Biofilm-associated proteins: from the gut biofilms to neurodegeneration

Human microbiota form a biofilm with substantial consequences for health and disease. Numerous studies have indicated that microbial communities produce functional amyloids as part of their biofilm extracellular scaffolds. The overlooked interplay between bacterial amyloids and the host may have detrimental consequences for the host, including neurodegeneration. This work gives an overview of the biofilm-associated amyloids expressed by the gut microbiota and their potential role in neurodegeneration. It discusses the biofilm-associated proteins (BAPs) of the gut microbiota, maps the amyloidogenic domains of these proteins, and analyzes the presence of bap genes within accessory genomes linked with transposable elements. Furthermore, the evidence supporting the existence of amyloids in the gut are presented. Finally, it explores the potential interactions between BAPs and α-synuclein, extending the literature on amyloid cross-kingdom interactions. Based on these findings, this study propose that BAP amyloids act as transmissible catalysts, facilitating the misfolding, accumulation, and spread of α-synuclein aggregates. This review contributes to the understanding of complex interactions among the microbiota, transmissible elements, and host, which is crucial for developing novel therapeutic approaches to combat microbiota-related diseases and improve overall health outcomes.

L3-SMI as a predictor of overall survival in oesophageal cancer patients receiving PD-1 inhibitors combined with chemotherapy

BACKGROUND

Programmed death ligand-1 (PD-1), as an immunotherapy target, has been increasingly used in tumour therapies. But as reactions and outcomes to PD-1 inhibitors combined with chemotherapy vary individually, it is primarily important to identify an ideal indicator for predicting the therapeutic effectiveness in individual patients. Oesophageal cancer (EC) patients often have difficulty eating due to tumour blockage of the oesophagus, leading to malnutrition and muscle loss. Sarcopenia is one of the influencing factors for poor prognosis in tumour patients, but its role in PD-1 inhibitors combined with chemotherapy of EC patients is not fully clarified. In this study, we aimed to explore the prognostic significance of Sarcopenia measured by CT in EC patients treated with PD-1 antibody combined with chemotherapy.

METHODS

The third lumbar skeletal muscle mass index (L3-SMI) was obtained from 83 EC patients before and 3 months after administration of PD-1 inhibitors combined with chemotherapy using conventional CT scans.

RESULTS

Baseline L3-SMI and 3-month L3-SMI values were found not suitable for predicting the overall survival (OS) of EC patients (p = 0.32 & p = 0.055). Longitudinal change in L3-SMI (ΔL3-SMI) during PD-1 inhibitors combined with chemotherapy was identified as a relevant marker of OS in univariable analysis (HR: 0.98, 95% CI: 0.96-1.00, p = 0.042) and multivariable analysis (HR: 0.96, 95% CI: 0.93-0.99, p = 0.02). L3-SMI-positive patients generally had better OS (p = 0.041).

CONCLUSION

Excessive muscle loss rather than muscle loss before and after administration of PD-1 inhibitors combined with chemotherapy is an important prognostic factor for therapeutic outcomes and OS in EC patients.

Humanized mouse models of KRAS-mutated colorectal and pancreatic cancers with HLA-class-I match for pre-clinical evaluation of cancer immunotherapies

Cancer immunotherapy promises to treat challenging cancers including KRAS-mutated colorectal cancer (CRC) and pancreatic ductal adenocarcinoma (PDAC). However, pre-clinical animal models that better mimic patient tumor and immune system interactions are required. While humanized mice are promising vehicles for pre-clinical immunotherapy testing, currently used cancer models retain limitations, such as lack of a human thymus for human leukocyte antigen (HLA)-based education of human T cells. As cytotoxic T lymphocyte (CTL) activity underlies many immunotherapies, we developed more clinically relevant KRAS-mutated CRC and PDAC humanized cancer models using transgenic NRG-A2 mice expressing HLA-A2.1 to enable HLA-class-I match between mouse tissues (including the thymus), the humanized immune system and human tumors. Using these novel humanized cancer models and a CTL-mediated combination (immuno)therapy with clinical potential, we were able to recapitulate the complexity and therapy-induced changes reported in patient biopsies, demonstrating the use of these HLA-matched models for pre-clinical validation of novel immunotherapies.

Human colitis-associated colorectal carcinoma progression is accompanied by dysbiosis with enriched pathobionts

Dysbiosis and pathobionts contribute to inflammation and the risk of colitis-associated carcinoma (CAC) in animal models, but their roles in humans with this uncommon disease are unknown. We identified microbiome differences in human CAC compared with longstanding inflammatory bowel disease (IBD) and sporadic colorectal carcinoma (CRC). Twenty-four CAC resections were matched with CRC and IBD controls. Methods included histopathology, 16S rDNA metagenomics, and pathobiont-specific qPCR. Beta diversity differed by diagnosis (PERMANOVA p = 0.007). The distinguishing taxa included Akkermansia enriched in CRC, and Bacteroides spp. enriched in IBD. The non-neoplastic mucosae presented distinct beta diversity (p = 0.005), but the CAC/CRC tumor microbiomes were similar (p = 0.7). Within metastases and margins, Enterobacteriaceae were enriched in CAC, and Bacteroidales in CRC. Pathobiont-specific qPCR confirmed a greater frequency of pks+ E. coli and enterotoxigenic Bacteroides fragilis in CAC than IBD. High alpha diversity was associated with active inflammation, advanced cancer stage, and shorter overall survival (log-rank p = 0.008). Mucosal microbiomes distinguish CAC from longstanding IBD, implicating pathobionts as markers for disease progression. Integrating our findings with prior animal model research, pathobionts promote carcinogenesis in IBD patients through genotoxicity and host cell signaling.

Establishing and validating models integrated with hematological biomarkers and clinical characteristics for the prognosis of non-esophageal squamous cell carcinoma patients

BACKGROUND

This study aimed to construct a novel model and validate its predictive power in non-esophageal squamous cell carcinoma (NESCC) patients.

METHODS

This retrospective study included 151 patients between October 2006 and September 2016. The LASSO Cox and Random Survival Forest (RSF) models were developed with the help of hematological biomarkers and clinical characteristics. The concordance index (C-index) was used to assess the prognostic power of the LASSO Cox model, RSF model, and TNM staging. Based on the risk scores of the LASSO Cox and RSF models, we divided patients into low-risk and high-risk subgroups.

RESULTS

We constructed two models in NESCC patients according to LASSO Cox regression and RSF models. The RSF model reached a C-index of 0.841 (95% CI: 0.792-0.889) in the primary cohort and 0.880 (95% CI: 0.830-0.930) in the validation cohort, which was higher than the C-index of the LASSO Cox model 0.656 (95% CI: 0.580-0.732) and 0.632 (95% CI: 0.542-0.720) in the two cohorts. The integrated C/D area under the ROC curve (AUC) values for the LASSO Cox and RSF models were 0.701 and 0.861, respectively. In both two models, Kaplan-Meier survival analysis and the estimated restricted mean survival time (RMST) values indicated that the low-risk subgroup had a better prognostic outcome than the high-risk subgroup (p < 0.05).

CONCLUSIONS

The RSF model has better prediction power than the LASSO Cox and the TNM staging models. It has a guiding value for the choice of individualized treatment in patients with NESCC.

Efficacy of first-line radiofrequency ablation combined with systemic chemotherapy plus targeted therapy for initially unresectable colorectal liver metastases

BACKGROUND/OBJECTIVE

The optimal strategy for patients with colorectal liver metastases is still controversially discussed. This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) combined with systemic chemotherapy plus targeted therapy as first-line treatment in patients with initially unresectable colorectal liver metastases (CRLM), to identify prognostic factors and construct nomograms predicting survival.

METHODS

This retrospective study included patients with initially unresectable CRLM treated with (study group n = 74) or without (control group n = 83) RFA at the National Cancer Center from January 2018 to January 2021. Survival curves were assessed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were used to determine prognostic factors and include these factors in the nomograms to predict progression-free survival (PFS) and overall survival (OS).

