[JOURNAL] HEPATOLOGY
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200 papers
Competing Mortality Redefines the Net Benefit of Additional Surgery After Endoscopic Resection for T1 Colorectal Cancer in Older Adults.
Ichimasa K, Kudo SE, Kouyama Y … +6 more , Okumura T, Maeda Y, Hayashi T, Yeoh KG, Miyachi H, Misawa M
Dig Endosc · 2026 Jul · PMID 42400343 · Publisher ↗
The oncologic benefit of additional surgery after endoscopic resection (ER) for the treatment of T1 colorectal cancer (CRC) remains uncertain in older adults, because competing causes of mortality may attenuate the gain...
The oncologic benefit of additional surgery after endoscopic resection (ER) for the treatment of T1 colorectal cancer (CRC) remains uncertain in older adults, because competing causes of mortality may attenuate the gain in survival. The proportion of patients aged ≥ 80 years has increased steadily, reflecting population aging. For patients with high-risk T1 CRC, the aim of additional bowel resection is to remove occult lymph node metastasis and reduce the risk of recurrence, and long-term studies have shown improvements in T1 CRC-related outcomes. However, age modifies the magnitude of this benefit. Cohort studies of high-risk T1 CRC have shown only small differences in 5-year cancer-specific survival between patients who underwent additional surgery and those who did not. Moreover, most deaths in the nonsurgical group were attributable to causes other than cancer. Data from meta-analyses have further suggested that the survival advantage associated with surgery becomes evident only after 10 years, indicating a substantial delay in its benefits. In contrast, the incidences of perioperative morbidity and short-term mortality increase with age and have immediate effects on prognosis. These findings indicate that the net survival benefit of additional surgery in older patients depends on the balance between the delayed oncologic benefit and the immediate treatment-related risks. Thus, although surgery remains appropriate for selected fit individuals, clinicians should consider the pathologic risk, frailty, comorbidity burden, and competing mortality of individual older patients with pT1 CRC in their decision-making to optimize outcomes.
Evaluating current bronchiectasis care in Italy according to the 2025 European respiratory society recommendations.
De Angelis A, Comellini V, Gramegna A … +12 more , Battaglia S, Montemurro G, Bellofiore A, Pagnini F, Privitera E, Ori M, Simonetta E, Nigro M, Chalmers JD, Nobile D, Blasi F, Aliberti S
Ther Adv Respir Dis · 2026 · PMID 42400276 · Publisher ↗
BACKGROUND: National quality standards for bronchiectasis in Italy were last defined in 2016. The publication of the 2025 European Respiratory Society (ERS) guidelines offers the opportunity to evaluate current clinical...
BACKGROUND: National quality standards for bronchiectasis in Italy were last defined in 2016. The publication of the 2025 European Respiratory Society (ERS) guidelines offers the opportunity to evaluate current clinical practice against updated evidence-based recommendations. OBJECTIVES: To assess the extent to which Italian bronchiectasis centers align with key statements from the 2025 ERS guidelines. DESIGN: National, multicenter, cross-sectional observational study based on a structured survey of Italian bronchiectasis centers, aligned with the 2025 ERS recommendations. METHODS: A national survey was conducted across Italian bronchiectasis centers affiliated with the Italian Bronchiectasis Patient Association (AIB). The structured questionnaire assessed center organization, diagnostic resources, multidisciplinary care, and alignment with ten predefined core management domains derived from the 2025 ERS recommendations. RESULTS: Most centers reported universal access to minimum bundle etiological tests, with improved capacity compared with 2016. However, specialized diagnostics for rare causes, structured physiotherapy programs, and written self-management plans remain inconsistently available. Long-term inhaled antibiotics and macrolides were widely prescribed, though access barriers persist. Monitoring practices were heterogeneous. CONCLUSION: Despite clear progress, substantial variability persists in physiotherapy access, rare disease diagnostics, self-management tools, and routine monitoring. Updated Italian quality standards aligned with ERS 2025 principles are warranted.
Interactive Roles of Metabolic Dysfunction-Associated Steatotic Liver Disease and Nutritional Status in the Prognosis of Patients With Hepatocellular Carcinoma After Surgical Resection.
Ho CT, Liu CA, Ho CJ … +8 more , Lin YC, Tsai SY, Lei HJ, Chou SC, Huang YH, Hou MC, Wu JC, Su CW
Kaohsiung J Med Sci · 2026 Jul · PMID 42400215 · Publisher ↗
The prognostic effect of concurrent metabolic dysfunction-associated steatotic liver disease (MASLD) on outcomes for hepatocellular carcinoma (HCC) patients remains unclear. The Prognostic Nutritional Index (PNI) reflect...
The prognostic effect of concurrent metabolic dysfunction-associated steatotic liver disease (MASLD) on outcomes for hepatocellular carcinoma (HCC) patients remains unclear. The Prognostic Nutritional Index (PNI) reflects nutritional and inflammatory status and is a well-known prognostic factor. We therefore aimed to evaluate and compare the prognostic role of PNI in patients with HCC with and without concurrent MASLD undergoing curative surgical resection. In our retrospective study, 991 patients undergoing curative HCC resection were stratified according to MASLD status and pre-operative PNI (cut-off: 45). Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier methods and Cox proportional hazards models. Further subgroup analysis was performed according to their concurrent viral hepatitis status. High PNI was identified as an independent protective factor against poor OS for the entire cohort (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.49-0.87, p = 0.004). The Kaplan-Meier analysis showed that the high-PNI/MASLD group had the best OS, while the low-PNI/no-MASLD group had the worst. Subgroup analysis indicated that high PNI was an independent protective factor for OS only in the no-MASLD group (HR: 0.59, p = 0.003) but not the MASLD group (HR: 0.94, p = 0.793). Its prognostic effect was more significant in HCC patients without concurrent MASLD or with chronic hepatitis B. To conclude, a better nutritional status, assessed by PNI, is a valuable prognostic marker for patients with HCC. Its protective effect on OS is significantly pronounced in patients without concurrent MASLD, indicating that MASLD status modifies the prognostic utility of PNI.
