This study aims to assess the association between the Dietary Index for Gut Microbiota (DI-GM) and sarcopenic obesity (SO) in middle-aged and elderly populations, and to evaluate whether the Hepatic Steatosis Index (HSI) acts as the mediation in this relationship. A cross-sectional analysis was conducted on 3746 participants from the National Health and Nutrition Examination Survey (NHANES) database from 2011 to 2018. Weighted multivariate linear and logistic regression models were used to explore the association between DI-GM and the prevalence of SO, DI-GM and HSI, and HSI and the prevalence of SO. Restricted cubic spline (RCS) analysis was used to assess the potential nonlinear relationship between DI-GM and SO. Subgroup analyses were performed to evaluate the consistency of this relationship across different demographic groups. Additionally, mediation analysis was conducted to explore whether there existed a potential association between DI-GM, HSI, and SO. Among the 3746 participants included in the study, 369 (9.8%) were diagnosed with SO. After adjusting for all covariates by weighted multivariate logistic regression, each unit increase in DI-GM was associated with a 15% decrease in the prevalence of SO [Model 3: OR = 0.85, 95% CI (0.76, 0.95), p = 0.006]. When DI-GM was categorized into quartiles, the results remained significant [Model 3: OR = 0.47, 95% CI (0.30, 0.75), p = 0.002]. Further analysis indicated that the protective effect of DI-GM was primarily attributed to the Beneficial gut microbiota score (BGMS). RCS analysis revealed a significant linear relationship between DI-GM and SO (p > 0.05). Subgroup analysis demonstrated the robustness of this association across various subgroups. Mediation analysis showed that 17.8% of the association between DI-GM and SO was mediated by HSI (p < 0.05). DI-GM is significantly inversely associated with the prevalence of SO in the aging population, and HSI partially mediates this association.

This letter comments on the retrospective cohort study by Liu et al , which evaluates the integration of traditional Chinese medicine (TCM) with conventional seton-based surgery for complex anal fistulas. The study reports a 90.0% success rate in the TCM-integrated group vs 78.8% in the conventional group, with a mean healing time reduced from 28.3 days to 21.5 days and recurrence rates of 5.0% vs 15.0%. These outcomes highlight the potential of TCM modalities - such as herbal decoctions and fumigation - to complement surgical management by addressing inflammation, pain, and tissue regeneration. While the retrospective design and single-center setting warrant cautious interpretation, this work provides a valuable foundation for future randomized trials and underscores the importance of personalized, integrative approaches in colorectal surgery. Further research should focus on standardizing TCM protocols and elucidating the underlying mechanisms of its efficacy.

Breast cancer remains a leading cause of cancer-related mortality in women worldwide. Metabolic reprogramming, especially enhanced glycolysis, is a hallmark of breast cancer progression and offers promising targets for therapeutic intervention. However, systematic identification of glycolysis-related gene markers at single-cell resolution remains limited.We integrated single-cell RNA sequencing, spatial transcriptomics, and multiple machine learning algorithms to analyze glycolytic heterogeneity in breast cancer. A novel interquartile range (IQR)-based scoring method was developed to quantify glycolytic activity at the single-cell level. Glycolysis-related genes (GRGs) were systematically screened using five machine learning models (RF, Boruta, Lasso, ABESS, and GBM), and their diagnostic and prognostic values were evaluated.We identified significant glycolytic heterogeneity among breast cancer cell subsets, with malignant cells exhibiting the highest glycolytic activity. Seven hub genes, namely PKM, MIF, SOD1, PGK1, APP, LDHB and NUPR1, were consistently identified and validated. These genes showed strong diagnostic potential with high AUC values in ROC analysis, and their elevated expression was confirmed in breast cancer tissues via immunohistochemistry. Spatial and cell communication analyses further revealed distinct metabolic niches and intercellular signaling networks associated with high-glycolytic cells.This study establishes a robust IQR-based glycolysis assessment strategy that overcomes limitations of previous scoring methods. We identified seven core glycolytic regulatory genes that are closely linked to breast cancer progression and poor prognosis. These findings provide novel insights into metabolic reprogramming in breast cancer and offer potential biomarkers for targeted metabolic therapy.

