Hasil untuk "Diseases of the digestive system. Gastroenterology"

G. Garcia‐Tsao, A. Sanyal, N. Grace et al.

Vadim Osadchiy, Clair R. Martin, Emeran A. Mayer

Robert J. Huang, Monika Laszkowska, Haejin In et al.

Brendan Kemple, Satish S.C. Rao

INTRODUCTION: Disaccharidases produced by the small intestinal brush border facilitate digestion of dietary carbohydrates. If deficient, they can cause carbohydrate malabsorption, resulting in several abdominal symptoms. Our aim was to examine the prevalence of disaccharidase deficiency and correlate this with abdominal symptoms in adult patients with chronic abdominal symptoms. METHODS: In a retrospective study, patients with gas and bloating and normal endoscopy and computed tomography scan were assessed for lactase, sucrase, maltase, palatinase, and glucoamylase activity. Nine common symptoms such as pain, cramping, constipation, belching, bloating, fullness, indigestion, nausea, diarrhea, vomiting, and gas were assessed for their frequency, intensity, and duration using a validated scale, and a total symptom index was calculated and compared. K-means cluster analysis was performed on lactase-deficient and pandeficient patients with deficiency in 3 or more enzymes. RESULTS: Four hundred ninety-six patients (78.4% female) were enrolled of whom 143 (28.8%) had single enzyme deficiency, 9 (1.8%) had double enzyme deficiency, and 48 (9.7%) were pandeficient. The mean symptom prevalence and its severity were not significantly different between those with or without disaccharidase deficiency. Patients with pandeficiency did not have worse symptoms than those with single or double enzyme deficiency. No single symptom was more prevalent in patients with confirmed enzyme deficiency than those without. Three groups were identified in cluster analysis of pandeficient patients with one group demonstrating significantly lower average symptoms of cramping, indigestion, and nausea. DISCUSSION: Disaccharidase deficiency is common in adults presenting with gas, bloating, distention, and pain. Because these deficiencies are treatable with enzyme supplements or diet, an evaluation for disaccharidase deficiency should be routinely considered.

Wenying Qi, Xu Cao, Yue Chen et al.

ABSTRACT Aims The TiaoGanXiaoZhi formula (TGXZ), a traditional Chinese medicine, has been shown to alleviate the progression of metabolic‐associated fatty liver disease (MAFLD) clinically. However, its underlying mechanism remains unclear. This study aimed to investigate the effects and mechanisms of TGXZ in treating MAFLD in mouse models. Methods The MAFLD mouse model was established using a high‐fat diet and 5% fructose water over 16 weeks. At Week 8, mice exhibited significant steatosis, inflammation, and insulin resistance. A total of 42 mice were divided into the normal feed diet (NFD) group (n = 18) and the high‐fat feed diet (HFD) group (n = 24). Six mice from each group were killed at Week 8 for serological and histopathological assessments. The remaining mice were allocated into NFD (n = 6), HFD (n = 6), HFD + TGXZ (n = 6), NFD + TGXZ (n = 6), and HFD + Placebo (n = 6) groups. TGXZ (or placebo) was administered at a clinical equivalent dose of 7.699 g/(kg·d) to the respective groups, while NFD and HFD groups received distilled water. Daily gavage started in Week 9. At Week 16, after fasting, body weight and liver condition were recorded, and mice were euthanized with pentobarbital sodium. Liver tissue was collected for further analysis, and the remaining tissue and feces were stored at −80°C. Data were graphed using GraphPad Prism 8.0.0 and analyzed with SPSS Statistics 25.0. Results are expressed as mean ± standard deviation. Statistical comparisons were made using Student's t‐test for two groups and one‐way ANOVA for more than two groups, with significance set at p < 0.05. Results Compared to the MAFLD mouse model group, TGXZ treatment significantly downregulated the weight of white adipose tissue (1.61 ± 0.66 vs. 3.06 ± 0.34 g, p < 0.0010), liver weight (1.22 ± 0.16 vs. 1.98 ± 0.39 g, p = 0.0031), and the levels of alanine aminotransferase (20.6 ± 3.4 vs. 46.1 ± 12.3 U/L, p < 0.0010), aspartate aminotransferase (99.9 ± 19.1 vs. 168.4 ± 34.3 U/L, p = 0.0014), cholesterol (2.95 ± 0.56 vs. 4.38 ± 0.34 mmol/L, p = 0.0053), triglycerides (2.25 ± 0.41 vs. 4.18 ± 0.67 mmol/L, p < 0.0010), low‐density lipoprotein (0.66 ± 0.11 vs. 1.41 ± 0.52 mmol/L, p = 0.0073), and total bile acid (0.71 ± 0.41 vs. 2.18 ± 0.61 mmol/L, p = 0.0017), except for high‐density lipoprotein (2.41 ± 0.81 vs. 2.55 ± 0.31 mmol/L, p = 0.5655). The liver transcriptome, fecal microbiota sequencing, and fecal lipidomics analysis demonstrated that TGXZ treatment improved the expression of genes related to lipid metabolism, alleviated intestinal microbiota disorders, and mitigated lipid disturbances caused by MAFLD. Conclusions Our study demonstrated that TGXZ treatment effectively alleviated the progression of MAFLD. The inhibitory effects of TGXZ on MAFLD may be attributed to its regulation of gut microbiota, lipid metabolism, and hepatic inflammation.