Danish validation of the Alcohol Use Disorder Identification Test (AUDIT).
Schøler PN, Andersen K, Thiele M … +3 more , Becker U, Christiansen E, Nielsen AS
Scand J Public Health · 2026 Jul · PMID 42400144 · Publisher ↗
AIM: To assess the diagnostic accuracy and optimal cut-off scores of the Alcohol Use Disorder Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) in a Danish general population. METHODS: Questionnaire-based cross...
AIM: To assess the diagnostic accuracy and optimal cut-off scores of the Alcohol Use Disorder Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) in a Danish general population. METHODS: Questionnaire-based cross-sectional study. Data collection from 26 September to 29 October 2024, via an anonymous online test of alcohol habits among adults aged 25+ years. MEASURES: Demographics, AUDIT, self-reported International Classification of Disease Tenth Revision (ICD-10) criteria for alcohol dependence, yes/no item on harmful alcohol use. We defined hazardous use as >10 standard drinks/week (national recommendations) and possible dependence as ⩾3 ICD-10 criteria. We evaluated area under the receiver operating characteristics curve (AUC), diagnostic properties and optimal cut-offs. RESULTS: Total sample: 17,959 participants, mean age 66.32 (SD=12.72) years, 51% males. Nineteen per cent reported drinking hazardously, 7.5% answered yes to harmful use and 7.8% to dependence according to ICD-10. AUDIT showed good diagnostic discrimination for hazardous use (AUC=0.89) and dependence (AUC=0.96), but not for harmful use (AUC=0.61). Internationally recommended AUDIT cut-offs for hazardous use and dependence were supported, with lower thresholds in women and the older (65+ years). AUDIT-C: hazardous use (AUC=0.92), dependence (AUC=0.92), harmful use (AUC=0.58). Optimal AUDIT-C cut-offs: hazardous 6, dependence 6, with age- and sex-specific variations. Internal consistency was high for AUDIT (α = 0.83) and low for AUDIT-C (α = 0.61). CONCLUSIONS:
The implementation of mindfulness-based cognitive therapy for patients with inflammatory bowel disease: a qualitative study.
Bosman SJE, van der Leegte M, Ter Avest MM … +5 more , Huijbers MJ, Nissen LHC, Kievit W, Speckens AEM, Kwakkenbos L
BMC Psychol · 2026 Jul · PMID 42400045 · Full text
BACKGROUND: Our recent trial studying mindfulness-based cognitive therapy (MBCT) for Inflammatory Bowel Disease (IBD) patients demonstrated reductions in psychological distress and improvements in well-being. Building on...
BACKGROUND: Our recent trial studying mindfulness-based cognitive therapy (MBCT) for Inflammatory Bowel Disease (IBD) patients demonstrated reductions in psychological distress and improvements in well-being. Building on these findings, the present study aimed to explore barriers and facilitators for implementation and scenarios to overcome these. METHODS: We conducted a sequential two-part study consisting of qualitative interviews followed by a survey. Semi-structured interviews were conducted with key stakeholders (n = 32) on barriers and facilitators for implementation. The Consolidated Framework for Implementation Research guided data collection and framework analysis. Based on interview outcomes, implementation scenarios were formulated and presented in a survey to stakeholders (n = 21) to explore their perspectives on the most suitable scenario. RESULTS: Key barriers identified were scepticism and misconceptions about MBCT and its lack of evidence, and limited funding, time, and perceived competency to discuss mental health in medical consultations. Facilitators included the presence of a local champion, growing attention to lifestyle factors in society and healthcare, and the group-based design of MBCT providing peer support. Stakeholders preferred integrating MBCT within a regional network, but opinions differed. Irrespective of the preferred scenario, stakeholders emphasized the need for a strong business case, including evidence on long-term (cost-)effectiveness, to secure broad support and insurance coverage. CONCLUSIONS: Although implementing MBCT for IBD patients is worthwhile, several prominent barriers currently hinder this process. A strong business case is needed to gain broad support and insurance coverage. Further research is required to determine the most suitable and feasible implementation scenario and associated strategies. CLINICAL TRIAL NUMBER: not applicable.
Therapeutic potential of mesenchymal stem cell-derived apoptotic vesicles in liver fibrosis: targeting the IGFBP3/PI3K-AKT axis via miR-409-3p.
Lu B, Chen X, Wang H … +10 more , Li M, Shi Y, Huang Y, Ding J, Wang Y, Li L, Luo J, Jia C, Lin N, Feng Y
Stem Cell Res Ther · 2026 Jul · PMID 42400044 · Full text
BACKGROUND: Hepatic fibrosis is a progressive pathology driven by hepatic stellate cell (HSC) activation and excessive extracellular matrix deposition. While mesenchymal stem cell (MSC) therapies show promise, their clin...
