Hon Ho Yu

Background: Gastroscopy remains a cornerstone in diagnosing upper gastrointestinal tract diseases. However, intragastric foam impairs mucosal visualization, potentially reducing early lesion detection rate. Simethicone is widely used as a defoaming agent in clinical practice, yet its efficacy may be influenced by administration methods and timing. Aims: T o investigate the effects of body position changes and waiting time after simethicone administration on defoaming efficacy during gastroscopy. Methods: A prospective study was conducted at the Endoscopy center , Hosp itol , Macau, Jul–Aug 2024. Patients scheduled for gastroscopy were divided into a control g roup (supine position) and an experimental g roup (body position changes). The experimental g roup was further subdivided into Group A (traditional sequence: right lateral, supine, left lateral positions, each maintained for 5 min) and Group B (modified sequence: right lateral position for 5 min, followed by alternating head-down/head-up positions for 1 min each, then left lateral position for 3–5 min). The control g roup was additionally stratified by waiting time post-simethicone administration (≤15 min, 16–30 min, ≥31 min). The primary outcome was mucosal clarity score assessed with the KUO score; secondary outcomes included examination time and polyp detection rate. Results: Group B demonstrated significantly better mucosal clarity compared with both the control group and Group A (P Conclusions: Combining optimized body position changes with appropriate timing post-simethicone administration significantly improves mucosal visualization during gastroscopy. This strategy provides a simple, cost-effective approach to enhance diagnostic performance and is recommended for broader clinical application.

INTRODUCTION: The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021. METHODS: The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990–2021. The metabolic burden trends of liver cancer across regions and countries by sociodemographic index (SDI) and sex were estimated. The annual percentage changes in age-standardized DALYs rate were also calculated. RESULTS: Globally, in 2021, primary liver cancer attributable to high BMI and/or high FPG was estimated to have caused 59,970 deaths (95% uncertainty interval [UI] 20,567–104,103) and 1,540,437 DALYs (95% UI 540,922–2,677,135). The age-standardized rates of death and DALYs were 0.70 (95% UI 0.24–1.21) and 17.64 (95% UI 6.19–30.65) per 100,000 person-years. A consistent global rise in liver cancer attributable to metabolic risks was observed from 1990 to 2021, with high BMI identified as the major contributing risk factor. The highest burden of deaths and DALYs of liver cancer consistently occurred in high SDI countries, while the fastest growth trends were observed in low-middle SDI countries. The burdens of high levels of BMI and FPG were higher in men than in women. DISCUSSION: Primary liver cancer attributable to high BMI and/or high FPG imposes an increasingly substantial clinical burden on global public health, particularly in high SDI countries. Rapid growth trends are also found in middle SDI countries.

Background: The pathogenesis of inflammatory bowel disease (IBD) is closely associated with the dysfunction of the intestinal epithelial barrier, leading to increased bacterial translocation, leukocyte infiltration, and mucosal injury, which may act as a pivotal or incipient event in the pathophysiology of the disorder. The primary objective of this study is to examine the key genes implicated in IBD and the perturbation of intestinal epithelial cell function. Methods: The genes associated with ferroptosis were identified through the utilization of the Gene Expression Omnibus (GEO) database and the GeneCard database. Additionally, an in vitro model of IBD was established by stimulating Caco-2 cells with lipopolysaccharides (LPSs) to investigate the molecular mechanisms underlying intestinal epithelial cell dysfunction. Results: We discovered evidence that establishes a connection between ferroptosis and the inflammatory responses associated with the development of IBD. This evidence suggests that IBD patients who exhibit an inflammatory response have higher expression of the acyl-CoA synthetase long-chain family member 4 (ACSL4) gene compared to IBD patients without an inflammatory response or healthy individuals. Exposure to LPS at concentrations of 1 or 10 μg/mL resulted in a significant upregulation of ferroptosis-related genes ACSL4, GPX4, and SLC7A11, as well as an increase in ferroptosis biomarkers MDA and a decrease in CAT and GSH-Px levels compared to the control group. Inhibition of ACSL4 using si-ACSL4 or rosiglitazone demonstrated protective effects against LPS-induced ferroptosis and NF-κB-mediated inflammatory response. Conclusion: ACSL4 shows potential as a promising target for ferroptosis in the prevention and treatment of IBD and dysfunction of intestinal epithelial cells.

