Helicobacter pylori-associated gastritis (HPAG) is a chronic inflammatory condition of the gastric mucosa caused by Helicobacter pylori infection, serving as the core etiological factor for peptic ulcers and gastric precancerous lesions. Given the persistently high global infection rates and the escalating burden of antibiotic resistance, conventional eradication therapies are encountering significant challenges. This article systematically delineates the molecular pathogenic mechanisms underlying HPAG, encompassing bacterial virulence factors, host immune responses, aberrant signaling pathways, oxidative stress, epigenetic regulation, and mucosal barrier damage. Building upon this foundation and in alignment with international mainstream diagnostic and therapeutic guidelines, we summarize the research progress of traditional Chinese medicine (TCM) interventions from a novel perspective of microecological homeostasis regulation. Specifically, we clarify the multifaceted roles of TCM monomers and formulas in immunomodulation, mucosal repair, and antibacterial synergism. By systematically synthesizing existing evidence from TCM studies, we construct a whole-course TCM intervention framework for HPAG that integrates "susceptibility prevention, active treatment, and posteradication repair." Furthermore, we critically analyze the current clinical translation bottlenecks and the limitations inherent in the "black-box" research paradigm of TCM monomers and formulas, and propose future research directions driven by multiomics technologies. This work provides both theoretical support and practical references for precise integrated Chinese and Western medicine diagnosis and treatment of HPAG.
Gastric cancer is a major global public health challenge, with high incidence and mortality rates, particularly in Costa Rica. Like most oncological diseases, it significantly wastes nutritional status, often leading to malnutrition, which in turn worsens prognosis and survival. Early identification of malnutrition is therefore critical. The Global Leadership Initiative on Malnutrition (GLIM) has proposed standardized diagnostic criteria to systematically diagnose malnutrition across diverse clinical settings. However, validation has not been performed versus reference methods in many conditions, such as gastric cancer, although it is essential before widespread adoption. This study is aimed at validating the GLIM criteria for the timely detection of malnutrition in patients newly diagnosed with gastric cancer. We conducted a cross-sectional analysis in which GLIM-based assessments were compared against the Patient-Generated Subjective Global Assessment (PG-SGA) as the gold standard. Diagnostic performance was evaluated through sensitivity, specificity, and positive and negative predictive values; agreement was assessed with kappa statistics. Survival probability was further examined using Kaplan-Meier curves to estimate the prognostic relevance of nutritional status. A total of 72 patients were included. GLIM criteria demonstrated a sensitivity of 81.9% and specificity of 81.8% compared with PG-SGA, with moderate agreement (kappa = 0.48). Survival analysis revealed that both GLIM and PG-SGA consistently identified better outcomes among patients with preserved nutritional status. In conclusion, the GLIM criteria represent a valid and practical tool for the early detection of malnutrition in gastric cancer patients at diagnosis, supporting their integration into routine clinical practice to improve patient management and survival outcomes.
Background:Ferroptosis is an iron-dependent form of regulated cell death, whereas the precise mechanism of ferroptosis in the pathogenesis of ulcerative colitis (UC) remains to be elucidated. The tissue inhibitor Metalloproteinase 1 (TIMP1) is involved in ferroptosis of UC, whereas its regulatory function remains unclear. This study is aimed at exploring the potential effect on ferroptosis in UC. Methods:Gene expression profiling data of colonic biopsies from UC patients and healthy controls were acquired from the GSE87466 dataset. The expression of TIMP1, GPX4, and SLC7A11 was determined using western blot. The mRNA levels of TIMP1, PGRMC1, IL-1β, and IL-6 were measured using reverse transcription quantitative PCR (RT-qPCR). The Fe2+ and malondialdehyde (MDA) contents were detected with commercial kits. The reactive oxygen species (ROS) production was analyzed via flow cytometry. The integrity of the intestinal epithelium was evaluated using a fluorescein isothiocyanate (FITC)-dextran permeability assay and transepithelial electrical resistance (TEER) measurements. Results:Bioinformatics identified TIMP1 and PGRMC1 as core genes related to ferroptosis of UC. Both TIMP1 and PGRMC1 were upregulated in colonic biopsies from UC patients in the GSE87466 dataset. The mRNA expression was induced after LPS treatment, whereas PGRMC1 was not significantly altered. TIMP1 knockdown inhibited the expression of IL-1β and IL-6; reduced Fe2+, MDA, and ROS levels; and upregulated the expression of GPX4 and SLC7A11 in LPS-induced intestinal epithelial cells. Furthermore, TIMP1 knockdown reduced the intestinal epithelial leakage in vitro. Conclusion:TIMP1 regulated ferroptosis, inflammatory response, and intestinal epithelial permeability in LPS-induced intestinal epithelial cells, suggesting TIMP1 as a potential therapeutic target for UC.
