Background Gut dysbiosis is associated with aging and several human diseases. Studies about bacteriophage have suggested its influence on bacteria and immunity. However, the role of gut microbiota, especially phages, in the progression of arterial stiffness remains largely unknown. Methods This was a cross-sectional study based on baseline data from our cardiovascular disease cohort. Cardiovascular disease-free participants (n=157) were divided into two groups, using brachial-ankle pulse wave velocity (baPWV) 1400 cm/s as the arterial stiffness cut-off point. The microbial composition between the two groups was compared with the integration of electronic medical records and fecal metagenomics. Results The microbial β-diversity based on the Bray-Curtis dissimilarity of the two groups was different (P = 0.039). Diverse bacteria and bacteriophages with altered abundance and specific functional pathways were found in the elevated arterial stiffness group. The abundance of species such as Agathobaculum butyriciproducens, Alistipes indistinctus, and Megamonas funiformis decreased in patients. Enriched opportunistic pathogens were found in individuals with elevated arterial stiffness, including Aggregatibacter aphrophilus, Clostridium aldenense, Morganella morganii, and Gemella haemolysans. A large number of phages differed between the two groups and a random forest model of arterial stiffness was constructed. In the case of using only 20 bacteriophage features, the area under the receiver operating curve (AUC) of the model reached 0.826 (95% CI, 0.760-0.892). Among these, we found a Caudovirales bacteriophage infecting Faecalibacterium prausnitzii and an unknown bacteriophage infecting Bacteroides, which was closely related to B. vulgatus (rho = 0.400, adjusted P < 0.001). Conclusions Our study identifies lots of novel associations between gut microbiota and arterial function. We speculated that the elimination of pathogenic bacteria and phage therapy may sustain vascular health.
Background There are many studies that have examined the association between Helicobacter pylori (H. pylori) infection and diabetic complications, but the results remained equivocal. The aim of this study was to evaluate the association between H. pylori infection and diabetic complications. Methods This retrospective study consisted of 2310 type-2 diabetes (T2D) patients between January 2016 and December 2021. H. pylori infection status was diagnosed by the rapid urease test or the 13C-urea breath test. Logistic regression analyses were carried out to evaluate the association of H. pylori infection with diabetic complications. Results We included a total of 960 T2D patients, and 481 patients (50.1%) were H pylori-positive. The H. pylori-positive patients had a higher proportion of diabetic nephropathy than patients without H. pylori infection (P = 0.042). Furthermore, we found that H. pylori infection was statistically associated with diabetic nephropathy (odds ratio [OR], = 1.462, 95% confidence interval [CI], 1.006–2.126, P = 0.046) after adjustment for potential confounders. In addition, we demonstrated that the H. pylori-positive and hypertension (OR = 4.451, 95% CI, 2.351-8.427, P < 0.001), H. pylori-positive and glycated hemoglobin A1c (HbA1c) ≥7% (OR = 3.364, 95% CI, 1.300-8.702, P = 0.012), H. pylori-positive and the known diabetes duration≥ 10 years (OR = 3.322, 95% CI,1.845-5.982, P <0.001) might have a synergistic effect on the development of diabetic nephropathy. H. pylori infection appeared not to be associated with the other complications of T2D (retinopathy, neuropathy and peripheral vascular disease). Conclusions Our results indicated that T2D patients with H. pylori infection had a higher risk of nephropathy development, which may be further aggravated under the combination of H. pylori infection and other risk factors.
