Effect of Anti-reflux Mucosal Ablation on Esophageal Motility in Patients With Gastroesophageal Reflux Disease: A Study Based on High-resolution Impedance Manometry

Background/Aims

Anti-reflux mucosal ablation (ARMA) is a promising endoscopic intervention for proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD). However, the effect of ARMA on esophageal motility remains unclear.

Methods

Twenty patients with PPI-dependent GERD receiving ARMA were prospectively enrolled. Comprehensive self-report symptom questionnaires, endoscopy, 24-hour impedance-pH monitoring, and high-resolution impedance manometry were performed and analyzed before and 3 months after ARMA.

Results

All ARMA procedures were performed successfully. Symptom scores, including GerdQ (11.16 ± 2.67 to 9.11 ± 2.64, P = 0.026) and reflux symptom index (11.63 ± 5.62 to 6.11 ± 3.86, P = 0.001), improved significantly, while 13 patients (65%) reported discontinuation of PPI. Total acid exposure time (5.84 ± 4.63% to 2.83 ± 3.41%, P = 0.024) and number of reflux episodes (73.05 ± 19.34 to 37.55 ± 22.71, P < 0.001) decreased significantly after ARMA. Improved esophagogastric junction (EGJ) barrier function, including increased lower esophageal sphincter resting pressure (13.89 ± 10.78 mmHg to 21.68 ± 11.5 mmHg, P = 0.034), 4-second integrated relaxation pressure (5.75 ± 6.42 mmHg to 9.99 ± 5.89 mmHg, P = 0.020), and EGJ-contractile integral (16.42 ± 16.93 mmHg·cm to 31.95 ± 21.25 mmHg·cm, P = 0.016), were observed. Esophageal body contractility also increased significantly (distal contractile integral, 966.85 ± 845.84 mmHg·s·cm to 1198.8 ± 811.74 mmHg·s·cm, P = 0.023). Patients with symptom improvement had better pre-AMRA esophageal body contractility.

Conclusions

ARMA effectively improves symptoms and reflux burden, EGJ barrier function, and esophageal body contractility in patients with PPIdependent GERD during short-term evaluation. Longer follow-up to clarify the sustainability of ARMA is needed.

Improving Irritable Bowel Syndrome (IBS) Symptoms and Quality of Life with Quebracho and Chestnut Tannin-Based Supplementation: A Single-Centre, Randomised, Double-Blind, Placebo-Controlled Clinical Trial

Background/Objectives: Irritable Bowel Syndrome (IBS) is a disorder of the gut-brain axis for which the gastroenterologist is most often consulted. Gastrointestinal symptoms and decreased quality of life lead to a considerable burden of disease. The exact causes of IBS are not well understood, and no standard therapy has been established. The primary outcome of the study focused on the improvements of the IBS symptoms assessed through the validated questionnaire IBS-Severity Scoring System (IBS-SSS). Similarly, secondary outcomes geared towards the improvement of the quality of life (IBS-Quality of Life (IBS-QoL) and the Gastrointestinal Quality of Life Index (GIQLI)) and specific IBS symptoms (bloating, abdominal distension, feeling of heaviness, abdominal pain, and flatulence), were assessed through self-administered questionnaires. Intestinal habits (consistency and frequency of depositions) through subject stratification into diarrhoea (IBS-D), constipation (IBS-C), mixed type (IBS-M), as well as the treatment tolerability were also evaluated. Methods: A randomised, placebo-controlled, double-blind, clinical trial was conducted on 156 enrolled IBS patients (79 female and 77 male), aged 18-70 years, randomised (1:1 allocation ratio) to receive either two capsules per day of the food supplement (containing 480 mg of a complex of tannin extracts) or a placebo for 56 days. Linear random intercept mixed models (LMM) were used to analyse all experimental variables Results: Supplementation resulted in a significant improvement (p < 0.05) in the primary outcome IBSS score, with respect to the placebo group, changing the IBS condition going from mild (242.3 ± 89.8) to moderate (148.1 ± 60.6). Similarly, all indicators concerning quality of life, and specific intestinal symptoms resulted in a significant improvement (p < 0.05). Furthermore, the tannin-based treatment showed the ability to modulate the response to different symptomatology such as diarrhoea and constipation, without side effects being reported. Conclusions: The use of a supplement based on chestnut and quebracho tannins presents great application potential in the management of IBS-related disorders, with the peculiarity of resolving opposite symptoms, such as diarrhoea and constipation, indiscriminately.

Protective effects and mechanisms of HuDiChangRong capsule on TNBS-induced ulcerative colitis in mice

ETHNOPHARMACOLOGICAL RELEVANCE

UC, characterized by chronic inflammation primarily affecting the colon and rectum, follows a protracted relapsing course marked by inflammation and an abundance of free radicals at the onset. Hudichangrong Capsule (HDCRC), a traditional Chinese medicinal formula, has long been employed in the treatment of UC and chronic bacillary dysentery, exhibiting positive therapeutic outcomes and a high rate of cure in clinical practice.

AIM OF THE STUDY

The precise mechanism underlying its efficacy for UC remains elusive. Our objective was to investigate the anti-inflammatory effect and underlying mechanisms of HDCRC on TNBS-induced UC.

MATERIALS AND METHODS

Here, we introduced HDCRC and induced UC using TNBS. SPF BALB/c mice were divided into 6 groups as follows: control group, colitis model group, colitis treated with sulfasalazine (400 mg/kg) group, and colitis treated with HDCRC (156, 312, and 624 mg/kg) groups. To assess the effects of HDCRC on colitis, we measured body weight loss, disease activity index (DAI), colon length, tissue damage, degree of inflammation, immune capacity, and oxidative stress. Additionally, we evaluated the TLR-4/MyD88 pathway and its downstream signaling using immunohistochemistry, real-time qPCR, and Western blot. Network pharmacology was used for main target prediction. 16s rRNA was employed for gut microbiota detechtion and UPLC-QTOF-MS was used for its and its metabonomics.

RESULTS

HDCRC significantly slowed weight loss, ameliorated DAI, restored colon length, alleviated TNBS-induced tissue damage. It exerted the therapeutic effects via reducing oxidative stress, restoring immune balance, normalizing the inflammatory mediator levels and restoring intestinal barrier integrity. Furthermore, HDCRC mainly alleviate UC via suppressing the TLR-4/MyD88 pathway and its downstream signaling. The key components of the downstream pathway, including TLR-4, MyD88, NF-κB p65, ERK, p-JNK, p38, p-JAK1, JAK1, p-STAT3, and STAT3, were improved, thereby ameliorating the TNBS-induced injury. In addition, HDCRC could regulate gut microbiota (eg. Erysipelaloclostridium,etc.) and its metabonomics (eg. Vitamin B6 metabolism) in UC mice.

CONCLUSIONS

In conclusion, HDCRC exerts a protective effect against TNBS-induced UC in mice by inhibiting the TLR-4/MyD88 pathway and its downstream signaling, and partially JAK1/STAT3, suppressing oxidative stress, regulating immunity, restoring intestinal barrier integrity, and regulating gut microbiota and its metabonomics.

MELD-Lactate as a predictor of in-hospital mortality in patients with variceal gastrointestinal bleeding

INTRODUCTION

Variceal upper gastrointestinal bleeding is a common cause of decompensation in patients with liver cirrhosis. While mortality data, which are from 10 to 15%, are available, there are no validated scales to predict in-hospital mortality in this patient population.

OBJECTIVE

To determine whether the MELD-Lactate (MELD-LA) level is associated with in-hospital mortality in patients with chronic liver disease who are admitted for variceal bleeding.

MATERIAL AND METHODS

A prospective, observational, and analytical study was conducted that included 120 patients. The MELD-LA cut-off point was obtained, and in-hospital mortality was obtained using conventional prognostic scales that had the highest sensitivity and specificity for comparison purposes. Additionally, a survival analysis was performed using the MELD-LA cut-off point obtained.

RESULTS

In our cohort, 6 (5.0%) patients died during hospitalization. Patients who died had a mean MELD-LA value of 20.0 (±4.97) as opposed to those who did not die, 13.62 (±3.29), (p<0.001). The MELD-LA cut-off point of >14.0, with a sensitivity of 100%, a specificity of 71.0%, a positive predictive value of 15.4%, a negative predictive value of 100.0%, and an AUC (area under the curve) of 0.886, was most well correlated with higher in-hospital mortality. Survival was 71.1% in patients with MELD-LA levels>14.0 versus 100.0% in those with lower levels (p=0.001) during hospitalization.

CONCLUSION

The measurement of MELD-LA at admission seems to be a good complementary marker for the evaluation and prognosis of in-hospital mortality in patients with liver cirrhosis, and variceal upper gastrointestinal bleeding.

