Background:We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way.Our case is the first in the literature to describe this minimally invasive treatment te...Background:We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way.Our case is the first in the literature to describe this minimally invasive treatment technique for colon perforation in a completely asymptomatic patient.Case Description:A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy placement.The patient had a history of endometrial cancer,treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy.Her recovery had been further complicated by the development of radiation cystitis,small bowel resection,and short gut syndrome.The strictures had previously been managed with bilateral double J stents,which have now failed.A left-sided nephrostomy insertion was performed.ACT-scan prompted by a repeat deterioration in renal function revealed a right-sided hydronephrosis and suggested transcolic passage of the previously placed leftsided nephrostomy.She had remained clinically well and apyretic.A right-sided nephrostomy was inserted,and the left re-sited following a colonoscopy-guided nephrostomy removal and clip occlusion of the nephrostomy tract.The patient then developed a pseudoaneurysm,which was managed with embolization.The patient was able to return home with corrected kidney function.The three-monthly checks for changes in nephrostomy catheters did not reveal any complications.Conclusions:The patient therefore presented with two major complications of nephrostomy placement:colonic perforation and pseudoaneurysm,classified as Clavien IIIb and IIIa,respectively.Multidisciplinary management,including urologists,gastroenterologists,general surgeons,and radiologists,enabled a minimally invasive management.Minimally invasive management with endoscopic clip placement appears to be a safe alternative to directed fistula of colonic perforation.展开更多
Background Weaning-induced diarrhoea and growth retardation in piglets are associated with impaired intestinal barrier function and decreased levels of colonic short-chain fatty acids(SCFAs).Although SCFA supplementat...Background Weaning-induced diarrhoea and growth retardation in piglets are associated with impaired intestinal barrier function and decreased levels of colonic short-chain fatty acids(SCFAs).Although SCFA supplementation has been proposed to mitigate these issues,the efficacy and optimal dosage of sodium isobutyrate remain unclear.Results We investigated the effects of sodium isobutyrate supplementation(500,1,000,2,000,and 4,000 mg/kg diet)on weaned piglets(Duroc×Landrace×Yorkshire,28 d of age;n=8).After a 28-d feeding trial,supplementation at 500–2,000 mg/kg significantly improved average daily gain and feed efficiency and reduced diarrhoea frequency,with maximal benefits observed at 1,000 mg/kg(P<0.0001).Additionally,500–1,000 mg/kg sodium isobutyrate supplementation increased the apparent digestibility of crude protein,organic matter,and crude fibre(P<0.05).Serum biochemical parameters were unaffected,although secretory immunoglobulin A(SIgA)levels significantly increased upon supplementation with 500–1,000 mg/kg(P<0.05).16S rRNA gene sequencing indicated that sodium isobutyrate increased the abundance of beneficial colonic microbiota.The 1,000 mg/kg group presented the most pronounced effect,with a significant increase of the relative abundance of Prevotella and the greatest improvement in SCFA concentrations(P<0.05).Metabolomics revealed elevated levels of colonic indole-3-lactic acid and 3-hydroxybutyrate upon supplementation with 1,000 mg/kg(P<0.05).Transcriptomic analyses indicated activation of protein digestion and absorption pathways,and PI3K-Akt signalling,marked by TSG-6 upregulation and the suppression of ISG15 and DDIT4 expression(P<0.05).Supplementation with 1,000 mg/kg was associated with improved intestinal barrier-related markers,including reduced serum D-lactate,diamine oxidase,and lipopolysaccharide levels,increased tight junction protein expression;activation of G protein-coupled receptors;and inhibition of TLR4/MyD88/NF-κB signalling(P<0.05),suggesting enhanced barrier function.Conclusions In conclusion,dietary supplementation with 1,000 mg/kg sodium isobutyrate was associated with improved intestinal morphology,reduced serum permeability,increased expression of tight junction proteins,and enhanced immune function in weaned piglets,suggesting enhanced colonic barrier function and providing dosage guidance and mechanistic insights for future applications.展开更多
BACKGROUND Magnetic compression anastomosis(MCA)offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract.Evidence regarding whether the design of the MCA device influences...BACKGROUND Magnetic compression anastomosis(MCA)offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract.Evidence regarding whether the design of the MCA device influences the anastomosis effect is lacking.AIM To investigate any difference in the side-to-side colonic anastomosis effect achieved with cylindrical vs circular ring magnets.METHODS We designed cylindrical and circular ring magnets suitable for side-to-side colonic anastomosis in rats.Thirty Sprague-Dawley rats were randomly divided into a cylindrical group,circular ring group,and cylindrical–circular ring group(n=10/group).Side-to-side colonic anastomosis was completed by transanal insertion of the magnets without incision of the colon.Operation time,perioperative complications,and magnet discharge time were recorded.Rats were euthanized 4 weeks postoperatively,and anastomotic specimens were obtained.The burst pressure and anastomotic diameter were measured sequentially,and anastomosis formation was observed by naked eye.Histological results were observed by light microscopy.RESULTS In all 30 rats,side-to-side colonic anastomosis was completed,for an operation success rate of 100%.No postoperative complications of bleeding and intestinal obstruction occurred,and the postoperative survival rate were 100%.The operation time,magnet discharge time,anastomotic bursting pressure,and anastomotic diameter did not differ significantly among the three designs(P>0.05).Healing was similar across the groups,with gross specimens showing good anastomotic healing and good mucosal continuity observed on histological analysis.CONCLUSION This study found no significant difference in the establishment of rat side-to-side colonic anastomosis with the use of cylindrical vs circular ring magnets.展开更多
Background Dietary protein level and amino acid(AA)balance are crucial determinants of animal health and productivity.Supplementing rumen-protected AAs in low-protein diets was considered as an efficient strategy to i...Background Dietary protein level and amino acid(AA)balance are crucial determinants of animal health and productivity.Supplementing rumen-protected AAs in low-protein diets was considered as an efficient strategy to improve the growth performance of ruminants.The colon serves as a crucial conduit for nutrient metabolism during rumen-protected methionine(RPMet)and rumen-protected lysine(RPLys)supplementation,however,it has been challenging to clarify which specific microbiota and their metabolites play a pivotal role in this process.Here,we applied metagenomic and metabolomic approaches to compare the characteristic microbiome and metabolic strategies in the colon of lambs fed a control diet(CON),a low-protein diet(LP)or a LP diet supplemented with RPMet and RPLys(LR).Results The LP treatment decreased the average daily weight gain(ADG)in lambs,while the LR treatment tended to elicit a remission in ADG.The butyrate molar concentration was greater(P<0.05),while acetate molar concentration(P<0.05)was lower for lambs fed the LP and LR diets compared to those fed the CON diet.Moreover,the LP treatment remarkably decreased total AA concentration(P<0.05),while LR treatment showed an improvement in the concentrations of methionine,lysine,leucine,glutamate,and tryptophan.Metagenomic insights proved that the microbial metabolic potentials referring to biosynthesis of volatile fatty acids(VFAs)and AAs in the colon were remarkably altered by three dietary treatments.Metagenomic binning identified distinct microbial markers for the CON group(Alistipes spp.,Phocaeicola spp.,and Ruminococcus spp.),LP group(Fibrobacter spp.,Prevotella spp.,Ruminococcus spp.,and Escherichia coli),and LR group(Akkermansia muciniphila and RUG099 spp.).Conclusions Our findings suggest that RPMet and RPLys supplementation to the low-protein diet could enhance the microbial biosynthesis of butyrate and amino acids,enriche the beneficial bacteria in the colon,and thereby improve the growth performance of lambs.展开更多