Background PD-1 monoclonal antibody combined with chemotherapy has become the standard first-line treatment for advanced gastric cancer. This study retrospectively analyzed the clinical efficacy and adverse reactions of PD-1 monoclonal antibody combined with chemotherapy compared with chemotherapy alone, and analyzed the factors that may affect the efficacy. Methods From January 2019 to October 2022, 62 patients with advanced gastric cancer were treated in Baotou Cancer Hospital, 32 in the PD-1 antibody combined chemotherapy group and 30 in the simple chemotherapy group; The two sets of baseline characteristic analysis are comparable. PD-1 antibodies include: Sintilimab, Tislelizumab, Nivolumab and Camrelizumab. Treatment protocol: PD-1 antibody 200mg, 21 days per cycle, chemotherapy protocol: oxaliplatin 130mg/m2+capecitabine 1000mg/m2, oral twice a day. The clinical efficacy, adverse reactions and duration of remission were recorded. SPSS20.0 was used for analysis, P Results In the combined group, the clinical effective rate was 58.38%(19/32), and the disease control rate was 78.13%(25/32); Chemotherapy group: the clinical effective rate was 53.33%(16/30), and in the disease control rate was 63.33%(19/30); The difference between the two groups was statistically significant (P<0.05); Among the adverse reactions, the incidence of more than three degrees of adverse reactions in the two groups was 15.63%(5/32) and 13.33%(4/30) respectively, with no statistically significant difference (P>0.05); The incidence of adverse reactions related to immunotherapy for more than three degrees was 12.50%(4/32); The median remission time of the two groups was 11.5 months and 7.5 months respectively, with a statistically significant difference(P<0.05). Among the influencing factors, the patients with HP+, good nutritional status and younger age benefited more from the combined treatment group. Conclusions In the real world, first-line PD-1 antibody combined chemotherapy has higher clinical efficacy than simple chemotherapy, has longer remission depth, and the adverse reactions are controllable, which is superior to chemotherapy. Immunotherapy is affected by many factors and needs individualized treatment.
Few prospective studies have investigated the joint effect of lifestyle factors and genetic susceptibility on the risk of irritable bowel syndrome (IBS). This study aims to evaluate the associations of lifestyle and genetic factors with incident IBS in the UK Biobank. We analyzed data from 481,057 participants (54% female) without prevalent IBS at enrollment in the UK Biobank. An overall healthy lifestyle was defined using six modifiable lifestyle factors, including smoking, body mass index (BMI), sleep duration, diet, physical activity, and alcohol consumption, and hence categorized into ‘favorable’, ‘intermediate’, and ‘unfavorable’ lifestyles. A Cox proportional hazard model was used to investigate the association between a healthy lifestyle and incident IBS. Furthermore, we constructed a polygenic risk score (PRS) for IBS and assessed whether lifestyle modified the effect of genetics on the development of IBS. During a median follow-up of 12.1 years, 8,645 incident IBS were ascertained. Specifically, among the six modifiable lifestyle factors, adequate sleep demonstrates the greatest protective effect (hazard ratio [HR]: 0.72, 95% CI: 0.69,0.75) against IBS.Compared with a favorable lifestyle, an unfavorable lifestyle was associated with a 56% (95% CI: 46%-67%) increased risk of IBS (P = 8.99×10-40). The risk of incident IBS was 12% (95% CI: 4%-21%) higher among those at high genetic risk compared with those at low genetic risk (P = 0.005). When considering the joint effect of lifestyle and genetic susceptibility, the HR nearly doubled among individuals with high genetic risk and unfavorable lifestyle (HR: 1.80; 95% CI:1.51-2.15; P = 3.50×10-11) compared to those with low genetic risk and favorable lifestyle. No multiplicative or addictive interaction was observed between lifestyle and genetics. The findings from this study indicated that lifestyle and genetic factors were independently associated with the risk of incident IBS. All these results implicated a possible clinical strategy of lowering the incidence of IBS by advocating a healthy lifestyle.
Background Magnetically controlled capsule endoscopy (MCE) is a novel technique for which there is no agreed gastric preparation. We aimed to investigate whether no talking from 1 hour prior to the MCE procedure could improve the quality of gastric preparation. Methods 48 patients referred for MCE were randomly assigned to gastric preparation with either routine regimen (A), or no talking from 1 hour prior to the procedure with routine regimen (B). Image quality was assessed using cleanliness and visualization scores, with higher scores equating to better image quality. Results The total cleanliness scores were (mean±SD) 15.28±1.81 (A) and 21.39±1.28 (B). The total visualization scores (mean±SD) were 10.65±2.54 (A) and 15.23±1.12 (B). While the image quality of the whole stomach in group B was significantly better than group A (P<0.01). Group B could significantly shorten operating time than group A (P<0.05). MCE detected positive findings in 21 (52.5%), 27 (67.5%) patients in groups A and B, respectively, with no significant difference between groups (P>0.5). Conclusions No talking prior to MCE shortened operating time and produced better gastric mucosal image quality. It helps improve the efficiency of MCE.
