Morphological and biochemical characteristics associated with autophagy in gastrointestinal diseases

Autophagy is a cellular catabolic process characterized by the formation of double-membrane autophagosomes.Transmission electron microscopy is the most rigorous method to clearly visualize autophagic engulfment and degradation.A large number of studies have shown that autophagy is closely related to the digestion,secretion,and regeneration of gastrointestinal(GI)cells.However,the role of autophagy in GI diseases remains controversial.This article focuses on the morphological and biochemical characteristics of autophagy in GI diseases,in order to provide new ideas for their diagnosis and treatment.

Clinical issues and challenges in imaging of gastrointestinal diseases:A minireview and our experience

Imaging techniques play a crucial role in the modern era of medicine,particularly in gastroenterology.Nowadays,various non-invasive and invasive imaging modalities are being routinely employed to evaluate different gastrointestinal(GI)diseases.However,many instrumental as well as clinical issues are arising in the area of modern GI imaging.This minireview article aims to briefly overview the clinical issues and challenges encountered in imaging GI diseases while highlighting our experience in the field.We also summarize the advances in clinically available diagnostic methods for evaluating different diseases of the GI tract and demonstrate our experience in the area.In conclusion,almost all imaging techniques used in imaging GI diseases can also raise many challenges that necessitate careful consideration and profound expertise in this field.

Global geoepidemiology of gastrointestinal surgery rates in Crohn’s disease

BACKGROUND Data regarding the worldwide gastrointestinal surgery rates in patients with Crohn’s disease(CD)remains limited.AIM To systematically review the global variation in the rates of surgery in CD.METHODS A comprehensive search analysis was performed using multiple electronic databases from inception through July 1,2020,to identify all full text,randomized controlled trials and cohort studies pertaining to gastrointestinal surgery rates in adult patients with CD.Outcomes included continent based demographic data,CD surgery rates over time,as well as the geoepidemiologic variation in CD surgery rates.Statistical analyses were conducted using R.RESULTS Twenty-three studies spanning four continents were included.The median proportion of persons with CD who underwent gastrointestinal surgery in studies from North America,Europe,Asia,and Oceania were 30%(range:1.7%-62.0%),40%(range:0.6%-74.0%),17%(range:16.0%-43.0%),and 38%respectively.No clear association was found regarding the proportion of patients undergoing gastrointestinal surgery over time in North America(R^(2)=0.035)and Europe(R^(2)=0.100).A moderate,negative association was seen regarding the proportion of patients undergoing gastrointestinal surgery over time(R^(2)=0.520)in Asia.CONCLUSION There appears to be significant inter-continental variation regarding surgery rates in CD.Homogenous evidencebased guidelines accounting for the geographic differences in managing patients with CD is prudent.Moreover,as a paucity of data on surgery rates in CD exists outside the North American and European continents,future studies,particularly in less studied locales,are warranted.

Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Criteria for assessing the diagnostic significance of modern methods of imaging gastrointestinal diseases in practical gastroenterology

Imaging methods are frequently used to diagnose gastrointestinal diseases and play a crucial role in verifying clinical diagnoses among all diagnostic algorithms.However,these methods have limitations,challenges,benefits,and advantages.Addressing these limitations requires the application of objective criteria to assess the effectiveness of each diagnostic method.The diagnostic process is dynamic and requires a consistent algorithm,progressing from clinical subjective data,such as patient history(anamnesis),and objective findings to diagnostics ex juvantibus.Caution must be exercised when interpreting diagnostic results,and there is an urgent need for better diagnostic tests.In the absence of such tests,preliminary criteria and a diagnosis ex juvantibus must be relied upon.Diagnostic imaging methods are critical stages in the diagnostic workflow,with sensitivity,specificity,and accuracy serving as the primary criteria for evaluating clinical,laboratory,and instrumental symptoms.A comprehensive evaluation of all available diagnostic data guarantees an accurate diagnosis.The“gold standard”for diagnosis is typically established through either the results of a pathological autopsy or a lifetime diagnosis resulting from a thorough examination using all diagnostic methods.

