori eradication: A systematic review, pairwise, and network meta-analysis of randomized controlled trials

BACKGROUND

Helicobacter pylori (H. pylori) infection increases the risks of chronic gastritis, peptic ulcer diseases, and the incidence of gastric cancer. However, antibiotic resistance and adverse effects led to the emergence of alternative treatments such as probiotics supplementation. This systematic review and network meta-analysis aims to assess the efficacy and safety of incorporating probiotics into the various eradication regimens for H. pylori.

METHODS

We searched PubMed, Embase, Scopus, Cochrane, and Web of Science from inception to May 2023, for randomized controlled trials (RCTs) comparing standard therapy (triple or quadrable therapy). for H. pylori with or without probiotic supplementation. Dichotomous data was reported using an odds ratio (OR) for intention-to-treat (ITT) and risk ratios (RR) for side effects with a 95 % confidence interval (CI).

RESULTS

We included 91 RCTs involving 13,680 patients. Adding probiotics to standard treatment was associated with a higher H. pylori eradication rate in the ITT analysis (78.75 % vs 62.43 %, OR = 1.62, 95 % CI: 1.41 to 1.87, P < 0.0001), and per-protocol (PP) analysis (80.33 % vs 72.63 %, OR = 1.60, 95 % CI: 1.34 to 1.91, P < 0.0001). Meanwhile, dyspepsia, gastric ulcer, and peptic ulcer were comparable in both groups. The probiotics group was associated with significantly fewer side effects including, abdominal pain (RR = 0.68, 95 % CI: 0.54 to 0.86), bad taste (RR = 0.64, 95 % CI: 0.53 to 0.78), diarrhea (RR = 0.49, 95 % CI: 0.40 to 0.61), epigastric pain/bloating (RR = 0.76, 95 % CI: 0.65 to 0.88), headache/dizziness (RR = 0.46, 95 % CI: 0.29 to 0.74), (RR = 0.65, 95 % CI: 0.55 to 0.77), or nausea/vomiting (RR = 0.69, 95 % CI: 0.56 to 0.83). The network meta-analysis showed that, compared to the placebo, Bifidobacterium longum had the highest efficacy in eradicating H. pylori (ITT: 81.06 % vs 64.88 %, PP: 88 % vs 75.71 %) (OR = 2.52, 95 % CI: 1.18 to 5.49).

CONCLUSION

Adding probiotics to standard H. pylori therapy not only increased the rate of eradication but also reduced some of the adverse reactions throughout therapy, particularly nausea, vomiting, diarrhea, abdominal pain, epigastric pain/bloating, and taste issues.

Perioperative Antibiotic Use in Pediatric Solid Tumor Resection: A Two-center Retrospective Cohort Study

PURPOSE

There is no consensus on the perioperative use of antibiotics in pediatric solid tumor resection. This study collected data from two pediatric centers that utilize perioperative antibiotics to varying degrees in pediatric solid tumor patients to investigate the occurrence of postoperative sepsis and infectious complications.

METHODS

A two-institution, retrospective cohort study was performed. Charts of children who underwent solid tumor resection between July 2018-June 2021 were reviewed. Patient characteristics, diagnosis, operative data, perioperative antibiotic use, and postoperative infection/sepsis were analyzed within 30 days of surgery. The primary outcome was surgical site infection (SSI) or systemic sepsis within 30 days of surgery. Fisher's tests were performed to evaluate differences.

RESULTS

250 patients underwent tumor resection between July 2018 and June 2021 at both centers. The median age was 4 years [Range: 0.02-26.1]. Seventy-five percent (N = 188) received perioperative antibiotics prophylaxis (AP), while 25 % of patients did not receive AP (N = 62). Only one patient in the AP group (0.5 %) developed postoperative sepsis, while 12 patients (19.4 %) in the non-AP group developed sepsis (p < 0.0001). There were 3 SSI in the AP group and none in the non-AP group (p = 1.0).

CONCLUSIONS

The administration of AP in children undergoing solid tumor resection is associated with a reduced rate of postoperative sepsis but no difference in SSI. This could possibly be related to bacterial translocation during surgery and the seeding of indwelling central venous access catheters. Our results support the standardized use of AP in this population.

TYPE OF STUDY

Retrospective Cohort Study.

LEVEL OF EVIDENCE

III.

The improvement of a refractory enterocutaneous fistula with colchicine in a patient with Crohn's disease who had an MEFV gene mutation

Enterocutaneous fistulas (ECFs) occurring in the setting of Crohn's disease (CD) are difficult to cure with medical treatment alone and affects a patient's quality of life. A 39-year-old man was diagnosed with an ileocolitis-type CD in 2007. His inflammation was insufficiently controlled despite the administration of an anti-tumor necrosis factor-alpha antibody. Therefore, he underwent subtotal colectomy, terminal ileal resection, and ileostomy for multiple colon and anal stenoses in Dec 2015. The patient subsequently received ustekinumab; however, purulent discharge was observed from a postoperative scar around the umbilicus in July 2019. In July 2021, enteroscopy and magnetic resonance imaging (MRI) showed an ECF extending from the small intestine to the umbilicus. Upon referral to our hospital, laboratory data showed elevated C-reactive protein (CRP) and serum amyloid A (SAA). After receiving colchicine, his purulent discharge disappeared, and his CRP and SAA levels rapidly decreased. Enteroscopy and MRI performed 1 year and 5 months after the administration of colchicine revealed ECF closure. Genetic analysis revealed that the patient harbored an MEFV exon 1 (E84K) mutation.

