Small intestinal bacterial (SIBO) or fungal overgrowth (SIFO) involves excessive microbial growth in the small intestine. While jejunal aspirate is the gold standard for diagnosis, duodenal aspiration is easier to perform. This study determined and compared the diagnostic yield of tandemly performed duodenal and jejunal aspirates and cultures. Patients with gas and bloating symptoms and suspected SIBO/SIFO underwent enteroscopy, during which duodenal and jejunal aspirates were sequentially collected using a 2 mm Liguory catheter under aseptic conditions. Cultures were performed for aerobic, anaerobic, and fungal organisms. The endoscopic time, diagnostic yield, and concordance rates were compared. Of 57 patients, 24 (42%) had positive cultures for SIBO and SIFO with diagnostic yield of 33% for both duodenal and jejunal aspirates. The overall concordance rate between duodenal and jejunal aspirates was 82% (47/57), with Cohen's kappa of 0.61. Among positive cases, the concordance was 58% (14/24). Using jejunal aspirates as the gold standard, duodenal aspirates had a sensitivity of 74%, specificity of 87%, positive predictive value of 74%, and negative predictive value of 87%. Aerobes predominated (79%), with 15% anaerobes and 6% fungi. Common aerobes included Streptococcus, Haemophilus, Klebsiella, Rothia, and Neisseria, and anaerobes included Clostridium and Bacteroides, with similar prevalence at both sites. Jejunal aspiration took significantly longer to perform than duodenal (p < 0.001). Duodenal and jejunal aspirates have comparable diagnostic yields for detecting SIBO/SIFO. With similar microbial profiles but shorter procedural time, duodenal aspirates offer a practical and efficient alternative for routine evaluation although may miss diagnosis.
The current study aimed to assess the potential biological and cellular impacts of dietary supplementation with chitosan-flaxseed oil nanocomposite (CFN) in boosting the growth performance indices, digestive enzyme activity, innate immune capacity, economic significance, gene expression, and histopathological alterations in the Nile tilapia exposed to chronic cold stress. Nile tilapia were distributed into six experimental groups, the first three groups were reared under optimum water temperature (25 °C) and fed 0 mg/kg CFN (control), 20 mg/kg CFN or 40 mg/kg -incorporated diets, respectively. However, the other three groups were reared under cold stress conditions (18 °C), and received the same previously mentioned diets, respectively. Growth performance and economic significance analysis were monitored throughout the experiment. Serum and tissue samples were collected after 60 days to evaluate immune indices (lysozyme, nitric oxide, and IgM), glucose, growth hormone (GH), digestive enzymes (amylase and lipase), gene expression (interleukin-8, tumor necrosis factor-alpha, interleukin-1ß, lysozyme-G, lysozyme-C, transforming growth factor-beta, nuclear factor kappa β, myeloperoxidase, and Toll-like receptor-5, and glutathione perioxidase-1), and histopathological changes. A subsequent bacterial challenge with Pseudomonas aeruginosa was carried out, where the clinical disorders and mortalities were monitored. The outcomes showed remarkable declines in various growth metrics, immune variables with dysregulation in the immune-linked genes in fish exposed to chronic cold stress circumstances, compared to fish reared at optimum temperature. Nonetheless, dietary intervention with CFN mitigated the negative impacts induced by cold stress exposure, where the growth, immune indices, and digestive enzymes were notably enhanced in the supplemented groups in relation to the non-supplemented group. The histopathological alterations in the intestine and spleen were also markedly alleviated. Additionally, the expression profiles of both inflammatory cytokines and apoptosis were positively modified. Furthermore, fish resilience to P. aeruginosa infection was triggered, which was evident by the amelioration of the clinical signs and declining mortality rates in CFN-enriched groups. Taken together, CFN is a promising antibacterial dietary additive which promotes the growth, health, and performance of the Nile tilapia.
Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, and its marked heterogeneity is closely associated with the complex tumormicroenvironment. Adipokines are important mediators linking metabolic regulation and immune modulation; however, the prognostic value of adipokine-related genes (ARGs) andtheir association with drug sensitivity in HCC remain unclear. Transcriptomic and clinical data for HCC were obtained from public databases. Diff erentially expressed ARGs were identifi ed, and a prognostic risk model was constructedusing univariate Cox regression, least absolute shrinkage and selection operator regression, and multivariate Cox regression, followed by validation in an independent cohort.Immune infi ltration, somatic mutation profi les, and predicted drug sensitivity were further analyzed. PGF was knocked down in Huh7 cells with or without imatinib treatment, andits functional eff ects were evaluated using CCK-8, colony formation, flow cytometry, gene set enrichment analysis, and western blotting. A total of 113 diff erentially expressed ARGs were identifi ed, and a 10-gene prognostic signature was established. The model showed favorable predictive performance inthe TCGA cohort and retained survival stratifi cation ability in the external GEO cohort. Patients in the high-risk group had signifi cantly shorter overall survival and exhibited potentialdiff erences in immune microenvironment characteristics and mutation profi les. PGF expression was positively correlated with the predicted half-maximal inhibitory concentration of imatinib. Invitro experiments showed that PGF knockdown enhanced the inhibitory eff ects of imatinib on Huh7 cell proliferation and colony formation and promoted apoptosis. Further analysessuggested that these eff ects may involve the Pl3K/AKT and MAPK/ERK signaling pathways. This study established an ARG-based prognostic model for HCC and preliminarily suggested that PGF may be involved in regulating the sensitivity of HCC cells toimatinib. These fi ndings provide a preliminary basis for further investigation of ARG-relaterognostic assessment and PGF-mediated drug sensitivity.
Endoscopic sphincterotomy (ES) and endoscopic papillary balloon dilation (EPBD) are established treatments for common bile duct (CBD) stones, each with limitations. Endoscopic sphincterotomy with large-balloon dilation (ESBD) combines both techniques, but its efficacy versus ES alone remains controversial. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ESBD with ES alone for the management of CBD stones. We searched PubMed, Scopus, Embase, Ovid, Web of Science, and Cochrane Library for RCTs comparing ESBD versus ES alone in adults with CBD stones. Primary outcomes were total and first-session stone clearance and mechanical lithotripsy (ML) use. Secondary outcomes included procedure time and complications. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed or random effect models based on heterogeneity. Subgroup analysis was performed based on stone size and balloon dilation time. Risk of bias was assessed using the Cochrane ROB-2 tool, and the certainty of evidence was evaluated using the GRADE approach. Seventeen RCTs with 2671 patients were included. ESBD significantly improved first-session stone clearance (RR 1.11; 95% CI: 1.04 to 1.17; P = 0.001), reduced ML use (RR 0.47; 95% CI: 0.34-0.65; P < 0.0001), and shortened procedure time (MD - 3.44 min; 95% CI: - 5.71 to - 1.17; P = 0.003) compared with ES alone. Total stone clearance was similar between groups. ESBD significantly reduced postoperative hemorrhage (RR 0.55; 95% CI 0.34 to 0.90; P = 0.02) and stone recurrence (RR 0.53; 95% CI 0.32 to 0.87; P = 0.01), with no difference in pancreatitis or other complications. ESBD significantly increases first-session stone removal and decreases ML use in both small- and large-stone-sized groups. Current low- to very-low-certainty evidence suggests possible procedural advantages of ESBD over ES alone, including higher first-session stone clearance, reduced mechanical lithotripsy use, shorter procedure time, and lower rates of bleeding and stone recurrence, across both large and small CBD stones. These findings are hypothesis-generating and should not be considered practice-changing until confirmed by high-quality randomized controlled trials (RCTs).
Clostridioides (Clostridium) difficile is an important pathogen in the feces of adult horses and foals. It can be clinically diagnosed using several testing methods, including culture isolation and, more commonly, direct toxin gene detection from feces using molecular methods. The importance of monitoring C. difficile shedding in foals or dams during hospitalization remains unclear. The objectives of this study were to determine the prevalence of C. difficile fecal shedding in mare-foal pairs and to compare detection using isolation and a commercial real-time polymerase chain reaction (qPCR) for toxin A and B genes in feces. Foals and their mares admitted to a veterinary hospital were enrolled in the study and their fecal samples were tested for C. difficile toxin A and B genes using qPCR and by culture using selective media. A total of 66 mare-foal pairs was included. Overall, C. difficile fecal qPCR for toxin A and B genes was positive in 29/132 samples from mares and foals and all positive samples originated from foal fecal samples (29/66). A total of 95 samples were negative on both testing modalities (61 mares and 34 foals) and 24 samples were positive on both tests (24 foals). Eight samples (5 mares and 3 foals) were culture positive and qPCR negative, although all of the culture isolates were positive for A and B genes on subsequent conventional PCR testing. Five samples were positive for toxin genes using qPCR and negative using culture. The most common ribotype detected was 078. Two mare-foal pairs cultured positive, of which one pair shared the same ribotype. Clostridioides (Clostridium) difficile est un agent