Li-Ping Ye

Background A major unmet need in gastric cancer prevention is the lack of biomarkers to predict precancerous lesion progression, and the potential of chromosomal instability (CIN) for this role, particularly regarding early cancer and recurrence, remains unclear. Objective To assess the predictive role of CIN in lesion progression and postoperative recurrence following endoscopic submucosal dissection (ESD). Design We enrolled 106 patients from Taizhou Hospital Affiliated to Wenzhou Medical University (2011–2025) and collected 1,045 temporally continuous pathological samples. Copy number variations were profiled using low-coverage whole-genome sequencing (LC-WGS), and CIN scores were calculated. Associations between CIN and clinical outcomes were analyzed using survival analysis and ROC curves. Results CIN was detectable up to two years before gastric cancer diagnosis, with positivity rates increasing alongside lesion severity: 25.5% in intestinal metaplasia, 39.7% in low-grade dysplasia, and 83.0% in gastric cancer. CIN positivity independently predicted lesion progression (hazard ratio [HR] = 2.55, 95% CI: 1.19–5.47, p = 0.016), with the greatest risk for progression to carcinoma (HR = 16.61, p < 0.001). The predictive AUC was 0.81, improving to 0.88 when combined with age. Among 84 patients who underwent ESD, CIN positivity significantly increased recurrence risk (HR = 19.57, 95% CI: 2.59 – 147.61, p = 0.004; AUC = 0.80). Chromosomal arms 7p/q, 8p/q, and 20p/q showed high CIN frequencies, with MYC being the most frequently mutated oncogene. Conclusion CIN represents a reliable biomarker for early prediction of lesion progression and postoperative recurrence, enabling proactive surveillance and precision management of gastric cancer. Single Sentence Summary Chromosomal instability (CIN) acts as a reliable biomarker for predicting the progression of gastric precancerous lesions and postoperative recurrence.

A 70-year-old woman with a refractory duodenal ulcer developed a 1.5-cm perforation at the duodenal bulb following two failed attempts at endoscopic hemostasis ([Fig. 1]). Placement of an over-the-scope clip for closure was unsuccessful, and resulted in sepsis. A nitinol duodenal covered stent (22 mm in diameter, 10 cm in length) was deployed endoscopically ([Fig. 2], [Video 1]). This stent integrates three key innovations: (i) a tripartite anchoring system – an umbrella-shaped gastric component for antral apposition, a cylindrical pyloric segment for radial fixation, and a bulbous duodenal anchor for coaptation; (ii) a papilla-aligned fenestration within the membranous mid-section to preserve physiological pancreatobiliary drainage; and (iii) optimized radial force distribution across segmented zones to minimize migration. Follow-up at 15 days confirmed closure of the complete perforation, and the stent was safely retrieved. Duodenal perforations are challenging owing to anatomical fragility and the enzyme-rich secretions [1] [2]. Conventional stents risk migration and obstructing drainage, thereby exacerbating leaks [3]. An anatomically designed duodenal stent uniquely addresses these limitations: its anchoring system ensures stable positioning without tissue injury, while the fenestration aligns precisely with the papilla, allowing continuous biliary/pancreatic flow into the bowel lumen. This design prevents reflux-related complications and promotes fistula healing by isolating the defect from digestive enzymes. The case underscores the stent’s dual role as a mechanical sealant and physiological conduit, which may be particularly critical in elderly patients with impaired healing. Endoscopy_UCTN_Code_TTT_1AO_2AZ Article published online: 20 August 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

INTRODUCTION: Endoscopic evaluation is crucial for predicting the invasion depth of esophagus squamous cell carcinoma (ESCC) and selecting appropriate treatment strategies. Our study aimed to develop and validate an interpretable artificial intelligence–based invasion depth prediction system (AI-IDPS) for ESCC. METHODS: We reviewed the PubMed for eligible studies and collected potential visual feature indices associated with invasion depth. Multicenter data comprising 5,119 narrow-band imaging magnifying endoscopy images from 581 patients with ESCC were collected from 4 hospitals between April 2016 and November 2021. Thirteen models for feature extraction and 1 model for feature fitting were developed for AI-IDPS. The efficiency of AI-IDPS was evaluated on 196 images and 33 consecutively collected videos and compared with a pure deep learning model and performance of endoscopists. A crossover study and a questionnaire survey were conducted to investigate the system's impact on endoscopists' understanding of the AI predictions. RESULTS: AI-IDPS demonstrated the sensitivity, specificity, and accuracy of 85.7%, 86.3%, and 86.2% in image validation and 87.5%, 84%, and 84.9% in consecutively collected videos, respectively, for differentiating SM2-3 lesions. The pure deep learning model showed significantly lower sensitivity, specificity, and accuracy (83.7%, 52.1% and 60.0%, respectively). The endoscopists had significantly improved accuracy (from 79.7% to 84.9% on average, P = 0.03) and comparable sensitivity (from 37.5% to 55.4% on average, P = 0.27) and specificity (from 93.1% to 94.3% on average, P = 0.75) after AI-IDPS assistance. DISCUSSION: Based on domain knowledge, we developed an interpretable system for predicting ESCC invasion depth. The anthropopathic approach demonstrates the potential to outperform deep learning architecture in practice.

