Turkish Journal of Gastroenterology最新文献

Background/aims: Postoperative pancreatic fistula (POPF), which is considered the most frightening complication after pancreatic oduodenectomy (PD), continues to be a serious problem even in experienced centers. In the present study, we aimed to determine the risk factors that increase the progression from biochemical leak (BL) to clinically relevant postoperative pancreatic fistula (CR-POPF) after PD.

Materials and methods: We retrospectively analyzed the data of 152 patients who underwent PD. A total of 71 patients who developed POPF were included in the study and divided into two groups: 52 patients remained in the BL stage and 19 patients progressed from BL to CR-POPF. The groups were compared in terms of preoperative data, perioperative findings, and postoperative results. Risk factors for progression from BL to CR-POPF were analyzed.

Results: Preoperative prognostic nutritional index (PNI) was significantly lower in the CR-POPF group compared to the BL group (35.6 (30.1-47.9) vs 41.6 (33.5-58), P < .001). Receiver operating characteristic (ROC) curve analysis showed that the best cutoff of preoperative PNI value for predicting this progression was 38 (AUC = 0.835; 95% CI, 0.717-0.953; P = .001). While the progression rate was 58.3% in the group with PNI < 38, it was 10.6% with PNI ≥ 38. In univariate and multivariate analysis, preoperative PNI value was the only independent risk factor for progression from BL to CR-POPF after PD (OR, 15.428; 95% CI, 3.714-64.085; P < .01).

Conclusion: Preoperative PNI value is an important parameter predicting the progression from BL to CR-POPF after PD.

Background/aims: Hepatocellular carcinoma (HCC) is a globally prevalent malignant tumor with high recurrence and mortality rates. Long noncoding RNAs (lncRNAs) have been utilized to investigate the progression of various cancers, including HCC. The objective of this research is to explore the mechanism and prognostic impact of lncRNA LINC00449 on HCC.

Materials and methods: LINC00449 and miR-329-3p levels in HCC were measured using RT-qPCR. The impact of high- or lowLINC00449 expression on survival was tested. CCK-8, plate cloning, flow cytometry, and Transwell assays were selected to assess the biological functions of HCC cells. Kaplan-Meier and multivariate Cox analyses were conducted to evaluate the potential of LINC00449 as a prognostic marker for HCC. The interaction between LINC00449, miR-329-3p, and KIF5A was investigated through luciferase activity assays.

Results: LINC00449 expression in HCC tissues was increased. Silencing of LINC00449 improved the survival prospects of patients with HCC. Moreover, LINC00449 targeting the miR-329-3p/KIF5A axis influences the progression of HCC.

Conclusion: LINC00449 may become a biomarker for the prognosis of HCC, and the LINC00449/miR-329-3p/KIF5A regulatory network mediates the deterioration of HCC.

Pancreatic cystic lesions (PCLs) are frequent incidental findings with an increasing prevalence with age. For these significant lesions, accurate characterization of cyst type and prediction of the risk of malignant progression are crucial for specific management, such as deciding to monitor a lesion or pursue surgical intervention. Fortunately, endoscopy-based diagnostic and therapeutic techniques like endoscopic ultrasound with fine needle aspiration, confocal endomicroscopy, through-the-needle biopsy, contrast-enhanced endoscopic ultrasound, ablation, and pancreatoscopy have enabled increasingly accurate diagnoses of PCLs. Surgical management should be considered in certain cases. This narrative review's objective is to appraise and synthesize the salient literature on the endoscopic and surgical management of PCLs to aid clinician decision-making. We analyze the current data and explore the benefits, challenges, and future prospects of endoscopy and surgery for pancreatic cysts.

Background/aims: Colorectal cancer (CRC) is one of the deadliest cancers worldwide, mostly arising from adenomatous polyps. Mounting evidence has demonstrated that changes in the gut microbiome play key roles in CRC progression, while quite few studies focused on the altered microbiota architecture of advanced adenoma (AA), a crucial precancerous stage of CRC. Thus, we aimed to investigate the microbial profiles of AA patients.

Materials and methods: Fecal samples were collected from 26 AA patients and 26 age- and sex-matched normal controls (NC), and analyzed by shotgun metagenomic sequencing.

Results: Gut microbial dysbiosis was observed in AA patients with lower alpha diversity. Advanced adenoma was characterized by an increased Bacillota/Bacteroidota ratio and higher Pseudomonadota levels compared to normal individuals. Linear discriminant analysis effect size (LEfSe) analysis was performed and identified 14 microbiota with significantly different abundance levels between AA and NC groups. Functional analysis revealed that tryptophan metabolism was upregulated in AA. Correspondingly, the expressions of gut microbes implicated in tryptophan metabolism also changed, including Akkermansia muciniphila, Bacteroides ovatus, Clostridium sporogenes, and Limosilactobacillus reuteri. The microbial network suggested that AA exhibited decreased correlation complexity, with Escherichia coli and Enterobacteriaceae unclassified harboring the strongest connectivity. A diagnostic model consisting of 3 microbial species was established based on random forest, yielding an area under the curve (AUC) of 0.799.

Conclusion: Our study profiled the alterations of the gut microbiome in AA patients, which may enrich the knowledge of microbial signatures along with colorectal tumorigenesis and provide promising biomarkers for AA diagnosis.

Background/aims: N-Methyl-N'-nitroso-N-nitrosoguanidine (MNNG) is suspected to increase the risk of developing stomach cancer. Folic acid (FA) is familiar with decreasing inflammation. We expected that FA would protect against MNNG-induced gastric mucosal injury.