pathogène important présent dans les fèces des chevaux adultes et des poulains. Son diagnostic clinique repose sur plusieurs méthodes, notamment l’isolement par culture et, plus fréquemment, la détection directe des gènes de toxines dans les fèces par des méthodes moléculaires. L’importance du suivi de l’excrétion de C. difficile chez les poulains et leurs mères hospitalisés reste incertain. Cette étude visait à déterminer la prévalence de l’excrétion fécale de C. difficile chez les couples jument-poulain et à comparer la détection par isolement et détection des gènes des toxines A et B dans les fèces par PCR quantitative en temps réel (qPCR) commerciale. Les poulains et leurs juments admis dans un hôpital vétérinaire ont été inclus dans l’étude et leurs échantillons fécaux ont été analysés pour la recherche des gènes des toxines A et B de C. difficile par qPCR et par culture sur milieux sélectifs. Au total, 66 paires jument-poulain ont été inclus. Globalement, la qPCR fécale pour les gènes des toxines A et B de C. difficile s’est révélée positive dans 29/132 échantillons provenant de juments et de poulains, tous les échantillons positifs étant issus de fèces de poulains (29/66). Au total, 95 échantillons étaient négatifs aux deux tests (61 juments et 34 poulains) et 24 échantillons étaient positifs aux deux tests (24 poulains). Huit échantillons (5 juments et 3 poulains) étaient positifs en culture et négatifs en qPCR, bien que tous les isolats de culture aient été positifs pour les gènes A et B lors de tests PCR conventionnels ultérieurs. Cinq échantillons étaient positifs pour les gènes des toxines en qPCR et négatifs en culture. Le ribotype le plus fréquemment détecté était le 078. Deux paires jument-poulain ont présenté une culture positive, dont une paire partageant le même ribotype.(Traduit par Docteur Serge Messier).
Pelvic floor physical therapy (PFPT) is recommended for conditions including constipation and fecal incontinence. There is limited evidence exploring characteristics of physical therapy practices, attitudes toward treating evacuation disorders, and potential barriers to care that may influence treatment outcomes. Therefore, a better understanding of these aspects of PFPT is needed. The purpose of this study was to survey PFPT practices, using the Chicagoland area as a microcosm. We aimed to explore practice characteristics, available treatment modalities, and attitudes toward treatment of evacuation disorders. We conducted a cross-sectional phone and email-based survey of pelvic floor physical therapists across 17 counties in the Chicagoland area. Of 149 eligible contacts, there were 48 respondents representing 58 total PFPT practices. Mixed methods were used to aggregate data quantitatively and perform mapping analysis and thematic analysis. There were geographic disparities in PFPT provider density. Most practices served all gender identities but consisted primarily of female therapists. Levels of PFPT-specific training and certification varied. Respondents felt that education on lifestyle, including diet, was an important therapeutic goal. Biofeedback in a variety of forms was used by most respondents (81%); some suggested that biofeedback was not as effective for chronic constipation as other therapies. Themes of potential barriers to satisfactory outcomes included delayed and vague referrals from other clinicians, as well as patient misinformation and inappropriate expectations. This study provides preliminary insights to guide further work on improving access to PFPT and improving treatment outcomes for bowel symptoms. To strengthen collaboration, we suggest that referring clinicians actively communicate and develop networks with local PFPT offices, and offer earlier, more detailed PFPT referrals to patients.
Individuals with inflammatory bowel disease experience persistent symptoms and disease challenges which may not be solved with medical management. Self-management interventions may support patients, but their feasibility, acceptability, and preliminary effectiveness should be evaluated prior to large-scale testing. We conducted a pilot randomized controlled trial with 2:1 allocation of a nurse-delivered, self-management program to usual care. Adults with a healthcare provider diagnosis of ulcerative colitis or Crohn's disease, aged 18-75 years, currently reporting at least two symptoms were recruited. The self-management program included eight online modules plus weekly phone check-ins with a registered nurse. Feasibility and acceptability were measured using surveys and interviews. Secondary outcomes included patient activation, self-regulation, self-efficacy, functional impairment, quality of life, symptoms, and fecal calprotectin. Linear mixed models estimated the differences in change scores between groups from baseline to 3- and 6-month follow-up. Fifty-five participants were randomized (n = 36 self-management, n = 19 usual care). Participants were on average 39.0 years old (range: 20-73), 76.4% women, and 80% Crohn's disease. The self-management program demonstrated high satisfaction (91.1/100), feasibility (4.34/5), and acceptability (4.28/5). Compared with usual care, the self-management program produced the largest improvement in functional impairment (mean change - 15.1 [95% CI - 23.3, - 6.8], with additional improvements in patient activation (10.3 [2.8, 17.9]), self-regulation (4.1 [1.1, 7.1]), and quality of life (4.6 [0.3, 8.9]). Symptom severity and fecal calprotectin were largely unchanged. Qualitative feedback emphasized the value of regular nurse check-ins, accountability, and applicability of the program beyond disease-specific concerns. A nurse-delivered self-management program was feasible, acceptable, and led to meaningful changes in key intervention targets for inflammatory bowel disease management. High engagement supports potential for future testing in a fully powered trial and eventual integration into routine care.
