In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for c...In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for clinical practice.However,we believe that the authors should also provide information on the patient's long-term prognosis.展开更多
This article discusses a recent study by Wang et al that sheds light on the metabolic and immunological mechanisms driving the progression of metabolic dysfunction-associated fatty liver disease(MAFLD)to hepatocellula...This article discusses a recent study by Wang et al that sheds light on the metabolic and immunological mechanisms driving the progression of metabolic dysfunction-associated fatty liver disease(MAFLD)to hepatocellular carcinoma(HCC).The study highlights the role of mitochondrial carnitine palmitoyltransferase Ⅱ(CPT Ⅱ)inactivity,which activates liver cancer stem cells marked by cluster of differentiation 44(CD44)and CD24 expression,promoting HCC development.Using dynamic mouse models and clinical samples,Wang et al identified CPT Ⅱ downregulation,mitochondrial membrane potential alterations,and reduced intrahepatic CD4^(+)T cell as key drivers of disease progression.The findings link these changes to steroid biosynthesis and p53 signaling,contributing to T-cell dysfunction and immunosuppression.This article emphasizes the relevance of these results in understanding MAFLD pathogenesis and discusses potential therapeutic strategies targeting CPT Ⅱ activity,mitochondrial function,and immune surveillance to prevent or mitigate HCC development in advanced MAFLD.展开更多
BACKGROUND Colorectal cancer is the third most common malignancy and the fourth leading cause of cancer-related deaths worldwide.Several studies have shown an association between gut microbiota and colorectal cancer.G...BACKGROUND Colorectal cancer is the third most common malignancy and the fourth leading cause of cancer-related deaths worldwide.Several studies have shown an association between gut microbiota and colorectal cancer.Gut microbiota is unique and can be influenced by geographic factors and habits.This study aimed to determine the diversity and composition of colonic mucosal microbiota in patients with and without colorectal cancer.AIM To determine the diversity and composition of colonic mucosal microbiota in patients with and without colorectal cancer in Indonesia.METHODS This case-control study included 59 subjects(35 colorectal cancer patients and 24 non-colorectal cancer patients indicated for colonoscopy at Dr.Cipto Mangunkusumo Gastrointestinal Endoscopy Center and Fatmawati Hospital.Microbiota examination was performed using 16S rRNA sequencing.Bioinformatics analysis was performed using the wf-metagenomics pipeline from EPI2Me-Labs(Oxford Nanopore Technologies platform).RESULTS Patients with colorectal cancer had a higher median index value on the Shannon index(3.28 vs 2.82,P>0.05)and a lower value on the Simpson index(0.050 vs 0.060,P>0.05).Significant differences in beta diversity were observed at the genus(P=0.002)and species levels(P=0.001).Firmicutes,Proteobacteria,Bacteroidetes,and Fusobacteria were the dominant phyla.The genera Bacteroides,Campylobacter,Peptostreptococcus,and Parvimonas were found more frequently in colorectal cancer,while Faecalibacterium,Haemophilus,and Phocaeicola were more frequently found in non-colorectal cancer.The relative abundance of Fusobacterium nucleatum,Bacteroides fragilis,Enterococcus faecalis,Campylobacter hominis,and Enterococcus faecalis species was significantly elevated in patients with colorectal cancer.Meanwhile,Faecalibacterium prausnitzii,Faecalibacterium duncaniae,and Prevotella copri were more commonly found in non-colorectal cancer.CONCLUSION Patients with colorectal cancer exhibit distinct differences in the composition and diversity of their colonic mucosal microbiota compared to those with non-colorectal cancer.This study was reviewed and approved by the Ethics Committee of Faculty of Medicine,Universitas Indonesia(No.KET-1517/UN2.F1/ETIK/PPM.00.02/2023).展开更多
This article explores the significant implications of the study by Ovadia et al,which innovatively compares the efficacy of a nutritional intervention(Modulen)to conventional pharmaceutical therapy(budesonide)in promo...This article explores the significant implications of the study by Ovadia et al,which innovatively compares the efficacy of a nutritional intervention(Modulen)to conventional pharmaceutical therapy(budesonide)in promoting mucosal healing in Crohn’s disease.Highlighting the paradox of a well-established yet underutilized nutritional approach,the findings suggest that Modulen may offer comparable therapeutic benefits despite its high withdrawal rate due to adherence challenges.This advancement underscores the evolving paradigm in inflammatory bowel disease treatment,shifting focus toward non-pharmacologic alternatives that target both clinical remission and endoscopic healing.The article advocates for the development of integrative treatment strategies that balance efficacy,patient adherence,and long-term disease management,emphasizing the need for further research to refine and optimize the role of nutritional therapies in clinical practice.展开更多
In the contemporary medical landscape,the burgeoning interest in natural therapies,particularly for managing gastrointestinal disorders,has brought traditional Chinese medicine(TCM)to the forefront.This article explai...In the contemporary medical landscape,the burgeoning interest in natural therapies,particularly for managing gastrointestinal disorders,has brought traditional Chinese medicine(TCM)to the forefront.This article explains the core principles and clinical applications of TCM in treating these conditions,furthering the discourse through an examination of integrated TCM strategies,as demonstrated in the study by Zhou et al.While TCM has shown promising clinical outcomes,it encounters significant hurdles in standardization,mechanistic research,and clinical validation.Future investigations should aim to solidify the scientific underpinnings of TCM and expand its use in gastrointestinal disease management,striving for a seamless fusion of traditional and contemporary medical practices.展开更多
BACKGROUND Strictures in ulcerative colitis(UC)are relatively uncommon but are associated with increased risk of malignancy and complications.Until recently,fibrogenesis and strictures have remained largely unexplored...BACKGROUND Strictures in ulcerative colitis(UC)are relatively uncommon but are associated with increased risk of malignancy and complications.Until recently,fibrogenesis and strictures have remained largely unexplored in UC.AIM To investigate the incidence,long-term prognosis and risk factors of colorectal strictures in a large cohort of UC patients.METHODS A total of 938 hospitalized UC patients at Peking Union Medical College Hospital were included from 2014 to 2024.Stricture was defined as a fixed localized narrowing of the colorectal lumen.Risk factors for stricture formation were identified by multivariable Cox regression.Prognosis was analyzed using the Kaplan-Meier or Fine-Gray method.Sensitivity analysis excluded malignant strictures due to their distinct pathophysiology.RESULTS The overall incidence of stricture was 12.4%over a median follow-up of 8.70 years,with a 10-year cumulative probability of 11.3%.Malignancy occurred in 8.6%of stricture cases.UC patients with strictures were at higher risk for intestinal complications,surgery and malignancy(P<0.05).The 10-year cumulative probabilities of surgery and all-cause mortality were 37.6%and 1.6%,respectively.Age≥40 years at diagnosis[hazard ratio(HR)=2.197,95%confidence interval(CI):1.487-3.242]and extraintestinal manifestations(HR=2.072,95%CI:1.326-3.239)were associated with higher stricture risk,while the use of biological agents such as vedolizumab(HR=0.382,95%CI:0.203-0.720)was protective against strictures(P<0.05).Sensitivity analysis on benign strictures showed consistent findings,with similar risk factors and worse longterm outcomes.CONCLUSION UC patients with strictures had worse long-term prognostic outcomes.Earlier endoscopic surveillance and biologic treatment should be considered in patients≥40 years or those with extraintestinal manifestations.展开更多
BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,wh...BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,which leads to insufficient understanding by clinicians,misdiagnosis,and unnecessary surgeries.CASE SUMMARY A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin.The transvaginal gynecological ultrasound ruled out pregnancy.Upper gastrointestinal endoscopy and colonoscopy were performed,but no bleeding focus was detected.The contrast-enhanced computed tomography was unremarkable.The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots.Therefore,oral single-balloon enteroscopy was performed,and two connected protuberant lesions were detected,with blood clot traces and local ulceration.The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor.The patient underwent surgical resection of the diseased jejunum.Intraoperative endoscopy was performed,and the findings were the same as those of the small intestine endoscopy.The postoperative pathology confirmed the preoperative diagnosis of invasive mole.CONCLUSION In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding,metastatic trophoblastic neoplasia should be considered.展开更多
BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and mali...BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and malignancies including pancreatic cancer.However,data on its association with pancreatic cystic neo-plasm(PCN),is unknown.AIM To investigate the association of GGT with the incidence of PCN.METHODS In this nationwide retrospective cohort study,participants who received general health checkup by National Health Insurance Service in 2009 were included.Newly diagnosed PCNs from one year after the checkup to 2020 were identified.Participants were divided into quartiles based on GGT levels.Multivariable cox proportional hazard models estimated the risk of PCNs according to GGT quartiles(Q1-Q4).Subgroup analyses by age,sex,and comorbidities,and sensitivity analyses varying lag periods and GGT categorizations were performed.RESULTS There were 28940 cases of PCNs among 2655665 eligible participants.The incidence rate was 1.09 cases per 1000 person-years,with a median follow-up of 10.32(interquartile range:10.09-10.58)years.In multivariate regression analysis,adjusted hazard ratios for GGT quartiles using Q1 group as a reference were:1.04[95%confidence interval(CI):1.005-1.075]for Q2,1.065(95%CI:1.03-1.102)for Q3,and 1.109(95%CI:1.07-1.15)for Q4.Subgroup analysis showed consistent results across age,sex,and comorbidities.In sensitivity analyses,the association remained robust even at 3-year and 5-year lag periods.A clear dose-response relationship was also observed when using GGT deciles(All P for trend<0.001).CONCLUSION Higher GGT level is associated with increased risk of PCNs.Therefore,serum GGT levels might have a role as a biomarker for the development of PCNs.展开更多
Gastric cancer(GC)is both the fifth most common cancer worldwide and the fifth in mortality.Owing to a lack of symptoms in the early stages and unspecific cli-nical presentation in the later stages,GC is usually diagn...Gastric cancer(GC)is both the fifth most common cancer worldwide and the fifth in mortality.Owing to a lack of symptoms in the early stages and unspecific cli-nical presentation in the later stages,GC is usually diagnosed at advanced stages.This means that only approximately 60%of patients are eligible for curative treat-ment,and overall,GC patients have a 5-year survival rate of only 28.3%,under-scoring the importance of developing new treatment strategies.Drug repurposing involves identifying new therapeutic uses for approved drugs and is a promising strategy for cancer treatment because of its lower cost and faster development time.A variety of targetable pathways are involved in GC progression,including the mitogen-activated protein kinase,phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin,p53,Janus kinase 2/signal transducer and activator of transcription 3,hypoxia-inducible factor-1α,wingless-type mouse mammary tumor virus integration site family/beta-catenin(Wnt/β-catenin),nuclear factor kappa B,and Hippo pathways.Therefore,the repurposing of drugs targeting these pathways represents an interesting option in the search for new treatments for GC.In this review,we explore some relevant pathways involved in the development of GC and the possibilities of repurposing drugs that target them.展开更多
The integration of artificial intelligence(AI)in gastroenterology has evolved from basic computer-aided detection to sophisticated multimodal frameworks that enable real-time clinical decision support.This study prese...The integration of artificial intelligence(AI)in gastroenterology has evolved from basic computer-aided detection to sophisticated multimodal frameworks that enable real-time clinical decision support.This study presents AI applications in gastric disease diagnosis and management,highlighting the transition from domain-specific deep learning to general-purpose large language models.Our research reveals a key finding:AI effectiveness demonstrates an inverse relationship with user expertise,with moderate-expertise practitioners benefiting the most,whereas experts and novices show limited performance gains.We developed a clinical decision support system achieving 96%lesion detection internally and 82%-87%classification accuracy in external validation.Multimodal integration,which combines endoscopic images,clinical histories,laboratory results,and genomic data,enables comprehensive disease assessment and personalized treatment.The emergence of large language models with expanding context windows and multiagent architectures represents a paradigm shift in medical AI.Furthermore,emerging technologies are expanding AI’s potential applications,and feasibility studies on smart glasses in endoscopy training suggest opportunities for hands-free assistance,although clinical implementation challenges persist.This minireview addresses persistent limitations including geographic bias in training data,regulatory hurdles,ethical considerations regarding patient privacy and AI accountability,and the concentration of AI development among tech-nology giants.Successful integration requires balancing innovation with patient safety,while preserving the irreplaceable role of human clinical judgment.展开更多
Inflammatory bowel disease(IBD)is a chronic gastrointestinal inflammatory disease.With the emergence of biologics and other therapeutic methods,two biologics or one biologic combined with a novel small-molecule drug h...Inflammatory bowel disease(IBD)is a chronic gastrointestinal inflammatory disease.With the emergence of biologics and other therapeutic methods,two biologics or one biologic combined with a novel small-molecule drug has been proposed in recent years to treat IBD.Although treatment strategies for IBD are being optimized,their efficacy and risks still warrant further consideration.This editorial explores the current risks associated with dual-targeted treatment for IBD and the great potential that fecal microbiota transplantation(FMT)may have for use in combination therapy for IBD.We are focused on addressing refractory IBD or biologically resistant IBD based on currently available dual-targeted treatment by incorporating FMT as part of this dual-targeted treatment.In this new therapy regimen,FMT represents a promising combination therapy.展开更多
BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and i...BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis(DISH).METHODS We retrospectively reviewed 2532 dengue patients over a period of 16 years(2007-2022).Patients with DISH,defined as transaminases>10 times the normal reference level and DISH with subsequent ALF,were included.Univariate regre-ssion analysis was used to identify factors associated with outcomes.Youden’s index in conjunction with receiver operating characteristic(ROC)analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death.Area under the ROC(AUROC)curve values were compared using paired data nonparametric ROC curve estimation.RESULTS Of 193 DISH patients,20 developed ALF(0.79%),with a mortality rate of 60.0%.International normalized ratio,bilirubin,albumin,and creatinine were indepen-dent predictors associated with ALF and death.Prognostic scores showed excel-lent performance:Model for end-stage liver disease(MELD)score≥15 predicted ALF(AUROC 0.917,sensitivity 90.0%,specificity 88.4%)and≥18 predicted death(AUROC 0.823,sensitivity 86.9%,specificity 89.1%);easy albumin-bilirubin(ALBI)score≥-30 predicted ALF and death(ALF:AUROC 0.835,sensitivity80.0%,specificity 72.2%;death:AUROC 0.808,sensitivity 76.9%,specificity 69.3%);ALBI score≥-2 predicted ALF and death(ALF:AUROC 0.806,sensitivity 80.0%,specificity 77.4%;death:AUROC 0.799,sensitivity 76.9%,specificity 74.3%).Platelet-ALBI score also showed good performance in predicting ALF and death(AUROC=0.786 and 0.699,respectively).MELD and EZ-ALBI scores had similar performance in predicting ALF(Z=1.688,P=0.091)and death(Z=0.322,P=0.747).CONCLUSION MELD score is the best predictor of ALF and death in DISH patients.EZ-ALBI score,a simpler yet effective score,shows promise as an alternative prognostic tool in dengue patients.展开更多
Bibliometric analyses are increasing in the field of gastric cancer.This letter discusses a recently published analysis that focused on the bidirectional relationship between depression and gastric cancer and evaluate...Bibliometric analyses are increasing in the field of gastric cancer.This letter discusses a recently published analysis that focused on the bidirectional relationship between depression and gastric cancer and evaluated the types of papers published in this field and the changes in the direction of research.There is an increasing need for new,clinically relevant studies of this association.展开更多
Small nucleolar RNAs(snoRNAs)represent a class of non-coding RNAs that play pivotal roles in post-transcriptional RNA processing and modification,thereby contributing significantly to the maintenance of cellular funct...Small nucleolar RNAs(snoRNAs)represent a class of non-coding RNAs that play pivotal roles in post-transcriptional RNA processing and modification,thereby contributing significantly to the maintenance of cellular functions related to protein synthesis.SnoRNAs have been discovered to possess the ability to influence cell fate and alter disease progression,holding immense potential in controlling human diseases.It is suggested that the dysregulation of snoRNAs in cancer exhibits differential expression across various cancer types,stages,metastasis,treatment response and/or prognosis in patients.On the other hand,colorectal cancer(CRC),a prevalent malignancy of the digestive system,is characterized by high incidence and mortality rates,ranking as the third most common cancer type.Recent research indicates that snoRNA dysregulation is associated with CRC,as snoRNA expression significantly differs between normal and cancerous conditions.Consequently,assessing snoRNA expression level and function holds promise for the prognosis and diagnosis of CRC.Nevertheless,current comprehension of the potential roles of snoRNAs in CRC remains limited.This review offers a comprehensive survey of the aberrant regulation of snoRNAs in CRC,providing valuable insights into the discovery of novel biomarkers,therapeutic targets,and potential tools for the diagnosis and treatment of CRC and furnishing critical cues for advancing research into CRC and the judicious selection of therapeutic targets.展开更多
Approximately 12-72 million people worldwide are co-infected with hepatitis B virus(HBV)and hepatitis delta virus(HDV).This concurrent infection can lead to several severe outcomes with hepatic disease,such as cirrhos...Approximately 12-72 million people worldwide are co-infected with hepatitis B virus(HBV)and hepatitis delta virus(HDV).This concurrent infection can lead to several severe outcomes with hepatic disease,such as cirrhosis,fulminant hepatitis,and hepatocellular carcinoma,being the most common.Over the past few decades,a correlation between viral hepatitis and autoimmune diseases has been reported.Furthermore,autoantibodies have been detected in the serum of patients co-infected with HBV/HDV,and autoimmune features have been reported.However,to date,very few cases of clinically significant autoimmune hepatitis(AIH)have been reported in patients with HDV infection,mainly in those who have received treatment with pegylated interferon.Interestingly,there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants.Consequently,several questions remain unanswered with the challenge to distinguish whether it is autoimmune or“autoimmune-like”hepatitis being the most crucial.Second,it remains uncertain whether autoimmunity is induced by HBV or delta virus.Finally,we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon.These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV,such as Bulevirtide or immu-nosuppressive drugs,are more appropriate for the management of patients with HDV and AIH.展开更多
BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children,respectively,requiring long-term enteral nutrition support.Pro...BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children,respectively,requiring long-term enteral nutrition support.Procedure-related mortality is a rare event,often reported to be zero in smaller studies.National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term(<30 d)and long-term survival.METHODS In this retrospective,population-based cohort study,individuals that had received a gastrostomy between 1998-2019 in Sweden were included.Individuals were identified in the Swedish National Patient Register,and survival analysis was possible by cross-referencing the Swedish Death Register.The cohort was divided into three age groups:Children(0-18 years);adults(19-64 years);and elderly(≥65 years).Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.RESULTS In total 48682 individuals(52%males,average age 60.9±25.3 years)were identified.The cohort consisted of 12.0%children,29.5%adults,and 58.5%elderly.An increased use of gastrostomies was observed during the study period,from 13.7/100000 to 22.3/100000 individuals(P<0.001).The use of PEG more than doubled(about 800 to 1800/year),with a corresponding decrease in open gastrostomy(about 700 to 340/year).Laparoscopic gastrostomy increased more than ten-fold(about 20 to 240/year).Overall,PEG,open gastrostomy,and laparoscopic gastrostomy constituted 70.0%(n=34060),23.3%(n=11336),and 4.9%(n=2404),respectively.Procedure-related mortality was 0.1%(n=44)overall(PEG:0.05%,open:0.24%,laparoscopic:0.04%).The overall 30-d mortality rate was 10.0%(PEG:9.8%,open:12.4%,laparoscopic:1.7%)and decreased from 11.6%in 1998-2009 vs 8.5%in 2010-2019(P<0.001).One-year and ten-year survival rates for children,adults,and elderly were 93.7%,67.5%,and 42.1%and 79.9%,39.2%,and 6.8%,respectively.The most common causes of death were malignancies and cardiovascular and respiratory diseases.CONCLUSION The annual use of gastrostomies in Sweden increased during the study period,with a shift towards more minimally invasive procedures.Although procedure-related death was rare,the overall 30-d mortality rate was high(10%).To overcome this,we believe that patient selection should be improved.展开更多
BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diff...BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants.All participants underwent multi-b value DWI.The main DWI-derived parameters included Mono-apparent diffusion coefficient(ADC)from mono-exponential DWI,intravoxel incoherent motion model-derived true diffusion coefficient(IVIM-D),diffusion kurtosis imaging-derived apparent diffusivity(DKI-MD),stretched exponential model-derived distributed diffusion coefficient(SEM-DDC),fractional order calculus(FROC)model-derived diffusion coefficient(FROC-D)and FROC model-derived microstructural quantity(FROC-μ),and continuous-time random-walk(CTRW)model-derived anomalous diffusion coefficient(CTRW-D)and CTRW model-derived temporal diffusion heterogeneity index(CTRW-α).The correlations between DWI-derived parameters and fibrosis stages and the parameters’diagnostic efficacy in detecting significant fibrosis(SF)were assessed and compared.RESULTS CTRW-D(r=-0.356),CTRW-α(r=-0.297),DKI-MD(r=-0.297),FROC-D(r=-0.350),FROC-μ(r=-0.321),IVIM-D(r=-0.251),Mono-ADC(r=-0.362),and SEM-DDC(r=-0.263)were significantly correlated with fibrosis stages.The areas under the ROC curves(AUCs)of the combined index of the six models for distinguishing SF(0.697-0.747)were higher than each of the parameters alone(0.524-0.719).The DWI models’ability to detect SF was similar.The combined index of CTRW model parameters had the highest AUC(0.747).CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease.The combined index of CTRW parameters had the highest AUC.展开更多
BACKGROUND The annual incidence of metabolic-associated fatty liver disease(MAFLD)in China has been increasing and is often overlooked owing to its insidious charac-teristics.Approximately 50%of the patients have a no...BACKGROUND The annual incidence of metabolic-associated fatty liver disease(MAFLD)in China has been increasing and is often overlooked owing to its insidious charac-teristics.Approximately 50%of the patients have a normal weight or are not obese.They are said to have lean-type MAFLD,and few studies of such patients are available.Because MAFLD is associated with abnormal lipid metabolism,lipid-targeted metabolomics was used in this study to provide experimental evidence for early diagnosis and pathogenesis.MAFLD and analyze metabolic pathways.UPLC-Q-Orbitrap/MS content determination was used to determine serum palmitic acid(PA),oleic acid(OA),linoleic acid(LA),and arachidonic acid(AA)levels in lean-type MAFLD patients.RESULTS Urea nitrogen and uric acid levels were higher in lean-type MAFLD patients than in healthy individuals(P<0.05).Alanine transaminase and cholinesterase levels were higher in lean-type MAFLD patients than in healthy indi-viduals(P<0.01).The expression of high-density lipoprotein and apolipoprotein A-1 were lower in lean-type MAFLD patients than in healthy individuals(P<0.05)and the expression of triglycerides and fasting blood glucose were increased(P<0.01).A total of 65 biomarkers that affected the synthesis and metabolism of fatty acids were found with P<0.05 and variable importance in projection>1.The levels of PA,OA,LA,and AA were significantly increased compared with healthy individuals.CONCLUSION The metabolic profiles of lean-type MAFLD patients and healthy participants differed significantly,yielding 65 identified biomarkers.PA,OA,LA,and AA exhibited the most significant changes,offering valuable clinical guidance for prevention and treatment of lean-type MAFLD.展开更多
Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of...Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.展开更多
BACKGROUND Ulcerative colitis is a chronic inflammatory disease of the colon with an unknown etiology.Alkaline sphingomyelinase(alk-SMase)is specifically expressed by intestinal epithelial cells,and has been reported ...BACKGROUND Ulcerative colitis is a chronic inflammatory disease of the colon with an unknown etiology.Alkaline sphingomyelinase(alk-SMase)is specifically expressed by intestinal epithelial cells,and has been reported to play an anti-inflammatory role.However,the underlying mechanism is still unclear.AIM To explore the mechanism of alk-SMase anti-inflammatory effects on intestinal barrier function and oxidative stress in dextran sulfate sodium(DSS)-induced colitis.METHODS Mice were administered 3%DSS drinking water,and disease activity index was determined to evaluate the status of colitis.Intestinal permeability was evaluated by gavage administration of fluorescein isothiocyanate dextran,and bacterial translocation was evaluated by measuring serum lipopolysaccharide.Intestinal epithelial cell ultrastructure was observed by electron microscopy.Western blotting and quantitative real-time reverse transcription-polymerase chain reaction were used to detect the expression of intestinal barrier proteins and mRNA,respectively.Serum oxidant and antioxidant marker levels were analyzed using commercial kits to assess oxidative stress levels.RESULTS Compared to wild-type(WT)mice,inflammation and intestinal permeability in alk-SMase knockout(KO)mice were more severe beginning 4 d after DSS induction.The mRNA and protein levels of intestinal barrier proteins,including zonula occludens-1,occludin,claudin-3,claudin-5,claudin-8,mucin 2,and secretory immunoglobulin A,were significantly reduced on 4 d after DSS treatment.Ultrastructural observations revealed progressive damage to the tight junctions of intestinal epithelial cells.Furthermore,by day 4,mitochondria appeared swollen and degenerated.Additionally,compared to WT mice,serum malondialdehyde levels in KO mice were higher,and the antioxidant capacity was significantly lower.The expression of the transcription factor nuclear factor erythroid 2-related factor 2(Nrf2)in the colonic mucosal tissue of KO mice was significantly decreased after DSS treatment.mRNA levels of Nrf2-regulated downstream antioxidant enzymes were also decreased.Finally,colitis in KO mice could be effectively relieved by the injection of tertiary butylhydroquinone,which is an Nrf2 activator.CONCLUSION Alk-SMase regulates the stability of the intestinal mucosal barrier and enhances antioxidant activity through the Nrf2 signaling pathway.展开更多
基金Supported by National Natural Science Foundation of China,No.821706751·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC21011.
文摘In this manuscript,we comment on a recent publication by Yuan et al.This article provides a detailed scientific diagnostic process for a multiple endocrine neo-plasia type 1 patient,thus offering strong guidance for clinical practice.However,we believe that the authors should also provide information on the patient's long-term prognosis.
