BackgroundEarly identification of patients at risk for severe Acute Pancreatitis (AP) remains a critical clinical challenge. Although sarcopenia reflects nutritional status and physiological reserve, its predictive value for disease progression in AP remains unclear. This study aimed to evaluate the association between sarcopenia, quantified by the psoas muscle index (PMI), and progression to moderately severe or severe AP, and to develop a practical risk-stratification tool.MethodsWe retrospectively analyzed 470 patients with AP. Sarcopenic status was assessed by measuring the psoas major muscle area at the L3 level on admission CT scans. Multivariate Cox regression was employed to identify independent risk factors for progression to moderately severe or severe AP (MSAP/SAP). A predictive nomogram was constructed and validated using C-index, time-dependent ROC curves, and decision curve analysis (DCA).ResultsDecreased PMI and Albumin (Alb), alongside elevated Systemic Immune-Inflammation index (SII) and Alanine Aminotransferase (ALT), were independent predictors of disease progression. The nomogram demonstrated moderate discriminatory ability, with C-indices of 0.68 and 0.63 in the training and validation sets, respectively. The 7-day Area Under the Curve (AUC) reached 0.69 (training) and 0.65 (validation). Survival analysis demonstrated significantly higher progression rates in the high-risk group (P < 0.001), and DCA indicated a meaningful clinical net benefit.ConclusionSarcopenia, characterized by a low PMI, is an independent predictor of early progression to moderately severe or severe AP. The developed nomogram, integrating PMI with routine laboratory markers (SII, ALT, Alb), may serve as a potentially useful tool for early risk stratification and personalized management.

INTRODUCTION:In recent years, diet has gained increasing attention as a modifiable risk factor of inflammatory bowel disease (IBD). This study aimed to assess the potential impacts of global dietary changes on IBD prevalence. METHODS:Data on IBD from 1999 to 2021 were obtained from the Global Burden of Disease study for global and region-specific dietary patterns. To quantify temporal patterns and assess trends in age-standardized rates of IBD prevalence, incidence, mortality, and years lived with disability, we computed disability-adjusted life years (DALYs) and years of life lost over the study period. Joinpoint software was used to analyze the average annual percent change and corresponding 95% confidence intervals. R statistical package (version 4.3.2) was used for statistical analyses and plot illustrations. RESULTS:The incidence of IBD globally and in six different dietary regions has increased annually from 1999 to 2021. Among these regions, the Mediterranean and African regions had the lowest incidence, whereas regions with a Western diet exhibited a higher incidence. The most common age of onset is between 50 and 69 years, while the highest mortality rate was observed in individuals aged 70 and above. A minimal difference in incidence was observed between males and females; however, the mortality rate, prevalence, and DALYs were higher in males than in females both globally and across the six dietary regions. CONCLUSION:We elucidated how various dietary habits contribute to the onset and progression of IBD and highlight future research directions in this evolving field.

Obesity is a chronic, multifactorial disease closely linked to a spectrum of cardiometabolic disorders, with its global prevalence rising at an alarming rate. In recent years, minimally invasive, safe, and effective endoscopic bariatric therapies have gained significant attention as alternatives to conventional surgical interventions. This review provides a comprehensive overview of various endoscopic weight-loss procedures, evaluating their advantages and limitations in comparison to surgical approaches to assist clinicians in optimizing patient-specific treatment strategies. Endoscopic bariatric therapies, including intragastric balloons, duodenal-jejunal bypass sleeves, endoscopic sleeve gastroplasty, gastric remodeling procedures, and interventions aimed at delaying gastric emptying are systematically reviewed. The efficacy, safety profiles, and clinical applicability are all synthesized. Endoscopic bariatric therapies exhibit distinct advantages and limitations, with varying indications and contraindications. As part of a multidisciplinary approach to obesity management, these procedures should be integrated with lifestyle modifications and nutritional counseling to maximize therapeutic benefits. Future research should focus on the long-term efficacy, safety, and patient-reported outcomes to refine clinical practice and optimize the role of endoscopic interventions in obesity treatment.