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is standard treatment for peritoneal metastases in Sweden. Prolonged postoperative ileus (PPOI) is a common complication following major abdominal surgery and is associated with increased morbidity and prolonged hospitalization. The aim of this study was to evaluate the incidence of PPOI following CRS-HIPEC and to identify factors associated with its development, including its relationship to postoperative complications. This retrospective, bicentre cohort study included patients undergoing CRS-HIPEC for peritoneal metastases between January 2012 and 2024. Patients were identified through the Swedish HIPEC Registry, with supplementary data obtained from medical records. PPOI was defined as delayed defaecation beyond postoperative day 5 and/or prolonged use or reinsertion of a nasogastric tube. Clinical, surgical and postoperative outcomes were analysed and risk factors for PPOI were assessed using a multivariable logistic regression model. A total of 982 patients were included, of whom 443 (45%) developed PPOI. Patients with PPOI had significantly longer hospital stays (median 11 vs. 9; p < 0.001) and delayed return of bowel function compared with patients without PPOI (median 6 vs. 3 days; p < 0.001). Major complications were more frequently observed in patients with PPOI (36% vs. 16%, p < 0.001). Independent risk factors for PPOI were major postoperative complications (aOR 3.74, CI 2.55-5.48), blood transfusion (aOR 1.70, CI 1.08-2.70) and omentectomy below the gastroepiploic arcade (aOR 1.51, CI 1.01-2.26). This association remained even after excluding patients with major postoperative surgical complications. Ileostomy formation was associated with a reduced risk of PPOI (aOR 0.51, CI 0.33-0.77). PPOI is a frequent complication following CRS-HIPEC and is associated with increased postoperative morbidity and prolonged recovery. Strategies aimed to optimize perioperative care and enhanced recovery protocols may help to reduce the incidence and the adverse effects of PPOI.
Liver stiffness measurement (LSM) is a non-invasive surrogate for hepatic fibrosis that informs risk stratification and management. Vibration-controlled transient elastography (VCTE; FibroScan®) is well established. Endoscopic ultrasound-guided shear wave elastography (EUS-SWE) offers the potential to assess LSM during routine EUS; however, its diagnostic performance remains uncertain. In this prospective, single-center diagnostic accuracy study, consecutive adults without biliary obstruction who were undergoing EUS additionally underwent LSM measurement from the right hepatic lobe using EUS-SWE (Olympus ME3) and same-day VCTE. VCTE thresholds defined advanced chronic liver disease (ACLD; > 15 kPa), cirrhosis (> 12 kPa), and advanced fibrosis (> 8 kPa). EUS-SWE performance was evaluated using correlation, Bland-Altman agreement, and area under the receiver-operating characteristic curve (AUROC). Among 146 patients (median VCTE-LSM 6.05 kPa, range 3-53.3), 57, 41, and 31 had LSM ≥ 8, ≥ 12, and ≥ 15 kPa, respectively. EUS-SWE showed moderate correlation with VCTE (Spearman ρ = 0.65, p < 0.001) and reported higher values by 34.1% (95% limits of agreement:-64.8% to 133.1%) without proportional bias on Bland-Altman analysis. EUS-SWE showed excellent accuracy for screening relevant VCTE-LSM thresholds with AUROC (95% CI) 0.89 (0.81-0.97) for ACLD, 0.89 (0.82-0.96) for cirrhosis, and 0.85 (0.79-0.92) for advanced fibrosis. Optimal EUS-SWE threshold for VCTE-defined ACLD was 12.9 kPa (sensitivity 93%, specificity 77%), representing the optimal screening cutoff; a regression-derived threshold of 21.4 kPa (sensitivity 67%, specificity 93%) represents the mathematical equivalent EUS-SWE value to VCTE ≥ 15 kPa, appropriate for direct modality comparison. Accuracy for ACLD declined monotonously with increasing variability (IQR/LSM%): AUROC 0.97 (for < 30%), 0.86 (30-45%), 0.83 (45-60%), and 0.78 (≥ 60%). EUS-SWE yields LSM values approximately 34% higher than VCTE-LSM; the two modalities are not interchangeable and require modality-specific thresholds. EUS-SWE provides accurate prediction of VCTE-defined fibrosis thresholds, particularly when IQR/LSM% ≤ 45%, and represents a promising adjunct for opportunistic liver stiffness assessment during routine EUS.
