Akbulut UE, Atalay A, Isik İA
… +7 more, Sivil N, Sarı M, Birsen G, Kara OK, Kara K, Ulu HS, İnal HA
Eur J Pediatr
· 2026 May · PMID 42081144
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UNLABELLED: While the gastrointestinal symptoms of ulcerative colitis (UC) are well-defined, its impact on motor development in children remains poorly understood. We aimed to assess motor proficiency, handgrip strength,...UNLABELLED: While the gastrointestinal symptoms of ulcerative colitis (UC) are well-defined, its impact on motor development in children remains poorly understood. We aimed to assess motor proficiency, handgrip strength, and physical activity levels in children with UC and to investigate associations with disease activity. In this cross-sectional study, 49 children with UC aged 8-17 years and 41 age‑ and sex-matched healthy controls were enrolled. Disease activity was assessed using the Pediatric Ulcerative Colitis Activity Index, and laboratory markers including C-reactive protein and erythrocyte sedimentation rate were measured. Motor proficiency was evaluated using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Handgrip strength was measured with a dynamometer, and physical activity was assessed via the Physical Activity Questionnaire (PAQ). Group comparisons were adjusted for age, sex, socioeconomic status, and body mass index, with False Discovery Rate correction for multiple testing. Children with UC scored significantly lower on the Total Motor Composite than controls (37.4 vs. 45.1, p < 0.001). Adjusted analyses revealed a specific pattern: fine motor skills were preserved, but significant deficits were found in gross motor domains, including bilateral coordination and strength and agility (all p < 0.001). Handgrip strength differences lost significance after adjustment for body mass index, and no difference was observed in physical activity. Within the UC group, a higher erythrocyte sedimentation rate correlated with lower non-dominant handgrip strength (ρ = - 0.533, p < 0.001) and poorer agility (ρ = - 0.414, p = 0.003). CONCLUSION: Children with UC exhibit significant gross motor deficits, even during clinical remission. These cross-sectional findings indicate that clinically well children may still have impaired motor proficiency compared to healthy peers. However, longitudinal studies are needed to determine whether these deficits predate diagnosis, emerge during active disease, or persist despite remission. WHAT IS KNOWN: • The primary treatment goal in ulcerative colitis with children is the resolution of symptoms and intestinal inflammation. • The potential effects of ulcerative colitis on a child's motor function are not routinely assessed in clinical practice. WHAT IS NEW: • Children with ulcerative colitis have significantly lower overall motor proficiency scores compared to their healthy peers. • Children in clinical remission may still have impaired motor skills, indicating a potential need for comprehensive functional assessment during follow-up.
Covert hepatic encephalopathy (CHE) is a frequent and clinically relevant complication of liver cirrhosis, affecting approximately 30-70% of patients. Despite the absence of overt neurological symptoms, CHE is associated...Covert hepatic encephalopathy (CHE) is a frequent and clinically relevant complication of liver cirrhosis, affecting approximately 30-70% of patients. Despite the absence of overt neurological symptoms, CHE is associated with impaired quality of life and increased risks of falls, traffic accidents, hospitalization, progression to overt HE (OHE), and mortality. The pathophysiology of HE, including CHE and OHE, is multifactorial and involves complex interactions among hyperammonemia, systemic inflammation, oxidative stress, gut dysbiosis, bile acid dysregulation, and sarcopenia along the gut-liver-brain axis. Several diagnostic tools are available, including psychometric batteries, computerized neuropsychological assessments, the Stroop test, critical flicker frequency, and the inhibitory control test. However, time and resource constraints hinder their routine implementation in real-world clinical settings, leading to substantial underdiagnosis of CHE. Although treatment strategies for CHE have not yet been fully established, non-absorbable disaccharides and rifaximin have emerged as promising ammonia-lowering therapies and microbiota-targeted interventions for improving cognitive function and reducing the risk of progression to overt HE. Early recognition and multidisciplinary intervention for CHE are essential to prevent disease progression and improve clinical outcomes. This review summarizes the current evidence on the epidemiology, pathophysiology, diagnosis, clinical significance, and therapeutic approaches for CHE in cirrhosis, with the aim of enhancing its recognition and optimizing patient management.