RESULTS

The study group had significantly better median PFS (17.16 months vs. 8.35 months, p < 0.01) and OS (34.9 months vs. 21.1 months, p < 0.01) than the control group after propensity score matching. Cox regression analyses identified RFA treatment and clinical risk score (CRS) as independent prognostic factors for PFS. The largest diameter of liver metastases, RFA treatment, and CRS were independent prognostic factors for OS. Based on this finding, nomograms with good discrimination and calibration were constructed.

CONCLUSION

RFA combined with systemic chemotherapy plus targeted therapy as first-line treatment could significantly prolong PFS and OS in patients with initially unresectable CRLM compared with systemic chemotherapy plus targeted therapy. The nomograms predicting PFS and OS might help clinicians select personalized treatment.

Solid and cystic intrapancreatic accessory spleen: report of 10 cases in a single institution

BACKGROUND

Precise diagnosis of intrapancreatic accessory spleen (IPAS) remains challenging due to its rarity and diverse presentations. Despite comprehensive examinations, including radiography and other diagnostic methods, the potential for malignancy cannot be excluded, often leading to unnecessary pancreatic surgeries. We review our institutional experience to provide insights for accurately distinguishing IPAS.

METHODS

We retrospectively reviewed 10 patients who underwent distal pancreatectomy for the lesion in the pancreas tail which was determined to be IPAS on final pathology at our institution between January 2020 and April 2024. The presenting symptoms, medical history, preoperative imaging, operative therapy, final pathology and postoperative course were evaluated.

RESULTS

Patient ages ranged from 30 to 72 (median 55.5), including six women and four men. Most patients were asymptomatic. One patient had the medical history of splenectomy. Lesions ranged from 1.4 to 7.3 cm (mean 2.9 cm). All lesions were located in the pancreatic tail. On radiologic evaluation, these lesions had both solid and cystic presentations. The most common operative approach was laparoscopic distal pancreatectomy and splenectomy. Four patients were diagnosed with epidermoid cysts arising in intrapancreatic accessory spleen (ECIPAS) on final pathologic evaluation.

CONCLUSIONS

IPAS are predominantly benign lesions which have solid and cystic presentations commonly mistaken for pancreatic neoplasms. Combining CT, MRI, EUS-FNA and nuclear medicine may enhance IPAS detection, though no definitive diagnostic method exists. Increased awareness of IPAS in the differential diagnosis of pancreatic tail tumors, coupled with advancements in imaging techniques could improve diagnostic accuracy and exclude malignancy, preventing unnecessary surgeries.

From PD-1/PD-L1 to tertiary lymphoid structures: Paving the way for precision immunotherapy in cholangiocarcinoma treatment

Cholangiocarcinoma (CCA) is a highly malignant hepatobiliary tumor characterized by limited treatment options and poor prognosis. The recent rise of immunotherapy has significantly influenced research in this field. This study presents a bibliometric analysis of 416 articles retrieved from the WOSCC, Wan fang Data, CNKI and VIP databases, spanning contributions from 32 countries, 589 institutions and 3,200 authors. The analysis identified "PD-L1," "PD-1" and "pembrolizumab" as central research foci, while "immune checkpoint inhibitors," "tumor immune microenvironment," "tertiary lymphoid structures" and "durvalumab" emerged as key areas of interest. These findings emphasize the pivotal role of immunotherapy in improving survival outcomes for CCA, and they highlight the significance of tertiary lymphoid structures within the tumor microenvironment as a promising target for future research. This study offers a strategic overview of the evolving landscape of CCA immunotherapy, providing valuable insights to guide future scientific endeavors in this domain.

High-density lipoprotein-based nanoplatform reprograms tumor microenvironment and enhances chemotherapy against pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is highly aggressive, with limited success in traditional therapies due to the fibrotic, immunosuppressive, pro-metastatic tumor microenvironment (TME), which collectively impede the drug accumulation and accelerate the tumor progression. In this work, we developed a PDAC-customized nutrient-mimicking reconstituted high-density lipoprotein (rHDL) capable of efficiently co-encapsulate versatile TME regulating cannabidiol and cytotoxic gemcitabine to simultaneously reprogram TME while suppressing PDAC progression. Specifically, a small-sized, nutrient-like rHDL was constructed to realize deep PDAC parenchyma penetration and efficient intra-tumoral uptake. Next, natural herbal compound cannabidiol was screened and incorporated into rHDL to regulate TME via attenuating fibrosis, reliving immunosuppression and mitigating metastatic tendency. At last, gemcitabine, the PDAC gold standard first-line therapy was co-delivered by the PDAC-customized rHDL to overcome drug resistance and amplify its PDAC suppression. Our findings demonstrate the feasibility of an integrated multi-stage TME regulation strategy for improved PDAC therapy, and might represent a modality in promoting chemotherapy against PDAC.

Significance of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio as prognostic predictors after liver transplantation

BACKGROUND

The use of biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-platelet ratio (NPR), has shown promise in evaluating early outcomes after medical, interventional, and surgical treatments. NLR has emerged as an indicator of systemic inflammation and physiological stress. NPR has emerged as a potential indicator of inflammation and thrombotic risk in the context of surgical and radiological procedures.

AIM

To analyze the correlation of NLR and NPR with the development of post-liver transplantation (LT) early complications after stratification for hepatocellular carcinoma diagnosis.

METHODS

Consecutive patients undergone LT between January 2019 and December 2023 were enrolled. Data regarding the concentration of hemoglobin and the differential leukocyte count on postoperative days (POD) 0, 1, 3, and 5 were collected.

RESULTS

The dataset included 161 consecutive patients undergone LT. Clavien-Dindo IV-V complications had a good correlation with NLR POD 1 (P = 0.05), NLR POD 3 (P < 0.001), NLR POD 7 (P < 0.001), NPR POD 3 (P < 0.001). In addition, the NPR ratio on POD 3 correlated with the onset of 30-day hemorrhage (P = 0.009). Finally, 30-day mortality had a significant association with the NLR POD 1 (P = 0.03) and with NLR POD 7 (P = 0.004), while NPR had a significant correlation with 30-day mortality in NPR POD 7 (P = 0.004).

CONCLUSION

The analysis of NLR and NPR are strictly correlated with Clavien-Dindo IV-V complications and 30-day post-LT death.

miR-660: A novel regulator in human cancer pathogenesis and therapeutic implications

MicroRNAs (miRNAs) are non-coding RNAs that regulate gene expression. Among these, miR-660, located on chromosome Xp11.23, is increasingly studied for its role in cancer due to its abnormal expression in various biological contexts. It is regulated by 8 competing endogenous RNAs (ceRNAs), which adds complexity to its function. miR- 660 targets 19 genes involved in 6 pathways such as PI3K/AKT/mTOR, STAT3, Wnt/β-catenin, p53, NF‑κB, and RAS, influencing cell cycle, proliferation, apoptosis, and invasion/migration. It also plays a role in resistance to chemotherapies like cisplatin, gemcitabine, and sorafenib in lung adenocarcinoma (LUAD), pancreatic ductal adenocarcinoma (PDAC), and hepatocellular carcinoma (HCC), thus highlighting its clinical importance. Additionally, leveraging liposomes as nanocarriers presents a promising avenue for enhancing cancer drug delivery. Our comprehensive study not only elucidates the aberrant expression patterns, biological functions, and regulatory networks of miR-660 and its ceRNAs but also delves into the intricate signaling pathways implicated. We envisage that our findings will furnish a robust framework and serve as a seminal reference for future investigations of miR-660, fostering advancements in cancer research and potentially catalyzing breakthroughs in cancer diagnosis and treatment paradigms.

Exploring preventive and treatment strategies for oral cancer: Modulation of signaling pathways and microbiota by probiotics

The evidence suggests that the microbiome plays a crucial role in cancer development. The oral cavity has many microorganisms that can influence oral cancer progression. Understanding the mechanisms and signaling pathways of the oral, gum, and teeth microbiome in tumor progression can lead to new treatment strategies. Probiotics, which are friendly microorganisms, have shown potential as anti-cancer agents. These positive characteristics of probiotic strains make them suitable for cancer prevention or treatment. The oral-gut microbiome axis supports health and homeostasis, and imbalances in the oral microbiome can disrupt immune signaling pathways, epithelial barriers, cell cycles, apoptosis, genomic stability, angiogenesis, and metabolic processes. Changes in the oral microbiome in oral cancer may suggest using probiotics-based treatments for their direct or indirect positive roles in cancer development, progression, and metastasis, specifically oral squamous cell carcinoma (OSCC). Here, reported relationships between probiotics, oral microbiota, and oral cancer are summarized.