BACKGROUND: Hepatic fibrosis is a progressive pathology driven by hepatic stellate cell (HSC) activation and excessive extracellular matrix deposition. While mesenchymal stem cell (MSC) therapies show promise, their clinical translation is hindered by the inherent safety constraints of live cell transplantation. MSC-derived apoptotic vesicles (MSC-ApoVs), a structurally distinct class of extracellular vesicles, emerge as a compelling cell-free alternative. However, their specific therapeutic efficacy and mechanistic targets in hepatic fibrosis remain elusive. METHODS: MSC-ApoVs were isolated from human umbilical cord MSCs and stringently characterized to exclude non-vesicular contaminants. Their anti-fibrotic efficacy was evaluated in vitro using TGF-β1-activated LX-2 cells and in vivo within a CCl₄-induced murine fibrosis model. To elucidate and functionally validate the underlying mechanisms, we integrated transcriptomic profiling (RNA-seq), dual-luciferase reporter assays, and dual-directional pharmacological interventions. Furthermore, human clinical liver biopsies were analyzed to determine the clinico-pathological relevance of the identified targets. RESULTS: We demonstrated that MSC-ApoVs were efficiently internalized by HSCs, significantly blunting TGF-β1-induced activation, proliferation, and migration, alongside a marked reduction in fibrotic markers (α-SMA, MMP2, and Collagen-I). Transcriptomic screening identified Insulin-like Growth Factor Binding Protein 3 (IGFBP3) as a crucial pro-fibrotic mediator. Mechanistically, MSC-ApoV-enriched miR-409-3p directly targeted and downregulated IGFBP3, thereby restricting the PI3K-AKT signaling cascade-a dependency unequivocally validated by targeted rescue and blockade assays. In vivo, systemic MSC-ApoV administration robustly ameliorated CCl₄-induced hepatic fibrosis and restored liver function. Crucially, clinical analyses revealed a strong positive correlation between elevated IGFBP3 expression and the severity of human fibrotic progression. CONCLUSIONS: This study delineates a novel cell-free therapeutic paradigm, demonstrating that MSC-ApoVs mitigate hepatic fibrosis largely through the miR-409-3p-mediated silencing of the IGFBP3/PI3K-AKT axis. By integrating robust in vitro, in vivo, and clinical evidence, these findings highlight MSC-ApoVs as a highly efficacious and translatable alternative to traditional live stem cell therapies for hepatic fibrosis.
Repurposing cepharanthine as a radiosensitizer in esophageal squamous cell carcinoma through dual metabolic intervention and direct targeting of p70s6K.
Hao Z, Su X, Li J … +9 more , Jin J, Li Z, Yan Z, Jiao W, Jiao W, Wang Y, Ji C, Wang X, He Y
J Transl Med · 2026 Jul · PMID 42400032 · Full text
BACKGROUND: Metabolic reprogramming underpins the acquisition of radioresistance in esophageal squamous cell carcinoma (ESCC); however, the specific bioenergetic vulnerabilities and direct pharmacological targets remain...
BACKGROUND: Metabolic reprogramming underpins the acquisition of radioresistance in esophageal squamous cell carcinoma (ESCC); however, the specific bioenergetic vulnerabilities and direct pharmacological targets remain to be fully elucidated. This study defines a distinct metabolic phenotype conferring radioresistance and evaluates the natural alkaloid Cepharanthine (CEP) as a mechanism-driven radiosensitizer. METHODS: Matched clinical cohorts of radiosensitive and radioresistant ESCC patients were analyzed using untargeted and targeted metabolomics. Bioenergetic profiling (ECAR/OCR) was performed on established isogenic radioresistant cells. The mechanistic interactions between CEP and its target were mapped via network pharmacology, surface plasmon resonance (SPR), cellular thermal shift assays (CETSA), ubiquitin-proteasomal degradation assays, and Q347A site-directed mutagenesis. In vivo efficacy was validated across human cell-derived xenografts (CDX) and immunocompetent syngeneic (AKR/C57BL/6) mouse models. RESULTS: Clinical multi-omics revealed a "metabolic duality" in radioresistant ESCC, characterized by the concurrent hyperactivation of glycolysis and oxidative phosphorylation (OXPHOS). CEP administration disrupted this metabolic network, significantly sensitizing ESCC cells to irradiation [Dose-modifying factor at 37% survival (DMF) > 1]. Mechanistically, CEP directly engages the kinase domain of p70S6K-a structural interaction dependent on the Q347 residue-and triggers its ubiquitin-proteasomal degradation. This targeted clearance disrupts the upstream PI3K/Akt/mTOR survival axis. Genetic overexpression of wild-type p70S6K, but not the Q347A mutant, rescued the dual hypermetabolic phenotype and reinstated radioresistance. Clinically, elevated p70S6K expression correlated with poor disease-free survival and therapeutic failure. In vivo, CEP synergized with radiotherapy to suppress tumor kinetics in both CDX and syngeneic models, while concurrently enhancing CD8 T cell infiltration in the immunocompetent microenvironment, with no observable systemic toxicity. CONCLUSIONS: Radioresistant ESCC relies on a dual hypermetabolic state driven by the PI3K/Akt/mTOR/p70S6K cascade. CEP overcomes this radioresistance by physically binding to and degrading p70S6K, thereby inducing bioenergetic exhaustion and reshaping the anti-tumor microenvironment. These findings provide a solid mechanistic rationale for translating CEP into clinical radiotherapeutic regimens.
Immunonutrition in Early Life: The Role of Complementary Feeding, Dietary Patterns, and Nutritional Exposures on the Health of Young Children-An EAACI Scoping Review.