Microbiota-Focused Dietary Approaches to Support Health: A Systematic Review

Diet affects the intestinal microbiota. Increasingly, research is linking the intestinal microbiota to various human health outcomes. Consumption of traditional prebiotics (inulin, fructo-oligosaccharides, and galacto-oligosaccharides) confers health benefits through substrate utilization by select intestinal microorganisms, namely Bifidobacterium and Lactobacilli spp. A similar but distinct concept focused on microorganisms to support human health is through direct consumption of certain live microorganisms recognized as probiotics, which classically include Lactobacilli or Bifidobacterium strains. With advances in sequencing technologies and culturing techniques, other novel functional intestinal microorganisms are being increasingly identified and studied to determine how they may underpin human health benefits. These novel microorganisms are targeted for enrichment within the autochthonous intestinal microbiota through dietary approaches and are also gaining interest as next-generation probiotics because of their purported beneficial properties. Thus, characterizing dietary approaches that nourish select microorganisms in situ is necessary to propel biotic-focused research forward. As such, we reviewed the literature to summarize findings on dietary approaches that nourish the human intestinal microbiota and benefit health to help fill the gap in knowledge on the connections between certain microorganisms, the metabolome, and host physiology. The overall objective of this systematic review was to summarize the impact of dietary interventions with the propensity to nourish certain intestinal bacteria, affect microbial metabolite concentrations, and support gastrointestinal, metabolic, and cognitive health in healthy adults. Findings from the 17 randomized controlled studies identified in this systematic review indicated that dietary interventions providing dietary fibers, phytonutrients, or unsaturated fatty acids differentially enriched Akkermansia, Bacteroides, Clostridium, Eubacterium, Faecalibacterium, Roseburia, and Ruminococcus species, with variable effects on microbial metabolites and subsequent associations with physiologic markers of gastrointestinal and metabolic health. These findings have implications for biotic-focused research on candidate prebiotic substrates as well as next-generation probiotics.

Inflammatory Protein Signatures as Predictive Disease-Specific Markers for Non-Alcoholic Steatohepatitis (NASH)

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic disease worldwide, consisting of a broad spectrum of diseases such as simple steatosis (NAFL), non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Hepatic inflammation plays a key role in the pathophysiology of NAFLD. Inflammatory mediators such as cytokines and chemokines are considered as contributing factors to NAFLD development and progression. In the present study, we aimed to investigate the inflammatory protein signatures as predictive disease-specific markers for non-alcoholic fatty liver disease (NAFLD). This cross-sectional study included healthy control (n = 64), NAFL (n = 109), and NASH (n = 60) human subjects. Serum concentrations of various cytokines and chemokines were evaluated using sensitive multiplex assays. We used principal component analysis (PCoA) to reveal distinct differences in the levels of cytokines and chemokines between each of the study groups. Further, a random forest classification model was developed to identify the panel of markers that could predict diseases. The protein-protein network analysis was performed to determine the various signaling pathways associated with the disease-specific panel of markers. Serum concentrations of TNF-α, IL-1β, IL-1ra, G-CSF, PDGF-BB, MCP-1, MIP-1a, MIP-1b, RANTES, eotaxin, IL-8 and IP-10 were significantly increased in NASH group as compared to control group. Furthermore, serum concentrations of IL-9 and IL-13 were significantly lower in the NASH group, whereas IL-2 levels were significantly decreased in the NAFL group when compared to the control group. PCoA results demonstrated statistically significant differences in cytokines and chemokines between each of the study groups (PERMANOVA p = 0.001; R2 = 0.102). RANTES, IL-1ra, MIP-1b, IL-2, and G-CSF could differentiate the NAFL group from the controls; G-CSF, IL-1ra, TNF-α, RANTES, and IL-9 could differentiate the NASH group from the controls; and G-CSF, IL-9, IL-13, eotaxin, and TNF- α could differentiate the NASH group from the NAFL group. Our protein-protein network revealed that these markers are involved in cytokine-cytokine receptor interaction, Th1 and Th2 cell differentiation, TNF, chemokine, JAK/STAT, P13K/Akt, TLR, NOD-like receptor, NF-kB, and adipocytokine signaling pathways which might be responsible for disease pathogenesis. Our study findings revealed a set of distinct cytokine and chemokine markers and they might be considered as biomarkers in distinguishing NASH from NAFL. Future multicentre studies with larger sample size are recommended to determine the potential utility of these panels of markers.

Prognosis of major bleeding based on residual variables and machine learning for critical patients with upper gastrointestinal bleeding: A multicenter study

BACKGROUND

Upper gastrointestinal bleeding (UGIB) is a significant cause of morbidity and mortality worldwide. This study investigates the use of residual variables and machine learning (ML) models for predicting major bleeding in patients with severe UGIB after their first intensive care unit (ICU) admission.

METHODS

The Medical Information Mart for Intensive Care IV and eICU databases were used. Conventional ML and long short-term memory models were constructed using pre-ICU and ICU admission day data to predict the recurrence of major gastrointestinal bleeding. In the models, residual data were utilized by subtracting the normal range from the test result. The models included eight algorithms. Shapley additive explanations and saliency maps were used for feature interpretability.

RESULTS

Twenty-five ML models were developed using data from 2604 patients. The light gradient-boosting machine algorithm model using pre-ICU admission residual data outperformed other models that used test results directly, with an AUC of 0.96. The key factors included aspartate aminotransferase, blood urea nitrogen, albumin, length of ICU admission, and respiratory rate.

CONCLUSIONS

ML models using residuals improved the accuracy and interpretability in predicting major bleeding during ICU admission in patients with UGIB. These interpretable features may facilitate the early identification and management of high-risk patients, thereby improving hemodynamic stability and outcomes.

Clinical efficacy of pancreas-preserving distal pancreatectomy for the treatment of pancreatic ductal adenocarcinoma

BACKGROUND

The long-term survival rate of patients with pancreatic ductal adenocarcinoma has improved alongside the development of multidisciplinary treatment, and there is now demand for less invasive surgery that maintains postoperative pancreatic function. We evaluated the efficacy of pancreas-preserving distal pancreatectomy in terms of oncologic parameters and postoperative pancreatic function.

METHODS

The data of 98 consecutive patients who underwent distal pancreatectomy for the treatment of pancreatic ductal adenocarcinoma between 2012 and 2022 in our institution were retrospectively analyzed. The surgical outcomes, overall survival, and postoperative pancreatic function were compared between pancreas-preserving distal pancreatectomy, in which the pancreatic stump was distal to the left margin of the portal vein on postoperative computed tomography, and conventional distal pancreatectomy.