Background The most common complication of Endoscopic Retrograde Cholangiopancreatography (ERCP) is post-ERCP Pancreatitis (PEP). Aggressive periprocedural hydration with PLR has been shown to reduce the incidence of PEP, but the evidence is still lacking. This meta-analysis aims to determine if aggressive hydration with Lactated Ringer Solution reduces the incidence of PEP. Methods RCTs studying the effect of aggressive PLR hydration on the incidence of PEP were retrieved from Pubmed, Cochrane and OVID databases using the following key terms and their equivalents: ERCP, pancreatitis, hydration. Nonrandomized studies and studies that included other interventions were excluded. Quality assessment was done using the Cochrane risk of bias tool. Pooled odds ratio (OR) at 95% confidence intervals was computed to generate forest plots. Data synthesis and analysis were performed using Revman 5.4 for Mac. A p-value <0.05 was considered as statistically significant. Results Six RCTs with 1516 patients were included in this meta-analysis. The incidence of PEP was significantly lower in the aggressive hydration group overall at 5.6% (43/765) compared to 13.4% (101/751) in the standard (OR=0.37, CI= 0.23 - 0.60, P<0.0001, I2=34%). This effect was maintained regardless of the timing of onset of hydration, with decreased risk of PEP seen in the aggressive hydration group, given hydration pre-procedure (OR =0.51, CI= 0.28 - 0.93, P=0.03, I2=41%) and those that only started hydration periprocedure (OR =0.22, CI= 0.11 - 0.44, P<0.00001, I2=0%). Conclusions Aggressive hydration with Lactated Ringer Solution in patients undergoing ERCP can prevent PEP.
Background The spleen can be the site of infectious as well as malignant lesions. With Cross-Sectional imaging these lesions can be localized but histology is essential for definitive diagnosis. Strategies to obtain splenic mass tissue include surgical, and percutaneous image-guided approaches. Endoscopic Ultrasound (EUS)-guided biopsy is a safe and effective method for obtaining samples from the spleen as an alternative to splenectomy. Methods We present two cases of splenic lesions that underwent EUS-guided biopsy. The procedure was done after informed consent with standard coagulation profile/platelet counts and performed under conscious sedation. No immediate or late complications or adverse events were noted. Results 72 years old male known case of vasculitis on multiple immunosuppressant medications came with complaints of abdominal pain and weight loss. CT scan abdomen revealed a splenic mass and a EUS-guided splenic mass biopsy was performed which revealed B cell related lymphoproliferative disorder. Case 2: A 62-year-old female presented with weight loss and decreased appetite, CT scan showed a large splenic mass with another peripancreatic nodal mass. EUS-guided biopsy performed revealed diffuse large B cell Lymphoma. Conclusions EUS-S in patients with splenic masses is a safe and effective diagnostic modality as an alternative to splenectomy.