Venter C, Beltran J, Bracchiglione J … +23 more , Fernández-Sáenz FK, Riera P, Solà I, Akdis C, Arasi S, Canani RB, Fleischer D, Eguíluz-Gracia I, Hourihane J, Lunjani N, Meyer R, Roberts G, Roth-Walter F, Santos AF, Skypala I, Smith PK, Sokolowska M, Torres MJ, Vassilopoulou E, Vlieg-Boerstra B, Walter J, Alonso-Coello P, O'Mahony L
Allergy · 2026 Jul · PMID 42400030 · Publisher ↗
BACKGROUND: Immunonutrition examines how diet influences immune development. Complementary feeding represents a critical window for long-term health. We aimed to map evidence linking complementary feeding to immune outco...
BACKGROUND: Immunonutrition examines how diet influences immune development. Complementary feeding represents a critical window for long-term health. We aimed to map evidence linking complementary feeding to immune outcomes, allergy, infection, and growth in infants and toddlers (≤ 3 years). We conducted a scoping review and evidence-gap mapping, following PRISMA-ScR. MEDLINE and Epistemonikos were searched from inception to November 2024. Concepts included diet diversity/patterns, feeding practices/models, and timing of allergen introduction, timing of complementary feeding, macronutrients, micronutrients, foods, supplementation, and ultra-processed foods. We included systematic reviews and recent primary studies meeting criteria. RESULTS: From 13,512 records screened, 108 systematic reviews were included, comprising 99 randomized controlled trials, 41 cohorts, 22 case-control, and 14 cross-sectional studies. Most reviews addressed nutrient intake, supplementation, or timing of allergen introduction, while fewer reviews explored diet diversity, foods, or ultra-processed food intake. Responsive complementary feeding was consistently associated with healthier growth and lower obesity risk, whereas restrictive practices showed adverse effects. Greater diet diversity was linked to reduced asthma and food allergy risk, though eczema findings were inconsistent. Western-style diets high in processed foods, fat, sugar, and meat correlated with higher allergy risk, while home-prepared diets were protective. Micronutrient supplementation (iron, zinc, vitamin D) reduced infection and anemia risk but had mixed effects on allergy. Early allergen introduction reduced food allergy incidence. CONCLUSIONS: Complementary feeding research now extends beyond calorie counting, macronutrients, and early allergen introduction to dietary patterns and early life nutrition that supports the microbiome. Evidence supports dietary diversity, timely food allergen introduction, and responsive feeding, while discouraging restrictive practices and ultra-processed foods. Future work should harmonize definitions and investigate plant-based diets, advanced glycation end products, and processed food exposures.
The PH score: a practical tool for screening myeloproliferative neoplasms in acute portal vein thrombosis.
Öztop H, Ada Tak NG, Eren F … +2 more , Hunutlu FÇ, Ocakoğlu G
Thromb J · 2026 Jul · PMID 42400017 · Full text
Portal vein thrombosis (PVT) is a rare but clinically significant condition often associated with myeloproliferative neoplasms (MPNs). Diagnosing MPNs in acute PVT may be difficult, particularly in the absence of overt h...
Portal vein thrombosis (PVT) is a rare but clinically significant condition often associated with myeloproliferative neoplasms (MPNs). Diagnosing MPNs in acute PVT may be difficult, particularly in the absence of overt hematologic abnormalities. We retrospectively analyzed 93 patients with acute PVT from January 2009 to June 2024, excluding those with chronic thrombosis or previously established systemic diseases. MPNs were identified in 23 patients (24.7%). Hemoglobin (Hb), platelet count (Plt) and inflammatory indices (PLR, SII, and PIV) were associated with MPNs in univariate analyses (p < 0.05), while Hb and Plt were retained as independent predictors in a parsimonious multivariable logistic regression model. Based on these parameters, the PH score was developed: PH = (0.510 × Hb) + (0.006 × Plt) - 9.470. The model demonstrated acceptable discriminative performance, with an apparent AUC of 0.864 in the training cohort and an AUC of 0.820 on internal validation in the overall cohort, using an optimal cut-off value of - 1.016. The PH score may act as a straightforward laboratory tool to aid in early risk stratification for patients with acute PVT, complementing, but not replacing, the standard diagnostic evaluation.
Surgical site infection prevention among surgical healthcare workers in Syria: a nationwide cross-sectional study.
Mohaisen MA, Atia M, Al-Noufi BMM … +25 more , Suliman BI, Aljalam RMK, Ghilan RD, Alahmad AM, Saadoun HA, Khaddour JW, Harba AMZ, Ghazali EG, Al-Nahas MW, Zaidan ZH, Obaid TA, Alhamid AAH, Ghabra AA, Fadhl HN, Baras BM, Shobnom AT, Moktadir G, Zaman MT, Nadarajah S, Elfaki AAM, Elfaki AAM, Saghir MA, Zeima Z, Almezaal AS, Almukbel R
Antimicrob Resist Infect Control · 2026 Jul · PMID 42400014 · Full text
BACKGROUND: Surgical site infections (SSIs), infections at or near surgical incisions, represent 20-30% of nosocomial infections globally, with higher prevalence in low- and middle-income countries such as Syria. This st...