The metastatic pattern of colon cancer is typically well characterized,with initial dissemination occurring through regional lymphatics,followed by hematogenous spread.The most frequent sites of metastasis in colorect...The metastatic pattern of colon cancer is typically well characterized,with initial dissemination occurring through regional lymphatics,followed by hematogenous spread.The most frequent sites of metastasis in colorectal cancer(CRC)include regional lymph nodes(50%–70%),liver(35%–50%),lungs(21%),peritoneum(15%),and ovaries(13%).1 Isolated distant lymph node metastasis,particularly in the absence of concurrent systemic disease,is exceedingly rare in CRC.To date,only six cases of isolated axillary lymph node metastasis(ALNM)from colorectal primaries have been documented in the literature.1–6 Even more uncommon is the incidental discovery of malignant cells in anastomotic doughnuts following stoma reversal procedures.Herein,we report a rare case involving both the incidental histopathological detection of tumor cells within doughnuts during stoma closure and the subsequent development of isolated ALNM after curative resection of sigmoid colon carcinoma.展开更多
High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relati...High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relatively good prognosis,advanced cases often respond poorly to standard chemotherapy.Immune checkpoint inhibitors,such as pembrolizumab,have shown strong and lasting effects in MSI-H CRC.Pembrolizumab is now approved as a first-line treatment for metastatic MSI-H CRC due to its superior outcomes compared to traditional chemotherapy.CASE SUMMARY A 44-year-old male with MSI-H transverse colon cancer presented with hematochezia,abdominal pain,and significant weight loss.Imaging revealed a bulky tumor with invasion of adjacent structures and multiple liver lesions.A diverting ileostomy was performed followed by 36 cycles of pembrolizumab.The patient achieved a clinical and radiologic complete response.One month after completing the treatment,the patient underwent laparoscopic right hemicolectomy.A spontaneous transection of the colon at the original tumor site was unexpectedly identified.Final pathology confirmed pathological complete response(ypT0N0)with fibrosis.The patient recovered well after surgery,and follow-up showed no evidence of recurrence.CONCLUSION Immune checkpoint inhibitors may cause delayed structural damage to bowel tissue even after apparent complete tumor regression.展开更多
BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters ...BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.展开更多
Objectives:Radiation enteropathy is a common complication of cervical cancer radiotherapy,and there is currently no effective treatment.This study evaluates the radioprotective effect of Premna microphylla Turcz.(PMT)...Objectives:Radiation enteropathy is a common complication of cervical cancer radiotherapy,and there is currently no effective treatment.This study evaluates the radioprotective effect of Premna microphylla Turcz.(PMT)on radiation-induced colon injury in mice.Materials and Methods:An 8 Gy abdominal irradiation model was established in mice,which were then gavaged with low(0.325 g/kg),medium(0.65 g/kg),or high(1.3 g/kg)doses of PMT.Weight and other routine information were recorded.The mice were euthanized on the 7 th day after radiotherapy.Colonic tissue was collected for observing structural changes.Reverse transcription quantitative polymerase chain reaction(RTqPCR)was used to detect inflammation infiltration in colon tissue.16S rRNA gene sequencing was performed to analyze the alterations in gut microbiota composition.Hepatic and renal function assessments were conducted to evaluate the safety profile of PMT.Results:PMT at medium dose significantly reduced radiation-induced weight loss(P<0.05).PMT alleviated gastrointestinal discomfort and partially reduced radiotherapy-induced faecal occult blood,although these effects were not statistically significant.Both medium and high doses of PMT reversed the shortening of colon length caused by radiotherapy(both P<0.05).The medium-and high-dose PMT improved the colonic inflammatory microenvironment by reducing the expression of inflammatory factors and chemokines(IL-1β,IL-6,IFN-γ,TNF-α,and Cxcl1)(P<0.05).PMT restored the diversity of the gut microbiota and normalized the Bacteroidetes/Firmicutes ratio disrupted by radiation.Beyond intestinal protection,PMT administration at all doses significantly reduced the postirradiation levels of serum creatinine(Cr),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(all P<0.05).Conclusions:PMT,particularly at medium doses,has potential for treating radiation-induced colonic injury in mice without causing hepatorenal toxicity,providing a novel therapeutic approach for radiation-induced colonic diseases.展开更多
BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains ...BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.展开更多
BACKGROUND Celiac disease(CD)is a chronic inflammatory disease that affects multiple systems in genetically predisposed individuals.The only known treatment for CD is adherence to a gluten-free diet.Gluten has been fo...BACKGROUND Celiac disease(CD)is a chronic inflammatory disease that affects multiple systems in genetically predisposed individuals.The only known treatment for CD is adherence to a gluten-free diet.Gluten has been found to exert deleterious immune-inflammatory effects beyond the small bowel,involving several genetic,cellular,and paracellular mechanisms in the context of chronic inflammation,leading to colorectal carcinoma(CRC)in CD patients.Several neoplasms,including adenocarcinoma and lymphoma,are associated with CD.Despite strong evidence of an association between CD and small intestinal malignancies,CRC is less common and underdiagnosed in patients with CD.In practice,most CD patients are only monitored for small bowel complications despite mild lower gastrointestinal symptoms;thus,colonoscopy is underused,with a greater focus on upper endoscopy and small bowel biopsy,a major hindrance in early diagnosis.Delayed diagnosis and poor prognosis have also been linked to nonspecific symptoms and late presentations.The lack of screening guidelines appears to be a critical gap due to disconnection between CD and heterogeneous expression of the disease complications add further diagnostic delay.AIM To critically evaluate and synthesize existing evidence on the association between CD and CRC to encourage early-stage detection through lower gastrointestinal screening in CD patients and suggest individual-specific management strategies.METHODS The Scopus,Web of Science,and PubMed databases were searched via Medical Subject Headings words related to the criteria pertinent to CD and colon cancer/neoplasm,with a focus on pathophysiological mechanisms,clinical presentations,and outcomes reviewed.RESULTS A total of 3028 citations related to CD and neoplasia were initially identified.Following a critical review and exclusions,136 citations were suitable for inclusion in this study.Despite its low incidence,a clinically significant association was found between CRC and CD that could impact the overall patient survival rate,suggesting early screening investigations,individual-specific interventions,and further longitudinal studies.CONCLUSION A low incidence of colon lymphoma and adenocarcinoma has been revealed.The clinical presentation of colon lymphoma and adenocarcinoma is indolent and nonspecific,with late presentation in the form of adhesions and perforation.A modest but statistically significant increase in CRC risk among CD patients was noted.Several overlapping factors,including individual variability,genetic and environmental factors,diagnostic delays and duration of gluten exposure,compliance with a gluten-free diet,lack of educational awareness,and complex immune-inflammatory interactions,were found to contribute to the overall incidence of CRC in CD patients.However,the true incidence may be underestimated due to the iceberg phenomenon,where limited clinical suspicion,poor screening,and underreporting may mask the underlying burden.This study highlights the need for increased clinical awareness and early screening,especially in noncompliant patients.展开更多
BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat t...BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.展开更多
A case-control study on the differences in colonic mucosa-associated microbiotas between patients with and without colorectal cancer(CRC)in the Indonesian population was recently published.The geographical distributio...A case-control study on the differences in colonic mucosa-associated microbiotas between patients with and without colorectal cancer(CRC)in the Indonesian population was recently published.The geographical distribution characteristics of the gut microbiota in the carcinogenic microenvironment are closely related to disease progression.Therefore,the results of that study are of great significance for determining the pathogenesis of CRC in the Indonesian region and for clinically diagnosing and treating CRC.While acknowledging the strengths of the study,its limitations should also be addressed.Future case-control studies of the gut microbiota based on specific populations should be further refined to provide more optimized guidance for clinical precision treatment.展开更多
Postruminal intestinal inflammation and hindgut acidosis caused by increased dietary starch supply and thereby increased quantities of ruminal degradable starch(RDS)in ruminants have been widely studied.Although the r...Postruminal intestinal inflammation and hindgut acidosis caused by increased dietary starch supply and thereby increased quantities of ruminal degradable starch(RDS)in ruminants have been widely studied.Although the roles of the microbiota in mediating hindgut health that are focused on the hindgut have been widely studied,the absence of whole gastrointestinal insight may influence the depth of research.We integrated the microbiome,metabolome,and host transcriptome changes in the rumen,jejunum,ileum,and colon to investigate the contributions of foregut changes to hindgut gene expression driven by gastrointestinal microbiota and metabolite flow.Forty goats were randomly assigned to receive either a low rumen-degradation-rate starch diet(LRDS,n=20)or a high rumen-degradation-rate starch diet(HRDS,n=20).Compared with the HRDS group,the LRDS group significantly decreased the diarrheal rate.Based on the mean values of the fecal scores,6 represented goats of LRDS group(fecal scores=(4.58±0.120))and 6 represented goats of HRDS group(fecal scores=(3.53±0.343))were selected for sampling and subsequent analysis.LRDS had significantly decreased the colonic pathologic scores.Transcriptomic analysis revealed that LRDS reduced jejunal,ileal,and colonic inflammatory responses.An increase in beneficial commensals and a decreased abundance of pathogenic genera in the small intestine and hindgut were found in goats fed the LRDS diet using 16S rRNA gene sequencing.To identify microbial transmission as well as the transmission of microbial metabolites,8 genera were identified as core genera according to their calculated niche width.Metabolomics analysis revealed that a total of 554 metabolites were identified among different gastrointestinal sites.Then,metabolites were incorporated into 3 modules:metabolites increased in the current site(ICS),unchanged inflow metabolites in the current site(UICS),and metabolites decreased in the current site(DCS).The results indicated that the UICS metabolites contributed more than 10%to host gene expression in the jejunum,ileum,and colon.When we further focused on the effects of colonic UICS metabolites on the colonic immune-related differentially expressed genes(DEGs),the results indicated that 1-palmitoylglycerol and deoxycholic acid contributed 60.74 and 11.5%to the colonic immune-related DEGs,respectively.Our findings provide a preliminary framework of microbial effects that includes the microbiota and their metabolite changes,especially reduced 1-palmitoylglycerol and deoxycholic acid,in the former gastrointestinal tract that could be involved in the alleviation of colonic inflammation in goats fed LRDS diets.展开更多
BACKGROUND Gastrointestinal duplication is a rare congenital anomaly of the digestive tract,with colonic manifestations being particularly uncommon.Malignant transformation of colonic duplication cysts is rare,with ad...BACKGROUND Gastrointestinal duplication is a rare congenital anomaly of the digestive tract,with colonic manifestations being particularly uncommon.Malignant transformation of colonic duplication cysts is rare,with adenocarcinoma being the most frequently reported type.Herein,we report a rare case of adenocarcinoma originating from a colonic duplication cyst.CASE SUMMARY A 49-year-old woman was found to have an elevated cancer antigen 19-9 level during a routine checkup.Imaging revealed a well-defined abdominal cavity cystic mass,which was initially suspected to be an ovarian teratoma.Laparoscopic surgery revealed a duplication cyst,and pathological examination confirmed adenocarcinoma arising from the cyst.The mass within the transverse mesocolon was successfully excised by a colorectal surgeon.Immunohistochemical analysis confirmed adenocarcinoma with invasion into the muscularis propria.Postoperative endoscopy and positron emission computed tomography scan showed no signs of malignancy,except for an elevated cancer antigen 19-9 level.A multidisciplinary team recommended no further chemotherapy,advising routine follow-up for monitoring.CONCLUSION Colonic duplications,though rare,remain a differential diagnosis of unexplained abdominal masses,with complete resection being their primary treatment approach.展开更多
BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of con...BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.展开更多
BACKGROUND Colonic neuroendocrine carcinomas(NECs)are highly malignant and invasive with poor prognosis.Long noncoding RNAs(LncRNAs)participate in the tumorigenesis and metastasis of multiple cancers AIM To detect the...BACKGROUND Colonic neuroendocrine carcinomas(NECs)are highly malignant and invasive with poor prognosis.Long noncoding RNAs(LncRNAs)participate in the tumorigenesis and metastasis of multiple cancers AIM To detect the roles and mechanisms of lncRNA prostate cancer associated transcript 6(PCAT6)in the progression of colonic NEC.METHODS Human NEC and adjacent normal samples were collected for immunohistochemistry staining of CgA and real-time quantitative polymerase chain reaction(RT-qPCR)of PCAT6 mRNA level.Subcutaneous xenograft tumor model and lung metastasis model were established in nude mice.The lung tissues were stained by hematoxylin and eosin to assess pulmonary metastasis.The expression of epithelial-mesenchymal transition(EMT)-related markers and pathway-related genes was measured by RT-qPCR and western blotting.CD56 expression was assessed by immunofluorescence staining.The biological functions of PCAT6 were examined by cell counting kit-8,colony formation assays,Transwell assays and wound healing assays.The interaction between PCAT6 and its potential downstream target was verified by luciferase reporter assays.RESULTS LncRNA PCAT6 was upregulated in human NEC samples and LCC-18 cells,and its high expression was positively correlated with poor prognosis in patients with colonic NEC.Additionally,the expression of PCAT6 was positively associated with the proliferation,migration,invasion,and EMT of LCC-18 cells.Moreover,PCAT6 facilitated tumor growth,lung metastasis and EMT in xenografts.Mechanistically,PCAT6 promoted the activation of MAPK to enhance the EMT in colonic NEC by targeting miR-326.CONCLUSION In conclusion,lncRNA PCAT6 accelerates the process of colonic NEC by activating ERK/p38 MAPK signaling through targeting miR-326.These results might provide useful information for exploring the potential therapeutic targets in colonic NEC.展开更多