Biomarkers, omics and artificial intelligence for early detection of pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed in its late stages when treatment options are limited. Unlike other common cancers, there are no population-wide screening programmes for PDAC. Thus, early disease detection, although urgently needed, remains elusive. Individuals in certain high-risk groups are, however, offered screening or surveillance. Here we explore advances in understanding high-risk groups for PDAC and efforts to implement biomarker-driven detection of PDAC in these groups. We review current approaches to early detection biomarker development and the use of artificial intelligence as applied to electronic health records (EHRs) and social media. Finally, we address the cost-effectiveness of applying biomarker strategies for early detection of PDAC.

MicroRNA-541-3p/Rac2 signaling bridges radiation-induced lung injury and repair

Background

While radiation-induced lung injury decreases quality of life and suppresses efficacy of radiotherapy, to date, the relationship between radiation-induced lung injury and repair remains unclear. Our previous studies revealed that TNFRSF10B-RIPK1/RIPK3-MLKL signaling induces necroptosis of alveolar epithelial cells and potentiates radiation-induced lung injury. We also found that microRNA-541-3p is differentially expressed in radiation-damaged lungs. The connection between microRNA-541-3p, TNFRSF10B signaling, and TGFβ1 signaling is also unclear.

Objective

This study was performed to explore the regulatory effects of microRNA-541-3p on TNFRSF10B and TGFβ1 signaling.

Methods

Mouse alveolar epithelial cells were transfected with a vector expressing microRNA-541-3p to regulate expression of target genes. Flow cytometry, polymerase chain reaction, and western blotting were used to analyze cell necroptosis, target gene expression, and target protein expression, respectively.

Results

Overexpression of microRNA-541-3p positively regulated TNFRSF10B-RIPK1/RIPK3-MLKL signaling through Rac2 to induce cell necroptosis. MicroRNA-541-3p negatively regulates Rac2. MicroRNA-541-3p and Rac2 regulate the expression of Tgf-beta1 and its encoded proteins.

Conclusions

The Rac2 gene synchronously regulates TNFRSF10B-RIPK1/RIPK3-MLKL and TGFβ1 signaling. MicroRNA-541-3P/Rac2 act as mediators of radiation damage and repair signaling.

Rare pancreatic cystic neoplasms: A pictorial review

Since rare pancreatic cystic tumors may differ from common pancreatic cystic neoplasms in terms of treatment plan and prognosis, the differential diagnosis of these diseases is clinically relevant. Various imaging tests play an important role in the differential diagnosis of rare cystic pancreatic tumors, but accurately distinguishing these diseases solely on the basis of imaging findings is challenging. The purpose of this pictorial review is to present CT and in particular MR imaging features of rare pancreatic cystic tumors and discuss potential elements for differential diagnosis.

Immunosenescence in skeletal muscle: The role-play in cancer cachexia chessboard

With the increase in life expectancy, age-related conditions and diseases have become a widespread and relevant social burden. Among these, immunosenescence and cancer cachexia play a significant often intertwined role. Immunosenescence is the progressive aging decline of both the innate and adaptive immune systems leading to increased infection susceptibility, poor vaccination efficacy, autoimmune disease, and malignancies. Cancer cachexia affects elderly patients with cancer causing severe weight loss, muscle wasting, inflammation, and reduced response to therapies. Whereas the connections between immunosenescence and cancer cachexia have been raising attention, the molecular mechanisms still need to be completely elucidated. This review aims at providing the current knowledge about the interplay between immunosenescence, skeletal muscle, and cancer cachexia, analyzing the molecular pathways known so far to be involved. Finally, we highlight potential therapeutic strategies suited for elderly population aimed to block immunosenescence and to preserve muscle mass in cachexia, also presenting the analysis of the current state-of-the-art of related clinical trials.

m6A-mediated regulation of CPSF6 by METTL3 promotes oxaliplatin resistance in colorectal cancer through enhanced glycolysis

Oxaliplatin resistance poses a significant challenge in colorectal cancer (CRC) treatment. Recent studies have implicated CPSF6 in cancer progression and drug resistance, although its role in chemotherapy resistance and regulatory mechanisms is unclear. This study investigates CPSF6's involvement in oxaliplatin resistance in CRC and its regulation via m6A methylation by METTL3. We assessed CPSF6 expression in oxaliplatin-resistant (OxR) CRC cell lines (HT29-OxR and HCT116-OxR) compared to sensitive counterparts using qRT-PCR and Western blotting. CPSF6 was significantly upregulated in OxR cells, and its knockdown reduced cell viability, colony formation, and glycolytic activity while increasing apoptosis. m6A modification of CPSF6 mRNA was elevated in OxR cells, correlating with increased METTL3 expression. METTL3 knockdown decreased CPSF6 levels and m6A enrichment, enhancing mRNA degradation, while its overexpression stabilized CPSF6 mRNA, promoting resistance. Xenograft experiments showed that CPSF6 knockdown suppressed tumor growth and glycolysis. Thus, CPSF6 is identified as a mediator of oxaliplatin resistance in CRC, regulated by the METTL3/m6A axis, suggesting potential therapeutic targets to overcome resistance.

PTEN/PI3K/AKT pathway activation with hypoxia-induced human umbilical vein endothelial cell exosome for angiogenesis-based diabetic skin reconstruction

Diabetic skin, a major clinical challenge due to impaired wound healing, is often exacerbated by a hypoxic microenvironment at the wound site. Exosomes have been proven to have excellent biological activities and applied to solve many bioengineering problems. However, the wide application of exosomes is still limited by their short in vitro lifetime and low yield. To overcome these application limitations, this study specifically enhances the pro-angiogenic biological efficacy of exosomes through hypoxic treatment and achieves sustained release using hydrogel loading. In vitro, hypoxia-induced exosomes (Hp-Exo) significantly enhanced endothelial cell migration, proliferation, and angiogenic capacity. In vivo, Gelman hydrogels loaded with Hp-Exo accelerated wound closure, promoted collagen deposition, and increased vascularization in diabetic mice. miRNA sequencing of Hp-Exo revealed that exosomes induced under hypoxic conditions contain various miRNAs, which enhance vascular endothelial cell proliferation, migration, and angiogenesis through the PTEN/PI3K/AKT pathway. These results highlight that hypoxia-induced exosomes, when delivered through a biocompatible hydrogel platform, provide potential therapeutic approach to improve diabetic wound healing by stimulating angiogenesis and tissue regeneration.

Octreotide attenuates experimental severe acute pancreatitis through inhibiting pyroptosis and modulating intestinal homeostasis

Severe acute pancreatitis (SAP) is a common clinical condition characterized by acute abdominal symptoms. Octreotide (OCT) is a commonly prescribed treatment for acute pancreatitis (AP). Recent research shows that pyroptosis and intestinal homeostasis significantly contribute to the progression of AP. However, it remains unclear whether OCT treats SAP through modulating pyroptosis and intestinal microbiota. Our study aimed to investigate and validate the potential therapeutic effects of OCT on SAP and underlying mechanisms. The inhibition of pyroptosis in mice using disulfiram was investigated to elucidate the role of pyroptosis in AP. Molecular biology experiments confirmed that OCT effectively inhibited the expression of pyroptosis-related markers. Additionally, the composition, abundance, and functionality of the intestinal microbiota were analyzed using 16S rRNA sequencing, while short-chain fatty acids (SCFAs) were quantified by targeted metabolomics. Our study demonstrated that the administration of OCT significantly mitigated the severity of SAP in a dose-dependent manner. Furthermore, the inhibition of pyroptosis in mice attenuated SAP, thereby highlighting the critical role of pyroptosis in this condition. OCT administration was observed to suppress the expression of key pyroptosis markers. Additionally, there was a notable reduction in intestinal permeability and bacterial translocation. OCT reverses gut dysbiosis caused by SAP, increasing beneficial bacteria while inhibiting pathogenic strains. Furthermore, OCT administration enhanced the levels of SCFAs, including propanoic acid, acetic acid, and butyric acid. Our findings indicate OCT has the potential to alleviate SAP by suppressing pyroptosis and restoring intestinal homeostasis.