Background Gastroesophageal reflux disease (GERD), a prevalent gastrointestinal disorder, is associated with extraesophageal complications. Emerging evidence suggests a clinically significant association between GERD and airway hyperresponsiveness (AHR), although the precise molecular mechanisms underlying this disease comorbidity remain unclear. Methods This study employed bioinformatics and exploratory feature‐prioritization analyses to identify candidate genes linking GERD‐related and asthma/AHR‐related transcriptomic contexts, followed by a comprehensive bioinformatics characterization and single‐cell transcriptomic profiling to elucidate their functional roles and associated immune landscape alterations. Furthermore, predictive models were developed and subjected to in silico drug–gene enrichment analysis to evaluate their potential as candidate biomarkers and therapeutic hypotheses. Results Our study identified differential expression patterns of FZD5 and GALNT10, showing significant upregulation in GERD patients. In the asthma/AHR‐related dataset, FZD5 was increased whereas GALNT10 was decreased. Functional analysis suggested links with Wnt‐, KRAS‐, and IL2/STAT5‐related programs. Immune microenvironment analysis demonstrated interindividual heterogeneity, with distinct immunological profiles observed between high‐ and low‐expression groups, particularly involving activated CD8+ T‐cell and Th17‐related patterns. Furthermore, both genes exhibited predictive potential for disease classification. Finally, DSigDB‐based in silico analysis suggested several candidate compounds, including digoxin, for further evaluation. Conclusion FZD5 and GALNT10 have been identified as candidate molecular links in GERD‐related and asthma/AHR‐related contexts, demonstrating potential as candidate biomarkers and putative therapeutic targets that require further validation.
Background:This study compared postoperative gastrointestinal function recovery between endoscopic retrograde appendicitis therapy (ERAT) and laparoscopic appendectomy (LA) in patients diagnosed with chronic fecalith appendicitis. Methods:This was a retrospective study enrolling patients with chronic fecalith appendicitis, who were divided into the ERAT group and the LA group. Gastrointestinal manifestations were recorded, and the Gastrointestinal Symptom Rating Scale (GSRS) score was applied to evaluate gastrointestinal function. Preoperative and postoperative symptomatic improvement and GSRS scores were compared across groups. Result:A total of 101 eligible patients were recruited and divided into the ERAT group (n = 40, 39.60%) and the LA group (n = 61, 60.40%). All ERAT procedures were completed successfully, with 100% rates of successful intubation and fecalith removal. No severe adverse events were reported postoperatively in either cohort. Compared with LA, ERAT presented significantly shorter operative duration and postoperative hospital stay (statistically significant differences). For GSRS score assessment, the median preoperative, postoperative scores and score reduction were 5 (4), 1 (1.75), and 3.5 (1) in the ERAT group, versus 4 (2), 3 (3), and 1 (2) in the LA group. The ERAT group exhibited a significantly larger magnitude of symptom improvement (p < 0.001, z = -5.484). Multivariate logistic regression analysis indicated that patients undergoing ERAT obtained a significantly higher degree of GSRS score improvement (p < 0.001, odds ratio = 2.137, 95% confidence interval: 1.461-3.126). Analysis of individual GSRS domains demonstrated that improvements in abdominal pain, dyspepsia and diarrhea were significantly more prominent in the ERAT group. Conclusion:As an organ-preserving endoscopic procedure, ERAT retains appendiceal function and protects gastrointestinal physiological function. Our findings offer meaningful clinical references of treatment strategies for chronic fecalith appendicitis.