RESULTS

Sixteen patients (16%) underwent pancreas-preserving distal pancreatectomy. Fewer lymph nodes were dissected in the pancreas-preserving distal pancreatectomy group than the conventional distal pancreatectomy group (19 vs 31, respectively; P < .01); however, the R0 resection rate (94% vs 93%, respectively; P = 1.00), recurrence-free survival, and overall survival were similar. Similar results were obtained in an analysis limited to patients with pancreatic ductal adenocarcinoma in the pancreatic tail. Patients who underwent pancreas-preserving distal pancreatectomy were less likely to develop worsening of their diabetes than those who underwent conventional distal pancreatectomy (19% vs 39%, respectively; P = .16). Nonalcoholic fatty liver disease newly developed in 22% of the patients who underwent conventional distal pancreatectomy but in none of those who underwent pancreas-preserving distal pancreatectomy (P = .04).

CONCLUSION

The pancreatic transection site should be distally located to preserve postoperative pancreatic function when R0 resection can be achieved.

Association between surrogate indices of fatty liver and the risk of colorectal cancer: a cross-sectional United States study

BACKGROUND

The presence of fatty liver (FL) has been suggested to influence the incidence of colorectal cancer (CRC). This study aimed to evaluate the predictive utility of six alternative indices of FL-namely, liver fat percentage (PLF), lipid accumulation product (LAP), hepatic steatosis index (HSI), United States fatty liver index (USFLI), fatty liver index (FLI), and Zhejiang University index (ZJU)-in assessing the risk of CRC. We aimed to determine their effectiveness in predicting CRC risk by comparing these surrogate indices.

METHODS

Data for this study were derived from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2018, focusing on adults over 20 years old. The six FLIs were calculated using established methodologies outlined in prior research. To identify key variables, the Boruta algorithm was employed. The relationships between FLIs and CRC risk were assessed using multivariable logistic regression, generalized linear models (GLMs), and restricted cubic spline (RCS) models. Additionally, subgroup analyses were performed to investigate the effects of potential confounders.

RESULTS

Among the 16,250 individuals surveyed, 96 were diagnosed with CRC. Those with CRC exhibited significantly higher levels of PLF (4.65 vs. 3.31, P=0.004), LAP (55.63 vs. 42.34, P=0.04), USFLI (23.22 vs. 17.83, P<0.001), and FLI (58.16 vs. 50.86, P=0.048) compared to individuals without CRC. Multivariate logistic regression and RCS analyses indicated that, of the six indices, only USFLI was significantly associated with an increased risk of CRC. Notably, further stratification of USFLI revealed that this association was consistently stronger in individuals aged over 65 years [odds ratio (OR) =1.023; 95% confidence interval (CI): 1.005-1.041; P=0.01] and among non-smokers (OR =1.018; 95% CI: 1.003-1.033; P=0.02) after adjusting for multiple confounders.

CONCLUSIONS

The USFLI index demonstrated a more significant association with the risk of CRC compared to the other five alternative FLIs, highlighting its potential utility in predicting CRC risk in clinical settings.

Multifunctionality and Possible Medical Application of the BPC 157 Peptide-Literature and Patent Review

BPC 157, known as the "Body Protection Compound", is a pentadecapeptide isolated from human gastric juice that demonstrated its pleiotropic beneficial effects in various preclinical models mimicking medical conditions, such as tissue injury, inflammatory bowel disease, or even CNS disorders. Unlike many other drugs, BPC 157 has a desirable safety profile, since only a few side effects have been reported following its administration. Nevertheless, this compound was temporarily banned by the World Anti-Doping Agency (WADA) in 2022 (it is not currently listed as banned by the WADA). However, it has not been approved for use in standard medicine by the FDA and other global regulatory authorities due to the absence of sufficient and comprehensive clinical studies confirming its health benefits in humans. In this review, we summarize information on the biological activities of BPC 157, with particular reference to its mechanism of action and probable toxicity. This generated the attention of experts, as BPC 157 has been offered for sale on many websites. We also present recent interest in BPC 157 as reflected in a number of patent applications and granted patents.

Decoding the Ability of Helicobacter pylori to Evade Immune Recognition and Cause Disease

Helicobacter pylori (H pylori) successfully and chronically colonizes the gastric mucosa of approximately 43% of the world's population. Infection with this organism is the strongest known risk factor for the development of gastric cancer, and disease development is dependent on several interactive components. One H pylori determinant that augments cancer risk is the strain-specific cag type IV secretion system, which not only translocates a pro-inflammatory and oncogenic protein, CagA, into host cells but also DNA, peptidoglycan, and a lipopolysaccharide intermediate, heptose-1,7-bisphosphate. However, cognate interactions between certain microbial and host constituents can also attenuate pro-inflammatory responses, and H pylori harbors multiple effectors that function differently than the respective counterparts in other mucosal pathogens. In this review, we discuss current data related to mechanisms utilized by H pylori to evade the immune response, sustain its longevity in the host, and further disease progression, as well as implications for developing targeted, immune-based eradication strategies.

Effects of the Curcuminoid and Non-Curcuminoid Compounds of Turmeric on the Gut Microbiome and Inflammation: Potential Use in the Treatment and Prevention of Disease

The gut microbiome is a complex system that directly interacts with and influences many systems in the body. This delicate balance of microbiota plays an important role in health and disease and is highly influenced by lifestyle factors and the surrounding environment. As further research emerges, understanding the full potential of the gut microbiome and the impact of using nutraceuticals to positively influence its function may open the door to greater therapeutic outcomes in the treatment and prevention of disease. Curcumin, a bioactive compound derived from the turmeric rhizome, has been studied in depth for its influence on human health as a potent anti-inflammatory and antioxidant properties. However, the therapeutic activity of curcumin is limited by its low oral bioavailability. While most available research has primarily focused on the curcuminoid compounds of turmeric, the non-curcuminoid compounds hold promise to offer therapeutic benefits while synergistically enhancing the bioavailability of curcumin and supporting the gut microbiome. This review summarizes current knowledge of the relationship between the gut and the various systems within the body, and how dysbiosis, or disruption in the gut microbial balance, leads to inflammation and increased risk of chronic disease. The review also summarizes recent research that focuses on the bioactivity of both the curcuminoid and non-curcuminoid compounds that comprise the whole turmeric root and their synergistic role in enhancing bioavailability to support a healthy gut microbiome and promising use in the treatment and prevention of disease.