Diagnosis and management of oesophageal granular cell tumour: A case report

Granular cell tumours (GCTs) are rare and typically benign neoplasms that can arise in various parts of the body, including the oesophagus. These tumours are considered to originate from Schwann cells and are characterized by their granular cytoplasm. Oesophageal GCTs (EGCTs) are particularly uncommon and often present with non-specific symptoms, making their diagnosis challenging. The present case report documents the case of a 68-year-old male patient who was admitted to the Affiliated Hospital of Jiujiang University (Jiujiang, China) after the incidental discovery of a submucosal oesophageal mass during a routine health examination. Upon diagnostic evaluation, including endoscopy and histopathological analysis, an EGCT was identified. Endoscopic ultrasonography revealed submucosal protrusion of the lower oesophagus, where endoscopic submucosal dissection (ESD) was subsequently performed. Histopathological staining and immunohistochemistry (IHC) indicated the presence of a GCT with positivity for S-100. The patient successfully underwent ESD without any complications. Although EGCTs are typically benign, they have the potential for malignant transformation and therefore require careful evaluation. The present case highlights the importance of differentiating EGCTs from other submucosal oesophageal lesions through histological and IHC methods. In particular, early detection and appropriate management are crucial for optimal patient outcomes. In conclusion, EGCT is a rare entity with a generally favourable prognosis when detected early. The present case underscores the importance of considering EGCTs in the differential diagnosis of oesophageal submucosal lesions and outlines the role of endoscopic and histopathological evaluation in their management.

PAMAM/miR-144 nanocarrier system inhibits the migration of gastric cancer by targeting mTOR signal transduction pathway

Exogenous microRNA-144 (miR-144) is considered as a potential biological drug for gastric cancer because of its biological activity to inhibit the epithelial-mesenchymal transition (EMT). However, the specific molecular mechanisms have not been fully revealed. In addition, their vulnerability to degradation by RNA enzymes in the blood limits their bioavailability. In this paper, a polyamidoamine (PAMAM)-wrapped miR-144 (PAMAM/miR-144) is prepared as a nanocarrier system to protect miR-144 from nuclease degradation. The PAMAM/miR-144 nanocarrier system achieves the optimal antitumor activity against gastric cancer migration and reduce mTOR protein expression by transferring miR-144 into human gastric cancer HGC-27 cells. At the same time, the PAMAM/miR-144 nanocarrier system significantly decreases the EMT via targeting mTOR signal pathway in HGC-27 cells and noticeably inhibited the growth of subcutaneous gastric cancer xenografts in nude mice. PAMAM/miR-144 nanocarrier system has effectively improved the bioavailability of miR-144, thus providing a promising combination modality for anticancer therapy.

RBBP8 Is a Prognostic Biomarker Associated With Response to Immune Checkpoint Inhibitors in Advanced Gastric Cancer

The current biomarkers for immune checkpoint inhibitor (ICI) therapy have several limitations, and new ones are being explored. Retinoblastoma-binding protein 8 (RBBP8) is associated with tumor-infiltrating immune cells (TIIC) and immune checkpoint molecules. Therefore, RBBP8 may serve as a novel biomarker for ICI therapy. Thus, in this study, we investigated the relationship between RBBP8 expression and the tumor immune environment in 58 patients with pathologic T3-4 gastric cancer who underwent radical gastrectomy. Immunohistochemistry of primary tumor specimens was performed to evaluate RBBP8, TIIC, and programmed cell death ligand 1 expression. Kaplan-Meier survival and prognostic factor analyses were also performed using Cox proportional hazards regression models. Patients were divided into RBBP8 high (HG, n=29) and low (LG, n=29) expression groups, using the median RBBP8 expression as the cutoff. The LG had a significantly worse overall survival rate than the HG (log-rank test, P =0.029). Furthermore, the overall survival rate of patients in LG who were treated with ICI (n=7) was worse than that of those in HG (n=9; log-rank P =0.005). Multivariate analysis identified extensive lymph node metastasis and low RBBP8 expression as independent prognostic factors. The HG and LG showed no significant difference in the number of TIICs; however, there was a difference in the number ratios of CD4+/CD8+ ( P =0.012) and CD4+/CD3+ cells ( P <0.001). Therefore, RBBP8 expression in patients with advanced gastric cancer is a prognostic marker that affects the proportion of CD4+ T-cell infiltration and may also be a biomarker for predicting ICI treatment response.

Pancreatic stellate cell: Update on molecular investigations and clinical translation in pancreatic cancer

Pancreatic cancer is a particularly aggressive tumor, distinguished by the presence of a prominent collagenous stroma and desmoplasia that envelops the tumor cells. Pancreatic stellate cell (PSC) contributes to the formation of a dense fibrotic stroma and has been demonstrated to facilitate tumor progression. As the significance of PSCs is increasingly revealed, more explorations are focused on the complex molecular mechanisms and tumor-stromal crosstalk in order to guide potential therapeutic approaches through deactivating or reprogramming PSCs. Nevertheless, significant challenges persist in translating preclinical discoveries into clinical applications. In this review, we expect to offer a comprehensive overview of the latest molecular advancements in PSCs, along with new insights into the clinical therapeutic strategies targeting PSCs.

Association of Sijunzi decoction plus chemotherapy with gastrointestinal function and serum markers in patients after gastric carcinoma surgery

BACKGROUND

The deleterious effects of surgical trauma and subsequent postoperative complications pose significant challenges to the smooth recovery of patients after gastric cancer (GC) resection despite the substantial curative benefits provided by surgical interventions for GC. Hence, the investigation of more optimal and efficacious treatment approaches has become an urgent necessity in the medical community.

AIM

To investigate the association of Sijunzi decoction plus chemotherapy with the gastrointestinal function and serum markers of patients after GC surgery.

METHODS

This study included patients who underwent GC surgery from June 2022 to February 2024. The control group included 45 patients who received chemotherapy (oxaliplatin + calcium folinate + 5-fluorouracil), whereas the research group consisted of 54 patients who received Sijunzi decoction therapy in addition to the treatment administered in the control group. Comparative analyses were conducted from the following perspectives: Gastrointestinal function (defecation time, intestinal gas discharge time, and hospitalization time), serum markers [carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 125, and CA199], nutritional indicators [total protein (TP) and transferrin (TRF), traditional Chinese medicine (TCM) syndrome score, and grades III–IV adverse events (gastrointestinal reactions, renal/liver function impairment, and myelosuppression).

RESULTS

The two groups demonstrated similar defecation time (P > 0.05), but the intestinal gas discharge time and hospitalization time were significantly shortened in the research group (P < 0.05). Further, the research group exhibited significant CEA, CA125, and CA199 reductions after treatment, which were lower compared to the control group, as well as notable increases in TP and TRF that were statistically higher than the control group (all P < 0.05). Furthermore, the research group demonstrated an evident decrease in TCM syndrome scores in areas, such as poor appetite, epigastric distension and pain, fatigue and weakness (P < 0.01), and abdominal distension after eating, which are notably lower than those in the control group (P < 0.01), with a comparable incidence of grades III–IV adverse events (P > 0.05).

CONCLUSION

Our research results indicate that Sijunzi decoction plus chemotherapy exerts a good rehabilitation-promoting effect on gastrointestinal function in patients after GC surgery and significantly downregulates abnormally increased CEA, CA125, and CA199 levels.

Construction and validation of a novel prognostic nomogram for patients with poorly differentiated gastric neuroendocrine neoplasms

BACKGROUND

The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms (PDGNENs) is dismal and related research is limited.

AIM

To investigate the prognostic factors, and validate a novel prognostic nomogram for PDGNEN patients.

METHODS

We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023. Overall survival (OS) differences were assessed with the Log-rank test and Kaplan-Meier survival curves. Cox regression analysis identified independent risk factors for prognosis. Model performance was evaluated using Harrell’s concordance index, receiver operating characteristic analysis, area under the curve, calibration curves, and decision curve analysis (UDC), including the area under the UDC.