BACKGROUND:The efficacy of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in the treatment of nonalcoholic fatty liver disease (NAFLD) has not been fully elucidated. OBJECTIVES:The purpose of this systematic review and meta-analysis is to provide reliable evidence for clinical interpretation of the advantages and disadvantages of RYGB and SG in the treatment of NAFLD by directly comparing the efficacy of RYGB and SG in the treatment of NAFLD. SETTING:All over the world. METHODS:PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched for relevant articles up to December 2025. Mean difference (MD) and 95% confidence interval (CI) were used for quantitative synthesis of continuous variables, and risk ratio and 95% CI were used for quantitative analysis of categorical variables. The primary outcomes of the study were changes in NAFLD activity score (NAS), fibrosis stage, and changes in liver enzymes (including alanine aminotransferase and aspartate aminotransferase) from initial to follow-up. Secondary outcomes included changes in body weight, body mass index, percentage total weight loss, and percentage excess weight loss. RESULTS:A total of 16 original studies were included in our final meta-analysis. Our primary analysis showed no significant overall difference between SG and RYGB in improving NAS (MD = .23, 95% CI: .69-1.16). Exploratory subgroup analyses suggested potential time-dependent patterns, although these varied by outcome: longer-term follow-up (> 1 year) was associated with a point estimate favoring RYGB for NAS (MD = .75, 95% CI: .03-1.47), but favoring SG for alanine aminotransferase reduction (MD = -5.92, 95% CI: -8.24 to 3.60). No significant between-group difference was observed for aspartate aminotransferase changes (P = .18), and RYGB was associated with greater weight loss. Given the exploratory nature of these subgroup analyses, these findings should be interpreted cautiously and considered hypothesis-generating. Metaregression analysis revealed that the difference in weight loss between procedures was significantly associated with the effect size for NAS improvement (β = -.11, 95% CI: -.21 to .01, P = .032) and accounted for 100% of the between-study heterogeneity (R2 = 100%). CONCLUSIONS:Although our primary analysis showed no significant overall difference between SG and RYGB in improving NAS, RYGB was associated with greater weight loss. Metaregression findings suggested that any potential histological advantage of RYGB may be largely attributable to its superior weight loss efficacy rather than to weight-independent mechanisms. Exploratory subgroup analyses suggested potential differences in long-term histological outcomes that varied across measures and should be considered hypothesis-generating. These findings warrant confirmation in future prospective studies.

Currently, the standard third-line treatment options for advanced metastatic colorectal cancer (mCRC) include regorafenib, fruquintinib, and trifluridine/tipiracil (TAS-102), but these drugs have limited clinical efficacy. This study aims to evaluate the efficacy and survival outcomes of tyrosine kinase inhibitor (TKI) versus chemotherapy rechallenge in third-line treatment for advanced mCRC patients. From January 2019 to December 2022, 107 patients met the inclusion criteria. After 1:1 matching, there were 34 patients in both the TKI and rechallenge groups. Cox regression analysis was performed to identify independent predictive factors. The result indicated that Eastern Cooperative Oncology Group (ECOG) score of 0–1 (hazard ratio [HR] = 0.03, 95% confidence interval [CI]: 0.01–0.17; P < 0.001) and chemotherapy rechallenge (HR = 0.43, 95% CI: 0.23–0.79; P = 0.007) were independent protective factors for overall survival (OS). Patient-Generated Subjective Global Assessment (PG-SGA) score of 0–3 (HR = 0.43, 95% CI: 0.23–0.80; P = 0.008), progression-free survival (PFS) of frontline treatment (HR = 0.66, 95% CI: 0.43-1.00, P = 0.047) and chemotherapy rechallenge (HR = 0.42, 95% CI: 0.24–0.73; P = 0.002) were independent protective factors for PFS. Kaplan-Meier survival analysis showed that the median OS in the rechallenge group was 13.2 months (95% CI: 9.6–19.3), compared with 7.7 months (95% CI: 6.5–14.5) in the TKI group, with a statistically significant difference (HR = 0.47, 95% CI: 0.26–0.86; P = 0.013). The median PFS for the rechallenge group was 5.0 months (95% CI: 4.3–6.7), compared with 3.4 months (95% CI: 2.7–4.8) in the TKI group, with a statistically significant difference too (HR = 0.54, 95% CI: 0.32–0.91; P = 0.019). Furthermore, subgroup analysis showed that in Group A, the rechallenge group also had superior median OS and PFS compared with the TKI group. In conclusion, while TKIs are the current standard for third-line treatment in mCRC patients, chemotherapy rechallenge is a more effective option for patients who have achieved disease control in the first two lines of treatment.