Harumatsu T, Tsuruno Y, Nagano A
… +17 more, Sugita K, Tabata Y, Nishida N, Kedoin C, Murakami M, Yano K, Kurimoto T, Yara A, Otsuka H, Onishi S, Yamada K, Yamada W, Hirakawa E, Kawano T, Torikai M, Tokuhisa T, Ieiri S
Pediatr Surg Int
· 2026 May · PMID 42080958
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PURPOSE: Small bowel atresia (SBA) presents with variable clinical features depending on anatomical location. We investigated the relationship between atresia location and preterm delivery. METHODS: We retrospectively re...PURPOSE: Small bowel atresia (SBA) presents with variable clinical features depending on anatomical location. We investigated the relationship between atresia location and preterm delivery. METHODS: We retrospectively reviewed 58 patients who underwent surgery for SBA at two institutions between April 2000 and March 2024. Patients were divided into preterm (<37 weeks, n=28) and term (≥37 weeks, n=30) groups. Clinical characteristics, prenatal findings, anatomical location, and surgical outcomes were compared. A logistic regression analysis identified independent predictors of preterm delivery. RESULTS: Preterm infants showed lower birth weight (1988±731 g vs. 3062±395 g, p<0.001) and higher rates of prenatal diagnosis (85.7% vs. 60.0%, p=0.040), polyhydramnios (42.9% vs. 13.3%, p=0.018), and bowel dilatation (78.5% vs. 50.0%, p=0.031). The distance from the ligament of Treitz was shorter in preterm infants (31.6±31.5 cm vs. 103.6±39.9 cm, p<0.001). Jejunal atresia was more common in preterm infants (71.4% vs. 6.7%; p<0.001). A strong correlation was observed between birth weight and atresia distance (r=0.63, p<0.001). In a multivariable analysis, proximal atresia was an independent predictor of preterm delivery (adjusted OR 0.79 per 10 cm, 95% CI 0.65-0.96, p=0.018). CONCLUSION: Proximal SBA was independently associated with preterm delivery. Prenatal identification may facilitate appropriate perinatal management and parental counseling.
Burdan A, Miutescu B, Gadour E
… +9 more, Burciu C, Danila M, Bende F, Tudor M, Almuhaidb A, Lupusoru R, Brasovan A, Sirli R, Popescu A
Medicina (Kaunas)
· 2026 Apr · PMID 42075651
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: Endoscopic ultrasound point shear-wave elastography (EUS-pSWE) bypasses subcutaneous fat and may provide weight-independent liver stiffness measurements; however, data on reproducibility and quality criteria remain lim...: Endoscopic ultrasound point shear-wave elastography (EUS-pSWE) bypasses subcutaneous fat and may provide weight-independent liver stiffness measurements; however, data on reproducibility and quality criteria remain limited. This study aimed to evaluate the intra-observer reproducibility and short-term variability of EUS-pSWE. : In this single-center prospective cohort study (December 2024-February 2025), 120 consecutive adults undergoing diagnostic EUS were enrolled. For each hepatic lobe, 10 consecutive measurements were obtained and grouped into two sequential blocks of five measurements without scope repositioning. Intra-observer reproducibility was assessed using intraclass correlation coefficients (ICC3,1). The agreement between acquisition runs and determinants of short-term variability was also evaluated. Same-day vibration-controlled transient elastography (VCTE) served as an external comparator. : Forty-six participants were obese (BMI ≥ 30 kg/m). The mean VCTE stiffness was 6.24 kPa, while the mean EUS-pSWE stiffness was 9.40 ± 5.64 kPa. Among examinations meeting IQR/Median < 30% quality criteria, reproducibility was excellent (left ICC 0.97 [0.95-0.98]; right ICC 0.92 [0.86-0.95]) and consistent across BMI strata. EUS-pSWE correlated strongly with VCTE (r = 0.81, < 0.001). In contrast, agreement between consecutive acquisition runs was low, indicating increased short-term variability. EUS-pSWE quality pass rates based on IQR/Median criteria were modest (left 56.7%, right 41.7%, both lobes 23.3%), although all measurements fulfilled device-specific validity criteria (VSN > 60%). Age and BMI were not significant predictors of variability. : EUS-pSWE demonstrates excellent intra-observer reproducibility under quality-controlled conditions and shows a strong correlation with VCTE. However, short-term variability between acquisition runs and limited feasibility based on conventional quality thresholds should be considered. EUS-pSWE appears to be a promising modality for liver stiffness assessment, warranting further validation of quality criteria and clinical thresholds.