From the mathematical model to the patient: The scientific and human aspects of artificial intelligence in gastrointestinal surgery

Recent medical literature shows that the application of artificial intelligence(AI)models in gastrointestinal pathology is an exponentially growing field,with pro-mising models that show very high performances.Regarding inflammatory bowel disease(IBD),recent reviews demonstrate promising diagnostic and prognostic AI models.However,studies are generally at high risk of bias(especially in AI models that are image-based).The creation of specific AI models that improve diagnostic performance and allow the establishment of a general prognostic fo-recast in IBD is of great interest,as it may allow the stratification of patients into subgroups and,in turn,allow the creation of different diagnostic and therapeutic protocols for these patients.Regarding surgical models,predictive models of post-operative complications have shown great potential in large-scale studies.In this work,the authors present the development of a predictive algorithm for early post-surgical complications in Crohn's disease based on a Random Forest model with exceptional predictive ability for complications within the cohort.The pre-sent work,based on logical and reasoned,clinical,and applicable aspects,lays a solid foundation for future prospective work to further develop post-surgical prognostic tools for IBD.The next step is to develop in a prospective and mul-ticenter way,a collaborative path to optimize this line of research and make it applicable to our patients.

Trend of robot-assisted surgery system in gastrointestinal and liver surgery: A bibliometric analysis

BACKGROUND Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations.AIM To illustrate the major areas of research and forward-looking directions over the past twenty-six years.METHODS Using the Web of Science Core Collection database,a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023.We used Citespace(Version 6.2.4)and Bibliometrix package(Version 4.3.0)to visualize the analysis of all publications including country,institutional affiliations,authors,and keywords.RESULTS In total,346 articles were retrieved.Surgical Endoscopy had with the largest number of publications and was cited in this field.The United States was a core research country in this field.Yonsei University was the most productive institution.The current focus of this field is on rectal surgery,long-term prognosis,perioperative management,previous surgical experience,and the learning curve.CONCLUSION The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997.This study provides new perspectives and ideas for future research in this field.

Unveiling the secrets of gastrointestinal mucous adenocarcinoma survival after surgery with artificial intelligence:A population-based study

BACKGROUND Research on gastrointestinal mucosal adenocarcinoma(GMA)is limited and controversial,and there is no reference tool for predicting postoperative survival.AIM To investigate the prognosis of GMA and develop predictive model.METHODS From the Surveillance,Epidemiology,and End Results database,we collected clinical information on patients with GMA.After random sampling,the patients were divided into the discovery(70%of the total,for model training),validation(20%,for model evaluation),and completely blind test cohorts(10%,for further model evaluation).The main assessment metric was the area under the receiver operating characteristic curve(AUC).All collected clinical features were used for Cox proportional hazard regression analysis to determine factors influencing GMA’s prognosis.RESULTS This model had an AUC of 0.7433[95% confidence intervals(95%CI):0.7424-0.7442]in the discovery cohort,0.7244(GMA:0.7234-0.7254)in the validation cohort,and 0.7388(95%CI:0.7378-0.7398)in the test cohort.We packaged it into Windows software for doctors’use and uploaded it.Mucinous gastric adenocarcinoma had the worst prognosis,and these were protective factors of GMA:Regional nodes examined[hazard ratio(HR):0.98,95%CI:0.97-0.98,P<0.001]and chemotherapy(HR:0.62,95%CI:0.58-0.66,P<0.001).CONCLUSION The deep learning-based tool developed can accurately predict the overall survival of patients with GMA postoperatively.Combining surgery,chemotherapy,and adequate lymph node dissection during surgery can improve patient outcomes.

Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery:A meta-analysis

BACKGROUND Explore the risk factors of gastrointestinal dysfunction after gastrointestinal tumor surgery and to provide evidence for the prevention and intervention of gastrointestinal dysfunction in patients with gastrointestinal tumor surgery.AIM To investigate the potential risk factors for gastrointestinal dysfunction following gastrointestinal tumor surgery and to present information supporting the prevention and management of gastrointestinal dysfunction in surgery patients.METHODS Systematically searched the relevant literature from PubMed,Web of Science,Cochrane Library,Embase,CNKI,China Biomedical Database,Wanfang Database,and Weipu Chinese Journal Database self-established until October 1,2022.Review Manager 5.3 software was used for meta-analysis after two researchers independently screened literature,extracted data,and evaluated the risk of bias in the included studies.RESULTS A total of 23 pieces of literature were included,the quality of which was medium or above,and the total sample size was 43878.The results of meta-analysis showed that the patients were male(OR=1.58,95%CI:1.25-2.01,P=0.002)and≥60 years old(OR=2.60,95%CI:1.76-2.87,P<0.001),physical index≥25.3 kg/m2(OR=1.6,95%CI:1.00-1.12,P=0.040),smoking history(OR=1.89,95%CI:1.31-2.73,P<0.001),chronic obstructive pulmonary disease(OR=1.49,95%CI:1.22-1.83,P<0.001),enterostomy(OR=1.47,95%CI:1.26-1.70,P<0.001),history of abdominal surgery(OR=2.90,95%CI:1.67-5.03,P<0.001),surgical site(OR=1.2,95%CI:1.40-2.62,P<0.001),operation method(OR=1.68,95%CI:1.08-2.62,P=0.020),operation duration(OR=2.65,95%CI:1.92-3.67,P<0.001),abdominal adhesion grade(OR=2.52,95%CI:1.90-3.56,P<0.001),postoperative opioid history(OR=5.35,95%CI:3.29-8.71,P<0.001),tumor TNM staging(OR=2.58,95%CI:1.84-3.62,P<0.001),postoperative blood transfusion(OR=2.92,95%CI:0.88-9.73,P=0.010)is a risk factor for postoperative gastrointestinal dysfunction in patients with gastrointestinal tumors.CONCLUSION There are many factors affecting gastrointestinal dysfunction in gastrointestinal patients after surgery.Clinical staff should identify relevant risk factors early and implement targeted intervention measures on the basis of personalized assessment to improve the clinical prognosis of patients.

Remazolam combined with transversus abdominis plane block in gastrointestinal tumor surgery:Have we achieved better anesthetic effects?

Laparoscopic surgery is the main treatment method for patients with gastrointestinal malignant tumors.Although laparoscopic surgery is minimally invasive,its tool stimulation and pneumoperitoneum pressure often cause strong stress reactions in patients.On the other hand,gastrointestinal surgery can cause stronger pain in patients,compared to other surgeries.Transversus abdominis plane block(TAPB)can effectively inhibit the transmission of nerve impulses caused by surgical stimulation,alleviate patient pain,and thus alleviate stress reactions.Remazolam is an acting,safe,and effective sedative,which has little effect on hemodynamics and is suitable for most patients.TAPB combined with remazolam can reduce the dosage of total anesthetic drugs,reduce adverse reactions,reduce stress reactions,and facilitate the rapid postoperative recovery of patients.

Novel insights into autophagy in gastrointestinal pathologies,mechanisms in metabolic dysfunction-associated fatty liver disease and acute liver failure

In this editorial,we comment on three articles published in a recent issue of World Journal of Gastroenterology.There is a pressing need for new research on autophagy's role in gastrointestinal(GI)disorders,and also novel insights into some liver conditions,such as metabolic dysfunction-associated fatty liver disease(MAFLD)and acute liver failure(ALF).Despite advancements,understanding autophagy's intricate mechanisms and implications in these diseases remains incomplete.Moreover,MAFLD's pathogenesis,encompassing hepatic steatosis and metabolic dysregulation,require further elucidation.Similarly,the mechanisms underlying ALF,a severe hepatic dysfunction,are poorly understood.Innovative studies exploring the interplay between autophagy and GI disorders,as well as defined mechanisms of MAFLD and ALF,are crucial for identifying therapeutic targets and enhancing diagnostic and treatment strategies to mitigate the global burden of these diseases.

