Abstract. Recent advances in biomedical research have facilitated the exploration of biomimetic materials and their potential for diagnosing and treating diseases. This review synthesizes reports of recent research into biomimetic materials and provides a focused analysis of their therapeutic and diagnostic efficacy across multiple physiological systems, including the locomotor, digestive, respiratory, urinary, endocrine, nervous, integumentary, hematopoietic, and circulatory systems. These findings highlight the transformative potential of these materials in the management of systemic diseases. They also reveal the challenges associated with material optimization, clinical translation, and future research. These challenges highlight the unresolved hurdles and largely untapped opportunities.

OBJECTIVES:Type I Helicobacter pylori (H. pylori) strains exhibit high levels of virulence. In this study, a rapid, visual self-testing kit for H. pylori typing using one drop of finger blood was developed based on the latex agglutination test (LAT). A prospective multicentre diagnostic accuracy study (ChiCTR2400082329) was conducted to evaluate its performance. METHODS:Each participant recruited from the Department of Gastroenterology or the Physical Examination Centre of four centres performed the novel LAT and interpreted the results independently. The performance of the novel LAT for H. pylori typing in screening population (individuals voluntarily undergoing H. pylori infection screening, regardless of the presence of gastrointestinal symptoms) was evaluated using the consistent results of the 13C-urea breath test, quantum dot-based immunofluorescence assay, and immunoblotting assay conducted by professionals as the reference standard. This strict reference standard was adopted to ensure diagnostic accuracy for both active infection and strain typing. RESULTS:A total of 1330 participants with consistent diagnostic data (13C-urea breath test, quantum dot-based immunofluorescence, and immunoblotting assay) were included in the final analysis. Compared with the reference standard, the novel LAT achieved a sensitivity, specificity, and accuracy of 93.63% (95% CI, 88.28-96.73%), 97.86% (95% CI, 96.82-98.59%), and 97.37% (95% CI, 96.32-98.13%), respectively in identifying type I H. pylori infection. CONCLUSIONS:The novel LAT developed in this study can potentially be used for the identification of type I H. pylori infection in home self-screening and large-scale population screening.

Limited immune cell infiltration is the main reason for poor immunotherapeutic efficacy in colorectal cancer patients. Here we design a peptide-based nanorobot that recognizes PD-L1 and breaks cancer cell membranes by in situ forming fibrils through a pH-responsive module. The nanorobot shows long retention in targeted tumours (>120 h) through interaction with PD-L1 and blocks PD-1/PD-L1 to activate the T cell killing effect. At the same time, in the tumour microenvironment (pH 6.5), it forms fibrils that break the cancer cell membrane, inducing immunogenic cell death with the release of damage-associated molecular patterns and the subsequent infiltration of T cells. The nanorobot shows higher therapeutic efficacy than the regimen of αPD-L1+oxaliplatin in a variety of colorectal-cancer-tumour-bearing mouse models and has good biocompatibility due to the targeted breakage of cancer cells, exhibiting great potential for colorectal cancer immunotherapy in clinic.

PURPOSE:Endoscopic submucosal dissection (ESD) is currently one of the most curative treatments for early esophageal cancer. We conducted a retrospective case analysis to identify the characteristics of early esophageal cancer that indicate esophageal stenosis prevention measures. Our aim was to provide a reference for clinical decision-making. METHODS:Six hundred and fifty-four patients with early esophageal cancer treated with ESD were admitted to our hospital between January 2011 and December 2018.Clinical information such as patients' demographic characteristics, lesion features, preventive measures if any, and complications of esophageal stenosis after ESD were collected from the hospital information system. The data were statistically analysed by SPSS software (version 23.0). RESULTS:1. Seventy-nine patients with early esophageal cancer suffered from esophageal stenosis after ESD. The median time from undergoing ESD to the first occurrence of stenosis was 27 (17-43) days. Specifically, among the 79 cases, 47 of them experienced stenosis within one month after ESD, and 23 cases experienced stenosis between 1 and 2 months after ESD, and 9 cases experienced stenosis more than 2 months after the operation.2. Taking preventive measures significantly reduced overall esophageal stenosis incidence in patients with early esophageal cancer with lesion circumferential ratio of 75%-99% (P < 0.05).3. Among patients with early esophageal cancer with 75%-99% circumferential proportion of lesions, the risk of esophageal stenosis within 2 months without prevention measures was 2.617(95% CI, 1.057-6.479) times higher than that with prevention measures. CONCLUSION:It is necessary to take measures to prevent esophageal stenosis after ESD for early esophageal cancer lesions with a circumferential ratio of 75%-99%.