Objective:To investigate the feasibility of using a colonic mucosa graft(CMG)for ureteral reconstruction and assess histological changes following the engrafted CMG in Beagles.Methods:Nine male Beagle dogs were random...Objective:To investigate the feasibility of using a colonic mucosa graft(CMG)for ureteral reconstruction and assess histological changes following the engrafted CMG in Beagles.Methods:Nine male Beagle dogs were randomly assigned to groups Ⅰ,Ⅱ,and Ⅲ(n=3).Resection of half of the ureteral wall caused a ventral ureteral defect.Ureteral defects with lengths of 3 cm,5 cm,and 10 cm were created in these groups,respectively.The CMG was harvested and used to repair the ureteral defects in an onlay fashion.After functional evaluation of the reconstructed ureter using CT urography at 3 months,6 months,and 12 months postoperatively,one Beagle from each group was euthanized using air embolization.Ureteral diameter measurements and the CMG shrinkage rate calculations were performed.Histological analysis was conducted to assess changes in the engrafted CMG.Results:All animals had no postoperative complications.CT urography showed normal renal function and a wide caliber ureter with no stricture or leakage.The ureteral diameter reconstructed by the CMG was larger than that of the proximal or distal normal ureter(p<0.05).The mean shrinkage rate of the CMG ranged from 11% to 14%.From 3 months to 12 months postoperatively,the colonic mucosal epithelium gradually underwent metaplasia into urothelium,and smooth muscle and neovascularization gradually developed beneath the mucosa.展开更多
Background Dysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention,especially in the context of alternative feeding strategies.This study aims to elucid...Background Dysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention,especially in the context of alternative feeding strategies.This study aims to elucidate the effects of milk replacer(MR)feeding on growth,lipid metabolism,colonic epithelial gene expression,colonic microbiota composition and systemic metabolism in goat kids compared to breast milk(BM)feeding,addressing a critical knowledge gap in early life nutrition.Methods Ten female goat kids were divided into 2 groups:those fed breast milk(BM group)and those fed a milk replacer(MR group).Over a period of 28 d,body weight was monitored and blood and tissue samples were collected for biochemical,transcriptomic and metabolomic analyses.Profiling of the colonial microbiota was performed using 16S rRNA gene sequencing.Intestinal microbiota transplantation(IMT)experiments in gnotobiotic mice were per-formed to validate causality.Results MR-fed pups exhibited reduced daily body-weight gain due to impaired lipid metabolism as evidenced by lower serum and liver total cholesterol(TC)and non-esterified fatty acid(NEFA)concentrations.Transcriptomic analysis of the colonic epithelium revealed upregulated genes involved in negative regulation of lipid metabolism,concomitant with microbiota shifts characterized by a decrease in Firmicutes and an increase in Actinobacteria.Specifically,genera such as Bifidobacterium and Prevotella were enriched in the MR group,while Clostridium and Fae-calibacterium were depleted.Metabolomics analyses confirmed alterations in bile acid and fatty acid metabolic path-ways.IMT experiments in mice recapitulated the metabolic phenotype observed in MR-fed goats,confirming the role of the microbiota in modulating host lipid metabolism.Conclusions Milk replacer feeding in goat kids disrupts lipid metabolism and gut microbiota dynamics,result-ing in reduced growth rates and metabolic alterations.These findings highlight the importance of early nutritional intervention on metabolic programming and suggest that modulation of the gut microbiota may be a target for improving growth and metabolic health in ruminants.This study contributes to the understanding of nutritional management strategies in livestock and their impact on animal health and productivity.展开更多
BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has ass...BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.展开更多
Whole-grain foods have attracted emerging attention due to their health benefits.Whole grains are rich in bound polyphenols(BPs)linked with dietary fibers,which is largely underestimated compared with free polyphenols...Whole-grain foods have attracted emerging attention due to their health benefits.Whole grains are rich in bound polyphenols(BPs)linked with dietary fibers,which is largely underestimated compared with free polyphenols.In this study,in vitro simulated gastrointestinal digestion and colonic fermentation models were used to study the release profile and metabolism of BPs of oat bran.Significantly higher level of BPs was released during in vitro colon fermentation(3.05 mg GAE/g)than in gastrointestinal digestion(0.54 mg GAE/g).Five polyphenols were detected via LC-MS and their possible conversion pathways were speculated.Released BPs exhibited chemical antioxidant capacity.16S rRNA sequencing further revealed that Clostridium butyricum,Enterococcus faecalis,Bacteroides acidifaciens were the key bacteria involved in the release of BPs,and this was verified by whole-cell transformation.Our results helped to explain the possible mechanism of the health benefits of BPs in whole grains.展开更多
文摘Background:We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way.Our case is the first in the literature to describe this minimally invasive treatment technique for colon perforation in a completely asymptomatic patient.Case Description:A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy placement.The patient had a history of endometrial cancer,treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy.Her recovery had been further complicated by the development of radiation cystitis,small bowel resection,and short gut syndrome.The strictures had previously been managed with bilateral double J stents,which have now failed.A left-sided nephrostomy insertion was performed.ACT-scan prompted by a repeat deterioration in renal function revealed a right-sided hydronephrosis and suggested transcolic passage of the previously placed leftsided nephrostomy.She had remained clinically well and apyretic.A right-sided nephrostomy was inserted,and the left re-sited following a colonoscopy-guided nephrostomy removal and clip occlusion of the nephrostomy tract.The patient then developed a pseudoaneurysm,which was managed with embolization.The patient was able to return home with corrected kidney function.The three-monthly checks for changes in nephrostomy catheters did not reveal any complications.Conclusions:The patient therefore presented with two major complications of nephrostomy placement:colonic perforation and pseudoaneurysm,classified as Clavien IIIb and IIIa,respectively.Multidisciplinary management,including urologists,gastroenterologists,general surgeons,and radiologists,enabled a minimally invasive management.Minimally invasive management with endoscopic clip placement appears to be a safe alternative to directed fistula of colonic perforation.
