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1
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"This multicenter study provides valuable real-world data on eosinophilic gastroenteritis (EGE) in 73 Korean patients. Strengths include detailed site-specific treatment analysis, showing high response rates to PPI monotherapy in gastroduodenitis (88.9%), and identifying colonic involvement as a key relapse predictor (43.3%). These findings offer practical clinical guidance. A minor suggestion: adopting the updated 2022 international consensus nomenclature (e.g., non-EoE EGIDs, EoG, EoN, EoC) would further enhance cross-study communication. Overall, a clinically useful study with robust regional data."
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Lee J, Kim SE, Cha RR, Lee BE, Choi CW, Jee SR. Presentation and treatment of eosinophilic gastroenteritis in Busan and Gyeongnam, Korea: A multicenter study. World J Gastroenterol 2026; 32(19): 117166 [DOI: 10.3748/wjg.v32.i19.117166]
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2
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"This retrospective study evaluates the real-world clinical performance of the deep learning-based ENDOANGEL system in detecting high-risk gastric lesions (HrGLs), demonstrating high readiness for academic publication. Utilizing a massive, propensity score-matched cohort of 15,528 patients to effectively control for major confounding variables, the authors convincingly establish that AI integration nearly doubles the HrGL detection rate (0.94% vs. 0.48%) while providing critical mechanistic validation through causal mediation analysis, proving that this diagnostic gain stems directly from AI-driven image recognition rather than a mere increase in blind biopsies. As an unwearied "second observer," the system holds extensive application prospects for mitigating diagnostic subjectivity, reducing early gastric cancer miss rates, and stabilizing quality control across lower-tier or high-workload endoscopic centers. Moving forward, while future development trends will naturally pivot toward multi-center video-stream integration and diverse ethnic cohort validation, the immediate clinical hurdles that must be surmounted include bridging the performance-gain variance observed across different endoscopist seniority levels, enhancing algorithmic robustness against real-world artifacts like gastric mucus and motion blur, and perfecting low-latency, seamless hardware-software integration."
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Ying JX, Yan SY, Fu XY, Zhou YJ, Zhou JJ, Yang Y, Zhou XB, Wang ZZ, Li SW, Fang LN, Mao XL. Artificial intelligence-assisted endoscopists improve the detection rate of high-risk gastric lesions: A propensity score-matched retrospective study. World J Gastroenterol 2026; 32(21): 117299 [DOI: 10.3748/wjg.v32.i21.117299]
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3
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"The article focuses on the relationship between the Healthy Sleep Score and MASLD. The significance of this study lies in suggesting that overall sleep health may be an important and relatively modifiable factor in the prevention and management of MASLD. For clinical and health management readers in particular, the study emphasizes not just a single sleep problem, but the combined effects of multiple dimensions of sleep, including sleep duration, sleep rhythm, insomnia, sleep apnea, and daytime sleepiness. This provides valuable insights for the early screening, lifestyle intervention, and risk stratification of MASLD. In addition, the authors propose that insulin resistance and inflammation may partially mediate the relationship between sleep and MASLD, offering directions for future mechanistic research and integrated intervention strategies. Although the study is cross-sectional in design and therefore cannot directly establish causality, its relatively large community-based sample and comprehensive analytical framework still make it a useful reference for understanding the link between sleep and metabolic liver disease."
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Yu QT, Lin YY, Gui ZH, Duan HL, Yang JJ, Meng Y, Peng XT, Liu L, Wan H, Shen J. Mediating roles of insulin resistance and inflammatory markers between healthy sleep scores and metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(21): 118057 [DOI: 10.3748/wjg.v32.i21.118057]
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4
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"The study focuses on enteric glial cells in the enteric nervous system and the cAMP/PKA/CREB signaling pathway, providing a new perspective for understanding how interactions among the nervous system, immune responses, and intestinal barrier function contribute to the development and progression of colitis. This places salidroside not merely as an anti-inflammatory natural compound, but within a more specific mechanistic framework of enteric neuroimmune regulation, thereby enhancing the scientific significance of the study. However, the current findings are mainly derived from experimental animal models, and further validation is still needed before clinical application, including evaluation of dose safety, long-term efficacy, the potential value of combination use with existing therapies, and the consistency of these mechanisms in human UC patients."
