Laparoscopic Gastrectomy for Heterotopic Pancreas with Concurrent Gastroduodenal Invagination and Gastric Wall Abscess: A Case Report

INTRODUCTION

Heterotopic pancreas refers to pancreatic tissue located outside its normal position and lacking anatomical or vascular continuity with the pancreas. Gastric heterotopic pancreas (GHP) is generally asymptomatic, but in rare cases large GHP lesions can cause gastric outlet syndrome or gastroduodenal invagination. GHP may also occasionally cause acute pancreatitis and abscess formation in the gastric wall. This report describes a rare case of GHP with concurrent gastroduodenal invagination and gastric wall abscess treated via laparoscopic distal gastrectomy.

CASE PRESENTATION

A 46-year-old man was admitted to the hospital with abdominal pain and vomiting. Computed tomography revealed a 40-mm low-density mass in the gastric pylorus, and gastroduodenal invagination. Gastroscopy confirmed a submucosal lesion at the gastric pylorus causing pyloric stenosis. The patient underwent laparoscopic distal gastrectomy with Roux-en-Y reconstruction. Histopathological examination revealed a gastric submucosal lesion containing pancreatic tissue with acinar cells and ducts, without islets of Langerhans, leading to a diagnosis of Heinrich type II GHP. The submucosal lesion also contained inflammatory components such as neutrophils and foamy histiocytes, forming a gastric wall abscess. Finally, the patient was discharged on postoperative day 11 and is progressing well 7 months after surgery.

CONCLUSIONS

Herein we report the first case of laparoscopic distal gastrectomy for GHP with concurrent gastroduodenal invagination and gastric wall abscess resulting in a favorable outcome.

Gut microbiota-derived extracellular vesicles form a distinct entity from gut microbiota

Extracellular vesicles (EVs), nanoparticles secreted by both gram-negative and gram-positive bacteria, carry various biomolecules and cross biological barriers. Gut microbiota-derived EVs are currently being investigated as a communication mechanism between the microbiota and the host. Few clinical studies, however, have investigated gut microbiota-derived EVs. Here, we show that machine learning models were able to accurately distinguish gut microbiota and respective microbiota-derived EV samples according to their taxonomic composition both within each data set (area under the curve [AUC] 0.764-1.00) and in a cross-study setting (AUC 0.701-0.997). These results show that gut microbiota-derived EVs form a distinct taxonomic entity from gut microbiota. Thus, conventional gut microbiota composition may not correctly reflect communication between the gut microbiota and the host unless microbiota-derived EVs are reported separately.IMPORTANCEGut microbiota-derived extracellular vesicles (EVs) have been suggested to be a communication mechanism between the gut microbiota and the human body. However, the data on EV secretion from the gut microbiota remain limited. To investigate and compare the composition of gut microbiota-derived EVs to gut microbiota composition, we used a machine learning approach to classify 16S rRNA gene sequencing data in seven clinical data sets incorporating both gut microbiota and gut microbiota-derived EV samples. The results of the study show that microbiota-derived EVs form a separate taxonomic entity from the gut microbiota. Gut microbiota-derived EVs should be included in clinical studies that investigate gut microbiota to gain more comprehensive insight into gut microbiota-host communication.

Mechanism of lncRNA gadd7 regulating mitofusin 1 expression by recruiting LSD1 to down-regulate H3K9me3 level, and mediating mitophagy in alveolar type II epithelial cell apoptosis in hyperoxia-induced acute lung injury

OBJECTIVE

Hyperoxic exposure induces acute lung injury (ALI). We analyzed the mechanism of long non-coding RNA (lncRNA) growth-arrested DNA damage-inducible gene 7 (gadd7) regulating mitofusin 1 (MFN1) in Hyperoxia-induced ALI (HALI) type II alveolar epithelial cell (AEC II) apoptosis.

METHODS

The HALI rat model was generated using hyperoxic induction and treated with shRNA-gadd7 and rapamycin (Rapa), with ALI, apoptotic level, total protein concentration and total cell, neutrophil and macrophage counts assessed. The HALI cell model was developed on hyperoxia-induced RLE-6TN cells and processed with oe-MFN1, si-gadd7 and Rapa. Cell viability, apoptosis, TOM20/LC3BII co-localization, mitochondrial membrane potential (MMP), superoxide dismutase activity, malonaldehyde, reactive oxygen species (ROS), tumor necrosis factor-α, interleukin (IL)-10, IL-6, IL-1β, gadd7, MFN1, Cleaved caspase-3, Cleaved poly (ADP-ribose) polymerase, B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X, LC3BI/II, lysine-specific demethylase 1 (LSD1), p62, and H3K9me3 protein levels were measured. gadd7-LSD1 interaction was predicted and verified by RPISeq database, RIP, and RNA pull-down assay.

RESULTS

In HALI rats, gadd7 was up-regulated in lung tissues, and gadd7 silencing alleviated oxidative stress, ALI and apoptosis. gadd7 knockdown inhibited oxidative stress and apoptosis though MFN1, and mediated mitophagy (evidenced by diminished LC3BII/LC3BI ratio, TOM20/LC3BII co-localization and ROS level, and elevated p62 level and MMP), which were reversed by mitophagy activation. By recruiting LSD1 to down-regulate H3K9me3 level and promote MFN1 expression, gadd7-mediated mitophagy affected ALI and apoptosis in HALI rats.

CONCLUSION

LncRNA gadd7 regulated MFN1 expression by recruiting LSD1 to down-regulate H3K9me3 level and mediate mitophagy, thereby promoting AEC II apoptosis in HALI.

Exploring the bioactive components and mechanism of Biling Weitong Granules in chronic gastric ulcer repair through network analysis and experimental verification

Biling Weitong Granules (BLWTG) is a clinical formula employed for treating epigastric pain, yet its pharmacodynamic components and mechanisms against chronic gastric ulcers (GU) remain inadequately understood. The objective of this study was to investigate the targets and mechanisms of BLWTG and its bioactive components in chronic GU. Chronic GU model was induced in SD rats through acetic acid injection, and administered BLWTG post-induction. The macroscopic ulcer appearance, microscopic histology, mucosal growth, vascular promoting factors, myeloperoxidase, and inflammatory factors in gastric tissue were assessed. Network analysis was used to predict the potential core targets and pathways. Further, bioactive components were screened based on cell model, identified by HPLC-QTOF-MS and validated in vivo. The results showed that BLWTG effectively mitigated pathological damage, achieving a 63.32% ulcer healing rate. Network analysis and experimental verification showed that the effectiveness of BLWTG stemmed from its capacity lower oxidative stress and inflammation, boost antioxidant levels, and promote the synthesis of gastric mucosal protective factors and repair. Further, the primary active fraction of BLWTG was ethyl acetate fraction, which increased the ulcer healing rate to 75.04%. Among the 55 compounds identified in the ethyl acetate fraction of BLWTG, evodiamine, dehydroevodiamine, berberine and tetrahydropalmatine may represent the active components responsible for facilitating the regeneration and repair of GU. In conclusion, BLWTG and its bioactive components significantly promote healing in rat models of chronic GU, providing a scientific basis for further applications of BLWTG in treating chronic GU.

Multisociety guidance for sterilization and high-level disinfection

SHEA, in partnership with ASGE, APIC, AAMI, AORN, HSPA, IDSA, SGNA, and The Joint Commission, developed this multisociety infection prevention guidance document for individuals and organizations that engage in sterilization or high-level disinfection (HLD). This document follows the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities. This guidance is based on a synthesis of published scientific evidence, theoretical rationale, current practices, practical considerations, writing group consensus, and consideration of potential harm when applicable. The supplementary material includes a summary of recommendations. The guidance provides an overview of the Spaulding Classification and considerations around manufacturers' instructions for use (MIFUs). Its recommendations address: point-of-use treatment prior to sterilization or HLD, preparation of reusable medical devices at the location of processing, sterilization, and immediate use steam sterilization (IUSS), HLD of lumened and non-lumened devices, processing of reusable medical devices used with lubricating or defoaming agents, monitoring for effectiveness of processing, handling of devices after HLD, augments and alternatives to HLD, processing of investigational devices, tracking of reusable medical devices, and approaches to implementation.

Integrated Needle Guide on Smartphone for Percutaneous Interventions Using Augmented Reality

PURPOSE

This study aimed to describe the workflow and evaluate the accuracy of a novel smartphone augmented reality (AR) application that includes an integrated needle guide, in a phantom.

MATERIALS AND METHODS

A smartphone cover with an integrated needle guide was designed and 3D-printed. An AR application for percutaneous application was developed, which integrated a projected needle path based on the rigid needle guide. After planning the needle path using this novel tool, the operator could place the needle through the guide to reach the target. Six lesions with out-of-plane entry points were targeted on an abdominal phantom. Timing and accuracy of needle placements were measured on post-procedural CT both using smartphone AR guidance and with a freehand approach. Results were compared using Wilcoxon rank sum and Pearson's chi-squared tests.

RESULTS

A total of 108 needle placements were performed by 9 physicians with widely varying experience. The median accuracy was 4 mm (IQR 3-6 mm) using the smartphone versus 18 mm (IQR 9-27 mm) for freehand (P < 0.001). Using the smartphone AR application, planning time was 91 s (IQR 71-151 s), and puncture time was 68 s (IQR 57-77 s). There was no difference in accuracy, planning, or puncture times according to experience level when using the AR tool.