An Update on Animal Models of Alcohol-Associated Liver Disease

Alcohol-associated liver disease (ALD) is a significant global health concern and a leading cause of liver disease-related deaths. However, the treatment options are limited due to the lack of animal models that accurately replicate ALD pathogenesis. An ideal ALD animal model should have pathological characteristics similar to those of human ALD, with a clear pathological process and ease of drug intervention. Over the years, researchers have focused on developing ideal ALD preclinical animal models by testing various methods, such as ad libitum drinking water with ethanol, acute, single large doses of ethanol gavage, multiple alcohol gavages in a short period, the Lieber-DeCarli liquid diet feeding model, the intragastric infusion model, and the Gao-binge model. With the increasing occurrence of obesity and metabolic dysfunction-associated steatotic liver disease, a new category of metabolic and alcohol-associated liver disease (MetALD) is also emerging. Studies have investigated the combined effects of a high-fat diet combined with binge alcohol or drinking water containing ethanol to mimic MetALD. In addition to mice, other species such as rats, guinea pigs, zebrafish, and non-human primates have also been tested to establish ALD preclinical models. This review aims to summarize current animal ALD models, particularly the emerging MetALD models, with the hope of providing a valuable reference for establishing more effective animal models in ALD studies in the future.

Early identification and multidisciplinary management of immune checkpoint inhibitors associated colitis can improve patient outcomes

Currently, the use of immune checkpoint inhibitors (ICIs) has shown notable clinical efficacy in treating various malignant tumors, significantly improving patient prognosis. However, while ICIs enhance the body's anti-tumor effects, they can also trigger immune-related adverse events (irAEs), with ICI-associated colitis being one of the more prevalent forms. This condition can disrupt treatment, necessitate drug discontinuation, and adversely affect therapeutic outcomes. In severe cases, irAEs may even become life-threatening. A recent case report by Hong et al highlights the importance of vigilance for ICI-associated colitis in patients experiencing symptoms such as diarrhea and abdominal pain, which can arise both during and even after completion of ICI treatment. Early identification, multidisciplinary management, and continuous monitoring of patients are essential steps to further improve outcomes.

Endoscopic submucosal dissection in the treatment of adult cystic lymphangioma: A case report

BACKGROUND

Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract. In the early stage, most patients are asymptomatic; after the onset of symptoms, there is often no specificity regarding symptoms.

CASE SUMMARY

Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon. One patient who came to our hospital with "dull pain in the left lower abdomen for 2 days" was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection. The final pathological results suggested cystic lymphangioma. One year later, no recurrence was found on re-examination via colonoscopy.

CONCLUSION

Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed. Endoscopy, imaging, histology, and immunohistochemical staining are useful for diagnosis. Surgical resection is the preferred treatment.

Management of Anal Fistula with Crohn's Disease

Crohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacerbated by perianal abscesses and/or fistulas. Perianal fistulizing CD (PFCD) has an unknown etiology and recurring symptoms such as pain and discharge, which seriously affects the patient's quality of life (QOL). In the past, radical surgery was performed for PFCD, but due to the risk of anal sphincter impairment, conservative therapy using antibiotics and immunosuppressive medications is currently the first treatment option. PFCD management has greatly improved with the use of biologics such as the antitumor necrosis factor alpha (TNF-α) antibodies infliximab and adalimumab. In this review, the results of the administration of anti-TNF-α (certolizumab pegol), anti-interleukin-12/23 (ustekinumab), and anti-α4β7 integrin antibodies (vedolizumab) were evaluated. Our investigation showed that these medications may be effective for maintenance therapy to prevent the recurrence of anal fistulas. In addition to biologics, molecular target drugs and even regenerative medicine using mesenchymal stem cells have been introduced to further expand the treatment options for consideration by medical personnel. We herein discuss the management of PFCD by focusing on studies conducted in the United States and Europe where researchers used recommended guidelines and consensus statements to evaluate the efficacy of each medication and published their findings in peer-reviewed journals.

Celiac Disease: Beyond Diet and Food Awareness

Celiac disease is attributable to a combination of genetic predisposition and exposure to dietary gluten, with immune system involvement. The incidence is increasing globally, and the societal economic burden of celiac disease stretches beyond the cost of gluten-free food. This enteropathy that affects the small intestine has been related to different disorders and comorbidities. Thus, the implications of suffering from this disease are multidimensional and need further consideration. Celiac disease is a serious condition that remains under-recognized, resulting in an increased need for programs for better management. This review aims to summarize the current evidence regarding celiac diseases, with special emphasis on clinical implications, diagnosis, dietary management, socioeconomical aspects, and future perspectives.

Diagnosis and Management of Acute Pancreatitis

Acute pancreatitis is an inflammatory condition of the exocrine pancreas that is a common indication for hospital admission and has had an increasing incidence in the last few decades. The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria: (1) abdominal pain radiating to the back, (2) serum lipase or amylase levels three or more times the upper limit of the normal level, and (3) findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI). The different etiologies include gallstones, autoimmune disorders, alcohol abuse, smoking, hypertriglyceridemia, obesity, drugs, and post-endoscope retrograde cholangiopancreatography (ERCP). The initial investigation includes serum amylase and lipase analysis, a lipid panel including triglycerides, analysis of immunoglobulins, a full blood count, electrolyte analysis, a hemoglobin A1c test, a complete metabolic panel, and transabdominal ultrasound. The initial therapy includes oxygen supplementation, the provision of intravenous fluids, pain control, and a nutrition regime. Early oral feeding is encouraged if tolerated; if not, liquid supplement provision or enteral tube feeding within 48 h of admission has shown better outcomes. Some complications of acute pancreatitis are necrosis, infection, insulin resistance leading to diabetes mellitus, and pancreatic exocrine insufficiency requiring enzyme supplementation. Patients need to attend regular follow-ups and abstain from alcohol and smoking (if warranted) to prevent the recurrence of acute pancreatitis. The mortality rate of acute pancreatitis has decreased in the past few decades because of better management skills, but the recent rise in acute pancreatitis episodes is concerning. Sustained endeavors through clinical trials are required to establish a broad variety of drugs that can be used for acute pancreatitis episodes.