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Li Y, Tao SS, Wang Y, Sun Q, Li MY, Zhang H, Li YQ. Salidroside mitigates experimental colitis through cyclic adenosine monophosphate pathway activation and suppression of enteric glial cell responses. World J Gastroenterol 2026; 32(21): 116337 [DOI: 10.3748/wjg.v32.i21.116337]
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5
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"Bae and colleagues provide the first large‑scale prospective evaluation of serum S100A6 as a diagnostic biomarker for pancreatic cancer (PC), with an emphasis on its complementary role to CA19‑9 and CEA. The study has several clear strengths: a well‑defined cohort of 414 subjects (301 PC, 52 chronic pancreatitis [CP], 61 healthy controls), prospective sample collection before treatment, and a clinically relevant focus on distinguishing early‑stage (resectable) PC from benign CP. The authors show that serum S100A6 levels are significantly higher in both early and late PC than in CP or healthy controls. While CA19‑9 alone is the most accurate single marker (AUC 0.839), adding S100A6 and CEA improves overall diagnostic performance (AUC 0.868, P = 0.007 compared to CA19‑9 alone). More importantly, for differentiating early PC from CP, the triple panel achieved an AUC of 0.821 and was the only combination that significantly outperformed CA19‑9 alone (P = 0.017). Bootstrap internal validation (2000 resamples) supports the robustness of the findings. Nevertheless, some limitations deserve attention. External validation in an independent cohort is still lacking, and all samples come from a single tertiary centre. The “early‑stage” group is dominated by stage II tumours (140/149), with only nine stage I cases, so the conclusions mainly apply to resectable rather than truly early, asymptomatic disease. Lewis antigen status was not assessed, which is a known confounder for CA19‑9 false‑negatives; therefore, the extent to which S100A6 compensates specifically for Lewis‑negative individuals remains unclear. S100A6 is not pancreas‑specific and is elevated in other cancers, which limits its use to patients already under suspicion for PC or CP rather than for population screening. Finally, cost‑effectiveness and longitudinal follow‑up data are not provided. In summary, this well‑designed study convincingly shows that serum S100A6 adds diagnostic value to CA19‑9, especially for identifying resectable PC in patients with CP. However, external validation, Lewis antigen stratification, and assessment of clinical net benefit are needed before routine clinical use. At present, S100A6 should be viewed as a promising complementary biomarker, not a standalone screening test."
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Bae GE, Kim SM, Lee JK, Lee SY. First large-scale prospective evaluation of serum S100A6 as a complementary biomarker for early pancreatic cancer detection. World J Gastroenterol 2026; 32(21): 116581 [DOI: 10.3748/wjg.v32.i21.116581]
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6
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"This study is the first large-scale case-control evaluation of the value of serum S100A6 in the early diagnosis of pancreatic cancer. The results show that combining S100A6 with CA19-9 significantly improves diagnostic performance, and that adding CEA further helps distinguish early-stage pancreatic cancer from chronic pancreatitis, suggesting promising clinical translational potential. A key strength of the study is its focus on early diagnosis, a major challenge in pancreatic cancer management, and its proposal of a biomarker combination that complements existing markers. However, the specificity of S100A6, its stability across different populations, and its performance in real-world screening settings still require independent, multicenter, and prospective validation. Overall, this study provides valuable new evidence for the development of biomarkers for early pancreatic cancer detection."
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Bae GE, Kim SM, Lee JK, Lee SY. First large-scale prospective evaluation of serum S100A6 as a complementary biomarker for early pancreatic cancer detection. World J Gastroenterol 2026; 32(21): 116581 [DOI: 10.3748/wjg.v32.i21.116581]
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7
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"This study focuses on postoperative acute kidney injury (AKI), one of the most challenging complications in the field of pancreatic surgery. It adopts advanced machine learning methods to construct the first interpretable predictive model specifically tailored for patients undergoing pancreatic surgery and develops an online risk calculator. Overall, this is a high-quality study with rigorous design, advanced methodology and clear clinical orientation, which has made significant contributions to the development of this field. However, it also has several issues worthy of in-depth discussion:
a. The single-center retrospective design limits the generalizability of the results;
b. There is a lack of independent external validation;
c. The model incorporates 24-hour postoperative data, which restricts its application in preoperative risk assessment;
d. It fails to distinguish between AKI subtypes with different etiologies and severity grades.
Despite these limitations, this study has laid a solid foundation for research on the prediction of AKI after pancreatic surgery and also provides a valuable reference for predictive studies of other surgical complications."
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Lin C, Fu RK, Zheng H, Li TY, Han JS, Margonis GA, Wang JJ, Dong LB, Wang NS, Sun YX, Wang YZ, Liu C, Xu Q, Han XL, Zhang TP, Guo JC, Dai MH, Xia P, Chen LM, Wang WB. Development and validation of an interpretable machine learning model for predicting acute kidney injury after pancreatic surgery. World J Gastroenterol 2026; 32(19): 116271 [DOI: 10.3748/wjg.v32.i19.116271]
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8
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"This article is remarkable and stands out for its thorough synthesis of the multidimensional characteristics of degenerative disc disease (DDD). The authors proficiently unify molecular biology, biomechanics, genetics, and lifestyle influences into a logical explanation that reflects the true complexity of disc degeneration.
The in-depth analysis of cytokine-mediated pathways (IL 1β, TNF α, IL 6) and their subsequent signalling cascades (NF κB, MAPK, Wnt/β catenin) provides functional understanding into how inflammation and matrix breakdown the disc pathology. Equally compelling is the emphasis on the avascular and hypoxic microenvironment of the intervertebral disc, which helps explain its susceptibility to metabolic and oxidative stress.