Olga Maria Nardone, Giulio Calabrese, Alessia La Mantia et al.

Background: Managing extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) patients remains challenging due to considerable heterogeneity in diagnostic criteria and the lack of a standardised definition and validated diagnostic pathways. Delays in recognising and treating EIMs can lead to significant disease progression. Therefore, early detection and treatment are crucial. Objectives: We aimed to assess the effectiveness of a dedicated immune-mediated inflammatory diseases (IMIDs) clinic in reducing EIM diagnostic delays and improving patients’ outcomes. Design: A single-centre observational study was conducted, including IBD patients presenting with EIMs red flags. Methods: We compared the EIMs diagnostic delay between patients who attended a multidisciplinary IMID outpatient clinic (IMID-G) and those who attended individual referral specialists representing the standard outpatient clinic group (SOC-G). We further evaluated the impact of diagnostic timing on 18-month clinical outcomes, including therapeutic changes, steroid and immunosuppressant use and biological therapy switch/swap. Results: We enrolled 238 IBD patients, 127 in the IMID-G and 111 in the SOC-G. The average time to EIM diagnosis was 2.48 ± 1.8 and 5.36 ± 2.3 months for the IMID and SOC-Gs (Δ = 2.88 months, p  = 0.005). The majority of patients received a diagnosis of peripheral arthritis (IMID-G = 37.5%; SOC-G = 33.7%) and spondyloarthropathy (IMID-G = 32.1%; SOC-G = 33.7%). No significant difference was observed in the rates of EIMs between the two groups (88.2% in IMID-G vs 92.8% in SOC-G, p  = 0.27). Regarding therapeutic changes, the IMID-G reported a mean time to the first therapeutic change driven by the specialist referral of 2.96 ± 1.8 months, compared to 6.09 ± 2.5 months in the SOC-G, showing a significant difference ( p  = 0.007). The IMID-G had a higher frequency of biological therapy switching/swapping and adding immunosuppressive treatment than the SOC-G ( p  = 0.008 and p  = 0.04, respectively). Survival curves revealed a significant reduction in diagnostic delay and time to treatment in the IMID-G compared to the SOC-G (log-rank test, p  < 0.001). Conclusion: Attending a dedicated IMID clinic can enhance the diagnostic process for EIMs in IBD patients, thereby reducing diagnostic delays and allowing early interventions to avoid disease progression.

Chanti Raju Mylay, Bobin Deng, Zhipeng Cai et al.

Crop diseases pose significant threats to global food security, agricultural productivity, and sustainable farming practices, directly affecting farmers' livelihoods and economic stability. To address the growing need for effective crop disease management, AI-based disease alerting systems have emerged as promising tools by providing early detection and actionable insights for timely intervention. However, existing systems often overlook critical aspects such as data privacy, market pricing power, and farmer-friendly usability, leaving farmers vulnerable to privacy breaches and economic exploitation. To bridge these gaps, we propose AgriSentinel, the first Privacy-Enhanced Embedded-LLM Crop Disease Alerting System. AgriSentinel incorporates a differential privacy mechanism to protect sensitive crop image data while maintaining classification accuracy. Its lightweight deep learning-based crop disease classification model is optimized for mobile devices, ensuring accessibility and usability for farmers. Additionally, the system includes a fine-tuned, on-device large language model (LLM) that leverages a curated knowledge pool to provide farmers with specific, actionable suggestions for managing crop diseases, going beyond simple alerting. Comprehensive experiments validate the effectiveness of AgriSentinel, demonstrating its ability to safeguard data privacy, maintain high classification performance, and deliver practical, actionable disease management strategies. AgriSentinel offers a robust, farmer-friendly solution for automating crop disease alerting and management, ultimately contributing to improved agricultural decision-making and enhanced crop productivity.