Diarrhea-predominant irritable bowel syndrome (IBS-D) is characterized by diarrhea and is often accompanied by depression, abdominal symptoms, and emotional comorbidities. Preclinical and clinical studies have shown that dysfunction of the brain-gut axis is a key pathogenic factor in IBS-D, yet the specific mechanisms remain unclear. Saikosaponin D (SSD), a major bioactive component of Bupleurum chinense DC., exhibits anti-inflammatory, antidepressant, and antitumor activities, with multi-target and multi-pathway interactions. Acetic acid and restraint stress induced an IBS-D mouse model. SSD (purity ≥ 98%, Macklin Inc.) was administered orally at low, medium, and high doses (5, 10, 20 mg/kg). Visceral sensitivity, inflammatory status, intestinal barrier function, HPA axis activity, and gut microbiota composition were systematically evaluated using behavioral tests, Western blot, qRT-PCR, and 16S rRNA sequencing. SSD significantly alleviated visceral hypersensitivity and depression-like behavior, inhibited the peripheral HMGB1-TLR4/NF-κB inflammatory pathway, and restored intestinal barrier integrity. SSD also downregulated hypothalamic Nesfatin-1/CRH/p-CREB expression, suppressed hyperactivation of the stress-related HPA neuroendocrine axis, and reshaped the gut microbial community structure (β-diversity). Network pharmacology analysis suggested that SSD targets were significantly enriched in brain-gut axis-related pathways. The present results indicate that SSD could ameliorate IBS-D by synergistically regulating peripheral inflammation, central stress, and intestinal microbes via the brain-gut-microbiota axis, providing experimental evidence for its potential application in TCM-based treatment.
Bile leak (BL) remains one of the major adverse events of hepatobiliary surgeries. We evaluated ERCP outcomes for postoperative BL (PBL) cholecystectomy (C-BL), hepatectomy (H-BL), and liver transplantation (LT-BL) and identified predictors of persistent leak after initial ERCP. This study includes consecutive patients who underwent ERCP for PBL at a single high-volume center (2011-2021). Leaks were graded as low-grade BL (LG-BL) or high-grade BL (HG-BL). Initial success was defined as cholangiographic and clinical resolution of BL following a single therapeutic ERCP session at the first follow-up ERCP. Final success was defined as cholangiographic and clinical resolution of the BL at the last follow-up assessment, irrespective of the number of therapeutic ERCP sessions required. 417 patients with PBLs were included: 348 (83.5%) C-BL, 43 (10.3%) H-BL, and 26 (6.2%) LT-BL. Initial clinical success was 80.7% overall, with the highest in LT-BL (91.7%), followed by C-BL (83.5%), and then H-BL (50%) (p < 0.001). HG-BLs had lower initial success (54.7% vs. 87.8% for LG-BL; p < 0.001). Final success was 96% overall, but lower in H-BL (84.2%) than C-BL (97.3%) and LT-BL (95.8%) (p < 0.001). Overall, HG-BL (adjusted odds ratio [aOR] 5.79) and H-BL (aOR 3.52) were independent predictors of persistent leak. ERCP is effective and safe for PBL. However, initial clinical success varied by surgical etiology and leak severity. HG-BL and H-BL were associated with lower initial success and more frequently required repeated ERCP interventions for leak resolution. Further studies are needed to validate optimal treatment strategies for higher-risk bile leak subgroups.
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder in which dietary interventions play a pivotal role in symptom management. Although traditional dietary advice, the low-FODMAP diet (LFD), and the gluten-free diet (GFD) are commonly employed in clinical practice, comparative evidence regarding their relative efficacy-particularly when applied in combination-remains limited. This randomized controlled trial with blinded outcome assessment was conducted in the gastroenterology outpatient clinic of a university hospital. Adult patients aged 19-65 years with IBS diagnosed according to the Rome IV criteria were randomized using a minimization method to one of four dietary interventions administered for four weeks: traditional diet (TD), LFD, GFD or a combined low-FODMAP gluten-free diet (LFGFD). Participants were blinded to the specific name of the dietary intervention, and outcome assessors were blinded to group allocation. The primary outcomes were changes in the IBS Symptom Severity Score (IBS-SSS) and the IBS Quality of Life questionnaire (IBS-QOL). Secondary outcomes included changes in FODMAP and gluten intake frequency scores, Bristol Stool Scale, body mass index (BMI), and responder rates. Baseline demographic and clinical characteristics were comparable across the four groups. IBS-SSS decreased significantly within all groups following dietary intervention (p ≤ 0.004), with significantly greater reductions observed in the LFD and LFGFD groups compared with the TD group (p = 0.002). IBS-QOL scores improved significantly within all groups (p ≤ 0.003); however, no significant between-group differences were detected (p = 0.082). Clinically meaningful symptom improvement, defined as a reduction of at least 50 points in IBS-SSS, was achieved by all participants in the LFD, GFD, and LFGFD groups, compared with 8 of 13 participants (61.5%) in the TD group (p = 0.001). Changes in BSS and BMI did not differ significantly between groups. LFD and LFGFD diets were more effective than traditional dietary advice in reducing IBS symptom severity, whereas all dietary approaches yielded significant within-group improvements in quality of life, with no significant between-group difference detected, indicating that no single dietary strategy demonstrated a clear advantage in this domain. These findings, which reflect the restriction phase only, support a stepwise, individualized dietary management strategy in IBS that balances symptom control with quality-of-life considerations. NCT04853381.