BACKGROUND: Surgical site infections (SSIs), infections at or near surgical incisions, represent 20-30% of nosocomial infections globally, with higher prevalence in low- and middle-income countries such as Syria. This study assessed SSI prevalence in two Syrian hospitals alongside a nationwide evaluation of surgical healthcare workers' knowledge, practices, compliance, and barriers to WHO/CDC SSI prevention guidelines. METHODS: A cross-sectional survey was conducted among 375 healthcare workers in surgical settings across Syria. A structured questionnaire collected data on demographics, educational background, work experience, self-reported practices, knowledge of WHO guidelines, and perceived barriers to implementation. Composite knowledge and practice scores were calculated. Data were analyzed using descriptive statistics, Pearson correlation, and ANOVA. RESULTS: Adherence to basic preventive practices was high, including hand preparation (89.33%) and intraoperative sterilization (91.47%). However, gaps persisted in avoiding preoperative shaving, appropriate antibiotic prophylaxis timing and duration, and postoperative antibiotic discontinuation. Major barriers included lack of role models (68%), inadequate training (63%), and staff shortages. Pearson analysis revealed positive correlations between compliance and practice scores (r = 0.5203, p < 0.001) and compliance and knowledge scores (r = 0.3372, p < 0.001). Crucially, the weakest correlation was found between knowledge and practice scores (r = 0.2662, p < 0.001), highlighting a prominent know-do gap. Hospital-reported SSI prevalence was 9.5% in one hospital and 1.47% in the other. CONCLUSION: This study identified suboptimal knowledge and inconsistent implementation of high-impact SSI prevention practices among Syrian surgical healthcare workers despite strong adherence to basic aseptic measures. Targeted training, improved surveillance systems, and institutional support are needed to strengthen guideline adherence and reduce preventable SSIs.
Sex-specific patterns of avoidant and restrictive eating in inflammatory bowel disease: validation of the German version of the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS).
Pueschel L, Fuhrberg SC, Kuhn L … +12 more , Conrad J, Florea M, Pueschel N, Schemann L, Kala YR, Atanasova K, Knoedler LL, Reindl W, Wilke EL, Middelhoff M, Thomann AK, Wiestler M
J Eat Disord · 2026 Jul · PMID 42400002 · Full text
BACKGROUND: Avoidant/Restrictive Food Intake Disorder (ARFID) is a possible comorbidity in patients with Inflammatory Bowel Disease (IBD). Early detection and intervention are crucial to prevent malnutrition and related...
BACKGROUND: Avoidant/Restrictive Food Intake Disorder (ARFID) is a possible comorbidity in patients with Inflammatory Bowel Disease (IBD). Early detection and intervention are crucial to prevent malnutrition and related complications. However, ARFID often remains undiagnosed due to its subtle presentation. METHODS: This multicenter study enrolled 235 patients with IBD at German tertiary referral centers between March and September 2025. The Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS), a screening tool for ARFID, was translated into German and administered at baseline and follow-up. The validity and reliability of the NIAS German were assessed via hypothesis testing and Cronbach's α coefficient. RESULTS: The NIAS German demonstrated excellent internal consistency (Cronbach's α = 0.810) and test-retest reliability (p < 0.001). A significant correlation was found between the initial and follow-up NIAS scores for all items (p < 0.001). Furthermore, the intraclass correlation coefficient of 0.896 (95% CI: 0.846-0.931) confirmed the reliability of the German questionnaire version. Notably, women with IBD scored significantly higher on the NIAS and its subscales, indicating a greater likelihood and severity of ARFID symptoms, as screened by the NIAS (Md [IQR]: women = 13 [7-17]; men = 10 [6-15]; p = 0.007). CONCLUSIONS: The German version of the NIAS demonstrated good reliability and initial evidence supporting its use as a screening instrument in German-speaking men and women with IBD. The findings of this study highlight the importance of sex-specific assessment and suggest that IBD women may be at higher risk of developing ARFID. Early detection and targeted interventions are essential to prevent malnutrition and related complications in this vulnerable population.
Targeting tumor-associated bacteria in digestive system cancers: carcinogenic mechanisms and nano-regulate platform design.
Liu H, Wang X, Xi QI … +5 more , Li T, Huang H, Zhao J, Guan L, Liu F
J Nanobiotechnology · 2026 Jul · PMID 42399994 · Full text
Tumor-associated bacteria (TAB) and their products can reprogram host signaling and metabolism, disrupt tissue homeostasis, and remodel antitumor immunity, collectively creating a cooperative protumor ecosystem. Accumula...
Tumor-associated bacteria (TAB) and their products can reprogram host signaling and metabolism, disrupt tissue homeostasis, and remodel antitumor immunity, collectively creating a cooperative protumor ecosystem. Accumulating evidence indicates that TAB promote the initiation and progression of digestive system malignancies and can also influence therapeutic outcomes. Although conventional bacterial modulation approaches can alter the composition and functions of TAB, their clinical application is hindered by major limitations, including poor in vivo stability, limited targeting specificity, difficulty in penetrating mucosal and tumor barriers, insufficient local persistence, and safety concerns related to dysbiosis. Nanotechnology-based engineering strategies-such as introducing specific ligands, designing biomimetic and stimuli-responsive coatings, improving adhesion and sustained-release performance, and integrating multifunctional modules-can help overcome these constraints, enabling selective elimination of TAB or rebalancing of bacterial communities to enhance anticancer efficacy. This review summarizes the carcinogenic mechanisms of TAB in digestive system cancers and outlines the features and shortcomings of conventional bacterial modulation tools. We further integrate recent advances in nanotechnology-based delivery platforms. Finally, we discuss considerations for translation, emphasizing that multifunctional systems must balance mechanistic synergy with manufacturability and safety, and that future progress may depend on multi-omics-guided patient stratification and modular, biocompatible platform design.
Competency based medical education: assessment of procedural and cognitive skills in gastroenterology residency training.
Cooper J, Gozdzik M, Lai H … +2 more , Silverman JA, Kroeker KI
BMC Med Educ · 2026 Jul · PMID 42399892 · Full text
INTRODUCTION: Competence by Design (CBD) was implemented in Canada to assess physician trainees' ability to demonstrate competence via entrustable professional activities (EPAs) utilizing the Ottawa Surgical Competency O...