RESULTS

The study included 336 patients (227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma). The average age was 62.7 years. The cohort comprised 80 (24.7%) patients in stage I, 146 (42.9%) in stage II, 62 (18.1%) in stage III, and 48 (14.3%) in stage IV. Significant differences in OS were observed across tumor-node-metastasis stages (P < 0.001). Multivariate analysis showed age, Ki-67 index, invasion depth, lymph node metastasis, distant metastasis, and platelet-to-lymphocyte ratio as independent risk factors. We developed a nomogram with a concordance index of 0.779 (95% confidence interval: 0.743-0.858). Receiver operating characteristic analysis showed area under the curves for 1-year, 3-year, and 5-year OS predictions of 0.865, 0.850, and 0.890, respectively. The calibration curve demonstrated good agreement with actual outcomes. The area under the UDC for the nomogram vs the 8^th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027, 0.291 vs 0.179, and 0.376 vs 0.216 for 1-year, 3-year, and 5-year OS, respectively.

CONCLUSION

PDGNENs are predominantly found in older men, often in advanced stages at diagnosis, resulting in poor prognosis. The established nomogram demonstrates strong predictive capability and clinical utility.

Pseudomyxoma peritonei originating from small intestine: A case report and review of literature

BACKGROUND

Pseudomyxoma peritonei (PMP) is a distinct form of peritoneal malignancy characterized by diffuse intra-abdominal gelatinous ascites, with an estimated incidence of 1-3 per 1000000. PMP is predominantly secondary to appendiceal mucinous neoplasms, with rarer origins including the ovaries, colon, and urachus. However, PMP originating from small intestine is extremely rare.

CASE SUMMARY

A 60-year-old male patient presented with anorexia and abdominal distension. Computed tomography revealed the presence of abdominopelvic effusions and multiple intra-abdominal space-occupying lesions. Ultrasound-guided aspiration indicated that the aspirated tissue was mucinous. Exploratory laparoscopy and tissue biopsy identified diffuse tumor nodules in peritoneum, omentum, pelvic region, intestinal walls, and mesentery. Histopathological analysis of the resected tumors confirmed the presence of mucinous adenocarcinoma, but the primary lesion was difficult to determine. The patient was referred to our center for further treatment and underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) under general anesthesia. The intraoperative peritoneal cancer index was 30. The surgery lasted 8 hours, with a blood loss of about 600 mL. A complete cytoreduction (CCR0) was achieved. No serious complications occurred after surgery, and the patient’s condition was good during the telephone follow-up. Postoperative pathology confirmed the diagnosis of small intestinal mucinous adenocarcinoma at proximal jejunum, which was complicated by high-grade PMP.

CONCLUSION

PMP originating from small intestine is an exceptionally rare entity that exhibits non-specific clinical features. The preferred treatment is CRS + HIPEC.

Prognostic value of neutrophil-to-lymphocyte ratio in gastric cancer: Enhancing clinical relevance

Gastric cancer (GC) is a leading cause of cancer-related deaths, highlighting the need for reliable prognostic biomarkers to guide treatment. Wei et al’s systematic review and meta-analysis evaluates the neutrophil-to-lymphocyte ratio (NLR) as a potential biomarker for GC patients undergoing neoadjuvant chemotherapy. NLR is a simple and cost-effective measure of systemic inflammation that shows promise in predicting treatment response and survival outcomes, including overall survival and progression-free survival. However, variations in NLR thresholds and timing of measurements affect its accuracy and clinical utility. Moreover, the studies reviewed primarily involved Asian populations, which may limit the generalizability of the findings. To improve NLR’s clinical relevance, future research should focus on standardizing NLR thresholds, refining measurement timing, and incorporating additional inflammatory markers like platelet-to-lymphocyte ratio and Glasgow prognostic score. Addressing confounders and including diverse patient populations will help improve NLR’s reliability as a prognostic marker for GC.

Personalized treatment selection in colorectal cancer with peritoneal metastasis: Do we need statistically validated indicators or cultural shift?

The study by Wu et al analyzed the correlation between nutritional and inflammatory markers and prognosis in patients with colorectal cancer peritoneal metastasis. The authors propose the neutrophil-to-lymphocyte ratio (NLR) as a predictor of overall survival (OS) and developed a nomogram incorporating NLR, hemoglobin (Hb), and peritoneal cancer index (PCI) to estimate 1- and 2-year survival. Although the nomogram shows high accuracy, the group of patients analyzed is heterogeneous with respect to the surgical treatment received, and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI (≥ 20). Patient selection for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy requires a multidisciplinary approach. Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit. While methodologically sound, the study does not consider the effect of treatment received on OS, thus introducing a potential bias.

Hepatocellular carcinoma resistance to tyrosine kinase inhibitors: Current status and perspectives

The study conducted by Wang et al, focuses on the role of Rho GTPase activating protein 12 (ARHGAP12), in hepatocellular carcinoma (HCC). This research reveals that ARHGAP12 expression, markedly elevated in malignant cells of HCC, correlates strongly with adverse outcomes for patients. Furthermore, the study illustrates that ARHGAP12 enhances the ability of HCC cells to invade and contributes to their resistance to tyrosine kinase inhibitors (TKIs) through modulation of the focal adhesion pathway. To comprehensively investigate the relationship between ARHGAP12 and TKI resistance, this study integrates single-cell and bulk RNA sequencing methodologies along with data from tumor immune single-cell hub 2, Gene Expression Omnibus, The Cancer Genome Atlas, CellMiner, Genomics of Drug Sensitivity in Cancer 2, as well as immunohistochemical staining and proteomic analyses. Statistical analyses, including the Wilcoxon rank-sum test and receiver operating characteristic curve analysis, were employed to evaluate the correlation between ARHGAP12 expression levels and clinical parameters, as well as drug sensitivity. It is evident that a more profound exploration of the molecular dynamics of HCC, especially those related to resistance against TKIs, is essential.

Precision medicine in the prediction of metachronous liver metastasis in rectal cancer: Applications and challenges

Rectal cancer is a major global health concern, and metachronous liver metastasis (MLM) significantly worsens patient prognosis. Advances in imaging and machine learning have led to the development of radiomics models, particularly those utilizing multiparametric magnetic resonance imaging, which are highly valuable in predicting MLM. These models analyze imaging features to provide insights that can aid clinical decision-making and potentially improve treatment outcomes and survival rates. However, realizing the full potential of radiomics models faces challenges in terms of accuracy, generalizability, and data dependency. This editorial comments on a study regarding radiomics prediction models for rectal cancer MLM published recently in the World Journal of Gastrointestinal Oncology, discusses the progress, challenges, and strategies for diagnostic models of MLM in rectal cancer, and proposes directions for future research.

Exosome biosensors for detection of prostate cancer

Prostate cancer (PCa) is a highly life-threatening disease in men, causing numerous deaths worldwide. As PCa is often diagnosed at a late stage, current diagnostic methods can be invasive and sometimes lead to unnecessary treatments. Therefore, new non-invasive approaches are needed to detect biomarkers for more rapid and accurate PCa diagnosis. Exosomes, extracellular vesicles, provide valuable insights into cellular health and disease progression. Recent studies have indicated the potential use of exosomes as biomarkers for diagnosing PCa. Developing fast, reliable, and sensitive methods for exosome detection is essential. Biosensors, powerful analytical tools for biological samples, have become increasingly crucial in exosome analysis. This review summarizes recent advancements in biosensor technology for exosome detection and provides insights into future perspectives. The goal is to encourage innovative biosensor-based approaches for exosome detection and contribute to the early diagnosis and clinical monitoring of various diseases.

Gastric cancer in patients with Helicobacter pylori-negative autoimmune gastritis

Although Helicobacter pylori (H. pylori) is implicated in the development of most cases of gastric cancer with autoimmune gastritis, cases of gastric cancer have been reported in patients testing negative for H. pylori. Here, we aimed to outline the current research status of the factors involved in the development of gastric cancer in H. pylori-negative autoimmune gastritis. Predictive pathological conditions for the development of gastric cancer in H. pylori-negative autoimmune gastritis are postulated to be: (1) Severe atrophy; (2) Hypergastrinemia; (3) Bile reflux; and (4) Low acidity, which are directly related to the pathophysiology of autoimmune gastritis, as well as smoking and family history, which are not related to autoimmune gastritis. In autoimmune gastritis, where there is a possibility of spontaneous disappearance of H. pylori in advanced atrophy, it is difficult to assess H. pylori. Since H. pylori infection begins in the antrum and subsequently progresses to the proximal stomach, it is interpreted as H. pylori-negative autoimmune gastritis if histologically consistent with autoimmune gastritis in the body with spared antrum, and negative for other H. pylori tests. However, it is essential to examine whether the currently prevailing histological interpretation used to evaluate H. pylori infection status is appropriate.