文摘This article discusses a recent study by Wang et al that sheds light on the metabolic and immunological mechanisms driving the progression of metabolic dysfunction-associated fatty liver disease(MAFLD)to hepatocellular carcinoma(HCC).The study highlights the role of mitochondrial carnitine palmitoyltransferase Ⅱ(CPT Ⅱ)inactivity,which activates liver cancer stem cells marked by cluster of differentiation 44(CD44)and CD24 expression,promoting HCC development.Using dynamic mouse models and clinical samples,Wang et al identified CPT Ⅱ downregulation,mitochondrial membrane potential alterations,and reduced intrahepatic CD4^(+)T cell as key drivers of disease progression.The findings link these changes to steroid biosynthesis and p53 signaling,contributing to T-cell dysfunction and immunosuppression.This article emphasizes the relevance of these results in understanding MAFLD pathogenesis and discusses potential therapeutic strategies targeting CPT Ⅱ activity,mitochondrial function,and immune surveillance to prevent or mitigate HCC development in advanced MAFLD.
文摘BACKGROUND Colorectal cancer is the third most common malignancy and the fourth leading cause of cancer-related deaths worldwide.Several studies have shown an association between gut microbiota and colorectal cancer.Gut microbiota is unique and can be influenced by geographic factors and habits.This study aimed to determine the diversity and composition of colonic mucosal microbiota in patients with and without colorectal cancer.AIM To determine the diversity and composition of colonic mucosal microbiota in patients with and without colorectal cancer in Indonesia.METHODS This case-control study included 59 subjects(35 colorectal cancer patients and 24 non-colorectal cancer patients indicated for colonoscopy at Dr.Cipto Mangunkusumo Gastrointestinal Endoscopy Center and Fatmawati Hospital.Microbiota examination was performed using 16S rRNA sequencing.Bioinformatics analysis was performed using the wf-metagenomics pipeline from EPI2Me-Labs(Oxford Nanopore Technologies platform).RESULTS Patients with colorectal cancer had a higher median index value on the Shannon index(3.28 vs 2.82,P>0.05)and a lower value on the Simpson index(0.050 vs 0.060,P>0.05).Significant differences in beta diversity were observed at the genus(P=0.002)and species levels(P=0.001).Firmicutes,Proteobacteria,Bacteroidetes,and Fusobacteria were the dominant phyla.The genera Bacteroides,Campylobacter,Peptostreptococcus,and Parvimonas were found more frequently in colorectal cancer,while Faecalibacterium,Haemophilus,and Phocaeicola were more frequently found in non-colorectal cancer.The relative abundance of Fusobacterium nucleatum,Bacteroides fragilis,Enterococcus faecalis,Campylobacter hominis,and Enterococcus faecalis species was significantly elevated in patients with colorectal cancer.Meanwhile,Faecalibacterium prausnitzii,Faecalibacterium duncaniae,and Prevotella copri were more commonly found in non-colorectal cancer.CONCLUSION Patients with colorectal cancer exhibit distinct differences in the composition and diversity of their colonic mucosal microbiota compared to those with non-colorectal cancer.This study was reviewed and approved by the Ethics Committee of Faculty of Medicine,Universitas Indonesia(No.KET-1517/UN2.F1/ETIK/PPM.00.02/2023).
文摘This article explores the significant implications of the study by Ovadia et al,which innovatively compares the efficacy of a nutritional intervention(Modulen)to conventional pharmaceutical therapy(budesonide)in promoting mucosal healing in Crohn’s disease.Highlighting the paradox of a well-established yet underutilized nutritional approach,the findings suggest that Modulen may offer comparable therapeutic benefits despite its high withdrawal rate due to adherence challenges.This advancement underscores the evolving paradigm in inflammatory bowel disease treatment,shifting focus toward non-pharmacologic alternatives that target both clinical remission and endoscopic healing.The article advocates for the development of integrative treatment strategies that balance efficacy,patient adherence,and long-term disease management,emphasizing the need for further research to refine and optimize the role of nutritional therapies in clinical practice.
基金Supported by the 2023 Government Funded Project of the Outstanding Talents Training Program in Clinical Medicine,No.ZF2023165Key Research and Development Projects of Hebei Province,No.18277731DNatural Science Foundation of Hebei Province,No.H202423105.
文摘In the contemporary medical landscape,the burgeoning interest in natural therapies,particularly for managing gastrointestinal disorders,has brought traditional Chinese medicine(TCM)to the forefront.This article explains the core principles and clinical applications of TCM in treating these conditions,furthering the discourse through an examination of integrated TCM strategies,as demonstrated in the study by Zhou et al.While TCM has shown promising clinical outcomes,it encounters significant hurdles in standardization,mechanistic research,and clinical validation.Future investigations should aim to solidify the scientific underpinnings of TCM and expand its use in gastrointestinal disease management,striving for a seamless fusion of traditional and contemporary medical practices.
基金Supported by the National Natural Science Foundation of China,No.82270567the Central High-Level Hospital Clinical Research Project of Peking Union Medical College Hospital,No.2022-PUMCH-B-022 and No.2022-PUMCH-C-055.
文摘BACKGROUND Strictures in ulcerative colitis(UC)are relatively uncommon but are associated with increased risk of malignancy and complications.Until recently,fibrogenesis and strictures have remained largely unexplored in UC.AIM To investigate the incidence,long-term prognosis and risk factors of colorectal strictures in a large cohort of UC patients.METHODS A total of 938 hospitalized UC patients at Peking Union Medical College Hospital were included from 2014 to 2024.Stricture was defined as a fixed localized narrowing of the colorectal lumen.Risk factors for stricture formation were identified by multivariable Cox regression.Prognosis was analyzed using the Kaplan-Meier or Fine-Gray method.Sensitivity analysis excluded malignant strictures due to their distinct pathophysiology.RESULTS The overall incidence of stricture was 12.4%over a median follow-up of 8.70 years,with a 10-year cumulative probability of 11.3%.Malignancy occurred in 8.6%of stricture cases.UC patients with strictures were at higher risk for intestinal complications,surgery and malignancy(P<0.05).The 10-year cumulative probabilities of surgery and all-cause mortality were 37.6%and 1.6%,respectively.Age≥40 years at diagnosis[hazard ratio(HR)=2.197,95%confidence interval(CI):1.487-3.242]and extraintestinal manifestations(HR=2.072,95%CI:1.326-3.239)were associated with higher stricture risk,while the use of biological agents such as vedolizumab(HR=0.382,95%CI:0.203-0.720)was protective against strictures(P<0.05).Sensitivity analysis on benign strictures showed consistent findings,with similar risk factors and worse longterm outcomes.CONCLUSION UC patients with strictures had worse long-term prognostic outcomes.Earlier endoscopic surveillance and biologic treatment should be considered in patients≥40 years or those with extraintestinal manifestations.