Yu Chao, Siyu Lin, xiaorong wang et al.

We introduce LLM x MapReduce-V3, a hierarchically modular agent system designed for long-form survey generation. Building on the prior work, LLM x MapReduce-V2, this version incorporates a multi-agent architecture where individual functional components, such as skeleton initialization, digest construction, and skeleton refinement, are implemented as independent model-context-protocol (MCP) servers. These atomic servers can be aggregated into higher-level servers, creating a hierarchically structured system. A high-level planner agent dynamically orchestrates the workflow by selecting appropriate modules based on their MCP tool descriptions and the execution history. This modular decomposition facilitates human-in-the-loop intervention, affording users greater control and customization over the research process. Through a multi-turn interaction, the system precisely captures the intended research perspectives to generate a comprehensive skeleton, which is then developed into an in-depth survey. Human evaluations demonstrate that our system surpasses representative baselines in both content depth and length, highlighting the strength of MCP-based modular planning.

Michael Schwarz, Julian Erhard

Sound static analysis can prove the absence of data races by establishing that no two conflicting memory accesses can occur at the same time. We repurpose the concept of digests -- summaries of computational histories originally introduced to bring tunable concurrency-sensitivity to thread-modular value analysis by abstract interpretation, extending this idea to race detection: We use digests to capture the conditions under which conflicting accesses may not happen in parallel. To formalize this, we give a definition of data races in the thread-modular local trace semantics and show how exclusion criteria for potential conflicts can be expressed as digests. We report on our implementation of digest-driven data race detection in the static analyzer Goblint, and evaluate it on the SV-COMP benchmark suite. Combining the lockset digest with digests reasoning on thread ids and thread joins increases the number of correctly solved tasks by more than a factor of five compared to lockset reasoning alone.

Dennis L. Shung

Matteo Martinato, Elena Boffo, Greta Lorenzon et al.

A prevalent symptom among Inflammatory Bowel Disease (IBD) patients is fatigue, characterized by a persistent sense of energy depletion that affects all aspects of daily life. This review aims to evaluate nursing interventions reported in the literature to alleviate fatigue in IBD patients. A comprehensive search was conducted across four electronic databases—PubMed, CINAHL, Cochrane, and Scopus—and four scientific journals: “Gastroenterology”, “Inflammatory Bowel Disease”, “Journal of Crohn’s and Colitis”, and “United European Gastroenterology Journal”. Inclusion criteria were clinical trials involving adult IBD patients in remission or mild disease activity. Out of 234 studies, 2 were selected for review. These studies assess the effectiveness of Solution-Focused Therapy (SFT) that emphasizes solving problems and developing strategies for improvement, and Problem-Solving Therapy (PST) that focuses on identifying problems and coping strategies. SFT showed a positive impact on fatigue with a significant improvement in the Checklist Individual Strength after three months: 45.5% in the control group, 85.7% in the SFT group, and 60% in the PST group, but its impact declined over time. Additionally, SFT demonstrated potential for reducing healthcare costs compared to standard of care and PST. Further research is needed to provide nurses interventions for managing fatigue in IBD patients. The review protocol has been registered at OSF.io.

