Search Results (2,021)

Ectopic expression of human leukocyte antigen class II (HLA-II) on tumor cells correlates with anti-tumor immunity and prognosis in various cancers, but its role in esophageal squamous cell carcinoma (ESCC) remains unclear. Methods: HLA-II expression was evaluated in 34 ESCC tissue sections and a 102-sample tissue microarray (TMA) using immunohistochemistry (IHC) and in 10 ESCC cell lines via flow cytometry. Transcriptome sequencing of KYSE270, KYSE180, KYSE450, and KYSE510 was performed to investigate HLA-II regulatory mechanisms, while tumor samples from 104 ESCC patients were analyzed for neoantigen load. The prognostic significance of neoantigen burden was assessed using Cox regression. Results: HLA-II was ectopically expressed in ESCC, with positivity rates of 20.59% (34 tissues) and 25.49% (TMA). Among 10 ESCC cell lines, only KYSE270 exhibited spontaneous HLA-II expression. Transcriptome analysis revealed 1278 KYSE270-specific genes enriched in immune-related pathways (e.g., “Cytokine–cytokine receptor interaction”), suggesting immune-mediated HLA-II regulation. IFN-γ stimulation induced HLA-II expression in KYSE180, KYSE450, and KYSE510, indicating broader inducible HLA-II potential. In 104 patients, MHC-II-restricted neoantigen burden varied widely (0–75) and lacked direct correlation with HLA-II expression. Additionally, MHC-II-restricted neoantigen load was not significantly associated with overall survival (p > 0.05). Conclusion: Ectopic HLA-II expression in ESCC may influence the tumor immune microenvironment, while the prognostic value of MHC-II-restricted neoantigen burden in ESCC remains unclear, providing potential implications for immunotherapy strategies. Full article

Diagnosing gastrointestinal disorders (GIDs) remains a significant challenge, particularly when relying on wireless capsule endoscopy (WCE), which lacks advanced imaging enhancements like Narrow Band Imaging (NBI). To address this, we propose a novel framework, the Spectrum-Aided Vision Enhancer (SAVE), especially designed to transform standard white light (WLI) endoscopic images into spectrally enriched representations that emulate both hyperspectral imaging (HSI) and NBI formats. By leveraging color calibration through the Macbeth Color Checker, gamma correction, CIE 1931 XYZ transformation, and principal component analysis (PCA), SAVE reconstructs detailed spectral information from conventional RGB inputs. Performance was evaluated using the Kvasir-v2 dataset, which includes 6490 annotated images spanning eight GI-related categories. Deep learning models like Inception-Net V3, MobileNetV2, MobileNetV3, and AlexNet were trained on both original WLI- and SAVE-enhanced images. Among these, MobileNetV2 achieved an F1-score of 96% for polyp classification using SAVE, and AlexNet saw a notable increase in average accuracy to 84% when applied to enhanced images. Image quality assessment showed high structural similarity (SSIM scores of 93.99% for Olympus endoscopy and 90.68% for WCE), confirming the fidelity of the spectral transformations. Overall, the SAVE framework offers a practical, software-based enhancement strategy that significantly improves diagnostic accuracy in GI imaging, with strong implications for low-cost, non-invasive diagnostics using capsule endoscopy systems. Full article

Background: The diagnosis and treatment of esophageal cancer often leads to complex and long-lasting psychological distress, such as anxiety and depression, in patients and their partners. This psychological distress can not only potentially worsen the poor prognosis of the disease, but also reduce health-related quality of life by affecting the patient’s ability to function and enjoy life. Objectives: These preliminary data were collected to identify the components required for the development of a health education program pertaining to improving psychological distress. Methods: A narrative review. Results: Two components, diet and physical activity, were identified as important factors for the well-being of esophageal cancer patients and their partners with psychological distress. Moreover, behavioral activation was assumed to be an effective approach for assisting esophageal cancer patients’ behavioral compliance with the given dietary intake and physical activity practices program. Conclusions: A health education program based on the above components (diet and physical activity) with a behavioral activation approach could be developed as a guideline to address the problem of psychological distress among esophageal cancer patients and their partners. However, these conclusions should be treated with caution, given that the findings have not yet been empirically tested. Further rigorous studies are required to confirm their effectiveness and determine which program components may be most effective in improving outcomes. Full article