Materials and methods: Thirty 12-week-old SPF-grade female Sprague-Dawley (SD) rats were treated with MNNG and given different dosages of FA as an intervention measure. Quantitative polymerase chain reaction (qPCR) was used to analyze the expression of IL-1, IL-6, IL-8, IL-18, TNF-α, NLRP3, ASC, and caspase-1 genes. The enzyme-linked immunosorbent assay (ELISA) was utilized for the identification of inflammatory cytokines. Western blot was accustomed to detecting IL-1β, IL-18, and NLRP3 inflammatory vesicles in gastric tissue. Furthermore, the gastric mucosal tissues underwent histological examination.

Results: Our investigation demonstrated that FA reduced MNNG-induced inflammatory factor increase by decreasing NF-κB signaling (P < .05). Furthermore, FA prevented the MNNG-induced upregulation of NLRP3 inflammasome-related genes and proteins (all P < .01).

Conclusion: Our data imply that MNNG exposure stimulates the NF-κB/NLRP3 pathway, while FA suppresses it, limiting stomach mucosal inflammation.

Background/aims: Pancreatic duct stones (PDS) are one of the leading complications of chronic pancreatitis, causing intractable upper abdominal pain, aggravating the underlying disease, and even increasing the risk of pancreatic cancer. At present, pancreatoscopyguided lithotripsy is considered the second-line endoscopic treatment for pancreatic duct stones. In this systematic review and metaanalysis, we evaluated the efficacy and safety of pancreatoscopy-guided lithotripsy.

Materials and methods: A systematic search was conducted across several medical electronic databases, including PubMed, Web of Science, Medline, and Embase, encompassing publications up to December 2022. Studies reporting complete stone clearance rate, clinical success rate, and adverse event rate were included for analysis. We further aimed to compare the outcomes between electrohydraulic lithotripsy and laser lithotripsy treatment groups.

Results: A total of 17 studies (5 prospective studies and 12 retrospective studies) with 441 patients were included in the meta-analysis. Pooled complete stone clearance rate was 81% (95% CI, 0.74-0.88), pooled clinical success rate was 90% (95% CI, 0.84-0.95), while the pooled adverse event rate was 12% (95% CI, 0.07-0.19).

Conclusion: Pancreatoscopy-guided lithotripsy is a safe and effective treatment for pancreatic duct stones. This is evidenced by high pooled rates of complete stone clearance and clinical success, combined with a relatively low incidence of adverse events.

Background/aims: Colorectal cancer (CRC) is a significant global health concern, and understanding the molecular mechanisms underlying CRC progression and prognosis is crucial. Neutrophil extracellular traps (NETs) have been implicated in various cancers, but their role in CRC and its clinical implications remain to be elucidated.

Materials and methods: Transcriptomic data from TCGA of CRC patients were analyzed to assess NETs enrichment and "NETs formation" pathway scores in NETs_high and NETs_low groups. Univariate Cox regression was used to identify prognosis-associated genes with the Log-Rank test for selection. Patients in the TCGA database were randomly split into training and testing sets to build a prognostic model with LASSO Cox regression. Model diagnostic performance was evaluated using Kaplan-Meier curves and receiver operating characteristic analysis. Single-sample gene set enrichment analysis (ssGSEA) was used to determine the abundance of 23 immune cells. ESTIMATE was used to calculate ImmuneScore and ESTIMATEScore, characterizing immune features of CRC samples.

Results: The NETs_high group in CRC showed significantly better survival than the NETs_low group. A robust prognostic model based on PRKRIP1, SERTAD2, ELFN1, and LINC00672 accurately predicted patient outcomes. NETs_high samples exhibited a more enriched immune environment with higher immune cell infiltration levels, as well as ImmuneScore and ESTIMATEScore. PRKRIP1, SERTAD2, ELFN1, and LINC00672 were significantly correlated with key immune cell types. Additionally, 18 drugs displayed differential sensitivity between NETs_high and NETs_low groups, with Daporinad and Selumetinib as potential therapeutic options.

Conclusion: Our findings may catalyze the development of personalized treatment modalities and bestow invaluable insights into the intricate dynamics governing CRC progression.

Background/aims: This study aimed to evaluate the possible synergistic gastroprotective activity of quercetin and misoprostol in gastric ulcers induced by ethanol in rats.

Materials and methods: Male Wister albino rats were allocated into 6 groups: Negative control, positive control, esomeprazole, quercetin, misoprostol, and a combination of quercetin and misoprostol. All the treatment groups except for the negative control were challenged with a single dose of ethanol (90%) after 14 days of treatment. The animals were euthanized 1 hour after ethanol administration, and the blood samples were collected and used for the measurement of catalase, GSH, LDH, and IL-6. The stomachs were immediately removed and used for the measurement of gastric ulcer index, lesion area, gastric volume, and pH. Finally, gastric tissue was sent for histopathological examination.

Results: The combination of quercetin with misoprostol resulted in a comparable effect to esomeprazole regarding the inhibitory effect on gastric lesions, ulcer index, and free and total acidity. Moreover, this combination significantly decreased the level of LDH with a nonsignificant decrease in the IL-6 level. Esomeprazole and the combination group restored the level of catalase and quercetin alone and in the combination group elevated the level of GSH. Additionally, remarkable protection appeared in the pathological findings, especially in the group treated with quercetin and misoprostol.

Conclusion: This study clearly revealed the gastroprotective effect produced by combining quercetin with misoprostol by decreasing ulcer area and index, restoring antioxidant enzyme levels, and ameliorating inflammation. These findings suggest the use of this combination in a clinical setting.