Anxiety and depression are closely related to digestive system diseases. However, anxiety and depression in gastroenterology outpatients are not consistently recognized or managed. This study aimed to investigate the prevalence of anxiety, depression and associated risk factors in gastroenterology outpatients. We conducted a cross-sectional study from June 2021 to June 2022 in the gastroenterology outpatients of three central hospitals. Professional researchers at each center collected data from patients through face-to-face interviews using a questionnaire. The Hamilton Anxiety Scale, Hamilton Depression Scale and Pittsburgh Sleep Quality Index were respectively used to assess anxiety, depression and sleep quality. Univariate and multivariate logistic regression were performed to identify associated risk factors. A total of 931 patients were finally included for analysis. The overall detection rates of anxiety and depression were 26.5% and 12.2%, respectively. Gastroesophageal reflux (AOR:1.559, 95%CI:1.084–2.244), dyspepsia (AOR:2.194, 95%CI:1.302–3.696), bile reflux (AOR:3.509, 95%CI:2.413–5.103), atrophic gastritis with intestinal metaplasia or intraepithelial neoplasia (AOR:3.814, 95%CI:1.399–10.402), biliary tract disease (AOR:1.584, 95%CI:1.042–2.410), liver disease (AOR:2.401, 95%CI:1.073–5.374), and poor sleep (AOR:5.578, 95%CI:3.859–8.063) were significantly associated with anxiety. Bile reflux (AOR:5.409, 95%CI:3.190–9.173), liver disease (AOR:3.177, 95%CI:1.183–8.531), and poor sleep (AOR:8.572, 95%CI:4.952–14.840) were significantly associated with depression. Physical exercise time ≥ 150 min/week (AOR:0.550, 95%CI:0.324–0.934) was inversely associated with depression. Anxiety and depression were prevalent among gastroenterology outpatients. Gastroenterologists should pay close attention to the psychological status of patients, especially those with gastroesophageal reflux, dyspepsia, bile reflux, atrophic gastritis with intestinal metaplasia or intraepithelial neoplasia, biliary tract disease, liver disease, and poor sleep.
An important aspect of patients’ behavior is their attitude toward healthy lifestyle principles, especially regarding smoking and alcohol consumption. Objective. To analyze the behaviors associated with compliance with the principles of a healthy lifestyle in patients with digestive system diseases. Materials and methods. The study patients were divided into three groups: Group 1 (531 subjects) included patients with digestive diseases receiving elective treatment in outpatient settings; Group 2 (822 subjects) included patients receiving elective treatment in inpatient settings (in the specialized gastroenterology department); Group 3 (147 subjects) included hospitalized patients receiving emergency treatment for complications of digestive diseases. The comparison between groups was performed using nonparametric criteria: the association coefficient (Cass) and the χ2 test. Results. Despite their subjective perception of the sufficiency of their efforts to maintain their own health, many patients do not adhere to the principles of a healthy lifestyle as a basis for maintaining it. The proportion of non-smoking patients was 64.4% in Group 1, 56.3% in Group 2, and significantly less in Group 3 — 37.1% (p<0.05). 5.4% of patients in Group 1, 4.1% of patients in Group 2, and 37.3% of patients in Group 3 consume alcohol almost daily. The differences between the groups were statistically significant (p<0.05). Conclusion. Patients with digestive diseases are critical of the sufficiency of their efforts to maintain their own health. Only 40.4% of patients in Group 1 and 39.5% in Group 2 consider their efforts sufficient, whereas the proportion in Group 3 is significantly lower (22.2%).
M. B. Braga Neto, S. Jatana, Florian Rieder
et al.
MANUEL BRAGA NETO, , ASSISTANT PROFESSOR, CLEVELAND CLINIC LERNER COLLEGE OF MEDICINE AT CASE WESTERN RESERVE UNIVERSITY, DEPARTMENT OF GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION, DIGESTIVE DISEASES AND SURGERY INSTITUTE CLEVELAND CLINIC, CLEVELAND, OH, USA INTRODUCTION Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic inflammatory conditions that affect millions of patients worldwide. Despite recent advances, the available IBD drugs targeting the immune system have limited efficacy, and disease recurrence is common. AREAS COVERED In this review, the authors describe reported applications of human intestinal organoids to understand the mechanisms of actions and predict patient response to current IBD therapies. Furthermore, they also outline the potential of human intestinal organoid-based technologies to accelerate drug discovery in IBD and propose a framework to bridge discoveries from the bench to the bedside. EXPERT OPINION The lag in the development of novel IBD therapies reflects the complex nature of the disease and our poor understanding of its pathogenesis. The future breakthrough in understanding IBD and developing novel IBD drugs require development and adaptation of novel disease-relevant experimental models, including organoid-based models, to evaluate the efficiency and accurately predict response to therapy. Indeed, presently the utilization of intestinal organoids in the IBD field has been limited and were not used in the development of any of the currently available therapies, including biologics (anti-TNF, anti-12/IL23, anti-α4β7) and small molecules. The authors affirm that a stepwise approach would help accelerate future organoid-based drug discovery efforts.