Background The number of immunoglobulin A (IgA) and IgG secreted by B cells explain the inflammatory bowel disease (IBD) progress, especially in maintaining the homeostasis barrier between luminal antigens and epithelium. However, the levels of highly coated with IgA/IgG/IgM feces bacteria of both ulcerative colitis (UC) and Crohn’s disease (CD) patients were not yet clarified. Methods We used bacterial fluorescence-activated cytometry analysis to detect highly IgA, IgG and IgM coating feces bacteria in IBD patients. Results A medium-scale evaluation of immunoglobulin coating of intestinal microbial consortia in IBD patients, including 33 patients of UC and 21 patients of CD and six healthy subjects, were performed. We noted a significant increase in bacterial highly IgA-coating (IgA+), IgG+, and IgM+ patterns in both UC and CD patients compared to healthy controls (IDDF2023-ABS-0211 Figure 1. Highly immunoglobulin-coated gut microbial consortia of IBD patients). Next, a higher level of IgA+ and IgG+ gut bacteria in active UC (AUC) than UC in remission (RUC) was obtained (IDDF2023-ABS-0211 Figure 2a. Correlation analysis between highly IG-coated fecal bacteria and IBD activity). Most noticeably, we detected moderate and strong positive correlations between IgA+/IgG+ fecal bacteria in UC and modified Mayo Score (r = 0.5096, P = 0.0029; r = 0.7445, P< 0.0001) respectively (IDDF2023-ABS-0211 Figure 2b-d. Correlation analysis between highly IG-coated fecal bacteria and IBD activity). Also, a similar result was found that there was an increasing proportion of highly IgA+, IgG+, and IgM+ gut consortia in active CD (ACD) compared to CD in remission (RCD) (IDDF2023-ABS-0211 Figure 2e. Correlation analysis between highly IG-coated fecal bacteria and IBD activity). Then, a highly positive correlation between highly IgG-coated feces microbe in CD and simplified CDAI (r = 0.7837, P< 0.0001), a moderate positive correlation between highly IgM-coated feces microbe in CD and simplified CDAI (r = 0.4716, P = 0.0309) were found (IDDF2023-ABS-0211 Figure 2f-h. Correlation analysis between highly IG-coated fecal bacteria and IBD activity). Conclusions Our research favored that gut microbiota-driven inflammation increased highly IgA, IgG and IgM coating in IBD patients. There were moderate and strong positive correlations between highly Ig-coated feces microbe and IBD activity.
Background To evaluate the clinical characteristics, microbial composition, and gut metabolites of Clostridiodes difficile infection (CDI) in children. Methods 91 stool samples of CDI patients from September 2014 to August 2022 were collected, including 30 RCDI and 61 non-RCDI. 16S rRNA sequencing and liquid chromatography/mass-spectrometry metabolomics were used to analyze the microbiota composition and metabolites in children with CDI. Results The original patients’ microbiota had low diversity in RCDI patients. Fecal samples of RCDI patients were rich in members of Lactobacillales, Bacilli, Entotheonellales, Reyranellas, Leuconostocaceae, Erwinia and so on. The most significantly increased in the CDI group were Lachnospiraceae, Erysipelotrichi, Erysipelotrichaceae, Erysipelotrichales, Ruminococcus, Ruminococcaceae and so on. A total of 37 potential stool biomarkers were screened out in this study, among which the five most significantly different were arachidonic acid, 3−Hydroxyisovalerylcarnitine, γ-linolenic acid, Eicosapentaenoic acid (EPA), α-linolenic acid. Conclusions Some functional strains are altered in RCDI children. Compared with non-RCDI patients, some lipid metabolites changed in RCDI.
Background Helicobacter pylori (H. pylori) is a gram-negative spiral bacterium whose presence is a significant risk factor contributing to gastric cancer development. However, accurately identifying H. pylori in biopsy specimens can be challenging for pathologists due to the bacterium’s small size, which can lead to inconsistencies and misdiagnosis. To address this issue, we propose to develop a deep-learning model for the H. pylori-infected region delineation in gastric biopsy specimens. Our goal was to support pathologists in identifying and diagnosing H. pylori infection, thereby improving the accuracy of diagnosis for patients with gastric cancer. Methods We collected haematoxylin and eosin (H&E) stained slides of five gastric biopsy cases positive for H. pylori and digitized them using our Hamamatsu NanoZoomer S210 whole slide imaging system at 40x magnification (0.23 µm/pixel). The areas positive for H. pylori on the whole slide images (WSI) were annotated, and 512 x 512-pixel image tiles without overlap were extracted for model development, resulting in a total of 1,717 image tiles containing gastric tissue. We trained a modified U-Net with ResNet34 backbone and Lovász-Softmax loss function. The proposed U-Net was configured with a batch size of 128, 400 epochs, Adam optimizer, and a 1.00-04 learning rate. We evaluated our model based on the Intersection of Union (IoU) and Sørensen–Dice coefficient (DICE). Results Our U-Net-based model demonstrated excellent performance for H. pylori infection region delineation, with an IoU of 0.7805 and DICE of 0.8767. Figure 1 illustrates that the model significantly highlights most of the H. pylori-infected regions. (IDDF2023-ABS-0229 Figure 1. Representative original tiled H&E-stained whole slide images (WSI) with H. pylori infection (A – B). The predicted (highlighted in yellow) and ground truth (highlighted in blue) regions generated from our proposed U-Net model are shown (C – D). The black and red arrows indicate the H. pylori present within the ground truth and predicted regions from our proposed U-Net model, respectively) Conclusions From our preliminary result, our development of a U-Net-based model showed great promise for future studies to improve H. pylori infection diagnosis.