Dietary content and eating behavior in ulcerative colitis: a narrative review and future perspective

Ulcerative colitis (UC) has experienced a steady increase in global incidence and prevalence recently. Current research into UC pathogenesis focuses on the complex interplay of genetic and environmental factors with the immune system and gut microbiome, leading to disruption of the intestinal barrier. Normally, the microbiome, intestinal epithelium, and immune system interact to maintain intestinal homeostasis. However, when this equilibrium is disturbed, a harmful cycle of dysbiosis, immune dysregulation, and inflammation emerges, resulting in intestinal barrier dysfunction and UC progression. Among various risk factors, diet significantly influences epithelial barrier integrity and architectural stability through both direct and indirect mechanisms, shaping the entire UC continuum from pre-clinical prevention to active phase treatment and remission maintenance. This review provides insights into the impact of dietary content and eating behaviors on UC, focusing on specific food, food groups, nutrients, and intermittent fasting, while providing a detailed explanation of why the gut microbiota may mediate the sustained effects of diet across all stages of UC. Additionally, it addresses the limitations of current studies, explores underexamined areas in UC dietary research and proposes potential directions for future research and expansion.

Acute Pancreatitis: An Unusual Side Effect of Adalimumab in Crohn's Disease Patient

Background

Drug-induced acute pancreatitis is a rare condition occurs at an incidence rate of 0.1-1.4% and represents a diagnostic challenge. TNFα inhibitors specially adalimumab is very rarely reported in the literature, primarily through case reports, as a potential cause of acute pancreatitis.

Case presentation

Our case report presents a case of a 23-year-old patient followed for Crohn disease in whom a diagnosis of acute pancreatitis induced by adalimumab was made. This diagnosis was confirmed after the elimination of other possible etiologies, and notably by the recurrence of pancreatitis after Adalimumab rechallenge. The occurrence of acute pancreatitis induced by TNFα inhibitors exposes to the risk of pancreatitis with other drugs in this class, hence the need to switch to another therapeutic class, which was Ustekinumab in our case.

Conclusion

Acute pancreatitis is an unusual complication of treatment with Adalimumab. Through our experience, based on solid scientific data, we want to draw the attention of clinicians to the reality of this complication. It should be considered in any patient on TNFα inhibitors who presents with acute pancreatitis without an obvious cause.

A case report of acute promyelocytic leukemia with myeloid sarcoma of the lumbar spine and literature review

Acute promyelocytic leukemia (APL) presenting solely as myeloid sarcoma (MS) is extremely rare. This report describes a 53-year-old male who presented with low back pain and a movement disorder in his lower limbs. MRI and PET/CT scans of the lumbar spine revealed an intraspinal mass. Pathological analysis of the surgically resected mass identified it as myeloid in origin. Routine blood tests were unremarkable, and bone marrow smears and immunophenotyping showed no evidence of abnormal myeloblasts or promyelocytes. However, bone marrow aspirates testing for acute leukemia fusion genes by qPCR revealed the presence of the PML::RARA fusion. Further investigation via FISH confirmed the fusion in both the bone marrow and the extramedullary mass. The patient was ultimately diagnosed with isolated promyelocytic extramedullary sarcoma (MS/APL). Treatment with all-trans retinoic acid and arsenic trioxide alleviated the back pain and restored the patient's mobility. After 1 year of consolidation therapy, bone marrow smears confirmed sustained remission, and the PML::RARA fusion gene was undetectable. In addition to this case, we review 41 other APL patients with extramedullary sarcoma as their first symptom (MS/APL) at the time of diagnosis and provide an analysis of these cases.

Mitigating Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD): The Role of Bioactive Phytoconstituents in Indian Culinary Spices

PURPOSE OF REVIEW

The term metabolic dysfunction-associated steatotic liver disease (MASLD) refers to a group of progressive steatotic liver conditions that include metabolic dysfunction-associated steatohepatitis (MASH), which has varying degrees of liver fibrosis and may advance to cirrhosis, and independent hepatic steatosis. MASLD has a complex underlying mechanism, with patients exhibiting diverse causes and phases of the disease. India has a pool prevalence of MASLD of 38.6% in adults. In 2023, the term NAFLD has been redefined and changed to MASLD. Currently, there are no drugs approved by the FDA for the treatment of MASLD. This study investigates the potential of bioactive phytoconstituents present in spices as a therapeutic approach for MASLD. Moreover, it offers comprehensive data on several pre-clinical studies of bioactive phytoconstituents derived from spices that primarily focus on treating obesity-associated MASLD.

RECENT FINDINGS

Spices include a high amount of bioactive chemicals and several research have indicated their diverse pharmacological activities. Bioactive phytoconstituents from common Indian spices like cinnamic acid, eugenol, curcumin, allicin, 6-gingerols, capsaicin, piperine, eucalyptol, trigonelline, and linalool have been reported to exhibit anti-MASLD effects both in-vivo and in-vitro. Bioactive phytoconstituents from different culinary species of India have shown promising potential against MASLD in pre-clinical status. Further clinical studies on a large scale would be beneficial for paving the path to the development of a new drug which is the need of time.

Curcumin in Ophthalmology: Mechanisms, Challenges, and Emerging Opportunities

Ocular diseases affecting the anterior and posterior segments of the eye are major causes of global vision impairment. Curcumin, a natural polyphenol, exhibits anti-inflammatory, antioxidant, antibacterial, and neuroprotective properties, making it a promising candidate for ocular therapy. However, its clinical use is hindered by low aqueous solubility, poor bioavailability, and rapid systemic elimination. This review comprehensively highlights advances in curcumin delivery systems aimed at overcoming these challenges. Emerging platforms, including proniosomal gels, transferosomes, and cyclodextrin complexes, have improved solubility, permeability, and ocular retention. Nanoparticle-based carriers, such as hybrid hydrogels and biodegradable nanoparticles, enable sustained release and targeted delivery, supporting treatments for posterior segment diseases like diabetic retinopathy and age-related macular degeneration. For anterior segment conditions, including keratitis and dry eye syndrome, cyclodextrin-based complexes and mucoadhesive systems enhance corneal permeability and drug retention. Mechanistically, curcumin modulates key pathways, such as NF-κB and TLR4, reducing oxidative stress, angiogenesis, and apoptosis. Emerging strategies like photodynamic therapy and neuroprotective approaches broaden their application to eyelid conditions and neuroinflammatory ocular diseases. These advancements address curcumin's pharmacokinetic limitations, supporting its clinical translation into ophthalmic therapies. This work underscores curcumin's potential in ocular disease management and advocates clinical trials to validate its safety, efficacy, and therapeutic relevance.