Convolutional neural networks in the field of artificial intelligence show great potential in image recognition. It assisted endoscopy to improve the detection rate of early gastric cancer. The 5-year survival rate for advanced gastric cancer is less than 30%, while the 5-year survival rate for early gastric cancer is more than 90%. Therefore, earlier screening for gastric cancer can lead to a better prognosis. However, the detection rate of early gastric cancer in China has been extremely low due to many factors, such as the presence of gastric cancer without obvious symptoms, difficulty identifying lesions by the naked eye, and a lack of experience among endoscopists. The introduction of artificial intelligence can help mitigate these shortcomings and greatly improve the accuracy of screening. According to relevant reports, the sensitivity and accuracy of artificial intelligence trained on deep cirrocumulus neural networks are better than those of endoscopists, and evaluations also take less time, which can greatly reduce the burden on endoscopists. In addition, artificial intelligence can also perform real-time detection and feedback on the inspection process of the endoscopist to standardize the operation of the endoscopist. AI has also shown great potential in training novice endoscopists. With the maturity of AI technology, AI has the ability to improve the detection rate of early gastric cancer in China and reduce the death rate of gastric cancer related diseases in China.

Liver transplantation is the ultimate method for treating end-stage liver disease. With the increasing prevalence of obesity, the number of patients with non-alcoholic fatty liver, a common cause of chronic liver disease, is on the rise and may become the main cause of liver transplantation in the future. With the increasing gap between the number of donor livers and patients waiting for liver transplantation and the increasing prevalence of non-alcoholic fatty liver, the proportion of steatosis livers among non-standard donor organs is also increasing. Ischemia-reperfusion injury has historically been the focus of attention in the liver transplantation process, and severe ischemia-reperfusion injury leads to adverse outcomes of liver transplantation. Studies have shown that the production of reactive oxygen species and subsequent oxidative stress play a key role in the pathogenesis of hepatic ischemia and reperfusion injury and non-alcoholic fatty liver. Furthermore, the sensitivity of fatty liver transplantation to ischemia-reperfusion injury has been suggested to be related to the production of reactive oxygen species (ROS) and oxidative stress. In ischemia-reperfusion injury, Kupffer cell and macrophage activation along with mitochondrial damage and the xanthine/xanthine oxidase system promote marked reactive oxygen species production and the inflammatory response and apoptosis, resulting in liver tissue injury. The increased levels of ROS and lipid peroxidation products, vicious circle of ROS and oxidative stress along with mitochondrial dysfunction promoted the progress of non-alcoholic fatty liver. In contrast to the non-fatty liver, a non-alcoholic fatty liver produces more reactive oxygen species and suffers more serious oxidative stress when subjected to ischemia-reperfusion injury. We herein review the effects of reactive oxygen species on ischemia-reperfusion injury and non-alcoholic fatty liver injury as well as highlight several treatment approaches.

Hepatic ischemia reperfusion injury (IRI), a fascinating topic that has drawn a lot of interest in the last few years, is a major complication caused by a variety of clinical situations, such as liver transplantation, severe trauma, vascular surgery, and hemorrhagic shock. The IRI process involves a series of complex events, including mitochondrial deenergization, metabolic acidosis, adenosine-5'-triphosphate depletion, Kupffer cell activation, calcium overload, oxidative stress, and the upregulation of pro-inflammatory cytokine signal transduction. A number of protective strategies have been reported to ameliorate IRI, including pharmacological therapy, ischemic pre-conditioning, ischemic post-conditioning, and machine reperfusion. However, most of these strategies are only at the stage of animal model research at present, and the potential mechanisms and exact therapeutic targets have yet to be clarified. IRI remains a main cause of postoperative liver dysfunction, often leading to postoperative morbidity or even mortality. Very recently, it was reported that the activation of peroxisome proliferator-activated receptor γ (PPARγ), a member of a superfamily of nuclear transcription factors activated by agonists, can attenuate IRI in the liver, and FAM3A has been confirmed to mediate the protective effect of PPARγ in hepatic IRI. In addition, non-coding RNAs, like LncRNAs and miRNAs, have also been reported to play a pivotal role in the liver IRI process. In this review, we presented an overview of the latest advances of treatment strategies and proposed potential mechanisms behind liver IRI. We also highlighted the role of several important molecules (PPARγ, FAM3A, and non-coding RNAs) in protecting against hepatic IRI. Only after achieving a comprehensive understanding of potential mechanisms and targets behind IRI can we effectively ameliorate IRI in the liver and achieve better therapeutic effects.

Liver disease is a severe health problem that endangers human health worldwide. Mesenchymal stem cell (MSC) therapy is a novel treatment for patients with different liver diseases due to its vast expansion potential and distinctive immunomodulatory properties. Despite several preclinical trials having confirmed the considerable efficacy of MSC therapy in liver diseases, the questionable safety and efficacy still limit its application. As a precursor cell, MSCs can adjust their characteristics in response to the surrounding microenvironment. The microenvironment provides physical and chemical factors essential for stem cell survival, proliferation, and differentiation. However, the mechanisms are still not completely understood. We, therefore, summarized the mechanisms underlying the MSC immune response, especially the interaction between MSCs and the liver microenvironment, discussing how to achieve better therapeutic effects.