Transcriptome analysis suggests broad jejunal alterations in Linghu’s obesity-diarrhea syndrome:A pilot study

BACKGROUND Obesity is associated with a significantly increased risk for chronic diarrhea,which has been proposed as Linghu’s obesity-diarrhea syndrome(ODS);however,its molecular mechanisms are largely unknown.AIM To reveal the transcriptomic changes in the jejunum involved in ODS.METHODS In a cohort of 6 ODS patients(JOD group),6 obese people without diarrhea(JO group),and 6 healthy controls(JC group),high-throughput sequencing and bioinformatics analyses were performed to identify jejunal mucosal mRNA expression alterations and dysfunctional biological processes.In another cohort of 16 ODS patients(SOD group),16 obese people without diarrhea(SO group),and 16 healthy controls(SC group),serum diamine oxidase(DAO)and D-lactate(DLA)concentrations were detected to assess changes in intestinal barrier function.RESULTS The gene expression profiles of jejunal mucosa in the JO and JC groups were similar,with only 1 differentially expressed gene(DEG).The gene expression profile of the JOD group was significantly changed,with 411 DEGs compared with the JO group and 211 DEGs compared with the JC group,129 of which overlapped.The enrichment analysis of these DEGs showed that the biological processes such as digestion,absorption,and transport of nutrients(especially lipids)tended to be up-regulated in the JOD group,while the biological processes such as rRNA processing,mitochondrial translation,antimicrobial humoral response,DNA replication,and DNA repair tended to be down-regulated in the JOD group.Eight DEGs(CDT1,NHP2,EXOSC5,EPN3,NME1,REG3A,PLA2G2A,and PRSS2)may play a key regulatory role in the pathological process of ODS,and their expression levels were significantly decreased in ODS patients(P<0.001).In the second cohort,compared with healthy controls,the levels of serum intestinal barrier function markers(DAO and D-LA)were significantly increased in all obese individuals(P<0.01),but were higher in the SOD group than in the SO group(P<0.001).CONCLUSION Compared with healthy controls and obese individuals without diarrhea,patients with Linghu’s ODS had extensive transcriptomic changes in the jejunal mucosa,likely affecting intestinal barrier function and thus contributing to the obesity and chronic diarrhea phenotypes.

Nicotinamide adenine dinucleotide phosphate oxidase in pancreatic diseases:Mechanisms and future perspectives

Pancreatitis and pancreatic cancer(PC)stand as the most worrisome ailments affecting the pancreas.Researchers have dedicated efforts to unraveling the mechanisms underlying these diseases,yet their true nature continues to elude their grasp.Within this realm,oxidative stress is often believed to play a causal and contributory role in the development of pancreatitis and PC.Excessive accumulation of reactive oxygen species(ROS)can cause oxidative stress,and the key enzyme responsible for inducing ROS production in cells is nicotinamide adenine dinucleotide phosphate hydrogen oxides(NOX).NOX contribute to pancreatic fibrosis and inflammation by generating ROS that injure acinar cells,activate pancreatic stellate cells,and mediate macrophage polarization.Excessive ROS production occurs during malignant transformation and pancreatic carcinogenesis,creating an oxidative microenvironment that can cause abnormal apoptosis,epithelial to mesenchymal transition and genomic instability.Therefore,understanding the role of NOX in pancreatic diseases contributes to a more in-depth exploration of the exact pathogenesis of these diseases.In this review,we aim to summarize the potential roles of NOX and its mechanism in pancreatic disorders,aiming to provide novel insights into understanding the mechanisms underlying these diseases.

Per-oral endoscopic myotomy is safe and effective for pediatric patients with achalasia:A long-term follow-up study

BACKGROUND Per-oral endoscopic myotomy(POEM)is emerging as a prefer treatment option for pediatric achalasia.However,data are limited on the long-term efficacy of POEM in children and adolescents with achalasia.AIM To evaluate the safety and long-term efficacy of POEM for pediatric patients with achalasia and compare those outcomes with adult patients.METHODS This retrospective cohort study was conducted in patients with achalasia who underwent POEM.Patients aged under 18 years were included in the pediatric group;patients aged between 18 to 65 years who underwent POEM in the same period were assigned to the control group.For investigation of long-term followup,the pediatric group were matched with patients from the control group in a 1:1 ratio.The procedure-related parameters,adverse events,clinical success,gastroesophageal reflux disease(GERD)after POEM,and quality of life(QoL)were evaluated.RESULTS From January 2012 to March 2020,POEM was performed in 1025 patients aged under 65 years old(48 in the pediatric group,1025 in the control group).No significant differences were observed in the occurrence of POEM complications between the two groups(14.6%vs 14.6%;P=0.99).Among the 34 pediatric patients(70.8%)who underwent follow-up for 5.7 years(range 2.6-10.6 years),clinical success was achieved in 35 patients(35/36;97.2%).No differences were observed in post-POEM GERD occurrence(17.6%vs 35.3%;P=0.10).QoL was significantly improved in both groups after POEM.CONCLUSION POEM is safe and effective for pediatric patients with achalasia.It can achieve significant symptoms relief and improve QoL.