Traditional Chinese medicine in the treatment of Helicobacter pylori-related gastritis: The mechanisms of signalling pathway regulations

Helicobacter pylori-associated gastritis (HPAG) is a common condition of the gastrointestinal tract. However, extensive and long-term antibiotic use has resulted in numerous adverse effects, including increased resistance, gastrointestinal dysfunction, and increased recurrence rates. When these concerns develop, traditional Chinese medicine (TCM) may have advantages. TCM is based on the concept of completeness and aims to eliminate pathogens and strengthen the body. It has the potential to prevent this condition while also boosting the rate of Helicobacter pylori eradication. This review elaborates on the mechanism of TCM treatment for HPAG based on cellular signalling pathways, which reflects the flexibility of TCM in treating diseases and the advantages of multi-level, multi-pathway, and multi-target treatments for HPAG.

Evaluation of variations in predominant gut microbiota members in inflammatory bowel disease using real-time PCR

Inflammatory Bowel Disease (IBD) is a persistent ailment that impacts many individuals worldwide. The interaction between the immune system and gut microbiome is thought to influence IBD development. This study aimed to assess some microbiota in IBD patients compared to healthy individuals. The investigation involved a selected group of twenty patients suffering from IBD and an equal number of healthy participants. Stool specimens were obtained and analyzed for Lactobacillus, Bifidobacterium, Bacteroides, Clostridium leptum, Akkermansia muciniphila, Fusobacterium and Enterobacteriaceae using real-time PCR. The findings indicated significantly higher levels of Bifidobacterium in IBD patients (Pv = 0.009) and lower levels of A. muciniphila (Pv = 0.003) healthy individuals. Other bacteria tested did not show significant differences. The study suggests that the progression of IBD patients could be influenced by the rising of Bifidobacterium and the declining of A. muciniphila. Targeting these bacteria could lead to improved treatments and quality of life for those with IBD.

The relationship between work-life balance and psychological well-being: an empirical study of metro rail travelers working in the information technology sector

Objectives

To investigate the relationship between work-life balance and the psychological well-being of metro rail travelers working in the information technology sector. The study also examined occupational stress as a pathway between work-life balance and psychological well-being. The study also investigated the impact of occupational stress and work-life balance on the psychological well-being of metro travelers who work in the information technology sector, modeling lower- and higher-order constructs.

Methods

A quantitative survey method was used, and the data were gathered from information technology employees who frequently travel on Metro Rail to commute to the office and return home when the COVID-19 pandemic peaked in India in 2022. A structured questionnaire was developed, and a link was provided to the IT sector employees visiting almost all the metro stations in Hyderabad, an Indian Metro, to measure 8 reflective constructs. The data were gathered via random sampling, and the questionnaires were randomly distributed to the different IT sector companies. The valid responses of 500 participants were analyzed for structural equation modeling. The eight reflective constructs in the study are occupational stress, the 3 constructs of work-life balance-"work interference with personal life, personal life interference with work and work-personal life enhancement"-and the four constructs of psychological well-being autonomy, self-acceptance, positive relations, and environmental mastery.

Results

The SEM results for the lower-order constructs indicate that the impact of occupational stress on psychological well-being was statistically significant (p < 0.005), as were the two constructs of psychological well-being, environmental mastery, and self-acceptance (p < 0.001; p < 0.05). With respect to the impact of the work-life balance constructs, the impacts of the WIPL, WPLE, and PLIW work-life balance constructs were statistically significant (p < 0.05; p < 0.001, respectively) for all four psychological well-being constructs. Occupational stress partially mediated the relationship between work-life balance and psychological well-being, as both the direct and indirect effects were statistically significant when the higher-order constructs work-life balance and psychological well-being were tested. The direct effects of occupational stress and work-life balance on psychological well-being are statistically significant (p < 0.05, p < 0.001).

Conclusion

The authors suggest framing policies to mitigate occupational stress and enhance the psychological well-being and work-life balance of employees in the information technology sector.

Gluten-Free Diet and Health-Related Quality of Life: The Validated Hellenic Version of the Celiac Dietary Adherence Test

BACKGROUND/OBJECTIVES

A reliable assessment of gluten-free diet (GFD) adherence is essential for managing celiac disease (CD). This study aimed to validate the Hellenic version of the Celiac Disease Adherence Test (H-CDAT) to evaluate adherence levels and explore the impact of dietary adherence on health-related quality of life (HRQoL)-both of which have never been objectively assessed in Greek CD patients.

METHODS

The study included 102 adult CD patients who completed H-CDAT, diet-related questions, and the 36-Item Short Form Health Survey (SF-36).

RESULTS

H-CDAT demonstrated good psychometric properties and showed multiple strong correlations with HRQoL dimensions. H-CDAT adherence was Good in 38.2%, Moderate in 42.2%, and Poor in 19.6% of patients, despite their perception of effective adherence, with 51% never having visited a dietitian for guidance on a GFD. Patients scored significantly lower across most HRQoL dimensions compared to the general Greek population. When stratified into the three adherence categories, striking differences emerged between Good and Moderate adherence across both physical and mental health domains, highlighting that moderate adherence is not sufficient for optimal health outcomes.

CONCLUSIONS

These findings emphasize the critical role of strict GFD adherence in improving overall health and underscore the importance of dietetic intervention for achieving optimal patient outcomes.

New Progress in the Study of Pathogenesis of Alcoholic Pancreatitis

BACKGROUND

Alcoholic pancreatitis is a progressive condition characterized by susceptibility to recurrence, progression to chronic pancreatitis, complications, and high morbidity.