Rebecca John, Kripa E. Cherian, Patricia Sebastian
et al.
Breast cancer, the most common hormone responsive cancer, is on a rise both globally and in India. With increased longevity of breast cancer survivors, addressing long-term complications such as osteoporosis is crucial. Several mechanisms contribute to the bone loss seen in breast cancer patients, including age, post-menopausal status, chemotherapy, and other adjuvant therapies received. Appropriate evaluation and counselling on the risks of therapy with aromatase inhibitors on bone health are much needed. Timely initiation of anti-resorptive medication can help improve bone mass, reduce the incidence of fractures, and improve quality of life.
Diseases of the endocrine glands. Clinical endocrinology, Diseases of the digestive system. Gastroenterology
Background and aims: Primary sclerosing cholangitis (PSC) is an autoimmune liver disease characterized by complex pathogenesis and limited available therapeutic options. The mechanisms underlying the development and progression of PSCs remain unclear. Liver X receptor beta (LXR-β) is recognized to modulate lipid metabolism and immune response, but its specific involvement in the PSC has not been elucidated. Here, we explored the role and mechanism of LXR-β in PSC induced by 3, 5-diethoxycarbonyl-1, 4-dihydro-2, 4, 6-collidine (DDC). Methods: CRISPR-Cas9 technology was applied to generate Abcb4 (coding MDR2, next named as Mdr2), Nr1h2 (coding LXR-β, next named as Lxrβ), and Rag2 (coding RAG2) knockout mice. DDC was used to induce PSC. Hematoxylin and eosin and Sirius red staining were used to assess the extent of hepatic injury and fibrosis. Flow cytometry was used to observe immune cell subsets. Results: We observed a declining trend in hepatic Lxrβ in the PSC model. Unexpectedly, Lxrβ knockout failed to modulate DDC-induced PSC pathogenesis. Concomitantly, assessment of the influence of Rag2 deficiency on PSC progression revealed the absence of aggravated or alleviated hepatic injury or fibrosis in the Rag2−/− DDC mice. However, Lxrβ depletion intensified DDC-induced PSC in the Rag2−/− mice, with more abundant infiltrative inflammatory cells and more severe liver fibrosis. Compared with Rag2−/− DDC mice, Lxrβ−/−Rag2−/− DDC mice had higher serum ALT and AST levels and mRNA expression of proinflammatory and profibrotic genes. Flow cytometry showed that LXR-β deficiency resulted in a diminished population of hepatic innate immune cells. Conclusion: This study indicated innate immune cell LXR-β deficiency can exacerbate hepatic injury and fibrosis in murine models of PSC suggesting that LXR-β may regulate the function of innate immunity in the fibrotic advancement of PSC.
Diseases of the digestive system. Gastroenterology
Ammad Javaid Chaudhary, Abdulmalik Saleem, Muhammad Shahzil
et al.
Colorectal cancer (CRC) continues to be a significant global health issue contributing to a high mortality rate. Despite advancements in treatment, the risk of recurrence remains due to inherent mutations and the rapid turnover of intestinal mucosa. We present an exceptionally rare case of CRC metastasis to the duodenum in a 42-year-old female who has been compliant with postsurgical surveillance. Despite previous negative surveillance results, elevated CEA levels and a 3-cm mesenteric mass were detected, raising concerns for carcinoma, which was later confirmed by biopsy. The tumor board deemed her ineligible for surgery due to vascular involvement, leading to palliative care and an attempt at neoadjuvant therapy. Vigilant monitoring is crucial for early detection and intervention.
Diseases of the digestive system. Gastroenterology
ABSTRACT Background and Objective Fluorescence imaging has emerged as a valuable adjunct in gastric surgery, enhancing resection precision and oncologic outcomes. However, the use of indocyanine green (ICG) remains controversial due to uncertainties in efficacy and administration. A lack of standardized protocols persists. This review summarizes current applications of fluorescence in gastric cancer surgery, outlining existing challenges and future research needs. Methods A systematic PubMed search (2004–2024) was conducted using keywords such as “indocyanine green,” “carbon particle,” “blue dye,” “gastric cancer,” and “gastroesophageal junction cancer” to identify and review key uses of fluorescence agents in gastrointestinal malignancies. Key Findings Fluorescence‐guided imaging aids intraoperative tumor localization, shortens operative time, and enhances lymph node (LN) yield, improving staging accuracy. Its role in sentinel lymph node (SLN) detection is still under debate due to false negatives. ICG fluorescence angiography (ICG‐FA) may lower anastomotic leak rates, though strong supporting evidence is limited. No consensus exists regarding ICG dosage, timing, or delivery method. Conclusions Current evidence supports the safety and efficacy of fluorescence imaging in gastrointestinal surgery, with promising outcomes in precision and staging. However, uniform protocols for fluorescence use are urgently needed. Future studies should aim to standardize administration and optimize clinical implementation to fully realize its benefits.