Desmoid-type fibromatosis (DF) is an uncommon, locally invasive, non-metastatic soft-tissue neoplasm with variable and unpredictable manifestations. The therapeutic arsenal of DF therapy is consistently expanding; however, there remains no standard treatment modality. Sporadic pancreatic DF is rarely described in current literature, reflecting a significant deficiency in clinical treatment experience, this case aims to share some clinical experiences that can serve as a reference for managing this rare disease. A 36-year-old male presented with occasional abdominal discomfort and weight loss over a year. Ultrasound revealed a large mass in the pancreatic tail, which was not observed a year ago. The diagnosis of DF was confirmed by immunohistochemistry nuclear staining of β-catenin. Distal pancreatectomy with splenectomy was performed and the patient received no further therapy. After 13 months of follow-up, no recurrence or distant metastasis was observed. DF is a distinct rare tumor entity, sporadic pancreatic DF is even rarer. It is imperative to select the individualized treatment strategy for each patient to optimize tumor control and enhance quality of life.

This study developed an immune-related long non-coding RNAs (lncRNAs)-based prognostic signature by integrating multi-omics data and machine learning algorithms to predict survival and therapeutic responses in breast cancer patients. Utilizing transcriptomic and gene expression data from TCGA and GEO databases, 72 immune-related lncRNAs were identified through weighted gene co-expression network analysis (WGCNA) and ImmuLncRNA algorithms. The model was further optimized using 101 combinations of 10 machine learning approaches, ultimately constructing an immune-related lncRNA signature(IRLS) scoring system comprising nine key lncRNAs. Validated across 17 independent cohorts, the model demonstrated that high-risk patients had significantly shorter overall survival (OS) (P < 0.05), with predictive performance surpassing 95 published models (P < 0.05). Additionally, the IRLS score predicted responses to paclitaxel chemotherapy, and the low-risk group exhibited higher immune cell infiltration (P < 0.05), showing significant negative correlations with CD8A, PD-L1, tumor mutational burden (TMB), and neoantigen load (NAL). In immune checkpoint inhibitor (ICI) treatment cohorts, low IRLS scores were associated with improved response rates to atezolizumab. Our findings suggest that the IRLS model serves as a novel biomarker for prognostic stratification and personalized therapeutic decision-making in breast cancer.