SUMMARY

The main causes include long-term alcoholism, excessive drinking, the toxic effects of alcohol metabolites, interactions with biliary diseases, and genetic factors. Alcohol is the second leading cause of acute pancreatitis (AP) in the USA, accounting for one-third of all AP cases. A follow-up study on readmission revealed that the readmission rate of alcoholic acute pancreatitis (AAP) patients within 11 months was 43.1%, of which men dominated the admissions and readmissions of AAP. Among this population, 82.3% have alcohol use disorder, over half have tobacco use disorders, 6.7% have tobacco use disorder, 4.5% have opioid use disorder, and 18.5% of patients exhibit signs of potential alcoholic chronic pancreatitis. Numerous animal and clinical studies suggest that alcohol alone does not cause pancreatitis; rather, additional factors such as smoking, endotoxin lipopolysaccharide (LPS), genetic mutations, or other genetic predispositions - are necessary for the disease's progression.

KEY MESSAGES

Given the high rates of admission and readmission for alcoholic pancreatitis, it is essential to further investigate its pathogenesis and pathological processes to develop more effective treatment strategies. Therefore, this paper summarizes the current understanding of the pathogenesis and treatment status of alcoholic pancreatitis, drawing on recently published literature and data to provide insights and references for future research and treatment efforts.

Gut dysbiosis is associated with difficult-to-treat rheumatoid arthritis

Background

Difficult-to-treat rheumatoid arthritis (D2T RA) refers to a subset of patients who fail to achieve adequate disease control after the use of two or more biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) with different mechanisms of action, while maintaining active inflammatory disease. This presents a therapeutic challenge and highlights the need to explore contributing factors such as the potential role of the gut microbiota. Therefore, the aim of this study was to analyze the gut microbiota and inflammation in patients with D2T RA in comparison to patients with easy-to-treat RA (E2T RA).

Objective

To analyze the gut microbiota and inflammation in patients with D2T RA.

Methods

We performed an observational study of a prospective cohort between 2007 and 2011 and analyzed the gut microbiota. In 2022, we identified 2 extreme patient phenotypes: (1) D2T RA, which was defined as failure of ≥2 biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) (with different mechanisms of action) plus signs of active disease; and (2) easy-to-treat RA (E2T RA), i.e., stable disease managed with a single treatment. The gut microbiota was analyzed using 16S rRNA gene sequencing; bioinformatics analysis was performed using QIIME2, and its functionality was inferred through PICRUSt. We recorded data on clinical findings, inflammation, and cytokines. A Cox multivariate analysis was performed to identify factors related to D2T RA.

Results

The study population comprised 39 patients: 13 (33%) with D2T RA and 26 (66%) with E2T RA. The families Lachnospiraceae and Pasteurellaceae, and their genera Coprococcus and Haemophilus were more abundant in E2T RA patients, while the genus Megasphaera was more abundant in D2T RA patients. The Firmicutes/Bacteroidetes ratio decreased in D2T RA patients. The metabolic profile of the gut microbiota was characterized by differences in Degradation/Utilization/Assimilation pathway and the Biosynthesis pathway. The factors associated with D2T RA were inflammatory activity according to DAS28-ESR (HR, 2.649; p = 0.013), prednisone (HR, 3.794; p = 0.008), and the Firmicutes/Bacteroidetes ratio (HR, 0.288; p = 0.033).

Conclusion

The composition of the gut microbiota of patients with D2T RA differed from that of E2T RA patients, as did the metabolic pathways.

Associations between brominated flame retardants exposure and non-alcoholic fatty liver disease: Mediation analysis in the NHANES

BACKGROUND

Exposure to brominated flame retardants (BFRs) may negatively impact human health. The association of BFRs with nonalcoholic fatty liver disease (NAFLD) in the general population is unclear. Meanwhile, limited studies have investigated the potential role of oxidative stress and inflammation in this link.

METHODS

We included 4110 adults from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). NAFLD was diagnosed by serum alanine aminotransferase (ALT), hepatic steatosis index (HSI), and United States fatty liver index (USFLI). The link between a single BFR exposure and NAFLD was estimated using weighted logistic regression and restricted cubic splines (RCS). The quantile-based g-computation (QGC), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were applied to evaluate the overall correlation of BFRs mixtures with NAFLD and identify significant compounds. Furthermore, we investigated the potential mediation function of oxidative stress and inflammation.

RESULTS

Our study demonstrated that specific concentrations of BFRs are related to an increased risk of NAFLD, both individually and when combined. PBB153, PBDE28, PBDE209, and PBDE153 exhibited the highest importance for NAFLD and were potential risk factors worthy of concern. Additionally, mediation analysis showed that absolute neutrophil cell count (ANC) and lymphocyte count (LC) (inflammation markers) have significantly mediated influences on the correlations of PBB153, PBDE85, and PBDE28 with N AFLD risk. Albumin (ALB) (oxidative stress marker) has notably mediated influences on the correlations of PBDE99, PBDE154, and PBDE85 with NAFLD risk. Men had higher serum BFRs concentrations than women, and the association between BFRs and NAFLD was also more prominent in men, which may be related to physiological differences between the sexes.

CONCLUSIONS

Our findings offer evidence for single and mixed associations of BFRs and NAFLD in ordinary US adults. Furthermore, oxidative stress and chronic inflammation may mediate the effects of BFR exposure on NAFLD development.

Correlation of sarcopenia with progression of liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease: a study from two cohorts in China and the United States

OBJECTIVE

The objective of this study was to investigate the association between sarcopenia and liver fibrosis in patients aged 18-59 years with metabolic dysfunction-associated steatotic liver disease (MASLD) and to assess the potential of sarcopenia as a risk factor for the progression of liver fibrosis.

METHODS

The study included 821 patients with MASLD in the US cohort and 3,405 patients with MASLD in the Chinese cohort. Liver controlled attenuation parameters (CAP) and liver stiffness measurements (LSM) were assessed by vibration-controlled transient elastography (VCTE) to evaluate the extent of hepatic steatosis and fibrosis. Sarcopenia was assessed by measuring appendicular skeletal muscle mass (ASM) and calculating ASMI. To analyze the relationship between sarcopenia, ASMI, and liver fibrosis, logistic regression models, multivariate-adjusted models, and restricted cubic spline (RCS) models were employed, with stratification and interaction analyses.