Advances in the Regulation of Inflammatory Mediators in Nitric Oxide Synthase: Implications for Disease Modulation and Therapeutic Approaches

Nitric oxide synthases (NOS) are crucial enzymes responsible for the production of nitric oxide (NO), a signaling molecule with essential roles in vascular regulation, immune defense, and neurotransmission. The three NOS isoforms, endothelial NOS (eNOS), neuronal NOS (nNOS), and inducible NOS (iNOS), are tightly regulated by inflammatory mediators and cellular signaling pathways. While physiological NO production is vital for maintaining homeostasis, dysregulated NOS activity contributes to the pathogenesis of numerous diseases, including cardiovascular disorders, neurodegenerative conditions, and cancer. Recent advances in understanding the molecular mechanisms of NOS regulation have unveiled novel therapeutic opportunities, including isoform-specific modulators, upstream pathways, and nanotechnology-enhanced delivery systems. This review highlights these advancements, offering insights into how targeting NOS and its regulatory network can enable precise and effective therapeutic strategies for managing inflammation-driven pathologies.

Unraveling the priming phase of NLRP3 inflammasome activation: Molecular insights and clinical relevance

The NLRP3 inflammasome plays a pivotal role in the innate immune response. Its activation involves a two-step mechanism that consists of priming and activation. The priming of the NLRP3 inflammasome is a vital initial phase necessary for its activation and subsequent involvement in the immune response, though its understanding varies across studies. Recent research has identified key proteins that influence the priming process, revealing a sophisticated regulatory network. This review provides a comprehensive review of the priming phase of NLRP3 inflammasome activation, with a particular focus on the underlying molecular mechanisms, including transcriptional regulation, orchestration of the phosphorylation status, deubiquitination and the relationships with the inflammation-associated diseases. Understanding the intricacies of NLRP3 inflammasome priming not only elucidates fundamental aspects of immune regulation, but also provides potential avenues for therapeutic intervention in inflammatory diseases.

Microwave ablation for liver metastases from colorectal cancer: A comprehensive review of clinical efficacy and safety

Microwave ablation (MWA) is emerging as a highly effective treatment for colorectal liver metastases (CRLMs). This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablation and cryoablation and highlights its clinical efficacy, safety, and technical considerations. MWA offers significant benefits, including higher intratumoral temperatures, larger ablation zones, and reduced susceptibility to the heat-sink effect, which make it particularly suitable for tumors near large blood vessels. This review details the patient selection criteria, procedural approaches, and the use of advanced imaging techniques to improve the precision and effectiveness of MWA. Clinical outcomes indicate that MWA achieves high rates of complete tumor ablation and long-term survival with a favorable safety profile. This review is significant because it provides updated insights into the expanding role of MWA in treating unresectable CRLM and its potential as an alternative to surgical resection for resectable tumors. By summarizing recent studies and clinical trials, this review highlights the comparative effectiveness, safety, and integration with systemic therapies of MWA. In conclusion, MWA is a promising treatment option for CRLM and offers outcomes comparable to or better than those of other ablative techniques. Future research should focus on optimizing technical parameters, integrating MWA with systemic therapies, and conducting large-scale randomized controlled trials to establish standardized treatment protocols. Advancing our understanding of MWA will enhance its application and improve long-term survival and quality of life for patients with CRLM.

Commonly prescribed medications and risk of pneumonia and all-cause mortality in people with idiopathic pulmonary fibrosis: a UK population-based cohort study

BACKGROUND

A growing body of evidence suggests that prolonged use of inhaled corticosteroids (ICS) and proton pump inhibitors (PPIs) is associated with increased risks of pneumonia. A substantial proportion of people with idiopathic pulmonary fibrosis (IPF) are prescribed PPIs or ICS to treat common comorbidities, giving rise to concerns that use of these medications may be associated with potential harms in this patient population.

METHODS

We used UK Clinical Practice Research Datalink (CPRD) Aurum primary care data linked to national mortality and hospital admissions data to create a cohort of people diagnosed with IPF on or after 1 January 2010. Patients were assigned to one of three exposure categories according to their prescribing history in the 12 months prior to IPF diagnosis as follows: "regular" users (≥ 4 prescriptions), "irregular" users (1-3 prescriptions) and "non-users" (no prescriptions). We explored the association between PPI/ICS prescription and pneumonia hospitalisation and all-cause mortality using multinomial Cox regression models.

RESULTS

A total of 17,105 people met our study inclusion criteria; 62.6% were male and 15.9% were current smokers. Median age at IPF diagnosis was 76.7 years (IQR: 69.6-82.7). 19.9% were regularly prescribed PPIs, and 16.0% ICS, prior to IPF diagnosis. Regular prescribing of PPIs and ICS was positively associated with hospitalisation for pneumonia; the adjusted HR for pneumonia hospitalisation comparing regular PPI users with non-users was 1.14 (95%CI: 1.04-1.24); for regular ICS users the corresponding HR was 1.40 (95%CI: 1.25-1.55). We also observed a small increased risk for all-cause mortality in the "regular ICS user" group compared with the "non-user" control group (HRadj = 1.19, 1.06-1.33). We found no evidence of an association between PPI prescribing and all-cause mortality.

CONCLUSION

Prolonged prescription of medications used to treat common comorbidities in IPF may be associated with increased risks for severe respiratory infections. These findings point to a need to adopt an adequate risk-benefit balance approach to the prescribing of ICS-containing inhalers and PPIs in people with IPF without evidence of comorbidities, especially older patients and/or those with more advanced disease in whom respiratory infections are more likely to result in poorer outcomes.

Relationship between Abnormal Lipid Metabolism and Gallstone Formation

Cholelithiasis is a common biliary system disease with a high incidence worldwide. Abnormal lipid metabolism has been shown to play a key role in the mechanism of gallstones. Therefore, recent research literature on the genes, proteins, and molecular substances involved in lipid metabolism during the pathogenesis of gallstones has been conducted. This study aimed to determine the role of lipid metabolism in the pathogenesis of gallstones and provide insights for future studies using previous research in genomics, metabolomics, transcriptomics, and other fields.

Review of Challenges in Performing Real-World Evidence Studies for Nonprescription Products

In recent years, regulatory authorities have signaled a willingness to consider real-world evidence (RWE) data to support applications for new claims and indications for pharmaceuticals. Historically, RWE studies have been the domain of prescription drugs, driven by the fact that clinical data on patients are routinely captured in medical records, claims databases, registries, etc. However, RWE reports of nonprescription drugs and supplements are relatively sparse due to methodological gaps in this area. The objective of this narrative review is to identify which RWE methodologies have been used to study nonprescription products. A total of 49 articles were included based on literature searches. Label comprehension studies, used to support prescription-to-nonprescription switches, are useful in determining how nonprescription products will be used; however, they provide no actual clinical data. The most common RWE studies of nonprescription products were cross-sectional surveys, which investigated a broad range of indications and were conducted in an array of settings, including online, by phone, point-of-sale (pharmacy), outpatient clinics, and shopping malls. However, while this type of study is effective for identifying use patterns and attitudes in the general population, recall bias limits the ability to collect safety and effectiveness data. Studies of electronic medical records and claims databases are hampered by incomplete or absent capturing of data on nonprescription products. As a result, most RWE studies to date have provided limited useful information. Although case reports and expert opinion should not be discounted, in the absence of other information they provide few actual data. Novel approaches using smartphone apps and artificial intelligence may provide new opportunities to collect RWE for nonprescription products, but these areas of research are in their infancy. Overall, there is a need to develop standards for execution of RWE studies of nonprescription products in terms of endpoints, study design, and study quality.

Anti-oxidation enhancement, inflammation alleviation, and microbial composition optimization of using tussah (Antheraea pernyi) silk fibroin peptides for hyperglycaemia remission

OBJECTIVE

This study aimed to evaluate the positive effects on anti-oxidation, anti-inflammation, and microbial composition optimization of diabetic mice using tussah (Antheraea pernyi) silk fibroin peptides (TSFP), providing the theoretical foundation for making the use of silk resources of A. pernyi and incorporating as a supplement into the hypoglycemic foods.

METHOD

The animal model of diabetes was established successfully. Alloxan-induced diabetic mice were orally administered using TSFP, and the hypoglycaemic effects in vivo were systematically investigated.

RESULTS

The results indicated that TSFP could significantly reduce the fasting blood glucose (FBG) levels and suppress the mRNA expression of glycometabolism genes of diabetic mice. In addition, the TSFP could ameliorate the lipid dysbolism and contribute to a higher anti-oxidation capacity. Moreover, TSFP could alleviate pathological damages and hinder inflammatory processes of diabetic mice. Besides, the supplementation of TSFP presented a greater ability to shape and optimize the gut microbial composition by enriching the profitable bacteria and inhibiting the pathogenic microorganisms. Correlation analysis also revealed that the abundances of functional bacteria in the TSFP-treated groups exhibited better correlations with serum parameters, which would be of positive significance for blood glucose regulation and inflammation remission.

CONCLUSIONS

These results collectively corroborated the feasibility and superiority of using TSFP for hyperglycaemia remission via anti-oxidation enhancement, inflammation alleviation, and microbial composition optimization, contributing to a safely feasible and biologically efficient strategy for improving anti-diabetic effects.