BACKGROUND: Type 2 diabetes (T2D) and alcohol consumption are well-established risk factors for adverse clinical outcomes among individuals with steatotic liver disease (SLD). However, data about the synergistic effects...BACKGROUND: Type 2 diabetes (T2D) and alcohol consumption are well-established risk factors for adverse clinical outcomes among individuals with steatotic liver disease (SLD). However, data about the synergistic effects of T2D and alcohol on all-cause and liver-related mortality in SLD remain scarce. METHOD: Leveraging data from UK Biobank and U.S. NHANES, we assessed risks of all-cause and liver-related mortality across 6 groups stratified by T2D status and SLD spectrum using Cox proportional hazards models: no T2D + MASLD, no T2D + MetALD, no T2D + ALD, T2D + MASLD, T2D + MetALD and T2D + ALD. The population attributable fraction (PAF) and relative excess risk due to interaction (RERI) were calculated to examine the interplay between these two factors. RESULTS: 24,052 all-cause and 953 liver-related deaths were recorded for 174,711 participants from the UK Biobank. The coexistence of T2D and elevated alcohol intake, particularly when with T2D and ALD, was associated with substantially worse outcomes, including a 1.23-1.60 fold increased risk of all-cause mortality and a markedly higher 1.65-7.45 fold risk of liver-related mortality compared with no T2D + MASLD. The combined effect of T2D and alcohol use accounted for a modest PAF of 6.74% for all-cause mortality, but they contributed to a PAF of 41.63% for liver-related mortality. Significant RERI was exclusively observed for liver-related mortality, but not for all-cause mortality. CONCLUSIONS: Co-exposure to T2D and alcohol intake substantially increased the risk of all-cause and liver-related mortality among individuals with SLD. Their interplay conferred significant disease burden, underscoring the importance of alcohol abstinence and glycemic control in this population.
BACKGROUND: Radiomics holds promise for extracting quantitative biomarkers from CT images of hepatocellular carcinoma (HCC), but its clinical translation is hampered by poor reproducibility caused by variations in image...BACKGROUND: Radiomics holds promise for extracting quantitative biomarkers from CT images of hepatocellular carcinoma (HCC), but its clinical translation is hampered by poor reproducibility caused by variations in image acquisition, manual segmentation and feature extraction. This multicenter study assessed the reproducibility of both segmentation and radiomic features in patients with early, intermediate and advanced HCC. METHODS: Forty-five patients (15 per centre; 5 per tumor stage) from three institutions underwent contrast-enhanced CT. Three radiologists independently delineated lesion and perilesion regions on arterial (HAP) and portal venous phases (PVP) using 3D‑Slicer. Segmentation quality was assessed with the Jaccard index; masks with < 25% concordance were manually revised. Using the SlicerRadiomics module, 851 features per phase were extracted, and reproducibility was measured via the generalized concordance correlation coefficient (GCCC) before and after revision. RESULTS: Median Jaccard values were 0,40, 0,56and 0,74, between center 1 and 2, between center 1 and center 3, and between center 2 and 3, respectively. Twenty-seven segmentations underwent manual revision based on Jaccard index. After manual revision Lesion features (mean GCCC 0,65) were more reproducible than perilesional ones (0,52), and PVP produced slightly higher concordance than HAP. Before revision, mean GCCC ranged from 0.45 to 0.68 (median 0.48-0.77); early-stage lesions had the highest reproducibility and advanced-stage the lowest. After revision, lesion mean GCCC improved to 0.71 (HAP) and 0.67 (PVP), with larger gains in intermediate-stage tumours, while perilesional concordance improved modestly. CONCLUSIONS: Radiomic feature reproducibility depends on HCC stage and region. Early HCC lesions yield more reproducible features compared to advanced tumours. Manual revision enhances concordance, particularly for lesion regions, but defining peritumoral tissue remains challenging.
