Ding-Guo Zhang

Background: Inflammatory bowel disease (IBD) remains difficult to manage in a substantial proportion of patients because conventional systemic therapies may fail to achieve sufficient drug accumulation at inflamed intestinal sites while causing systemic adverse effects. Therefore, localized delivery systems capable of protecting therapeutic agents during gastrointestinal transit and releasing them at disease sites are urgently needed. Natural polymer-based hydrogels have attracted increasing attention because of their biocompatibility, biodegradability, mucoadhesiveness, and tunable responsiveness to intestinal pathological cues. Main Body: This review focuses on natural polymer-based hydrogels for localized therapy in IBD. We first summarize the major drug-loading strategies, including physical encapsulation, diffusion/permeation, covalent bonding, and electrostatic interaction, as well as key release mechanisms, including stimulus-responsive, diffusion-controlled, swelling-controlled, and chemically controlled release. We then systematically discuss six widely studied natural polymer-based hydrogel systems—gelatin, hyaluronic acid, alginate, chitosan, cellulose, dextran, and their derivatives. Particular attention is given to how material composition, network architecture, and disease-responsive properties influence drug protection, mucosal retention, colon-targeted release, anti-inflammatory activity, and intestinal barrier repair. Representative preclinical and translational studies are reviewed to compare the advantages and limitations of these systems. We also highlight major formulation and translation challenges, including batch variability, insufficient mechanical stability, burst release, limited targeting precision, unpredictable in vivo degradation, and scalable manufacturing. Conclusion: Natural polymer-based hydrogels provide a promising platform for localized IBD therapy by integrating biocompatible materials with controllable drug loading and disease-responsive release. Future progress will depend on disease-driven material design, rational integration of multi-responsive or composite hydrogel systems, rigorous evaluation in physiologically relevant models, and scalable manufacturing strategies. These advances may facilitate the clinical translation of personalized and locally acting hydrogel therapies for IBD.

Apoptotic vesicles (apoVs), a specialized subtype of extracellular vesicles released during cellular apoptosis, play crucial roles in intercellular communi

Simethicone (SIM) can enhance bowel preparation efficiency, but the optimal dose for patients undergoing afternoon colonoscopy is still unclear. This study compares bowel preparation efficiency and adenoma detection rate (ADR) between patients receiving 3 L of polyethylene glycol electrolyte solution (PEG-ELS) with 200 mg SIM or 1200 mg SIM for afternoon colonoscopy. This prospective, randomized, and observer-blinded trial included consecutive patients undergoing colonoscopy. It compared the effects of two SIM dosages (200 mg and 1200 mg) added to a 3 L PEG-ELS regimen. The primary outcome of our study was the rate of adequate bowel preparation, as defined by all 3 segments 2 or 3 on the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included the Bubble Scale (BS) score and ADR. Adverse effects related to bowel preparation were systematically administered by a trained nurse using standardized patient questionnaire. A total of 668 participants were randomly assigned to either the 200 mg group (n = 332) or 1200 mg SIM group (n = 336). There were no significant differences in baseline characteristics between the two groups. Additionally, no significant differences were observed in adequate bowel preparation rate (95.8% vs. 97.6%, P = 0.276) and ADR (22.3% vs. 25.6%, P = 0.561). Both regimens were well tolerated and accepted by participants, as assessed through a standardized patient questionnaire. 200 mg versus 1200 mg of SIM in 3 L PEG-ELS for afternoon colonoscopy demonstrated no statistically significant difference in bowel cleansing quality, ADR and bowel preparation-related adverse events. This evidence supports the clinical feasibility of 200 mg simethicone as an effective alternative for optimizing colonic preparation while maintaining procedural standards. This clinical trial was retrospectively registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400089196) on 3 September 2024.