Digestive endoscopy has been widely used in the diagnosis and treatment of digestive diseases. However, the anatomical complexity of specific lesions increases the difficulty of these operations, resulting in complications or treatment failure. Although various strategies, such as floss traction and the application of transparent caps, have been explored, their effectiveness remains limited due to individual differences in patients' anatomical characteristics. The multibending (MB) endoscope represents a significant innovation as it is a conventional endoscope with an additional bending section and dual channels. Currently, this technology has been applied in gastroscopy, duodenoscopy and peroral cholangioscopy. The bending part of the endoscope facilitates its passage into difficult-to-reach anatomical regions and improves operating angles, thereby enhancing surgical precision and efficiency while reducing complication rates. Furthermore, the dual-channel design accelerates procedural workflows and increases operational versatility. This innovation is poised to transform endoscopic diagnosis and treatment of digestive system diseases. Since the MB endoscope is relatively new, further research is needed to comprehensively explore its benefits for and potential in endoscopic diagnosis and treatment. The aim of this review is to summarize the current research, indications, and future directions of MB endoscope.

Endoscopic submucosal dissection (ESD) is an effective treatment with minimal invasiveness for early gastric cancer (EGC). However, cases undergoing non-curative resection (NCR) may still undergo additional surgical procedures. We aimed to analyze the features of NCR under white light imaging (WLI), and develop a prediction model to assess the risk of NCR before ESD. We retrospectively collected and analyzed WLI and clinicopathological features of 568 EGC patients undergoing ESD between March 2016 and March 2024. A nomogram was developed on 455 patients from the training set after subgroup difference analysis. 91 out of 568 (16.0%) cases had NCR. WLI features including remarkable redness, ulceration, fold convergence, marginal elevation, whitish mucosal change, larger lesions, and Helicobacter pylori (Hp) infection were associated with independent risk factors for NCR. The nomogram based on these features showed good predictive value for NCR, with an area under the curve (AUC) of 0.8095 (95% CI: 0.7538-0.8651) in the training set and 0.7567 (95% CI: 0.6427-0.8707) in the validation set. We developed a nomogram incorporating WLI features that exhibits good predictive performance and could potentially assist in selecting optimal treatment strategies for EGC.

The clinical course and manifestations of subepithelial lesions (SEL) patients tend to vary from different pathological types, therefore the accurate diagnosis of SEL would undoubtedly be beneficial to the treatment and prognosis of SEL patients. Based on the decision tree method, we developed a novel classification model for SELs by combining endoscopy with endoscopic ultrasound (EUS). We retrospectively collected data from 469 patients hospitalized in the Affiliated Hospital of Qingdao University between January 2017 to November 2021 for endoscopic resection. Chi-square test (P < 0.05), independence test (P < 0.001), and Pearson correlation analysis (|r|<0.8) were performed to identify significant variables among endoscopic and EUS features, which were subsequently incorporated into decision tree analysis. Finally, a hierarchical diagnostic model based on multiple decision trees was constructed. The predictive performance of the model was obtained through a five-fold cross-validation, and each decision tree model was evaluated by the area under the curve (AUC) and F1. A total of 13 variables were included in the construction of the model. The overall accuracy of this hierarchical model was 75.12

BACKGROUND:Inflammatory bowel disease (IBD) encompasses Crohn's disease (CD) and ulcerative colitis (UC) and represents a heterogeneous spectrum of chronic intestinal inflammation with no exclusive etiology. Emerging evidence underscores that IBD arises from complex interactions between host factors and microbial communities. The disruption of microbial homeostasis facilitates the colonization and invasion of opportunistic pathogens within the gut, precipitating an exaggerated host immune response and driving disease progression. While extensive research has elucidated the role of the gut microbiota in IBD pathogenesis, the contribution of the oral microbiota to this process is garnering increasing attention. Oral microbes can translocate to the intestine via the swallowing of saliva, and harmful oral bacteria and proinflammatory immune cells from the oral mucosa may migrate to the gut, eliciting immune activation. This review explores the emerging role of the oral microbiota in IBD pathogenesis and synthesizes recent advancements in understanding the intricate relationship between oral microbial communities and IBD.