Comparative observation of the effectiveness and safety of remimazolam besylate versus dexmedetomidine in gastrointestinal surgery in obese patients

BACKGROUND Surgery for obese patients carries a higher risk of anesthesia complications compared with surgery for nonobese patients.Thus,a safe and effective anesthesia strategy is necessary to improve the medical experience of such patients and ensure their safety.AIM To compared the effectiveness and safety of remimazolam besylate versus dexmedetomidine(DEX)in gastrointestinal surgery in obese patients.METHODS The study cohort included 60 obese patients undergoing gastrointestinal surgery between July 2021 and April 2023,comprising 30 patients who received DEX intervention(control group)and 30 patients who received remimazolam besylate intervention(research group).Heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),safety(nausea and vomiting,bradycardia,hypotension,and apnea),anesthesia and examination indices[induction time,anesthesia recovery time,and postanesthesia care unit(PACU)discharge time],sedation effect(Ramsay Sedation Scale),and postoperative pain visual analog scale were comparatively analyzed before anesthesia(T0),during anesthesia(T1),and after anesthesia(T2).RESULTS At T1,the research group showed significantly smaller changes in HR,RR,MAP,and SpO_(2) than the control group,with a significantly lower adverse reaction rate and shorter induction,anesthesia recovery,and PACU discharge times.Additionally,the intra-and postoperative Ramsay Sedation Scale scores were statistically higher in the research group than in the control group.CONCLUSION Remimazolam besylate was significantly more effective than DEX in gastrointestinal surgery in obese patients and had a higher safety profile and value in clinical promotion.

Meta-analysis of electrical stimulation promoting recovery of gastrointestinal function after gynecological abdominal surgery

BACKGROUND The effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery was not clear.AIM To systematically evaluate the effects of electrical stimulation on gastrointestinal function recovery after gynecological abdominal surgery.METHODS The Cochrane Library,Web of Science,PubMed,ProQuest,and the Chinese bio-medical literature databases Wanfang,Weipu,and CNKI were used to search for relevant studies on controlled trials of electrical stimulation in gynecological abdominal surgery patients from self-established databases to May 2024.The RevMan software(version 5.3)was used to analyze the included literature and explore the heterogeneity of each study.RESULTS Seven controlled trials,involving 520 patients,were included.The results of meta-analysis showed that electrical stimulation could shorten the recovery time of intestinal sound after gynecological abdominal surgery[odds ratio(OR):-5.11,95%CI:-5.84 to-4.38,P<0.00001]and improve the time of first anal exhaust(OR:-1.19,95%CI:-1.38 to-0.99,P<0.00001),improved the time of first anal defecation(OR:-0.98,95%CI:-1.19 to-0.78,P<0.00001),The difference is significant.According to the funnel plot,if the scatter is symmetrical,it indicates that the funnel plot is unbiased.CONCLUSION Electrical stimulation can shorten this reduces the length of time it takes for the patient to recover from bowel sounds and also affects the time to first anal voiding and defecation to some extent,thereby promoting gas-trointestinal function recovery after gynecological abdominal surgery.The quality of the studies included in this review was poor,which may have affected the final results.It is necessary to conduct a randomized controlled study with higher quality and more samples to further confirm the promoting effect of electrical stimulation on gastrointestinal function recovery to guide clinical treatment.

Gastric IgG4-related disease mimicking a gastrointestinal stromal tumor in a child: A case report

BACKGROUND Gastric IgG4-related disease(IgG4-RD)is rarely encountered in clinical practice,and especially more so among pediatric patients.To our knowledge,this is the first report of IgG4-RD presenting as a calcifying gastric mass in a child.We describe how this entity was difficult to differentiate from a gastrointestinal stromal tumor(GIST)imaging-based approaches.Therefore,this case highlights the importance of considering IgG4-RD in the differential diagnosis of gastric tumor before performing surgical resection,especially to distinguish it from malignancy to avoid unnecessary surgery.CASE SUMMARY The patient suffered from epigastric pain for several days.Panendoscopy and computed tomography scan revealed a submucosal tumor.Differential diagnoses included GIST,leiomyoma,teratoma,and mucinous adenocarcinoma.However,laparoscopic proximal gastrectomy allowed for the definitive diagnosis of IgG4-related stomach disease.CONCLUSION We emphasize the importance of considering IgG4-RD in the differential diagnosis of gastric submucosal tumors before performing surgical resection.