Triplophysa yarkandensis, a unique saline-alkali tolerant fish in the Tarim River Basin, exhibits unclear adaptive mechanisms of its digestive system to saline-alkali stressors. This study compared the histological characteristics of the digestive system in fish reared in saline-alkali water (salinity 5.89, alkalinity 125.60) and freshwater. Histological characteristics were analyzed using hematoxylin-eosin staining, and parameters were quantified via Image-Pro Plus software, with statistical comparisons performed using independent sample t-tests. Key findings included a 2.7-fold increase in oropharyngeal club cell density (48.50 ± 2.68 vs. 17.80 ± 2.04, p < 0.01) with denser stratified squamous epithelium in the saline-alkali group; a 74% increase in esophageal goblet cells (104.42 ± 6.67 vs. 59.94 ± 4.68, p < 0.01) alongside a 39% reduction in mucosal fold height; 87%, 24%, and 51% increases in villi number across the foregut, midgut, and hindgut, respectively, with an 84% elevation in midgut goblet cells (p < 0.01); and mild vacuolization in the hepatopancreas. Results indicate that T. yarkandensis adapts via synergistic strategies of enhanced digestive mucus secretion, epithelial structural optimization, and hepatopancreatic metabolic reprogramming. The coordinated villi proliferation and mucus secretion enhance nutrient absorption and osmotic barrier function, providing a theoretical basis for saline-alkali aquaculture. Full article

Respiratory effort is a critical parameter for assessing respiratory function in various pathological conditions such as obstructive sleep apnea (OSA), as well as in patients undergoing respiratory ventilation. Currently, the gold-standard method for measuring it is esophageal pressure (Pes), which is obtrusive and uncomfortable for patients. An alternative approach is using diaphragmatic electromyography (dEMG), a non-obtrusive method that directly reflects the electrical drive triggering respiratory effort, holding potential for quantifying effort. Despite progress in this area, there is still no clear agreement on the best features for assessing respiratory effort from dEMG. This feasibility study considers several time, frequency, and statistical domain features, providing a comparative analysis to determine their performance in estimating respiratory effort. In particular, we evaluate the correlation of the different features with Pes using overnight recordings from 10 OSA patients and assess their robustness across different signal quality levels with the Kruskal–Wallis test. Our results support that time-domain dEMG features such as the filtered envelope, root mean square, and waveform length (WL) exhibit moderately strong correlations (R > 0.6) with respiratory effort. In terms of robustness to noise, the best features were WL, the area under the curve, and the slope sign change, demonstrating moderately strong to fair correlations (R > 0.5) even in low- to very low-quality signals. In contrast, features like skewness, the mean frequency, and the median frequency performed poorly (R < 0.3), regardless of signal quality, likely because they focus on overall signal characteristics rather than the dynamic and transient changes associated with respiratory effort by temporal features. These findings highlight the importance of selecting optimal features to obtain a reliable estimation of respiratory effort, providing a foundation for future research on non-intrusive methods. Full article