CONCLUSION

This smartphone application with an integrated needle guide allows path planning and accurate needle placement on phantoms with real-time angular feedback in less than 3 min. This technology could promote standardization, reduce experience requirements, or provide accurate low-cost guidance in environments without procedural imaging for percutaneous interventions.

Extraesophageal reflux: Clinical manifestations and tools for diagnosis and treatment

Extraesophageal reflux is a complex clinical entity, classically presenting with laryngopharyngeal symptoms including chronic cough and vocal changes, but it is also implicated in conditions such as subglottic stenosis and lung injury. Diagnosis is challenging, in large part due to the oftentimes vague presenting symptoms with multiple possible etiologies, as well as limited consistency of currently available diagnostic tests. Furthermore, effective medical treatment is limited, and acid suppression therapy such as proton pump inhibitors has shown low to mixed efficacy in relieving signs and symptoms of reflux outside the esophagus. In this review, we will address laryngopharyngeal reflux and its diagnosis based on symptoms and exam findings, and diagnostic tools such as impedance monitoring and salivary pepsin testing. A summary of the use and limitations of acid-suppressing therapies for extraesophageal reflux and the rationale for targeting pepsin as a nonacid component of reflux will be presented. Finally, the current literature on the potential role of reflux in subglottic stenosis and lessons learned regarding reflux in the lung transplant surgery field in higher risk patient populations will be discussed.

Effect of rapid rehabilitation surgical nursing on patients' gastrointestinal function recovery and sleep quality after laparoscopic appendectomy

BACKGROUND

Appendicitis is a common acute abdominal pain disorder. Laparoscopic appendectomy, a commonly used modality, is associated with less trauma and faster recovery than traditional open appendectomy. However, postoperative recovery remains an important issue that affects rehabilitation quality and surgical results.

AIM

To explore the effects of rapid rehabilitation and surgical nursing care on gastrointestinal function recovery and sleep quality among patients undergoing laparoscopic appendectomy.

METHODS

A total of 120 patients who underwent laparoscopic appendectomy at our hospital between January 2019 and March 2024 and for whom complete clinical data were available were selected. Patients were randomly assigned to two groups (n = 60 each) using the random number table method. The control group received routine nursing care, while the experimental group received rapid rehabilitation surgical nursing care; all patients continued to receive nursing care until discharge. The recovery of gastrointestinal function, length of hospital stay, complications, Pittsburgh sleep quality index, and nursing satisfaction were compared between groups.

RESULTS

Following the implementation of effective nursing measures, the times to bowel sound recovery, first exhaust, first defecation, and first feeding were notably shorter in the study vs control group (P < 0.05). Additionally, the duration of the first postoperative activity and the length of hospital stay were significantly shorter in the study vs control group (P < 0.05). Furthermore, the study group exhibited better sleep quality than the control group (P < 0.05). The postoperative complication rate was significantly lower and the nursing satisfaction rate significantly higher in the study vs control group (P < 0.05).

CONCLUSION

Rapid rehabilitation surgical nursing interventions provided to patients after laparoscopic appendectomy can accelerate their postoperative recovery, reduce the occurrence of complications, and improve their sleep quality and nursing satisfaction.

Using CBT-E in the Treatment of Anorexia Nervosa With Comorbid Obsessive-Compulsive Personality Disorder and Clinical Perfectionism

OBJECTIVE

Several studies and clinical vignettes emphasize the association between eating disorders and maladaptive personality traits that should be targeted in treatment to strengthen the therapeutic prognosis and outcome. The aim of this paper is to present a single case study with a patient showing comorbid Anorexia Nervosa (AN) and Obsessive-Compulsive Personality Disorder (OCPD) with perfectionistic traits, using Cognitive Behavioral Therapy for Eating disorders (CBT-E) and Perfectionism (CBT-P).

METHODS

The patient, a young girl aged 17 years, was underweight when entering therapy and received an enhanced version of CBT-E with 40 sessions as recommended in the manual. The treatment was adjusted for adolescents with a heightened focus on motivation, therapeutic alliance, and parental involvement. The clinical interventions were structured in accordance with CBT-E for adolescents with six added sessions targeting clinical perfectionism based on CBT-P focusing on over-evaluation of achievements in addition to weight and shape.

RESULTS

The patient showed a gradual decrease in eating disorder symptoms and perfectionism through the 1-year treatment. She was normal weight by the end of therapy, enjoyed varied food, was more socially engaged and balanced clinical perfectionism with more healthy strivings and standards. She was also able to express her need for boundaries and rest to family, friends and her sports team. At the final assessment, she did not fulfill diagnostic criteria for AN or OCPD with perfectionistic traits, but she showed some symptoms in achievement situations that was targeted by information and preventive interventions.

CONCLUSION

In accordance with the manual for CBT-E, perfectionism should be targeted as part of the treatment for eating disorders when in the clinical range. This was done in the present case with AN and perfectionistic traits within a comorbid OCPD, using elements of CBT-P that showed positive results and meaningful changes for the patient.

Research progress on N6-methyladenosine and non-coding RNA in multiple myeloma

N6-methyladenosine (m6A) and non-coding RNA (ncRNA) play important roles in the occurrence, development, and prognosis of multiple myeloma (MM). They not only affect stemness, growth, and apoptosis of MM cells but also intervene in MM proliferation, migration, invasion, and even drug resistance. It is also a prognostic factor for poor MM survival. Therefore, in-depth research on the mechanisms of m6A and ncRNA in MM significant for diagnosis, treatment, and prognosis of MM.

Therapeutic Potential of Mesenchymal Stem Cells in Niemann-Pick Disease

Niemann-Pick disease (NPD) is a rare autosomal recessive neurodegenerative disease characterized by hepatosplenomegaly, neuropathy, and a significantly shortened lifespan. Lipid metabolism disorder is the main pathological feature of NPD. Currently, the exact pathogenesis of NPD remains unclear, and drug therapy is largely palliative, focusing on symptom management, but it has side effects. Mesenchymal stem cells (MSCs) possess several advantageous properties, including their differentiation potential, wide availability, low immunogenicity, and the ability to secrete regulatory factors, which have led to their extensive application in basic research targeting neurodegenerative diseases. Studies have demonstrated that transplantation of MSCs from different sources into animal models of NPD can delay the loss of Purkinje cells in the cerebellum, reduce lipid deposition, improve motor coordination, slow the rate of weight loss, and extend lifespan. This review explores the therapeutic potential of MSCs in the treatment of NPD, highlighting their emerging role in addressing this challenging condition.

ANXA5: related mechanisms of osteogenesis and additional biological functions

Annexin A5 (ANXA5), also known as Annexin V, is a calcium-dependent phospholipid-binding protein and has a high affinity with phosphatidylserine (PS). This characteristic facilitates its involvement in a wide range of biological functions, including vesicle transport, the formation of mineral phases in the extracellular matrix, anticoagulation and antithrombotic, the inhibition of tumor growth, and apoptosis regulation. ANXA5 plays a role in anti-inflammatory and antithrombotic properties. It also has protective effects on the nervous system. ANXA5 has been reported to facilitate osteogenic differentiation and take part in chondrocyte apoptosis and mineralization. More and more attention is paid to the potential of ANXA5 for bone defect repair. Most current studies on ANXA5 mainly concentrate on immune disorders, pregnancy disorders and serve as a biomarker for various diseases as well as apoptosis detection. However, there is still a lack of systematic studies on ANXA5 involving multiple tissues, including bone, cartilage, vessels, and nerves in the process of bone regeneration. Our study aims to summarize the biological functions in bone tissue and the related signaling pathways of ANXA5. This work provides a theoretical foundation for applying ANXA5 in clinical orthopedics in the future.

Study on the Effect and Mechanism of Weichang'an Pill and Its Extract on Slow Transit Constipation

BACKGROUND

Weichang'an pill (WCA) possesses potential advantages in promoting gastrointestinal motility and treating constipation. Ethanol extract (EE) and aqueous extract (AE) of WCA were used to investigate its efficacy in treating slow transit constipation (STC) and the material basis for exerting this effect.

METHODS

The STC model was established in vivo by gavage of loperamide (Lop) in Sprague-Dawley rats, followed by gavage of WCA, EE, and AE. In vitro, norepinephrine (NE) was used to stimulate isolated ileal smooth muscle of rats to imitate the state of insufficient gastrointestinal motility during STC, and a model of excessive relaxation of isolated ileal smooth muscle was established. This model was used to observe and record the changes in contraction tension, amplitude, and frequency of ileal smooth muscle after treatment with WCA, EE, AE, and the active ingredients of WCA.

KEY RESULTS

In vivo, WCA, EE, and AE treatment increased fecal parameters, improved gastrointestinal transit time, and alleviated pathological damage to the colon in STC rats. Its mechanism might be closely related to c-kit/SCF, RhoA/ROCK/MYPT1/MLC signaling pathways. In vitro, WCA, EE, AE, and the active ingredients of WCA, including costunolide (Cos), dehydrocostus lactone (Deh), agarotetrol (Aga), muscone (Mus), gallic acid (GA), oleic acid (Oleic), linoleic acid (Lin), umbelliferone (Umb), synephrine (Syn), ferulic acid (FA), chlorogenic acid (ChA), betaine (Bet), and riboflavin (Rib), significantly inhibited the NE-induced excessive relaxation of ileal smooth muscles.

CONCLUSIONS

WCA, EE, and AE significantly improved constipation in STC rats. Moreover, the active ingredients in WCA, including Cos, Deh, Aga, Mus, GA, Oleic, Lin, Umb, Syn, FA, ChA, Bet, and Rib, might be the material basis for promoting intestinal motility.