Objective: To investigate associations between novel inflammatory biomarkers and disease severity in Hypertriglyceridemia-associated acute pancreatitis (HTG-AP) and to evaluate their prognostic utility for risk stratification. Methods: This retrospective cohort study included 340 HTG-AP patients. Neutrophil-to-high-density lipoprotein Cholesterol Ratio (NHR), Monocyte-to-High-Density Lipoprotein Cholesterol Ratio (MHR), Lymphocyte-to-HDL cholesterol ratio (LHR), Platelet-to-high-density lipoprotein cholesterol ratio (PHR), Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and aggregate index of systemic inflammation (AISI) indices were calculated. Multivariable logistic regression (unadjusted/age-sex-adjusted/fully-adjusted models) was conducted, and ROC analysis was performed to determine the predictive performance for MSAP+SAP/SAP. Results: Among 340 HTG-AP patients (156 MAP, 130 MSAP, 54 SAP), novel inflammatory markers NHR, SII, SIRI, MHR, PHR, and AISI significantly increased with severity (P < 0.01). Restricted cubic splines revealed nonlinear associations of NHR, SII, AISI, MHR, and SIRI with MSAP+SAP risk (Overall P < 0.05; Nonlinear P < 0.05). In fully adjusted models: For each 1-unit increase in NHR, the OR was 1.06 (95% CI: 1.03– 1.09; P < 0.001). Comparing the highest tertile (Q3) to the lowest (Q1), the OR was 6.03 (95% CI: 2.98– 12.19; P < 0.001). MHR Q3 vs Q1: OR=4.52 (2.26– 9.03; P < 0.001). SIRI Q3 vs Q1: OR = 3.12 (1.61– 6.06; P < 0.001). SII Q3 vs Q1: OR 3.12–(1.61– 6.04; P < 0.001). AISI Q3 vs Q1: OR = 2.74 (95% CI: 1.42– 5.28; P = 0.003). LHR and PHR showed no statistically significant associations (P > 0.05). ROC analysis demonstrated that NHR was the best predictor of MSAP+SAP (AUC = 0.701; optimal cutoff = 14.484), outperforming other indices (SII: AUC = 0.666; LHR: AUC = 0.505). Conclusion: NHR is a novel independent predictor of moderate-severe or severe HTG-AP, with the highest tertile conferring a 6.03-fold increased risk (95% CI: 2.98– 12.19; P < 0.001) and an AUC of 0.701 for MSAP+SAP prediction. SII, MHR, SIRI, and AISI provide complementary prognostic value, supporting early risk stratification using NHR (cutoff = 14.484).

BACKGROUND Multiple endocrine neoplasias (MENs) are a group of hereditary diseases involving multiple endocrine glands, and their prevalence is low. MEN type 1 (MEN1) has diverse clinical manifestations, mainly involving the parathyroid glands, gastrointestinal tract, pancreas and pituitary gland, making it easy to miss the clinical diagnosis. CASE SUMMARY We present the case of a patient in whom MEN1 was detected early. A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hospital. Blood tests at admission revealed hypercalcemia and hypophosphatemia, and emission computed tomography of the parathyroid glands revealed a hyperfunctioning parathyroid lesion. Gastroscopy findings suggested a duodenal bulge and ulceration. Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb. Further blood tests revealed elevated levels of serum gastrin. Surgery was performed, and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy. The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year. CONCLUSION For patients who present with gastrointestinal symptoms accompanied by hypercalcemia and hypophosphatemia, clinicians need to be alert to the possibility of MEN1.

Background. Ascites is a common clinical finding caused by many different diseases, so we developed a technique termed single orifice percutaneous endoscopic surgery (SOPES) which can access peritoneal cavity through the contralateral McBurney’s point or umbilicus to seek the underlying causes. In this study, we describe the initial clinical experience of SOPES and compare the application of two accesses. Methods. This is a retrospective study performed between 2007 and 2018. Patients with ascites of unknown origin who underwent these two kinds of SOPES were included. Main outcomes were measured by diagnostic accuracy, complication rate, procedure time, time till stitches removal, length of hospital stay, and hospital cost. Results. 148 patients successfully undergone SOPES via the contralateral McBurney’s point (IM group, ) or the umbilicus (UM group, ). 63 patients in the IM group and 71 patients in the UM group reached clear diagnosis (90.0% vs. 91.0%, ). The overall complication rate was 5.4%, while the UM group was higher than the IM group (10.3% vs. 0%, ). All complications were resolved after medical treatment, and no mortality resulted from this procedure. The procedure time and the time until stitches removal in the UM group were longer than that in the IM group. There were no significant differences in length of hospital stay and hospital cost between the two groups. Conclusions. SOPES, which combines the strength of minimally invasive single orifice incision and flexible angles of examination and instrumentation, is a newly developed flexible endoscopic surgical modality that provides new important clinical valuable in evaluation of ascites of unknown origin. Moreover, SOPES via the contralateral McBurney’s point was safer than the umbilicus approach.

Background and Aims. Simethicone (SIM), as an antifoaming agent, has been shown to improve bowel preparation during colonoscopy. However, the optimal timing of SIM addition remained undetermined. We aimed to investigate the optimal timing of SIM addition to polyethylene glycol (PEG) to improve bowel preparation. Methods. Eligible patients were randomly assigned to two groups: the SIM evening group (SIM addition to PEG in the evening of the day prior to colonoscopy) and the SIM morning group (SIM addition to PEG in the morning of colonoscopy). The primary outcome was Bubble Scale (BS). The secondary outcomes were Boston Bowel Preparation Scale (BBPS) and adenoma detection rate (ADR). Results. A total of 419 patients were enrolled in this study. The baseline characteristics of the patients were similar in both groups. No significant differences were observed in terms of BS (8.76 ± 0.90 vs. 8.65 ± 1.16, P = 0.81), ADR (34.1% vs. 30.8%, P = 0.47), Boston Bowel Preparation Scale (BBPS) (8.59 ± 0.94 vs. 8.45 ± 1.00, P = 0.15), and withdrawal time (8.22 ± 2.04 vs. 8.01 ± 2.51, P = 0.094) between the two groups. Moreover, safety and compliance were similar in both groups. However, the SIM evening group was associated with shorter cecal intubation time (3.80 ± 1.81 vs. 4.42 ± 2.03, P < 0.001), higher BS (2.95 ± 0.26 vs. 2.88 ± 0.38, P = 0.04) in the right colon, and diminutive ADR (62.5% vs. 38.6%, P = 0.022) in the right colon, when compared to the SIM evening group. Conclusions. The SIM addition to PEG in the evening of the day prior to colonoscopy can shorten cecal intubation time and improve BS scores and diminutive ADR of the right colon compared with the SIM addition to PEG in the morning of colonoscopy in bowel preparation.

