Autophagy and its role in gastrointestinal diseases

Gastrointestinal disorders encompass a spectrum of conditions affecting various organs within the digestive system,such as the esophagus,stomach,colon,rectum,pancreas,liver,small intestine,and bile ducts.The role of autophagy in the etiology and progression of gastrointestinal diseases has garnered significant attention.This paper seeks to evaluate the impact and mechanisms of autophagy in gastrointestinal disorders by synthesizing recent research findings.Specifically,we delve into inflammation-related gastrointestinal conditions,including ulcerative colitis,Crohn’s disease,and pancreatitis,as well as gastrointestinal cancers such as esophageal,gastric,and colorectal cancers.Additionally,we provide commentary on a recent publication by Chang et al in the World Journal of Gastroenterology.Our objective is to offer fresh perspectives on the mechanisms and therapeutic approaches for these gastrointestinal ailments.This review aims to offer new perspectives on the mechanisms and therapeutic strategies for gastrointestinal disorders by critically analyzing relevant publications.As discussed,the role of autophagy in gastrointestinal diseases is complex and,at times,contentious.To harness the full therapeutic potential of autophagy in treating these conditions,more in-depth research is imperative.

Cholangioscopy-assisted extraction through novel papillary support for small-calibre and sediment-like common bile duct stones

BACKGROUND To date,endoscopic retrograde cholangiopancreatography has become a wellestablished treatment for common bile duct(CBD)stones.However,it is not suitable for some special patients,such as pregnant women,children or those who cannot stop taking anti-coagulation/anti-platelet agents because of radiation injury and the risk of postoperative bleeding resulting from endoscopic sphincterotomy.To overcome these two problems,this study introduced cholangioscopy-assisted extraction through a novel papillary support for small-calibre and sediment-like CBD stones.AIM To assess the feasibility and safety of cholangioscopy-assisted extraction through a novel papillary support(CEPTS)for small-calibre and sediment-like common bile duct(CBD)stones.METHODS This Retrospective study was approved by the Ethics Committee of the Chinese PLA General Hospital.We designed a covered single dumbbell-style papillary support between 2021 and 2022.Between July 2022 and September 2022,7 consecutive patients with small-calibre(cross diameter≤1.0 cm)or sediment-like CBD stones underwent CETPS procedures in our center.The clinical characteristics and treatment outcomes of these 7 patients were extracted from a prospectively collected database.And the related data were analyzed.Informed consent was obtained from all participating patients.RESULTS A total of 2 patients had yellow sediment-like CBD stones,and aspiration extraction was performed after the insertion of papillary support.Of the 5 patients with clumpy CBD stones(0.4-1.0 cm),2 underwent basket extraction under direct vision for a single stone(0.5-1.0 cm,black and black grey),1 underwent balloon plus aspiration extraction under direct vision for 5 stones(0.4-0.6 cm,brown),and 2 underwent aspiration extraction only for a single stone(0.5-0.6 cm,yellow,none).Technical success,namely,no residual stones in the CBD or left and right hepatic ducts,was achieved in all 7 cases(100%).The median operating time was 45.0 minutes(range 13.0–87.0 minutes).Postoperative pancreatitis(PEP)occurred in one case(14.3%).Hyperamylasaemia without abdominal pain was noted in 2 of 7 patients.No residual stones or cholangitis were found during the follow-up.CONCLUSION CETPS appeared to be feasible to treat patients with small-calibre or sediment-like CBD stones.Patients,especially pregnant women and those who cannot stop anticoagulation/anti-platelet agents,could benefit from this technique.

Plasma exosomal hsa_circ_0079439 as a novel biomarker for early detection of gastric cancer

BACKGROUND Due to the poor prognosis of gastric cancer(GC),early detection methods are urgently needed.Plasma exosomal circular RNAs(circRNAs)have been suggested as novel biomarkers for GC.AIM To identify a novel biomarker for early detection of GC.METHODS Healthy donors(HDs)and GC patients diagnosed by pathology were recruited.Nine GC patients and three HDs were selected for exosomal whole-transcriptome RNA sequencing.The expression profiles of circRNAs were analyzed by bioinformatics methods and validated by droplet digital polymerase chain reaction.The expression levels and area under receiver operating characteristic curve values of plasma exosomal circRNAs and standard serum biomarkers were used to compare their diagnostic efficiency.RESULTS There were 303 participants,including 240 GC patients and 63 HDs,involved in the study.The expression levels of exosomal hsa_circ_0079439 were significantly higher in GC patients than in HDs(P<0.0001).However,the levels of standard serum biomarkers were similar between the two groups.The area under the curve value of exosomal hsa_circ_0079439 was higher than those of standard biomarkers,including carcinoembryonic antigen,carbohydrate antigen(CA)19-9,CA72-4,alpha-fetoprotein,and CA125(0.8595 vs 0.5862,0.5660,0.5360,0.5082,and 0.5018,respectively).The expression levels of exosomal hsa_circ_0079439 were significantly decreased after treatment(P<0.05).Moreover,the expression levels of exosomal hsa_circ_0079439 were obviously higher in early GC(EGC)patients than in HDs(P<0.0001).CONCLUSION Our results suggest that plasma exosomal hsa_circ_0079439 is upregulated in GC patients.Moreover,the levels of exosomal hsa_circ_0079439 could distinguish EGC and advanced GC patients from HDs.Therefore,plasma exosomal hsa_circ_0079439 might be a potential biomarker for the diagnosis of GC during both the early and late stages.