RESULTS

The results demonstrated that patients with sarcopenia exhibited a markedly elevated risk of significant liver fibrosis, advanced liver fibrosis, and cirrhosis compared to those without sarcopenia in both cohorts. After adjusting for confounding variables, sarcopenia was identified as an independent risk factor for the progression of liver fibrosis in patients with MASLD. A significant negative correlation was observed between ASMI and the severity of liver fibrosis, with a progressive reduction in the risk of liver fibrosis associated with increasing ASMI. Additionally, a non-linear feature was evident in some liver fibrosis indicators. Subgroup analysis further corroborated the finding that the harmful effect of sarcopenia on liver fibrosis was consistent across all identified subgroups.

CONCLUSION

Sarcopenia may be associated with the progression of liver fibrosis in patients with MASLD. Monitoring ASMI may assist in identifying individuals at an elevated risk of liver fibrosis in MASLD patients.

Investigating neutropenic enterocolitis: a systematic review of case reports and clinical insights

BACKGROUND

Neutropenic enterocolitis is a serious gastrointestinal complication that can develop in patients undergoing chemotherapy or other immunosuppressive treatments. It is characterized by inflammation and necrosis of the bowel, and most commonly affects the cecum and ascending colon. Although individual case reports have described the features of NE, a comprehensive synthesis of all the published cases is required.

METHODS

A systematic search of the literature databases was conducted to identify all NE case reports. Data on patient demographics, clinical presentation, diagnostic findings, treatment approaches, and outcomes were independently extracted by the five reviewers. Generalized estimating equations were used to examine the associations between variables.

RESULTS

In total, 227 cases from 159 publications met the inclusion criteria. Most cases occur in patients with hematological cancers undergoing chemotherapy. Common presentations include abdominal pain, fever, and diarrhea. Imaging typically shows a thickening of the bowel wall. Broad-spectrum antibiotics and bowel rest were the primary initial treatment. The overall mortality rate was 33.5%. While statistical analyses did not find significant associations, factors showing clinically significant increased odds for mortality included sepsis, multiorgan failure, and isolated ileocecal valve involvement, potentially representing important prognostic indicators.

CONCLUSION

This systematic review and meta-analysis provides the largest consolidated analysis of NE cases. It identifies typical clinical features and helps characterize risk factors and prognostic indicators to aid in the early diagnosis and management of this potentially lethal complication.

Case report: Looking for relationship between type 1 diabetes and chronic recurrent osteomyelitis: short literature review and case presentation

Background

Childhood autoimmune disorders involve the immune system attacking its own tissues, leading to varied symptoms, while autoinflammatory disorders result from innate immune system dysregulation, both requiring extensive diagnosis and multidisciplinary management due to their complexity.

Case presentation

We present a unique clinical case of a teenager with a combination of autoimmune and autoinflammatory disorders. The initial manifestation of hip pain, coupled with progressive symptoms over several years and findings in multiple magnetic resonance imaging (MRI) scans, culminated in the diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Subsequently, the patient was diagnosed with type 1 diabetes (T1D), celiac disease, and juvenile idiopathic arthritis.The therapeutic course proved challenging, marked by unsuccessful attempts with nonsteroidal anti-inflammatory drugs (NSAIDs), and biphosphonates. However, a stable clinical status was ultimately achieved upon the introduction of methotrexate, concomitant with insulin therapy for diabetes and the implementation of a gluten-free diet for celiac disease.

Conclusions

Our case showed that the combination of autoimmune and autoinflammatory diseases, brought not only a challenging diagnostic process, but also complicated treatment.

Chemical Composition of Mexicali Propolis and Its Effect on Gastric Repair in an Indomethacin-Induced Gastric Injury Murine Model

Propolis is a resinous substance produced by bees that has several biomedical properties that could contribute to the repair process of the gastric mucosa, such as antioxidant, anti-inflammatory, healing, and gastroprotective properties. Thus, this study aimed to determine the chemical composition of Mexicali propolis, its antioxidant capacity, and its effect on gastric repair. Three polarity-directed extracts were obtained: the ethanolic extract, the ethyl acetate extract, and the hexane extract. The antioxidant activity, total phenolic content (TPC), and flavone/flavonol content were determined for each extract. The chemical composition was analysed using HPLC-TOF-MS (High-Performance Liquid Chromatography-Time-Of-Flight Mass Spectrometry) and GC-MS (Gas Chromatography-Mass Spectrometry), and a total of 52 compounds were identified. The results revealed that the ethanolic extract had the greatest effect on free radical scavenging and the content of bioactive compounds. On the basis of these results, the effect of the Mexicali ethanolic extract of propolis (MeEEP) on gastric repair was subsequently evaluated. Prior to the evaluation, MeEEP was found to exhibit low oral toxicity, as determined under the Organisation for Economic Co-operation and Development (OECD) 425 guidelines. Gastric injury was induced in male C57BL/6 mice by intragastric administration of indomethacin (10 mg/kg). MeEEP (300 mg/kg) was administered 6 h after the induction of injury using indomethacin and daily thereafter. The mice were sacrificed at 12, 24, and 48 h to assess the effect. As a result, MeEEP enhanced the repair of the gastric lesion by decreasing the percentage of the bleeding area and attenuating the severity of histological damage, as demonstrated by H&E staining. This effect was associated with a reduction in MPO enzyme activity and in the levels of the proinflammatory cytokines TNF-α, IL-1β, and IL-6, maintaining controlled inflammation in gastric tissue. Furthermore, the administration of the extract increased SOD enzymatic activity and GSH levels, reducing the degree of oxidative damage in the gastric tissue, as demonstrated by low MDA levels. Finally, after evaluating the effect on apoptosis via immunohistochemistry, MeEEP was shown to reduce the expression of the proapoptotic marker Bax and increase the expression of the antiapoptotic marker Bcl-2. In conclusion, these findings suggest that MeEEP may enhance gastric repair through a cytoprotective mechanism by controlling inflammation exacerbation, reducing oxidative stress, and regulating apoptosis. These mechanisms are primarily attributed to the presence of pinocembrin, tectochrysin, chrysin, apigenin, naringenin, acacetin, genistein, and kaempferol. It is important to highlight that this study provides a preliminary exploration of the reparative effect of Mexican propolis, describing the potential mechanisms of action of the compounds present in Mexicali propolis.