The exploration of genetic predisposition adds significant depth to the discussion. The inclusion of heritability estimates of 50–70% and polymorphisms involving collagen, aggrecan, and inflammatory mediators clarifies why certain individuals may be more vulnerable to degeneration. Furthermore, the incorporation of epigenetic mechanisms, including DNA methylation, histone modifications, and microRNAs, highlights the dynamic interaction between environmental influences and gene regulation, making the article highly relevant to emerging precision medicine approaches.
I found the section addressing metabolic contributors particularly illuminating. The discussion of diabetes and obesity leading to advanced glycation end-product (AGE) accumulation and extracellular matrix stiffening effectively connects systemic metabolic dysfunction with localized disc degeneration.
Clinically, the article makes an important distinction between structural degeneration and symptomatic disease, emphasizing that radiographic abnormalities do not always correlate with pain. The discussion of aberrant nerve ingrowth, cytokine-driven sensitization, and biomechanical instability as mechanisms of pain successfully bridges the gap between imaging findings and patient experience. In addition, the diagnostic overview, highlighting MRI as the gold standard alongside emerging AI-driven radiomics, reflects both current clinical practice and future directions in the field.
The management section is balanced and comprehensive, covering conservative approaches such as physical therapy and lifestyle modification, as well as surgical interventions including spinal fusion and disc replacement. The inclusion of regenerative therapies, such as platelet-rich plasma (PRP), stem cell therapy, biomaterial scaffolds, and gene therapy adds considerable value for both clinicians and researchers. Particularly exciting is the forward-looking discussion of epigenetic modulation and senolytic therapies as potential disease-modifying strategies, which underscores the evolving future of DDD treatment.
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Gradisnik L, Prestor B, Zele T, Kocivnik N, Maver U, Velnar T. Pathophysiology and current understanding of degenerative disc disease. World J Orthop 2026; 17(5): 117153 [DOI: 10.5312/wjo.v17.i5.117153]
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9
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"Hopley et al. conducted a well‑designed, single‑center observational study using a large 17‑year real‑world cohort of 1,191 patients with presumed benign branch‑duct intraductal papillary mucinous neoplasms (BD‑IPMNs). The long median follow‑up of 9.74 years and the inclusion of both imaging‑only and imaging‑plus‑EUS groups strengthen the reliability of the findings. A key strength is the identification of a clear “window of opportunity” for surgical intervention within the first two years of surveillance, after which the incremental benefit of continued monitoring declines sharply. The authors also provide compelling data that patient age and comorbidity burden (Charlson comorbidity index) critically affect net benefit, supported by competing risk analyses from independent groups (Crippa et al., Gut 2024). Limitations inherent to the single‑center, retrospective design, such as potential selection bias and lack of external validation, are appropriately acknowledged. The manuscript is written in clear, standard academic English. Abbreviations are defined at first use, tables are properly formatted, and the flow of information is logical. The language is concise, respectful, and meets the journal’s requirements for scientific reporting. Overall, the scientific quality is high, and the presentation is professionally polished."
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Hopley PJ, Whelan P, Jackson R, Evans J, Andrews T, Ghaneh P, Raraty M, Greenhalf W, Halloran CM. Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance? World J Gastroenterol 2026; 32(19): 115852 [DOI: 10.3748/wjg.v32.i19.115852]
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10
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"his review article provides an insightful and clinically important discussion on the functional disorders associated with chronic constipation. The authors successfully combine evidence from the literature with their extensive personal experience, making the manuscript both academically informative and practically relevant.The concept of the “iceberg model” is particularly noteworthy, as it clearly illustrates how underlying functional abnormalities may remain undetected in patients presenting with apparent structural pathology. The emphasis on comprehensive functional evaluation prior to surgical intervention is highly valuable and reflects current multidisciplinary approaches in colorectal practice.The manuscript also effectively highlights the role of anorectal physiology, pelvic floor dysfunction, and psychological factors in the pathogenesis of chronic constipation. The review will be useful for gastroenterologists, colorectal surgeons, pelvic floor specialists, and trainees involved in managing complex constipation disorders.
Overall, this is a well-written and educational review that contributes meaningfully to the understanding of chronic constipation and its functional components."
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Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
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11
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"This is a highly practical and timely observational study by Hopley et al. The management of presumed innocent branch duct IPMNs often necessitates an overwhelming volume of serial cross-sectional imaging and EUS procedures, which places a heavy demand on diagnostic resources and creates a prolonged psychological burden for patients. By demonstrating that the diagnostic yield of continued investigations dramatically drops after the first two years, the authors provide a strong, data-driven argument for refining our protocols. Establishing clear, objective thresholds, specifically a maximum cyst size of < 30 mm on imaging and a serum CA 19-9 of < 43 KU/L, offers a reliable baseline for predicting high-grade dysplasia or malignancy. Safely de-escalating follow-up for stable lesions after two years, and potentially discharging patients at the five-year mark, is a necessary evolution in pancreatic surveillance pathways. This approach allows multidisciplinary teams to concentrate advanced imaging and interventional resources during that critical, early front-loaded period where the opportunity to detect and definitively resect PDAC is actually at its highest."