Helicobacter pylori (H. pylori) infection remains a major challenge in gastric disease treatment, with conventional antibiotic therapies hindered by poor gastric retention, lack of specificity, and the growing threat of bacterial resistance. To address these limitations, we introduce a novel bioengineered robotic system inspired by icebreakers, integrating multi-functional nanomaterials for targeted, autonomous, and efficient H. pylori eradication. Our micro-robots combine a platinum nanozyme-based calcium carbonate complex with chitosan (Cs) modification, gastric epithelial cell membranes (CM) coating, and pronase (P) incorporation, enabling selective targeting and autonomous motility. Upon gastric acid exposure, this system undergoes controlled decomposition, generating carbon dioxide to propel movement, releasing pronase to penetrate and degrade mucus barriers, and deploying Pt nanozymes for deep bacterial eradication. This multi-modal mechanism significantly enhances gastric retention, precision targeting, and therapeutic effectiveness. Our in vitro and in vivo studies validate its superior antibacterial activity, biocompatibility, and its unprecedented ability to mitigate H. pylori-induced inflammation while preserving intestinal microbiota balance. By combining bioengineering, nanotechnology, and autonomous propulsion, this innovation represents a paradigm shift in H. pylori therapy, offering a precise, efficient, and resistance-mitigating alternative to conventional treatments.

Electrocoagulation with an electrosurgical knife is the traditional approach to achieve haemostasis during endoscopic submucosal dissection (ESD), as bleeding may obscure the operative field and increase the risks of muscle injury and perforation. The aim of this study was to assess the efficacy and safety of the sequential injection-electrocoagulation procedure during ESD. In this randomized controlled trial, 69 patients undergoing upper gastrointestinal ESD were randomized to either the control group (traditional electrocoagulation) or the experimental group (“Sequential injection-electrocoagulation” method) from September 2023 to June 2024. Two endoscopists scored the visibility of each bleeding point from 1 (undetectable) to 4 (easily detectable). The median time to haemostasis at each bleeding point was 17 (11–23) seconds in the experimental group and 22 (14.5–41) seconds in the control group (P < 0.001). The visibility scores were significantly higher in the experimental group than in the control group (3.24 ± 0.63 vs. 2.82 ± 0.57) (P < 0.001). Muscle injuries occurred more frequently in the control group (P = 0.003). Unfortunately, there was one case of perforation in the control group caused by haemostasis. The sequential injection-electrocoagulation strategy shortened the time to hemostasis during ESD, improved the visibility of bleeding points, and minimized the risks of muscle injury and perforation.

Gastrointestinal bleeding (GIB) is a critical condition that requires rapid and effective intervention. Although thrombin is a widely used hemostatic agent, its efficacy is limited in the harsh environment of the digestive tract, especially in patients with chronic liver disease or coagulation disorders. Current treatment techniques often fall short, particularly when faced with severe blood loss and coagulation challenges. Here, a novel solution: waxberry-inspired smart nanogels that offer a cost-effective, highly efficient, and mechanically stable approach for local hemostasis is presented. Drawing inspiration from the microfibrous structures of waxberry, a waxberry-like nano-silica with a radially fibrous structure is synthesized for effective thrombin loading and release upon emergency. This nano-silica, coated with GelMA, forms a stable nanogel network activated by blue laser during endoscopy. Within just 5 s, the nanogel effectively triggers coagulation, even in patients with coagulation disorders. The formed blood clots are stable enough to withstand the challenging conditions of the digestive tract, preventing secondary bleeding. Upon injection, thrombin rapidly converts fibrinogen to fibrin, creating a secondary network that reinforces clot stability. This dual-network system demonstrates strong adhesive properties and effective hemostasis in the blood of cirrhotic patients, as well as in gastrointestinal bleeding scenarios involving the esophagus, stomach, and duodenum of mini-pigs.