Acute-on-chronic liver failure (ACLF) is a life-threatening condition characterized by acute hepatic decompensation, multi-organ failure, and high short-term mortality in patients with liver cirrhosis. A hallmark of ACLF...Acute-on-chronic liver failure (ACLF) is a life-threatening condition characterized by acute hepatic decompensation, multi-organ failure, and high short-term mortality in patients with liver cirrhosis. A hallmark of ACLF is profound deterioration of the immune system, which contributes to organ-specific excessive inflammation and immune dysfunction, predisposing patients to infection and multi-organ failure. This review aims to elucidate the cellular and molecular mechanisms underlying systemic immune dysfunction in ACLF, highlighting key pathophysiological pathways and their clinical significance. We provide an overview of ACLF including its global prevalence and clinical significance, against the background of the underlying immune dysfunction in its pathogenesis. The discussion focuses on innate immune alterations, such as impaired neutrophil and monocyte phagocytosis, excessive neutrophil extracellular trap (NET) formation, and monocyte/macrophage dysfunction contributing to immuneparesis and exaggerated inflammation, respectively, which evolve in an organ-specific manner. Dysregulation of natural killer (NK) cell cytotoxicity and adaptive immune dysfunction, including changes in T cell subpopulations and B cell antibody production in ACLF, are discussed. We further dissect the emerging evidence of molecular pathways driving dysfunction of immune cells and their impaired ability to control infections in ACLF, emphasizing the roles of pathogen- and damage-associated molecular patterns (PAMPs/DAMPs), toll-like receptor (TLR) signaling, oxidative stress, mitochondrial dysfunction, epigenetic/metabolic reprogramming and immune checkpoint molecules. The review expands on immune cell communication within the immune system (innate and adaptive), with other non-parenchymal and parenchymal cells and at the inter-organ level, detailing interactions between immune cells of key organs and compartments affected during ACLF, including the liver, circulation, brain, gut and kidney. Finally, we summarize the latest preclinical and clinical findings exploring biomarkers of immune dysfunction and immunomodulatory therapeutic strategies aimed at restoring immune homeostasis in patients with ACLF.