Practical effect of different teaching modes in teaching gastrointestinal surgery nursing

BACKGROUND With the continuous development and progress of medical technology,the position of surgical nursing in the field of clinical medicine is becoming in-creasingly prominent.As an important branch of the surgical field,the nursing requirements and difficulty of gastrointestinal surgery are also increasing.In order to improve the teaching quality of nursing care in gastrointestinal surgery,many educators and researchers are actively exploring new teaching methods.Among them,the teaching method case-based learning(CBL),scene-simulated learning(SSL),task-based learning(TBL),combining self-evaluation and training mode is considered as an effective method.This method aims to help students to better master knowledge and skills and improve their comprehensive quality by cultivating their self-evaluation ability.AIM To explore the practical effect of CBL-SSL-TBL combined with training mode and student self-assessment in nursing teaching of gastrointestinal surgery.METHODS Seventy-one nursing interns in our hospital from December 2020 to December 2021 were selected.According to different teaching modes,they were divided into observation group CBL-SSL-TBL combined with training mode combined with student self-assessment and control group(conventional teaching mode),of which 36 were in observation group and 35 were in control group.The results of operational skills,theoretical knowledge,nursing students'satisfaction,learning effectiveness questionnaire and teaching effect were compared between the two groups.RESULTS Compared between the two groups,the operational skills and theoretical knowledge scores of the observation group were higher than those of the control group,and the difference was statistically significant(P<0.05).Compared between the two groups,the total satisfaction ratio of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).Compared between the two groups,the observation group was lower than the control group in the questionnaire results of learning efficacy,and the difference was statistically significant(P<0.05).Compared between the two groups,the proportion of thinking ability,subjective initiative and understanding of theoretical knowledge in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).CONCLUSION The use of CBL-SSL-TBL combined with training mode and student self-assessment in gastrointestinal surgery nursing teaching can improve the operational skills of nursing interns,theoretical knowledge and satisfaction scores of nursing students,improve the results of learning efficiency questionnaire and teaching effect,which can be popularized in clinical teaching.

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery

BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.

Effects of comprehensive nutrition support on immune function,wound healing,hospital stay,and mental health in gastrointestinal surgery

BACKGROUND Postoperative patients undergoing gastrointestinal surgery often encounter challenges such as low immune function,delayed wound healing owing to surgical trauma,and increased nutritional demands during recovery.AIM To assess the effect of comprehensive nutritional support program on immune function and wound healing in patients undergoing gastrointestinal surgery.METHODS This retrospective comparative study included 60 patients who underwent gastrointestinal surgery,randomly assigned to either the experimental group(n=30)or the control group(n=30).The experimental group received comprehensive nutritional support,including a combination of enteral and parenteral nutrition,whereas the control group received only conventional comprehensive nutritional support.Evaluation indicators included immune function markers(e.g.,white blood cell count,lymphocyte subsets),wound healing(wound infection rate,healing time),pain score[visual analog scale(VAS)score],and psychological status(anxiety score,depression score)7 days post-surgery)and duration of stay.RESULTS The immune function of patients in the experimental group was significantly better than that in the control group.The white blood cell count was 8.52±1.19×109/L in the experimental group vs 6.74±1.31×109/L(P<0.05).The proportion of CD4+T cells was higher in the experimental group(40.09%±4.91%)than that in the control group(33.01%±5.08%)(P<0.05);the proportion of CD8+T cells was lower(21.79%±3.38%vs 26.29%±3.09%;P<0.05).The CD4+/CD8+ratio was 1.91±0.32 in the experimental group whereas 1.13±0.23 in the control group(P<0.05).The wound infection rate of the experi-mental group was significantly lower than that of the control group(10%vs 30%,P<0.05),and the wound healing time was shorter(10.35±2.42 days vs 14.42±3.15 days,P<0.05).The VAS score of the experimental group was 3.05±1.04,and that of the control group was 5.11±1.09(P<0.05);the anxiety score(Hamilton Anxiety Rating Scale)was 8.88±1.87,and that of the control group was 12.1±3.27(P<0.05);the depression score(Hamilton Depression Rating Scale)was 7.37±1.41,and that of the control group was 11.79±2.77(P<0.05).In addition,the hospitalization time of the experimental group was significantly shorter than that of the control group(16.16±3.12 days vs 20.93±4.84 days,P<0.05).CONCLUSION A comprehensive nutritional support program significantly enhances immune function,promote wound healing,reduces pain,improves psychological status,and shortens hospitalization stays in patients recovering from gastrointestinal surgery.