Won Beom Jung

Rectal cancer is one of the most common carcinomas and a leading cause of cancer-related mortality. Although significant advancements have been made in the treatment of rectal cancer, the deterioration of quality of life (QoL) remains a challenging issue. Various tools have been developed to assess QoL, including the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale, the QLQ-C30 and QLQ-CR29 by the European Organization for Research and Treatment of Cancer (EORTC), and the 36-Item Short Form Health Survey (SF-36). Factors such as the lower location of the tumor, radiation therapy, chemoradiotherapy, and chemotherapy are associated with a decline in QoL. Furthermore, anastomotic leakage following rectal cancer resection is an important risk factor affecting QoL. With the development of novel treatment approaches, including neoadjuvant therapies such as chemoradiotherapy and total neoadjuvant therapy, the rate of clinical complete remission has increased, leading to the emergence of organ-preserving strategies. Both local excision and the “watch-and-wait” approach following neoadjuvant therapy improved functional outcomes and QoL. Efforts to improve QoL after rectal cancer surgery are ongoing in surgical techniques for rectal cancer. Since QoL is determined by a complex interplay of factors, including the patient's physical condition, surgical techniques, and psychological and social elements, a comprehensive approach is necessary to understand and enhance it. This review aims to describe the methods for measuring QoL in rectal cancer patients after surgery, the key risk factors involved, and various strategies and efforts to improve QoL outcomes.

A. M. Ostrovsky, I. N. Koliada

The purpose of the study was to analyze mortality from diseases of the digestive system in the Gomel region for the period 2009-2019. Intensive and extensive mortality rates of the population from diseases of the digestive system were analyzed. Differences in the compared indicators were considered statistically significant with a Student’s t-test value of ≥ 2 and a significance р-level ≤ 0.05. From the data obtained, it was established that during the analyzed period there was no statistically significant trend in the increase in mortality rates of the Gomel region population from diseases of the digestive system in general, as well as among people of working age and older than working age. The mortality rate of the rural population of the Gomel region from diseases of the digestive system is 1.5 times higher than the mortality rate of the urban population. In the structure of mortality causes of the Gomel region population from diseases of the digestive system, including urban and rural populations, liver diseases (fibrosis and cirrhosis of the liver, except alcoholic) are in first place, vascular diseases of the intestine are in second place, acute pancreatitis and other diseases of the pancreas are in third place, in fourth place alcoholic liver diseases (cirrhosis, hepatitis, fibrosis), followed by duodenal ulcers, stomach ulcers and other diseases of the digestive system. Since liver diseases (fibrosis and cirrhosis of the liver, except alcoholic) are in the first place in these categories of the population, the main attention should be paid to primary prevention at all levels: rational and balanced nutrition, quality of medical care through high-quality clinical examination, timely diagnosis, effective treatment and rehabilitation.

James E. Everhart, Constance E. Ruhl

Apoorva K. Chandar, Eric E. Low, Mendel E. Singer et al.

Eduardo Vilar-Gomez, Tiebing Liang, Katherine Yates et al.

Peyman Gholami, Hulya Seferoglu

Two widely considered decentralized learning algorithms are Gossip and random walk-based learning. Gossip algorithms (both synchronous and asynchronous versions) suffer from high communication cost, while random-walk based learning experiences increased convergence time. In this paper, we design a fast and communication-efficient asynchronous decentralized learning mechanism DIGEST by taking advantage of both Gossip and random-walk ideas, and focusing on stochastic gradient descent (SGD). DIGEST is an asynchronous decentralized algorithm building on local-SGD algorithms, which are originally designed for communication efficient centralized learning. We design both single-stream and multi-stream DIGEST, where the communication overhead may increase when the number of streams increases, and there is a convergence and communication overhead trade-off which can be leveraged. We analyze the convergence of single- and multi-stream DIGEST, and prove that both algorithms approach to the optimal solution asymptotically for both iid and non-iid data distributions. We evaluate the performance of single- and multi-stream DIGEST for logistic regression and a deep neural network ResNet20. The simulation results confirm that multi-stream DIGEST has nice convergence properties; i.e., its convergence time is better than or comparable to the baselines in iid setting, and outperforms the baselines in non-iid setting.

Xiaobo Wang, Haiyang Guo, Yong Tang et al.

