Chinese research into severe ulcerative colitis has increased in quantity and complexity

Application of deep learning in the diagnosis and evaluation of ulcerative colitis disease severity

Background

Achieving endoscopic and histological remission is a critical treatment objective in ulcerative colitis (UC). Nevertheless, interobserver variability can significantly impact overall assessment performance.

Objectives

We aimed to develop a deep learning algorithm for the real-time and objective evaluation of endoscopic disease activity and prediction of histological remission in UC.

Design

This is a retrospective diagnostic study.

Methods

Two convolutional neural network (CNN) models were constructed and trained using 12,257 endoscopic images and biopsy results sourced from 1124 UC patients who underwent colonoscopy at a single center from January 2018 to December 2022. Mayo Endoscopy Subscore (MES) and UC Endoscopic Index of Severity Score (UCEIS) assessments were conducted by two experienced and independent reviewers. Model performance was evaluated in terms of accuracy, sensitivity, and positive predictive value. The output of the CNN models was also compared with the corresponding histological results to assess histological remission prediction performance.

Results

The MES-CNN model achieved 97.04% accuracy in diagnosing endoscopic remission of UC, while the MES-CNN and UCEIS-CNN models achieved 90.15% and 85.29% accuracy, respectively, in evaluating endoscopic severity of UC. For predicting histological remission, the CNN models achieved accuracy and kappa values of 91.28% and 0.826, respectively, attaining higher accuracy than human endoscopists (87.69%).

Conclusion

The proposed artificial intelligence model, based on MES and UCEIS evaluations from expert gastroenterologists, offered precise assessment of inflammation in UC endoscopic images and reliably predicted histological remission.

Research trends in the field of the gut-brain interaction: Functional dyspepsia in the spotlight – An integrated bibliometric and science mapping approach

Objectives

This study aims to perform a bibliometric analysis of functional dyspepsia (FD), which includes visualizing bibliographic information, in order to identify prevailing study themes, topics of interest, contributing journals, countries, institutions, and authors as well as co-citation patterns.

Methods

The Web of Science™ Core Collection Database was used to retrieve all peer-reviewed scientific publications related to FD research. The validated search terms were entered into the “title” and “author keywords” fields, and the results were sorted by publication year from 2006 to 2022. There were no restrictions on language. On 12 February 2023, a manual export of the complete metadata for each original publication and review article was performed. CiteSpace was used to reveal co-authorship, publication, and co-citation patterns to find prominent authors, organizations, countries, and journals in FD research as well as to identify author keywords with strong citation bursts, which could indicate an emerging research area. VOSviewer was used to build the co-occurrence indicator (co-word) to identify the main author keywords on which previous studies focused and to induce clustered scientific landscape for two consecutive periods to identify intriguing areas for future research.

Results

A search of the database retrieved 2,957 documents. There was a wave-like pattern in the number of publications until 2017, after which there was a spike in publication volume. The USA, China, and Japan provided the majority of contributions. In terms of institution, Mayo Clin, Univ Newcastle, and Katholieke Univ Leuven were found to be the prolific institutions. Additionally, the results indicate that eastern Asian researchers contributed significantly to the global knowledge of literature that led other countries; however, Canada, the USA, Australia, England, and Germany were found to have the highest degree of betweenness centrality. Nicholas J. Talley, Jan Tack, Gerald Holtmann, Michael Camilleri, Ken Haruma, and Paul Moayyedi occupied the top positions based on productivity and centrality indicators. Six thematic clusters emerged (Helicobacter pylori infection; pathophysiological mechanisms of FD; extraintestinal co-morbidities and overlap syndromes associated with FD; herbal medicine in FD; diabetic gastroparesis; and dietary factors in FD). “Acupuncture,” “duodenal eosinophilia,” “gut microbiota,” and others were among the author keywords with rising prevalence.

Conclusion

In FD research, eastern Asian countries have established themselves as major contributors with the highest publishing productivity; however, research has primarily been driven by North America, Europe, and Australia, where cooperation is generally more active and highly influential scientific results are produced. Our analysis suggests that increased investments, training of human resources, improved infrastructures, and expanded collaborations are essential to improving the quality of FD research in Asia. The emerging author keyword analysis suggests that eosinophil-mast cell axis, gut microbiota, mental disorders, and acupuncture are the key areas that attract researchers’ attention as future research boulevards. There is a highly skewed distribution of research output across Asia, with most focus on complementary and alternative medicine (CAM) coming from Chinese, Japanese, and South Korean centers. However, CAM remains an underexplored area of research in the context of FD, and it deserves greater research efforts in order to obtain quality scientific evidence. Furthermore, we propose that the research framework of CAM should not be limited to dysmotility; rather, it could be interpreted within a more holistic context that includes the brain-gut-microbiota axis, as well as novel concepts such as duodenitis, increased mucosal permeability, and infiltration and activation of eosinophils and mast cells, among others. Overall, we provided bibliometrics-based overviews of relevant literature to researchers from different backgrounds and healthcare professionals to provide an in-depth overview of major trends in FD research.