Self-expandable metallic stents (SEMSs) are recommended for preoperative biliary drainage in patients with pancreatic cancer. However, they are associated with a relatively high incidence of non-recurrent biliary obstruction (RBO) adverse events (AEs), such as pancreatitis and cholecystitis. The 11.5-Fr large-bore plastic stent (LBPS) is a newly developed stent with a larger diameter than conventional plastic stents. The aim of the present study was to compare the clinical outcomes of LBPS and SEMS in preoperative biliary drainage for pancreatic cancer. We retrospectively evaluated 80 patients who underwent preoperative biliary drainage for pancreatic cancer between January 2011 and December 2025. Patients were divided into the LBPS and SEMS groups according to the stent placed. RBO occurred in 20.0% and 25.0% of patients in the LBPS and SEMS groups, respectively, with no significant difference in the time to RBO between the groups. Pancreatitis and cholecystitis were observed in 0% versus 18.3%, and 0% versus 8.3% of patients in the LBPS and SEMS groups, respectively. The 11.5-Fr LBPS demonstrated patency comparable to that of SEMS and was associated with a low incidence of non-RBO AEs. These findings should be interpreted cautiously and require confirmation in larger prospective studies.
To explore the role of asparagine-linked glycosylation 10 (ALG10) in intestinal fibrosis (IF) and elucidate its underlying molecular mechanisms. Western blot and RT-qPCR were employed to detect ALG10 expression in a TNBS/DSS-induced mouse IF model and in primary colonic fibroblasts. TNBS/DSS-induced ALG10-/- mouse models were established, and primary colonic fibroblasts were isolated in vitro. Pathological changes and collagen deposition in colon tissues were evaluated via Masson's trichrome staining and H&E staining. RT-qPCR, Western blot, and ELISA were performed to measure the expression of IF-related markers. A TGF-β1-induced CCD-18Co cell model was established, and immunofluorescence was used to detect the fluorescence intensity of COL I and E-cadherin. The interaction mechanism between ALG10 and TGF-β1 was further explored by molecular docking, MD simulation, Co-IP and dual-luciferase reporter gene experiments. Compared with the WT group, ALG10 expression was significantly increased in the TNBS/DSS group. In both in vivo and in vitro models, ALG10 silencing markedly alleviated fibrosis severity and pathological damage, downregulated the expression of COL I and α-SMA, and upregulated E‑cadherin expression and significantly reduced the levels of p‑PI3K, p‑Akt, and the target genes FGF2 and p‑FoxO1/3a. Molecular docking, MD simulations, and Co-IP assays suggested that ALG10 potentially interacts with TGF-β1, while dual-luciferase reporter assays further demonstrated that ALG10 promotes TGF-β1 promoter activity. ALG10 acts as a key mediator promoting the progression of IF. Silencing ALG10 can alleviate IBD-related IF, a mechanism that may involve the regulation of the TGF‑β1/PI3K/Akt signaling pathway.