Background:Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern. High fasting plasma glucose (HFPG) is a major metabolic driver, yet its long-term burden and future trends in China versus globally remain unclear. Methods:Data from the Global Burden of Disease Study 2021 were analyzed. Deaths and disability-adjusted life years (DALYs) were assessed using counts and age-standardized rates (ASRs). Temporal trends were evaluated using estimated annual percentage change (EAPC). An age-period-cohort (APC) model was used to project the burden through 2046. Results:In 2021, HFPG-attributable MASLD caused 10,021 deaths and 213,481 DALYs worldwide. From 1990 to 2021, global age-standardized death and DALY rates increased significantly (EAPC, 2.22% and 2.02%, respectively). The burden was higher in males and increased with age, peaking in those aged ≥ 80 years. Projections suggest that absolute deaths and DALYs will continue to rise globally and in China through 2046, whereas ASRs are expected to decline, particularly among females. China showed a lower increase in age-standardized death rate (EAPC, 1.28%) compared with the global average. Conclusion:The burden of HFPG-attributable MASLD continues to increase globally and remains substantial in China. Although ASRs may stabilize or decline, population aging is expected to sustain growth in the absolute burden. These findings highlight the need for early metabolic screening, integrated management of metabolic and liver diseases, and targeted interventions for older adults and other high-risk populations.
Metabolic diseases, including obesity, Type 2 diabetes, and nonalcoholic fatty liver disease, have become a severe global health burden, and their pathogenesis is closely associated with gut microbiota dysbiosis. As the core unit of traditional Chinese medicine (TCM) compatibility theory, Chinese herb pairs possess unique advantages in metabolic regulation due to their multicomponent and multitarget characteristics. Recent studies have confirmed that herb pairs can improve host metabolic homeostasis by reshaping gut microbial community structure, regulating microbial metabolites (e.g., short-chain fatty acids, bile acids, and tryptophan metabolites), and repairing intestinal barrier function. This review systematically summarizes the latest research progress regarding the intervention of Chinese herb pairs in metabolic diseases by modulating the gut microbiota metabolic network, provides an in-depth analysis of their action mechanisms based on the "microbiota-gut-organ axis," and discusses the current research challenges and future translational directions.
Introduction:Effects of aging on the relationship of striated esophagus (StEso) motor function with pharyngeal deglutitive biomechanics has not been systematically studied. Objective:The aim of this study is to characterize the effects of aging on the correlation of deglutitive StEso with pharyngeal function. Materials and Methods:We studied 33 healthy subjects. Fifteen elderly (age: 75 ± 7 years, 8 female) and 18 nonelderly (age: 50 ± 14 years, 9 F) were evaluated using high resolution manometry/impedance. Nine elderly (73 ± 7 years, 5 F) and eight young (24 ± 3 years, 4 F) were further evaluated by digital videofluoroscopy. Results and Discussion:Duration of StEso excursion averaged 2.56 ± 0.65 s in elderly and 2.33 ± 0.41 in young. We identified four periods in StEso motor function during deglutitive excursion: (a) anterosuperior ascent without bolus/peristaltic activity, (b) nonperistaltic bolus receiving function at apogee of StEso excursion during UES opening and pharyngeal peristalsis, (c) peristaltic bolus transport as StEso descends, (d) continued peristalsis in resting position. Apart from the final period described, the periods are significantly different in the elderly compared with the young subjects (p < 0.04). Furthermore, the interaction of striated esophageal flow dynamics and peristaltic contractile vigor showed that a significant correlation (r = -0.71, p = 0.0009) was found when comparing the average bolus injection length to the average SECI in young subjects. This correlation was muted in the elderly and did not reach statistical significance (r = -0.41, p = 0.13). Conclusions:Sequencing of StEso/pharyngeal deglutitive motor function is preserved in the elderly. The differences observed in early stages of spatiotemporal mapping of StEso deglutitive motor function when comparing healthy elderly to young populations may be due to age-related suprahyoid muscle weakness since the affected periods are those associated with the active StEso ascent and descent. Like young individuals, elderly pressure signatures currently attributed to the StEso deglutitive motor activity do not represent the entirety of StEso peristalsis.