Background:Pancreatic lymphoma is a rare pancreatic malignancy that is challenging to differentiate from diseases such as pancreatic cancer (PC). Although pathological examination of specimens obtained through surgery or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) can aid in diagnosis, factors such as the occasional need for surgery and the variability in specimen quality from EUS-FNA complicate the diagnostic process. Misdiagnosis of pancreatic lymphoma as PC often leads to unnecessary surgery. In addition, surgical intervention may be necessary as a second-line treatment option for pancreatic lymphoma patients presenting with severe gastrointestinal symptoms. However, an optimal postoperative treatment strategy remains undefined, particularly in cases with extensive invasion, thereby impacting long-term survival. This lack of consensus underscores the need for further research to establish evidence-based therapeutic protocols. Case Description:We present the case of a 55-year-old patient (abdominal pain for over one month, intensified for two weeks). Imaging studies suggested a hypodense mass in the tail of the pancreas with ill-defined margins extending to the spleen, as well as a hypodense lesion within the spleen. The patient underwent surgical intervention, and postoperative pathological analysis confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). Following surgery, the patient was initially treated with a short-term C2PET oral chemotherapy regimen, which was subsequently transitioned to the R-CHOP regimen. This therapeutic approach resulted in a favorable outcome, with the patient achieving a 5-year survival period. As far as we know, this may be the first reported case of pancreatic lymphoma with such a widespread involvement, in which patient underwent surgery and postoperative chemotherapy and obtained a 5-year survival period. Literature Review:We reviewed previously reported cases of the DLBCL pancreatic lymphoma located in the body and tail of pancreas, and conducted a comparative analysis. Purposes and Clinical Relevance:Our objectives are twofold: first, to highlight the critical role of preoperative EUS-FNA and positron emission tomography-computed tomography in the diagnostic evaluation for patients with pancreatic mass and suspected lesions in immune-associated organs; and second, to propose evidence-based recommendations for postoperative chemotherapy in cases of DLBCL involving the pancreas.

Endoscopic procedures and surgery are common treatments for early colorectal cancer (CRC). However, only approximately 10

Colorectal cancer (CRC) is identified as a primary cause of death around the world. The current chemotherapies are not cost-effective. Therefore, finding novel potential therapeutic target is urgent. Titin (TTN) is a muscle protein that is critical in hypertrophic cardiomyopathy. However, its role in CRC is not well understood. The study focused on exploring the possible role of TTN in CRC carcinogenesis. TTN mRNA and protein expression levels presented an obvious downregulation in CRC tissue samples, relative to normal control (p < 0.05). TTN expression significantly correlated with the clinical stage (normal vs. Stage 1, p < 0.05; normal vs. Stage 4, p < 0.05), node metastasis (normal vs. N1, p < 0.05; N1 vs. N2, p < 0.05), histological type (normal vs. adenocarcinoma, p < 0.05), race (Caucasian vs. Asian, p < 0.05; African-American vs. Asian, p < 0.05) and TP53 mutation (normal vs. TP53 mutation, p < 0.05), considering The Cancer Genome Atlas database. However, for patients who had higher TTN expression, the overall survival was remarkably shorter than patients who had low TTN expression. Furthermore, TTN was lowly expressed in four CRC cell lines. TTN overexpression facilitated CRC cells in terms of the proliferation, metastasis and invasion. Based on gene set enrichment analysis, the ERB pathway might be responsible for TTN-related CRC. Besides, TTN was involved in the response to azacitidine. Overall, TTN might serve as a potential novel therapeutic target for treating and overcoming chemotherapy resistance in CRC.

Supplementary Figure 1, related to Figure 1. Clinical relevance of lncRNA candidate BC041951 in gastric cancer. Supplementary Figure 2, related to Figure 2. Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA) in gastric cancer cells and gastric cancer patients with high and low GClnc1 expression. Supplementary Figure 3, related to Figure 3. GClnc1 is an oncogenic lncRNA in gastric cancer. Supplementary Figure 4, related to Figure 4. GClnc1 interacts with WDR5 and KAT2A epigenetic modification complex. Supplementary Figure 5, related to Figure 5. GClnc1 coordinates the localization of WDR5 and KAT2A genome-wide. Supplementary Figure 6, related to Figure 6. GClnc1 promotes gastric cancer progression via SOD2. Supplementary Figure 7, related to Figure 7. GClnc1 is a molecular link among WDR5/KAT2A and SOD2.