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Hopley PJ, Whelan P, Jackson R, Evans J, Andrews T, Ghaneh P, Raraty M, Greenhalf W, Halloran CM. Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance? World J Gastroenterol 2026; 32(19): 115852 [DOI: 10.3748/wjg.v32.i19.115852]
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12
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"This review focuses on functional factors that are often overlooked in chronic constipation, particularly issues underlying OD, such as anxiety and depression, pelvic floor dyssynergia, rectal hyposensitivity, slow-transit constipation, and pudendal neuropathy. It therefore has considerable clinical practical value. The article emphasizes that, before deciding on surgery, organic causes should be thoroughly excluded and hidden functional disorders should be identified through functional assessment. This is important for reducing unnecessary surgery and avoiding postoperative symptom worsening or treatment failure. The model proposed by the authors vividly illustrates the relationship between superficial lesions and deeper functional disorders in patients with OD, helping readers understand why some patients have poor outcomes after surgery."
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Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
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13
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"The article indicates that high PRMT5 expression is associated with poor prognosis in hepatocellular carcinoma (HCC). It further reveals that PRMT5 can suppress DDIT3 transcription by enhancing H4R3me2 modification at the DDIT3 promoter region and recruiting STAT3, thereby promoting anti-apoptotic behavior and malignant progression of tumor cells. This mechanism links epigenetic regulation, transcription factor cooperation, and tumor cell escape from apoptosis, providing a new perspective for understanding the development and progression of HCC. A key strength of the article is that it not only identifies the association between PRMT5 and prognosis, but also further elucidates the dual inhibitory mechanism by which PRMT5 regulates DDIT3, making the study’s conclusions more biologically convincing."
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Jiang H, Yan JH, Tang WJ, Shen B, Mo S, Wang Y, Hu DH, Dong ZX, Zhang SB. PRMT5 imposed a dual repression on DDIT3 transcription to promote the malignancy of hepatocellular carcinoma. World J Gastroenterol 2026; 32(19): 115332 [DOI: 10.3748/wjg.v32.i19.115332]
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14
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"This multicenter retrospective study provides valuable real-world evidence on the clinical presentation, endoscopic features, treatment patterns, and outcomes of eosinophilic gastroenteritis in the Busan and Gyeongnam regions of Korea. The study is clinically meaningful because eosinophilic gastroenteritis remains a relatively rare and heterogeneous disease, and regional data from Asian populations are still limited. A major strength of the article is its location-based analysis, which shows that gastroduodenitis, enterocolitis, and gastroenterocolitis may differ in symptoms, treatment selection, and relapse risk. The finding that patients with gastroduodenal involvement may respond well to proton pump inhibitor therapy is particularly interesting and may encourage clinicians to consider more individualized and less steroid-dependent strategies in selected patients. The observation that relapse was more frequent in enterocolitis also has practical relevance, as it highlights the need for closer follow-up in patients with colonic involvement. The manuscript is generally well organized, and the language is clear and accessible. From a critical perspective, the retrospective design, modest sample size, short median follow-up duration, and non-standardized treatment approaches across centers limit the ability to draw firm conclusions about predictors of treatment response or recurrence. The association between male sex and clinical response is intriguing but should be interpreted cautiously given the wide confidence interval. Future prospective multicenter studies with standardized diagnostic thresholds by gastrointestinal site, uniform treatment protocols, longer follow-up, and histological as well as symptomatic outcome measures would further strengthen the evidence base. Overall, this article makes a useful contribution to the understanding of eosinophilic gastroenteritis in Asian clinical practice and provides a solid foundation for future studies on tailored management strategies."
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Lee J, Kim SE, Cha RR, Lee BE, Choi CW, Jee SR. Presentation and treatment of eosinophilic gastroenteritis in Busan and Gyeongnam, Korea: A multicenter study. World J Gastroenterol 2026; 32(19): 117166 [DOI: 10.3748/wjg.v32.i19.117166]
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15
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"The study by Qin et al. pioneered the elucidation of the multi-target mechanism of Anwei Formula in chronic atrophic gastritis. By directly suppressing NLRP3 inflammasome activity in gastric tissue and reshaping the gut microbiota–metabolism axis, it systematically demonstrated, for the first time, the molecular basis through which traditional Chinese medicine exerts therapeutic effects via the "gut–stomach axis," providing robust scientific support for the application of multi-omics integration in modern mechanistic analysis of traditional Chinese medicine."