文摘BACKGROUND Gastrointestinal bleeding due to metastasis of an invasive mole to the small intestine is very rare.Most reported cases of metastatic invasive mole are diagnosed after surgery,and lack rich illustrations,which leads to insufficient understanding by clinicians,misdiagnosis,and unnecessary surgeries.CASE SUMMARY A 22-year-old female patient presented with bloody stool and elevated human chorionic gonadotropin.The transvaginal gynecological ultrasound ruled out pregnancy.Upper gastrointestinal endoscopy and colonoscopy were performed,but no bleeding focus was detected.The contrast-enhanced computed tomography was unremarkable.The capsule endoscopy suggested jejunal protuberant lesions with dark red blood clots.Therefore,oral single-balloon enteroscopy was performed,and two connected protuberant lesions were detected,with blood clot traces and local ulceration.The enteroscopic biopsy revealed trophoblastic cells with a probable diagnosis of trophoblastic tumor.The patient underwent surgical resection of the diseased jejunum.Intraoperative endoscopy was performed,and the findings were the same as those of the small intestine endoscopy.The postoperative pathology confirmed the preoperative diagnosis of invasive mole.CONCLUSION In non-pregnant women with elevated human chorionic gonadotropin and gastrointestinal bleeding,metastatic trophoblastic neoplasia should be considered.
文摘BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and malignancies including pancreatic cancer.However,data on its association with pancreatic cystic neo-plasm(PCN),is unknown.AIM To investigate the association of GGT with the incidence of PCN.METHODS In this nationwide retrospective cohort study,participants who received general health checkup by National Health Insurance Service in 2009 were included.Newly diagnosed PCNs from one year after the checkup to 2020 were identified.Participants were divided into quartiles based on GGT levels.Multivariable cox proportional hazard models estimated the risk of PCNs according to GGT quartiles(Q1-Q4).Subgroup analyses by age,sex,and comorbidities,and sensitivity analyses varying lag periods and GGT categorizations were performed.RESULTS There were 28940 cases of PCNs among 2655665 eligible participants.The incidence rate was 1.09 cases per 1000 person-years,with a median follow-up of 10.32(interquartile range:10.09-10.58)years.In multivariate regression analysis,adjusted hazard ratios for GGT quartiles using Q1 group as a reference were:1.04[95%confidence interval(CI):1.005-1.075]for Q2,1.065(95%CI:1.03-1.102)for Q3,and 1.109(95%CI:1.07-1.15)for Q4.Subgroup analysis showed consistent results across age,sex,and comorbidities.In sensitivity analyses,the association remained robust even at 3-year and 5-year lag periods.A clear dose-response relationship was also observed when using GGT deciles(All P for trend<0.001).CONCLUSION Higher GGT level is associated with increased risk of PCNs.Therefore,serum GGT levels might have a role as a biomarker for the development of PCNs.
基金Supported by the Instituto de Salud Carlos III,No.PI24/00784,No.PI24/00737,No.PI21/01181,No.PI21/00333 and No.INT22/00112Departamento de Universidad,Innovación y Transformación Digital Gobierno de Navarra,No.0011-1408-2024-000011,No.0011-1408-2022-000010.
文摘Gastric cancer(GC)is both the fifth most common cancer worldwide and the fifth in mortality.Owing to a lack of symptoms in the early stages and unspecific cli-nical presentation in the later stages,GC is usually diagnosed at advanced stages.This means that only approximately 60%of patients are eligible for curative treat-ment,and overall,GC patients have a 5-year survival rate of only 28.3%,under-scoring the importance of developing new treatment strategies.Drug repurposing involves identifying new therapeutic uses for approved drugs and is a promising strategy for cancer treatment because of its lower cost and faster development time.A variety of targetable pathways are involved in GC progression,including the mitogen-activated protein kinase,phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin,p53,Janus kinase 2/signal transducer and activator of transcription 3,hypoxia-inducible factor-1α,wingless-type mouse mammary tumor virus integration site family/beta-catenin(Wnt/β-catenin),nuclear factor kappa B,and Hippo pathways.Therefore,the repurposing of drugs targeting these pathways represents an interesting option in the search for new treatments for GC.In this review,we explore some relevant pathways involved in the development of GC and the possibilities of repurposing drugs that target them.
基金Supported by Hallym University Medical Center Research Fund。
文摘The integration of artificial intelligence(AI)in gastroenterology has evolved from basic computer-aided detection to sophisticated multimodal frameworks that enable real-time clinical decision support.This study presents AI applications in gastric disease diagnosis and management,highlighting the transition from domain-specific deep learning to general-purpose large language models.Our research reveals a key finding:AI effectiveness demonstrates an inverse relationship with user expertise,with moderate-expertise practitioners benefiting the most,whereas experts and novices show limited performance gains.We developed a clinical decision support system achieving 96%lesion detection internally and 82%-87%classification accuracy in external validation.Multimodal integration,which combines endoscopic images,clinical histories,laboratory results,and genomic data,enables comprehensive disease assessment and personalized treatment.The emergence of large language models with expanding context windows and multiagent architectures represents a paradigm shift in medical AI.Furthermore,emerging technologies are expanding AI’s potential applications,and feasibility studies on smart glasses in endoscopy training suggest opportunities for hands-free assistance,although clinical implementation challenges persist.This minireview addresses persistent limitations including geographic bias in training data,regulatory hurdles,ethical considerations regarding patient privacy and AI accountability,and the concentration of AI development among tech-nology giants.Successful integration requires balancing innovation with patient safety,while preserving the irreplaceable role of human clinical judgment.
基金Supported by The Science and Technology Plan of Liaoning Province,China,No.2022JH2/101500063.
文摘Inflammatory bowel disease(IBD)is a chronic gastrointestinal inflammatory disease.With the emergence of biologics and other therapeutic methods,two biologics or one biologic combined with a novel small-molecule drug has been proposed in recent years to treat IBD.Although treatment strategies for IBD are being optimized,their efficacy and risks still warrant further consideration.This editorial explores the current risks associated with dual-targeted treatment for IBD and the great potential that fecal microbiota transplantation(FMT)may have for use in combination therapy for IBD.We are focused on addressing refractory IBD or biologically resistant IBD based on currently available dual-targeted treatment by incorporating FMT as part of this dual-targeted treatment.In this new therapy regimen,FMT represents a promising combination therapy.
基金Supported by the Fatty Liver Unit,Foundation of the Faculty of Medicine,Chulalongkorn University.