[This retracts the article DOI: 10.1155/2012/845672.][This retracts the article DOI: 10.1155/2012/845672.].
Aim:Sarcopenia is a common complication in patients with chronic liver disease (CLD). However, most prior studies on sarcopenia in CLD have predominantly focused on viral hepatitis and cirrhosis, with limited data available on its prevalence in primary biliary cholangitis (PBC), especially at noncirrhotic stages. This study is aimed at investigating the clinical characteristics and identifying independent risk factors for sarcopenia in female PBC patients. Methods:We retrospectively enrolled 229 female patients, including 118 with chronic hepatitis B (CHB) and 111 with PBC. All patients underwent abdominal computed tomography (CT). The skeletal muscle area at the level of the third lumbar vertebra (L3) was measured using the image analysis software SliceOmatic V5.0 (TomoVision, Magog, Canada), and the skeletal muscle index (SMI) was calculated accordingly. Sarcopenia was defined based on the L3-SMI index. We compared the prevalence of sarcopenia between PBC and CHB patients at different stages of liver fibrosis and further analyzed the clinical characteristics and independent risk factors for sarcopenia in PBC patients. Results:Among the 229 female patients, 93 were noncirrhotic (45 with PBC and 48 with CHB). The prevalence of sarcopenia was significantly higher in noncirrhotic PBC patients than in noncirrhotic CHB patients (75.60% vs. 31.30%, χ 2 = 18.29, p < 0.001). Among the 136 cirrhotic patients (66 with PBC and 70 with CHB), sarcopenia prevalence showed no significant difference between PBC and CHB patients (60.60% vs. 52.90%, χ 2 = 0.83, p > 0.05). After propensity score matching (PSM), both cirrhotic and noncirrhotic PBC groups demonstrated a high prevalence of sarcopenia (85.30% vs. 70.60%, χ 2 = 2.138, p > 0.05). Multivariate analysis identified that low body mass index (BMI) (OR = 1.342; 95%CI = 1.150-1.565; p < 0.001) and osteopenia/osteoporosis (OR = 4.2; 95%CI = 1.408-12.533; p = 0.01) were independent risk factors for sarcopenia in female PBC patients. Conclusion:Sarcopenia is highly prevalent in female PBC patients. In contrast to female CHB patients, in whom sarcopenia mainly occurs at the cirrhotic stage, female PBC patients exhibit high sarcopenia prevalence at both noncirrhotic and cirrhotic stages. Low BMI and osteopenia/osteoporosis are independent risk factors for sarcopenia in female PBC patients. Notably, sarcopenia should also be considered in PBC patients with normal or high BMI. Early and routine screening for sarcopenia and its risk factors is recommended in all PBC patients, regardless of cirrhosis stage.
Objectives:This randomized controlled trial aimed to evaluate the effects of Gui-Shao San umbilical moxibustion on symptoms of the disease, psychological well-being, and quality of life in patients with IBS-D. Interventions:The patients were randomly assigned to three groups: One received Gui-Shao San umbilical moxibustion alongside conventional Western medicine treatment; one received placebo umbilical moxibustion alongside conventional Western medicine treatment; and one received only conventional Western medicine treatment for use as a positive control group. Outcomes:The primary outcome measures included TCM clinical symptom score, IBS-SSS, and grading criteria for TCM syndrome scores. Secondary outcome measures included SAS, SDS, and IBS-QOL. The effects of the intervention on these outcomes were measured at three time points: baseline (T0), Week 2 (T1), and Week 4 (T2). At Week 8, the recurrence of patients was measured based on whether their IBS-SSS score increased by one grade. Results:After 4 weeks of treatment, compared with the positive drug control group, both the Gui-Shao San umbilical moxibustion group and the placebo umbilical moxibustion group effectively relieved patients' symptoms, anxiety, and depression, while improving their quality of life. Significant differences were observed between groups in IBS-SSS scores (120.61 ± 30.61 vs. 128.13 ± 41.85 vs. 161.82 ± 59.87, p < 0.001) and TCM syndrome scores (7.88 ± 1.709 vs. 8.59 ± 2.722 vs. 9.97 ± 2.099, p < 0.001). Conclusions:Gui-Shao San umbilical moxibustion is an effective method for treating IBS-D. Further rigorous, large-scale, long-term trials are needed to evaluate the therapeutic effects of Gui-Shao San umbilical moxibustion, focusing on interdisciplinary collaboration. Trial Registration:The International Traditional Medicine Clinical Trial Registry (ITMCTR) Reg. No.: ITMCTR2025001072.