Background The international guideline recommends starting the last dose of bowel preparation within 5 hours of colonoscopy. However, local data on this issue are limited. The primary objective is to determine whether starting the second dose of bowel preparation within 5 hours of colonoscopy is associated with a higher rate of adequate bowel preparation among adult Chinese patients. The secondary objective is to identify the independent predictors of adequate bowel preparation. Methods Hospital records of consecutive Chinese adults with elective colonoscopies performed at Caritas Medical Centre, Hong Kong, from March to August 2021, were reviewed retrospectively. Results 354 subjects were enrolled. The median age was 63 years (inter-quantile range 55 - 71 years) and there were 194 males (54.8%). 319 subjects had successful caecal intubation (90.1%). Based on the time interval between the second dose of bowel preparation (Kleanprep or Picoprep) and the start of colonoscopy, subjects were divided into three groups: group 1 (≤5 hours), group 2 (>5 to 10 hours) and group 3 (>10 hours). Group 1 had the best Boston Bowel Preparation Scale (BPPS) score (6.94±1.48 vs. 6.18±1.95 vs. 5.69±1.42, P<0.001), the highest rate of adequate bowel preparation (74.2% vs. 64.4% vs. 54.0%, P<0.05) and there was a decreasing trend of adequate bowel preparation across the three groups (P=0.014). IDDF2023-ABS-0085 Figure 1 shows the BBPS scores of the three groups. Outpatient colonoscopies (P=0.041) and compliance with bowel preparation instructions (P=0.017) were independent predictors of adequate bowel preparation, as shown in IDDF2023-ABS-0085 Table 1. Conclusions Starting bowel preparation within 5 hours of colonoscopy results in a better quality of bowel preparation among Chinese adults.
Background Current guidelines recommend a surveillance interval of 10 years in average-risk patients after a negative colonoscopy. Evidence is limited in supporting the extension of this surveillance interval, particularly in the Asia-Pacific region. Methods We performed a territory-wide population-based retrospective cohort study involving patients in Hong Kong through the Clinical Data Analysis and Reporting System. All patients who received diagnostic colonoscopies with normal findings from January 2000 to June 2006 were included. Patients with a known history of CRC, familial polyposis syndromes, inflammatory bowel disease and colectomy at baseline were excluded. All patients were followed longitudinally for interval CRC and death for up to 16 years. Age-standardised incidence and standardised incidence ratios (SIR) were calculated with reference to the population incidence retrieved from the Hong Kong Cancer Registry. Sensitivity analyses were conducted to assess the effect of different reference years on the SIRs. Subgroup analysis was performed based on various risk factors—age group, history of colonic polyp, and family history of CRC. Results A total of 14,708 patients were included in the main analysis. At baseline, 6,574 (44.7%) of patients were male, with an average age of 55.45 (SD = 14.59). In terms of risk factors, 2,537 (17.2%) patients had a history of non-malignant colorectal polyp prior to the index colonoscopy of this study and 230 (1.6%) patients had a positive family history of CRC. The average follow-up duration was 9.42 (SD = 5.86) years. At 3, 6 and 9 years, the SIRs were 0.164, 0.287 and 0.479 respectively. At 12 and 16 years, the SIRs were 0.501 (95% confidence interval: 0.240 - 0.920) and 0.557 (95% confidence interval: 0.278 - 0.996) respectively, which indicated a sustained risk reduction by 44.3% beyond the standard surveillance interval (IDDF2023-ABS-0082 Figure 1. Standardised incidence ratios with 95% confidence intervals across different timeframes in the follow-up period, comparing the incidence of CRC within the study cohort versus the population incidence of CRC in Hong Kong). The findings were consistent in sensitivity and subgroup analyses. Conclusions A negative baseline colonoscopy was associated with a 44.3% reduced risk of interval CRC when compared to the general population for up to 16 years. Our findings suggest the possibility to personalise and extend the surveillance intervals among average-risk patients with normal colonoscopies.