British Elbow and Shoulder Society patient care pathway: Frozen shoulder

Background

Current guidelines from the British Elbow and Shoulder Society (BESS) were published in 2015 for managing frozen shoulders in the primary and secondary care setting. Updated guidelines have been developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology.

Methods

A multi-disciplinary BESS Working Group defined key management questions based on agreed outcome measures and time points. A literature search, conducted up to March 2023 following PRISMA guidelines, identified randomised controlled trials, systematic reviews, and meta-analyses. Quality assessments were performed using the GRADE Decision Framework, considering bias, imprecision, indirectness, and inconsistency. Data were extracted for meta-analysis. In the absence of high-quality trials, narrative reviews were created.

Results

Consensus opinions produced statements based on the quality and volume of evidence and the magnitude of desirable and undesirable effects. These statements form a comprehensive framework for managing frozen shoulder.

Discussion

This updated guideline provides evidence-based guidance for managing frozen shoulder and identifies key areas for future research.

Temporal evolution and factors influencing visual function and RNFL thickness in ethambutol-associated optic neuropathy

PURPOSE

This study aimed to investigate the temporal evolution and influencing factors of visual function and optic nerve structure in ethambutol-associated optic neuropathy (EON).

METHODS

In this single-center retrospective observational study, we analyzed data from 48 EON patients (26 males and 22 females) with a 12-month follow-up. Comprehensive ophthalmologic assessments, including best corrected visual acuity (BCVA), visual field (VF), optical coherence tomography (OCT), and magnetic resonance imaging (MRI), were conducted to evaluate visual function and optic nerve structure. Statistical analyses including multiple linear regression and comparative analyses (independent t-tests/Mann-Whitney U tests) were performed to identify factors influencing recovery, with effect sizes calculated using Cohen's d.

RESULTS

Significant improvements in best corrected visual acuity and visual field were observed between 3 and 6 months. The mean improvement in BCVA was 0.25 logMAR (from 1.28 ± 0.64 at 3 months to 0.82 ± 0.60 at 6 months, p < 0.0001, Cohen's d = 0.74, 95% CI [0.33, 1.15]), and the mean improvement in VF mean deviation was 2.5 dB (from - 13.85 ± 9.23 dB at 3 months to - 10.33 ± 7.58 dB at 6 months, p = 0.037, Cohen's d = 0.42, 95% CI [0.11, 6.93]), indicating a critical recovery window. Peripapillary retinal nerve fiber layer (pRNFL) thinning was most pronounced between 3 and 9 months, with the temporal quadrant showing the earliest thinning (40.21% reduction by 3 months). Macular ganglion cell-inner plexiform layer (mGCIPL) thickness showed a decreasing trend (73.20 ± 4.76 μm to 55.33 ± 4.16 μm) from 1 month post-onset. Multivariate analysis revealed that disease course was the primary factor influencing VF recovery (β = - 0.31, p = 0.001), while peripapillary retinal nerve fiber layer thinning was associated with gender, ethambutol dosage, and disease duration. Female patients exhibited slower peripapillary retinal nerve fiber layer thinning compared to males.

CONCLUSIONS

This study identifies a critical recovery window for visual function in EON between 3 and 6 months, with peripapillary retinal nerve fiber layer thinning progressing significantly between 3 and 9 months. The temporal quadrant of the peripapillary retinal nerve fiber layer may serve as an early marker for disease progression. These findings provide valuable insights for optimizing monitoring and intervention strategies in EON patients, highlighting that early therapeutic interventions-particularly for patients showing temporal RNFL thinning or high-risk features-may maximize visual recovery potential.

Fish bone migration: complications, diagnostic challenges, and treatment strategies

BACKGROUND

Fish bone impaction in the pharynx is a common otolaryngological emergency. However, if the fish bone perforates the pharyngeal wall or the gastrointestinal wall and migrates to the neck tissues or organs, entering the lungs, mediastinum, heart, liver, biliary tract, spleen, pancreas, or other structures, or damages major blood vessels in the thoracic or abdominal cavities, it can lead to severe complications. This condition is rare and dangerous, potentially resulting in a series of serious complications, including neck abscess, thyroid abscess, thrombosis or air embolism of the cervical vessels, esophageal perforation, rupture of major mediastinal vessels, mediastinitis, aorto-esophageal fistula, lung abscess, spinal injury, sepsis, splenic abscess, hepatic abscess, anal fistula, and it may even be misdiagnosed as a tumor.

OBJECTIVE

This narrative review synthesizes evidence on fish bone translocation complications to (1) identify high-risk clinical presentations, (2) guide site-specific imaging selection, and (3) inform multidisciplinary management strategies.

METHODS

Use the keyword "fishbone" to systematically search articles from PubMed、CNKI and Embase databases from 1972 to 2024. Review all original articles and include them in this review where appropriate. This narrative review synthesizes evidence from case reports and observational studies to explore complications and management of fish bone translocation in uncommon sites. Given the predominance of heterogeneous case reports, a formal systematic review with meta-analysis was not feasible; however, we employed systematic search strategies to minimize selection bias.

CONCLUSION

To avoid severe complications, it is crucial to provide comprehensive information on the management of fish bone impaction. When fish bone removal cannot be achieved using laryngoscopy, prompt and decisive surgical intervention is required to extract the foreign body.

Interpretable machine learning model for predicting delirium in patients with sepsis: a study based on the MIMIC data

OBJECTIVE

The aim of this study was to construct interpretable machine learning models to predict the risk of developing delirium in patients with sepsis and to explore the impact of delirium on the 28-day survival rate of patients.

METHODS

We enrolled 10,321 patients with sepsis older than eighteen years from the MIMIC-IV (Medical Information Mart for Intensive Care) database. Sepsis is defined as the presence or suspected presence of infection, along with a SOFA (Sequential Organ Failure Assessment) score of ≥ 2. Four machine learning models, namely XGBoost (extreme gradient Boost), SVM (support vector machine), Logistic (logistic regression) and RF (random forest), were established for prediction, and the prediction model was constructed.

RESULTS

A total of 10,321 sepsis patients were included, among whom 4,691 (45.45%) developed delirium. The 28-day mortality rate was markedly elevated in the delirium group (log-rank P < 0.001). The XGBoost model has the best performance. Finally, 5 variables were selected to draw a nomogram: hypertension, SOFA score, chlorine, Hb (hemoglobin), creatinine. The receiver operating characteristic (ROC) curve of the predictive delirium model showed better predictive efficiency, with an AUC of 0.767 (95%CI (confidence interval): 0.726-0.798).

CONCLUSION

The nomogram built on the XGBoost model provides clinicians with an easy tool to quickly assess the risk of developing delirium in patients with sepsis. It provides a new idea and direction for the best model to predict delirium in patients with sepsis, so as to promote the development of delirium related research.

Portal vein embolization and subsequent major hepatectomy for hepatocellular carcinoma with insufficient residual liver volume: experience of a tertiary center

Portal vein embolization (PVE) allows for liver regeneration to enhance reduced residual liver volume before resection in hepatocellular carcinoma (HCC) patients with systemic liver disease. A retrospective review of medical records was conducted, including patients who underwent PVE and subsequent major hepatectomy to treat resectable non-metastatic HCC at the University Medical Center in Ho Chi Minh City between 01/2016 and 6/2023. Patient demographics, timing of procedures, surgical interventions, intra- and postoperative complications, pattern of recurrence, and survival were analyzed. A total of 58 patients with HCC were included, and the median length of stay after surgery was 8 days (range 5-24). Post-hepatectomy liver failure (PHLF) occurred with an overall incidence of 31% (18/58 cases). Severe PHLF occurred in 6 cases: grade B in 5 cases (8.6%) and grade C in 1 case (1.7%), resulting in patient death. Postoperative bleeding and bile leak each occurred in 1 case (1.7%). Univariable and multivariable analyses identified portal vein pressure (PVP) after PVE as the only significant preoperative parameter associated with outcomes, correlating with PHLF occurrence (OR 1.27, p = 0.009) at a cut-off of 15 mmHg (p = 0.018). The overall survival at 3, 6, and 12 months was 96%, 94%, and 94%, respectively, with disease-free survival rates of 94%, 90%, and 87%, respectively. Major hepatectomy can be performed safely and effectively in HCC patients who have PVE-induced liver hypertrophy (sFLR ≥ 40%) and preserved liver function (Child-Pugh A) maintaining low morbidity. Multivariate analysis revealed that a post-PVE PVP cutoff of 15 mmHg significantly correlated with perioperative parameters, including operating time, blood loss, and PHLF occurrence.

Clinical value of NT-proBNP, MPO, and NLR combined with echocardiography in prediction of malignant arrhythmia in elderly patients with valvular heart disease

OBJECTIVE

We aimed to probe the clinical value of N-terminus pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), and neutrophil lymphocyte ratio (NLR) combined with echocardiography in the prediction of malignant arrhythmias (MA) in elderly patients with valvular heart disease (VHD).

METHODS

MPO, NT-proBNP, and NLR were detected in blood samples. After 1 year of follow-up, receiver operating characteristic curves were analyzed to determine the clinical value of NT-proBNP, MPO, NLR, and echocardiography for predicting MA in patients with VHD.