Background:Chronic inflammation due to Helicobacter pylori infection causes the development of many gastrointestinal diseases, such as gastric ulcer and atrophic gastritis. This study is aimed at investigating the relationship between inflammatory cytokines and pepsinogen levels in H. pylori-infected patients. Method:A total of 165 H. pylori-infected subjects without atrophic gastritis were recruited, and their demographic, medical, and lifestyle information were collected. Inflammatory cytokines such as IL-8, IFN-γ, TNF-α, CRP, IL-17A, IL-1β, IL-18, and pepsinogen (PGs I and II) levels were measured. Multiple linear regression was used to analyze the relationship between cytokines and PG levels, whereas segmental regression explored threshold or saturation effects. Result:IL-17A and IFN-γ were positively correlated with PG I and LNPG II, with each 1-pg/mL increase in IL-17A associated with a 2.595 (95% CI: 0.854, 4.335)-ng/mL increase in PG I and a 0.012 (95% CI: 0.002, 0.022)-ng/mL increase in LNPG II; each 1-pg/mL increase in IFN-γ was associated with a 1.746 (95% CI: 0.702, 2.791)-ng/mL increase in PG I and a 0.008 (95% CI: 0.002, 0.0191)-ng/mL increase in LNPG II. No significant correlation was found between inflammatory cytokines and the PG I/PG II ratio (PGR). Conclusion:In H. pylori-infected patients without atrophic gastritis, IL-17A and IFN-γ levels showed a linear correlation with PG levels. These cytokines may be closely associated with early gastric mucosal lesions. However, further research is needed to elucidate their specific mechanisms in disease pathogenesis.
Background and ObjectivesNutrition- and inflammation-related indicators have been shown the prognostic value in cancer patients; however, few studies focus on gastric cancer (GC) patients who underwent prophylactic intraperitoneal hyperthermic chemotherapy (p-HIPEC) following radical gastrectomy. This study is aimed at developing and validating a prognostic nutritional scoring system (PNSS) integrating systemic inflammatory markers and body composition parameters specifically for these patients.Methods and ResultsBody composition was assessed via computed tomography, and systemic inflammatory markers were recorded preoperatively. A total of 267 patients with GC who received p-HIPEC were included, and the incidences of sarcopenia, myosteatosis, and sarcopenic obesity were 32.6%, 27.3%, and 18.7%, respectively. Logistic regression analysis identified that platelet-to-lymphocyte ratio (PLR) is a significant risk factor for sarcopenia and myosteatosis. The PNSS was constructed using PLR, systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), skeletal muscle index (SMI), and sarcopenia-myosteatosis risk (SMR) score which further integrates skeletal muscle attenuation (MA). This model demonstrated superior predictive accuracy for overall survival (OS) compared to the classic TNM model (C-index: 0.76 vs. 0.71 for 3-year OS in the primary cohort and 0.68 vs. 0.64 for 5-year OS in the validation cohort).ConclusionsThe PNSS, incorporating both body composition and systemic inflammatory markers, provides robust prognostic value for predicting OS in GC patients undergoing curative resection with p-HIPEC.