Background/Objectives: The application of predictive and explainable artificial intelligence to bioinformatics data such as single nucleotide polymorphism (SNP) information is attracting rising attention in the diagnosis of various diseases. However, there are few reviews available on the recent progress of genetic artificial intelligence for the early diagnosis of gastrointestinal disease (GID). The purpose of this study is to complete a systematic review on the recent progress of genetic artificial intelligence in GID. Methods: The source of data was ten original studies from PubMed. The ten original studies were eligible according to the following criteria: (participants) the dependent variable of GID or associated disease; (interventions/comparisons) artificial intelligence; (outcomes) accuracy, the area under the curve (AUC), and/or variable importance; a publication year of 2010 or later; and the publication language of English. Results: The performance outcomes reported varied within 79–100 for accuracy (%) and 63–98 for the AUC (%). Random forest was the best approach (AUC 98%) for the classification of inflammatory bowel disease with 13 single nucleotide polymorphisms (SNPs). Similarly, random forest was the best method (R-square 99%) for the regression of the gut microbiome SNP saturation number. The following SNPs were discovered to be major variables for the prediction of GID or associated disease: rs2295778, rs13337626, rs2296188, rs2114039 (esophageal adenocarcinoma); rs28785174, rs60532570, rs13056955, rs7660164 (Crohn’s disease early intestinal resection); rs4945943 (Crohn’s disease); rs316115020, rs316420452 (calcium metabolism); rs738409_G, rs2642438_A, rs58542926_T, rs72613567_TA (steatotic liver disease); rs148710154, rs75146099 (esophageal squamous cell carcinoma). The following demographic and health-related variables were found to be important predictors of GID or associated disease besides SNPs: age, body mass index, disease behavior, immune cell type, intestinal microbiome, MARCKS protein, smoking, and SNP density/number. No deep learning study was found even though deep learning was used as a search term together with machine learning. Conclusions: Genetic artificial intelligence is effective and non-invasive as a decision support system for GID. Full article

Background/Objectives: Despite advances in minimally invasive procedures, anastomotic leakages (ALs) after esophageal resections mark the most feared complication. Its early detection can lead to quick interventional treatment with improved survival. Nonetheless, early detection remains challenging, and scores are imprecise and complex. Methods: In our study we analyzed mediastinal drainage fluid to find parameters suggesting AL even before it became clinically evident and correlated them to routine biomarkers. All patients with AL after robotically assisted esophageal resections were included and matched 1:1 with uneventful controls. Additionally, transhiatal distal esophageal resections operated during this period were included. Drainage fluid was collected on postoperative days (PODs) 1–4 with consecutive blood gas analysis. Test quality was determined by the area under the curve (AUC) of the receiver operating characteristic curve (ROC). Results: In total, 40 patients were included, with 17 developing AL. There were no significant differences in gender, age, BMI or oncological treatment. The 30-day morbidity rate was 65.0%. The study was restricted to events in the first 12 days. While lactate value in drainage fluid differed significantly from POD 3 onwards in the two groups, serum CRP remained without significant differences. We developed the LacCRP score (CRP/30 + lactate/2). The AUC on POD 3 was 0.96, with a sensitivity and specificity of 100% and 75%, respectively. An estimator of 1.08 was found in multivariate analysis: one-point increase in the LacCRP score increases AL probability by 8%. Conclusions: This study demonstrates that postoperative lactate determinations in drainage fluid can predict AL after esophageal resection, and its combination with serum CRP results in a reliable LacCRP score. Full article

Esophageal squamous cell carcinoma (ESCC) accounts for the majority of esophageal cancers worldwide, with a poor prognosis and increasing resistance to conventional treatments. Faced with these limitations, nanoparticles (NPs) are attracting growing interest as innovative therapeutic agents capable of improving specificity and efficacy and reducing systemic toxicity. This study critically examines the pharmacological effects, mechanisms of action, and toxicity profiles of different metallic or organic nanoparticles tested on ESCC cell lines. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed by a meticulous literature search of Google Scholar, Web of Science, PubMed/Medline, and Scopus databases to achieve this goal. The results show that the anti-tumor properties vary according to the type of nanoparticle (copper(II) oxide (CuO), silver (Ag), gold (Au), nickel(II) oxide (NiO), nano-curcumin, etc.), the synthesis method (chemical vs. green), and the biological activity assessment method (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), Bromodeoxyuridine (BrdU), Cell Counting Kit-8 (CCK8) assays, etc.). NPs derived from green synthesis, such as those based on Moringa oleifera, Photinia glabra, or pomegranate bark, exhibit moderate cytotoxic activity (50% inhibitory concentration (IC₅₀) between 92 and 500 µg/mL) but show good tolerance on normal cells. In contrast, chemically synthesized NPs, such as Cu(II) complexes with 1,3,5-benzenetricarboxylic acid (H₃btc) or 1,2,4-triazole (Htrz), show lower IC₅₀ (34–86 µM), indicating more marked cytotoxicity towards cancer cells, although data on their toxicity are sometimes lacking. In addition, multifunctional nanoparticles, such as gold-based nano-conjugates targeting Cluster of Differentiation 271 (CD271) or systems combined with doxorubicin, show remarkable activity with IC₅₀ below 3 µM and enhanced tumor selectivity, positioning them among the most promising candidates for future clinical application against ESCC. The most frequently observed mechanisms of action include induction of apoptosis (↑caspases, ↑p53, ↓Bcl-2), oxidative stress, and inhibition of proliferation. In conclusion, this work identifies several promising nanoparticles (silver nanoparticles derived from Photinia glabra (PG), gold-based nano-immunoconjugates targeting CD271, and silver–doxorubicin complexes) for future pharmaceutical exploitation against ESCC. However, major limitations remain, such as the lack of methodological standardization, insufficient in vivo and clinical studies, and poor industrial transposability. Future prospects include the development of multifunctional nanocomposites, the integration of biomarkers for personalized targeting, and long-term toxicological assessment. Full article