文摘BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis(DISH).METHODS We retrospectively reviewed 2532 dengue patients over a period of 16 years(2007-2022).Patients with DISH,defined as transaminases>10 times the normal reference level and DISH with subsequent ALF,were included.Univariate regre-ssion analysis was used to identify factors associated with outcomes.Youden’s index in conjunction with receiver operating characteristic(ROC)analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death.Area under the ROC(AUROC)curve values were compared using paired data nonparametric ROC curve estimation.RESULTS Of 193 DISH patients,20 developed ALF(0.79%),with a mortality rate of 60.0%.International normalized ratio,bilirubin,albumin,and creatinine were indepen-dent predictors associated with ALF and death.Prognostic scores showed excel-lent performance:Model for end-stage liver disease(MELD)score≥15 predicted ALF(AUROC 0.917,sensitivity 90.0%,specificity 88.4%)and≥18 predicted death(AUROC 0.823,sensitivity 86.9%,specificity 89.1%);easy albumin-bilirubin(ALBI)score≥-30 predicted ALF and death(ALF:AUROC 0.835,sensitivity80.0%,specificity 72.2%;death:AUROC 0.808,sensitivity 76.9%,specificity 69.3%);ALBI score≥-2 predicted ALF and death(ALF:AUROC 0.806,sensitivity 80.0%,specificity 77.4%;death:AUROC 0.799,sensitivity 76.9%,specificity 74.3%).Platelet-ALBI score also showed good performance in predicting ALF and death(AUROC=0.786 and 0.699,respectively).MELD and EZ-ALBI scores had similar performance in predicting ALF(Z=1.688,P=0.091)and death(Z=0.322,P=0.747).CONCLUSION MELD score is the best predictor of ALF and death in DISH patients.EZ-ALBI score,a simpler yet effective score,shows promise as an alternative prognostic tool in dengue patients.
文摘Bibliometric analyses are increasing in the field of gastric cancer.This letter discusses a recently published analysis that focused on the bidirectional relationship between depression and gastric cancer and evaluated the types of papers published in this field and the changes in the direction of research.There is an increasing need for new,clinically relevant studies of this association.
基金the National Natural Science Foundation of China,No.82273457Guangdong Basic and Applied Basic Research Foundation,No.2021A1515012180 and No.2023A1515012762+1 种基金Special Grant for Key Area Programs of Guangdong Department of Education,No.2021ZDZX2040and Science and Technology Special Project of Guangdong Province,No.210715216902829.
文摘Small nucleolar RNAs(snoRNAs)represent a class of non-coding RNAs that play pivotal roles in post-transcriptional RNA processing and modification,thereby contributing significantly to the maintenance of cellular functions related to protein synthesis.SnoRNAs have been discovered to possess the ability to influence cell fate and alter disease progression,holding immense potential in controlling human diseases.It is suggested that the dysregulation of snoRNAs in cancer exhibits differential expression across various cancer types,stages,metastasis,treatment response and/or prognosis in patients.On the other hand,colorectal cancer(CRC),a prevalent malignancy of the digestive system,is characterized by high incidence and mortality rates,ranking as the third most common cancer type.Recent research indicates that snoRNA dysregulation is associated with CRC,as snoRNA expression significantly differs between normal and cancerous conditions.Consequently,assessing snoRNA expression level and function holds promise for the prognosis and diagnosis of CRC.Nevertheless,current comprehension of the potential roles of snoRNAs in CRC remains limited.This review offers a comprehensive survey of the aberrant regulation of snoRNAs in CRC,providing valuable insights into the discovery of novel biomarkers,therapeutic targets,and potential tools for the diagnosis and treatment of CRC and furnishing critical cues for advancing research into CRC and the judicious selection of therapeutic targets.
文摘Approximately 12-72 million people worldwide are co-infected with hepatitis B virus(HBV)and hepatitis delta virus(HDV).This concurrent infection can lead to several severe outcomes with hepatic disease,such as cirrhosis,fulminant hepatitis,and hepatocellular carcinoma,being the most common.Over the past few decades,a correlation between viral hepatitis and autoimmune diseases has been reported.Furthermore,autoantibodies have been detected in the serum of patients co-infected with HBV/HDV,and autoimmune features have been reported.However,to date,very few cases of clinically significant autoimmune hepatitis(AIH)have been reported in patients with HDV infection,mainly in those who have received treatment with pegylated interferon.Interestingly,there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with immunosuppressants.Consequently,several questions remain unanswered with the challenge to distinguish whether it is autoimmune or“autoimmune-like”hepatitis being the most crucial.Second,it remains uncertain whether autoimmunity is induced by HBV or delta virus.Finally,we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated interferon.These pressing issues should be elucidated to clarify whether new antiviral treatments for HDV,such as Bulevirtide or immu-nosuppressive drugs,are more appropriate for the management of patients with HDV and AIH.
文摘BACKGROUND Percutaneous endoscopic gastrostomy(PEG)and laparoscopically inserted gastrostomy have become the gold standard for adult patients and children,respectively,requiring long-term enteral nutrition support.Procedure-related mortality is a rare event,often reported to be zero in smaller studies.National data on 30-d mortality and long-term survival rates after gastrostomy placement are scarce in the literature.AIM To study the use of gastrostomies in Sweden from 1998-2019 and to analyze procedure-related mortality and short-term(<30 d)and long-term survival.METHODS In this retrospective,population-based cohort study,individuals that had received a gastrostomy between 1998-2019 in Sweden were included.Individuals were identified in the Swedish National Patient Register,and survival analysis was possible by cross-referencing the Swedish Death Register.The cohort was divided into three age groups:Children(0-18 years);adults(19-64 years);and elderly(≥65 years).Kaplan-Meier with log-rank test and Cox regression were used for survival analysis.RESULTS In total 48682 individuals(52%males,average age 60.9±25.3 years)were identified.The cohort consisted of 12.0%children,29.5%adults,and 58.5%elderly.An increased use of gastrostomies was observed during the study period,from 13.7/100000 to 22.3/100000 individuals(P<0.001).The use of PEG more than doubled(about 800 to 1800/year),with a corresponding decrease in open gastrostomy(about 700 to 340/year).Laparoscopic gastrostomy increased more than ten-fold(about 20 to 240/year).Overall,PEG,open gastrostomy,and laparoscopic gastrostomy constituted 70.0%(n=34060),23.3%(n=11336),and 4.9%(n=2404),respectively.Procedure-related mortality was 0.1%(n=44)overall(PEG:0.05%,open:0.24%,laparoscopic:0.04%).The overall 30-d mortality rate was 10.0%(PEG:9.8%,open:12.4%,laparoscopic:1.7%)and decreased from 11.6%in 1998-2009 vs 8.5%in 2010-2019(P<0.001).One-year and ten-year survival rates for children,adults,and elderly were 93.7%,67.5%,and 42.1%and 79.9%,39.2%,and 6.8%,respectively.The most common causes of death were malignancies and cardiovascular and respiratory diseases.CONCLUSION The annual use of gastrostomies in Sweden increased during the study period,with a shift towards more minimally invasive procedures.Although procedure-related death was rare,the overall 30-d mortality rate was high(10%).To overcome this,we believe that patient selection should be improved.