基金The National Natural Science Foundation of China(32302759,32372924)the CAST Youth Talent Support Project-Special Program for Doctoral Students(156-O-230-0000375-5)。
文摘Background Weaning-induced diarrhoea and growth retardation in piglets are associated with impaired intestinal barrier function and decreased levels of colonic short-chain fatty acids(SCFAs).Although SCFA supplementation has been proposed to mitigate these issues,the efficacy and optimal dosage of sodium isobutyrate remain unclear.Results We investigated the effects of sodium isobutyrate supplementation(500,1,000,2,000,and 4,000 mg/kg diet)on weaned piglets(Duroc×Landrace×Yorkshire,28 d of age;n=8).After a 28-d feeding trial,supplementation at 500–2,000 mg/kg significantly improved average daily gain and feed efficiency and reduced diarrhoea frequency,with maximal benefits observed at 1,000 mg/kg(P<0.0001).Additionally,500–1,000 mg/kg sodium isobutyrate supplementation increased the apparent digestibility of crude protein,organic matter,and crude fibre(P<0.05).Serum biochemical parameters were unaffected,although secretory immunoglobulin A(SIgA)levels significantly increased upon supplementation with 500–1,000 mg/kg(P<0.05).16S rRNA gene sequencing indicated that sodium isobutyrate increased the abundance of beneficial colonic microbiota.The 1,000 mg/kg group presented the most pronounced effect,with a significant increase of the relative abundance of Prevotella and the greatest improvement in SCFA concentrations(P<0.05).Metabolomics revealed elevated levels of colonic indole-3-lactic acid and 3-hydroxybutyrate upon supplementation with 1,000 mg/kg(P<0.05).Transcriptomic analyses indicated activation of protein digestion and absorption pathways,and PI3K-Akt signalling,marked by TSG-6 upregulation and the suppression of ISG15 and DDIT4 expression(P<0.05).Supplementation with 1,000 mg/kg was associated with improved intestinal barrier-related markers,including reduced serum D-lactate,diamine oxidase,and lipopolysaccharide levels,increased tight junction protein expression;activation of G protein-coupled receptors;and inhibition of TLR4/MyD88/NF-κB signalling(P<0.05),suggesting enhanced barrier function.Conclusions In conclusion,dietary supplementation with 1,000 mg/kg sodium isobutyrate was associated with improved intestinal morphology,reduced serum permeability,increased expression of tight junction proteins,and enhanced immune function in weaned piglets,suggesting enhanced colonic barrier function and providing dosage guidance and mechanistic insights for future applications.
基金Supported by the Key Research and Development Program of Shaanxi,No.2024SF-YBXM-447the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07the Fundamental Research Funds for the Central Universities,No.xzy022023068.
文摘BACKGROUND Magnetic compression anastomosis(MCA)offers a simple and reliable technique for inducing anastomoses at any point along the digestive tract.Evidence regarding whether the design of the MCA device influences the anastomosis effect is lacking.AIM To investigate any difference in the side-to-side colonic anastomosis effect achieved with cylindrical vs circular ring magnets.METHODS We designed cylindrical and circular ring magnets suitable for side-to-side colonic anastomosis in rats.Thirty Sprague-Dawley rats were randomly divided into a cylindrical group,circular ring group,and cylindrical–circular ring group(n=10/group).Side-to-side colonic anastomosis was completed by transanal insertion of the magnets without incision of the colon.Operation time,perioperative complications,and magnet discharge time were recorded.Rats were euthanized 4 weeks postoperatively,and anastomotic specimens were obtained.The burst pressure and anastomotic diameter were measured sequentially,and anastomosis formation was observed by naked eye.Histological results were observed by light microscopy.RESULTS In all 30 rats,side-to-side colonic anastomosis was completed,for an operation success rate of 100%.No postoperative complications of bleeding and intestinal obstruction occurred,and the postoperative survival rate were 100%.The operation time,magnet discharge time,anastomotic bursting pressure,and anastomotic diameter did not differ significantly among the three designs(P>0.05).Healing was similar across the groups,with gross specimens showing good anastomotic healing and good mucosal continuity observed on histological analysis.CONCLUSION This study found no significant difference in the establishment of rat side-to-side colonic anastomosis with the use of cylindrical vs circular ring magnets.
基金jointly supported by the International Partnership Program of Chinese Academy of Sciences(161343KYSB20200015)Guangxi Provincial Natural Science Foundation of China(2023GXNSFAA026107)+1 种基金the Science and Technology Innovation Program of Hunan Province(2022RC1158)Youth Innovation Promotion Association CAS(2023382)。
文摘Background Dietary protein level and amino acid(AA)balance are crucial determinants of animal health and productivity.Supplementing rumen-protected AAs in low-protein diets was considered as an efficient strategy to improve the growth performance of ruminants.The colon serves as a crucial conduit for nutrient metabolism during rumen-protected methionine(RPMet)and rumen-protected lysine(RPLys)supplementation,however,it has been challenging to clarify which specific microbiota and their metabolites play a pivotal role in this process.Here,we applied metagenomic and metabolomic approaches to compare the characteristic microbiome and metabolic strategies in the colon of lambs fed a control diet(CON),a low-protein diet(LP)or a LP diet supplemented with RPMet and RPLys(LR).Results The LP treatment decreased the average daily weight gain(ADG)in lambs,while the LR treatment tended to elicit a remission in ADG.The butyrate molar concentration was greater(P<0.05),while acetate molar concentration(P<0.05)was lower for lambs fed the LP and LR diets compared to those fed the CON diet.Moreover,the LP treatment remarkably decreased total AA concentration(P<0.05),while LR treatment showed an improvement in the concentrations of methionine,lysine,leucine,glutamate,and tryptophan.Metagenomic insights proved that the microbial metabolic potentials referring to biosynthesis of volatile fatty acids(VFAs)and AAs in the colon were remarkably altered by three dietary treatments.Metagenomic binning identified distinct microbial markers for the CON group(Alistipes spp.,Phocaeicola spp.,and Ruminococcus spp.),LP group(Fibrobacter spp.,Prevotella spp.,Ruminococcus spp.,and Escherichia coli),and LR group(Akkermansia muciniphila and RUG099 spp.).Conclusions Our findings suggest that RPMet and RPLys supplementation to the low-protein diet could enhance the microbial biosynthesis of butyrate and amino acids,enriche the beneficial bacteria in the colon,and thereby improve the growth performance of lambs.