INTRODUCTION: Competence by Design (CBD) was implemented in Canada to assess physician trainees' ability to demonstrate competence via entrustable professional activities (EPAs) utilizing the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE); a score originally validated to assess surgical competence. Our study assessed for differences in O-SCORE utilization between non-procedural (cognitive) and procedural EPA assessments in a real-world setting to inform future critical appraisal of CBD. METHODS: Adult Gastroenterology subspecialty EPA assessments from 2019 to 2023 at the University of Alberta were reviewed. Evaluator gender, clinical vs. academic practice, advanced training expertise, EPA type, and O-SCOREs were extracted from each EPA assessment. Competence assessments (achieved, neutral, not achieved) were assigned to each EPA assessment based on local competence committee protocols. Chi-squared testing with 95% confidence intervals were calculated. RESULTS: 2660 EPA assessments were included (1385 cognitive and 1275 procedural). Approximately 70% of total EPA assessments denote competence, with approximately 20% neutral, and < 10% indicating "competence not yet achieved". Proportionally higher cognitive EPA assessments denoted competence compared to procedural EPA assessments (75% vs. 63%, p < 0.01). Evaluator characteristics associated with EPA achievement were male gender, community (vs. academic), and hepatology (vs. luminal GI) practice. DISCUSSION: We report low rates of the full range of O-SCORE utilization and the majority amount of EPA assessments denoting competence. Further the proportion of EPAs assessed as success varied by evaluator characteristics (gender, specialty, and practice type). This stresses the need for continued cycles of critical appraisal to improve faculty assessment and feedback in residency trainee progress.
Uncommon initial presentation of a gastric mass in a patient with primary plasma cell leukemia: a case report.
Cui SJ, Yin H, Xu CL … +3 more , Chen Y, Wu ZY, Huang DP
BMC Gastroenterol · 2026 Jul · PMID 42399824 · Full text
BACKGROUND: Extramedullary infiltration is a recognized manifestation of primary plasma cell leukemia (pPCL); however, presentation as a gastric mass is rarely reported. This report describes a rare case of pPCL complica...
BACKGROUND: Extramedullary infiltration is a recognized manifestation of primary plasma cell leukemia (pPCL); however, presentation as a gastric mass is rarely reported. This report describes a rare case of pPCL complicated with prostate cancer, initially presenting as a gastric mass, and outlines the pathogenic mechanisms and clinical management course. A 68-year-old man presented with intermittent epigastric pain. Contrast-enhanced abdominal computed tomography (CT) revealed a gastric mass measuring 97 mm × 131 mm × 63 mm, subsequently confirmed as an extramedullary plasmacytoma on pathological examination. Bone marrow biopsy and peripheral blood immunophenotyping established the diagnosis of pPCL with gastric involvement. In view of an elevated prostate-specific antigen level, a targeted prostate biopsy was performed, confirming concomitant prostate cancer. The patient received three cycles of the Dara-RVD regimen for pPCL, along with leuprolide acetate and bicalutamide for prostate cancer. Follow-up evaluation demonstrated partial remission of pPCL. CONCLUSION: Additional case accumulation and further investigation of pathogenic mechanisms are warranted to optimize diagnostic approaches and improve therapeutic outcomes.
Benefits and challenges of adding BKM120 to a BI-3406 plus trametinib combination therapy.
Schulz B, Leitner E, Rabierad M … +6 more , Khan MI, Ehlers L, Escobar HM, Jaster R, Vollmar B, Zechner D
BMC Cancer · 2026 Jul · PMID 42399819 · Full text
BACKGROUND: Achieving a balance between efficacy and side effects is essential for the success of new combinatorial cancer therapies. This study investigated the impact of adding BKM120, a PI3K inhibitor, to a dual regim...
BACKGROUND: Achieving a balance between efficacy and side effects is essential for the success of new combinatorial cancer therapies. This study investigated the impact of adding BKM120, a PI3K inhibitor, to a dual regimen consisting of BI-3406, a KRAS/SOS1 inhibitor, and trametinib, a MEK inhibitor. METHODS: The therapeutic effects of these drug combinations were evaluated in the pancreatic cancer cell line 6606PDA using both monolayer and three-dimensional cultures. Additionally, their efficacy and potential side effects were assessed in vivo using a syngeneic orthotopic mouse model of pancreatic cancer. RESULTS: In vitro studies demonstrated that the addition of BKM120 to BI-3406 and trametinib significantly reduced cell viability in both monolayer and three-dimensional cultures. However, in a syngeneic pancreatic cancer mouse model, the triple therapy failed to significantly improve survival outcome compared to the dual therapy. Tumor weights were unaffected in female mice, while a minor, non-significant reduction was observed in male mice. This was accompanied by a slight, non-significant decrease in cancer cell proliferation. In the triple therapy group, Cdkn2a expression in tumors, a marker for senescence, remained largely unchanged. However, PD-L1 was significantly reduced in males, and CD8 T-cell infiltration was notably enhanced in females. Importantly, the triple therapy demonstrated several concerning drawbacks. It significantly increased lung metastases in female mice, reduced lymphocyte and erythrocyte counts, and elevated C-peptide concentrations in both sexes. Furthermore, behavioral analysis indicated a significant decline in burrowing and nesting activities among female mice during specific experimental phases. CONCLUSION: The addition of BKM120 to the combination of BI-3406 and trametinib provides minimal therapeutic benefit while introducing significant adverse effects, underscoring the need for caution when considering clinical applications.