Introduction and aim: duodenal subepithelial lesions (SELs) are increasingly detected during endoscopic examinations. However, no feasible and safe methods are available to remove duodenal SELs. The present study aimed to assess the feasibility and safety of endoscopic resection in combination with ligation (ER-L) for the removal of duodenal SELs. Patients and methods: a total of 101 patients with duodenal SELs underwent ER-L from February 2010 to February 2020. The primary outcomes were complete resection, en bloc resection and R0 resection. The secondary outcomes included procedure duration, bleeding, perforation and residual lesions. A total of 101 patients with 101 duodenal SELs (ranged from 8.4 mm to 20.2 mm in size) were included in the study. Results: most of the SELs (95.1 %) originated from the submucosal layer and were successfully removed using ER-L. The rates of complete resection, en bloc resection and R0 resection were 100 %, 96.0 % and 88.1 %, respectively. The median procedure duration was eight minutes. There were no severe complications, except for four patients who developed post-procedure bleeding (4.0 %) and recovered after conservative treatment. Furthermore, no residual lesions were detected during the follow-up period (median of 36 months). In fact, logistic regression analysis showed that the size of duodenal SELs was an independent factor for R0 resection during the ER-L procedure.Conclusion: in conclusion, ER-L is feasible and safe to remove duodenal SELs that originate from the submucosal layer and are less than 20 mm. However, the feasibility and safety of the ER-L should be further confirmed when removing the duodenal SELs that originate from the muscularis propria (MP) layer and are larger than 20 mm in diameter.

Background and Aim: Endoscopic ultrasound‐guided fine‐needle biopsy (EUS‐FNB) is used to diagnose lesions within or adjacent to the digestive tract. However, there is no report on the overall diagnostic accuracy, technical success, and adverse events of FNB. The aims of this study were to conduct a systematic review and meta‐analysis to comprehensively assess the diagnostic accuracy, technical success, and adverse events of FNB.Methods: Pubmed, Embase, and Cochrane Library databases were searched for relevant articles published in English from January 1998 to May 2019 (No. CRD42019141647). Primary outcomes were EUS‐FNB related diagnostic accuracy rate, technical success rate, and adverse event rate.Results: A total of 51 articles including 5330 patients met our criteria. The overall EUS‐FNB related diagnostic accuracy rate, technical success rate, and adverse event rate was 90.82% [95% confidence interval (CI) 88.69–92.76%], 99.71% [95% CI 99.35–99.93%], and 0.59% [95% CI 0.29–1.0%], respectively. Biopsy with 22G needle could increase the diagnostic accuracy rate and technical success rate to 92.17% [95% CI 89.32–94.61%] and 99.88% [95% CI 99.64–99.99%], respectively, and decrease the adverse event to 0.37% [95% CI 0.08–0.87%]. Moreover, it showed that 22G needle was an independent factor associated with a higher diagnostic accuracy rate and technical success rate and a lower adverse event rate (P = 0.04, P < 0.001, and P = 0.04, respectively) by univariate and multivariate meta‐regression analyses.Conclusion: Endoscopic ultrasound‐guided fine‐needle biopsy is a feasible and safe procedure for lesions within or adjacent to the digestive tract. Biopsy using 22G needle could increase the diagnostic accuracy rate and technical success rate and decrease adverse event rate during the FNB procedure.

Background This study aimed to evaluate the clinical efficacy, safety, and feasibility of performing endoscopic submucosal resection with a ligation device (ESMR-L) after apical mucosal incision (AMI) for the treatment of gastric subepithelial tumors originating from the muscularis propria (SET-MPs). Methods 14 patients with gastric SET-MPs were treated by ESMR-L with AMI between December 2016 and May 2017. The complete resection rate, operation duration, and postoperative complications were collected. All patients were followed for 2 – 6 months. Results The complete resection rate was 100 %, the mean tumor size was 10.71 ± 3.45 mm (7 – 18 mm), and the median operative time was 18.5 minutes. Perforation occurred in four patients, with all lesions being completely repaired endoscopically. No delayed bleeding or peritoneal signs were observed. No residual lesions or recurrence were found during the follow-up period. Conclusions AMI with ESMR-L appears to be an efficient and simple method for the histological diagnosis of gastric SET-MPs, but it carries a high perforation rate and cannot guarantee cure.