Abstract Background A missed diagnosis of colorectal polyps during colonoscopy may be associated with the occurrence of interval colorectal cancer. The risk factors for a missed diagnosis or a method to predict the risk of a missed diagnosis of colorectal polyps during colonoscopy remain unidentified. Methods The clinical data of patients who underwent two colonoscopies within three months at the Affiliated Hospital of North Sichuan Medical College between February 2017 and August 2019 were retrospectively reviewed. Independent risk factors for missed diagnoses were identified, and a nomogram was established to predict the risk of missed diagnoses. The prediction performance of the nomogram was evaluated using C-index and calibration curves, and its clinical application value was assessed using the Youden index and decision curve analysis. Results Independent influencing factors for missed diagnoses included age, endoscopist experience, bowel preparation, retroflected view, withdrawal time, number of polyps in the right colon, and number of polyps ≥ 6 mm. The C-index of the nomogram in the training and validation cohorts was 0.763 (95% confidence interval [CI]: 0.724 − 0.807) and 0.726 (95%CI: 0.657 − 0.794), respectively. The optimal cut-off value of the nomogram calculated using the Youden index was 152.2 points. Under the cut-off value, the sensitivity, specificity, positive predictive value, and negative predictive value were 67.1%, 75.7%, 45.8%, and 88.2%, respectively, in the training cohort, and 57.1%, 79.9%, 53.3%, and 82.3%, respectively, in the validation cohort. Conclusions The nomogram provides a reference value for clinicians to analyse the risk of a missed diagnosis of colorectal polyps in individuals, identify high-risk groups, and formulate appropriate follow-up strategies.

Daisuke Kikuchi, Hiroyuki Odagiri, Yoshio Hoshihara et al.

Background. Gastroesophageal reflux disease is diagnosed endoscopically based on the presence of mucosal breaks. However, mucosal breaks can be judged differently depending on the endoscopist, even in the same image. We investigated how narrow-band imaging (NBI) and magnified endoscopy affect the judgment of mucosal breaks. Methods. A total of 43 consecutive patients were enrolled who had suspected mucosal breaks on white-light images (WLI) and underwent nonmagnified NBI (N-NBI) and magnified NBI (M-NBI) by a single endoscopist. From WLI, N-NBI, and M-NBI, 129 image files were created. Eight endoscopists reviewed the image files and judged the presence of mucosal breaks. Results. The 8 endoscopists determined mucosal breaks were present in 79.4 ± 9.5% (67.4%–93.0%) on WLI, and 76.7 ± 12.7% (53.5%–90.7%) on N-NBI. However, the percentage of mucosal breaks on M-NBI was significantly lower at 48.8 ± 17.0% (18.6%–65.1%) (p<0.05). Intraclass correlation between observers was 0.864 (95% CI 0.793–0.918) for WLI and 0.863 (95% CI 0.791–0.917) for N-NBI but was lower for M-NBI at 0.758 (95% CI 0.631–0.854). Conclusion. Rates of detection and agreement for mucosal breaks on WLI and N-NBI were high among endoscopists. However, these rates were lower on M-NBI.

Luca Di Martino, Carlo De Salvo, Kristine-Ann Buela et al.

Background &amp; Aims: We previously showed that abundance of Candida tropicalis is significantly greater in Crohn’s disease patients compared with first-degree relatives without Crohn’s disease. The aim of this study was to determine the effects and mechanisms of action of C tropicalis infection on intestinal inflammation and injury in mice. Methods: C57BL/6 mice were inoculated with C tropicalis, and colitis was induced by administration of dextran sodium sulfate in drinking water. Disease severity and intestinal permeability subsequently were evaluated by endoscopy, histology, quantitative reverse-transcription polymerase chain reaction, as well as 16S ribosomal RNA and NanoString analyses (NanoString Technologies, Seattle, WA). Results: Infected mice showed more severe colitis, with alterations in gut mucosal helper T cells (Th)1 and Th17 cytokine expression, and an increased frequency of mesenteric lymph node–derived group 2 innate lymphoid cells compared with uninfected controls. Gut microbiome composition, including changes in the mucin-degrading bacteria, Akkermansia muciniphila and Ruminococcus gnavus, was altered significantly, as was expression of several genes affecting intestinal epithelial homeostasis in isolated colonoids, after C tropicalis infection compared with uninfected controls. In line with these findings, fecal microbiome transplantation of germ-free recipient mice using infected vs uninfected donors showed altered expression of several tight-junction proteins and increased susceptibility to dextran sodium sulfate–induced colitis. Conclusions: C tropicalis induces dysbiosis that involves changes in the presence of mucin-degrading bacteria, leading to altered tight junction protein expression with increased intestinal permeability and followed by induction of robust Th1/Th17 responses, which ultimately lead to an accelerated proinflammatory phenotype in experimental colitic mice.