Prevalence and factors associated with hepatitis B serostatus disclosure among adults receiving care at Hawassa University Comprehensive Specialized Hospital, southern Ethiopia: a cross-sectional study.
Woldegeorgis BZ, Ekubazgi KW, Urgesa EA
BMC Infect Dis · 2026 Jul · PMID 42399789 · Full text
BACKGROUND: Hepatitis B virus (HBV) infection is a globally prevalent disease and remains a significant public health burden. In Ethiopia, where HBV is endemic, it is a major contributor to chronic liver disease and live...
BACKGROUND: Hepatitis B virus (HBV) infection is a globally prevalent disease and remains a significant public health burden. In Ethiopia, where HBV is endemic, it is a major contributor to chronic liver disease and liver-related mortality. Timely disclosure of serostatus is crucial for preventing intra-family transmission, facilitating contact tracing and vaccination, promoting adherence to follow-up and antiviral therapy, and improving the physical and psychosocial well-being of affected individuals. Therefore, this study aimed to assess the prevalence of HBV serostatus disclosure and identify factors associated with disclosure among adults receiving care at the Gastroenterology clinic of Hawassa University Comprehensive Specialized Hospital. METHODS: An institution-based analytical cross-sectional study was conducted from July 20 to September 30, 2025, to enroll all eligible participants. Data were collected via interviewer-administered, semi-structured questionnaires supplemented by a data abstraction sheet, and analyzed using STATA version 16.1. Poisson regression with robust variance estimation identified factors associated with HBV serostatus disclosure; results were presented as adjusted prevalence ratios (aPR) with 95% confidence intervals (CI), and statistical significance was set at P < 0.05. RESULTS: Of the 245 participants, 171 (69.8%) were male, and the median age was 34 years (interquartile range: 26-45 years). Overall, 46.5% of participants (95% CI: 40.3-52.8%) disclosed their HBV serostatus to at least one contact. Factors independently associated with HBV serostatus disclosure included being female (aPR = 1.46; 95% CI: 1.07-2.00), being ever married (aPR = 1.80; 95% CI: 1.21-2.68), living with chronic HBV for more than five years (aPR = 1.25; 95% CI: 1.11-1.96), having no comorbidities (aPR = 3.24; 95% CI: 1.43-5.39), having normal liver status (aPR = 1.31; 95% CI: 1.00-1.72), and having a higher HBV knowledge score (aPR = 1.07; 95% CI: 1.03-1.12). CONCLUSIONS: The findings indicated that HBV serostatus disclosure was low when compared to other African settings. Disclosure was driven by female gender, being ever married, longer duration of HBV diagnosis, absence of comorbidities, normal liver status and higher HBV knowledge. While the study provided valuable insights into the dynamics of disclosure, its cross-sectional design meant that definitive causal relationships could not be established. CLINICAL TRIAL NUMBER: Not applicable.
Examining the effect of nurse navigation programme on stoma adjustment, quality of life, and prevention of complications in patients with stoma: a randomized controlled trial.
Yurdagül G, Tosun N
BMC Gastroenterol · 2026 Jul · PMID 42399788 · Full text
BACKGROUND: While the care of the stoma poses a problem for individuals, the presence of complications, lack of stoma adjustment, and impaired quality of life can be more exhausting for patients, as well. METHODS: This t...
BACKGROUND: While the care of the stoma poses a problem for individuals, the presence of complications, lack of stoma adjustment, and impaired quality of life can be more exhausting for patients, as well. METHODS: This thesis study was designed and conducted as a multicenter, randomised controlled intervention study with repetitive measurements in a pretest-posttest order. Patients, who underwent intestinal stoma in 5 hospitals, (one of which was private), in a city in the south-eastern Turkey between 20 March and December 31, 2021, participated in the study. Seventy-four patients, who were regarded eligible, were randomised and divided into experimental and control groups. A patient information form, the Stoma Complications Evaluation Form, the Stoma-Related Problems Form, the Ostomy Adjustment Inventory-23, and the Stoma Quality of Life Scale were used to collect data. RESULTS: Results of the study revealed a significant difference between the groups based on quality of life and stoma adjustment. CONCLUSIONS: The nurse navigation programme not only increases the quality of life and stoma adjustment in patients with stoma but also reduces stoma complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT05809661 (Registered: 30/03/2023). Retrospectively registered.
Determinants of eligibility for second-line chemotherapy following gemcitabine plus nab-paclitaxel therapy in patients with unresectable pancreatic cancer: a retrospective study.
Ueda T, Miyagawa K, Shibata M … +10 more , Mori Y, Oe S, Kajitani K, Uchihara D, Shinohara N, Ogino N, Kumei S, Honma Y, Watanabe T, Harada M
BMC Gastroenterol · 2026 Jul · PMID 42399778 · Full text
BACKGROUND: Second-line chemotherapy (2L) is recommended after gemcitabine plus nab-paclitaxel (GnP) first-line chemotherapy (1L) for unresectable pancreatic cancer (UR-PC). However, in routine clinical practice, not all...