RESULTS

MPO, NT-proBNP, and NLR were higher in the VHD group. MPO, NT-proBNP, and NLR were higher with severe cardiac dysfunction. MPO, NT-proBNP, NLR, and LVESV in the MA group were higher. NT-proBNP was an independent factor influencing the occurrence of MA in elderly patients with VHD. The AUC for predicting MA in elderly patients with VHD using NT-proBNP, MPO, NLR, and echocardiography were 0.782 (sensitivity 61.50%, specificity 94.60%, 95% CI 0.630-0.934), 0.759 (sensitivity 69.20%, specificity 81.10%, 95% CI 0.579-0.938), 0.736 (sensitivity 76.90%, specificity 64.90%, 95% CI 0.562-0.910), and 0.782 (sensitivity 76.90%, specificity 75.70%, 95% CI 0.646-0.918), respectively. The AUC for the combined prediction using NT-proBNP, MPO, NLR, and echocardiography was 0.913 (sensitivity 76.90%, specificity 94.60%, 95% CI 0.820-1.000), higher than that of each parameter alone (P < 0.05).

CONCLUSION

The combination of NT-proBNP, MPO, NLR, and echocardiography has a predictive value in detecting MA in elderly VHD patients.

Impact of early versus delayed enteral nutrition on ICU outcomes: a comparative study on mortality, ventilator dependence, and length of stay

BACKGROUND AND OBJECTIVE

The timing of enteral nutrition initiation in critically ill patients in the intensive care unit (ICU) plays a crucial role in clinical outcomes. This study aimed to evaluate the impact of early (within 48 h of ICU admission) versus delayed enteral feeding on 28-day mortality, ventilator dependency, and ICU length of stay.

METHODS

A retrospective cohort study was conducted involving 295 patients across four ICUs in two Tehran hospitals, admitted between 2017 and 2018. Participants were grouped into early (n = 161) and delayed (n = 134) enteral feeding categories. Baseline characteristics were analyzed using the Mann-Whitney and Chi-Square tests. Mortality was assessed using Kaplan-Meier survival analysis and Cox proportional hazards models, while logistic and linear regression models were applied to examine associations with ventilator dependency and ICU length of stay, respectively.

RESULTS

Early enteral feeding (EEF) was significantly associated with reduced 28-day mortality (25.5% vs. 50.0%, p < 0.001), lower incidence of mechanical ventilation (66.5% vs. 80.6%, p = 0.007), and a shorter ICU stay (13.07 ± 16.44 days vs. 16.23 ± 13.57 days, p < 0.001). Kaplan-Meier analysis revealed a higher survival probability at 28 days in the early feeding group (log-rank test, p < 0.001). However, after adjusting for potential confounders (age, gender, BMI, baseline APACHEII, baseline SOFA score, number of comorbid, primary diagnosis and admission category), the relationships between delayed feeding and mortality (HR: 1.49, 95% CI 0.98, 2.26, p = 0.062), ventilator dependency (OR: 1.28, 95% CI 0.59, 2.70, p = 0.558), and ICU length of stay (LOS) (β: 1.96, 95% CI - 1.52, 5.45, p = 0.268) were not statistically significant. Subgroup analyses revealed that delayed enteral feeding was significantly associated with higher mortality risk in surgical patients (adjusted HR: 1.85, 95% CI 1.02, 3.35, p = 0.043) and prolonged ICU stay (β: 3.75, 95% CI 0.27, 7.23, p = 0.035), whereas no significant associations were observed in medical patients.

CONCLUSION

Initiating enteral feeding within 48 h of ICU admission is associated with improved clinical outcomes, although these benefits may be influenced by individual patient factors and disease severity. Future studies should focus on tailoring enteral feeding strategies to optimize outcomes across varied ICU populations.

Mean amplitude of glycemic excursion and mortality in critically ill patients: A retrospective analysis using the MIMIC-IV database

BACKGROUND

Glycemic variability (GV) is increasingly recognised as a critical determinant of outcomes in critically ill patients. However, standardised criteria for assessing GV remain undefined.

OBJECTIVE

This study aimed to evaluate the relationship between the Mean Amplitude of Glycemic Excursion (MAGE) and mortality in intensive care unit (ICU) patients, and to determine optimal MAGE thresholds for distinct patient populations.

METHODS

A retrospective cohort of 13 852 critically ill adults with ICU stays exceeding 24 h was analysed. Patients were stratified into MAGE quartiles, and various GV metrics were compared for their predictive performance on mortality. Multivariable-adjusted models were employed to examine associations between MAGE and mortality outcomes.

RESULTS

Patients in higher MAGE quartiles exhibited significantly elevated mortality risks, with the highest quartile associated with ICU mortality (HR 3.59 [95% CI: 2.99-4.31]), in-hospital mortality (HR: 3.43 [95% CI: 2.92-4.02]) and 28-day mortality (HR 2.04 [95% CI: 1.47-2.82]). The relationship between MAGE and mortality was notably stronger in non-diabetic patients (HR: 3.36 [95% CI: 2.90-3.89]) compared to diabetic patients (HR: 1.59 [95% CI: 1.33-1.91]). Restricted cubic spline analyses identified optimal MAGE thresholds of 44.28 mg/dL for the overall population, 58.97 mg/dL for diabetic patients and 17.11 and 37.72 mg/dL for non-diabetic patients. MAGE demonstrated effective predictive performance for all-cause mortality (AUC: 0.6286 [95% CI: 0.6171-0.6400]) compared to other GV metrics. Incorporating MAGE into prognostic models alongside SAPS II and SOFA scores improved performance for all-cause mortality, with net reclassification improvement (NRI) of 0.238 and integrated discrimination improvement (IDI) of 0.008.

CONCLUSION

MAGE exhibits effective predictive value for mortality in ICU patients, with distinct thresholds for diabetic and non-diabetic populations. These findings underscore the importance of tailored GV management strategies in critical care settings and support the adoption of MAGE as a standardised metric for GV assessment in ICU settings.

Development and external validation of nomogram associated with gastroparesis syndrome after subtotal gastrectomy depending on random forest and traditional model: does robotic surgery have advantages?

Postsurgical gastroparesis syndrome (PGS) significantly diminishes the quality of life for patients following surgery. With the evolution of robotic surgery, there is a debate on whether it can offer a novel treatment modality for gastric cancer and reduce the incidence of gastric paralysis syndrome. This study utilizes machine learning techniques and traditional logistic regression to construct and validate predictive models, with the aim of providing guidance for clinical practitioners. This study included two cohorts from one medical centers based on the surgical timing for division (Cohort 1: n = 619 for model building and internal validation; Cohort 2: n = 312 for external validation). In Cohort 1, a 3:1 ratio was used for training and validation in random forest and a 7:3 ratio for logistic regression. After analyzing the Receiver Operating Characteristic curves (ROC), we chose classical logistic regression to build the prediction model followed by evaluation with calibration and decision curve analysis (DCA). Finally, we performed external validation on Cohort 2. The model incorporated 7 factors including: Pre-operative TBIL (OR = 2.99), Pre-operative DBIL (OR = 2.35), Pre-operative potassium (OR = 6.8), Surgical type (OR = 3.76), Gastric tube removal time (OR = 3.48), Reconstruction mode (OR = 4.63) and Operative time (OR = 2.21). The model performed well in ROC, with AUC values of 0.892 in the training set, 0.858 in the inner validation set (Cohort 1), and 0.849 in the exterior validation set (Cohort 2). All three datasets' calibration curves revealed a high level of agreement between projected and actual probability. DCA suggested that the model had great clinical usefulness. We have established a more reliable predictive model for PGS which can provide guidance for clinical practitioners. Robotic surgery is also considered to be one of the factors that can reduce the occurrence of PGS.

Rectovaginal Extra-Gastrointestinal Stromal Tumors (EGISTs): A Systematic Review of the Literature and a Pooled Survival Analysis

Background/Objectives: Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors arising outside the gastrointestinal tract, making up <5% of all GISTs. Rectovaginal EGISTs are particularly uncommon, with limited available data. This study systematically reviews the clinicopathological features, management, and outcomes of rectovaginal EGISTs. Methods: A systematic review of the English-language literature was conducted for studies on rectovaginal EGISTs (search date: 15 January 2025). Results: Thirty-one studies, including 40 female patients (mean age: 55.2 ± 15.4 years), met the inclusion criteria. Presenting symptoms included vaginal bleeding (24.3%), palpable mass (13.5%), constipation (10.8%), and abdominal pain (8.1%); however, the majority of patients (45.9%) were asymptomatic. Surgical excision was undertaken in 95% of patients, more often via local resection (61.1%). A high-grade mitotic index (>5/50 HPF) was noted in 63.2%. CD117, DOG-1, and vimentin was expressed in all cases, while CD34 was positive in 97.1%. Adjuvant therapy with tyrosine kinase inhibitors (TKIs) was administered in 57.5%, and neoadjuvant therapy was rare (8.6%). Recurrence occurred in 39.4% over a median follow-up of 40 ± 61.5 months, with a median disease-free survival (DFS) of 48 months. One death occurred 13 months postoperatively. Conclusions: Rectovaginal EGISTs are exceedingly rare and often asymptomatic, complicating preoperative diagnosis. Surgical resection remains the cornerstone of treatment, complemented by stage-specific neoadjuvant or adjuvant TKI therapy. The challenging location predisposes to recurrence, underscoring the need for further studies to optimize management and improve outcomes.