Research Progress of Bioactive Peptides in Improving Type II Diabetes

Type II diabetes mellitus (T2DM) is a prevalent, long-standing metabolic condition marked by the body's reduced response to insulin and inadequate insulin production, impacting a significant portion of the global population. Research has demonstrated that bioactive peptides play a crucial role in reducing blood sugar levels, enhancing insulin sensitivity, balancing lipid metabolism, and combating inflammation. These peptides also contribute to the enhancement of pancreatic islet function, lowering systemic inflammation by influencing various molecular signaling pathways. This paper provides an overview of recent advancements and potential applications of bioactive peptides in addressing T2DM. It highlights the diverse impacts of bioactive peptides sourced from different origins in combating diabetes. This comprehensive review offers theoretical substantiation and novel insights to support the future clinical utilization and exploration of bioactive peptides for T2DM management.

The Dynamic Evolution of Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory condition of the esophagus characterized by eosinophilic infiltration, and hallmark symptoms of esophageal dysfunction such as dysphagia and food impaction. Over the past three decades, EoE has been recognized as a distinct clinical entity, distinguished from gastroesophageal reflux disease (GERD) through advancements in diagnostic techniques, particularly endoscopy with biopsy. The rising global prevalence of EoE reflects enhanced diagnostic awareness, evolving criteria, and environmental along with lifestyle changes. The etiology of EoE is multifactorial, involving genetic predispositions, immune dysregulation, the gut microbiome, and environmental triggers, including dietary allergens and aeroallergens. Key mechanisms include a type 2 helper T-cell (Th2)-driven immune response, epithelial barrier dysfunction, and genetic variants such as CAPN14 and TSLP. Chronic inflammation leads to tissue remodeling, fibrosis, and esophageal narrowing, contributing to disease progression and complications. Management strategies have evolved to include dietary elimination, proton pump inhibitors, topical corticosteroids, biologics, and endoscopic interventions for fibrostenotic complications. Emerging therapies targeting cytokines such as interleukin (IL)-4, IL-5, and IL-13, alongside novel diagnostic tools like the esophageal string test and Cytosponge, offer promising avenues for improved disease control and non-invasive monitoring. Long-term surveillance combining endoscopic and histological evaluations with biomarkers and non-invasive tools is critical to optimizing outcomes and preventing complications. Future research should address gaps in understanding the role of the esophageal microbiome, refine therapeutic approaches, and develop personalized strategies to improve disease management and patient quality of life.

Investigating the potential immunomodulatory effects of commercial oral probiotic supplements on equine gastrointestinal tract barrier function

Background

Oral probiotic dietary supplements are widely used in veterinary medicine, including in horses. It is hypothesized that the presence of probiotic strains can both modulate the intestinal microbiota and affect mucosal immunity parameters. Such a study has not yet been conducted in horses.

Methods

This study involved 12 healthy horses, which were randomly divided into a control group and a group that received a commercial oral probiotic formula containing Lactobacillus rhamnosus, Pedioccus acidilactici or Enterococcus faecium for 84 days. Fecal samples were collected from all horses on day 0 (D0), 28 days after starting the probiotic (D28), 56 days (D56), 84 days (D84) and 28 days after stopping the probiotic (DX) treatment. The samples were subjected to microbiome analysis via next-generation sequencing of hypervariable regions V3-V4 and V7-V9 of the 16S rRNA gene for analysis of short-chain fatty acids via HPLC analysis and fecal secretory immunoglobulin A (SIgA) quantification via ELISA.

Results

Microbiome analysis revealed no significant differences in either alpha or beta diversity parameters between the groups. No probiotic strains were detected in the samples. Significant changes were detected in three taxa: the family Bacteroidales RF16 group, the genus Erysipelotrichaceae UCG-004, and the genus Fibrobacter during the study in both groups. In all the cases, there was a gradual decrease in relative abundance over time. The concentrations of SCFAs, specifically acetic and propionic acids, significantly increased over time in both groups according to the generalized linear mixed effects (GLME) model. There were no significant differences in fecal SIgA secretion.

Conclusion

The present study revealed no effect of the use of a commercial probiotic dietary supplement on either mucosal immunity or the composition of the intestinal microbiota.

Outlet type constipation in adult patients treated with type A botulinum toxin: a cohort study

PURPOSE

Chronic constipation is a common symptom. Constipation due to pelvic floor disorders remain a therapeutic challenge. Biofeedback therapy is considered as the first-choice treatment for pelvic floor disorders, whenever dedicated expertise is available. Type A botulinum toxin has been used to selectively weaken the external anal sphincter and puborectalis muscle in constipated patients.

METHOD

Eighty-two patients with chronic outlet obstruction constipation were treated with 100 units type A botulinum toxin, injected into the puborectalis muscle and the external anal sphincter.

RESULTS

At the 2-month evaluation, a symptomatic improvement was noted in 69 patients. Seven (8.5%) patients had mild flatus incontinence. Stool frequency per week increased from 2.4 ± 0.9 to 5.1 ± 1.0 (P = 0.0001). Anorectal manometry demonstrated decreased tone during straining from 91 ± 28 mmHg to 61 ± 27 mmHg (P = 0.0001). Defecography after the treatment showed improvement in anorectal angle during straining, which increased from 96 ± 12° to 124 ± 14° (P = 0.0001).

CONCLUSION

Type A botulinum toxin relaxes the puborectalis muscle. Pressure values decline after the treatment. Transrectal ultrasonography to guide injections is a safe procedure. Repeated injections were needed to maintain the clinical improvement.

Digestive cancers: mechanisms, therapeutics and management

Cancers of the digestive system are major contributors to global cancer-associated morbidity and mortality, accounting for 35% of annual cases of cancer deaths. The etiologies, molecular features, and therapeutic management of these cancer entities are highly heterogeneous and complex. Over the last decade, genomic and functional studies have provided unprecedented insights into the biology of digestive cancers, identifying genetic drivers of tumor progression and key interaction points of tumor cells with the immune system. This knowledge is continuously translated into novel treatment concepts and targets, which are dynamically reshaping the therapeutic landscape of these tumors. In this review, we provide a concise overview of the etiology and molecular pathology of the six most common cancers of the digestive system, including esophageal, gastric, biliary tract, pancreatic, hepatocellular, and colorectal cancers. We comprehensively describe the current stage-dependent pharmacological management of these malignancies, including chemo-, targeted, and immunotherapy. For each cancer entity, we provide an overview of recent therapeutic advancements and research progress. Finally, we describe how novel insights into tumor heterogeneity and immune evasion deepen our understanding of therapy resistance and provide an outlook on innovative therapeutic strategies that will shape the future management of digestive cancers, including CAR-T cell therapy, novel antibody-drug conjugates and targeted therapies.

Bacteriophage Treatment Induces Phenotype Switching and Alters Antibiotic Resistance of ESBL Escherichia coli

Background/Objectives: Bacteriophage therapy represents a promising strategy to combat multidrug-resistant pathogens, such as Escherichia coli. In this study, we explored the effects of a bacteriophage infection on an Extended Spectrum Beta-Lactamase (ESBL) positive E. coli isolate. Methods: We used next generation sequencing, proteomics and phenotypic screens to investigate the effect of bacteriophage infections on E. coli metabolism and resistance phenotypes. Results: The bacteriophage infection led to notable alterations in colony morphology, indicating profound changes in bacterial metabolism. Proteomic analysis revealed significant shifts in protein expression, with 65 proteins upregulated and 246 downregulated post-infection. The downregulated proteins were involved in various metabolic pathways, including nucleic acid, protein and lipid metabolism, and iron acquisition. Bacteriophage treatment also led to increased bacterial membrane permeability. Altogether, these alterations in bacterial metabolism and membrane permeability may lead to a general reduction in antibiotic resistance. Indeed, the bacteriophage-infected E. coli exhibited increased sensitivity to various classes of antibiotics, including beta-lactams, fluoroquinolones, trimethoprim-sulfamethoxazole, and aminoglycosides. Conclusions: Our findings highlight the potential of bacteriophage therapy as an adjunct to existing antibiotics, enhancing their efficacy against resistant strains.

US multicenter outcomes of endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents for acute cholecystitis

Background and study aims

EUS-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has excellent technical and short-term clinical success for acute cholecystitis (AC). The goals of this study were to determine the long-term clinical outcomes and adverse events (AEs) of EUS-GBD with LAMS.

Patients and methods

A multicenter, retrospective study was conducted at 18 US tertiary care institutions. Inclusion criteria: any AC patient with attempted EUS-GBD with LAMS and minimum 30-day post-procedure follow-up. Long-term clinical success was defined as absence of recurrent acute cholecystitis (RAC) > 30 days and long-term AE was defined as occurring > 30 days from the index procedure.

Results

A total of 109 patients were included. Technical success was achieved in 108 of 109 (99.1%) and initial clinical success in 106 of 109 (97.2%). Long-term clinical success was achieved in 98 of 109 (89.9%) over a median follow-up of 140 days (range 30-1188). On multivariable analysis (MVA), acalculous cholecystitis (odds ratio [OR] 15.93, 95% confidence interval [CI] 1.22-208.52, P = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08-799.29, P <0.01) were associated with RAC. AEs occurred in 38 of 109 patients (34.9%) at any time, and in 10 of 109 (9.17%) > 30 days from the index procedure. Most long-term AEs (7 of 109; 6.42%) were LAMS-specific. No technical or clinical factors were associated with occurrence of AEs. LAMS were removed in 24 of 109 patients (22%). There was no difference in RAC or AEs whether LAMS was removed or not.