Functional abdominal pain disorders (FAPD) are common in children and there is heterogeneity in the available literature regarding the role of fibre in FAPD and none so-far in functional abdominal pain-not otherwise specified (FAP-NOS). The study aimed to evaluate the efficacy of psyllium fiber in pediatric FAPD including Irritable bowel syndrome (IBS) and FAP-NOS. In this prospective randomized placebo-controlled trial, children (5-18 years) diagnosed as FAPD based on Rome IV criteria were randomized to psyllium fiber or placebo (maltodextrin) for 12 weeks. Post-treatment improvement of pain and quality of life (QoL) from baseline was compared between the two groups. Pain assessment was done using the pain score table, which assessed duration, frequency, and intensity of pain. The mean age of 109 children (FAP-NOS: 85%; psyllium fiber 57, placebo 52) was 11.8 ± 3.9 years (58% boys). There was a significant difference in pain improvement in terms of reduction in scores for intensity (5.5 vs. 3.2), frequency (6.0 vs. 3.2), duration (5.3 vs. 3.3), and QoL (4.4 vs. 2.3) between the psyllium and placebo group (P < 0.001 in all). Responders (> 50% reduction in pain) were seen in 86% of the psyllium as compared to 60% in the placebo group (P = 0.001). On multivariate analysis, use of psyllium fiber was the only factor predictive of response (OR: 5.49, 95% CI 2.05-14.72, P < 0.001). After discontinuation of psyllium fiber, 81% had sustained response over a mean follow-up of 6.7 ± 4.0 months. A 12-week trial of psyllium fiber improves pain in most and gives sustained relief in three-fourths of children with FAP-NOS and IBS. Clinical Trial Registry of India ( CTRI/2023/08/056772; Website http://ctri.nic.in ).
Accurate differentiation between T1a and T1b Barrett's adenocarcinoma (BAC) is essential for selecting endoscopic resection (ER) versus surgery. The diagnostic reliability of optical endoscopic evaluation (OEE) and endoscopic ultrasound (EUS) remains inconsistent. We performed a systematic review and meta-analysis to assess their diagnostic performance. PubMed, Embase, Scopus, and Cochrane were searched through December 2025. Studies evaluating OEE or EUS for differentiating T1a from T1b BAC were included. Pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated using random-effects models. Heterogeneity was assessed with I2. Hierarchical summary receiver operating characteristic (HSROC) analysis compared modalities. Secondary analyses evaluated Paris morphology and Barrett's segment length (BSL) using diagnostic odds ratios (DORs). Nineteen studies (2,292 patients) were included. OEE showed pooled sensitivity of 55.3% and specificity of 75.1%, with accuracy of 63.1%. EUS demonstrated sensitivity of 66.1%, specificity of 89.3%, and accuracy of 82.8%. HSROC analysis showed no significant difference between modalities (AUC 0.69 vs 0.87; P = 1). Paris 0-I, 0-IIa, lesions with 0-IIc components, and BSL ≥ 3 cm were not associated with T1b invasion. Paris 0-IIb lesions were significantly less likely to harbor T1b disease (DOR 0.17, 95% CI 0.07-0.38). Both OEE and EUS demonstrate modest accuracy for differentiating T1a from T1b BAC. Endoscopic morphology is not a reliable predictor of submucosal invasion, except for flat lesions being less likely T1b. ER remains essential for definitive staging.
Adolescents with a new diagnosis of celiac disease (CeD) face challenges navigating social relationships while also managing symptoms and the gluten-free diet. The purpose of this study is to evaluate the relationship between quality of life (QoL), symptoms, and CeD serology in adolescents with CeD. Cross-sectional survey study of adolescent patients (13-18 years old) within one year of biopsy-proven diagnosis of symptomatic CeD. Participants completed the PedsQL questionnaire, a health-related QoL assessment, and the Celiac Symptom Index (CSI), a measure of CeD-related symptoms. Tissue transglutaminase IgA (tTG-IgA) was used as a measure of disease activity. Means, mean difference, t test, and point biserial correlations were computed to assess the association of tTG-IgA with CSI and PedsQL scores. Fifty-four adolescents and parents/guardians were surveyed. Thirty-seven had abnormal tTG-IgA and were compared to those with normal tTG-IgA. There were significant differences in overall PedsQL scores (84.75 vs 77.03, r = -0.28, p = 0.05), social subscores (95.42 vs 88.59, r = 0.24, p = 0.02), emotional subscores (80.83 vs 66.62, r =- 0.31, p = 0.03), and school functioning subscores (81.25 vs 68.89, r =- 0.36, p = 0.01). There was no significant relationship between tTG-IgA and the physical subscore or CSI score. Females report higher CSI scores and lower PedsQL scores. Older age at diagnosis was associated with lower PedsQL scores. Adolescents with abnormal tTG-IgA serology had lower QoL scores that were unrelated to measures of physical symptoms (CSI and physical subscore of PedsQL). This suggests more complex drivers of QoL that are not related to physical symptoms but are still associated with persistently elevated serology.