Sigmoidoscopic extent of ulcerative colitis and associated factors in Pakistani population

OBJECTIVES

To determine the extent of ulcerative colitis and associated factors in patients who underwent sigmoidoscopy at Liver Center, Jail Road, Lahore, Pakistan.

METHODS

In this retrospective cohort study, patients who underwent sigmoidoscopy from July 2013 to July 2020 at Liver Clinic, Jail Road, Lahore, were categorized into two cohorts: who had ulcerative colitis confirmed on histology and who had no ulcerative colitis. Extent and severity of the disease as well as coexisting pathologies were also noted. SPSS version 25 was used. Independent sample T-test was applied to compare quantitative variables like age and weight, and chi-square test to compare qualitative variables with two cohorts. The p-value less than 0.05 was opted as significant. Odd ratio with 95% confidence interval (CI) were also computed for each association.

RESULTS

About 11.55% patients (165 out of 1428) had ulcerative colitis, whose mean age and mean weight were 38.27 ± 14.15 years and 74.08 ± 13.20 Kg respectively. Among ulcerative colitis patients, 18.2% had proctitis, 22.4% had proctosigmoiditis, 27.7% had left-sided colitis, and 31.5% had extensive colitis. May endoscopic severity score was found 0,1,2, and 3 in 12.1%, 23.6%, 31.5%, and 32.7% patients respectively. Ulcerative colitis cohort had significant association with younger age (p<0.01), female gender (p<0.01), non or former smoking (p=0.02) and presentation with bloody diarrhea (p<0.01), and no association with body weight (p=0.311), presence of diabetes mellitus (p=0.311) and family history of IBD (P=0.368).

CONCLUSION

Endoscopic extent and severity of ulcerative colitis is high in our studied population. Ulcerative colitis is more prevalent in younger age and female gender patients who presented with bloody diarrhea, while the presence of active smoking has negative association with finding the ulcerative colitis. However, presence of family history of IBD, diabetes mellitus and body weight of the patient has no statistical correlation with finding ulcerative colitis during sigmoidoscopic examination in our patients.

The Communication Between Intestinal Microbiota and Ulcerative Colitis: An Exploration of Pathogenesis, Animal Models, and Potential Therapeutic Strategies

Ulcerative Colitis (UC) is a chronic inflammatory bowel disease. The prolonged course of UC and the lack of effective treatment management make it difficult to cure, affecting the health and life safety of patients. Although UC has received more attention, the etiology and pathogenesis of UC are still unclear. Therefore, it is urgent to establish an updated and comprehensive understanding of UC and explore effective treatment strategies. Notably, sufficient evidence shows that the intestinal microbiota plays an important role in the pathogenesis of UC, and the treating method aimed at improving the balance of the intestinal microbiota exhibits a therapeutic potential for UC. This article reviews the relationship between the genetic, immunological and microbial risk factors with UC. At the same time, the UC animal models related to intestinal microbiota dysbiosis induced by chemical drugs were evaluated. Finally, the potential value of the therapeutic strategies for restoring intestinal microbial homeostasis and treating UC were also investigated. Comprehensively, this study may help to carry out preclinical research, treatment theory and methods, and health management strategy of UC, and provide some theoretical basis for TCM in the treatment of UC.

Diosmetin attenuate experimental ulcerative colitis in rats via suppression of NF-κB, TNF-α and IL-6 signalling pathways correlated with down-regulation of apoptotic events

Introduction

Ulcerative colitis (UC) is a chronic inflammation of colon in which the innermost tissue of colon and rectum develops deep-rooted inflammation. Diosmetin is the aglycone of the flavonoid glycoside diosmin, commonly found in citrus fruits. Therapeutically diosmetin is indicated to demonstrate anticancer, antimicrobial, antioxidant, oestrogenic and anti-inflammatory activity.

Methods

In this research, we studied the action of diosmetin on TNBS (2,4,6-trinitrobenzene sulfonic acid)-induced UC in rats. Male Wister rats were anesthetised with pentobarbital and TNBS introduced by performing an enema. Diosmetin treatment was provided through oral gavage for the next 28 days. Animals were sacrificed on the 29th day and colon tissues were collected for further examinations.