Conclusions

EUS-GBD with LAMS has a high rate of long-term clinical success and modest AE rates in patients with AC and is a reasonable destination therapy for high-risk surgical candidates.

Integrating machine learning and structure-based approaches for repurposing potent tyrosine protein kinase Src inhibitors to treat inflammatory disorders

Tyrosine-protein kinase Src plays a key role in cell proliferation and growth under favorable conditions, but its overexpression and genetic mutations can lead to the progression of various inflammatory diseases. Due to the specificity and selectivity problems of previously discovered inhibitors like dasatinib and bosutinib, we employed an integrated machine learning and structure-based drug repurposing strategy to find novel, targeted, and non-toxic Src kinase inhibitors. Different machine learning models including random forest (RF), k-nearest neighbors (K-NN), decision tree, and support vector machine (SVM), were trained using already available bioactivity data of Src kinase targeting compounds. The performance evaluation of these models demonstrated SVM as the best model, which was further utilized to shortlist 51 highly potent compounds by screening an FDA-approved library of 1040 drugs. Molecular docking and molecular dynamic simulation were subsequently employed to evaluate the binding affinity and stability of the proposed compounds. Orlistat, acarbose and afatinib were identified as the potent leads, demonstrating stable conformations and stronger interactions, validated by root mean square deviation (RMSD), root mean square fluctuation (RMSF), radius of gyration (RoG), and hydrogen bond analyses. Molecular Mechanics/Generalized Born Surface Area (MMGBSA) analysis validated their binding affinities by providing comparably lower binding free energies for orlistat (- 33.4743 ± 3.8908), acarbose (- 19.5455 ± 5.4702), and afatinib (- 36.4944 ± 5.4929) than the control, dasatinib (- 13.7785 ± 5.8058). Finally, toxicity analysis revealed orlistat and acarbose as the possible safer therapeutics by eliminating afatinib as it showed significant toxicity concerns. Our investigation supports the advance computational methods utilization in the field of drug discovery and suggest further experimental validation of proposed inhibitors of Src kinase for their safer use against inflammatory diseases. The ultimate aim of this study is to advance the development of effective treatments for inflammatory diseases, linked with Src overexpression.

Analysis of the risk of oncological adverse events associated with infliximab in combination with azathioprine compared to monotherapy: insights from the FAERS database

Objective

This study aimed to evaluate the risk of tumor formation with infliximab or azathioprine monotherapy versus their combination, using the FDA Adverse Event Reporting System (FAERS) database.

Methods

Data were extracted from the FAERS database for patients treated with infliximab, azathioprine, and combination therapy from Q1 2004 to Q2 2024. Signal mining employed methods such as Reported Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Multiple Gamma-Poisson Scaling Assessment (MGPSA) and Bayesian Confidence Interval Progressive Neural Network (BCPNN).

Results

Our analysis of the FAERS database revealed that the highest number of reported cases involved skin-related tumors, both individually and in combination. In terms of sex, the risk of cancer was higher in men compared to women in the infliximab-only and combination groups; however, no sex difference was observed in the azathioprine-only group. Regarding age, we noted an increasing incidence of adverse tumor events in middle-aged and elderly individuals compared to minors, except in the azathioprine group, where age was not identified as an independent risk factor. Additionally, body weight was not found to be an independent risk factor in any of the three medication groups. After controlling for age, sex, and body weight, combination therapy did not increase the risk of tumor development compared to the azathioprine group alone. In contrast, for patients using infliximab alone, combination therapy not only did not elevate the risk of tumor development but also appeared to reduce it. The results of the Weber distribution suggest a random failure-type profile for the infliximab and azathioprine-only group, while an early failure-type profile was observed for the combination therapy. Furthermore, we analyzed the median time to onset and cumulative incidence rates, revealing no significant differences in median time to tumor onset or cumulative incidence rates between the combination therapy and the single agent.

Conclusion

After adjusting for age, sex, and body weight, combination therapy did not significantly increase tumor development risk compared to the azathioprine-only group. Additionally, in patients on infliximab monotherapy, combination therapy appeared to reduce the risk of tumor development.

Age-period-cohort analysis of gallbladder and biliary diseases epidemiological trends from 1990 to 2021 and forecasts for 2035: a systematic analysis from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary diseases (GABD) represent prevalent disorders of the digestive system.

METHODS

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were extracted from the Global Burden of Disease (GBD) 2021 study. The estimated annual percentage change (EAPC) was utilized to quantify temporal trends in GABD. Age-period-cohort analysis was conducted to determine the effects attributable to age, period, and birth cohort. Additionally, we projected global trends to 2035.

RESULTS

Globally, GABD incident cases, mortality cases, and DALYs increased by 60.11%, 71.71%, and 56.90%, respectively. However, all corresponding age-standardized rates (ASRs) demonstrated overall downward trends with estimated annual percentage changes (EAPC) of -0.32 (-0.38 to -0.26), -0.95 (-1.08 to -0.83), and - 0.69 (-0.74 to -0.65), respectively. The number of incident cases was higher in females than in males across all age groups. The age effect indicated that older individuals had higher age-specific incidence and death rates. Both period and cohort effects showed declining risk across incidence and mortality. The ASIR and ASMR of GABD are projected to continue decreasing over the next 15 years.

CONCLUSION

GABD continue to pose a significant global public health challenge, particularly affecting women and the elderly population. Consequently, the implementation of effective interventions to mitigate the GABD burden is of paramount importance.

Study on the effects of Massa Medicata Fermentata with different formulations on the intestinal microbiota and enzyme activities in mice with spleen deficiency constipation

Objective

This study aims to explore the therapeutic mechanism of Massa Medicata Fermentata (MMF) with different formulations on spleen deficiency constipation in mice by analyzing gastrointestinal hormones, D-xylose, intestinal microbiota, and intestinal enzyme activities.

Methods

A spleen deficiency constipation model was established using an oral administration of Sennae Folium decoction combined with controlled diet and water intake. After successful model establishment, the mice with spleen deficiency constipation were treated with MMF S1, S2, S3. Following the intervention, serum samples from each group of mice were collected to measure VIP, 5-HT, and D-xylose. Additionally, small intestine contents were analyzed for intestinal enzyme activity and subjected to 16S rRNA high-throughput sequencing.

Results

Mice with spleen deficiency constipation showed significant decreases in body weight and fecal water content. In contrast, the body weight of the CS2 and CS3 groups returned to normal levels, and fecal water content in the CS2 and CS3 groups also returned to normal. The MMF S2 and S3 significantly increased protease and sucrase enzymes levels compared with CM group. Serum D-xylose levels were significantly reduced in the CM and CS2 group. VIP levels increased significantly in the CM group but decreased in the CS2 and CS3 groups. Additionally, 5-HT levels in the CM and CS1 groups decreased significantly, with the CS2 group returning to normal and the CS3 group showing significant increases. 16S rRNA sequencing analysis revealed that all three MMF formulations effectively restored the intestinal microbiota composition in mice. LEfSe analysis identified characteristic microbiota linked to different intervention groups. The CS3 group significantly upregulated the chloroalkane and chloroalkene degradation and vibrio cholerae pathogenic cycle pathways compared to the CM group. Candidatus_Arthromitus in the CS3 group and Psychrobacter in the CS2 group were positive and negative correlations with 5-HT and VIP, respectively.

Conclusion

The three formulations of MMF significantly alleviated spleen deficiency constipation symptoms by modulating intestinal enzyme activities, D-xylose, VIP, and 5-HT levels, and restoring intestinal microbiota balance. Psychrobacter and Candidatus_Arthromitus were identified as potential biomarkers for the treatment of spleen deficiency constipation. Different formulations of MMF have different mechanisms of regulating constipation through intestinal microbiota.

Appropriateness and inappropriate medication predictors of stress ulcer prophylaxis in the intensive care unit

Introduction

Preventive drugs for stress ulcers are widely and unreasonably used in the Intensive Care Unit (ICU). This study aims to examine the appropriate utilization of medications for stress ulcer prophylaxis (SUP) and identify factors that contribute to the inappropriate use of these medications in the ICU of the Second Hospital of Shanxi Medical University.

Methods

Patient cases admitted to the ICU during the period from May 2022 to May 2023 were extracted from the hospital's information management system. Single-factor analysis and multivariate logistic regression model analysis were performed using the SPSS to identify factors associated with inappropriate medication for prophylaxis. The efficacy of this predictive model was assessed through the use of the Receiver Operating Characteristic Curve (ROC), while the Hosmer test was utilized to evaluate the model fit.

Results

This study included a total of 651 patient cases that met the inclusion criteria. Among these cases, 48.39% were found to have received inappropriate medication of SUP. The analysis revealed a significant association between inappropriate medication and partial transfer to departments (P < 0.05), as well as the use of anticoagulants (P = 0.009) in the prophylaxis group. In the non-prophylaxis group, the multifactorial logistic analysis indicated a significant correlation between inadequate prescriptions and partial transfer to departments (P < 0.05), as well as the presence of artificial airways (P < 0.01).