Validation and Cultural Adaptation of the Serbian Version of the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire: A Comprehensive Psychometric Evaluation

Backround/Objectives: Colorectal cancer presents a significant quality of life (QoL) challenge as a result of both the disease and its treatments. This study aimed to validate and culturally adapt the Cleveland Clinic Colorectal Cancer Quality of Life Questionnaire (CCF-CaQL) for Serbian-speaking colorectal cancer patients. Methods: The CCF-CaQL offers a detailed assessment of the physical, emotional, social, and functional impacts of the disease. This study, conducted at the University Clinical Center of Serbia, involved 150 colorectal cancer patients undergoing treatment. The translation and adaptation process followed the EORTC Quality of Life Group's guidelines, ensuring cultural relevance and comprehensibility. Statistical analyses, including Cronbach's alpha for internal consistency and Pearson's correlation for concurrent validity, reliability, and known-groups validity, were performed using SPSS and R software. Results: The Serbian version of the CCF-CaQL maintains strong psychometric properties with high internal consistency (Cronbach's alpha = 0.85) and significant correlations with the FACT-C questionnaire, confirming its validity. Known-groups validity showed distinct variations in QoL scores based on tumor location, stoma presence, and neoadjuvant therapy status, highlighting its sensitivity to different clinical conditions. Conclusions: The CCF-CaQL questionnaire has been skillfully translated, culturally adapted, and carefully validated through psychometric evaluations for Serbian patients diagnosed with colorectal cancer.

The role of resistance exercise-induced local metabolic stress in mediating systemic health and functional adaptations: could condensed training volume unlock greater benefits beyond time efficiency?

The majority of "specialised" exercise configurations (e.g., supersets, drop sets, blood flow restriction) are being assessed as "shortcuts" to hypertrophy and strength improvements. However, these advanced training techniques may also offer significant benefits for systemic health and functional outcomes across recreational and clinical populations via locally induced metabolic responses. Stress-regulating mechanisms are known to enhance the body's resilience by facilitating allostasis, the process of coordinating adaptive processes in reaction to stressors such as physical training. Yet, the role of the local metabolic stress provoked by resistance exercise has not gained much research attention despite its wide potential. Positive effects are not only linked to improved muscular endurance, hypertrophy and strength via primary and secondary mechanisms, but also to the release of myokines, hormones, microRNAs, immune factors, inflammatory substances and other endocrine molecules that initiate numerous health-promoting modifications on a systemic level. Resistance exercise strategies that maximise the local accumulation of metabolites are not well defined, although high volume, close proximity to failure and shorter rests seem to be a necessity. Additionally, blood flow restriction training provides a potent alternative for inducing local acidosis, thereby triggering several pathways associated with improved immunity and physical function even in remote muscle tissues. Future research is warranted to further explore advanced resistance training techniques, as these approaches may offer comparable benefits for physical and mental health to those seen with other forms of exercise such as high-intensity interval training and heavy resistance training.

Korea, Japan, Europe, and the United States: Why are guidelines for gastric cancer different?

As a global health concern, gastric cancer management has been systematized by individual countries and regions into regimented guidelines. To explore international differences, we examined the guidelines of Korea, Japan, Europe, and the United States. Guidelines are created by experts in the field, focusing on evidence-based recommendations to standardize and improve patient care, but the methodology for guideline creation, incorporation of new innovations, and review differs significantly. National and regional differences within the guidelines are apparent, stemming from various factors including local incidence, stage, presentation, patient preferences, and governmental influences. Differences include the use of neoadjuvant chemotherapy, criteria for endoscopic resection, and extent of lymphadenectomy. Nonetheless, fundamental treatment principles remain universal, and the goals of national guidelines are uniform: standardizing patient care, providing the highest quality treatments, incorporating cutting-edge clinical trial results, and consensus in guidelines to help formulate governmental policies. This review highlights how the guidelines are constructed, the unique elements of each guideline, how they differ, and why they differ.

Effects of anesthetics on development of gynecological cancer

Gynecological cancers remain a leading cause of cancer among female patients, and surgery continues to be the primary therapeutic approach. Anesthesia is an indispensable component of perioperative period. In recent years, the influence of anesthesia drugs on cancer has become one of the focuses of anesthesiologists. Anesthetic drugs may influence cancer metabolic reprogramming and modulate immune function through the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Emerging evidence suggests that the choice of anesthetic agents could affect the prognosis of gynecological cancers. This review explores the relationship between anesthetic drugs and gynecological cancers (cervical cancer, ovarian cancer, and endometrial cancer), elucidating their effects on cancer prognosis through cellular pathways, metabolic regulation, and immune mechanisms. The findings aim to guide clinical decision-making and evaluate optimal perioperative anesthetic management strategies for gynecological cancer patients.

Advancements in the diagnosis of biliopancreatic diseases: A comparative review and study on future insights

Owing to the complex and often asymptomatic presentations, the diagnosis of biliopancreatic diseases, including pancreatic and biliary malignancies, remains challenging. Recent technological advancements have remarkably improved the diagnostic accuracy and patient outcomes in these diseases. This review explores key advancements in diagnostic modalities, including biomarkers, imaging techniques, and artificial intelligence (AI)-based technologies. Biomarkers, such as cancer antigen 19-9, KRAS mutations, and inflammatory markers, provide crucial insights into disease progression and treatment responses. Advanced imaging modalities include enhanced computed tomography (CT), positron emission tomography-CT, magnetic resonance cholangiopancreatography, and endoscopic ultrasound. AI integration in imaging and pathology has enhanced diagnostic precision through deep learning algorithms that analyze medical images, automate routine diagnostic tasks, and provide predictive analytics for personalized treatment strategies. The applications of these technologies are diverse, ranging from early cancer detection to therapeutic guidance and real-time imaging. Biomarker-based liquid biopsies and AI-assisted imaging tools are essential for non-invasive diagnostics and individualized patient management. Furthermore, AI-driven models are transforming disease stratification, thus enhancing risk assessment and decision-making. Future studies should explore standardizing biomarker validation, improving AI-driven diagnostics, and expanding the accessibility of advanced imaging technologies in resource-limited settings. The continued development of non-invasive diagnostic techniques and precision medicine approaches is crucial for optimizing the detection and management of biliopancreatic diseases. Collaborative efforts between clinicians, researchers, and industry stakeholders will be pivotal in applying these advancements in clinical practice.

Obsessive-compulsive symptoms in individuals with a history of eating disorders

BACKGROUND

OCD symptoms are well documented in anorexia nervosa (AN) and to a lesser extent in bulimia nervosa (BN), yet remain virtually unstudied in binge-eating disorder (BED).

METHODS

In this cross-sectional observational study, 5927 participants with lifetime eating disorders (EDs) (i.e., past or current) were categorized into five groups based on their diagnostic histories: AN only (n = 2330), BN only (n = 740), BED only (n = 665), AN and another ED diagnosis (AN Mixed) (n = 1293), and BN and BED (BN-BED) (n = 899). Obsessive-Compulsive Inventory-12 scores were compared across these groups and with OCD (n = 1040), anxiety-related disorders (ANX) (n = 423), and non-clinical community (NCC) (n = 1194) cohorts.

RESULTS

OCD symptoms were common among individuals with lifetime AN, BN, BED, and multiple EDs, with obsessing being the most prevalent dimension, followed by ordering, checking, and washing. The obsessing scale, which captures general intrusive thoughts rather than traditional OCD obsessions, was notably high. ED groups generally scored higher on the OCI-12 subscales than the ANX and NCC cohorts but lower than the OCD cohort, although ordering severity was higher in some ED groups. Positive correlations were found between ED symptoms and OCI-12 subscales, and gender-diverse individuals and men had greater OCD symptoms than women.

CONCLUSIONS

Clinicians should be vigilant for OCD symptoms in individuals with AN, BN, and BED. These findings call for research on the mechanisms linking EDs and OCD symptoms and support integrated treatment approaches for both conditions.

Melatonin and the nervous system: nanomedicine perspectives

The mechanism of action of melatonin on the nervous system, sleep, cognitive deficits, and aging is not fully understood. Neurodegenerative diseases (ND) are one of the leading causes of disability and mortality worldwide. Sleeping and cognitive impairments also represent common and serious public health problems, particularly deteriorating with the aging process. Melatonin, as a neuromodulatory hormone, regulates circadian rhythms and the sleep-wake cycle, with functions extending to antioxidant, anti-inflammatory, neuroprotective, and anti-aging properties. However, melatonin is a hydrophobic compound with relatively low water solubility and a short half-life. While melatonin can cross the blood-brain barrier, exogenous melatonin administered orally or intravenously has poor bioavailability, undergoes rapid metabolism in the circulation, and shows limited brain accumulation, ultimately compromising its therapeutic efficacy. In recent years, the convergence of melatonin research with nanomedicine ensures safe therapeutic uses, limited drug degradation, and perspectives for targeted drug delivery to the central nervous system. Here we outline the promising neurotherapeutic properties of nanomaterials as carriers loaded with melatonin drug alone or in combinations with other active molecules.

Patient with Atezolizumab-induced Encephalitis in Hepatocellular Carcinoma

A 65-year-old man treated with atezolizumab plus bevacizumab for hepatocellular carcinoma was admitted to our hospital with a fever, difficulty in moving, and aphasia. The patient became comatose immediately after admission. Imaging and cerebral fluid tests revealed no evidence of malignancy or infection. A diagnosis of atezolizumab-induced encephalitis was made, and steroid pulse therapy was initiated on admission, immediately after which the patient regained consciousness and was able to talk and walk. He was discharged with slight paralysis of his legs and was able to resume chemotherapy. An early diagnosis and treatment are required to improve the prognosis of encephalitis.