Understanding metastatic patterns in gastric cancer: Insights from lymph node distribution and pathology

Gastric cancer (GC) represents a significant global health burden due to its high morbidity and mortality. Specific behaviors of GC sub-types, distinct dissemination patterns, and associated risk-factors remain poorly understood. This editorial highlights several key prognostic factors, including pathological staging and vascular invasion, that impact GC. It examines a recent study’s investigation of differential metastatic lymph nodes distribution and survival in upper and lower GC sub-types, focusing on histological characterization, pathophysiology, usage of neoadjuvant chemotherapy, and additional predictive determinants. We assess the statistical robustness and clinical applicability of the findings, underscoring the importance of treating GC as a heterogeneous disease and emphasizing how tailored surgical approaches informed by lymph node distribution can optimize tumor detection while minimizing unnecessary interventions. The study’s large cohort, multi-center design, and strict inclusion criteria strengthen its validity in guiding surgical planning and risk-stratification. However, integrating genetic and molecular data is critical for refining models and broadening applicability. Additionally, recurrence-metrics and infection-related factors, such as Helicobacter pylori and Epstein-Barr virus, absent in the original study, remain vital for directing future research. By bridging metastatic patterns with prospective methodologies and inclusion of diverse populations, this editorial provides a framework for advancing early detection and personalized GC care.

How is single-cell RNA sequencing contributing to the advancement of cancer therapeutics?

The study of Tang et al investigated the distribution and dynamic changes of cell populations in the tumor microenvironment of gastric cancer (GC) patients using single-cell RNA sequencing (scRNA-seq). This comprehensive analysis highlights key interactions within the tumor microenvironment across different GC stages. Discussing applications of scRNA-seq data in clinical settings could pave the way for developing promising and personalized therapeutic strategies for GC patients. Therefore, further exploration of selecting anticancer drug candidates through gene screening derived from scRNA-seq will provide deeper insights into GC care.

Natural products and cancer: The urgent need to bridge the gap between preclinical and clinical research

Any new report on the anticancer properties of natural products always awakens new satisfaction and hope about the role of the international scientific community in its continuous contributions to human health, particularly when those reports contribute to both the understanding and therapeutics of cancer. For many decades, natural products have been pivotal in drug discovery programs because they offer a diverse array of anticancer therapeutic possibilities. Recently, two manuscripts published in the World Journal of Gastrointestinal Oncology added new data to the already extensive body of anticancer preclinical evidence for resveratrol and senegenin, two compounds widely present in herbal preparations used in traditional Chinese medicine. The first one, with comprehensive and recognized anticancer properties, and the second one, shows a compelling body of evidence supporting its neuroprotective effects, but with emerging anticancer activities. Natural products have become key elements in the expanding and dynamic field of anticancer drug discovery. However, urgent and collective efforts are still needed to bridge the gap between preclinical and clinical research and thus bring new anticancer therapeutic breakthroughs.

Endoscopic resection of gastrointestinal tumors: Training levels and professional roles explored

In this editorial, we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology. The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers. We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques, particularly endoscopic submucosal dissection. This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy, as well as a summary of key studies on the learning curve for these techniques. Additionally, we explore the impact of an endoscopist’s specialty on endoscopy outcomes, drawing from current evidence in the literature to shape our perspective in this evolving field.

Plasma extracellular cold inducible RNA-binding protein levels are elevated for 1 month post-colectomy which may promote metastases

BACKGROUND

Cold-inducible RNA-binding protein (CIRP) is related to a family of stress-induced RNA-binding proteins. It is primarily found in the nucleus, where it regulates transcription. Under stress, CIRP translocates to the cytoplasm where it modulates translation; a subset is secreted as extracellular CIRP (eCIRP) which is a damage-associated molecular pattern (DAMP) molecule that stimulates the production of inflammatory mediators. Elevated blood eCIRP levels may foster immune tolerance and facilitate tumor growth. Increased CIRP levels have been noted in various malignancies including colorectal cancer (CRC). This study’s objective was to determine plasma eCIRP levels before and after minimally invasive colorectal resection (MICR) for CRC.

AIM

To assess plasma eCIRP levels prior to and following minimally invasive colorectal resection in the context of cancer pathology.

METHODS

MICR patients from an IRB-approved data/tissue bank for whom plasma samples were available were eligible. Plasma specimens were obtained preoperatively (preop) and at least 3 time’s postop [between postoperative day (POD) 1-41]; late samples were grouped into 7-day blocks and were considered separate time points. eCIRP levels were assessed via enzyme-linked immunosorbent assay (pg/mL) and results presented as mean ± SD, analysis with Wilcoxon paired t-test).

RESULTS

A total of 83 CRC patients who underwent MICR [colon 66%, rectal 34%; laparoscopic-assisted (LA), 70%; hand-assisted laparoscopic (HAL), 30%] were studied. The mean preop eCIRP level was 896.8 ± 757.0 pg/mL. Elevations in mean plasma levels (P = < 0.001) were noted on POD1 (2549 ± 2632 pg/mL, n = 83), POD3 (1871 ± 1362 pg/mL, n = 77), POD7-13 (1788 ± 1403 pg/mL, n = 57), POD14-20 (1473 ± 738.8 pg/mL, n = 30), and POD21-27 (1681 ± 1375 pg/mL, n = 21). No significant differences were noted at POD 28-41. Higher values were noted in the HAL’s (vs LA) group, however, there were more rectal cancers in the former.

CONCLUSION

Elevated plasma eCIRP levels persist for a month post MICR for CRC (change from baseline, 77%-184%); highest values seen on POD1. The initial surge may be due to the acute inflammatory response while later elevations may be related to wound healing and remodeling. The higher levels noted in the HAL’s group (with greater IL and more rectal cases) suggest the extent of surgical trauma impacts eCIRP levels. Further investigations are needed.

Integrative analysis of bulk RNA and single-cell sequencing data reveals a liquid-liquid phase separation signature for clear cell renal cell carcinoma

Liquid-liquid phase separation (LLPS) is a significant biophysical phenomenon that plays a crucial role in numerous pathophysiological processes associated with tumors. This study aims to establish a prognostic and immunotherapeutic response prediction signature for clear cell renal cell carcinoma (ccRCC) based on LLPS-related genes. Firstly, 66 differentially expressed LLPS-related genes were obtained from the TCGA, and then the LLPS prognostic signature constructed from five genes, including HOXA13, TEAD4, KMT5C, TRNP1, and SGO1, was identified by univariate Cox and least absolute shrinkage and selection operator algorithm. Meanwhile, the results of Kaplan-Meier analysis, ROC curves, principal component analysis, and nomogram showed high reliability of the constructed LLPS signature. Additionally, the relationship between the signature and immune infiltration, immunotherapy, and sensitivity to targeted therapeutic agents was discussed in this study. Single-cell sequencing data were used to analyze the expression levels of the signature genes in different cells in the ccRCC microenvironment. Finally, the expression of the signature genes was verified in ccRCC cells, and the effect of SGO1 on the malignant biological behavior of ccRCC cells was also verified by in vitro experiments. In conclusion, this LLPS prognostic signature may be a potential clinical prognostic and immunotherapeutic response-related indicator for ccRCC patients.