Conclusion

There is a notable prevalence of inappropriate SUP in the ICU of this hospital. Attention should be paid to the SUP of some patients transferred to the department, the use of anticoagulants and the presence of artificial airway.

Chitosan nano-formulation enhances stability and bactericidal activity of the lytic phage HK6

BACKGROUND

Successful treatment of pathogenic bacteria like Enterobacter Cloacae with bacteriophage (phage) counteract some hindrance such as phage stability and immunological clearance. Our research is focused on the encapsulation of phage HK6 within chitosan nanoparticles.

RESULT

Encapsulation significantly improves stability, efficacy, and delivery of phages. Chitosan nanoparticles (CS-NPs) achieve a phage entrapment efficiency of 97%. Fourier-transform infrared spectroscopy (FT-IR) reveals shifts towards higher wavenumbers and a new peak, indicating amide bond formation and successful phage encapsulation. The average particle sizes for CS-NP and phage HK6 encapsulated CS-NPs were 180 ± 10 nm and 297 ± 18 nm, respectively. Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) analyses reveal that phage HK6 encapsulated CS-NPs are larger on average than CS-NPs, highlighting successful phage encapsulation. Encapsulated bacteriophages maintain its effectiveness at higher pH levels of 11 and 12. Both encapsulated and free bacteriophages are thermostable between 25 and 60 °C; while at higher temperatures (up to 80 °C), the encapsulated phage is thermally stable. Over four days, 70.57% of phages were released from encapsulated CS-NPs. Encapsulation of bacteriophage HK6 in CS-NPs enhances antibacterial activity within the first 2 h, compared to phage or nanoparticles alone.

CONCLUSION

This suggests that the phage HK6 encapsulated CS-NPs exhibit potentiality as biocontrol agents against resistant microorganisms offering an alternative to phage alone.

Gut Microbiota Secondary Metabolites: Key Roles in GI Tract Cancers and Infectious Diseases

The gut microbiota, a dynamic ecosystem of trillions of microorganisms, produces secondary metabolites that profoundly influence host health. Recent research has highlighted the significant role of these metabolites, particularly short-chain fatty acids, indoles, and bile acids, in modulating immune responses, impacting epigenetic mechanisms, and contributing to disease processes. In gastrointestinal (GI) cancers such as colorectal, liver, and gastric cancer, microbial metabolites can drive tumorigenesis by promoting inflammation, DNA damage, and immune evasion. Conversely, these same metabolites hold therapeutic promise, potentially enhancing responses to chemotherapy and immunotherapy and even directly suppressing tumor growth. In addition, gut microbial metabolites play crucial roles in infectious disease susceptibility and resilience, mediating immune pathways that impact pathogen resistance. By consolidating recent insights into the gut microbiota's role in shaping disease and health, this review underscores the therapeutic potential of targeting microbiome-derived metabolites for treating GI cancers and infectious diseases and calls for further research into microbiome-based interventions.

Nociplastic pain: controversy of the concept

Classically, pain can be of a nociceptive or neuropathic nature, which refers to non-neural or neural tissue lesions, respectively. Chronic pain in conditions such as migraine, fibromyalgia, and complex regional pain syndrome (CRPS), is thought to perpetuate without a noxious input. Pain in such patients can be assigned neither to the nociceptive nor neuropathic category. Therefore, a third pain descriptor, named "nociplastic pain", has been adopted by the International Association for the Study of Pain. The current controversy-focused narrative review updates littledebated aspects of the new pain concept. The most disputable feature of nociplastic pain is its autonomous persistence, i.e., existence without causative tissue damage, presumably because of a malfunction of pain pathways and processing. This contradicts the fact that nociplastic pain is accompanied by persistent central sensitization that has been shown to require a continuing noxious input, e.g ., nerve injury. Even if sensitization occurs without a lesion, e.g ., in psychogenic and emotional pain, peripheral stimulus is necessary to produce pain. A logical weakness of the concept is that the word "plastic" in biology refers to adaptation rather than to maladaptation. The pathophysiologic mechanism of nociplastic pain may, in fact, be associated with background conditions that elude diagnosis because of the limitations of current diagnostic means. Misapplication of the nociplastic pain category may weaken diagnostic alertness toward occult causes of pain. Possible diagnostic errors could be avoided by understanding that nociplastic pain is a mechanism of pain rather than a diagnosis. Clinical use of this pain descriptor deserves a wider critical discussion.

An insight into the applications of bacteriophages against food-borne pathogens

Novel and emerging pathogens, enduring contamination, antibiotic resistance, an environment that is always changing, and the complexity of food production systems all contribute to the worsening of foodborne illness. It has been proposed that bacteriophages can serve as both fast food-borne pathogen detection tools and natural food preservatives in a variety of foods. Phages, like many other antimicrobial interventions used in food production systems, are not a cure-all for issues related to food safety, though. Consequently, phage-based biocontrol has a generally narrower antibacterial spectrum than most antibiotics, even though it can be promising in the fight against foodborne infections. Among the difficulties phage-based biocontrol techniques encounter are forming phage-insensitive single-cell variations and creating potent cocktails. To better understand when and where phage-based applications can be successfully implemented at the production and processing levels, this review focuses on phage-based applications at crucial control points in food production systems.

Delineating CYP2C19-mediated Interactions: Network Pharmacology Investigation of Ilaprazole and Clopidogrel versus Conventional Proton Pump Inhibitors

BACKGROUND

Clopidogrel, an antiplatelet drug commonly used in cardiovascular disease, is metabolized by the liver mainly through CYP2C19. Concomitant use of Proton pump inhibitors along with clopidogrel may affect the potency of clopidogrel by CYP2C19 inhibition. However, a novel PPI, ilaprazole is known to differ in its pharmacokinetic features, given the potential differences between ilaprazole's interactions and their metabolism with clopidogrel. Network pharmacology investigation could be a useful tool to evaluate the drug-drug interaction between them.

METHODOLOGY

The molecular structures and targets were retrieved from PubChem and SwissTargetPrediction to establish the information related to the identified drugs. The possible shared targets between the clopidogrel and PPIs were explored by a Venn analysis. Subsequently, Protein-Protein Interaction networks were established using the STRING database. Hub genes were also determined using the Cytoscape cytoHubba plugin.

RESULTS AND DISCUSSION

Ilaprazole (13.6%) and pantoprazole (13.6%) were characterized by fewer targets being shared with clopidogrel compared to conventional PPIs (14.9%). Moreover, CYP2C19 was not a hub gene in ilaprazole and pantoprazole interactions, which indicated no significant CYP2C19 involvement. On the other hand, CYP2C19 functioned as a hub gene in the interactions with rabeprazole, lansoprazole, dexlansoprazole, omeprazole, and esomeprazole. As a result, patients receiving pantoprazole and ilaprazole would be at a lower risk for developing adverse cardiovascular events by maintaining the clopidogrel therapeutic effect.

CONCLUSION

The application of the network pharmacology technique allows us to consider the potential for different effects of PPIs on clopidogrel and its metabolism via CYP2C19. There is a lower chance of experiencing adverse effects from an interaction between ilaprazole and clopidogrel as ilaprazole has not been linked to CYP2C19. More research is necessary to confirm these results and provide clinical guidance for patients undergoing clopidogrel and PPI combination therapy.

cDNA Display Selection of Interacting Peptide Ligands of the Guanylate Cyclase C Receptor

Guanylate cyclase C (GC-C), a receptor expressed on the apical membrane of intestinal mucosal cells, is activated by heat-stable enterotoxin (STa) produced by enterotoxigenic Escherichia coli, as well as the endogenous ligands guanylin and uroguanylin. In this study, novel peptides that interact with GC-C were generated using the cDNA display method, and their binding affinity and biological activity were evaluated. While the linear peptide library did not yield peptides with sufficient affinity for GC-C, three cyclic peptides (GCC-P1, GCC-P2, and GCC-P3), each containing two cysteine residues within a 15-residue sequence, were obtained from a cyclic peptide library containing nine-residue random sequences. GC-P2 exhibited significant binding affinity in Biacore assays, although the affinity was lower than those reported for known ligands. Notably, GCC-P2 and GCC-P3 demonstrated enhanced cGMP activity when used in combination with linaclotide. However, the agonist activity of these peptides was minimal, indicating that further modifications may be necessary to develop them for clinical applications. This study successfully extracted consensus sequences of peptide motifs that bind to GC-C from a highly diverse nine-residue random sequence library, which provides fundamental insights for the discovery and optimization of novel GC-C ligands.

Review Article: Green Management of IBD-New Paradigms for an Eco-Friendly Approach

BACKGROUND

The worldwide prevalence of inflammatory bowel disease (IBD) is increasing, with its potential evolution as a global disease and a consequent increase in its burden on healthcare systems. These estimates do not factor in the 'real' price of IBD, which, beyond curbing career aspirations, instilling social stigma, and impairing the quality of life in patients, could also significantly affect the environment.