Background Allergic disorders are prevalent in children and can lead to life-threatening conditions. A better understanding of the triggers and clinical presentations is critical for early identification and timely treatment to prevent severe allergic reactions such as anaphylaxis. This study aimed to characterize the profile of allergic reactions in pediatric patients admitted to an emergency department. Methods The study reviewed the medical records of pediatric patients (aged below 18 years) with allergy-related symptoms admitted to the Emergency Department of Qingdao Women and Children’s Hospital, Qingdao, east Shandong Province, China, between July 2019 and October 2022. The discharge diagnoses included ‘anaphylactic shock’, ‘allergy (unspecified)’, ‘food allergy’, ‘drug allergy’, ‘anaphylactic shock after sting’, ‘urticaria’, ‘angioedema’, and ‘asthma exacerbation’, based on the International Classification of Diseases diagnostic criteria. All information was retrieved using standardized data collection forms. Results We identified 304 cases with 314 emergency visits that fulfilled clinical criteria during the study period. Patients’ mean age (± SD) at first admission was 4.8 ± 3.5 years and 52.9% were boys. Food was the predominant trigger of allergic reactions leading to emergency admission (20.7%), followed by drugs (7.0%). Egg (35.4%) and wheat (13.8%) ranked the top in identified food triggers. Most allergic episodes occurred without the presence of identifiable co-factors (69.7%), but of those with co-factors, most were related to acute infection. Mucocutaneous manifestations were present in 76.8% of allergic episodes, mainly with erythematous skin (86.7%) and urticaria (68.0%). Twenty cases developed anaphylaxis requiring adrenaline administration, the majority of which was induced by food (13/20), mostly egg (7/20). Young children under 4 years of age were more likely to develop allergic reactions induced by food (p = 0.002). Most anaphylaxis episodes to identified allergens also occurred in the 0- to 4-year age group. Conclusions Egg was the most common trigger of allergic reactions, particularly anaphylaxis, in pediatric patients admitted to an emergency department in East China. The distinct clinical features of allergic responses and the vulnerability of young children highlight the need to raise awareness about the management of pediatric allergies.
Background Fecal microbiota transplantation (FMT) has been recommended as a highly effective treatment for recurrent clostridium difficile infection (CDI). Although the majority of patients have benefited from FMT, it is vital to recognized the latent risk to the safety of FMT. The impact of the gut microbiome on the occurrence of FMT-related Adverse events (AEs) remains unclear. To analyze the risk factors of FMT-related AE in patients with ulcerative colitis (UC) and Crohn’s disease (CD), as well as the difference between the fecal microbiota for patients with FMT-related AEs and non-AEs, moreover, identify the dominant microbiota in patients with FMT-related AEs. Methods 110 patients with UC and CD were recruited from April 2013 to July 2015. Clinical efficacy was followed up for three months and details of AEs during the FMT and the follow-up period after FMT were carefully recorded. The stool samples were analyzed by 16S rRNA gene sequencing. Results 63 patients with CD and 39 patients with UC were divided into the AE group (n = 34) and the non-AE group (n = 68). 43 cases of FMT-related AEs from 34 patients were recorded in the study. Enterococcus, Faecalibacterium, Haemophilus and Bifidobacterium were more abundant in the AE group, Multivariate logistic regression analysis indicated that Bifidobacterium, Enterococcus, and Propionibacterium were independent risk factors of FMT-related AEs (p < 0.05). The AE group was divided into the fever subgroup (n = 15) and gastrointestinal complications (GC) subgroup (n = 19) rely on the type of FMT-related AEs. The LEfSe analysis showed a high abundance of Enterococcus in the fever group, and a high abundance of Bifidobacterium in the GC group. Moreover, the abundance of Bifidobacterium in the diarrhea subgroup in the GC group was higher than that in the non-AE group (p < 0.05). The AE group was divided into subgroups according to clinical efficacy. The abundance of the Enterococcus genus was enriched in the AE-pre group (IDDF2023-ABS-0133 Figure 1). Conclusions Gut microbiome components are associated with FMT-related AEs. The high abundance of Enterococcus in patients may affect the clinical efficacy of FMT.