Zenker’s diverticulum (ZD) is an esophageal condition that results in an outpouching of the mucosal layer through a weakened area in the hypopharyngeal wall. This condition can cause symptoms like dysphagia, regurgitation, and aspiration, impacting patients’ quality of life. Historically, open surgery was the primary treatment. Although effective, this method is associated with longer recovery times and risks such as infections, nerve damage, and prolonged hospitalization. Rigid endoscopic stapling emerged as a less invasive alternative, offering high success rates for patients with favorable anatomy. Zenker’s peroral endoscopic myotomy (Z-POEM), adapted from treatments for achalasia, represents the latest advancement in ZD management. It involves creating a submucosal tunnel and precisely dividing the cricopharyngeus muscle. Z-POEM is minimally invasive and often provides quick relief with a high success rate of around 92%, while enabling outpatient treatment or brief hospital stays. However, it requires specialized expertise, and long-term data on recurrence rates are still emerging. This review discusses the evolution of these treatment modalities through comprehensive searches of PubMed, MEDLINE, and ScienceDirect databases. Studies reporting on treatment outcomes, complication rates, operative times, and clinical success associated with open surgery, rigid endoscopic stapling, and Z-POEM were included, with emphasis on meta-analyses, multicenter studies, and large case series highlighting Z-POEM’s comparable success to open surgery and increased patient tolerance. Open surgery achieves long-term symptom resolution rates of 90–95% but is associated with higher complication rates (up to 30%) and prolonged recovery times. Rigid endoscopic stapling offers symptom relief in approximately 90% of cases, with lower morbidity and shorter hospital stays (1–2 days), though anatomical limitations restrict its use. Z-POEM has demonstrated clinical success rates of 85.5–93%, with major complications reported in 4.8–5% of cases and recurrence rates as low as 1.4% at one-year follow-up in larger diverticula. Z-POEM’s minimally invasive nature and suitability for high-risk patients make it increasingly preferred in specialized centers. Management of Zenker’s diverticulum has evolved significantly, with endoscopic techniques, particularly Z-POEM, offering comparable success to open surgery but with fewer complications and faster recovery. Ongoing advances in endoscopic equipment and technique, along with emerging data on long-term outcomes, are likely to further refine treatment algorithms for ZD, especially for elderly and high-risk populations. Future directions in ZD management include ongoing research to enhance the safety and efficacy of endoscopic techniques, with new technologies on the horizon that could further improve outcomes and accessibility. Full article