Dajianzhong decoction:a review of its phytochemistry and therapeutic potential for gastrointestinal disease

Dajianzhong decoction(DJZD)is one of the traditional herbal prescriptions originated from Synopsis of Golden Chamber,which clinically used for the treatment of various gastrointestinal(GI)disease.This paper was aimed to provide a systematic review on the phytochemistry of DJZD and its therapeutic potential for GI disease and the mechanism.Finally,the possible development and perspectives for future research on this prescription were also discussed.To date,over 60 compounds have been identified form DJZD,including unsaturated fatty acid,saponins,and polyphenols,with hydroxy-sanshool and ginsenoside compounds as the predominant ones.DJZD possessed widely pharmacological activities on the GI disease from the Eastern Han Dynasty to the present,such as intestinal obstruction,colitis,and irritable bowel syndrome.Especially for the intestinal obstruction,it had demonstrated the efficacy of DJZD treatment for relief of postoperative ileus in patients undergoing surgery for GI cancer.The detailed mechanism was mainly related with NF-ᴋB signaling pathway.However,further research elucidating the protective effects of DJZD on GI disease,exploring new clinical effects,as well as establishing criteria for quality control for DJZD should be studied.

Circadian rhythms in the pathogenesis of gastrointestinal diseases

The etiology of digestive pathologies such as irritable bowel syndrome(IBS), inflammatory bowel diseases(IBD) and cancer is not yet fully understood. In recent years, several studies have evidenced circadian variations in mechanisms involved in digestive health. In situations of disturbed circadian rhythms(chronodisruption) where the central clock and the peripheral clocks receive incoherent signals, the synchronicity is lost producing implications for health. This lack of coordination could alter the tissue function and cause long term damage to the organs. Life habits such as sleep, physical exercise, social interaction, and feeding times are determinants for stability and integrity of circadian rhythms. In recent years, experimental and clinical studies have consistently evidenced that the alteration of circadian rhythms is associated with the development of digestive pathologies mainly linked to dismotility or changes in microbiota composition. Likewise, it seems reasonable to deep into the importance of chronodisruption as a factor that may participate in the development of pathologies such as IBS, IBD and digestive cancers. Moreover, life habits respecting circadian rhythms should be promoted for the prevention of these diseases. Further studies will allow us a better understanding of the mechanisms acting at molecular level, and the development of new therapeutic targets.

Upper gastrointestinal microbiota and digestive diseases

Metagenomics which combines the power of genomics,bioinformatics,and systems biology,provide new access to the microbial world.Metagenomics permit the genetic analysis of complex microbial populations without requiring prior cultivation.Through the conceptual innovations in metagenomics and the improvements in DNA high-throughput sequencing and bioinformatics analysis technology,gastrointestinal microbiology has entered the metagenomics era and become a hot topic worldwide.Human microbiome research is underway,however,most studies in this area have focused on the composition and function of the intestinal microbiota and the relationship between intestinal microbiota and metabolic diseases(obesity,diabetes,metabolic syndrome,etc.) and intestinal disorders [inflammatory bowel disease,colorectal cancer,irritable bowel syndrome(IBS),etc.].Few investigations on microbiota have been conducted within the upper gastrointestinal tract(esophagus,stomach and duodenum).The upper gastrointestinal microbiota is essential for several gastrointestinal illnesses,including esophagitis,Barrett's esophagus,and esophageal carcinoma,gastritis and gastric cancer,small intestinal bacterial overgrowth,IBS and celiac disease.However,the constitution and diversity of the microbiota in different sections of the upper gastrointestinal tract under health and various disease states,as well as the function of microbiota in the pathogenesis of various digestive diseases are still undefined.The current article provides an overview of the recent findings regarding the relationship between upper gastrointestinal microbiota and gastrointestinal diseases;and discusses the study limitations and future directions of upper gastrointestinal microbiota research.