Non-invasive liquid biopsy based on transcriptomic profiling for early diagnosis of occult peritoneal metastases in locally advanced gastric cancer

This study proposes a novel non-invasive diagnostic approach utilizing transcriptomic profiling of liquid biopsy samples for the early detection of occult peritoneal metastases in locally advanced gastric cancer (LAGC). By analyzing RNA expression patterns of cancer cells, this method identifies specific gene signatures associated with peritoneal spread, potentially offering a more sensitive and comprehensive diagnostic tool compared to conventional imaging techniques. A 4-mRNA panel (BUB1, SPC25, CT83, MMP3) integrated with clinical features was developed into a Risk Stratification Assessment (RSA) model, demonstrating superior predictive accuracy in multiple cohorts with an area under the curve (AUC) of 0.836 in training and 0.882 in validation. This approach offers a promising alternative for early diagnosis, improving treatment decisions and clinical outcomes for gastric cancer patients, while enabling a shift from tissue-based testing to non-invasive blood-based diagnostics.

Precision risk stratification of primary gastric cancer after eradication of H. pylori by a DNA methylation marker: a multicentre prospective study

BACKGROUND

Precision cancer risk stratification for gastric cancer is urgently needed for the growing number of healthy people after Helicobacter pylori eradication. The epimutation burden in non-malignant tissues has been associated with cancer risk in multiple cross-sectional studies.

OBJECTIVE

To confirm the clinical usefulness of a DNA methylation marker for epimutation burden, and to identify a cut-off methylation level for a super-high-risk population.

DESIGN

Healthy people after H. pylori eradication with open-type atrophy were prospectively recruited. DNA methylation levels of a marker gene, RIMS1, were measured in biopsy specimens from gastric antrum and body. The primary endpoint was the incidence rate of gastric cancer in quartiles of the methylation levels.

RESULTS

1624 participants had at least one endoscopic follow-up with a median follow-up of 4.05 years, and a primary gastric cancer developed in 27 participants. The highest quartile of RIMS1 methylation levels had a higher incidence rate (972.8 per 100 000 person-years) than the lowest quartile (127.1). Cox regression analysis revealed a univariate HR of 7.7 (95% CI 1.8-33.7) and an age- and sex-adjusted HR of 5.7 (95% CI 1.3-25.5). As a secondary objective, a cut-off methylation level of 25.7% (95% CI 1.7-7.7) was obtained to identify a population with a super-high risk based on the number needed to screen of 1000.

CONCLUSION

A DNA methylation marker can risk-stratify healthy people after H. pylori eradication even though all of them have clinically high risk. Individuals with super-high risk will need more frequent gastric cancer screening than currently recommended.

TRIAL REGISTRATION NUMBER

UMIN-CTR000016894.

Exosomes: innovative biomarkers leading the charge in non-invasive cancer diagnostics

Exosomes, nanoscale extracellular vesicles secreted by diverse cell types, have emerged as promising biomarkers for non-invasive tumor diagnostics, offering significant advantages over traditional methods. These vesicles, typically ranging from 30 to 150 nanometers in size, carry a diverse cargo of proteins, lipids, RNA, and microRNAs, which reflect the molecular alterations occurring within their parent cells. Notably, exosomes can be isolated from easily accessible biofluids such as blood, urine, and saliva, making them ideal candidates for liquid biopsy applications. This review explores the transformative potential of exosome-based biomarkers in the early detection and monitoring of cancers across diverse organ systems, including respiratory, digestive, hematological, neurological, endocrine malignancies and so on. Special emphasis is placed on their application in clinical trials, where exosome-based diagnostics have demonstrated promising results in detecting tumors at early stages and monitoring treatment responses, offering a less invasive and more accessible alternative to traditional biopsies. While recent advancements in exosome isolation and characterization technologies have significantly improved the sensitivity and specificity of these diagnostics, challenges such as biological heterogeneity, lack of standardization, and regulatory hurdles remain. Nevertheless, exosome-based diagnostics hold the promise of providing real-time, dynamic insights into tumor progression, enhancing personalized medicine. The integration of exosomes into clinical practice could revolutionize cancer diagnostics and therapy, improving patient outcomes. Further research and large-scale clinical validation are essential to fully realize the clinical potential of exosome-based biomarker applications in routine clinical settings.

HDCA alleviates Parkinson's disease symptoms by promoting autophagic degradation of α-synuclein in enteric neurons

INTRODUCTION

Bile acids (BAs) are emerging as key modulators of Parkinson's disease (PD) through gut-brain interactions, yet their therapeutic potential remains underutilized. While BA imbalances contribute to PD pathogenesis, the specific subspecies regulating α-synuclein (α-syn) homeostasis and their mechanisms in enteric neurons-critical sites for PD initiation-require systematic investigation.

OBJECTIVE

To investigate whether hyodeoxycholic acid (HDCA), a secondary BA with documented neuroprotective properties but unproven efficacy in synucleinopathy, modulates α-syn clearance through enteric neuronal autophagy to mitigate PD progression.

METHODS

A53T transgenic mice underwent behavioral assessments for PD phenotyping. State-of-the-art UPLC/MS-based metabolomics quantified BA profiles. Pharmacological interventions using target-specific inhibitors (Gly-MCA, T0070907, VER-155,008) dissected the FXR-PPARγ-HSPA8 pathway. Multiscale analyses spanning immunofluorescence, western blotting, and LC3B autophagy flux reporter assays elucidated α-syn aggregation and autophagic dynamics in primary enteric neurons.

RESULTS

HDCA decline correlated with PD severity, positioning it as a novel biomarker for gut-brain axis dysfunction in PD. HDCA supplementation not only alleviated motor/non-motor deficits but also conferred dual neuroprotection-reducing colonic α-syn oligomers and preserving nigral dopaminergic neurons. Mechanistic decoding revealed HDCA's unparalleled capacity to activate enteric neuronal autophagy via FXR-PPARγ-HSPA8 signaling, a pathway previously unrecognized in PD therapeutics.

CONCLUSION

Our study reveals a novel gut-brain axis where HDCA depletion drives PD pathogenesis via FXR-PPARγ-HSPA8-mediated autophagic dysfunction in enteric neurons. PD-associated HDCA deficiency directly impairs α-syn clearance, identifying HDCA as both a gut-derived synucleinopathy biomarker and a therapeutic target.

Advancing Colorectal Cancer Diagnostics from Barium Enema to AI-Assisted Colonoscopy

Colorectal cancer (CRC) remains a major global health burden, necessitating continuous advancements in diagnostic methodologies. Traditional screening techniques, including barium enema and fecal occult blood tests, have been progressively replaced by more precise modalities, such as colonoscopy, liquid biopsy, and artificial intelligence (AI)-assisted imaging. Objective: This review explores the evolution of CRC diagnostic tools, from conventional imaging methods to cutting-edge AI-driven approaches, emphasizing their clinical utility, cost-effectiveness, and integration into multidisciplinary healthcare settings. Methods: A comprehensive literature search was conducted using the PubMed, Medline, and Scopus databases, selecting studies that evaluate various CRC diagnostic tools, including endoscopic advancements, liquid biopsy applications, and AI-assisted imaging techniques. Key inclusion criteria include studies on diagnostic accuracy, sensitivity, specificity, clinical outcomes, and economic feasibility. Results: AI-assisted colonoscopy has demonstrated superior adenoma detection rates (ADR), reduced interobserver variability, and enhanced real-time lesion classification, offering a cost-effective alternative to liquid biopsy, particularly in high-volume healthcare institutions. While liquid biopsy provides a non-invasive means of molecular profiling, it remains cost-intensive and requires frequent testing, making it more suitable for post-treatment surveillance and high-risk patient monitoring. Conclusions: The future of CRC diagnostics lies in a hybrid model, leveraging AI-assisted endoscopic precision with molecular insights from liquid biopsy. This integration is expected to revolutionize early detection, risk stratification, and personalized treatment approaches, ultimately improving patient outcomes and healthcare efficiency.

Synchronous Portal Vein Embolization of Terminal Branches with Transcatheter Arterial Chemoembolization Prior to Planned Major Hepatectomy for Hepatitis B Virus-Related Hepatocellular Carcinoma: A Single Center Retrospective Cohort Study

BACKGROUND

Terminal branches portal vein embolization (TBPVE) is a novel technical modification. The clinical impact of synchronous TBPVE with transcatheter arterial chemoembolization (TACE) before planned major hepatectomy in hepatitis B virus (HBV) related HCC is still unknown.

METHOD

From November 2016 to December 2021, the study enrolled 115 patients with HBV-related HCC who were scheduled for major hepatectomy but had insufficient FLR. Patients were grouped according to whether they received TBPVE combined with TACE (the TBPVE group, n = 62) or PVE combined with TACE (the PVE group, n = 53). We compared the outcomes of the procedures and the perioperative and long-term outcomes of patients who subsequently underwent major hepatectomy between the groups.

RESULTS

FLR volume increment and degree of hypertrophy were significantly higher in the TBPVE group than in the PVE group (P≤0.003). FLR proliferation was pronounced remarkably within the first two weeks after TBPVE synchronous with TACE, the kinetic growth rates were 17.4 (12.7-21.9) mL/day and 6.9 (4.1-11.1) mL/day respectively. 54 patients in the TBPVE group and 41 patients in the PVE group finally underwent major hepatectomies. Pringle's maneuver time, intraoperative blood loss, transfusion, and postoperative hospital stays were less in the TBPVE group (P<0.05). Disease-free survival (DFS) rates were better in the TBPVE group than in the PVE group (P=0.042).