Background/Objectives: “Accelerated Recovery after Surgery” (ARAS) programs for esophagectomy aim to shorten the perioperative course without increases in morbidity or mortality. In such programs, the prediction and early detection of perioperative complications is essential, as ICU observation times are limited. We evaluated two potential laboratory markers as predictors for postoperative complications: shedding of the endothelial glycocalyx and the veno-arterial CO₂-gap as indicators of microcirculatory disturbances. Methods: In total, 26 patients undergoing hybrid Ivor Lewis esophagectomy within an ARAS program were included. Macrocirculatory conditions were kept stable by enhanced hemodynamic monitoring (PiCCO). Glycocalyx shedding parameters (Syndecan-1, heparan sulfate, hyaluronic acid) and a panel of inflammatory mediators were measured preoperatively, upon ICU-admission, and on the first postoperative day. The veno-arterial CO₂-gap was calculated at induction of anesthesia, during laparoscopy, and upon admission to the ICU. Results: Complications (Dindo-Clavien ≥3) occurred in n = 16 (62%) patients. From preoperatively to admission to the ICU, Syndecan-1 (29 pre-op to 56 ng/mL at ICU-admission) and Interleukins 1b (1.2 to 1.4 pg/mL), 6 (1.3 to 19.9 pg/mL), 8 (5.2 to 19.9 pg/mL), and 10 (0.50 to 1.33 pg/mL) increased, indicating a temporary increase in inflammation and glycocalyx shedding during surgery. A difference between patients with or without complications could not be detected. There was also no difference in the veno-arterial CO₂-gap between the two groups (median of 6.8 mmHg in all patients, 6.7 in patients with complications, 7.8 in patients without complications). Conclusions: Signs of microcirculatory dysfunctions and inflammation occurred during esophagectomy within an ARAS protocol with tightly controlled hemodynamics. Increases in Syndecan-1 and the veno-arterial CO₂-gap could not predict perioperative complications. Full article

Background: Portal vein thrombosis (PVT) occurs in nearly 8% of pediatric liver transplants (LT), leading to portal hypertension (PH). This study aims to describe the clinical features and management of PVT in children post-transplant (PVTt) compared to those with PVT in native livers (PVTn). Methods: All children diagnosed with PVTt between January 2002 and October 2021 were included. The control group comprised pediatric patients with PVTn diagnosed and managed at our center during the same period. Results: PVTt was diagnosed in 37 out of 610 children (6%), while 36 children with PVTn were included as controls. At 5-year follow-up, medium-to-large esophageal varices (grade II–III) developed in 15/37 (38%) PVTt patients compared to 23/36 (64%) PVTn patients (p = 0.002). Among 11 patients who bled, upper gastrointestinal bleeding occurred in 2/7 (29%) with PVTt, versus 4/4 (100%) PVTn patients (p = 0.06). Mean spleen length was 9.3 cm in PVTt versus 7.4 cm in PVTn (p = 0.039). Mean platelet count was 76 × 10³/L in PVTt versus 93 × 10³/L in PVTn (p = 0.16). Conclusions: Despite more severe PH and marked hypersplenism, children with PVTt have a reduced risk of developing esophageal varices, but an increased risk of bleeding from the lower gastrointestinal tract. This suggests the need for a different surveillance strategy in this patient group. Individualized care is key, mainly in PVTt, where hypersplenism does not correlate with risk of bleeding from esophageal varices. Full article

Background/Objectives: Opportunistic fungal infections are common among people living with HIV (PLHIV) and contribute substantially to morbidity, mortality, and hospitalization rates in this population. This study aimed to determine the prevalence of dermatological manifestations of fungal infections in HIV-positive patients and examine their association with demographic, clinical, and immunological characteristics. Methods: A retrospective review of medical records from 2500 PLHIV treated at the Infectious Diseases Unit of “Andreas Syggros” Hospital for Skin and Venereal Diseases between 1988 and 2017. Data from patients diagnosed with opportunistic fungal infections were analyzed. Participants were classified as either antiretroviral therapy (ART)-naïve or already receiving treatment. Recorded fungal infections were correlated with epidemiological variables and CD4+ T-cell counts. Results: Opportunistic fungal infections were identified in 859 patients (34.36%), with a marked male predominance. Candidiasis was the most frequently reported condition, with a higher prevalence among female patients. Lower CD4+ counts were significantly associated with an increased risk of cryptococcal meningitis, esophageal candidiasis, Pneumocystis jirovecii pneumonia (PJP), and oral candidiasis, whereas higher CD4+ counts were more common in patients with dermatophytosis, onychomycosis, and pityriasis/tinea versicolor. Conclusions: Opportunistic fungal infections remain highly prevalent in PLHIV, particularly among those with advanced immunosuppression. CD4+ T-cell counts are key diagnostic and prognostic markers, reinforcing their importance in monitoring disease progression and guiding clinical management. Full article