文摘The metastatic pattern of colon cancer is typically well characterized,with initial dissemination occurring through regional lymphatics,followed by hematogenous spread.The most frequent sites of metastasis in colorectal cancer(CRC)include regional lymph nodes(50%–70%),liver(35%–50%),lungs(21%),peritoneum(15%),and ovaries(13%).1 Isolated distant lymph node metastasis,particularly in the absence of concurrent systemic disease,is exceedingly rare in CRC.To date,only six cases of isolated axillary lymph node metastasis(ALNM)from colorectal primaries have been documented in the literature.1–6 Even more uncommon is the incidental discovery of malignant cells in anastomotic doughnuts following stoma reversal procedures.Herein,we report a rare case involving both the incidental histopathological detection of tumor cells within doughnuts during stoma closure and the subsequent development of isolated ALNM after curative resection of sigmoid colon carcinoma.
文摘High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relatively good prognosis,advanced cases often respond poorly to standard chemotherapy.Immune checkpoint inhibitors,such as pembrolizumab,have shown strong and lasting effects in MSI-H CRC.Pembrolizumab is now approved as a first-line treatment for metastatic MSI-H CRC due to its superior outcomes compared to traditional chemotherapy.CASE SUMMARY A 44-year-old male with MSI-H transverse colon cancer presented with hematochezia,abdominal pain,and significant weight loss.Imaging revealed a bulky tumor with invasion of adjacent structures and multiple liver lesions.A diverting ileostomy was performed followed by 36 cycles of pembrolizumab.The patient achieved a clinical and radiologic complete response.One month after completing the treatment,the patient underwent laparoscopic right hemicolectomy.A spontaneous transection of the colon at the original tumor site was unexpectedly identified.Final pathology confirmed pathological complete response(ypT0N0)with fibrosis.The patient recovered well after surgery,and follow-up showed no evidence of recurrence.CONCLUSION Immune checkpoint inhibitors may cause delayed structural damage to bowel tissue even after apparent complete tumor regression.
文摘BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.
基金supported by the Zhejiang Province Traditional Chinese Medicine Key Laboratory Project(No.GZY-ZJ-SY-2303)the Cultivation Foundation of National Natural Science Foundation of Zhejiang Cancer Hospital(No.PY2024047)+1 种基金the Joint TCM Science&Technology Projects of National Demonstration Zones for Comprehensive TCM Reform(No.GZY-KJS-ZJ-2025-036)the Key Project of Zhejiang Provincial Administration of Traditional Chinese Medicine(No.GZY-ZJ-KJ-23050),China。
文摘Objectives:Radiation enteropathy is a common complication of cervical cancer radiotherapy,and there is currently no effective treatment.This study evaluates the radioprotective effect of Premna microphylla Turcz.(PMT)on radiation-induced colon injury in mice.Materials and Methods:An 8 Gy abdominal irradiation model was established in mice,which were then gavaged with low(0.325 g/kg),medium(0.65 g/kg),or high(1.3 g/kg)doses of PMT.Weight and other routine information were recorded.The mice were euthanized on the 7 th day after radiotherapy.Colonic tissue was collected for observing structural changes.Reverse transcription quantitative polymerase chain reaction(RTqPCR)was used to detect inflammation infiltration in colon tissue.16S rRNA gene sequencing was performed to analyze the alterations in gut microbiota composition.Hepatic and renal function assessments were conducted to evaluate the safety profile of PMT.Results:PMT at medium dose significantly reduced radiation-induced weight loss(P<0.05).PMT alleviated gastrointestinal discomfort and partially reduced radiotherapy-induced faecal occult blood,although these effects were not statistically significant.Both medium and high doses of PMT reversed the shortening of colon length caused by radiotherapy(both P<0.05).The medium-and high-dose PMT improved the colonic inflammatory microenvironment by reducing the expression of inflammatory factors and chemokines(IL-1β,IL-6,IFN-γ,TNF-α,and Cxcl1)(P<0.05).PMT restored the diversity of the gut microbiota and normalized the Bacteroidetes/Firmicutes ratio disrupted by radiation.Beyond intestinal protection,PMT administration at all doses significantly reduced the postirradiation levels of serum creatinine(Cr),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)(all P<0.05).Conclusions:PMT,particularly at medium doses,has potential for treating radiation-induced colonic injury in mice without causing hepatorenal toxicity,providing a novel therapeutic approach for radiation-induced colonic diseases.
文摘BACKGROUND Self-expandable metal stent(SEMS)as a bridge to surgery(BTS)has become a popular alternative to emergency surgery in the management of acute left-sided malignant colonic obstruction(MCO).However,it remains controversial for colonic stent as a BTS due to a lack of consensus and insufficient data.AIM To assess the clinical and oncological safety of SEMS insertion followed by elective resection for acute left-sided MCO.METHODS The data from 96 patients with acute left-sided MCO in our institution from January 2018 to May 2020 were analyzed retrospectively.They underwent colonic stenting as a bridge to elective surgery(BTS group:n=40)or emergency resection(ER group:n=56).Demographic characteristics,stoma rate,laparoscopy rate,postoperative complications,and oncological outcomes were compared between the two groups.RESULTS The two groups were comparable with regard to the demographics and tumor characteristics.The stoma rate was 7.5%in the BTS group vs 48.2%in the ER group(P<0.05).Primary anastomosis was performed in all patients in the BTS group,and only three patients underwent protective stoma in the BTS group.The BTS group had a significantly higher rate of laparoscopic surgery than the ER group(90%vs 57.1%,P<0.05),and the major postoperative complication rate was significantly higher in the ER group than in the BTS group(33.9%vs 15%,P=0.04).According to the Kaplan-Meier survival analysis and log rank test,no significant differences existed in the two groups with regard to the overall survival and disease-free survival.CONCLUSION The utilization of SEMS as a BTS is a useful alternative to emergency surgery in the treatment of acute left-sided MCO.SEMS insertion as a BTS can provide an effective and safe therapeutic option compared to emergency surgery.