Radiomics and machine learning for predicting metachronous liver metastasis in rectal cancer

A recent study by Long et al used a predictive model to explore the efficacy of radiomics based on multiparametric magnetic resonance imaging in predicting metachronous liver metastasis (MLM) in newly diagnosed rectal cancer (RC) patients. The machine learning algorithms, particularly the random forest model (RFM), appeared well-matched to the complex nature of radiomics data. The predictive capabilities of the RFM, as evidenced by the area under the curve of 0.919 in the training cohort and 0.901 in the validation cohort, highlighted its potential clinical utility. However, we highlighted several methodological limitations, including excluding genomic markers, potential biases from the retrospective design, limited generalizability due to a single-center study, and variability in image interpretation. We propose further investigation into integrating multi-omic data, conducting larger multicenter studies, and utilizing advanced imaging techniques. Additionally, we highlighted the importance of interdisciplinary collaboration to improve predictive model development and advocate for cost-effectiveness analyses to facilitate clinical integration. Overall, this predictive model may improve the early detection and management of MLM in RC patients, with promising avenues for future exploration. Ongoing research in this domain can potentially improve clinical outcomes and the quality of care for RC patients.

Machine learning-based reconstruction of prognostic staging for gastric cancer patients with different differentiation grades: A multicenter retrospective study

BACKGROUND

The prognosis of gastric cancer (GC) patients is poor, and an accurate prognostic staging system would help assess patients' prognostic status before treatment and determine appropriate treatment strategies.

AIM

To develop positive lymph node ratio (LNR) and machine learning (ML)-based staging systems for GC patients with varying differentiation.

METHODS

This multicenter retrospective cohort study included 11772 GC patients, with 5612 in the training set (Harbin Medical University Cancer Hospital) and 6160 in the validation set (Surveillance, Epidemiology, and End Results Program database). X-tile software identified optimal cutoff values for the positive LNR, and five ML models were developed using pT and LNR staging. Risk scores were divided into seven stages, constructing new staging systems tailored to different tumor differentiation levels.

RESULTS

In both the training and validation sets, regardless of the tumor differentiation level, LNR staging demonstrated superior prognostic stratification compared to pN. Extreme Gradient Boosting exhibited better predictive performance than the other four models. Compared to tumor node metastasis staging, the new staging systems, developed for patients with different degrees of differentiation, showed significantly better predictive performance.

CONCLUSION

The new positive lymph nodes ratio staging and integrated staging systems constructed for GC patients with different differentiation grades exhibited better prognostic stratification capabilities.

Kan-AAE-driven synthetic SERS spectra generation method for Precise cancer identification

Surface-Enhanced Raman Spectroscopy (SERS) is gaining popularity in cancer detection studies because it offers a non-invasive and rapid approach. Label-free SERS detection techniques often needs machine learning, which depends on adequate data for training. The scarcity of blood serum samples from cancer patients, due to challenges in collection linked to confidentiality concerns and other restrictions, can result in model overfitting and poor generalization ability. To tackle this challenge, we propose the KAN-AAE method, a new approach for creating synthetic SERS spectra, which lever- ages the power of Kolmogorov-Arnold Networks (KAN) in conjunction with Adversarial Autoencoders (AAE) and has the excellent capability of fitting the distribution of complex data in feature space. We conducted experiments by collecting serum samples from patients with four different types of cancer, two types of other diseases, and healthy individuals, subsequently measuring their SERS spectra. We trained the KAN-AAE model using the SERS spectral data and used it to produce synthetic spectra, which were then combined with actual data for classifier training, enhancing data diversity. Utilizing the combined dataset, there was a notable increase of 1% to 3% in the accuracy of classification models like logistic regression, decision tree, multilayer perceptron, 1D-convolutional neural network, and KAN. The KAN classifier outperformed others, achieving an accuracy rate of 95.62%. The experimental results demonstrate that: (1) our proposed method gener- ates high-quality and reliable SERS spectra data; (2) the method effectively improves the classification accuracy for various types of cancer.

A blood- and brain-based EWAS of smoking

DNA methylation offers an objective method to assess the impact of smoking. In this work, we conduct a Bayesian EWAS of smoking pack years (n = 17,865, ~850k sites, Illumina EPIC array) and extend it by analysing whole genome data of smokers and non-smokers from Generation Scotland (n = 46, ~4-21 million sites via TWIST and Oxford Nanopore sequencing). We develop mCigarette, an epigenetic biomarker of smoking, and test it in two British cohorts. Results of brain- and blood-based EWAS (nbrain=14, nblood = 882, >450k sites, Illumina arrays) reveal several loci with near-perfect discrimination of smoking status, but which do not overlap across tissues. Furthermore, we perform a GWAS of epigenetic smoking, identifying several smoking-related loci. Overall, we improve smoking-related biomarker accuracy and enhance the understanding of the effects of smoking by integrating DNA methylation data from multiple tissues and cohorts.

Advancements and innovations in liquid biopsy through microfluidic technology for cancer diagnosis

Cancer is one of the leading causes of death worldwide, with approximately 10 million deaths and almost 20 million cases diagnosed in 2022. Various diagnostic methods for cancer, including physical examination, lab tests, imaging, and biopsy (tissue or liquid), are available in clinical settings. Liquid biopsy earned considerable attention due to its minimal invasiveness, patient convenience, and rapidness. Liquid biopsy is experiencing a significant transformation owing to the incorporation of microfluidic technologies. Microfluidic technologies allow for real-time observations and precise, sensitive, and efficient results in early cancer diagnosis through the identification of various biomarkers using body fluids at the microscale. This review highlights the transition from conventional cancer diagnostic methods to critically analyzing innovations and the integration of modern microfluidic technologies, presenting their influence in improving cancer diagnosis. This review highlights the significance of identifying exosomes and their biological components, such as micro RNAs, circular RNA, and mRNA, via microfluidics as biomarkers for cancer diagnosis. It also highlights the integration of microfluidics with advanced technologies, such as CRISPR gene editing, organ-on-a-chip models, 3D bioprinting, and nanotechnology, for cancer diagnosis. Moreover, integrating artificial intelligence into microfluidic systems has significantly transformed research related to cancer diagnosis. This advancement enables more precise diagnosis and personalized treatment strategies using the large available data on networks along with algorithmic approaches. Collectively, microfluidics and their integration into advanced technologies have shown the potential for progress in early cancer diagnosis and the customization of treatment approaches, such as immunotherapy, in the future.

A large non-inverted true diverticulum resembling a submucosal tumor of the ascending colon: a report of a rare case

A 57-year-old woman presented with a chief complaint of right lower abdominal pain. Abdominal radiography and plain abdominal computed tomography revealed a mass with extensive calcification. A colonoscopy demonstrated a 20-mm-sized mass lesion protruding into the intestinal lumen from the ileocecal valve's lower lip. The mass was covered with normal mucosa without erosions. Endoscopic ultrasonography indicated that the tumor originated from or beneath the proper muscle layer. To treat the pain, eliminate the obstruction risk, and obtain a definitive diagnosis, the patient chose surgical resection. Laparoscopic-assisted ileocecal resection was performed under the diagnosis of a submucosal ascending colon tumor. Macroscopically, the tumor showed no gross epithelial abnormalities. However, it was filled with fecal material and had an orifice of approximately 3 mm on the proximal side of the tumor. Histopathologically, the cyst wall consisted of an entire colonic structure, and continuity was noted between the cystic lesion's wall and the ascending colon's wall, leading to a diagnosis of diverticular expansion due to fecal matter. No malignancies were detected. A diverticulum can collect feces and protrude into the colonic lumen, resembling colonic submucosal tumors with calcification. Although rare, this condition should be included in the differential diagnosis of colon tumors.

Effect of exercise based on the ACSM recommendations on fatigue in patients with digestive tumors: a meta-analysis of randomized controlled trials

OBJECTIVE

Fatigue is the most common side effect in cancer and cancer treatment. This study aimed to investigate the effect of different amounts of exercise on fatigue in patients with digestive tumors.

METHODS

We searched articles published to March 2024 in the PubMed, Embase, Web of Science, and Cochrane databases. The amount of exercise was evaluated according to the American College of Sports Medicine (ACSM) and divided into high compliance and low compliance. The effect of compliance on fatigue in patients with digestive tumors was compared using standardized mean difference and 95% confidence intervals (95% CI).

RESULTS

A total of 18 articles were included, and we found that exercise had beneficial effects on cancer-related fatigue (CRF) in patients with digestive tumors. Fifteen studies that met the ACSM recommendations were grouped eventually. Eight studies were classified as high compliance and 7 studies as low compliance. The CRF was improved significantly in the high compliance (- 1.89; 95% [CI], - 2.93 to - 0.86) compared with the low compliance (- 1.43; 95% [CI], - 2.25 to - 0.61).

