[JOURNAL] GASTROENTEROLOGY
Sun
200 papers
Mental health outcomes of living related donors for recipients with alcohol-associated hepatitis.
Hegde C, Venishetty S, D RS … +8 more , Kolar S, Alla M, Iyengar S, Menon PB, Sharma M, Rao PN, Reddy DN, Kulkarni AV
Indian J Gastroenterol · 2026 Jul · PMID 42400825 · Publisher ↗
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Association between response to gemcitabine-based neoadjuvant therapy and efficacy of gemcitabine plus nab-paclitaxel for recurrent pancreatic ductal adenocarcinoma.
Kinomoto T, Ikezawa K, Gotoh K … +14 more , Kai Y, Takada R, Masumoto T, Kawabata M, Kishimoto H, Ito K, Urabe M, Mukai K, Nakabori T, Shigekawa M, Akita H, Takahashi H, Kobayashi S, Ohkawa K
Int J Clin Oncol · 2026 Jul · PMID 42400776 · Publisher ↗
BACKGROUND: Gemcitabine-based neoadjuvant therapy is frequently employed to enable curative resection of pancreatic ductal adenocarcinoma. Gemcitabine plus nab-paclitaxel (GnP) is often given to patients who relapse post...
BACKGROUND: Gemcitabine-based neoadjuvant therapy is frequently employed to enable curative resection of pancreatic ductal adenocarcinoma. Gemcitabine plus nab-paclitaxel (GnP) is often given to patients who relapse post-resection, resulting in multiple courses of gemcitabine-containing treatment regimens. However, the effect of prior gemcitabine-based neoadjuvant therapy on the efficacy of GnP therapy remains unclear. This study aimed to determine whether prior gemcitabine-based neoadjuvant therapy affects the therapeutic outcomes of GnP in patients with recurrent pancreatic ductal adenocarcinoma following curative resection. METHODS: We retrospectively analyzed 51 patients with resectable and borderline resectable pancreatic ductal adenocarcinoma who received gemcitabine-based neoadjuvant chemoradiotherapy, underwent curative-intent surgery, and were treated with GnP post-recurrence. Patients were divided into high-regression (≥ 30% reduction in tumor diameter; 32 patients) and low-regression (< 30%; 19 patients) groups based on the tumor reduction rate during neoadjuvant therapy. RESULTS: Multivariate analysis identified tumor regression and the time from surgery to recurrence as independent prognostic factors for progression-free survival of GnP therapy following recurrence. Median progression-free survival was significantly longer in the high-regression group (11.8 vs. 5.8 months, p = 0.010). The objective response rate to GnP was significantly higher in the high-regression than low-regression groups (43.8% vs. 10.5%; p = 0.015). CONCLUSIONS: Patients with greater tumor regression during gemcitabine-based neoadjuvant therapy had better progression-free survival and treatment response to GnP therapy following recurrence. These findings suggest that treatment response to neoadjuvant therapy correlates with post-recurrence outcomes and contributes to the advancement of treatment strategies for recurrent pancreatic ductal adenocarcinoma.
Cardiac Arrests During Inpatient Gastrointestinal Endoscopic Procedures: A United States Nationwide Assessment.
Goble SR, Arias DW, Akambase JA … +1 more , Leventhal TM
Dig Dis Sci · 2026 Jul · PMID 42400717 · Publisher ↗
BACKGROUND: Major cardiac events can complicate endoscopic procedures. However, the true incidence and outcomes of these events are not well defined. AIMS: We aimed to define the true incidence of cardiac arrest during i...
BACKGROUND: Major cardiac events can complicate endoscopic procedures. However, the true incidence and outcomes of these events are not well defined. AIMS: We aimed to define the true incidence of cardiac arrest during inpatient endoscopic procedures and the associated outcomes. METHODS: We performed a cross-sectional retrospective analysis of the National Inpatient Sample from 2016 to 2023. Endoscopic intraprocedural cardiac arrests were identified using ICD-10 diagnostic and procedural codes. Multivariable logistic regression was used to assess patient and procedural factors associated with cardiac arrest. Outcomes among patients experiencing endoscopic intraprocedural cardiac arrest were compared with those of all other cases of in-hospital cardiac arrest. RESULTS: Among 11,137,008 inpatient endoscopic procedures, 1,110 were complicated by cardiac arrest, corresponding to one cardiac arrest per 10,125 procedures. Among assessed patient factors, congestive heart failure had the strongest association with cardiac arrest (aOR = 2.78, 95% CI 2.04-3.78; p < 0.001). Compared with upper endoscopy, colonoscopy was associated with a lower risk of cardiac arrest (aOR = 0.50, 95% CI 0.36-0.69; p < 0.001), while endoscopic retrograde cholangiopancreatography had a similar risk (aOR = 0.75, 95% CI 0.49-1.15; p = 0.183). In-hospital mortality was lower among patients with endoscopy-associated cardiac arrest compared with other cases of in-hospital cardiac arrest (30.6% vs. 71.0%; aOR-0.17, 95% CI 0.13-0.23; p < 0.001). CONCLUSIONS: Intraprocedural cardiac arrest is an uncommon complication of inpatient endoscopy. Upper endoscopy carries a higher risk than colonoscopy, and patients with congestive heart failure are at increased risk. Outcomes following endoscopy-associated cardiac arrest are more favorable than for other in-hospital cardiac arrests.