The cGAS‐STING signaling pathway effectively activates antitumor immune responses and holds promise for overcoming drug resistance in hepatocellular carcinoma (HCC) immunotherapy. However, achieving specific activation of this pathway in HCC remains challenging. Here, it is introduced a single‐metal‐doped nanoplatform, ZMRPF, which leverages ferroptosis‐induced mitochondrial DNA (mtDNA) release to stimulate cGAS‐STING‐mediated immune activation. ZMRPF initiates HCC ferroptosis by inducing high levels of lipid reactive oxygen species, leading to mitochondrial stress and the release of endogenous mtDNA. This mtDNA synergistically activates the cGAS‐STING pathway, enhanced by immunoactivating Mn 2 ⁺ ions released from ZMRPF. Concurrently, the tumor antigens released during ferroptosis amplify the activity of antigen‐presenting cells, creating a cascade that links ferroptosis with innate immunity. This cascade drives a robust systemic antitumor immune response, effectively reversing the immunosuppressive microenvironment of HCC. These results demonstrate the ability of ZMRPF to reshape the immune microenvironment of HCC and offer a promising strategy for next‐generation tumor immunotherapy.

Background and AimsGiant esophageal leiomyoma usually requires a thoracotomy or thoracoscopic surgery, which is more invasive than an endoscopic treatment. The purpose of this study is to evaluate the efficacy and safety of piecemeal submucosal tunneling endoscopic resection (P-STER) for giant leiomyoma originating from the muscularis propria (MP) layer of the esophagus.MethodsThis is a retrospective study. Patients with giant esophageal leiomyoma (transverse diameter ≥ 3 cm) who underwent P-STER were enrolled from November 2012 to May 2023. Clinical data and results were investigated.ResultsA total of 16 patients were enrolled for analysis. The lesion mean transverse diameter and longitudinal diameter were 4.22 ± 1.20 cm and 6.20 ± 1.57 cm, respectively. Our mean operation time was 195.38 ± 84.99 min. The mean number of piecemeal resected was 4.31 ± 2.36. An adverse event noted was an esophageal fistula that occurred in one case (6.25%) and was treated conservatively. The mean length of hospital stay was around 11.81 ± 7.30 days. The mean total hospitalization cost was U.S. dollars (USD) $5976.50 ± 2866.39. No recurrence or metastasis was found during the follow-up period.ConclusionsP-STER can be an effective and safe treatment for giant leiomyoma originating from the MP layer of the esophagus.

ObjectivesEndoscopic necrosectomy (EN) is a promising minimally invasive approach for treating infected walled‐off pancreatic necrosis (WOPN). Multiple EN approaches are currently available, though criteria for selecting the optimal approaches are lacking. We aimed to propose a rational selection strategy of EN and to retrospectively evaluate its safety and effectiveness.MethodsAltogether 101 patients who underwent EN for infected WOPN at a tertiary hospital between June 2009 and February 2023 were retrospectively included for analysis. Demographic characteristics, details of the EN procedures, procedure‐related adverse events, and clinical outcomes were investigated.ResultsAmong these 101 patients with WOPN, 56 (55.4%) underwent transluminal EN, 38 (37.6%) underwent percutaneous EN, and seven (6.9%) underwent combined approach, respectively. Clinical success was achieved in 94 (93.1%) patients. Seven (6.9%) experienced procedure‐related adverse events, and seven (6.9%) died during the treatment period. During a median follow‐up of 50 months, 5 (5.3%) of the 94 patients had disease recurrence, 17.0% (16/94) had new‐onset diabetes mellitus, and 6.4% (6/94) needed oral pancreatic enzyme supplementation. The clinical success rate, procedure‐related adverse event rate, and long‐term follow‐up outcomes were not significantly different among the three groups. High APACHE‐II scores (≥15) and organ failure were identified as factors related to treatment failure.ConclusionsA selection strategy for EN approaches, based on the extent of necrosis and its distance from the gastrointestinal lumen (using a threshold of 15 mm), is safe and effective for treating infected WOPN in both short‐term and long‐term outcomes.

Nature presents the most beautiful patterns through evolving. Here, a layered porous pattern in golden ratio (0.618) is reported from a type of mushroom -Dictyophora Rubrovalvata stipe (DRS). The hierarchical structure shows a mathematical correlation with the golden ratio. This unique structure leads to superior mechanical properties. The gradient porous structure from outside to innermost endows it with asymmetrical hydrophilicity. A mathematical model is then developed to predict and apply to 3D printed structures. The mushroom is then explored to repair gastric perforation because the stomach is a continuous peristaltic organ, and the perforated site is subject to repeated mechanical movements and pressure changes. At present, endoscopic clipping is ineffective in treating ulcerative perforation with fragile surrounding tissues. Although endoscopic implant occlusion provides a new direction for the treatment of gastric ulcers, but the metal or plastic occluder needs to be removed, requiring a second intervention. Decellularized DRS (DDRS) is found with asymmetric water absorption rate, super-compressive elasticity, shape memory, and biocompatibility, making it a suitable occluder for the gastric perforation. The efficacy in blocking gastric perforation and promoting healing is confirmed by endoscopic observation and tissue analysis during a 2-month study.