Ling classification describes endoscopic progressive process of achalasia and successful peroral endoscopy myotomy prevents endoscopic progression of achalasia

AIM To verify the hypothesis that the Ling classification describes the endoscopic progressive process of achalasia and determine the ability of successful peroral endoscopic myotomy (POEM) to prevent endoscopic progression of achalasia. METHODS We retrospectively reviewed the endoscopic findings, symptom duration, and manometric data in patients with achalasia. A total of 359 patients (197 women, 162 men) with a mean age of 42.1 years (range, 12-75 years) were evaluated. Symptom duration ranged from 2 to 360 mo, with a median of 36 mo. Patients were classified with Ling type I (n = 119), II a (n = 106),II b (n = 60),II c (n = 60), or III (n = 14), according to the Ling classification. Of the 359 patients, 349 underwent POEM, among whom 21 had an endoscopic follow-up for more than 2 years. Pre-treatment and post-treatment Ling classifications of these 21 patients were compared. RESULTS Symptom duration increased significantly with increasing Ling classification (from I to III) (p < 0.05), whereas lower esophageal sphincter pressure decreased with increasing Ling type (from I to III) (p < 0.05). There was no difference in sex ratio or onset age among the Ling types, although the age at time of diagnosis was higher in Ling types I c and III than in Ling types I, IIa, and I b. Of the 21 patients, 19 underwent high-resolution manometry both before and after treatment. The mean preoperative and postoperative lower esophageal sphincter pressure were 34.6 mmHg (range, 15.3-59.4 mmHg) and 15.0 mmHg (range, 2.1-21.6 mmHg), respectively, indicating a statistically significant decrease after POEM. All of the 21 patients were treated successfully by POEM (postoperative Eckardt score <= 3) and still had the same Ling type during a mean follow-up period of 37.8 mo (range, 24-51 mo). CONCLUSION The Ling classification represents the endoscopic progressive process of achalasia and may be able to serve as an endoscopic assessment criterion for achalasia. Successful POEM (Eckardt score <= 3) seems to have the ability to prevent endoscopic evolvement of achalasia. However, studies with larger populations are warranted to confirm our findings.

Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy: A retrospective study at a single center

AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy(POEM).METHODS Twenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, Eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy(EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during POEM.RESULTS All 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had ahole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients(two patients required 5 m L fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d(range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furthermore, the median LESP decreased from 31.9 mm Hg (range: 21.9-67.1 mm Hg) preoperatively to 20.3 mm Hg (range: 6.0-41.0 mm Hg) postoperatively(P < 0.05). The median preoperative and postoperative Eckardt scores were 5.0(range; 4-10) and 1.0(range: 0-4), respectively (P < 0.05). Of the 21 patients with mucosal penetration, symptom remission, which is defined as a postoperative Eckardt score ≤ 3, was achieved in 20 patients(95.2%) indicating that mucosal penetration did not influence the success of POEM treatment if closed successfully using fibrin sealant.CONCLUSION Fibrin sealant is safe and effective for closure of mucosal penetration during POEM. Mucosal penetrations do not appear to influence the treatment success of POEM if closed successfully using fibrin sealant. Additional studies regarding the feasibility, efficacy, and safety of fibrin sealant for closure of larger mucosal penetrations is warranted.

Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia

BACKGROUND The use of radiofrequency ablation(RFA)has been reported in the treatment of gastric low-grade intraepithelial neoplasia(LGIN).However,its efficacy and prognostic risk factors have not been well analyzed.AIM To explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large,long-term follow-up clinical study.METHODS The clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective study.Data on operative parameters,complications,and follow-up outcomes including curative rates were recorded and analyzed.RESULTS The curative rates of endoscopic RFA for gastric LGIN at 3 mo,6 mo,and 1-5 years after the operation were 93.3%,92.8%,91.5%,90.3%,88.5%,85.7%,and 83.3%,respectively.Multivariate analyses revealed that Helicobacter pylori(H.pylori)infection and disease duration>1 year had a significant effect on the curative rate(P<0.001 and P=0.013,respectively).None of patients had bleeding,perforation,infection,or other serious complications after RFA,and the main discomfort was postoperative abdominal pain.CONCLUSION RFA was safe and effective for gastric LGIN during long-term follow-up.H.pylori infection and disease course>1 year may be the main risk factors for relapse of LGIN after RFA.

Elevated nitrogen and co-evolution history with competitors shape the invasion process of Galinsoga quadriradiata

Invasive plants usually experience population differentiation as they expand from their initial invasive range to the edge.Moreover,invasive plants usually encounter competitors which shared different co-evolutionary histories with them.These factors may lead to varying responses of invasive plant populations to elevated nitrogen deposition during expansion.However,this issue has received limited attention in prior research.To address these challenges,we conducted a greenhouse experiment to investigate how population differentiation of Galinsoga quadriradiata interacts with the presence of various competitors in response to increased nitrogen deposition.Competitor types(new or old that shared short or long co-evolutionary history with the invader,respectively)were set to compete with the invasive central and edge populations under different nitrogen addition treatments.Individuals from the central population of G.quadriradiata,originating from the initial invasion range,showed greater total mass,reproduction and interspecific competitiveness compared with the edge population.Nitrogen addition improved growth and reproductive performance in both populations,and the central population had a stronger response compared with the edge population.The performance of G.quadriradiata was inhibited more effectively by old competitors than new competitors.Our results indicate that population differentiation occurs in terms of growth and competitiveness during the range expansion of G.quadriradiata,with the central population exhibiting superior performance.Co-evolutionary history with competitors is considered unfavorable for invasive plants in this study.Our results highlight the combined effects of population differentiation in invasive species and their co-evolution history with competitors in the context of global change factors.

入侵植物粗毛牛膝菊根际土壤和根系真菌群落会沿海拔扩散路径发生变化

与入侵植物相关的真菌群落可能会随着海拔发生变化,这可能会影响入侵植物的表现和入侵力。我们最近的研究表明,入侵植物粗毛牛膝菊(Galinsoga quadriradiata)的根系AMF侵染率随着海拔的升高而下降。然而,尚不清楚这是否与真菌群落沿海拔的变化相关。为此,我们采用高通量测序技术、功能分组和线性分析等方法,研究了秦巴山区的粗毛牛膝菊根际土壤和根系真菌群落组成与结构沿海拔的变化趋势。研究结果表明,粗毛牛膝菊根际土壤和根系真菌群落物种多样性和种类组成随海拔升高发生了显著变化。在根际土壤中真菌群落香农-威纳多样性指数随着海拔升高呈上升趋势,而在根系中则呈下降趋势。同时,在根际土壤中共生真菌的相对丰度随海拔高度没有发生显著变化,而在根系中呈下降趋势;在根际土壤中病原真菌的相对丰度随着海拔呈下降趋势,而在根系中呈上升趋势。这些研究结果暗示,该种在向研究区域高海拔地区入侵时,土壤共生真菌的供给并不会缺乏,但其与这些真菌之间建立并维持共生关系的能力降低了;在向高海拔扩张过程中,该种倾向于在根系中积累更多的病原真菌,而减少对共生真菌的依赖。这些研究结果说明,入侵植物与真菌群落之间的相互作用会沿着海拔梯度发生显著变化,植物地下部分与真菌的相互作用可能是我们理解外来种如何在高海拔环境中入侵成功的关键。

Long-term outcomes of peroral endoscopic myotomy in achalasia patients with a minimum follow-up of 7 years

There was an enormous increase in reports confirming the safety and efficacy of using peroral endoscopic myotomy(POEM)to treat achalasia since the pioneering of the technique in 2010.[1]However,the reports focused on short to medium-term follow-ups,and data on long-term outcomes of POEM for achalasia were very limited.It still remains unknown whether the satisfactory short-term outcomes are long lasting.Additionally,some achalasia patients receiving POEM noted that they could benefit from post-operative dietary recommendations that would be helpful for symptom remission.Therefore,this study aimed to determine the long-term treatment outcomes of using POEM to treat achalasia,and to assess postoperative Eckardt scores over this period.We also crafted a set of post-POEM dietary recommendations according to the feedback from achalasia patients who underwent this treatment to achieve better symptom remission for post-POEM patients.