Targeting SYK to alleviate MDSC-driven immunosuppression and augment anti-PD1 efficacy.
Zeng Z, Cao X, Li C … +21 more , He Y, Guo H, Cao X, Gong T, Sun J, Hu Y, Hu Z, Lai Y, Zhang D, Warner N, Uhlig HH, Li Q, Muise AM, Tan Y, Huang Y, Deng L, Deng L, Sun Z, Zhong M, Zhang X, Li D
Sci China Life Sci · 2026 Jun · PMID 42400713 · Publisher ↗
Myeloid-derived suppressor cells (MDSCs) play a crucial role in tumor-associated immune suppression and in impeding immune checkpoint blockade (ICB) therapies; however, effective intervention strategies targeting MDSCs r...
Myeloid-derived suppressor cells (MDSCs) play a crucial role in tumor-associated immune suppression and in impeding immune checkpoint blockade (ICB) therapies; however, effective intervention strategies targeting MDSCs remain limited. In this study, we observed a positive correlation between spleen tyrosine kinase (SYK) activity in immune cells and tumor progression in human cancers. Utilizing a mouse model with a gain-of-function SYK mutation, we demonstrated that SYK activation promotes tumorigenesis in carcinogen-induced and xenograft models across multiple cancer types, largely through MDSC-dependent mechanisms. Mechanistically, SYK activates the JAK-STAT-CXCR2 signaling axis, enhancing MDSC migration and suppressing antitumor T cell responses. Notably, pharmacological inhibition of SYK not only inhibited tumor growth but also enhanced the therapeutic effect of anti-PD-1 in mouse models and patient-derived tumor organoid models. Our findings highlight the immunoregulatory role of SYK in tumor progression and suggest that targeting SYK represents a promising strategy to remodel the tumor microenvironment and enhance the efficacy of checkpoint blockade immunotherapy.
Retraction Note: 2-Hydroxylethyl methacrylate (HEMA), a tooth restoration component, exerts its genotoxic effects in human gingival fibroblasts trough methacrylic acid, an immediate product of its degradation.
Szczepanska J, Poplawski T, Synowiec E … +4 more , Pawlowska E, Chojnacki CJ, Chojnacki J, Blasiak J
Mol Biol Rep · 2026 Jul · PMID 42400694 · Publisher ↗
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Immune evasion, infectivity, and membrane fusion of SARS-CoV-2 variants LP.8.1.1, XEC.25.1, XFG, and NB.1.8.1.
Jiang F, Zheng M, Gao L … +11 more , Zhuo Y, Liang X, Chen Z, Huang X, Chen Y, Zeng Z, Xiao Y, Du X, Qin FX, Liu W, Tang H
Microbiol Spectr · 2026 Jun · PMID 42400485 · Publisher ↗
UNLABELLED: Emerging SARS-CoV-2 variants, with potentially enhanced immune evasion and transmissibility, pose a serious challenge to public health. This study provides a systematic characterization of the virological fea...
UNLABELLED: Emerging SARS-CoV-2 variants, with potentially enhanced immune evasion and transmissibility, pose a serious challenge to public health. This study provides a systematic characterization of the virological features of JN.1 descendant subvariants, including LP.8.1.1, KP.3, XEC.25.1, XFG, and NB.1.8.1, focusing on their infectivity, receptor binding, membrane fusion, and immune evasion capacity. Multiple JN.1 descendant variants exhibited reduced infectivity across various human cell lines, whereas XEC.25.1 and NB.1.8.1 demonstrated significantly enhanced cellular infectivity. JN.1 descendant variants retained the capability to infect cells expressing ACE2 orthologs from diverse mammalian species, indicating their persistent risk of zoonotic transmission. Notably, NB.1.8.1 exhibited the highest ACE2-binding affinity among all tested variants, while XEC.25.1 shows superior membrane fusion activity, particularly in cells expressing TMPRSS2. Serum neutralization assays revealed that LP.8.1.1, KP.3, XEC.25.1, XFG, and NB.1.8.1 exhibited enhanced immune evasion capabilities compared to the JN.1 strain, which was closely associated with their rapid transmission. These findings reveal that emerging JN.1 subvariants accelerate viral transmission by altering receptor-binding affinity, optimizing cellular entry efficiency, and enhancing immune evasion. Therefore, it is necessary to update vaccines and improve antiviral treatment strategies to meet the public health challenges posed by these variants. IMPORTANCE: SARS-CoV-2 JN.1 has continuously evolved during the epidemic, giving rise to multiple descendant variants. Currently, JN.1 sublineages NB.1.8.1, XFG, XEC.25.1, and LP.8.1.1 have emerged as the predominant circulating variants globally. The cellular infectivity, cross-species transmission potential, and immune evasion capacity of these emerging variants remain poorly characterized. This study employed a VSV pseudovirus system to characterize the virological features of JN.1 descendant subvariants. We found that the cellular infectivity of JN.1 descendant variants was significantly altered, which may be attributed to changes in receptor-binding affinity or membrane fusion activity. The emerging JN.1 subvariants retained the ability to infect cells expressing ACE2 orthologs from diverse species. Furthermore, the emerging variants LP.8.1.1, KP.3, XEC.25.1, XFG, and NB.1.8.1 exhibited enhanced immune evasion capabilities compared to the JN.1 strain. Our study underscores the importance of surveillance and virological research for emerging JN.1 descendant variants.
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.
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.
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