Advanced chronic liver disease (ACLD) with underlying cirrhosis is increasingly recognised as a condition shaped by the 'oral-gut-liver axis', in which dysbiosis within the oral microbiome contributes to systemic inflamm...Advanced chronic liver disease (ACLD) with underlying cirrhosis is increasingly recognised as a condition shaped by the 'oral-gut-liver axis', in which dysbiosis within the oral microbiome contributes to systemic inflammation, infection, decompensation, and acute-on-chronic liver failure. Periodontal disease is highly prevalent in ACLD and is associated with endotoxaemia, immune dysfunction, and hepatic complications. The protected dental biofilm and keystone pathogens are key to the development of local and systemic inflammatory processes. The concept of "oralisation" of the gut microbiome further links oral dysbiosis to microbial translocation and hepatic injury. Recent advances in multi-omics, resistome profiling, and spatially resolved imaging have deepened insights into community function and host-microbial crosstalk, while salivary biomarker panels and microbial signatures across different aetiologies suggest potential tools for non-invasive diagnosis and risk stratification. Clinical priorities now lie along two complementary paths. The first is immediate implementation: embedding routine periodontal assessment and professional plaque removal within hepatology care; consistent advice on oral hygiene, fluoride use, diet, and smoking and alcohol cessation; careful review of proton-pump inhibitor use; and much closer coordination between hepatologists and dentists to facilitate indicated procedures. The second is innovation: development of precision microbiome-based interventional trials powered for hepatic outcomes, including targeted probiotics and postbiotics, biofilm-disrupting and quorum-quenching strategies, and phage or narrow-spectrum antimicrobial therapies supported by rapid diagnostics and robust antimicrobial stewardship. Integrating oral health into hepatology practice may represent a practical opportunity to reduce infection risk, delay decompensation, and improve survival and quality of life in people living with ACLD. This review aims to synthesise current knowledge of the pathobiological mechanisms, analytical innovations, and therapeutic opportunities that underpin this evolving connection, while identifying gaps in the evidence base and proposing future avenues for harnessing the oral-gut-liver axis.
BACKGROUND: More than 80% of eligible adults who smoke are not up to date with lung cancer screening, and >40% are overdue for colorectal cancer screening. Blood-based screening tests may offer a less burdensome alternat...BACKGROUND: More than 80% of eligible adults who smoke are not up to date with lung cancer screening, and >40% are overdue for colorectal cancer screening. Blood-based screening tests may offer a less burdensome alternative to existing modalities. We used conjoint analysis to assess preferences for blood-based lung cancer and colorectal cancer screening compared with traditional methods [low-dose computed tomography (LDCT) for lung cancer; stool tests or colonoscopy for colorectal cancer]. METHODS: An online choice-based conjoint survey was administered to US adults aged 50 to 75 years who were not up to date with lung cancer and colorectal cancer screening. To recruit respondents, we collaborated with a survey research firm (Cint) that partners with multiple survey panels across the United States. Participants compared hypothetical screening test combinations varying in modality, frequency, and accuracy. Simulations identified preferred screening strategies, and logistic regression examined factors associated with preferring blood-based screening. RESULTS: Among 1,741 participants, 43.9% preferred blood tests every 3 years for both cancers, whereas 28.6% favored traditional screening for both. Another 21.9% preferred a blood test for lung cancer and a traditional colorectal cancer test, and 5.6% chose LDCT with a colorectal cancer blood test. Nonmarried individuals, those with comorbidities, and those who exercised infrequently were more likely to prefer blood-based screening (P < 0.05). Conversely, non-Hispanic Black participants and higher-income individuals were less likely to choose blood tests (P < 0.05). CONCLUSIONS: Nearly half of adults not up to date with lung cancer and colorectal cancer screening preferred blood-based testing for both cancers. IMPACT: Blood-based tests may help reduce barriers and improve lung cancer and colorectal cancer screening uptake.