CONCLUSION

Exercise intervention with high compliance showed a more significant improvement in fatigue in patients with digestive tumors compared with low compliance. However, these studies have not yet been fully uniform for the scoring tool for CRF, and further studies are needed to validate these findings.

IMPLICATIONS FOR CANCER SURVIVORS

Compared with low compliance, exercise intervention with high compliance has shown a more significant improvement in fatigue among patients with digestive tumors. In addition, the beneficial effects of high compliance with exercise intervention on fatigue in patients with digestive tumors also provide important implications for cancer survivors. Regular exercise that conforms to the American College of Sports Medicine (ACSM) recommendations, especially maintaining high compliance, can serve as an effective strategy to alleviate cancer-related fatigue and improve the quality of life of survivors. However, these studies have not yet been fully unified in the scoring tools for cancer-related fatigue (CRF), and further research is needed to validate these findings.

Prognostic significance of the liver stiffness value on magnetic resonance imaging elastography in patients undergoing hepatectomy for hepatocellular carcinoma

SYNOPSIS

This study shows the utility of magnetic resonance imaging elastography as an independent predictor of the postoperative recurrence of hepatocellular carcinoma.

PURPOSE

Accurate assessment of postoperative recurrence risk is crucial for the perioperative management of patients undergoing surgical resection for hepatocellular carcinoma (HCC). Magnetic resonance imaging elastography (MRE) has emerged as a noninvasive tool for assessing liver fibrosis. This study evaluated whether MRE independently predicts HCC recurrence more effectively than well-known oncological factors, including pathological findings.

METHODS

The subjects of this retrospective observational study were HCC patients who underwent preoperative MRE and hepatectomy between 2013 and 2023. Data collected included demographics, laboratory findings, imaging, pathology, operative details, and prognosis. Patients were followed up for at least 1 year after hepatectomy or until recurrence.

RESULTS

Recurrence developed in 46 of 100 patients. Multivariable Cox regression analysis for overall recurrence identified MRE ≥ 3.7 kPa (hazard ratio [HR] 3.161, p = 0.021), the FIB-4 index (HR 3.176, p = 0.001), tumor size > 5 cm (HR 5.893, p < 0.001), invasive growth pattern (HR 2.375, p = 0.036), METAVIR F3-4 (HR 2.562, p = 0.046), and venous invasion (HR 10.622, p < 0.001) as risk factors. The recurrence-free rate at 1 year for patients with MRE ≥ 3.7 kPa was lower than for those with MRE < 3.7 kPa (72.0% vs. 92.0%, p = 0.017).

CONCLUSIONS

Preoperative MRE predicts postoperative HCC recurrence, underscoring its utility in risk stratification.

Molecular hydrogen as a potential mediator of the antitumor effect of inulin consumption

Inulin consumption and dihydrogen (H2) administration both exert antitumor effects on preclinical models as well as in clinical trials. As H2 is one of the major byproducts of inulin fermentation by bacterial species of the gut microbiota (GM), we hypothesized that H2 could mediate the antitumor effects of inulin. To provide evidence in favor of this hypothesis, we first determined the pattern of H2-exposure to which mice are subjected after inulin administration and developed an inhaled hydrogen therapy (H2T) protocol replicating this pattern. We then compared the effects on circulating immunity of a two-week daily inulin gavage with those of the corresponding H2T. We also compared the effects of inulin supplementation to those of the corresponding H2T on implanted melanoma growth and infiltration by T lymphocytes. Inulin and H2T induced a similar increase in circulating CD4+ and CD8+ T cells. In addition, both treatments similarly inhibited melanoma tumor growth. These results support a mechanism by which the H2 resulting from inulin fermentation by the GM diffuses across the intestinal barrier and stimulates the immunosurveillance responsible for the antitumor effect.

Exploring the diagnostic potential of plasma circ-CCDC66 in colorectal cancer

Owing to the subtle symptoms and low sensitivity of colorectal cancer (CRC), such as rectal bleeding, anemia, and abdominal pain, CRC generally occurs in late stages. This leads to delayed diagnosis and reduced treatment efficiency. Therefore, novel and effective CRC markers are needed. In this study, we conducted circRNA expression profiling on GSE datasets and identified circ-CCDC66 as a potential marker. Through qPCR analysis of plasma samples from 50 CRC patients, 50 with colorectal polyps, and 50 healthy individuals, circ-CCDC66 emerged as a promising biomarker for CRC detection capable of identifying polyps among healthy individuals. Furthermore, plasma circ-CCDC66 levels exhibited superior diagnostic accuracy, with an AUC of 0.920, compared to traditional markers, such as serum CEA and CA19-9. Remarkably, the combined detection of circ-CCDC66, CEA, and CA19-9 further increased the AUC for distinguishing the colorectal polyps' group from the healthy control group to 0.991, with sensitivity and specificity increasing to 98% and 96%, respectively. Additionally, a circ-CCDC66-miRNA-mRNA regulatory network was established to provide insight into how circ-CCDC66 influences CRC pathways. This pioneering study highlights circ-CCDC66's clinical relevance as a blood-based diagnostic marker for CRC and offers valuable insights into future developments in the diagnosis and treatment of the disease.

Pedunculated gastric tube with distal partial gastrectomy for esophageal reconstruction in synchronous or metachronous esophagectomy

While the stomach is commonly used as an esophageal substitute after esophagectomy, it may not be a viable option in some cases. One alternative for esophageal reconstruction is a pedunculated gastric tube with distal partial gastrectomy (PGT-DPG). However, no studies have comprehensively analyzed its efficacy. We retrospectively evaluated the clinical characteristics and surgical outcomes of patients who underwent PGT-DPG between 2011 and 2023, and reviewed previously published studies on the surgical outcomes of PGT-DPG. Among the nine patients in the current study, seven underwent PGT-DPG for gastric cancer; of which, five were performed concurrently with esophagectomy, while two were conducted following prior esophagectomy. Additionally, PGT-DPG was performed in two cases with benign gastric lesions. The major postoperative complications included pneumonia (two cases), anastomotic leakage (two cases), and recurrent laryngeal nerve paralysis (one case). No graft necrosis or mortality was observed. Our review of these cases, along with previously reported cases, indicated that PGT-DPG showed efficacy due to its availability for antral early gastric cancer, avoidance of bowel reconstruction, simplified technique, and improved cervical elevation. PGT-DPG is a valuable rescue option in cases in which gastric tube reconstruction is challenging. Therefore, esophageal surgeons should be well acquainted with this technique.

Sample Size Estimations Based on Human Microbiome Temporal Stability Over 6 Months: A Shallow Shotgun Metagenome Sequencing Analysis

BACKGROUND

Biological factors affect the human microbiome, highlighting the need for reasonably estimating sample sizes in future population studies.

METHODS

We assessed the temporal stability of fecal microbiome diversity, species composition, and genes and functional pathways through shallow shotgun metagenome sequencing. Using intraclass correlation coefficients (ICC), we measured biological variability over 6 months. We estimated case numbers for 1:1 or 1:3 matched case-control studies, considering significance levels of 0.05 and 0.001 with 80% power, based on the collected fecal specimens per participant.

RESULTS

The fecal microbiome's temporal stability over 6 months varied (ICC < 0.6) for most alpha and beta diversity metrics. Heterogeneity was seen in species, genes, and pathways stability (ICC, 0.0-0.9). Detecting an OR of 1.5 per SD required 1,000 to 5,000 cases (0.05 significance for alpha and beta; 0.001 for species, genes, and pathways) with equal cases and controls. Low-prevalence species needed 15,102 cases, and high-prevalence species required 3,527. Similar needs applied to genes and pathways. In a 1:3 matched case-control study with one fecal specimen, 10,068 cases were needed for low-prevalence species and 2,351 for high-prevalence species. For ORs of 1.5 with multiple specimens, cases needed for low-prevalence species were 15,102 (one specimen), 8,267 (two specimens), and 5,989 (three specimens).

CONCLUSIONS

Detecting disease associations requires a large number of cases. Repeating prediagnostic samples and matching cases to more controls could decrease the needed number of cases for such detections.

IMPACT

Our results will help future epidemiologic study designs and implement well-powered microbiome studies.