CONCLUSION

TBPVE synchronous with TACE induced safe and rapid FLR hypertrophy with satisfactory efficacy in initially unresectable HBV-related HCC patients improved the planned major hepatectomy resectability rate and has better DFS.

Epigenetic Modifications as Novel Biomarkers for Diagnosis, Prognosis, and Therapeutic Targeting in Thyroid, Pancreas, and Lung Neuroendocrine Tumors

Neuroendocrine neoplasms (NENs) comprise a heterogeneous tumor group arising from neuroendocrine cells, commonly originating in the gastroenteropancreatic tract and bronchopulmonary system. Their incidence has risen significantly, owing to improved diagnostic techniques and increased clinical recognition. While previous reviews have explored the molecular and genetic basis of NENs, limited attention has been given to the role of epigenetic modifications, particularly DNA methylation, in tumorigenesis and disease progression. This review focuses on lung, pancreas, and thyroid well-differentiated neuroendocrine tumors (NETs), highlighting epigenetic mechanisms, particularly DNA methylation, as promising biomarkers for early diagnosis and risk stratification. Aberrant DNA methylation can silence key tumor suppressor genes, including RASSF1A and CDKN2A, thereby promoting tumorigenesis. Integrating DNA methylation profiles with conventional biomarkers such as chromogranin A (CgA) may enhance diagnostic accuracy and inform therapeutic strategies. Emerging epigenetic therapies offer potential avenues for personalized treatment based on molecular profiling. Unlike prior reviews that broadly cover genetic and epigenetic changes in NENs, this review uniquely emphasizes the translational potential of epigenetic biomarkers in clinical practice. By synthesizing recent findings and evaluating their clinical implications, we aim to bridge the gap between molecular research and practical applications in diagnosis, prognosis, and therapy.

Functional Cure for Hepatitis B Virus: Challenges and Achievements

The Hepatitis B Virus (HBV) presents a formidable global health challenge, impacting hundreds of millions worldwide and imposing a considerable burden on healthcare systems. The elusive nature of the virus, with its ability to establish chronic infection and evade immune detection, and the absence of curative agents have prompted efforts to develop novel therapeutic approaches beyond current antiviral treatments. This review addresses the challenging concept of a functional cure for HBV, a state characterized by the suppression of HBV and HBsAg, mitigating disease progression and transmission without a complete cure. We provide an overview of HBV epidemiology and its clinical impact, followed by an exploration of the current treatment landscape and its limitations. The immunological basis of a functional cure is then discussed, exploring the intricate interplay between the virus and the host immune response. Emerging therapeutic approaches, such as RNA interference-based interventions, entry inhibitors, nucleic acid polymers, and therapeutic vaccines, are discussed with regard to their success in achieving a functional cure. Lastly, the review underscores the urgent need for innovative strategies to achieve a functional cure for HBV.

Rare Malignant Liver Tumors: Current Insights and Imaging Challenges

Rare malignant liver tumors (RMLTs) comprise a diverse group of neoplasms with distinct imaging features and significant diagnostic challenges due to their low prevalence and overlap with more common hepatic lesions. This review highlights the main radiologic characteristics of selected RMLTs-including fibrolamellar hepatocellular carcinoma, hepatic lymphoma, hepatocellular carcinoma in non-cirrhotic liver, mucinous cystic neoplasm, intraductal papillary neoplasm of the bile duct, epithelioid hemangioendothelioma, angiosarcoma, malignant hepatic adenoma, neuroendocrine tumor, hepatocholangiocarcinoma, hepatoblastoma, undifferentiated embryonal sarcoma, and infantile hepatic hemangioendothelioma-focusing on their presentation in CT and MRI. Recognizing specific imaging findings, such as arterial hyperenhancement, biliary communication, target and lollipop signs, and tumor morphology, can help narrow differential diagnoses and guide appropriate clinical management. Despite advancements in imaging, histopathologic confirmation is often required due to nonspecific features. Improved radiologic awareness of these rare entities is essential to facilitate early diagnosis and individualized treatment planning.

Comprehensive pan-cancer analysis identifies PLAG1 as a key regulator of tumor immune microenvironment and prognostic biomarker

Background

The literature on the role of pleomorphic adenoma gene 1 (PLAG1) in malignant tumors is limited. This study aimed to perform pan-cancer analysis of PLAG1.

Methods

The expression of PLAG1 was analyzed by Human Protein Atlas (HPA). The differential expression and prognosis of PLAG1 were analyzed based on TCGA pan-cancer data. The relationship between PLAG1 expression and tumor heterogeneity, stemness and immune infiltration was investigated. The enrichment analysis and biological function of PLAG1 in bladder cancer were analyzed.

Results

The expression of PLAG1 was increased in a variety of tumors and significantly correlated with the prognosis of patients. Their expression levels were associated with key immune checkpoint genes (CD274, HAVCR2), immune infiltration and immune stimulation factors (CD48, CD27). In bladder cancer, functional enrichment analysis indicated that PLAG1 was involved in epidermal related processes and immune pathways. PLAG1 gene expression reduction can significantly inhibit the proliferation of bladder cancer cells.

Conclusions

PLAG1 has the potential to be a prognostic marker and a potential therapeutic target for patients with malignant tumors.

Chitosan/κ-Carrageenan/Carbon Nitride Hydrogel Adsorbent for Removing Free Hemoglobin from Extracorporeal Circulation

Extracorporeal circulation often causes mechanical damage to erythrocytes, which release hemoglobin into the plasma, resulting in postsurgical hazard, so lowering the free hemoglobin (f-Hb) level in the blood is important. In this study, based on the good biocompatibility of chitosan/κ-carrageenan and the adsorption effect of carbon nitride, a chitosan/κ-carrageenan/carbon nitride (CS/κ-Car/C3N4) hydrogel was prepared through the charge electrostatic interaction between polysaccharides. The incorporation of C3N4 enhanced both the adsorptive capacity and the stability of the hydrogel. Specifically, the CS/κ-Car/C3N4-0.4% hydrogel exhibited an adsorption amount of 185.79 mg/g for human hemoglobin, approximately twice that of the CS/κ-Car hydrogel. The CS/κ-Car/C3N4 hydrogel also showed a significantly lower breakage and degradation rate. In addition, the CS/κ-Car/C3N4 hydrogel did not induce hemolysis, complement activation, or coagulate when in contact with blood and showed good blood compatibility. Furthermore, in vivo studies in rabbits revealed that the CS/κ-Car/C3N4 hydrogel significantly reduced elevated f-Hb levels to near-normal concentrations postcirculation, without inducing any severe adverse effects on the subjects. This investigation has elucidated that the CS/κ-Car/C3N4 hydrogel possesses superior adsorptive efficacy and biocompatibility, effectively clearing f-Hb in vivo. Consequently, the findings of this study offer novel insights into the design paradigm for adsorbents intended for blood circulation applications.

Case Report: Radiological characteristics and pathological correlation analysis of extranodal Rosai-Dorfman disease of liver

Background

Rosai Dorfman disease (RDD), also known as sinus histiocytosis with extensive lymph node involvement, is a rare histiocytosis with unknown etiology. Liver RDD is relatively rare and is often reported in individual cases. Exploring the imaging and pathological features of extrahepatic Rosai Dorfman disease (RDD) and conducting a comprehensive analysis of reported cases in domestic and foreign literature to enhance understanding of this rare disease.

Methods

We collected data from a patient diagnosed with liver RDD in our hospital. In addition, we searched for liver RDD cases through PubMed and conducted a literature review.

Results

Of the patient data used in this study, 1 patient's data was obtained from our hospital records and 16 were retrieved from literature. There were 6 males and 11 females aged between 2-72 years, with an average age of 33.55 ± 19.38 years. Four patients presented with isolated liver nodules without the involvement of lymph nodes or extranodal organs, two patients presented with a case that involved extranodal organs but not lymph nodes, two patients presented with a case involving lymph nodes but not extranodal organs, eight patients presented with a case involving both lymph nodes and extranodal organs and lastly one patient presented with a case that did not involve either lymph nodes or extranodal organs. Four of the patients underwent enhanced scanning. The results revealed that 2 of them showed low enhancement, and the other 2 showed no significant enhancement. Only 1 case underwent PET-CT, and the results indicated a high uptake. Immunohistochemistry was performed on all 17 cases of liver RDD, and the results were positive for CD1a (-), CD68 (+), and S-100 (+).

Conclusions

Liver RDD can manifest at any age. It presents with nonspecific imaging findings and a challenging preoperative diagnosis. Patients with extranodal hepatic RDD present with typical RDD characteristic immunohistochemistry features such as, high uptake on PET-CT, and no to mild enhancement on contrast-enhanced scans. For an early diagnosis, it is beneficial to fully comprehend these traits.

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.