Background:Clostridioides difficile infection (CDI) is one of the most prevalent infections in the United States, with rising mortality and disease severity in the early 2000s, followed by a steady decline after 2010. This study analyzes national trends in CDI mortality across different demographic and regional groups from 1999 to 2020. Methods:We used CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) to analyze CDI-related deaths among adults aged ≥ 35 years. Age-adjusted mortality rates (AAMRs) per 100,000 individuals, along with annual percent change (APC) and average annual percent change (AAPC), were calculated and stratified by year, sex, race, and region. Statistical significance was assessed using Joinpoint regression analysis. Results:During the study period, 191,653 CDI-related deaths were reported. The AAMR for CDI-related mortality increased from 1.1 in 1999 to 7.3 in 2011 (AAPC: 33.60). However, from 2011 to 2020, there was a notable decline in CDI mortality (AAPC: -10.48; 95% CI: -13.31 to -7.52). Mortality increased significantly with age, and females had a higher total number of deaths, while males maintained a higher AAMR throughout the study period. Among different racial groups, non-Hispanic White individuals recorded the highest AAMR (6.1) in 2011, while Asian individuals had the lowest AAMR (2.3). Geographically, the Northeastern census region reported the highest AAMR (4.8) in 2008, while the Southern census region had the lowest AAMR (3.1). The majority of CDI-related deaths (78%) occurred in hospitals, with nursing homes accounting for 17.7% of fatalities. Conclusions:The sharp decline in CDI mortality starting in 2010 aligns with the implementation of strict guidelines and collaborative efforts between professional societies (IDSA/SHEA), the ACG, and government agencies (CDC). This underscores the success of coordinated public health initiatives in reducing healthcare-associated infections and improving patient outcomes. However, disparities in mortality rates persist across different age, sex, ethnic, and geographic groups, emphasizing the need to further study disease trends and explore strategies to address these disparities in high-risk populations.
BackgroundAs the lack of analysis on risk factors for the short-term outcomes of acute small bowel obstruction (ASBO), the current high readmission rate and severe postoperative complications of ASBO seriously affect the quality of life of patients. Risk-scoring models for evaluating the short-term outcomes of ASBO are still urgently needed.MethodsA total of 278 patients diagnosed with complete ASBO were included in this study. Cox proportional hazards regression analysis was used to construct predictive models for the length of stay (LOS) and the length of short-term recurrence (LOR). The receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess the performance.ResultsThe mean LOS of 278 patients was 11.19 days, and 17 patients (6.1%) were readmitted. Multivariate analysis showed that longer duration of disease (Hazard ratio, HR = 1.551), low albumin (HR = 1.681), high lumen diameter(max) (HR = 1.477), low chlorine (HR = 1.046), and operation (HR = 7.456) were risk factors for LOS. Calcium (HR = 29.391) was an independent risk factor for LOR. Operation is not a risk factor for LOR. A risk-scoring model of LOS (RS_LOS) was constructed to predict the posttreatment recovery (AUC, 30 days = 0.859). In the high-risk group, the severe adverse events (SAE) rate reached 17.1%, exceeding 1.4% in the low-risk group. The performance of RS_LOR was also satisfactory (AUC, 12 months = 0.802). In the high-risk group, the recurrence rate reached 14.3%, nearly triple that in the low-risk group (3.4%).ConclusionThe risk-scoring models of LOS and LOR provide a comprehensive evaluation on the short-term outcomes of ASBO treatment.
Objective:Gastrointestinal stromal tumors (GISTs) lack specific clinical manifestations and are challenging to distinguish from other gastric submucosal tumors (SMTs). This study is aimed at illustrating the atypical manifestations of non-GISTs mimicking gastric GISTs and determining whether objective preoperative factors can help differentiate gastric GISTs from non-GISTs in patients. Methods:We included 29 GIST patients and 27 patients preoperatively misdiagnosed with GIST located in the stomach. We compared demographic data and tumor characteristics based on endoscopic ultrasound (EUS) and computed tomography (CT) findings between GIST and non-GIST groups. Results:Clinical symptoms in the extragastric compressions group were significantly more common (100%) than in the GISTs group (35.7%) (p < 0.05). Gastrointestinal stromal tumors more commonly exhibited an exophytic growth pattern than gastric non-GISTs SMTs (p < 0.05). Mean arterial phase attenuation was significantly lower in gastric non-GISTs SMTs (54.3 HU) compared with GISTs (59 HU, p = 0.003), with an optimal cutoff value of < 28.9 HU and an AUC of 0.689. There was a significant difference in lesion size between the GIST and gastric non-GIST groups, with GISTs presenting larger lesions (4.2 vs. 3.3 cm, p = 0.038). Additionally, necrosis was more frequently observed in the GISTs. Conclusions:For gastric submucosal protuberant lesions, a comprehensive EUS and CT imaging examination is necessary for accurate diagnosis to avoid misdiagnosis and inappropriate treatment, which may affect patient prognosis.