文摘BACKGROUND Celiac disease(CD)is a chronic inflammatory disease that affects multiple systems in genetically predisposed individuals.The only known treatment for CD is adherence to a gluten-free diet.Gluten has been found to exert deleterious immune-inflammatory effects beyond the small bowel,involving several genetic,cellular,and paracellular mechanisms in the context of chronic inflammation,leading to colorectal carcinoma(CRC)in CD patients.Several neoplasms,including adenocarcinoma and lymphoma,are associated with CD.Despite strong evidence of an association between CD and small intestinal malignancies,CRC is less common and underdiagnosed in patients with CD.In practice,most CD patients are only monitored for small bowel complications despite mild lower gastrointestinal symptoms;thus,colonoscopy is underused,with a greater focus on upper endoscopy and small bowel biopsy,a major hindrance in early diagnosis.Delayed diagnosis and poor prognosis have also been linked to nonspecific symptoms and late presentations.The lack of screening guidelines appears to be a critical gap due to disconnection between CD and heterogeneous expression of the disease complications add further diagnostic delay.AIM To critically evaluate and synthesize existing evidence on the association between CD and CRC to encourage early-stage detection through lower gastrointestinal screening in CD patients and suggest individual-specific management strategies.METHODS The Scopus,Web of Science,and PubMed databases were searched via Medical Subject Headings words related to the criteria pertinent to CD and colon cancer/neoplasm,with a focus on pathophysiological mechanisms,clinical presentations,and outcomes reviewed.RESULTS A total of 3028 citations related to CD and neoplasia were initially identified.Following a critical review and exclusions,136 citations were suitable for inclusion in this study.Despite its low incidence,a clinically significant association was found between CRC and CD that could impact the overall patient survival rate,suggesting early screening investigations,individual-specific interventions,and further longitudinal studies.CONCLUSION A low incidence of colon lymphoma and adenocarcinoma has been revealed.The clinical presentation of colon lymphoma and adenocarcinoma is indolent and nonspecific,with late presentation in the form of adhesions and perforation.A modest but statistically significant increase in CRC risk among CD patients was noted.Several overlapping factors,including individual variability,genetic and environmental factors,diagnostic delays and duration of gluten exposure,compliance with a gluten-free diet,lack of educational awareness,and complex immune-inflammatory interactions,were found to contribute to the overall incidence of CRC in CD patients.However,the true incidence may be underestimated due to the iceberg phenomenon,where limited clinical suspicion,poor screening,and underreporting may mask the underlying burden.This study highlights the need for increased clinical awareness and early screening,especially in noncompliant patients.
文摘BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.
基金Supported by the Beijing High Level Public Health Technology Talent Construction Project,No.backbone-03-04.
文摘A case-control study on the differences in colonic mucosa-associated microbiotas between patients with and without colorectal cancer(CRC)in the Indonesian population was recently published.The geographical distribution characteristics of the gut microbiota in the carcinogenic microenvironment are closely related to disease progression.Therefore,the results of that study are of great significance for determining the pathogenesis of CRC in the Indonesian region and for clinically diagnosing and treating CRC.While acknowledging the strengths of the study,its limitations should also be addressed.Future case-control studies of the gut microbiota based on specific populations should be further refined to provide more optimized guidance for clinical precision treatment.
基金supported by the National Natural Science Foundation of China(32072761,31902184 and 32102570)the Shaanxi Provincial Science and Technology Association Young Talents Lifting Program Project,China(20220203)。
文摘Postruminal intestinal inflammation and hindgut acidosis caused by increased dietary starch supply and thereby increased quantities of ruminal degradable starch(RDS)in ruminants have been widely studied.Although the roles of the microbiota in mediating hindgut health that are focused on the hindgut have been widely studied,the absence of whole gastrointestinal insight may influence the depth of research.We integrated the microbiome,metabolome,and host transcriptome changes in the rumen,jejunum,ileum,and colon to investigate the contributions of foregut changes to hindgut gene expression driven by gastrointestinal microbiota and metabolite flow.Forty goats were randomly assigned to receive either a low rumen-degradation-rate starch diet(LRDS,n=20)or a high rumen-degradation-rate starch diet(HRDS,n=20).Compared with the HRDS group,the LRDS group significantly decreased the diarrheal rate.Based on the mean values of the fecal scores,6 represented goats of LRDS group(fecal scores=(4.58±0.120))and 6 represented goats of HRDS group(fecal scores=(3.53±0.343))were selected for sampling and subsequent analysis.LRDS had significantly decreased the colonic pathologic scores.Transcriptomic analysis revealed that LRDS reduced jejunal,ileal,and colonic inflammatory responses.An increase in beneficial commensals and a decreased abundance of pathogenic genera in the small intestine and hindgut were found in goats fed the LRDS diet using 16S rRNA gene sequencing.To identify microbial transmission as well as the transmission of microbial metabolites,8 genera were identified as core genera according to their calculated niche width.Metabolomics analysis revealed that a total of 554 metabolites were identified among different gastrointestinal sites.Then,metabolites were incorporated into 3 modules:metabolites increased in the current site(ICS),unchanged inflow metabolites in the current site(UICS),and metabolites decreased in the current site(DCS).The results indicated that the UICS metabolites contributed more than 10%to host gene expression in the jejunum,ileum,and colon.When we further focused on the effects of colonic UICS metabolites on the colonic immune-related differentially expressed genes(DEGs),the results indicated that 1-palmitoylglycerol and deoxycholic acid contributed 60.74 and 11.5%to the colonic immune-related DEGs,respectively.Our findings provide a preliminary framework of microbial effects that includes the microbiota and their metabolite changes,especially reduced 1-palmitoylglycerol and deoxycholic acid,in the former gastrointestinal tract that could be involved in the alleviation of colonic inflammation in goats fed LRDS diets.
基金Supported by a research fund from Dankook University in 2024this research was supported by the Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT)(RS-2023-00220408).
文摘BACKGROUND Gastrointestinal duplication is a rare congenital anomaly of the digestive tract,with colonic manifestations being particularly uncommon.Malignant transformation of colonic duplication cysts is rare,with adenocarcinoma being the most frequently reported type.Herein,we report a rare case of adenocarcinoma originating from a colonic duplication cyst.CASE SUMMARY A 49-year-old woman was found to have an elevated cancer antigen 19-9 level during a routine checkup.Imaging revealed a well-defined abdominal cavity cystic mass,which was initially suspected to be an ovarian teratoma.Laparoscopic surgery revealed a duplication cyst,and pathological examination confirmed adenocarcinoma arising from the cyst.The mass within the transverse mesocolon was successfully excised by a colorectal surgeon.Immunohistochemical analysis confirmed adenocarcinoma with invasion into the muscularis propria.Postoperative endoscopy and positron emission computed tomography scan showed no signs of malignancy,except for an elevated cancer antigen 19-9 level.A multidisciplinary team recommended no further chemotherapy,advising routine follow-up for monitoring.CONCLUSION Colonic duplications,though rare,remain a differential diagnosis of unexplained abdominal masses,with complete resection being their primary treatment approach.