Pancreatic cancer remains one of the most lethal diseases worldwide owing to its late diagnosis, early metastasis, and poor prognosis. Because current therapeutic options are limited, there is an urgent need to investigate novel targeted treatment strategies. Pancreatic cancer faces significant metabolic challenges, principally hypoxia and nutrient deprivation, due to specific microenvironmental constraints, including an extensive desmoplastic stromal reaction. Pancreatic cancer cells have been shown to rewire their metabolism and energy production networks to support rapid survival and proliferation. Increased glucose uptake and glycolytic pathway activity during this process have been extensively described. However, growing evidence suggests that pancreatic cancer cells are glutamine addicted. As a nitrogen source, glutamine directly (or indirectly via glutamate conversion) contributes to many anabolic processes in pancreatic cancer, including amino acids, nucleobases, and hexosamine biosynthesis. It also plays an important role in redox homeostasis, and when converted to α-ketoglutarate, glutamine serves as an energy and anaplerotic carbon source, replenishing the tricarboxylic acid cycle intermediates. The present study aims to provide a comprehensive overview of glutamine metabolic reprogramming in pancreatic cancer, focusing on potential therapeutic approaches targeting glutamine metabolism in pancreatic cancer.

Background and purposeAlthough endoscopic submucosal dissection (ESD) is considered standard treatment for early gastric cancer (EGC), patients with non-curative resection (NCR) of ESD may still require gastrectomy. The systemic immune-inflammation index (SII) showed great potential in predicting the prognosis of gastric cancer patients. This study aims to investigate the predictive validity of SII of NCR in EGC patients. MethodsWe reviewed data from EGC patients who underwent ESD in the past. The relationship between SII and clinicopathologic features was investigated. We used Receiver operating characteristic curves to compare the predictive values of NCR between SII and other inflammation indices. Binary logistic analysis was used to identify independent risk factors for NCR. These factors were then used to construct a predictive nomogram. ResultsSII was associated with larger tumor size, male gender, older age, submucosal invasion, and a greater risk of NCR. SII showed better predictivity of NCR than platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). SII [odds ratio (OR) = 1.003, P = 0.001], NLR (OR = 1.520, P = 0.029), PLR (OR = 1.009, P = 0.010), upper stomach tumors (OR = 16.393, P < 0.001), poorly differentiated type (OR = 29.754, P < 0.001), ulceration (OR = 4.814, P = 0.001), and submucosal invasion (OR = 48.91, P < 0.001) were independent risk factors for NCR. The nomogram model based on these factors exhibited superior concordance and accuracy. ConclusionSII could be considered a simple and effective predictor of NCR of ESD in EGC patients.

Supplementary Table S4. Proteins identified by mass spectrometry from the TMEFF2 co-immunoprecipitate sample.

Supplementary Table 6. A, ChIP-Seq Library Statistics. B, ChIP-Seq Library Peak Calls. C, WDR5 and KAT2A peaks within 2kb of RefSeq gene promoters where read coverage were significant decreased in BGC823 GC cells after transduction of GClnc1 shRNA virus,compared with transduction of control shRNA virus. D, the differentiated expression genes in BGC823 cells after downregulation of GClnc1. E, Intersection of ChIP-Seq and RNA seq data. Supplementary Table 7. The association between GClnc1 with target genes in the coexpression network analysis.

PDF - 69K, MiRNA microarray analysis.

Supplementary Table 5. Proteins in the two distict bands specific to GClnc1 identified by Liquid Chromatography-Mass Spectrometry.

This file contains figure legends corresponding to supplementary figures.

Supplementary Figure S1. Identification of TMEFF2 as a key regulator in gastric cancer progression and the expression of TMEFF2 decreased in gastric carcinogenesis. Supplementary Figure S2. Gene Set Enrichment Analysis (GSEA) in TMEFF2-higher/lower expression patients. Supplementary Figure S3. The mRNA levels of the top-score tumorigenesis genes were measured in gastric cells after transfection of TMEFF2 overexpression plasmid or siRNA Supplementary Figure S4. Functional impact of TMEFF2 Supplementary Figure S5. Cell proliferation assays were performed in MKN45 cells after overexpression of SHP-1WT/ΔSH2D1/ΔSH2D2/ΔPTPD or these constructs combined with TMEFF2. n = 3, non-parametric Mann-Whitney test. Supplementary Figure S6. Correlation of TMEFF2 and SHP-1 expression in human GC.