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Dai WX, Li HW, Guo W, Zheng LY, Zhou HX. From traditional formula to modern mechanism: How Anwei decoction alleviates chronic atrophic gastritis via regulating the gut-stomach axis. World J Gastroenterol 2026; 32(19): 117151 [DOI: 10.3748/wjg.v32.i19.117151]
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16
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"This retrospective study displayed a critical role in the performing of training and testing results using several artificial techniques in the occurrence of acute kidney damage clinically. Although it is meaningful to indicate the incidence of acute kidney injury after clinical treatment, there are several issues to need further explanation for achieving better effect by readers such that the patient number difference between training and testing group presented significantly as well as the cross sections among acute kidney injury or non-acute kidney injury versus training cohort and validation cohort displayed without overlapped demonstration. "
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Lin C, Fu RK, Zheng H, Li TY, Han JS, Margonis GA, Wang JJ, Dong LB, Wang NS, Sun YX, Wang YZ, Liu C, Xu Q, Han XL, Zhang TP, Guo JC, Dai MH, Xia P, Chen LM, Wang WB. Development and validation of an interpretable machine learning model for predicting acute kidney injury after pancreatic surgery. World J Gastroenterol 2026; 32(19): 116271 [DOI: 10.3748/wjg.v32.i19.116271]
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17
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"The review by Pescatori et al provides a valuable and practical overview of functional disorders associated with chronic constipation and obstructed defecation. The “iceberg” concept is particularly interesting in highlighting the frequently overlooked functional and psychological components that may contribute to poor surgical outcomes. The emphasis on careful patient selection and multidisciplinary management is highly relevant in current practice.
An interesting aspect of this review is the inclusion of the authors’ personal clinical experience, which adds practical insight to the discussion. However, in sections where specific therapeutic approaches and institutional experiences are mentioned, it would be worthwhile to directly cite the authors’ previously published studies more consistently, allowing interested readers to further explore the original data and clinical outcomes in greater detail."
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Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
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18
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"This single-centre, observational study offers pragmatic evidence to support de-escalating surveillance in presumed “innocent” BD-IPMN. The front-loaded nature of actionable findings and surgery—88% within two years—along with the predictive thresholds (serum CA19-9 ≥43 KU/L and cyst size ≥30 mm) are clinically useful and align with evolving guideline debates. Importantly, the authors highlight declining operability with time, an underappreciated real-world constraint that strengthens the case for time-bound surveillance and potential discharge at five years when cysts remain <30 mm and CA19-9 <43 KU/L.
Overall, this is a valuable contribution that reframes surveillance intensity around early yield, patient fitness, and simple biomarkers, offering actionable criteria for de-escalation while acknowledging residual PDAC risk."
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Hopley PJ, Whelan P, Jackson R, Evans J, Andrews T, Ghaneh P, Raraty M, Greenhalf W, Halloran CM. Branch duct intraductal papillary mucinous neoplasms: How ready are we to de-escalate surveillance? World J Gastroenterol 2026; 32(19): 115852 [DOI: 10.3748/wjg.v32.i19.115852]
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19
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"The mini-review by Mario Pescatori and colleagues offers a clinically relevant, experience-based overview of functional disorders associated with chronic constipation and obstructed defecation. The “iceberg model” presented by the authors is particularly valuable because it highlights the often-overlooked functional and psychological contributors to obstructed defecation. The article also effectively emphasizes the risks of inappropriate surgical intervention in patients with predominantly functional pathology and reinforces the importance of multidisciplinary management.
The discussion of anxiety-depression, anismus, rectal hyposensitivity, and pudendal neuropathy is concise yet clinically meaningful. Including institutional experience alongside the literature review strengthens the article’s practical relevance. The proposed treatment strategies, particularly psycho-echo-biofeedback and selective puborectalis myotomy, provide useful insight into individualized management approaches.
A few additional points could further strengthen the manuscript. Incorporating recent guideline-based recommendations from international colorectal and gastroenterology societies would reinforce the evidence-based framework of the review. A brief discussion of standardized diagnostic algorithms for pelvic floor dyssynergia, including the role of high-resolution anorectal manometry, may also improve completeness. In addition, a summary table outlining functional disorders, diagnostic modalities, and preferred management strategies would enhance readability for practicing clinicians and trainees.
Overall, this article makes an important contribution to the understanding of functional constipation and obstructed defecation. It appropriately cautions against excessive reliance on surgery and underscores the need for careful functional evaluation before operative intervention."
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Pescatori M, Perrotta G, De Nardi P. Functional disorders in patients with chronic constipation: Review of the literature and personal experience. World J Gastroenterol 2026; 32(19): 113841 [DOI: 10.3748/wjg.v32.i19.113841]
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20
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"Dearly respected Editor
Greetings
The authors touched an important topic in metabolic disease, metabolic-associated fatty liver disease (MAFLD) is common in particular in patients with type 2 diabetes mellitus which is approaching an epidemic. Nearly two-thirs of patients wirh diabetes are suffering from from MASLD with seroius consequences in terms of liver cirrhosis, hepatocellular carcinoma, and mortality. In addition, patients with MASLD have higher prevalence of type 2 diabetes. The current literatures shows significant geographic, age, and gender variation. Importantly, males had a higher rate of MASLD than women, but the mortality is higher in women. Although, the variation can be explained in part by the differences in hypertension, serum uric acid, and other cardiovascular risk factors. Genetic and sex hormone in particular sex-hormone binding globulins play important roles. Investigating the gender differences could direct personalized management specific for age and gender. This is an important hot topic in Medicine on which Iam very thrilled to write an editorial or an umbrella review.