Surgery, Diseases of the digestive system. Gastroenterology
Alberto Pliego Marugán, Jesús M. Pinar-Pérez, Fausto Pedro García Márquez
Efficient maintenance has always been essential for the successful application of engineering systems. However, the challenges to be overcome in the implementation of Industry 4.0 necessitate new paradigms of maintenance optimization. Machine learning techniques are becoming increasingly used in engineering and maintenance, with reinforcement learning being one of the most promising. In this paper, we propose a gamma degradation process together with a novel maintenance model in which repairs are increasingly imperfect, i.e., the beneficial effect of system repairs decreases as more repairs are performed, reflecting the degradational behavior of real-world systems. To generate maintenance policies for this system, we developed a reinforcement-learning-based agent using a Double Deep Q-Network architecture. This agent presents two important advantages: it works without a predefined preventive threshold, and it can operate in a continuous degradation state space. Our agent learns to behave in different scenarios, showing great flexibility. In addition, we performed an analysis of how changes in the main parameters of the environment affect the maintenance policy proposed by the agent. The proposed approach is demonstrated to be appropriate and to significatively improve long-run cost as compared with other common maintenance strategies.
Franco Oberti, Stefano Di Carlo, Alessandro Savino
The Controller Area Network (CAN) protocol, essential for automotive embedded systems, lacks inherent security features, making it vulnerable to cyber threats, especially with the rise of autonomous vehicles. Traditional security measures offer limited protection, such as payload encryption and message authentication. This paper presents a novel Intrusion Detection System (IDS) designed for the CAN environment, utilizing Hardware Performance Counters (HPCs) to detect anomalies indicative of cyber attacks. A RISC-V-based CAN receiver is simulated using the gem5 simulator, processing CAN frame payloads with AES-128 encryption as FreeRTOS tasks, which trigger distinct HPC responses. Key HPC features are optimized through data extraction and correlation analysis to enhance classification efficiency. Results indicate that this approach could significantly improve CAN security and address emerging challenges in automotive cybersecurity.
Manuela Daniela Danu, George Marica, Constantin Suciu
et al.
The rapidly increasing volume of electronic health record (EHR) data underscores a pressing need to unlock biomedical knowledge from unstructured clinical texts to support advancements in data-driven clinical systems, including patient diagnosis, disease progression monitoring, treatment effects assessment, prediction of future clinical events, etc. While contextualized language models have demonstrated impressive performance improvements for named entity recognition (NER) systems in English corpora, there remains a scarcity of research focused on clinical texts in low-resource languages. To bridge this gap, our study aims to develop multiple deep contextual embedding models to enhance clinical NER in the cardiology domain, as part of the BioASQ MultiCardioNER shared task. We explore the effectiveness of different monolingual and multilingual BERT-based models, trained on general domain text, for extracting disease and medication mentions from clinical case reports written in English, Spanish, and Italian. We achieved an F1-score of 77.88% on Spanish Diseases Recognition (SDR), 92.09% on Spanish Medications Recognition (SMR), 91.74% on English Medications Recognition (EMR), and 88.9% on Italian Medications Recognition (IMR). These results outperform the mean and median F1 scores in the test leaderboard across all subtasks, with the mean/median values being: 69.61%/75.66% for SDR, 81.22%/90.18% for SMR, 89.2%/88.96% for EMR, and 82.8%/87.76% for IMR.
To evaluate the efficacy of peptide hydrolysates of animal and fish origin in reducing the severity of symptoms in patients with chronic diseases of the digestive system. Patients with chronic gastritis, chronic pancreatitis, gastroesophageal reflux disease, chronic constipation, intestinal malabsorption, multiple intestinal polyposis participated in the study. The prevalence of symptoms of the described diseases among participants was assessed before treatment and during one year of peptide hydrolysate supplementation. By the end of the course of monotherapy with peptide hydrolysates, the prevalence of all analysed symptoms of chronic digestive diseases was significantly lower compared to the pre-test results. The clinical effect in the majority of patients was achieved within the first 3–6 months of treatment.
The current approach to healthcare in developed countries is too costly and inefficient to be replicated in developing countries. This paper focuses on India, with over 1.4 billion people and fewer than 3000 gastroenterologists and hepatologists (GIH) mostly clustered in a few major cities with many regions having no GIH specialist. The Indian government has implemented personal identification numbers including health ID, and access to smartphones has increased nationally. With emerging health information technology (HIT) and clinical decision support systems utilizing detailed patient information, there is an opportunity to utilize precision medicine (treatment tailored to an individual’s disease mechanisms using biomarkers and disease modelling with clinical decision support for healthcare workers) to bypass the high cost of modern Western healthcare models and improve the lives of millions of people with a more effective healthcare delivery system paradigm. Digestive diseases are a major area of need that is ready for precision medicine solutions.
