Muscle strength and non-alcoholic fatty liver disease/metabolicassociated fatty liver disease

This editorial comments on an article published in a recent issue of World Journal of Gastroenterology,entitled“Association of low muscle strength with metabolic dysfunction-associated fatty liver disease:A nationwide study”.We focused on the association between muscle strength and the incidence of non-alcoholic fatty liver disease(NAFLD)and metabolic-associated fatty liver disease(MAFLD),as well as the mechanisms underlying the correlation and related clinical applications.NAFLD,which is now redefined as MAFLD,is one of the most common chronic liver diseases globally with an increasing prevalence and is characterized by malnutrition,which may contribute to decreased muscle strength.Reduction of muscle strength reportedly has a pathogenesis similar to that of NAFLD/MAFLD,including insulin resistance,inflammation,sedentary behavior,as well as insufficient vitamin D.Multiple studies have focused on the relationship between sarcopenia or muscle strength and NAFLD.However,studies investigating the relationship between muscle strength and MAFLD are limited.Owing to the shortage of specific medications for NAFLD/MAFLD treatment,early detection is essential.Furthermore,the relationship between muscle strength and NAFLD/MAFLD suggests that improvements in muscle strength may have an impact on disease prevention and may provide novel insights into treatments including dietary therapy,as well as tailored physical activity.

Gut microbiota and female health

The gut microbiota is recognized as an endocrine organ with the capacity to influence distant organs and associated biological pathways.Recent advan-cements underscore the critical role of gut microbial homeostasis in female health;with dysbiosis potentially leading to diseases among women such as polycystic ovarian syndrome,endometriosis,breast cancer,cervical cancer,and ovarian cancer etc.Despite this,there has been limited discussion on the underlying mechanisms.This editorial explores the three potential mechanisms through which gut microbiota dysbiosis may impact the development of diseases among women,namely,the immune system,the gut microbiota-estrogen axis,and the metabolite pathway.We focused on approaches for treating diseases in women by addressing gut microbiota imbalances through probiotics,prebiotics supple-mentation,and fecal microbiota transplantation(FMT).Future studies should focus on determining the molecular mechanisms underlying associations between dysbiosis of gut microbiota and female diseases to realize precision medicine,with FMT emerging as a promising intervention.

Retrievable puncture anchor traction method for endoscopic ultrasound-guided gastroenterostomy: A porcine study

BACKGROUND Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)is an alternative method for the surgical treatment of gastric outlet obstruction,but it is regarded as a challenging technique for endoscopists as the bowel is highly mobile and can tent away.Thus,the technique requires superb skill.In order to improve EUS-GE,we have developed a retrievable puncture anchor traction(RPAT)device for EUSGE to address the issue of bowel tenting.AIM To evaluate the feasibility of RPAT-assisted EUS-GE using an animal model.METHODS Six Bama mini pigs each weighing between 15 and 20 kg underwent the RPATassisted EUS-GE procedure.Care was taken to ensure that the animals experienced minimal pain and discomfort.Two days prior to the procedure the animals were limited to a liquid diet.No oral intake was allowed on the day before the procedure.A fully covered metal stent was placed between the stomach and the intestine using the RPAT-assisted EUS-GE method.Infection in the animals was determined.Four weeks after the procedure,a standard gastroscope was inserted into the pig’s intestine through a previously created fistula in order to check the status of the stents under anesthesia.The pig was euthanized after examination.RESULTS The RPAT-assisted EUS-GE method allowed placement of the stents with no complications in all six animals.All the pigs tolerated a regular diet within hours of the procedure.The animals were monitored for four weeks after the RPATassisted EUS-GE,during which time all of the animals exhibited normal eating behavior and no signs of infection were observed.Endoscopic imaging performed four weeks after the RPAT-assisted EUS-GE showed that the stents remained patent and stable in all the animals.No tissue overgrowth or ingrowth was observed in any case.Each animal had a mature fistula,and the stents were removed without significant bleeding.Autopsies of all six pigs revealed complete adhesion between the intestine and the stomach wall.CONCLUSION The RPAT method helps reduce mobility of the bowel.Therefore,the RPATassisted EUS-GE method is a minimally invasive treatment modality.

Total pancreatectomy for metachronous mixed acinar-ductal carcinoma in a remnant pancreas

In October 2009, a 71-year-old female was diagnosed with a cystic tumor in the tail of the pancreas with an irregular dilatation of the main pancreatic duct in the body and tail of the pancreas. A distal pancreatectomy with splenectomy, and partial resection of the duodenum, jejunum and transverse colon was performed. In March 2011, a follow-up computed tomography scan showed a low density mass at the head of the remnant pancreas. We diagnosed it as a recurrence of the tumor and performed a total pancreatectomy for the remnant pancreas. In the histological evaluation of the resected specimen of the distal pancreas, the neoplastic cells formed an acinar and papillary structure that extended into the main pancreatic duct. Mucin5AC, α1-antitrypsin (α-AT) and carcinoembryonic antigen (CEA) were detected in the tumor cells by immunohistochemistry. In the resected head of the pancreas, the tumor was composed of both acinar and ductal elements with a mottled pattern. The proportions of each element were approximately 40% and 60%, respectively. Strongly positive α-AT cells were detected in the acinar element. Some tumor cells were also CEA positive. However, the staining for synaptophysin and chromogranin A was negative in the tumor cells. Ultimately, we diagnosed the tumor as a recurrence of mixed acinar-ductal carcinoma in the remnant pancreas. In conclusion, we report here a rare case of repeated pancreatic resection for multicentric lesions of mixed acinar-ductal carcinoma of the pancreas.