Best regards
Hyder Mirghani, Peofessor of Internal Medicie, Endocrinology, and Metabolism, University of Tabuk, Saudi Arabia"
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Lonardo A, Jamalinia M, Weiskirchen R. Type 2 diabetes, sex and metabolic dysfunction-associated steatotic liver disease. World J Diabetes 2026; 17(5): 119756 [DOI: 10.4239/wjd.v17.i5.119756]
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21
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"the current article addressed the role of vitamin D in pathogenesis and management of inflammatory bowel diseases. it is an interesting article as it paves the way for role of diets in management of IBD.in the same context, Functional medicine in Inflammatory Bowel Disease (IBD) aims to treat the root causes of inflammation rather than just managing symptoms, using personalized nutrition, lifestyle modifications, and gut-healing protocols"
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Costa BG, Yoshihara RNY, Spiller AL, Castelhano NS, Santos A, Baima JP, Imbrizi M, De Freitas MB, Magro DO, Sassaki LY. Vitamin D, vitamin D receptor gene polymorphisms, and inflammatory bowel disease outcomes: From molecular mechanisms to clinical application. World J Gastroenterol 2026; 32(15): 115533 [DOI: 10.3748/wjg.v32.i15.115533]
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22
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"Thank you for an interesting article. HAV is an important infection which cause acute hepatitis, including acute liver failure and acute-on-chronic liver failure. Liver transplantation is an option for patients with acute liver failure and patients with acute-on-chronic liver failure. This article provided an useful information for us. Thank you very much."
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Bautista-Mondragón CA, Mijangos-Trejo AM, González-Chon O, Mondragón-Ratkovich P, Chávez-Tapia NC. Predictors of mortality and liver transplant requirement in patients with hepatitis A virus: A case series from Mexico. World J Gastrointest Surg 2026; 18(1): 112767 [PMID: 41695881 DOI: 10.4240/wjgs.v18.i1.112767]
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23
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"This prospective observational study by Semeya et al. provides significant real-world evidence regarding the systemic implications of Helicobacter pylori (H. pylori) infection in high-risk patients on long-term low-dose aspirin. The authors elegantly demonstrate the clinical value of successful eradication in reducing both peptic ulcer bleeding (PUB) and cardiovascular disease (CVD) progression. This research is timely and offers practical guidance for the multidisciplinary management of these complex patients. However, a few methodological and technical nuances warrant further attention to enhance the study's scientific rigor. Most notably, a critical discrepancy exists in Table 4, where row labels such as "Endoscopic" and "Histopathological" appear under the "Cardiovascular disease" header instead of specific clinical conditions. Additionally, the P-value for ischemic heart disease is inconsistently reported as P < 0.001 in the text but P = 0.006 in Table 4. Furthermore, the overall eradication rate of 51.9% achieved with levofloxacin-based triple therapy and the relatively brief 6-month follow-up period for observing chronic CVD progression present opportunities for deeper discussion. The broad range of aspirin dosages (81–325 mg) utilized without stratified analysis may also act as a confounding factor. We are currently drafting a formal Letter to the Editor to provide a more detailed appraisal of these methodological considerations and to explore the integration of advanced diagnostic technologies for optimizing risk stratification in this vulnerable population."
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Semeya AA, Makled WA, Elnagdy MA, Elgamal R, Othman AAA. Helicobacter pylori eradication and the prevention of peptic ulcer bleeding and cardiovascular disease progression in chronic aspirin users. World J Gastroenterol 2026; 32(17): 117544 [DOI: 10.3748/wjg.v32.i17.117544]
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24
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"This retrospective study analyzed data from 5,986 patients in Zhejiang Province, China, to investigate the association between Helicobacter pylori (H. pylori) infection and colorectal cancer (CRC) and colorectal adenomas, particularly advanced adenomas (AAs). The prevalence of advanced adenomas was significantly higher in H. pylori–positive patients compared to uninfected individuals. Although the prevalence of CRC was also slightly higher in the infected group, the difference did not reach statistical significance. H. pylori infection was not associated with non-adenomatous polyps (NAPs) or low-risk adenomas (LRAs).
Multivariate logistic regression analysis identified H. pylori infection as a risk factor for both advanced adenomas and CRC. No significant differences were observed in the prevalence of adenomas or CRC across degrees of H. pylori infection. In H. pylori–positive patients, CRC lesions were more frequently located in the distal colon (left colon and rectum). Male sex and older age were also identified as risk factors for advanced adenomas and CRC.
This study suggests that H. pylori infection may contribute to the development of advanced adenomas and CRC and recommends prioritizing colonoscopic evaluation in H. pylori–positive patients. In particular, patients at high risk of advanced adenomas (H. pylori–positive, male, and elderly) may benefit from regular colonoscopic surveillance for early detection and treatment. It is a fascinating study.