The automatic analysis of endoscopic images to assist endoscopists in accurately identifying the types and locations of esophageal lesions remains a challenge. In this paper, we propose a novel multi-task deep learning model for automatic diagnosis, which does not simply replace the role of endoscopists in decision making, because endoscopists are expected to correct the false results predicted by the diagnosis system if more supporting information is provided. In order to help endoscopists improve the diagnosis accuracy in identifying the types of lesions, an image retrieval module is added in the classification task to provide an additional confidence level of the predicted types of esophageal lesions. In addition, a mutual attention module is added in the segmentation task to improve its performance in determining the locations of esophageal lesions. The proposed model is evaluated and compared with other deep learning models using a dataset of 1003 endoscopic images, including 290 esophageal cancer, 473 esophagitis, and 240 normal. The experimental results show the promising performance of our model with a high accuracy of 96.76% for the classification and a Dice coefficient of 82.47% for the segmentation. Consequently, the proposed multi-task deep learning model can be an effective tool to help endoscopists in judging esophageal lesions.

Background: Non-alcoholic steatohepatitis (NASH) is an advanced form of non-alcoholic fatty liver disease (NAFLD) for which there is yet any standard pharmacotherapy. Traditional Chinese medicine formula such as Qushihuayu (QSHY) composing of multiple bioactive compounds has been used to treat NAFLD and NASH and shows beneficial effects over single compound treatment. This study aimed to investigate the mechanism of hepatoprotective effect of QSHY formula using a rat model.Methods: Six-weeks old male Wistar rats were given methionine/choline supplemented (MCS) diet for 8 weeks and used as the blank control. Another 7 rats, which received methionine/choline deficient (MCD) diet in the first 6 weeks and a MCS&MCD (1:1) mixture diet in the last 2 weeks, were used as the model group. The groups of QSHY pre-treatment, low dosage, medium dosage and high dosage were given the same diet as the model group. Except for pre-treatment group (1 week in advanced of other groups), all QSHY treatment groups received QSHY formula by gavage every day since the MCD diet started.Results: In the MCD diet group, the QSHY formula decreased the serum ALT and AST levels, lipid droplets, inflammation foci, FAS and α-SMA protein expression than MCD diet group. MAPK pathways phospharylation were markedly depressed by the QSHY formula. Moreover, QSHY formula enhanced PPAR-γ and p-p65 translocating into nucleus. The administration of QSHY increased hepatic mRNA levels of Transcription Factor 1 alpha (HNF1A), Hepatocyte Nuclear Factor 4 alpha (HNF4A) and Forkhead box protein A3 (FOXA3) which play a pivotal role in Hepatic stellate cell (HSCs) reprogramming.Conclusion: These findings suggest that QSHY formula exerts a hepatoprotective effect against steatosis and fibrosis presumably via depressed MAPK pathways phosphorylation, reinforcement of PPAR-γ and p-p65 translocating into nucleus and enhanced HSCs reprogramming.

In parallel with the prevalence metabolic syndrome, nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in most countries. It features a constellation of simple steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and even hepatocellular carcinoma. There are no approved drugs for effective management of NAFLD and NASH. Jianpi Huoxue formula (JPHX) mainly consists of Atractylodes macrocephal(Baizhu), Salvia miltiorrhiza (Danshen), Rasux Paeonia Alba (Baishao), Rhizoma Alismatis (Zexie), and Fructus Schisandrae Chinensis (Wuweizi), which may have beneficial effects on NAFLD. The aim of the study was to identify the effect of JPHX on NAFLD.A NAFLD model was induced by methionine-choline-deficient food (MCD) in Wistar rats and orally administered with simultaneous JPHX, once a day for 8 weeks. Hepatocellular injury, lipid profile, inflammation, fibrosis, and apoptosis were evaluated. The results showed that JPHX significantly decreased the abnormal serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels compared with the MCD model (Pαlevels and reduced collagen and matrix metalloproteinases in MCD diet-fed rats. In addition, JPHX prevented rats from MCD-induced cellular apoptosis, as suggested by TUNEL staining, and suppressed the activation of caspase 3 and 7 proteins. JPHX also inhibited the phosphorylation of JNK. In conclusion, JPHX exhibited a hepatoprotective effect against NAFLD in an MCD experimental model.