ObjectiveThe colonic sigmoid mucosal microbiome is reportedly different from the faecal microbiome in patients with cirrhosis. This exploratory study is aimed at comparing the luminal and mucosal microbiome in patients with cirrhosis, with a specific focus on the proximal intestine.MethodsMucosal and faecal samples were obtained from 12 patients with cirrhosis. The microbiome was quantified with V4 16S rRNA gene sequencing. Relative abundance, alpha and beta diversity were calculated, compared between the mucosal and faecal samples and correlated with stage of cirrhosis.ResultsFaecal samples displayed lower microbial diversity than mucosal samples (Shannon diversity, p = 0.025) and the microbiome profiles differed significantly: Operational taxonomic units primarily of the phyla Firmicutes and Actinobacteria were more abundant in faecal samples, whereas biopsy samples contained units spanning all six phyla. Microbial composition of faecal samples were more similar to faecal samples from other patients rather than to the individual ' s corresponding biopsy sample (principal coordinate analysis, p = 0.004). At the family level, Lachnospiraceae, Erysipelotrichaceae and Enterobacteriaceae were significantly more abundant in faecal samples, whereas biopsy samples contained more Streptococcaceae (p = 0.011) and Prevotellaceae (p = 0.031). Faecal samples from patients in Child-Pugh Stage C contained less Bacteroidetes but significantly more Streptococcaceae than Stage B samples (p = 0.04); however, biopsy samples did not differ significantly.ConclusionsThis exploratory study in a small sample of patients with cirrhosis observed significant differences in the microbial signature of faecal versus biopsy samples from the proximal intestine. Future studies are needed to further investigate the relationship between different gastrointestinal microbial sites and cirrhosis.
Background:We investigated the incidence, timing, risk factors and prognosis of delayed haemorrhage after endoscopic injection sclerotherapy (EIS) with lauromacrogol for internal haemorrhoids (IHs) using an inverted colonoscope without transparent caps. Methods:The clinical data of 252 patients undergoing EIS with lauromacrogol for IH using an inverted colonoscope without transparent caps were retrospectively analysed. Delayed haemorrhage was defined as bleeding occurring between 24 h and 1 month postoperatively. The incidence, timing and volume of delayed bleeding were recorded. Clinical risk factors were analysed, and patients were followed up for 2 years. Results:Delayed bleeding occurred in 17.5% (44/252) of patients, with a median onset of 2 (1-17) days. Among them, 97.7% (43/44) experienced < 20-mL bleeding within 9 days that resolved spontaneously; one patient developed 500-mL bleeding on postoperative Day 17. Multivariate logistic regression analysis showed that albumin < 40 g/L (odds ratio [OR]: 5.093; p < 0.001), triglycerides > 1.7 mmol/L (OR: 3.814, p < 0.001), Wexner Constipation Score ≥ 15 (OR: 5.340, p < 0.001) and > 4 injection sites (OR: 4.425, p = 0.005) were independent risk factors. The case of 500-mL bleeding may have resulted from an excessively deep injection and a high injection position. After 2 years, treatment effectiveness did not differ significantly between patients with and without delayed bleeding (p = 0.622). Conclusions:Delayed bleeding is a common complication after EIS with lauromacrogol for IHs using an inverted colonoscope without transparent caps. Most cases are small volume, early onset and self-limiting. Delayed bleeding does not affect long-term EIS efficacy. Risk factors include hypertriglyceridaemia, hypoproteinaemia, postoperative constipation and > 4 injection sites. As delayed massive bleeding may occur when injections are too deep or positioned too high, EIS should be performed cautiously. Adherence to guidelines, including the use of a transparent cap or forward-view endoscopy, is recommended.