Background Sarcopenia is associated with poor outcomes in many malignancies. However, the relationship between sarcopenia and the prognosis of pancreatic cancer has not been well understood. The aim of this meta-analysis was to identify the prognostic value of preoperative sarcopenia in patients with pancreatic cancer after curative-intent surgery. Methods Database from PubMed, Embase, and Web of Science were searched from its inception to July 2023. The primary outcomes were overall survival (OS), progression-free survival (PFS), and the incidence of major complications. The hazard ratio (HR), odds ratio (OR), and 95% confidence intervals (CIs) were used to assess the relationship between preoperative sarcopenia and the prognosis of patients with pancreatic cancer. All statistical analyses were conducted by Review Manager 5.3 and STATA 17.0 software. Results A total of 23 retrospective studies involving 5888 patients were included in this meta-analysis. The pooled results demonstrated that sarcopenia was significantly associated with worse OS (HR = 1.53, P < 0.00001) and PFS (HR = 1.55, P < 0.00001). However, this association was not obvious in regard to the incidence of major complications (OR = 1.33, P = 0.11). Conclusion Preoperative sarcopenia was preliminarily proved to be associated with the terrible prognosis of pancreatic cancer after surgery. However, this relationship needs to be further validated in more prospective studies.

Abstract Objective In this study, we aimed to explore the risk factors influencing post recurrence survival (PRS) of early recurrence (ER) and late recurrence (LR) in stage advanced gastric cancer (AGC) patients after radical surgery, respectively, and to develop predictive models in turn. Methods Medical records of 192 AGC patients who recurred after radical gastrectomy were retrospectively reviewed. They were randomly divided into the training and validation set at a ratio of 2:1. Nomograms were built based on risk factors influencing PRS of ER and LR explored by Cox regression analyses, respectively. Concordance index (C-index) values and calibration curves were used to evaluate predictive power of nomograms. Results Body mass index < 18.5 kg/m2, prealbumin level < 70.1 mg/l, positive lymph nodes ratio ≥ 0.486 and palliative treatment after recurrence were independent risk factors for the prognosis of ER. In contrast, prealbumin level < 170.1 mg/l, CEA ≥ 18.32 μg/l, tumor diameter ≥ 5.5 cm and palliative treatment after recurrence were independent risk factors for the prognosis of LR. The C-index value was 0.801 and 0.772 for ER and LR in the training set, respectively. The calibration curves of validation set showed a C-index value of 0.744 and 0.676 for ER and LR, respectively. Conclusions Nomograms which were constructed to predict the prognosis of ER and LR of AGC after surgery showed great predictive power and could provide reference for clinicians’ treatment strategies to some extent.

Rationale:Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare malignant primary hepatic lymphoma. The sensible choice of treatment for patients with primary lymphoma combined with atrial fibrillation (AF) is controversial and challenging.Patient concerns:The patient presented with both primary hepatic MALT lymphoma and AF, which was difficult to manage.Diagnoses:Pathological and immunohistochemical examination are helpful for definitive diagnosis.Interventions:Surgical resection and subsequent anticoagulant therapy are main treatment methods, and adjuvant therapy depends on the situation.Outcomes:Primary hepatic MALT lymphoma is easy to misdiagnosis due to a lack of typical symptoms and imaging signs.Lessons:This case highlights for patients with primary hepatic MALT lymphoma combined with AF, toxicity caused by adjuvant chemotherapy should be fully considered, and careful selection should be made based on the general conditions and complications of patients.

Colorectal cancer (CRC) is one of the most prevalent types of malignant tumors. It's vital to explore new biomarkers and potential therapeutic targets in CRC lung metastasis through adopting integrated bioinformatics tools. Multiple cohort datasets and databases were integrated to clarify and verify potential key candidate biomarkers and signal transduction pathways in CRC lung metastasis. DAVID, STRING, UALCAN, GEPIA, TIMER, cBioPortal, THE HUMAN PROTEIN ATLAS, GSEA 4.3.2, FUNRICH 3.1.3, and R 4.2.3 were utilized in this study. The enriched biological processes and pathways modulated by the differentially expressed genes (DEGs) were determined with Gene Ontology, Kyoto Encyclopedia of Genes and Genomes. The search tool Retrieval of Interacting Genes and Cytoscape were used to construct a protein-protein interaction network among DEGs. Four hundred fifty-nine colorectal primary cancer and lung metastatic gene expression profiles were screened from 3 gene expression profiles (GSE41258, GSE68468, and GSE41568). Forty-one upregulated genes and 8 downregulated genes were identified from these 3 gene expression profiles and verified by the transcriptional levels of hub genes in other GEO datasets and The Cancer Genome Atlas database. Two pathways (immune responses and chemokine receptors bind chemokines), 13 key DEGs, 6 hub genes (MMP3, SFTPD, ABCA3, CLU, APOE, and SPP1), and 2 biomarkers (APOE, SPP1) with significantly prognostic values were screened. Forty-nine DEGs were identified as potential candidate diagnostic biomarkers for patients with CRC lung metastasis in present study. Enrichment analysis indicated that immune responses and chemokine receptors bind chemokines may play a leading role in lung metastasis of CRC, and further studies are needed to validate these findings.