Results

Diosmetin treatment decreased colonic ulceration dramatically and decreased the percentage of inflammation in the colonic mucosa. Depletion of the TNBS assisted of superoxide dismutase and catalase was substantially restricted, while lipid peroxidation was recorded in the colonic tissue as malondialdehyde content was also decreased. After treatment with diosmetin, the occurrence of TNF-α, IL-6and NF-κB was considerably lowered and the number of apoptotic cells observed was significantly reduced.

Conclusion

Taken together, these observations demonstrated the potential of diosmetin against ulcer formation and development.

A Correlative Study Between Personality Traits and the Preference of Site Selection in Cosmetic Treatment

Background: Cosmetic treatment was closely associated with beauty seekers' psychological well-being. Patients who seek cosmetic surgery often show anxiety. Nevertheless, not much is known regarding how personality traits relate to the selection of body parts that receive cosmetic treatment. Aims: This study aims to investigate the correlation between personality traits and various selection sites for cosmetic treatment via Eysenck Personality Questionnaire (EPQ). Methods: A cross-sectional approach was adopted to randomly recruited patients from a general hospital planning to undergo cosmetic treatments. All respondents completed the EPQ and provided their demographic information. The EPQ involves four scales: the extraversion (E), neuroticism (N), psychoticism (P), and lying scales (L). Psychological scales were evaluated to verify that people who selected different body sites for cosmetic intervention possessed different personality portraits. Results: A total of 426 patients with an average age of 32.14 ± 8.06 were enrolled. Among them, 384 were females, accounting for more than 90% of patients. Five treatment sites were analyzed, including the body, eye, face contour, nose, and skin. Comparatively, patients with neuroticism were more likely to undergo and demand rhinoplasty (OR 1.15, 95% CI 1.07-1.24, P < 0.001). Face contour treatment was commonly associated with extraversion (OR 1.05, 95% CI 1.00-1.11, P = 0.044), psychoticism (OR 1.13, CI 1.03-1.25, P = 0.013), and neuroticism (OR 1.05, CI 1.01-1.10, P = 0.019). Conclusions: This novel study attempted to determine the personality profiles of beauty seekers. The corresponding assessments may provide references for clinical treatment options and enhance postoperative satisfaction for both practitioners and patients.

Chlorogenic Acid Suppresses miR-155 and Ameliorates Ulcerative Colitis through the NF-κB/NLRP3 Inflammasome Pathway

SCOPE

The over-activation of the nucleotide-binding domain like receptor protein 3 (NLRP3) inflammasome plays an important role in the pathogenesis of ulcerative colitis (UC). Chlorogenic acid (CGA) exposure is identified as an effective strategy for repressing inflammatory responses.

METHODS AND RESULTS

In this study, the NLRP3 inflammasome model with LPS/ATP-induced RAW264.7 cells in vitro and dextran-sulfate-sodium (DSS)-induced colitis in mice are used to evaluate the effect of CGA on NLRP3 inflammasome-related signaling. The results suggest that CGA suppressed the expression of NLRP3 inflammasome-related genes (apoptosis-associated speck-like protein containing CARD (ASC), cysteine-requiring aspartate protease (Caspase)-1 p45, Caspase-1 p20, pro-/cleaved-interleukin (IL)-1β, pro-/cleaved-IL-18), p-nuclear factor kappa B (NF-κB) protein, and miR-155 in mice with colitis. Gain- and loss-of-function studies of miR-155 are performed to elucidate its role in inflammation. Moreover, activation of the NF-κB/NLRP3 inflammasome pathway and miR-155 expression is investigated. CGA exposure in lipopolysaccharide (LPS)/adenosine triphosphate (ATP)-stimulated RAW264.7 cells leads to a decrease in p-NK-κB and NLRP3 inflammasome-related proteins, which is dependent on the downregulation of miR-155 expression.

CONCLUSIONS

These findings indicate that CGA prevented colitis by downregulating miR-155 expression and inactivating the NF-κB/NLRP3 inflammasome pathway in macrophages. The current study has promising therapeutic implications in the treatment of UC.