BACKGROUND: Second-line chemotherapy (2L) is recommended after gemcitabine plus nab-paclitaxel (GnP) first-line chemotherapy (1L) for unresectable pancreatic cancer (UR-PC). However, in routine clinical practice, not all patients proceed to 2L. This retrospective study aimed to identify baseline clinical and biological factors associated with 2L eligibility. METHODS: We retrospectively reviewed the data of 124 consecutive patients with UR-PC who received 1L GnP between 2016 and 2024 at a single center, excluding those with postoperative recurrence. Patients were grouped by 2L receipt [2L( +), n = 63] or non-receipt [2L( -), n = 61]. Ascites was assessed based on baseline imaging findings and additionally classified as none, mild, or moderate-to-severe. Overall survival (OS) was assessed from completion or discontinuation of 1L GnP, and progression-free survival (PFS) was assessed from 1L GnP initiation, using Kaplan-Meier and Cox regression analyses. Cox regression analysis for OS included only baseline variables. RESULTS: The 2L( +) group less frequently had baseline ascites and better Eastern Cooperative Oncology Group performance status. The distribution of ascites severity also differed significantly between the groups. Median OS was 7.1 vs. 1.9 months (p < 0.001) and median PFS was 5.9 vs. 3.0 months (p = 0.004) for 2L( +) vs. 2L( -). Multivariate Cox analysis identified the absence of ascites as an independent factor associated with longer OS (hazard ratio [HR] 0.595, 95% confidence interval 0.367-0.963; p = 0.035). Multivariate logistic regression revealed that the absence of ascites independently predicted 2L eligibility (adjusted odds ratio 4.435, 95% CI 1.583 - 12.423, p = 0.005). CONCLUSIONS: Baseline ascites was independently associated with reduced eligibility for 2L after 1L GnP in patients with UR-PC. Nevertheless, patients who received 2L had longer survival than those who did not, including among those with baseline ascites. However, this association should be interpreted cautiously because of the retrospective design and potential treatment-selection bias. These findings may support individualized reassessment and proactive supportive care to maximize opportunities for sequential chemotherapy.
Integrating WGCNA and machine learning to identify and validate key biomarkers in MASLD.
Zhang J, Liang Q, Xu X … +2 more , Wang P, Yan B
BMC Gastroenterol · 2026 Jul · PMID 42399771 · Full text
BACKGROUND: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) represents the most prevalent chronic liver disease worldwide. The absence of approved pharmacotherapies is largely attributed to their profoun...
BACKGROUND: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) represents the most prevalent chronic liver disease worldwide. The absence of approved pharmacotherapies is largely attributed to their profound molecular heterogeneity. The identification of novel hub genes in MASLD is therefore critical for unraveling the complex molecular mechanisms driving disease pathogenesis and progression. METHODS: We employed an integrative systems-biology approach utilizing Weighted Gene Co-expression Network Analysis (WGCNA) followed by multi-algorithm machine learning (LASSO, Random Forest, SVM-RFE) across GEO datasets (GSE89632, GSE63067) to identify hub genes. Key hub genes were validated in vitro with FFA-treated HepG2 cells and in vivo with an HFD-fed mouse model. RESULTS: Bioinformatic analyses revealed two distinct pathological networks. First, a lipogenesis-associated cluster revealed FMO1 and C10orf140 as upregulated, alongside JUNB downregulation. In vitro, the expression of these genes was significantly associated with the activation of the SREBP-1c/FASN lipogenic pathway. Second, WGCNA revealed a co-expression module that exhibited high correlation with inflammation (R = 0.59, p = 4e-05), from which 11 hub genes relating to inflammation (such as MAP3K8, PFKFB3) were identified. In vivo, HFD mice developed severe steatosis and demonstrated a key pathological paradox: high-level activation of both the pro-lipogenic p-AKT and the inhibitory p-AMPK pathways. CONCLUSION: Our study identified the hub genes FMO1, C10orf140, and JUNB as novel regulators of MASLD lipogenesis through the SREBP-1c pathway. Additionally, we showed that co-activated p-AKT and p-AMPK in steatotic livers indicates "AMPK Resistance". Ultimately, we describe a mechanism of pro-lipogenic signaling that is not curtailed and is accompanied by the inability to compensate for the inhibitory path. All findings reveal potential therapeutic targets for MASLD.
Swallowing‑induced spontaneous pneumomediastinum after ingestion of a large, unchewed food bolus in a young adult: a case report.
Nakamura M, Suzuki K, Yoshida E … +4 more , Miyamoto Y, Nomoto T, Dohi K, Wada G
Int J Emerg Med · 2026 Jul · PMID 42399761 · Full text
BACKGROUND: Spontaneous pneumomediastinum (SPM) is a rare condition with a generally favorable prognosis, although severe complications, including respiratory arrest or tension emphysema, are reported; swallowing may be...
BACKGROUND: Spontaneous pneumomediastinum (SPM) is a rare condition with a generally favorable prognosis, although severe complications, including respiratory arrest or tension emphysema, are reported; swallowing may be an under-recognized precipitating factor. CASE PRESENTATION: A man in his 20s swallowed one‑third of a 10‑cm steamed meat bun without chewing. He developed throat tightness and chest pain without cough and presented to our emergency department. Chest computed tomography (CT) findings revealed extensive mediastinal emphysema; swallowing‑triggered spontaneous pneumomediastinum was diagnosed, and intravenous piperacillin/tazobactam was initiated. Esophagography on day 2 and endoscopy on day 3 showed no leakage or perforation. A CT scan on day 8 revealed near resolution, and he was discharged on day 9 without recurrence. We speculated that the large, unchewed bolus caused transient airway obstruction, leading to a sudden increase in intratracheal pressure and resulting in tracheal or alveolar microinjury. CONCLUSIONS: This case highlights swallowing of a large, unchewed food bolus as a potential trigger of pneumomediastinum. Considering swallowing‑triggered spontaneous pneumomediastinum in patients presenting with chest pain after eating may facilitate early diagnosis and help avoid unnecessary invasive investigations.
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