The Wntβ-catenin signaling pathway is a key regulator of gastrointestinal (GI) tumorigenesis, modulating cellular processes such as proliferation, differentiation, and epithelial-to-mesenchymal transition (EMT). In this review, we evaluate the expression and mutation profiles of core Wntpathway components in the most common GI malignancies. Our findings outline notable alterations in ligands, receptors, co-receptors, and intracellular effectors across different GI cancers. In gastric cancer tissue, elevated levels of Wnt proteins, FZD7 receptor, and LRP5/6, along with β-catenin accumulation and reduced APC expression, are associated with poor prognosis. In colorectal cancer samples, common APC mutations and Wnt ligand overexpression contribute to β-catenin nuclear localization and EMT. Esophageal cancer specimens exhibit co-overexpression of Wnt2 and Wnt5A, as well as receptors such as FZD2 and FZD6, which are linked to worse prognosis and reduced survival. Liver cancer tissue commonly harbors CTNNB1 mutations, which encode β-catenin and are associated with poor differentiation. In pancreatic cancer samples, overexpression of Wnt ligands, FZD receptors, and β-catenin is associated with the presence of distant metastasis and poor clinical outcomes. In conclusion, this pathway represents a promising avenue for identifying novel diagnostic, prognostic, and therapeutic biomarkers in GI cancers, warranting further clinical investigation. Full article

Background: The rise of opioid drug usage in the U.S. correlates with increasing recognition of gastrointestinal side effects, especially in the esophagus. The literature has recently noted that abnormalities in the upper esophageal sphincter (UES) are a poor prognostic factor in Achalasia treatment response. A better understanding of the relationship between opioid therapy and esophageal motility and sphincter function may shape our management guidelines for esophageal dysmotilities. This study aimed to evaluate dysmotility patterns, specifically UES function, among the veteran population, where opioid use is reportedly high. Methods: We performed a retrospective search of all the veterans at a large urban veteran affairs hospital who had undergone esophageal manometry from 2013 to 2022, collecting data on patient demographics, indication for procedure, diagnosis, sphincter pressure values, and presence of chronic opioid use. Results: Of 395 patients, 29% had a history of chronic opioid therapy. Notably, patients that were diagnosed with Achalasia had a greater proportion of chronic opioid use as compared to those who were not. Additionally, there was a statistically significant lower average upper esophageal resting pressure in opioid patients compared to non-opioid patients. Conclusions: Veteran patients with Achalasia have a greater proportion of chronic opioid use as compared to those without. There are significant manometric pressure differences at the upper esophageal sphincter among chronic opioid users when compared to non-opioid users. Full article

Background/Objectives: Advances in cancer diagnosis and treatment improved survivorship rates, but survivors’ long-term quality of life remains a critical concern. Survivors of esophageal and gastric cancer often undergo extensive curative surgery, which can have lasting impacts on nutritional status. This study aimed to assess the nutritional status, dietary challenges, and supportive care needs of this population of cancer survivors. Methods: In this cross-sectional study, adults diagnosed with esophageal or gastric cancer were invited to complete an anonymous survey to assess their nutritional status, quality of life, and psychological well-being. Results: A total of 114 responses were analyzed. Although over 70% of participants were more than two years post-diagnosis, more than 30% remained at risk of malnutrition. Additionally, over 36% reported ongoing dietary complications such as swallowing difficulties, dumping syndrome, diarrhea, and reflux. Impaired quality of life was observed in 31.7% of respondents, defined as having a global health status score below 66.1 on the EORTC QLQ-C30. Psychological distress was also evident, with over 25% screening positive for anxiety or borderline anxiety, and more than 22% for depression or borderline depression. Conclusions: Malnutrition, gastrointestinal symptoms, impaired quality of life, and psychological distress remain prevalent among esophageal and gastric cancer survivors many years after diagnosis. These findings underscore the need for ongoing monitoring and the provision of targeted supportive care to improve long-term survivorship outcomes. Full article