AIM

To highlight potential areas for intervention and develop management strategies aimed at minimising environmental impacts in the field of IBD over time.

METHODS

Various aspects of IBD care (organisation of IBD centres, diagnostics and therapeutics) are examined from an environmental sustainability perspective.

RESULTS

Each stage, from the patient's means of transport to the hospital to the physician's diagnostic and therapeutic decisions, contribute to CO2 and waste production. Strategies to contain the environmental impact are feasible. Some are easy to implement, such as ensuring the appropriateness of the diagnostic and therapeutic pathway for patients; others need to be implemented in synergy with healthcare providers' policies and pharmaceutical companies.

CONCLUSIONS

With an inevitable increase in the number of patient visits, endoscopies, laboratory testing, and long-term therapeutic strategies for IBD, the clinical community should be aware of environmental concerns and investigate possible strategies to reduce the environmental impact of IBD care.

The association between exocrine pancreatic insufficiency and changes in gut microbiota: a narrative review

Due to their physical proximity, the healthy pancreas and the gut microbiome are known to interact in a variety of ways. The gut microbiota has been recognized as a potential factor in the development and progression of exocrine pancreatic insufficiency through several mechanisms. Pancreatic diseases like chronic and acute pancreatitis or pancreatic cancer are frequently accompanied by pancreatic exocrine insufficiency which affects the gut microbiota. Firstly, the gut microbes are controlled by antimicrobial pancreatic secretions, while themselves induce the secretion of substances by the pancreas through metabolite production, such as short-chain fatty acids. Secondly, dysbiosis, the alteration in the abundance and diversity of different species, has been observed in patients with pancreatic diseases. Dysbiosis influences carcinogenesis in pancreatic cancer in ways that are either procarcinogenic or anticarcinogenic and finding these connections will have clinical implications. Identifying microbial biomarkers allow for an earlier diagnosis, improved therapy and prognosis in pancreatic cancer. The gut microbiome has a role in the pathogenesis of pancreatitis by either a bacterial translocation or a host immune response mechanism. The disruption of the normal gut barrier is believed to be the primary source of bacteria in acute pancreatitis which leads to infected pancreatic necrosis. In this paper, we review the current data about the association between pancreatic diseases linked to exocrine insufficiency and gut microbiota.

[Relationship between intestinal insufficiency syndrome and risk of external intestinal fistulas in patients with severe acute pancreatitis]

OBJECTIVE

To identify the risk factors of external intestinal fistulas in patients with severe acute pancreatitis (SAP) and pancreatic necrosis.

MATERIAL AND METHODS

A retrospective and prospective study included 537 patients (354 (65.9%) men and 183 (34.1%) women) with SAP. Mean age was 51.2±18.5 years. To assess the effectiveness of intensive therapy, patients were divided into 2 groups. The control group (n=207) included patients who underwent examination and treatment according to the national guidelines «Acute pancreatitis», 2020). In the main group (n=330), examination and treatment were supplemented with original protocol.

RESULTS. P

Atients with intestinal failure score< 5 had no purulent-septic complications and multiple organ failure. Among patients with 6-9 scores, purulent-septic complications were observed in 11.7% of cases, multiple organ failure - 14.8% of cases. Among patients with 10-12 scores, the incidence of purulent-septic complications was 24.6%, multiple organ failure - 30% of cases. Thus, intestinal failure score > 10 is an important prognostic criterion of purulent-septic complications and multiple organ failure. In addition, external intestinal fistulas occurred in 8.5% of patients with intestinal failure score > 10.

CONCLUSION. P

Rogression of intestinal failure correlates with purulent-septic complications and external intestinal fistulas in patients with SAP and pancreatic necrosis. Original diagnostic algorithm is valuable for early detection of functional gastrointestinal disorders, severity and localization of these changes. Original scoring system makes it possible to predict the risk of purulent-septic complications and multiple organ failure on the first day after admission. Moreover, timely therapy improves treatment outcomes in patients with SAP. In our study, the incidence of purulent-septic complications including external intestinal fistulas decreased from 10% to 7% in the main group.

Combination of Cannabidiol with Taurine Synergistically Treated Periodontitis in Rats

The active component in cannabis, cannabidiol (CBD), was first isolated from the hemp plant in 1940. Chronic pain, inflammation, migraines, depression, and anxiety have long been treated with CBD. The fundamental mechanisms of CBD's effects on periodontal inflammation have yet to be fully understood. The amino sulfonic acid taurine is a substance that naturally exists in the body and is an inhibitory modulator of inflammation. This study examined the effects of CBD, taurine, and their combination on inflammatory cytokines and periodontitis in vivo. To assess the expression of inflammatory markers of iNOS, COX-2, TNF-α, and IL-1β, as well as TRAP count and resorbed pit areas, CBD and taurine were applied to RAW264.7 cells. The following groups of 45 Sprague-Dawley rats each were created: control (healthy), vehicle (induced periodontitis), low- and high-dose-CBD with taurine which were each treated for an additional 21 days. Rat teeth were obtained and subjected to histomorphometric studies. The combination of the two significantly decreased the expression of inflammatory markers TNF-α and IL-1β and the amount of TRAP+ cells and resorbed pit areas. Among rats with P. gingivalis-induced periodontitis, the alveolar bone resorption levels, periodontal pocket depth, and distance between cementoenamel junction (CEJ) and alveolar bone crest (ABC) were significantly reduced after treatment with CBD and taurine, suggesting that combining CBD with taurine could be a novel therapeutic agent against periodontal disease.

Acute Kidney Injury in Patients with Chronic Liver Disease: A Review

Introduction

Acute kidney injury (AKI) is a frequent complication of chronic liver disease (CLD) contributing to high morbidity and mortality worldwide. While liver transplantation (LT) has shown favorable outcomes, early identification and management of AKI is imperative for survival. This review aims to highlight the epidemiology, pathophysiology, management, and prognosis of AKI in CLD.

Methods

An extensive literature search was performed using PubMed, Medline, and Google Scholar to identify literature related to epidemiology, burden, clinical presentations, prognosis, and management of AKI in CLD.

Results

The identified studies highlighted a wide range of prevalence of AKI in hospitalized patients with CLD. The etiology and pathophysiology are multifactorial and include prerenal AKI, acute tubular injury, sepsis, gastrointestinal bleeding, bacterial translocation from the gut, and hepatorenal syndrome (HRS). AKI is associated with a higher risk of morbidity and mortality and progression to chronic kidney disease following LT. Management of AKI in CLD varies based on the underlying etiology. While vasoconstrictors like terlipressin have shown great potential in the treatment of HRS-AKI and is widely used in Europe and United States, LT remains the definitive therapy of choice. In most cases, kidney replacement therapy serves as a bridge to liver transplant.

Conclusion

AKI is a serious complication of CLD and early identification is essential. Diagnosis and management, particularly HRS is challenging and requires a high index of suspicion. More research is required to identify novel therapies to improve outcomes of AKI in patients with CLD.

Evolving Dynamics of Colorectal Cancer in High Socio-Demographic Regions

BACKGROUND

Colorectal cancer (CRC) poses a significant global health challenge, with evolving demographic trends emphasizing the need for accurate forecasting models. Existing forecasting models lack comprehensive coverage. By integrating machine learning algorithms, this study aims to provide more accurate and precise predictions, filling critical gaps in understanding CRC incidence, death, and disability-adjusted life year (DALY) rate trends, especially in high socio-demographic index (SDI) regions. Specific emphasis is placed on exploring age-, sex-, and country-specific variations in CRC trends.

MATERIALS AND METHODS

An ensemble forecasting algorithm integrating Simple Linear Regression, Exponential Smoothing, and Autoregressive Integrated Moving Average, capable of handling a short time series was developed and validated, utilizing a dataset encompassing age-, sex-, and country-specific CRC incidence, mortality, and DALY rates.

RESULTS

Our forecasting models reveal rising trends in CRC burden in the 15-49 years age group (young-onset) and decreasing trends in CRC burden in the 50-74 years age group (late-onset) in high SDI regions with sex-specific variations in incidence, mortality, and DALY rates. Some inflection points for demographic shifts in CRC disease burden, particularly death rates, were identified as early as within the next 5 years. We predict a shift in CRC burden towards females, particularly in older adults.

CONCLUSION

A novel multifactor model was developed for comparing the incidence, mortality, and DALY rates of young- and late-onset CRC in high SDI regions. The rising incidence of young-onset CRC in high SDI regions underscores the need for proactive health strategies. By refining predictive models, adjusting screening guidelines to target younger, high-risk populations, and investing in public awareness and research, we can facilitate early detection and improve outcomes. This study addresses a significant gap in CRC forecasting and provides a robust framework for anticipating demographic shifts in CRC burden, making it an indispensable tool for healthcare planning.

Melatonin alleviates oral epithelial cell inflammation via Keap1/Nrf2 signaling

BACKGROUND

Oral mucosal diseases manifest primarily as inflammatory conditions. These diseases affect approximately half a billion people worldwide.