MELD has been well established as the gold standard metric for predicting mortality in patients with cirrhosis. Here, we hypothesized that Black race is an important factor in predicting mortality in patients with cirrhosis when controlling for social determinants of health. All adults who had a liver biopsy showing F4 fibrosis at our institution from January 1, 2013 through July 1, 2021 were identified. Histology, fibrosis stage, and complete clinical data were abstracted. Patients were propensity matched based on age, gender, Charlson Comorbidity Index, and the CDC/ATSDR Social Vulnerability Index Themes 1, 2, and 4. Cox Proportional Hazard Modeling was used to identify if race was a predictor of 5-year liver-related mortality. Logistic regression analysis was performed comparing race, MELD 3.0, and their interaction on ninety-day liver-related mortality. Of 3572 patients having a liver biopsy, 64 Black and 61 White patients had F4 fibrosis after propensity matching. No significant differences between these groups existed for MELD scores. Liver-related mortality at 5 years was not significantly different between White and Black patients. Logistic regression analysis did not reveal an association between race and liver-related mortality. Black and White patients with similar comorbidities and social vulnerabilities had comparable liver-related mortality at similar MELD 3.0 scores. The data suggest that the MELD 3.0 score is equally predictive of mortality in Black and White patients.
Individuals with cystic fibrosis (CF) develop pancreatic cysts and cancer more frequently than the general population, particularly among lung transplant recipients due to long-term immunosuppression. CF lung transplant guidelines address many gastrointestinal malignancies including colorectal cancer, but do not provide recommendations for routine surveillance of the pancreas. We aim to highlight the increased risk that CF lung transplant patients face for developing pancreatic cysts and malignancy. This study may inform future multicenter studies and guideline revisions to include monitoring of the pancreas in this population. An observational, retrospective chart review of CF lung transplant recipients (N = 54) was conducted monitoring pancreatic cyst incidence and severity. Statistics and figures were generated in RStudio. Twenty-two patients (40.7%) had pancreatic cystic lesions. Nearly, all patients underwent post-transplant, abdominal CT (100%), and ultrasound (98.1%), while 30 patients (55.6%) received an MRI/MRCP. Of those with cysts, 7 (31.8%) had cysts detected pre-transplant, while 15 (68.2%) had cysts detected post-transplant. Seven patients (31.8%) were diagnosed with suspected IPMNs. Seven patients (31.8%) had cysts measuring ≥ 30 mm, 4 (18.2%) exhibited main pancreatic duct dilation > 5 mm, and 8 patients (36.4%) showed a cystic growth rate ≥ 3.0 mm per year. Seven individuals (13.0%) had their cysts sampled for malignancy; two (3.7%) were diagnosed with pancreatic cancer and an additional patient experienced rapid multifocal cyst progression and underwent total pancreatectomy. Findings indicate a higher-than-expected pancreatic cyst and cancer prevalence, supporting the need for formal screening guidelines for CF lung transplant recipients.
The optimal bowel preparation for acute lower gastrointestinal bleeding (ALGIB) in the emergency remains uncertain. This study aimed to compare the efficacy and safety of oral versus non-oral laxative approaches for emergency colonoscopy in ALGIB patients. We retrospectively analyzed 157 patients undergoing emergency colonoscopy for ALGIB, stratified into PEG (n = 67) and non-PEG (n = 90) groups. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline confounders, including pre-procedural suspected etiology. Primary outcomes were endoscopic diagnosis (including definitive and presumptive) and hemostasis rates. Secondary outcomes included bowel preparation quality, procedural completion, and medical resource utilization. Post hoc analyses were performed by categorizing etiologies into focal/subtle and diffuse/obvious types. After IPTW adjustment, overall core outcomes including endoscopic diagnosis (86.5% vs. 80.3%), stigmata of recent hemorrhage (SRH) detection (42.7% vs. 43.9%) and hemostasis (12.5% vs. 16.9%) were comparable between groups (all adjusted P > 0.05). The PEG group demonstrated significantly higher rates of adequate bowel preparation (BBPS ≥ 6: 70.6% vs. 31.8%, P < 0.001) and cecal intubation (86.2% vs. 55.9%, P = 0.001), with no significant differences between groups in procedural efficiency or resource utilization (all P > 0.05). However, outcomes were significantly etiology-dependent. Diffuse/obvious lesions were associated with significantly higher definite diagnosis rates (64.3% vs. 38.6%, P = 0.004) but lower cecal intubation success (66.1% vs. 84.3%, P = 0.017) compared to focal/subtle lesions. Clinical outcomes in ALGIB are fundamentally etiology-dependent. While PEG and non-PEG strategies achieve comparable overall diagnostic and therapeutic yields, their distinct clinical utilities vary across lesion types. These findings advocate for a stratified, etiology-driven approach to bowel preparation. Future efforts should prioritize the development of pre-procedural predictive models to refine individualized management strategies.