However, in my opinion, several concerns have been raised. In this study, H. pylori infection status and infection level were evaluated using gastric mucosal biopsy specimens, but the specific biopsy sites (e.g., antrum or corpus) were not described in detail. Generally, biopsy from the antrum and/or corpus is recommended for accurate detection of H. pylori, whereas this study refers only to “gastric mucosal specimens.”
Furthermore, the manuscript does not address the distinction between viable and non-viable H. pylori, nor the clinical significance of non-viable bacteria. The assessment of H. pylori infection in this study appears to be based on the presence of organisms observed in histological specimens, which typically reflects viable bacteria associated with infection and disease risk. In contrast, non-viable bacteria do not confer infectivity but may still contribute to immune responses. In clinical practice, accurate diagnosis of H. pylori infection can be challenging, and this issue warrants further discussion.
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Shan N, Hou JJ, Jin CQ, Jin Q, Qin YH, Li WW. Helicobacter pylori positively associated with colorectal cancer and advanced, but not low-risk, adenomas: A retrospective study in China. World J Gastrointest Surg 2026; 18(4): 117397 [DOI: 10.4240/wjgs.v18.i4.117397]
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25
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"The meta-analysis by Mapouka et al., involving 10.7 million participants, provides critical evidence that lean MASLD patients share comparable risks for MASH, cardiovascular disease, and mortality with non-lean individuals. While non-lean patients show higher odds of fibrosis and steatosis, lean patients demonstrate lower risks of cirrhosis and hypertension. These findings reinforce that BMI alone is an insufficient standalone screening metric.
Methodologically, however, extreme heterogeneity was observed for outcomes including fibrosis (94%), MASH (91%), and mortality (90.9%), suggesting substantial variance in study populations. Classification bias remains a concern due to inconsistent BMI thresholds (<23 vs. <25 kg/m²) used across the 31 included studies. Additionally, significant gaps in reporting sociodemographic data—specifically age, sex, and race—limit robust subgroup stratification. While the authors effectively advocate for a transition toward multidimensional metabolic risk assessment, these data inconsistencies highlight the need for more standardized, prospective longitudinal research.
Ultimately, this study serves as a vital reminder to maintain vigilance for MASLD complications regardless of patient weight."
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Mapouka M, Pabingui E, Tazinkeng NN, Gurmessa M, Vickos U, Ndemazie NB, Camengo Police SM. Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 114657 [DOI: 10.3748/wjg.v32.i13.114657]
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"Wuda granules in the inflammation-estrogen-microbiota axis
Dina Johar*
Department of Biochemistry and Nutrition, Faculty of Women for Arts, Sciences and Education, Heliopolis, Cairo, Egypt
*Dina Johar, PhD.
Department of Biochemistry and Nutrition
Faculty of Women for Arts, Sciences, and Education
Ain Shams University, Cairo, Egypt
Phone:+2 01060782045
Email: dinajohar@gu.edu.eg
*To whom correspondence should be addressed
Abstract
The inflammation-estrogen-microbiota axis dynamically remodel one another in a two-way, body-wide control loop. In Chinses Traditional Medicine, Wuda granules (WDG), which are derived from simo decoction, have been used clinically, and modified to enhance intestinal motility, restore bowel activity, relieve obstruction-related discomfort, and promote stool and gas elimination. Given the high recurrence rates of post-surgical functional dyspepsia and related GI disorders such as paralytic ileus and mechanical intestinal obstruction, it remains a significant clinical challenge to determine whether targeted treatments with WDG alter gut bacteria to raise body estrogen levels. In this commentary, we highlight recent findings from Wang et al.(2026)[1]. We draw attention to the potential benefits of studying experimental models in parallel with multi-omics approaches. The commentary offers insights for clinical decision-making and pre-clinical trials.
Keywords
Wuda granules; Post-operative ileus; Proteomics; Gastroenterology; Probiotics; Isovaleric acid.
Core Tip
The study of Wang et al, (2026)[1], presents an interesting, rich, multi-omics evaluation of WDG in a mouse model of POI, suggesting involvement of estrogen signaling and gut microbiota. However, additional experimental controls and mechanistic evidence is necessary to be fully supported. In multi-omics approaches, addressing the statistical test descriptions, sample sizes for high-throughput assays, multiple testing corrections, and computational pipeline parameters is necessary to ensure the robustness of the conclusions. Further contextualization regarding the functional validation of the proposed estrogen-mediated mechanisms and the physiological interpretation of the metabolite data are insightful. Addressing these limitations will significantly strengthen the study's mechanistic conclusions.