OBJECTIVE

Novel and effective strategies for treating inflammatory diseases of the oral mucosa have great potential for improving patient outcomes, and warrant study.

METHODS

The impact of melatonin on inflammation was investigated using RAW264.7 macrophages and HOEC and HSC-3 oral epithelial cells.

RESULTS

Melatonin decreased macrophage-induced inflammation by acting through the melatonin receptor MTNR1A. Additionally, melatonin mitigated macrophage-induced inflammation in oral epithelial cells. Importantly, the results demonstrated that the effects of melatonin on oral epithelial inflammation were mediated through the KEAP1/Nrf2 signaling pathway.

CONCLUSION

These findings will contribute to the development of innovative therapies for inflammatory conditions affecting the oral epithelium.

Applicability of the Pancreatic Exocrine Insufficiency Test (PEI-TEST) in Pediatric Patients

In mild cases, it is difficult to diagnose pancreatic exocrine insufficiency (PEI). There is no gold standard method for the diagnosis of PEI. A reliable method is needed for preliminary diagnosis of PEI. The PEI-TEST was applied to the patients with nonspecific gastrointestinal complaints. Serum amylase, lipase, serum trypsinogen, and fecal elastase 1 (FE-1) were analyzed from each patient. According to the PEI-TEST, PEI was present in 42 (47.7%) and PEI was not present in 46 (52.3%) patients. No significant difference was observed between the 2 groups with regard to age, gender and amylase, lipase, serum trypsinogen, and FE-1. When an FE-1 value of <200 µg/dL was considered as indicating PEI, the sensitivity and specificity of the test were found to be 47.4% and 52.2%, respectively. Although it is promising that PEI-TEST is a validated test in our country and suitable for our society, it is not suitable for pediatric patients.

Safety and efficacy of curcumin in the treatment of ulcerative colitis: An updated systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

This study aims to systematically evaluate the safety and efficacy of curcumin as an adjunctive treatment for patients with ulcerative colitis (UC) and to assess the methodological quality of the published studies.

METHODS

A comprehensive search was conducted in PubMed, Embase, and CENTRAL databases for randomized controlled trials published up to August 18, 2023. Two independent reviewers screened studies based on predefined criteria. Meta-analysis was performed using a random-effects model with RevMan 5.4. Heterogeneity was assessed using Cochran's Q test and I² statistic.

RESULTS

Eight randomized controlled trials involving 482 patients were included. Seven studies reported clinical remission, and three reported endoscopic remission. Compared to the placebo group, adjunctive curcumin therapy significantly improved clinical remission (RR=2.33, 95 % CI: 1.25 to 4.34; P = 0.008; I²=80 %). Although endoscopic remission showed an increasing trend, it was not statistically significant (RR=4.17, 95 % CI: 0.63 to 27.71; P = 0.14; I²=80 %). Significant improvements were also observed in clinical improvement (RR=1.93, 95 % CI: 1.10 to 3.36; P = 0.02; I²=56 %) and endoscopic improvement (RR=1.76, 95 % CI: 1.12 to 2.77; P = 0.01; I²=62 %) in the curcumin group. No serious adverse events were reported. Subgroup analysis indicated a positive correlation between treatment efficacy and dosage, with no significant impact of administration method or follow-up duration on the pooled results or heterogeneity.

CONCLUSION

Curcumin as an adjunctive treatment shows promise in improving clinical and endoscopic outcomes in UC patients without significant adverse effects. However, due to the limited number of studies and substantial heterogeneity, further large-scale randomized controlled trials are necessary to confirm these findings.

Rat Fecal Metabolomics-Based Analysis

The gut's symbiome, a hidden metabolic organ, has gained scientific interest for its crucial role in human health. Acting as a biochemical factory, the gut microbiome produces numerous small molecules that significantly impact host metabolism. Metabolic profiling facilitates the exploration of its influence on human health and disease through the symbiotic relationship. Fecal metabolomics-based analysis is an indisputably valuable tool for elucidating the biochemistry of digestion and absorption in the gastrointestinal system, serving as the most suitable specimen to study the symbiotic relationship between the host and the intestinal microbiota. It is well-established that the balance of the intestinal microbiota changes in response to various stimuli, both physiological, such as gender, age, diet, and exercise, and pathological, such as gastrointestinal and hepatic diseases. Fecal samples have been analyzed using widely adopted analytical techniques, including NMR spectroscopy, GC-MS, and LC-MS/MS. Rat fecal samples are frequently used and particularly useful substrates for metabolomics-based studies in related fields.The complexity and diversity of fecal samples necessitate careful and skillful handling to extract metabolites, while avoiding their deterioration, effectively and quantitatively. Several determinative factors, such as the fecal sample weight to extraction solvent solution volume, the nature and pH value of the extraction solvent, and the homogenization process, play crucial roles in achieving optimal extraction for obtaining high-quality metabolic fingerprints, whether for untargeted or targeted metabolomics.

Safety of potassium-competitive acid blockers in the treatment of gastroesophageal reflux disease

INTRODUCTION

Proton pump inhibitors (PPIs) are the first-line treatment for gastroesophageal reflux disease (GERD). However, due to their intrinsic limitations, there are still unmet clinical needs that have fostered the development of potassium-competitive acid blockers (P-CABs). Currently, four different drugs (vonoprazan, tegoprazan, fexuprazan, and keverprazan) are marketed in some Asian countries, whereas only vonoprazan and tegoprazan are available in Western countries (USA and Brazil or Mexico, respectively).

AREAS COVERED

This review summarizes the current knowledge on P-CABs acute and long-term safety in GERD treatment compared to that of PPIs. Full-text articles and abstracts were searched in PubMed.

EXPERT OPINION

P-CABs proved to address some of the unmet clinical needs in GERD, with a favorable risk-benefit ratio compared to conventional PPIs. Preclinical and clinical findings have highlighted P-CAB safety to be superimposable, to that of PPIs, in short-term treatments, although further studies are warranted to monitor their effects in long-term therapy. From an epidemiological point of view, the paucity of rigorous data for many variables (e.g. age, ethnicity, drug interactions, comorbidities, genetic polymorphisms, interindividual susceptibility, and gut dysbiosis) deserves a worldwide framework of continuous pre/post-marketing pharmacovigilance programs to reduce potential confounding factors and accurately link acute and chronic P-CAB therapy to adverse outcomes.

Achalasia: beyond the basics

Achalasia is a rare oesophageal disease characterised by an unrelaxing lower oesophageal sphincter and abnormal peristalsis of the oesophageal body. Achalasia symptoms include dysphagia to solid and liquid, chest pain, regurgitation and weight loss. Achalasia diagnosis might be delayed for many years when atypical symptoms dominate. Significant progress has been made over the last two decades regarding our understanding of pathophysiology, methods of evaluation and management. The development of high-resolution manometry in particular has improved the diagnosis of achalasia, as well as other major motility disorders. Subtyping achalasia into manometric patterns has pathophysiological and therapeutic implications. Furthermore, complementary tests such as timed barium swallow and the functional lumen imaging probe (EndoFLIP; Crospon Medical Devices, Galway, Ireland) have significantly added to achalasia diagnosis algorithm and management decision-making. Progression in management has helped optimise established therapy (pneumatic dilatation and Heller myotomy) and introduced new endoscopic treatments (peroral endoscopic myotomy) and surgical techniques (surgical robotic Heller myotomy). This review will aim to shed light on the most recent advances in achalasia diagnosis, classification and management.

Functionalized Nanomaterials In Pancreatic Cancer Theranostics And Molecular Imaging

Pancreatic cancer (PC) is one of the most fatal malignancies in the world. This lethality persists due to lack of effective and efficient treatment strategies. Pancreatic ductal adenocarcinoma (PDAC) is an aggressive epithelial malignancy which has a high incidence rate and contributes to overall cancer fatalities. As of 2022, pancreatic cancer contributes to about 3 % of all cancers globally. Over the years, research has characterised germline predisposition, the origin cell, precursor lesions, genetic alterations, structural alterations, transcriptional changes, tumour heterogeneity, metastatic progression, and the tumour microenvironment, which has improved the understanding of PDAC carcinogenesis. By using molecular-based target therapies, these fundamental advancements support primary prevention, screening, early detection, and treatment. The focus of this review is the use of targeted nanoparticles as an alternative to conventional pancreatic cancer treatment due to the various side effects of the latter. The principles of nanoparticle based cancer therapy is efficient targeting of tumour cells via enhanced permeability and retention (EPR) effects and decrease the chemotherapy side effects due to their non-specificity. To increase the efficiency of existing therapies and modify target nanoparticles, several molecular markers of pancreatic cancer cells have been identified. Thus pancreatic cancer cells can be detected using appropriately functionalized nanoparticles with specific signalling molecules. Once cancer has been identified, these nanoparticles can kill the tumour by inducing hyperthermia, medication delivery, immunotherapy or gene therapy. As potent co-delivery methods for adjuvants and tumor-associated antigens; nanoparticles (NPs) have demonstrated significant promise as delivery vehicles in cancer therapy. This ensures the precise internalization of the functionalized nanoparticle and thus also activates the immune system effectively against tumor cells. This review also discusses the immunological factors behind the uptake of functionalized nanoparticles in cancer therapies. Theranostics, which combine imaging and therapeutic chemicals in a single nanocarrier, are the next generation of medicines. Pancreatic cancer treatment may be revolutionised by the development of a tailored nanocarrier with diagnostic, therapeutic, and imaging capabilities. It is extremely difficult to incorporate various therapeutic modalities into a single nanocarrier without compromising the individual functionalities. Surface modification of nanocarriers with antibodies or proteins will enable to attain multifunctionality which increases the efficiency of pancreatic cancer therapy.