Bak MTJ, de Vries AC, Stassen LPS
… +4 more, Ter Kuile MM, van der Meulen-de Jong AE, van Ruler O, ALERT‐CD study group, the Dutch Initiative on Crohn and Colitis and the Dutch Initiative on Crohn and Colitis—Surgery
Colorectal Dis
· 2026 May · PMID 42059297
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BACKGROUND: Sexual function is one of the determinants of quality of life (QoL) and is prevalent in approximately half of the patients with inflammatory bowel disease. However, the sexual function in patients with perian...BACKGROUND: Sexual function is one of the determinants of quality of life (QoL) and is prevalent in approximately half of the patients with inflammatory bowel disease. However, the sexual function in patients with perianal fistulizing Crohn's disease (pCD) needs to be further elucidated. This study aimed to evaluate the sexual function, the correlation with health-related QoL (HR-QoL), and to identify risk factors for sexual dysfunction (SD) in patients with active pCD. METHODS: Patients with active pCD were identified from a prospective multicentre cohort study in 41 Dutch hospitals. Respondents to sexual function (FSFI for females or IIEF-5 for males) and HR-QoL questionnaires were included in this study. The primary outcome was the prevalence of SD (FSFI <26.55, IIEF-5 <22). Potential risk factors for SD were identified using multivariable logistic regression. RESULTS: 211 patients were included (52% females, median age 37 years, median pCD duration 4 years). Overall, SD was reported by 69% (females 75%, males 63%, p = 0.046). A weak correlation of SD was observed with the CAF-QoL scale (r = 0.25) and the sIBDQ (r = -0.24). Older age (aOR 1.0; 95% CI 1.0-1.1), a longer pCD duration (aOR 0.9; 95% CI 0.8-0.9) and a decreased pCD-related QoL (aOR 1.0; 95% CI 1.0-1.1) were independently associated with SD. In subgroup analysis of patients with a known partner status (66.1%), having a partner (aOR 0.3; 95% CI 0.1-0.9) was identified as a protective factor. CONCLUSION: Sexual dysfunction is common in both male and female patients with active pCD. A weak correlation between HR-QoL and sexual dysfunction suggests that these questionnaires do not fully assess sexual function, highlighting the need for separate evaluation. Factors such as age, reduced pCD-related QoL, longer pCD duration and having a partner were associated with sexual dysfunction. Given its prevalence, routine sexual function assessment by the treating team is recommended, with referral to a sexologist or other expert when needed.
Int J Chron Obstruct Pulmon Dis
· 2026 · PMID 42058956
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an emerging non-communicable priority in Africa, yet how the COVID-19 era has shaped COPD burden and its drivers across the continent remains unclear. METHODS:...BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an emerging non-communicable priority in Africa, yet how the COVID-19 era has shaped COPD burden and its drivers across the continent remains unclear. METHODS: Using Global Burden of Disease (GBD) 2023 estimates, we quantified COPD incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for 52 African countries from 2019 to 2023. Age-standardised rates (ASRs) per 100,000 population were calculated using the GBD standard population. Trends were summarised using estimated annual percentage change (EAPC). Das Gupta decomposition partitioned changes in total DALYs into contributions from population growth, population ageing, and epidemiologic change (changes in age-specific DALY rates). Frontier analysis benchmarked 2023 age-standardised DALY rates against Socio-demographic Index (SDI)-expected values to identify over- and under-performing countries. Socioeconomic gradients were assessed using the Slope Index of Inequality (SII). RESULTS: From 2019 to 2023, incident COPD cases increased from 751,091 to 871,054 (+16.0%), prevalent cases from 10.99 to 12.70 million (+15.6%), DALYs from 3.56 to 3.86 million (+8.5%), and deaths from 119,371 to 125,680 (+5.3%). Median age-standardised DALY and mortality rates declined from 579.6 to 540.6 and from 23.2 to 21.2 per 100,000, respectively, whereas incidence and prevalence ASRs rose modestly in most countries. Men had higher age-specific incidence and prevalence than women, with substantially larger excesses in DALYs (~50-60%) and mortality (~70-80%) across adult age groups. Decomposition showed that the net increase of ~303,100 DALYs was driven mainly by population growth and ageing, while epidemiologic improvements offset ~60% of demographic pressure. Frontier analysis showed marked heterogeneity: about one-third of countries had DALY rates ≥20% above SDI-expected values, whereas another third achieved burdens at or below the frontier. CONCLUSION: In the immediate post-pandemic period, Africa has rising absolute COPD burden but improving age-standardised disability and mortality in most countries. Large sex disparities and wide performance gaps at similar SDI levels highlight opportunities for targeted tobacco control, clean-energy transitions, and strengthened chronic respiratory care.