Background Accumulating evidence indicates that gut microbiota is closely related to the tumorigenesis of digestive system cancers (DSCs). However, whether a causal relationship between gut microbiota and DSCs exists is unknown. Methods Genome-wide association study (GWAS) summary statistics of gut microbiota and DSCs from public databases and the bidirectional two-sample MR analysis were utilized to assess the causality between gut microbiota and DSCs as well as its direction. Sensitivity analyses were also performed to evaluate the robustness of our results. Results We found that the genus Eggerthella (OR = 0.464, 95%CI: 0.27 to 0.796, P = 0.005) was negatively associated with the risk of gastric cancer. Genetically predicted genus Lachnospiraceae FCS020 group (OR = 0.607, 95%CI: 0.439 to 0.84, P = 0.003) correlated with a higher risk of colorectal cancer, and genus Turicibacter (OR = 0.271, 95%CI: 0.109 to 0.676, P = 0.005) was a protective factor for liver cancer. In the reverse MR, DSCs regulated the relative abundance of specific strains of gut microbiota. Conclusions In conclusion, we comprehensively screened the association of gut microbiota with DSCs via a bidirectional two-sample MR analysis and identified the causal relationship between several microbial taxa and DSCs. Our discoveries are beneficial for the development of novel microbial markers and microbiota-modifying therapeutics for DSCs patients.
Background PE-1 test has become a painless and non-invasive diagnostic method for the diagnosis of pancreatic exocrine insufficiency (PEI) in clinical practice and is widely used in clinical practice. However, there is no effective method to diagnose PEI in China and the diagnostic accuracy of PE-1 test in the Chinese population has not been demonstrated. This study aims to clarify the application efficacy of PE-1 test in PEI through a multicenter clinical study comparing PE-1 test with strict clinical diagnosis to study the accuracy of the PE-1 test in the diagnosis of PEI. Methods Each subject underwent rigorous clinical diagnosis and fecal PE-1 test. Patients with PEI-related clinical symptoms such as abdominal distension, weight loss or steatorrhea after chronic pancreatitis, pancreatectomy or gastrectomy, and Convalescence of severe acute pancreatitis were diagnosed with PEI patients; Healthy volunteers and patients with functional gastrointestinal disorders, benign hepatobiliary diseases, thyroid diseases, breast diseases, digestive tract diseases, excluding pancreatic disease, pancreatectomy, gastrectomy, abdominal radiotherapy were diagnosed as non-PEI. Fecal samples from the volunteers were detected using the pancreatic elastase 1 detection kit from ScheBo Biotech AG, Germany. Results We enrolled 1053 subjects (525 PEI patients and 528 non-PEI patients) from Changhai Hospital, Shanghai, China, Peking Union Medical College Hospital and Xuanwu Hospital, Beijing, China between July 30, 2020, and August 26, 2021. The fecal elastase 1 mean concentration in PEI patients was much lower than that in non-PEI patients (88.59 vs 568.05). The fecal PE-1 test was consistent with clinical diagnosis in the diagnosis of PEI (Kappa=0.884,95%CI 0.857,0.911, P<0.0001). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the PE-1 test in the diagnosis of PEI were 90.10%, 98.3%, 52.86, 0.10. The accuracy of PE-1 test in the diagnosis of PEI was 94.21%. Conclusions PE-1 test has a good diagnostic value for pancreatic exocrine insufficiency and is recommended for the diagnosis of PEI in the Chinese population.