Dihydromyricetin restores lysosomal function in Schwann cells to alleviate bortezomib-induced peripheral neuropathy via ERK/TFEB signaling

Bortezomib (BTZ) serves as a first-line drug for multiple myeloma (MM) treatment by reversibly inhibiting of the proteasomes. However, BTZ-induced peripheral neuropathy (BIPN) remains a significant toxicity concern, with its molecular mechanisms not fully elucidated, resulting in limited therapeutic options. Dihydromyricetin (DHM) has been shown to alleviate neuropathic pain, but its potential effect on BIPN has not been investigated. We found that oral administration of DHM (40 mg/kg/day, 200 mg/kg/day) for 2 weeks significantly improved mechanical allodynia, sciatic nerve conduction, and demyelination in a BIPN mouse model (BTZ 1.0 mg/kg, i.v.). BTZ (50 nmol/L) impaired lysosomal function and blocked autophagy flux in both primary cultured rat Schwann cells and RSC96 Schwann cells; these effects were reversed by DHM treatment (3 μmol/L, 10 μmol/L). Mechanistically, DHM facilitated the nuclear translocation of TFEB, a master regulator of lysosomal-related genes, and the protective effects of DHM on Schwann cells were abolished by Tfeb shRNA. Furthermore, BTZ treatment activated ERK signaling, leading to TFEB phosphorylation and impaired nuclear translocation. DHM treatment prevented the BTZ-induced ERK activation, and the protective effects of DHM were compromised by the ERK activator TBHQ. Importantly, DHM did not diminish the efficacy of BTZ against RPMI 8226 myeloma cells. This study demonstrates that DHM mitigates BTZ-induced toxicity on Schwann cells by restoring lysosome-autophagy activity through the ERK-TFEB pathway, highlighting DHM as a promising candidate for improving the adverse reaction of BTZ in the peripheral nervous system.

A systematic review of preoperative radiological factors associated with the development of low anterior resection syndrome (LARS)

The aim of this systematic review is to summarise the available evidence for radiological changes associated with postoperative low anterior resection syndrome (LARS). A literature search was undertaken for all studies focusing on preoperative radiological predictors of postoperative LARS. Articles were selected from MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) databases up to October 2024. Eighty-four articles were screened: eighty-one were excluded and three were included in the analysis. All included studies focused on preoperative Magnetic Resonance Imaging (MRI) already performed as part of the oncological assessments, no study examined ultrasound or defecography. Authors retrospectively selected patients that underwent LAR, screened them with the LARS score, and reviewed preoperative MRI images with specific softwares in order to find radiological characteristics associated with LARS. Results showed that particular anatomical characteristics were present in patients that subsequently developed major LARS: the volume of the pubococcygeal + iliococcygeus muscles in 27 LARS patients out of 46 LAR (odds ratio-OR 14.7, 95% CI 1.7-128.3; p = 0.02), the thickness of the anorectal joint in 136 LARS out of 255 LAR preceded by neoadjuvant chemoradiotherapy (OR 0.653, 95% CI 0.565-0.756; p = 0.001) and the mesorectal/pelvic volumes in 135 LARS out of 236 LAR (Cox Regression analysis, p = 0.0017 and p = 0.0001 respectively). Pelvic floor musculature is a factor, among the others, that contributes to LARS. Future prospective studies need to validate these retrospective results, further delineate its influence, and investigate the potential contribution of other radiologic investigations (ultrasound and defecography) in this setting.

Transcranial focused ultrasound targeting the default mode network for the treatment of depression

Introduction

Up to 50% of individuals fail to respond to current depression treatments. Repetitive negative thought and default mode network hyperconnectivity are central in depression and can potentially be targeted using novel neuromodulation techniques. This community-based study assessed whether a treatment using non-invasive transcranial focused ultrasound targeting the default mode network can decrease depression symptoms and repetitive negative thought, and improve quality of life.

Methods

Study recruitment began in August 2023 and ended in February 2024. Twenty individuals aged 18 - 50 were enrolled from among 247 screened. Exclusion criteria included history of psychosis/mania, acute suicidality, MRI contraindications, pregnancy, and medical and neurological factors that may complicate diagnosis or brain function. Participants completed up to three weeks of transcranial ultrasound (11 sessions) targeting the anterior medial prefrontal cortex; ten minutes per session. Depression severity (Beck Depression Inventory - II and the Hamilton Depression Rating Scale), repetitive negative thought (Perseverative Thinking Questionnaire), and quality of life (World Health Organization Quality of Life Scale) were outcomes.

Results

This sample was young (mean 30.4 years ± 10.0), predominantly female (75%), with moderate to severe depression and high comorbidity. Fifty percent of participants endorsed current psychiatric medication use. Ten percent of subjects dropped out of the study due to time constraints. Significant decreases in depression were observed over the course of treatment on self-report, 10.9 (p < 0.001, CI = -13.55, -7.92) and interview depression ratings, 4.2 (p < 0.001, CI = -5.85, -2.62), as well as significant decreases in repetitive negative thought, 8.4 (p <0.001, CI = -10.55, -6.03). Improvements in physical and psychological well-being were also observed over the course of treatment, 7.2 (p < 0.001, CI = 3.64, 10.63) and 11.2 (p < 0.001, CI = 7.79, 14.49), respectively, as well as improvements in environment satisfaction, 5.0 (p =0.001, CI = 2.24, 7.56).

Discussion

Non-invasive transcranial focused ultrasound holds promise as a treatment for depression holds promise as a treatment for depression, however, future work including control arms is required to ascertain its causal role in depression.

Clinical trial registration

https://clinicaltrials.gov/study/NCT06320028intr=Ultrasound&cond=depression&locStr=Arizona&country=United%20States&state=Arizona&rank=1, identifier NCT06320028.

Epidemiology, prognostic factors, and survival analysis in small cell esophageal carcinoma: A population-based study with external validation

Small cell esophageal carcinoma (SCEC) is a poorly differentiated esophageal neuroendocrine neoplasm with a poor prognosis. This study aimed to explore the factors and treatment approaches influencing the prognosis of SCEC. In this retrospective study, we collected data from the 18 Surveillance, Epidemiology, and End Results (SEER) registries cohort between 2004 and 2019, as well as from a Chinese institutional registry covering the period from 2012 to 2022. We assessed the annual percentage change (APC) in incidence of SCEC. Kaplan-Meier and Cox regression analyses were conducted to evaluate survival outcomes. Additionally, nomograms were developed for overall survival (OS) and cancer-specific survival (CSS) in the SEER cohort for SCEC and validated in an independent Chinese cohort. This analysis included 299 SCEC patients from the SEER cohort and 66 cases from the Chinese cohort. During the period of 2004-2019, the incidence of SCEC reached a plateau, with an APC of -1.40 (95% confidence interval [CI]: -4.3 to 1.40, P > 0.05). Multivariable Cox regression analysis revealed that age, distant metastasis, and chemotherapy were independent factors for OS, while distant metastasis and chemotherapy were independent factors for CSS. The nomograms developed for OS and CSS in SCEC exhibited remarkable accuracy and reliable predictive capacity in estimating 1-year, 3-year, and 5-year OS and CSS. SCEC is a rare malignancy with aggressive behavior. Distant metastasis is significantly associated with worse OS and CSS in patients with SCEC. Currently, chemotherapy remains the primary treatment approach for SCEC.

Preoperative pan-immuno-inflammatory values and albumin-to-globulin ratio predict the prognosis of stage I-III colorectal cancer

This study evaluated the prognostic value of the pan-immune-inflammation value (PIV) combined with the albumin-to-globulin ratio (AGR) for postoperative survival in colorectal cancer (CRC) patients and developed a nomogram for survival prediction. A total of 650 CRC patients who underwent radical surgery were included, with data from one institution used as the training set. The optimal cut-off values for PIV (426.8) and AGR (1.4) were determined using maximally selected rank statistics. Kaplan-Meier analysis showed that patients in the low-PIV group had significantly better 5-year overall survival (OS) compared to the high-PIV group, while those in the high-AGR group had better 5-year OS than those in the low-AGR group. Multivariate analysis identified age, N stage, degree of differentiation, PIV, and AGR as independent prognostic factors for OS. A nomogram for OS was developed and validated, demonstrating robust predictive performance. This study highlights the value of PIV and AGR as reliable indicators for predicting OS in CRC patients, with high PIV and low AGR associated with worse prognosis. Timely interventions may improve patient outcomes.

Preliminary investigation of gut microbiota and associated metabolic pathways in the pathogenesis of primary central nervous system lymphoma

Background

Primary central nervous system lymphoma (PCNSL) is a rare and highly aggressive form of non-Hodgkin lymphoma, primarily confined to the central nervous system. In recent years, growing evidence has indicated that dysbiosis of the gut microbiota is closely associated with the development of various malignancies. This study aims to systematically explore the potential role of gut microbiota and their metabolic pathways in the pathogenesis of PCNSL by integrating metagenomic and metabolomic approaches.

Materials and methods

A total of 33 PCNSL patients and 32 healthy controls were enrolled in this study, and fecal samples were collected from each participant. The fecal samples were analyzed using metagenomic and metabolomic techniques, followed by KEGG pathway enrichment analysis to investigate the biological pathways enriched by the differential gut microbiota and metabolites.

Results

Significant differences were observed in the composition of gut microbiota and metabolites between PCNSL patients and healthy controls. In the gut microbiota of PCNSL patients, the abundance of the phylum Proteobacteria was markedly increased, while the Firmicutes/Bacteroidetes (F/B) ratio was significantly elevated. Metabolomic analysis revealed that the abundance of oleamide was significantly reduced in the PCNSL group, while the relative abundance of deoxycholic acid was significantly elevated. KEGG pathway analysis indicated that the differential gut microbiota and metabolites were primarily involved in key metabolic pathways such as nitrogen metabolism, phenylalanine metabolism, purine metabolism, and pyrimidine metabolism, with these pathways being more active in PCNSL patients.

Conclusion

This study is the first to systematically investigate the differences in gut microbiota and their metabolites between PCNSL patients and healthy individuals, highlighting the potential role of gut microbiota alterations in the pathogenesis of PCNSL.