BACKGROUND AND AIMS:Despite the benefits of artificial intelligence in small-bowel (SB) capsule endoscopy (CE) image reading, information on its application in the stomach and SB CE is lacking. METHODS:In this multicenter, retrospective diagnostic study, gastric imaging data were added to the deep learning-based SmartScan (SS), which has been described previously. A total of 1069 magnetically controlled GI CE examinations (comprising 2,672,542 gastric images) were used in the training phase for recognizing gastric pathologies, producing a new artificial intelligence algorithm named SS Plus. A total of 342 fully automated, magnetically controlled CE examinations were included in the validation phase. The performance of both senior and junior endoscopists with both the SS Plus-assisted reading (SSP-AR) and conventional reading (CR) modes was assessed. RESULTS:SS Plus was designed to recognize 5 types of gastric lesions and 17 types of SB lesions. SS Plus reduced the number of CE images required for review to 873.90 (median, 1000; interquartile range [IQR], 814.50-1000) versus 44,322.73 (median, 42,393; IQR, 31,722.75-54,971.25) for CR. Furthermore, with SSP-AR, endoscopists took 9.54 minutes (median, 8.51; IQR, 6.05-13.13) to complete the CE video reading. In the 342 CE videos, SS Plus identified 411 gastric and 422 SB lesions, whereas 400 gastric and 368 intestinal lesions were detected with CR. Moreover, junior endoscopists remarkably improved their CE image reading ability with SSP-AR. CONCLUSIONS:Our study shows that the newly upgraded deep learning-based algorithm SS Plus can detect GI lesions and help improve the diagnostic performance of junior endoscopists in interpreting CE videos.

In an emergency, nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic hemostasis is considered the gold standard intervention. However, current endoscopic hemostasis is very challenging to manage bleeding in large-diameter or deep lesions highly prone to rebleeding risk. Herein, a novel hemostatic peptide hydrogel (HPH) is reported, consisting of a self-assembly peptide sequence CFLIVIGSIIVPGDGVPGDG (PFV) and gelatin methacryloyl (GelMA), which can be triggered by blue laser endoscopy (BLE) for nonvariceal upper gastrointestinal bleeding treatment without recurring bleeding concerns. Upon contact with GelMA solution, PFV immediately fibrillates into β-sheet nanofiber and solvent-induced self-assembly to form HPH gel. HPH nanofiber networks induced ultrafast coagulation by enveloping blood cells and activating platelets and coagulation factors even to the blood with coagulopathy. Besides its remarkable hemostatic performance in artery and liver injury models, HPH achieves instant bleeding management in porcine NVUGIB models within 60 s by preventing the rebleeding risk. This work demonstrates an extraordinary hemostatic agent for NVUGIB intervention by BLE for the first time, broadening potential application scenarios, including patients with coagulopathy and promising clinical prospects.

Arrest of bleeding usually applies clotting agents to trigger coagulation procedures or adhesives to interrupt blood flow through sealing the vessel; however, the efficiency is compromised. Here, we propose a concept of integration of hemostasis and adhesion via yam mucus's microgels. The mucus microgels exhibit attractive attributes of hydrogel with uniform size and shape. Their shear-thinning, self-healing and strong adhesion make them feasible as injectable bioadhesion. Exceptionally, the blood can trigger the microgels' gelation with the outcome of super extensibility, which leads to the microgels a strong hemostatic agent. We also found a tight gel adhesive layer formed upon microgels' contacting the blood on the tissue, where there is the coagulation factor XIII triggered to form a dense three-dimensional fibrin meshwork. The generated structures show that the microgels look like hard balls in the dispersed phase into the blood-produced fibrin mesh of a soft net phase. Both phases work together for a super-extension gel. We demonstrated the microgels' fast adhesion and hemostasis in the livers and hearts of rabbits and mini pigs. The microgels also promoted wound healing with good biocompatibility and biodegradability.