Objective To compare the efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in a medium-volume medical center. Methods Data for patients who underwent OPD or LPD for carcinoma of the ampulla of Vater (VPC) between January 2017 and June 2022 were acquired retrospectively. Propensity score-matching (PSM) analysis was performed to balance the baseline characteristics between the groups. The primary outcome was disease-free survival (DFS). Cox regression analysis was used to explore the independent risk factors for DFS. Results A total of 124 patients with pathologically diagnosed VPC were included. After 1:1 matching, there were 23 cases each in the OPD and LPD groups. Kaplan–Meier survival analyses showed that the median DFS in the OPD and LPD groups was identical (16.0 months vs 16.0 months, respectively). Multivariate Cox regression analysis showed that low levels of alkaline phosphatase and γ-glutamyl transpeptidase, positive surgical margin, and lymph node enlargement were independent risk factors for DFS. Conclusion LPD in medium-volume centers with acceptable technical conditions may approach or even achieve the efficacy of LPD in large-volume centers.

BACKGROUND:The incidence of non-alcohol fatty liver disease (NAFLD) has been increasing annually with the improvement of living standards. Numerous epidemiological observations have linked sex hormone-binding protein (SHBG) levels to NAFLD. However, evidence of the causal role of SHBG in the development and progression of NAFLD is still absent. Therefore, a systematic assessment of the causal relationship is needed.METHOD:A two-sample Mendelian randomisation (MR) analysis was conducted. Genome-wide association study (GWAS) data for SHBG were obtained online from the IEU database (ebi-a-GCST90012111) as exposure. GWAS data from the NAFLD of the Finngen consortium were used for preliminary analysis, while NAFLD data from another GWAS involving 8434 participants were used for replication and meta-analyses. Causal effects were investigated with inverse variance weighted (IVW), weighted median and MR-Egger regression. Sensitivity analyses including Cochran's Q test, leave-one-out analysis and MR-Egger intercept analysis were simultaneously conducted to assess heterogeneity and pleiotropy.RESULTS:After rigorous selection, 179 single-nucleotide polymorphisms (SNPs) were identified as strongly correlated instrumental variables. Preliminary analysis suggested a significant causal relationship between genetically determined serum SHBG levels and NAFLD [odds ratio (OR) IVW  = .54, 95% confidence interval (CI) = .30-.98, p = .043], supported by the results of the replication analysis (ORIVW  = .61, 95% CI = .46-.81, p = .0006) and further meta-analysis (OR = .59, 95% CI = .46-.77, p < .0001).CONCLUSION:The genetic tendency to high levels of SHBG was causally correlated with a reduced risk of NAFLD, indicating that circulating high levels of SHBG was a protective factor for NAFLD.

Colorectal cancer is the second largest cause of cancer-related death in the world, and ranks as the third most common malignant tumor in the world. Approximately 25% of patients present with colorectal liver metastases(CRLM) at first diagnosis, and surgical treatment is often considered necessary for the potential long-term survival of patients with CRLM. The median overall survival (OS) of patients who achieved R0 resection in CRLM was 42 months, and the 5-year survival rate was 35%~40%. The initial resectable rate is less than 20%. Therefore, surgical resection of initial unresectable CRLM after conversion therapy will significantly improve the prognosis of patients with CRLM. In this review, we introduce the latest literature on initial unresectable CRLM conversion therapy,and discuss the advances in diagnosis, treatment methods and therapeutic effects, so as to guide clinical practice.