The amelioration of ulcerative colitis induced by Dinitrobenzenesulfonic acid with Radix Hedysari

Ulcerative colitis (UC) is a chronic inflammatory disease with an unknown precise etiology. This study proves that Radix Hedysari (RH) ameliorates UC. Four RH extracts were used to ameliorate UC induced by 2,4-Dinitrobenzenesulfonic acid by 7 days intervention in agreement to preliminary studies. Compared to treatment with RH extracts, the RH ethanol extract (EE) was found to be more effective in ameliorating UC. With EE, the DAI were significantly decreased. Macroscopic and histopathological assessments suggest that the colon mucosa was repaired, the organizational structure of the colon had been rebuilt. The levels of MPO, TNF-α, IL-1β, and MDA were significantly decreased (p < .01), the levels of T-SOD and CAT were significantly increased (p < .01). Moreover, the compounds in EE were analyzed by HPLC. The results show that EE can ameliorate UC, and its anti-inflammatory capability probably plays an important role. RH can act as a functional food and ameliorate UC. PRACTICAL APPLICATIONS: In this work, the ameliorative effect of RH on UC was evaluated from multiple angles. There are two practical applications of this work. On the one hand, a new approach to ameliorating UC is provided by this work. In addition, UC patients have a new option for improving their symptoms. On the other hand, this work also provides information on how best to process RH for therapeutic use. In addition, we can utilize some compounds of RH that were once considered useless and reduce the waste of natural resources.

Phloretin Ameliorates Acetic Acid Induced Colitis Through Modulation of Immune and Inflammatory Reactions in Rats

BACKGROUND

Adverse effects associated with current therapy for Ulcerative colitis (UC) over prolonged treatment periods and the high relapse rate limit their use. Incorporating fruits as regular diet has beneficial role in the management of UC. Phloretin, a dihydrochalcone of apple is reported for its anti-oxidant and anti-inflammatory effects. Our study aims to evaluate the effectiveness of phloretin on experimentally induced ulcerative colitis in rats.

METHODS

In vitro study was performed using Raw 264.7 cells stimulated with LPS (1μg/mL) and in in-vivo study, colitis was induced by intra rectal administration of 4% Acetic acid. Phloretin (50 mg/kg) was given orally for 3 days to Wistar rats after induction for the post-treatment group and 1 day before induction to the pre-treatment group. Macroscopical, biochemical and histopathological evaluations were performed to assess the effectiveness.

RESULTS

A concentration dependent inhibition of MPO and iNOS activity was obtained in LPS stimulated neutrophil cells. Phloretin exerted ameliorative effect in both pre and post-treatment groups by restoring plasma ALP and LDH level and reduce inflammatory markers like myeloperoxidase, nitric oxide and eosinophil peroxidase level as well as downregulates colon ICAM-1 gene in acetic acid induced ulcerative colitis in rats. Antioxidative potency was confirmed by restoring tissue GSH level. Phloretin prevents mucosal damage and it was confirmed by histopathological analysis.

CONCLUSION

Collectively, our findings provide evidence that phloretin might be useful as a natural therapeutic agent in the management of UC as well as may pose a promising outcome for future clinical usage.

Chinese research into ulcerative colitis from 1978 to 2017: A bibliometric analysis

BACKGROUND

Over the last 40 years, with accumulating evidence demonstrating a significant increase in the incidence of ulcerative colitis (UC) in China, the number of studies on UC has been rapidly increasing. But it still lacks a comprehensive meta-analysis of publications regarding UC for the last four decades in China. Thus, a bibliometric analysis of UC is warranted to investigate the trend and distribution of the publications on UC in China in recent years. And it is supposed that the number of the papers related to UC increased by year.

AIM

To investigate the current status of research output from Chinese studies related to UC during the period of 1978 to 2017, with special attention paid to the distribution of publication dates, journals, regions, and research organizations.

METHODS

Publications on UC were searched in the Chinese periodical database SinoMed from January 1978 to December 2017. The search term used for retrieval was “ulcerative colitis”. The language of the publications was restricted to English or Chinese. The studies have to be performed in China. Then, a bibliometric analysis was performed on the distribution of publication dates, journals, regions, and research organizations with EndNote, Excel, MySQL, and GraphPad Prism.

RESULTS

A total of 16257 papers matched the search criteria, which included 7561 papers published in core journals, 4641 evidence-based articles, and 4177 publications of randomized controlled trials. These papers were mainly published in Chinese Journal of Coloproctology, World Chinese Journal of Digestology, Chinese Journal of Digestion, Chinese Journal of Integrated Traditional and Western Medicine on Digestion, and Modern Journal of Integrated Traditional Chinese and Western Medicine. In particular, the majority of these organizations were located in Jiangsu, Henan, Shandong, and Guangdong Provinces which are rich areas or have the largest population per province. Most of these studies were conducted by academic institutions.

CONCLUSION

Over the past four decades, the output of research into UC in China has increased significantly, with academic institutions playing a central role in the academic field, but the number and quality of these researches vary substantially among different regions.