基金the Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital,NO.CY2021-QNB09the Science and Technology Project of Gansu Province,NO.21JR11RA122+1 种基金Department of Education of Gansu Province:Innovation Fund Project,NO.2022B-056Gansu Province Clinical Research Center for Functional and Molecular Imaging,NO.21JR7RA438.
文摘BACKGROUND Diffusion-weighted imaging(DWI)has been developed to stage liver fibrosis.However,its diagnostic performance is inconsistent among studies.Therefore,it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.AIM To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.METHODS This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants.All participants underwent multi-b value DWI.The main DWI-derived parameters included Mono-apparent diffusion coefficient(ADC)from mono-exponential DWI,intravoxel incoherent motion model-derived true diffusion coefficient(IVIM-D),diffusion kurtosis imaging-derived apparent diffusivity(DKI-MD),stretched exponential model-derived distributed diffusion coefficient(SEM-DDC),fractional order calculus(FROC)model-derived diffusion coefficient(FROC-D)and FROC model-derived microstructural quantity(FROC-μ),and continuous-time random-walk(CTRW)model-derived anomalous diffusion coefficient(CTRW-D)and CTRW model-derived temporal diffusion heterogeneity index(CTRW-α).The correlations between DWI-derived parameters and fibrosis stages and the parameters’diagnostic efficacy in detecting significant fibrosis(SF)were assessed and compared.RESULTS CTRW-D(r=-0.356),CTRW-α(r=-0.297),DKI-MD(r=-0.297),FROC-D(r=-0.350),FROC-μ(r=-0.321),IVIM-D(r=-0.251),Mono-ADC(r=-0.362),and SEM-DDC(r=-0.263)were significantly correlated with fibrosis stages.The areas under the ROC curves(AUCs)of the combined index of the six models for distinguishing SF(0.697-0.747)were higher than each of the parameters alone(0.524-0.719).The DWI models’ability to detect SF was similar.The combined index of CTRW model parameters had the highest AUC(0.747).CONCLUSION The DWI models were similarly valuable in distinguishing SF in patients with liver disease.The combined index of CTRW parameters had the highest AUC.
基金Supported by Shanghai Natural Science Foundation,No.22ZR1455900Shanghai Putuo District Health System Science and Technology Innovation Project Key Project,No.ptkwws202201Shanghai Putuo District Xinglin Excellent Youth Talent Training Program,No.ptxlyq2201.
文摘BACKGROUND The annual incidence of metabolic-associated fatty liver disease(MAFLD)in China has been increasing and is often overlooked owing to its insidious charac-teristics.Approximately 50%of the patients have a normal weight or are not obese.They are said to have lean-type MAFLD,and few studies of such patients are available.Because MAFLD is associated with abnormal lipid metabolism,lipid-targeted metabolomics was used in this study to provide experimental evidence for early diagnosis and pathogenesis.MAFLD and analyze metabolic pathways.UPLC-Q-Orbitrap/MS content determination was used to determine serum palmitic acid(PA),oleic acid(OA),linoleic acid(LA),and arachidonic acid(AA)levels in lean-type MAFLD patients.RESULTS Urea nitrogen and uric acid levels were higher in lean-type MAFLD patients than in healthy individuals(P<0.05).Alanine transaminase and cholinesterase levels were higher in lean-type MAFLD patients than in healthy indi-viduals(P<0.01).The expression of high-density lipoprotein and apolipoprotein A-1 were lower in lean-type MAFLD patients than in healthy individuals(P<0.05)and the expression of triglycerides and fasting blood glucose were increased(P<0.01).A total of 65 biomarkers that affected the synthesis and metabolism of fatty acids were found with P<0.05 and variable importance in projection>1.The levels of PA,OA,LA,and AA were significantly increased compared with healthy individuals.CONCLUSION The metabolic profiles of lean-type MAFLD patients and healthy participants differed significantly,yielding 65 identified biomarkers.PA,OA,LA,and AA exhibited the most significant changes,offering valuable clinical guidance for prevention and treatment of lean-type MAFLD.
文摘Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.
基金the Natural Science Foundation of Hainan Province,No.823MS046the Talent Program of Hainan Medical University,No.XRC2022007.
文摘BACKGROUND Ulcerative colitis is a chronic inflammatory disease of the colon with an unknown etiology.Alkaline sphingomyelinase(alk-SMase)is specifically expressed by intestinal epithelial cells,and has been reported to play an anti-inflammatory role.However,the underlying mechanism is still unclear.AIM To explore the mechanism of alk-SMase anti-inflammatory effects on intestinal barrier function and oxidative stress in dextran sulfate sodium(DSS)-induced colitis.METHODS Mice were administered 3%DSS drinking water,and disease activity index was determined to evaluate the status of colitis.Intestinal permeability was evaluated by gavage administration of fluorescein isothiocyanate dextran,and bacterial translocation was evaluated by measuring serum lipopolysaccharide.Intestinal epithelial cell ultrastructure was observed by electron microscopy.Western blotting and quantitative real-time reverse transcription-polymerase chain reaction were used to detect the expression of intestinal barrier proteins and mRNA,respectively.Serum oxidant and antioxidant marker levels were analyzed using commercial kits to assess oxidative stress levels.RESULTS Compared to wild-type(WT)mice,inflammation and intestinal permeability in alk-SMase knockout(KO)mice were more severe beginning 4 d after DSS induction.The mRNA and protein levels of intestinal barrier proteins,including zonula occludens-1,occludin,claudin-3,claudin-5,claudin-8,mucin 2,and secretory immunoglobulin A,were significantly reduced on 4 d after DSS treatment.Ultrastructural observations revealed progressive damage to the tight junctions of intestinal epithelial cells.Furthermore,by day 4,mitochondria appeared swollen and degenerated.Additionally,compared to WT mice,serum malondialdehyde levels in KO mice were higher,and the antioxidant capacity was significantly lower.The expression of the transcription factor nuclear factor erythroid 2-related factor 2(Nrf2)in the colonic mucosal tissue of KO mice was significantly decreased after DSS treatment.mRNA levels of Nrf2-regulated downstream antioxidant enzymes were also decreased.Finally,colitis in KO mice could be effectively relieved by the injection of tertiary butylhydroquinone,which is an Nrf2 activator.CONCLUSION Alk-SMase regulates the stability of the intestinal mucosal barrier and enhances antioxidant activity through the Nrf2 signaling pathway.