Chinese herbal compound prescriptions have demonstrated efficacy in preventing and treating liver fibrosis (LF), though their mechanisms remained unclear. This study is aimed at identifying diagnostic biomarkers and elucidating the molecular mechanism underlying the effects of the TCM prescription on LF. LF-related datasets (GSE162694, GSE84044, and GSE136103) were obtained from a public database. Active ingredient-related target genes (AIRTGs) and LF-related target genes (LFRTGs) were intersected with differentially expressed genes (DEGs) between the LF and normal control (NC) group to select candidate genes. Subsequently, biomarkers for LF diagnosis were determined using Boruta and LASSO algorithms, receiver operating characteristic (ROC), and expression analyses. A nomogram was constructed to evaluate the capability of these biomarkers for predicting LF risk. Furthermore, GSEA and immunoinfiltration analysis were conducted, along with single-cell analysis to identify relevant cell types in LF. COL3A1 and ALOX5 were identified as diagnostic biomarkers for LF, and the nomogram was proven effective in predicting LF risk. GSEA showed that COL3A1 might play vital roles in cell growth and differentiation, extracellular matrix organization, and cell-matrix interactions. The functions of ALOX5 might be associated with cell-cell interaction, cytoskeletal regulation, and so forth. Immunoinfiltration analysis revealed that activated dendritic cells (DCs) were highly infiltrated, whereas monocytes were less infiltrated in LF. COL3A1 expression was positively correlated with monocytes, but both COL3A1 and ALOX5 showed negative correlations with activated DCs. Single-cell analysis identified nine cell types, with macrophages, B cells, and mesenchyme cells emerging as key cell types. Cell communication analysis demonstrated stronger interactions between macrophages and mesenchymal cells in the LF group. Pseudotime analysis unveiled that the expression of ALOX5 was upregulated and then downregulated, whereas that of COL3A1 was gradually downregulated during the midstage and stabilized thereafter. COL3A1 and ALOX5 may serve as biomarkers for the diagnosis and treatment of LF with Chinese herbal compound prescriptions, contributing to more accurate diagnosis and improved LF therapy.
Background and Aim:Azathioprine is one of the commonly used maintenance therapies in patients with inflammatory bowel disease (IBD), specifically in low- and middle-income countries. However, the use of thiopurines is questioned due to safety concerns. We aimed to assess the adverse event (AE) profile of azathioprine in IBD patients. Methods:This was a single-centre retrospective study. All the consecutive patients treated with azathioprine were considered for this study. Data were collected from prospectively maintained IBD files. The primary objective was to assess the adverse events arising due to azathioprine use. The AEs were defined as per standard definitions. The relation between the AE and dose and duration of azathioprine use was assessed. Results:Among 48 patients [UC: 20 (41.7%) and CD: 28 (58.3%)] included, 30 (62.5%) were male. The mean age and the disease duration were 41.2 ± 15.7 years and 15 (5-40.5) months, respectively. The initiation and maximum dose of azathioprine were 0.91 ± 0.15 and 2.04 ± 0.58 mg/kg. The median thiopurine treatment duration was 6.5 (2.25-15), 11.5 (3.5-23.5) and 5.75 (2-12.5) months, respectively, in the whole cohort, UC and CD. A total of 25 (52.1%) patients developed adverse events [8 (40.0%) in UC and 17 (60.7%) in CD]. The commonest AEs were leukopenia in 15 (31.2%), GI intolerance in 5 (10.4%), arthralgia in 4 (8.3%), hepatitis in 3 (6.2%) and hair fall in 2 (4.1%) patients. No infection or acute pancreatitis episode or malignancy was reported. A total of 16 (33.3%) patients stopped azathioprine. AEs were the most common cause of azathioprine withdrawal in 12 (25.0%). No serious adverse event was reported. Conclusion:Adverse events are common and lead to therapy discontinuation in one fourth of the IBD patients on azathioprine. The commonest adverse events are leukopenia, GI intolerance, arthralgia, hepatitis, and hair fall.