Background Fistulising Crohn’s Disease (fCD) affects up to 40% of people with Crohn’s disease (CD) over their lifetime. Despite its prevalence, the burden of disease, treatment and ‘natural history’ is poorly described. This study explored demographics, disease and treatment factors in a real-world cohort. Methods A registry created from deidentified data entered during routine care was interrogated in December 2022. People with CD and a care encounter in the last 14 months were included. The current fistula was defined as those with an actively draining fistula on the most recent radiologic, endoscopic or clinical assessment. Results There were 3039 people with CD with a mean age of 43.1 and a mean disease duration of 13.7 years. Current or previous fCD was seen in 220 & 312 people. Current or previous fCD cohorts were younger than those without fCD (mean age 40.50, 39.63 & 44.1 years, p=0.0038 & p<0.0001). Male gender was more common in those with current (58%, p=0.022) or previous fCD (58%, p=0.007) compared to those without (50%). Current and previous fCD cohorts had higher rates of current biologic use compared to those without fCD (75.5%, 68.3% & 48.9%, p<0.001 & p<0.001). People with current or previous fistula were more likely on anti-TNF therapy (Adalimumab or Infliximab) compared to those without fCD (85.5%, 82.2% & 68.1%; p<0.001 & p<0.001). People with current or previous fCD had higher hospital admission rates for CD-related complications compared to those without fCD (5%, 6% & 1.9%, p<0.001 & p=<0.001). The previous fCD cohort had higher rates of CD-related surgery within the last year compared to people without fCD (21.2% vs 13.3%, p<0.001). People with active or previous fCD were less likely to have been on steroid therapy compared to those without fCD (23.2%, 24.4% & 32.3%, p<0.001 & p<0.001). Conclusions People with current and previous fCD continue to experience higher hospitalisation rates for disease-related complications and more frequently require surgical procedures. This highlights the importance of further research into care gaps to improve outcomes and provide support for people with fCD.
Background It is well-established that depression and fatigue are more prevalent in patients with nonalcoholic fatty liver disease (NAFLD) compared to the general population. The aim of this study was to evaluate the association between the presence of depression, clinically meaningful fatigue and body composition parameters in patients with NAFLD. Methods The cross-sectional study included 71 patients with NAFLD. Fatty liver was diagnosed based on ultrasonographic findings and Fatty Liver Index (FLI) ≥ 60. Depression was determined as values on the Hospital Anxiety and Depression Scale (HADS) of ≥8, and clinically meaningful fatigue – as values on the Fatigue Assessment Scale (FAS) of ≥22. The body composition was measured using bioimpedance analyzer ABC-02 Medass (NTC Medass, Russia), which utilizes bioelectrical impedance technology. All the study procedures were carried out on the same visit. For all analyses, two-sided statistical significance was determined as p<0.05. Results Median age was 49 years (interquartile range (IQR)=38-58); 59.2% were female. Median body mass index was 33.7 (29.5-38.2). Depression was identified in 17 (23.9%) patients, and fatigue – in 30 (42.2%) patients. Body fat mass (BFM) and percent body fat (%BF) were positively correlated with HADS scores for depression (HADS-D) (Spearman’s r =0.303, p=0.023 and r=0.308, p=0.021) and FAS scores (r=0.298, p=0.023 and r=0.297, p=0.023), whereas relative skeletal muscle mass (RSMM) was negatively correlated with both scores (HADS-D: r=-0.509, p<0.001; FAS: r=-0.415, p=0.001). Patients with NAFLD and HADS-D ≥8 had significantly higher BFM and%BF (p=0.033 and p=0.005 respectively) and significantly lower RSMM (p=0.001). BFM and%BF were significantly greater in NAFLD patients with FAS ≥22 (p=0.024 and p=0.045), whereas the differences for RSMM did not reach the statistically significant level (p=0.087). Conclusions The presence of depression and clinically meaningful fatigue in patients with NAFLD may be associated with body composition, in particular with excess fat mass and decreased relative skeletal muscle mass.
