BMC Gastroenterology最新文献

Objectives: Transcutaneous neuromodulation (TN) has been reported effective for functional constipation (FC). The underlying mechanism remains unclear. In this study, we aimed to investigate the gut microbiota (GM) and short chain fatty acids (SCFAs) metabolism changed in FC patients due to TN treatment. The correlation between GM and 5-HT was evaluated.

Methods: Fourteen FC patients were recruited, and the FC related symptoms were evaluated by questionnaires before and after 4-week TN treatment. Blood and fecal samples were collected to assess the fecal microbiome and SCFAs.

Results: The richness and diversity of fecal microbiota were both found to be increased in FC patients before TN treatment. Fecal metabolomic differences between FC patients and healthy controls were observed at baseline, including elevated branched-chain SCFAs (isobutyric, isovaleric, and valeric acids) in FC. TN treatment did not significantly alter SCFA levels but improved constipation symptoms and increased plasma 5-HT. The correlation of Blautia-serotonin and 5-HT was observed in FC patients (r = 0.574, P = 0.035) and disappeared after TN treatment (r = 0.160, P = 0.584).

Conclusion: TN treatment significantly improved the symptoms of FC patients and increased their plasma 5-HT expression levels. The correlation between 5-HT and Blautia-serotonin (which changed after TN treatment) indicated that the 5-HT changes caused by TN treatment might have a potential interaction with the dynamic changes of the intestinal microbiota.

Introduction: Hepatocellular carcinoma (HCC) accounts for approximately 90% of all primary liver cancers resulting in approximately 830,000 deaths in 2020, making HCC the sixth most common cancer globally. Several members of the Melanoma Antigen Gene (MAGE) family, such as MAGE-A1 and A3 genes of the MAGE I-A subfamily, are abnormally expressed in a variety of cancers including melanomas, colorectal cancer, non-small cell lung cancer, gliomas, HCC, prostate, and breast cancers. In addition, they have been linked to tumor stemness and, therefore, may predict therapeutic response and prognosis.

Aim of the study: To investigate the expression pattern of MAGE-A1 and A3 genes in HCC patients and to evaluate their prognostic value.

Subjects and methods: This prospective four-year case-control study was conducted from 2020 to 2024 on 95 subjects classified into three groups. Group (A): Fifty patients with HCC developed on top of hepatitis C virus (HCV) - induced liver cirrhosis, Group (B): 30 patients with post-HCV liver cirrhosis and Group (C): 15 healthy control subjects. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to evaluate the expression of MAGE-A1 and A3 genes in peripheral blood sample after peripheral blood mononuclear cells (PBMCs) isolation. Patients were followed up over 2 years duration for assessment of treatment response.

Results: At cutoff levels 11.54 and 11.39 MAGE-A1 and MAGE-A3, respectively, could distinguish HCC from liver cirrhosis with area under the curve (AUC) of 0.781 and 0.966, respectively (P ≤ 0.001). Regarding treatment response, MAGE-A1 and A3 showed significantly higher expression in patients with progressive disease (16.16 and 17.79, respectively) compared to complete response patients (9.21 and 13.25, respectively). Finally, when assessing overall survival (OS) in HCC patients multivariate analysis showed that independent factors for shorter OS were increased MAGE-A1 (HR: 9.407, P: 0.048), high MAGE-A3 (HR: 9.199, P: 0.042) and elevation of both alpha fetoprotein (AFP) and MAGE-A3 (HR: 10.681, P: 0.039).

Conclusion: MAGE-A1 and A3 genes can be used as diagnostic and prognostic markers in HCC patients predicting therapeutic response and overall survival.

Background and aims: The accurate and timely diagnosis of ileus versus volvulus is essential in emergency care, as treatment choices directly influence patient outcomes. In this study, the diagnostic accuracy and adherence to guidelines of multidisciplinary AI systems were compared with those of single-model approaches and actual clinical decisions in managing these acute gastrointestinal conditions.

Methods: We conducted a retrospective analysis of 234 adult patients diagnosed with ileus (n = 120, 51. 3%) or volvulus (n = 114, 48. 7%) from January 2018 to December 2024. We assessed three approaches: (1) the use of a multidisciplinary AI system including GPT-4 V (radiology), Med-PaLM (emergency medicine), BioGPT (ICU), and LLaMA 4 (surgical decisions); (2) the use of ChatGPT 5.5.0 as a single multimodal AI system; and (3) actual clinical team decisions as the reference standard. The key outcomes were diagnostic accuracy, decision alignment, and guideline adherence across management areas.

Results: The multidisciplinary AI system achieved 94.4% accuracy, outperforming ChatGPT 5.0 at 87.2% (p < 0.001). The multidisciplinary method also resulted in greater guideline adherence for sigmoid volvulus management (96.7% vs. 88.3%, p < 0.01), cecal volvulus surgical intervention (100% vs. 93.3%, p < 0.05), conservative ileus treatment (87.5% vs. 83.3%, p < 0.05), and ICU triage (91.1% vs. 85.2%, p < 0.01). Surgical decision alignment was better with the multidisciplinary system (92.8% vs. 85.5%, p < 0.001), and ICU admission predictions were more accurate (90.6% vs. 83.7%, p < 0.001). The AI system also made decisions faster: 2.5 ± 5.05 min vs. 3.2 ± 0.016 min for ChatGPT and 15.3 ± 3.2 min for clinical teams (p < 0.01 and p < 0.001, respectively).

Conclusion: Multidisciplinary AI systems that combine specialized models for different clinical areas significantly outperform a single AI model in terms of diagnostic accuracy, guideline consistency, and decision alignment for ileus and volvulus. These results indicate that task-specific AI integration could improve clinical support, but further validation is needed before its routine use.