Introduction . Currently, considerable attention of researchers is attracted to the study of the state and therapeutic significance of the human gut microbiota (GM), the imbalance of which can lead to the occurrence or aggravation of existing diseases and syndromes. The purpose of the study . To systematize the literature data on GM and its pathogenetic significance for humans, the possibilities of using probiotics – psychobiotics in general clinical practice and in some gastroenterological diseases. Materials and methods . The research was based on publications by domestic and foreign authors, available in specialized databases (PubMed, Scopus, eLibrary). An analysis of original and review articles, meta-analyses, and clinical cases on this issue has been performed. Results and discussions . The gut microflora performs a number of important functions for the body: digestive, barrier, metabolic, immune, regulatory (mood, stress and anxiety levels). The intestine constantly receives regulatory signals from the central nervous system and vice versa, on the basis of which the term «enterocerebral axis» arose, which includes afferent and efferent nervous, endocrine, immunological and nutritional connections between the gastrointestinal tract and the central nervous system, which cause disorders of many systems. Probiotics-рsychobiotics containing lactobacilli-have been associated with reduced abdominal pain, flatulence, and quality of life, while Bifidobacterium improved imperative urges and general symptoms of IBS. In another study, a probiotic psychobiotic based on Bifidobacterium longum NCC 3001 led to a decrease in depression rates and a decrease in reactions in the amygdala and frontolimbic regions. Conclusion . The use of psychobiotics as an additional, and sometimes alternative, treatment method for gastroenterological diseases such as irritable bowel syndrome and obesity shows significant positive effects, especially when associated with the underlying disease of depressive syndrome.
Morphological changes in the gastric wall under the influence of various pathological factors represent one of the most pressing problems in modern gastroenterology and morphology. The stomach, as one of the central organs of the digestive system, is characterized by high plasticity and adaptive properties in response to various endogenous and exogenous factors. Understanding the processes of structural remodeling of the gastric mucosa is essential for developing effective therapeutic agents for gastrointestinal tract diseases. Despite significant progress in studying the features of gastric wall remodeling, many factors of this process remain insufficiently studied. In particular, the relationships between different types of pathogenic influences and characteristic morphological changes require more detailed investigation. The aim of the study is to systematize and analyze current scientific data on morphofunctional changes in the gastric wall under the influence of the following exogenous and endogenous factors: radiation damage, compressive loading, electron ionization, bariatric surgery, heavy metals, toxic effects of cadmium and copper, tetrabromobisphenol A, indomethacin, acetylsalicylic acid, ibuprofen, food additives, as well as dehydration, diabetes mellitus, inflammatory processes, chronic alcoholic hepatitis, concomitant thyroid pathology with atrophic gastritis, autoimmune atrophic gastritis in systemic scleroderma, and cancer diseases. The results of the analysis will contribute to the development of scientifically-based approaches for the prevention and treatment of gastroenterological 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 ul-cerative 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.
Timely detection of illnesses is vital to prevent severe infections and ensure effective treatment, as it's always better to prevent diseases than to cure them. Sadly, many patients remain undiagnosed until their conditions worsen, resulting in high death rates. Expert systems offer a solution by automating early-stage diagnoses using a fuzzy rule-based approach. Our study gathered data from various sources, including hospitals, to develop an expert system aimed at identifying early signs of diseases, particularly heart conditions. The diagnostic process involves collecting and processing test results using the expert system, which categorizes disease risks and aids physicians in treatment decisions. By incorporating expert systems into clinical practice, we can improve the accuracy of disease detection and address challenges in patient management, particularly in areas with limited medical resources.
Plant disease recognition is a critical task that ensures crop health and mitigates the damage caused by diseases. A handy tool that enables farmers to receive a diagnosis based on query pictures or the text description of suspicious plants is in high demand for initiating treatment before potential diseases spread further. In this paper, we develop a multimodal plant disease image retrieval system to support disease search based on either image or text prompts. Specifically, we utilize the largest in-the-wild plant disease dataset PlantWild, which includes over 18,000 images across 89 categories, to provide a comprehensive view of potential diseases relating to the query. Furthermore, cross-modal retrieval is achieved in the developed system, facilitated by a novel CLIP-based vision-language model that encodes both disease descriptions and disease images into the same latent space. Built on top of the retriever, our retrieval system allows users to upload either plant disease images or disease descriptions to retrieve the corresponding images with similar characteristics from the disease dataset to suggest candidate diseases for end users' consideration.