Abstract Background There are few studies on the predictive factors and recurrence patterns of early and late postoperative recurrence of advanced gastric cancer (GC). Our study aims to explore the difference of clinicopathological features and recurrence patterns between early and late recurrence in patients with advanced GC after curative intent surgery, and further compare and analyze independent predictors influencing the prognosis respectively. Materials and Method Clinical data of patients with GC who received radical gastrectomy in Shaoxing People's Hospital between June 2016 and December 2019 was retrospectively collected. Survival analyses were conducted using the Kaplan-Meier method with log-rank tests. Cox regression analyses were used to identify independent risk factors of influencing post-recurrence survival (PRS). Results There was significantly statistical difference in median PRS between the early and late recurrence (4 months vs. 11 months, P = 0.038). Low body mass index (BMI) (HR = 0.86, P = 0.001), elevated monocytes (HR = 4.54, P = 0.003) and neutrophil–lymphocyte ratio (HR = 1.03, P = 0.037) at the time of recurrence were independent predictors of PRS after early recurrence. Low BMI (HR = 0.88, HR = 0.036) and hemoglobin (HR = 0.97, P = 0.008) at the time of recurrence were independent predictors of PRS after late recurrence. There were significant difference in prognosis between the three different BMI ranges for all recurrent patients (4 months vs. 9 months vs. 15 months, P = 0.02), especially for those with early recurrence (4 months vs. 7 months vs. 15 months, P = 0.015). Conclusion In view of the different predictive factors of early and late recurrence of GC, individualized treatment strategies can be considered to improve the survival rate in the future.

胆囊癌是指原发于胆囊黏膜上皮的一种恶性肿瘤,恶性程度高且预后较差.外科治疗是唯一可能治愈的方法,但在手术切除范围、胆总管切除、意外胆囊癌的处理及微创外科技术的应用等方面仍然存在热议.笔者就近年来胆囊癌的外科治疗进展并围绕外科治疗中存在的热点和争议问题作一综述,为临床和科研工作中胆囊癌的治疗提供参考方案.

There are few studies on the predictive factors of early recurrence (ER) and late recurrence (LR) of advanced gastric cancer (GC) after curative surgery. Our study aims to explore the independent predictors influencing the prognosis between ER and LR in patients with advanced GC after curative intent surgery respectively. And we will further develop nomograms for prediction of post recurrence survival (PRS). Data of patients with GC who received radical gastrectomy was retrospectively collected. Recurrence was classified into ER and LR according to the 2 years after surgery as the cutoff value. Multivariate Cox regression analyses were used to explore significant predictors in our analysis. Then these significant predictors were integrated to construct nomograms. The 1-, 2- and 3-year probabilities of PRS in patients with ER were 30.00%, 16.36% and 11.82%, respectively. In contrast, the late group were 44.68%, 23.40%, and 23.30%, respectively. Low body mass index (hazard ratio [HR]=0.86, P=.001), elevated monocytes count (HR=4.54, P=.003) and neutrophil-lymphocyte ratio (HR=1.03, P=.037) at the time of recurrence were risk factors of PRS after ER. Decreased hemoglobin (HR=0.97, P=.008) and elevated neutrophil-lymphocyte ratio (HR=1.06, P=.045) at the time of recurrence were risk factors of PRS after LR. The calibration curves for probability of 1-, 2-, and 3-year PRS showed excellent predictive effect. Internal validation concordance indexes of PRS were 0.722 and 0.671 for ER and LR respectively. In view of the different predictive factors of ER and LR of GC, the practical predictive model may help clinicians make reasonable decisions.