文摘BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.
文摘BACKGROUND Colonic neuroendocrine carcinomas(NECs)are highly malignant and invasive with poor prognosis.Long noncoding RNAs(LncRNAs)participate in the tumorigenesis and metastasis of multiple cancers AIM To detect the roles and mechanisms of lncRNA prostate cancer associated transcript 6(PCAT6)in the progression of colonic NEC.METHODS Human NEC and adjacent normal samples were collected for immunohistochemistry staining of CgA and real-time quantitative polymerase chain reaction(RT-qPCR)of PCAT6 mRNA level.Subcutaneous xenograft tumor model and lung metastasis model were established in nude mice.The lung tissues were stained by hematoxylin and eosin to assess pulmonary metastasis.The expression of epithelial-mesenchymal transition(EMT)-related markers and pathway-related genes was measured by RT-qPCR and western blotting.CD56 expression was assessed by immunofluorescence staining.The biological functions of PCAT6 were examined by cell counting kit-8,colony formation assays,Transwell assays and wound healing assays.The interaction between PCAT6 and its potential downstream target was verified by luciferase reporter assays.RESULTS LncRNA PCAT6 was upregulated in human NEC samples and LCC-18 cells,and its high expression was positively correlated with poor prognosis in patients with colonic NEC.Additionally,the expression of PCAT6 was positively associated with the proliferation,migration,invasion,and EMT of LCC-18 cells.Moreover,PCAT6 facilitated tumor growth,lung metastasis and EMT in xenografts.Mechanistically,PCAT6 promoted the activation of MAPK to enhance the EMT in colonic NEC by targeting miR-326.CONCLUSION In conclusion,lncRNA PCAT6 accelerates the process of colonic NEC by activating ERK/p38 MAPK signaling through targeting miR-326.These results might provide useful information for exploring the potential therapeutic targets in colonic NEC.
基金funded by the grant from Zhongnan Hospital of Wuhan University(CN,Grant No.rcyj20230102 to Li B)the grant from Wuhan Union Hospital(CN,Grant No.2021xhlcyj11 to Li B).
文摘Objective:To investigate the feasibility of using a colonic mucosa graft(CMG)for ureteral reconstruction and assess histological changes following the engrafted CMG in Beagles.Methods:Nine male Beagle dogs were randomly assigned to groups Ⅰ,Ⅱ,and Ⅲ(n=3).Resection of half of the ureteral wall caused a ventral ureteral defect.Ureteral defects with lengths of 3 cm,5 cm,and 10 cm were created in these groups,respectively.The CMG was harvested and used to repair the ureteral defects in an onlay fashion.After functional evaluation of the reconstructed ureter using CT urography at 3 months,6 months,and 12 months postoperatively,one Beagle from each group was euthanized using air embolization.Ureteral diameter measurements and the CMG shrinkage rate calculations were performed.Histological analysis was conducted to assess changes in the engrafted CMG.Results:All animals had no postoperative complications.CT urography showed normal renal function and a wide caliber ureter with no stricture or leakage.The ureteral diameter reconstructed by the CMG was larger than that of the proximal or distal normal ureter(p<0.05).The mean shrinkage rate of the CMG ranged from 11% to 14%.From 3 months to 12 months postoperatively,the colonic mucosal epithelium gradually underwent metaplasia into urothelium,and smooth muscle and neovascularization gradually developed beneath the mucosa.
基金financially supported by National Natural Science Foundation of China (32160801)China Agriculture Research System (CARS-39-12)+1 种基金Young Talent Fund of Association for Science and Technology in Shaanxi, China (2023-6-2-1)“Double-chain” project on livestock breeding (2022GDTSLD-46)
文摘Background Dysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention,especially in the context of alternative feeding strategies.This study aims to elucidate the effects of milk replacer(MR)feeding on growth,lipid metabolism,colonic epithelial gene expression,colonic microbiota composition and systemic metabolism in goat kids compared to breast milk(BM)feeding,addressing a critical knowledge gap in early life nutrition.Methods Ten female goat kids were divided into 2 groups:those fed breast milk(BM group)and those fed a milk replacer(MR group).Over a period of 28 d,body weight was monitored and blood and tissue samples were collected for biochemical,transcriptomic and metabolomic analyses.Profiling of the colonial microbiota was performed using 16S rRNA gene sequencing.Intestinal microbiota transplantation(IMT)experiments in gnotobiotic mice were per-formed to validate causality.Results MR-fed pups exhibited reduced daily body-weight gain due to impaired lipid metabolism as evidenced by lower serum and liver total cholesterol(TC)and non-esterified fatty acid(NEFA)concentrations.Transcriptomic analysis of the colonic epithelium revealed upregulated genes involved in negative regulation of lipid metabolism,concomitant with microbiota shifts characterized by a decrease in Firmicutes and an increase in Actinobacteria.Specifically,genera such as Bifidobacterium and Prevotella were enriched in the MR group,while Clostridium and Fae-calibacterium were depleted.Metabolomics analyses confirmed alterations in bile acid and fatty acid metabolic path-ways.IMT experiments in mice recapitulated the metabolic phenotype observed in MR-fed goats,confirming the role of the microbiota in modulating host lipid metabolism.Conclusions Milk replacer feeding in goat kids disrupts lipid metabolism and gut microbiota dynamics,result-ing in reduced growth rates and metabolic alterations.These findings highlight the importance of early nutritional intervention on metabolic programming and suggest that modulation of the gut microbiota may be a target for improving growth and metabolic health in ruminants.This study contributes to the understanding of nutritional management strategies in livestock and their impact on animal health and productivity.
文摘BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.
基金the support from the research grants by National Natural Science Foundation of China(32202051)National Key R&D Program of China(2022YFF1100104)the Major Project of Inner Mongolia Science and Technology Department,China(2021ZD0002)。
文摘Whole-grain foods have attracted emerging attention due to their health benefits.Whole grains are rich in bound polyphenols(BPs)linked with dietary fibers,which is largely underestimated compared with free polyphenols.In this study,in vitro simulated gastrointestinal digestion and colonic fermentation models were used to study the release profile and metabolism of BPs of oat bran.Significantly higher level of BPs was released during in vitro colon fermentation(3.05 mg GAE/g)than in gastrointestinal digestion(0.54 mg GAE/g).Five polyphenols were detected via LC-MS and their possible conversion pathways were speculated.Released BPs exhibited chemical antioxidant capacity.16S rRNA sequencing further revealed that Clostridium butyricum,Enterococcus faecalis,Bacteroides acidifaciens were the key bacteria involved in the release of BPs,and this was verified by whole-cell transformation.Our results helped to explain the possible mechanism of the health benefits of BPs in whole grains.