Guidelines for the diagnosis and treatment of chronic pancreatitis in China(2018 edition)

Chronic pancreatitis(CP)is a progressive inflammatory disease of pancreas that alters the organ’s normal structure and functions.CP seriously affects the quality of life of patients and greatly increases the public medical burden of society.In recent years,the incidence of CP has increased worldwide.The concepts of etiology and therapies have been continuously updated.

肥胖成人慢性腹泻患病率的系统评价和Meta分析

目的肥胖已成为全球严重的健康问题。多项研究表明,慢性腹泻在肥胖人群中较为常见。本研究对肥胖成人中慢性腹泻的患病率进行了系统评价和Meta分析。方法在PubMed、Embase和Web of Science文献数据库进行了系统检索,检索时间截止至2022年10月15日。本研究纳入了能够计算腹泻患病率的基于人群或肥胖患者的研究,由2名研究人员独立进行研究筛选,数据提取和质量评估。数据采用随机效应模型进行汇总。结果本研究共评估了8项研究,涉及19701名受访者,其中11820名为超重和肥胖个体。身体质量指数(body mass index,BMI)≥25 kg/m^(2)的超重肥胖人群中,慢性腹泻的总体患病率为23.02%(95%CI:17.47%,28.57%)。肥胖组(BMI≥30 kg/m^(2))的腹泻患病率(23.79%,95%CI:16.29%,31.29%)高于超重组(25 kg/m^(2)≤BMI<30 kg/m^(2),18.82%,95%CI:13.02%,24.62%),但差异不具有统计学意义(P=0.30)。结论慢性腹泻在肥胖人群中相当常见,随着肥胖人数的增加,肥胖与慢性腹泻的共存值得更多关注。

Commentary: A nearly forgotten class of anti-inflammatory lipid molecules in central nervous system

Lipids are the major components of cells in the central nervous system(CNS) and are essential for the brain development and homeostasis. Several studies have demonstrated that impaired lipid metabolism is closely related to neurological diseases among the elderly^(1). Lipidomics can serve us well in identifying and quantifying lipid molecules in cells, tissues, and organisms at the system level. However, finding out biologically meaningful lipids from the massive lipidomics data is not straightforward.

Impact of pancreatic and biliary stent on post-endoscopic papillectomy complications:A single-center retrospective study

Background:Endoscopic papillectomy(EP)is recommended as the first-line therapy for ampullary tumors,despite a relatively high incidence of complications.Pancreatic and/or biliary stents are placed at the endoscopist’s discretion to prevent post-EP complications.The present study aimed to evaluate the efficacy of different stents.Methods:A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study.These patients were divided into a pancreatic stent group(PS group,n=47),a biliary stent group(BS group,n=38),and a two-stent group(PBS[PS and BS]group,n=32).Relevant clinical data were collected and compared among the three groups.Multivariate logistic analyses were performed to explore risk factors for post-EP complications.Results:The incidence of all complications was 37.6%(44/117).Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5%(17/117)and 17.9%(21/117).The incidence rates of post-EP pancreatitis were 10.6%(5/47),23.7%(9/38),and 9.4%(3/32)in the PS group,BS group,and PBS group,respectively,with no significant differences.There were also no significant differences in other complications among the three groups.Age(odds ratio[OR]:0.95;95%confidence interval[CI]:0.91-0.99;P=0.022)was independently associated with post-EP pancreatitis while tumor size(OR:1.66;95%CI:1.06-2.60;P=0.028)was independently associated with post-EP hemorrhage.Conclusions:While pancreatic stenting is the first choice to prevent post-EP pancreatitis,biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic cannulation.Two-stent(biliary and pancreatic stent)placement is unnecessary unless it is required due to other concerns.