Simethicone with or without N-acetylcysteine as premedication in esophagogastroduodenoscopy: a systematic review and meta-analysis

BACKGROUND

The impairment of gastrointestinal mucosa visibility during esophagogastroduodenoscopy (EGD), due to the presence of foam and bubbles, may lead to reduced quality in the EGD results. The combination of simethicone, a defoaming agent, along with N-acetylcysteine (NAC), which has mucolytic properties, has been proposed to improve the visibility of the mucosa. This study aimed to evaluate the effectiveness of pre-procedural administration of simethicone and N-acetylcysteine in improving mucosal visibility, procedure time and mucosal cleansing volume needed during EGD.

METHODS

We conducted a comprehensive literature search from inception to November 23, 2023, in PubMed, CENTRAL, ProQuest, SAGE, and JSTOR. We included randomized clinical trials that investigated the effects of simethicone with or without NAC as premedication in EGD. For the quantitative analysis, standardized mean difference (SMD) was used to assess continuous outcomes and risk ratio for dichotomous outcomes. The Cochrane risk of bias 2 tool was used to evaluate the risk of bias.

RESULTS

This meta-analysis comprised a total of 20 studies and found that simethicone with or without NAC improved mucosal visibility compared with control (SMD -1.27, 95% confidence interval [CI] -1.74 to -0.81, P<0.001). The combination of simethicone and NAC was significantly better than simethicone alone (SMD -0.68, 95%CI -1.08 to -0.28, P=0.001). Simethicone with or without NAC also shortened the procedure time compared to control (MD -1.40, 95%CI -2.67 to -0.12, P=0.03). The risk of bias was low with a moderate grade of certainty.

CONCLUSION

The administration of simethicone with or without NAC may improve EGD quality.

Insights from Shigella bacteriophage genomes analysis

Shigella species, a major cause of shigellosis, remain a substantial global health issue and the emergence of antibiotic-resistant Shigella strains has aggravated the situation. Hence, four Shigella phages were investigated to provide insights into the evolutionary trajectories and genomic properties of Shigella-infecting bacteriophages using comparative genome analysis. Analysis shows that these four phages belong to the Tequatrovirus genus and include a considerable number of proteins for 'Tail' and "DNA, RNA and Nucleotide Metabolism," indicating their aptitude for specialized host interaction and replication efficiency. The identification of 10 tRNAs further support that, these phages have high replication efficiency. Thus, this study improves our understanding of phage evolution by exposing the genetic mechanisms that drive phage adaptability and host specificity. This also highlights the significance of phage genomic research in developing viable therapies for antibiotic-resistant Shigella infections.

(-)-Fenchone Ameliorates TNBS-Induced Colitis in Rats via Antioxidant, Immunomodulatory, and Cytoprotective Mechanisms

BACKGROUND

(-)-Fenchone is a bicyclic monoterpene present in the plant species Foeniculum vulgare Mill, Thuja occidentalis L. (tuja), and Lavandula stoechas (lavender). These plants have therapeutic value in the treatment of intestinal disorders.

AIM

To evaluate intestinal anti-inflammatory activity in an acute and chronic trinitrobenzene sulphonic acid (TNBS)-induced colitis model in rats.

METHODS

Intestinal anti-inflammatory effects were assessed using the acute and chronic TNBS-induced colitis model in rats. The mechanisms were evaluated from colonic tissue fragments of the acute and chronic models.

RESULTS

Oral administration of the (-)-fenchone (37.5-300 mg/kg) acute phase or (150 mg/kg) (p < 0.001) chronic phase reduced the macroscopic lesion score, ulcerative area, intestinal weight/length ratio, and diarrheal index in TNBS-treated animals. At a dose of 150 mg/kg, the acute and chronic phase decreased malondialdehyde (MDA) and myeloperoxidase (MPO) (p < 0.001), restored glutathione (GSH) levels and superoxide dismutase (SOD) (p < 0.001), decreased immunomarking for factor nuclear kappa B (NF-κB) and levels of interleukin (IL)-1 and tumor necrosis factor α (TNF-α), and maintained IL-10 and TGF-β basal levels. Furthermore, increased immunostaining for zonula occludens 1 (ZO-1) was observed.

CONCLUSIONS

(-)-fenchone has intestinal anti-inflammatory activity related to cytoprotection of the intestinal barrier, as well as antioxidant and immunomodulatory effects.

Using the Cardiac-Electrophysiological Balance Index to Predict Arrhythmia Risk After Colonoscopy

Background and Objectives: Colorectal cancer is the second leading cause of cancer-related deaths in the U.S., and colonoscopy is a critical tool for colon cancer screening and diagnosis. Electrolyte disturbances and autonomic nervous system dysfunction that may occur due to bowel preparation and the colonoscopy procedure itself may play a role in the development of cardiac arrhythmia. This study aimed to assess the index of cardiac-electrophysiological balance (iCEB) to predict ventricular arrhythmia risk related to colonoscopy. Materials and Methods: Patients undergoing elective colonoscopy with a normal sinus rhythm were included. Electrocardiography (ECG) recordings both before bowel preparation and after the colonoscopy procedure were obtained. Values of the index of cardiac-electrophysiological balance (iCEB) were compared. Results: Among 36 patients, it was determined that the heart rate values of the patients before bowel preparation were higher than the heart rate values after colonoscopy [74.5 (60-108) bpm vs. 68.5 (53-108) bpm, p = 0.021]. The duration of QT interval increased (370.9 ± 27.8 ms vs. 398.7 ± 29.4 ms, p < 0.001) and the iCEB increased from 4.1 ± 0.5 to 4.5 ± 0.6 (p < 0.001), indicating a significant post-procedural risk of ventricular arrhythmias. Conclusions: These findings suggest that routine iCEB assessment post-colonoscopy could identify high-risk patients requiring closer monitoring.

Importance of Fecal Microbiota Transplantation and Molecular Regulation as Therapeutic Strategies in Inflammatory Bowel Diseases

Noncoding RNAs, particularly microRNAs (miRNAs) and small interfering RNAs (siRNAs), have emerged as key players in the pathogenesis and therapeutic strategies for inflammatory bowel disease (IBD). MiRNAs, small endogenous RNA molecules that silence target mRNAs to regulate gene expression, are closely linked to immune responses and inflammatory pathways in IBD. Notably, miR-21, miR-146a, and miR-155 are consistently upregulated in IBD, influencing immune cell modulation, cytokine production, and the intestinal epithelial barrier. These miRNAs serve as biomarkers for disease progression and severity, as well as therapeutic targets for controlling inflammation. This comprehensive review highlights the intricate interplay between the gut microbiota, fecal microbiota transplantation (FMT), and miRNA regulation. It concludes that microbiota and FMT influence miRNA activity, presenting a promising avenue for personalized IBD treatment.

Cholelithiasis in Infants: Risk Factors, Management, and the Role of Ursodeoxycholic Acid

BACKGROUND

Cholelithiasis is a rare disease in infants, and there is limited data on its risk factors and management.

OBJECTIVES

To evaluate the risk factors, management, and response to medical treatment of cholelithiasis in infants.

METHODS

Infants diagnosed with cholelithiasis by ultrasound between 2018 and 2023 were retrospectively analyzed. Details of patient history, imaging findings, current symptoms, and treatments were reviewed.

RESULTS

Over 5 years, 98 infants were diagnosed with cholelithiasis. Thirty-three (33.7%) were girls, and the most common risk factors were the use of cephalosporin antibiotic therapy in 46.9%, sepsis in 30.6%, total parenteral nutrition in 29.6%, prematurity in 27.6%, congenital heart disease in 18.4%, and genetic disease (Down syndrome diagnosis in seven patients) in 16.3%. Only fifteen patients (15.3%) were symptomatic. Ursodeoxycholic acid (UDCA) treatment was given to 90.8% of patients, but nine of them used it for a short period or irregularly, and regular users were 81.6%. Gallstones disappeared in 46 patients (46.9%), including 14 (30.4%) without using UDCA regularly. The response rate to UDCA treatment was lower in preterm infants (p = 0.004). Gallstone resolution was higher in the nonusers, 14/18 (77.8%) versus 32/79 (40.5%) (p = 0.03). Acute cholecystitis was observed in only four patients; no other complications were noted. No infant required surgical or endoscopic treatment.

CONCLUSIONS

UDCA should not be used routinely in children, especially infants, except in symptomatic children with a contraindication to surgery or to reduce clinical symptoms. In the absence of symptoms, patients may be monitored clinically.