Background
The WDG-based therapies have shown potential to treat intestinal motility, relieve obstruction-related discomfort and promote elimination of stools and gases. However, their success is limited by difficulty in ensuring survival and targeting in the harsh gastrointestinal environment, especially post-surgery. The paper by Wang et al., 2026[1], provides an interesting and rich multi-omics evaluation of WDG in a mouse model of Post-Operative Ileus (POI), suggesting involvement of estrogen signaling and gut microbiota activity. In the proteomics dataset, sham controls are used to distinguish biological changes caused by a specific disease or treatment from changes due to the experimental procedure itself, such as surgery or anesthesia[2]. Including sham analyses, helps research to identify proteins that are only dysregulated because of the condition being studied rather than the stress of the intervention, as this reduces bias and improves accuracy[3]. Although the experimental design by Wang et al.(2026)[1] included a sham group, the resultant proteomics analysis compared the WDG-treated and POI model groups to identify the differentially expressed proteins without indicating the inclusion of sham/healthy baseline controls in the clustering or Venn diagram analysis. Without a baseline comparator, their claim that "WDG substantially reverses POI-induced protein dysregulation." is not logically supported, since the data only show that WDG creates a different expression profile from the POI state. Including sham control in the proteomics data set to definitively determine whether WDG normalizes protein expression or induces a novel state is key to exclude causality claims. Further, the study relies heavily on high-dimensional data (proteomics, 16S rRNA sequencing and Short-Chain Fatty Acid (SCFA) profiling), yet there is no indication that multiple testing correction was applied. Evaluating thousands of proteins or microbial taxa using standard P values thresholds greatly increases the false-positive rate, while applying and reporting appropriate multiple testing corrections (i.e., False Discovery Rate/ Benjamini-Hochberg) for these analyses helps to clarify the method-derived conclusion. I.e., in the description of the proteomic Venn diagram, the study states that there are "348 proteins uniquely present in each group." It is highly improbable that the WDG-treated group and the POI model group contain exactly 348 unique proteins each.
Estrogen receptors (ERs) are nuclear proteins that bind estrogens, acting as transcription factors. The two primary intracellular receptors, ERα and ERβ, often play distinct or opposing roles in cell proliferation[4], regulate the synthesis of specific RNAs and proteins, regulate complex metabolic processes, and influence inflammation. Beyond reproduction studies, controversial findings on ERβ expression levels in disease progression, prediction, prognosis, and therapy remain paradoxical. This may be partly due to the ERβ- compensatory expression associated with some antisera available for research[5]. The hormone effects on the brain are particularly interesting, as ERβ is involved in anxiety and aggression[6]. Various antiestrogen strategies have been used in research, such as the high-affinity ERβ antagonist PHTPP: (4-[2-Phenyl-5,7-bis(trifluoromethyl)pyrazolo[1,5-a]pyrimidin-3-yl]phenol), are ERβ-specific. PHTPP blocks ERβ signaling in vivo and in vitro, reducing the expression of target genes like the Minichromosome Maintenance Complex Component 5 (mcm5), which regulates cell growth. In the ERβ-KO mouse model, the gene coding for Erβ is permanently lost. Knocking down ERβ using ERβ-shRNA in ERβ-positive human bladder cancer BCa J82, 647v, and T24 Erβ-positive cell lines led to suppressed cell growth and invasion[7]. Further, pharmacological or genetic suppression of ERβ alter mitochondrial metabolism, resulting in metabolic dysregulation[8]. Systems‐based approaches have focused almost exclusively on the use of data‐driven approaches based on ever‐expanding ‘omics’ data sets, which had a profound impact on clinical immunology. However, they are neither determined nor restricted by previous biological knowledge. Specifically, the hypotheses and predictions generated by data‐driven models are generally abstract, and relate to patterns or correlations rather than to biological mechanisms. The Wang et al. study[1] states that the therapeutic effects of WDG are "mediated, at least in part, via ERβ-dependent signaling pathways." based on the restoration of ERβ levels. However, this observation is correlative. To establish a causal mechanistic link, performing in vivo experiment using an ERβ antagonist- as aforementioned- to determine whether blocking this receptor abrogates the anti-inflammatory and motility-restoring effects of WDG is an inevitable approach. Further, molecular docking data are used to suggest that WDG constituents (i.e. linderane and quercetin) "act as key ligands modulating estrogenic signaling.". While docking provides theoretical binding affinity, it cannot distinguish between receptor agonists and antagonists, nor does it prove functional modulation. Including in vitro functional assay (i.e. an ER transactivation/luciferase reporter assay) to confirm that these compounds actively stimulate ER signaling is informative. The conclusion proposes a unified "inflammation-estrogen-microbiota axis" as the key mechanism of WDG-mediated regulation of POI. The study investigates estrogen receptor expression, inflammatory markers, and microbial shifts simultaneously, without demonstrating a precise directional or causal relationship between these three compartments. Because it is fundamentally unclear whether ER activation induces microbial shifts, or if microbial metabolites induce ER activation and subsequent anti-inflammatory responses, emphasizing that WDG concurrently modulates these pathways is necessary, unless additional experiments (e.g., evaluating the microbiome in ER-antagonized mice) are performed to establish the sequence of the axis.
Postoperative ileus is characterized by impaired or absent gastrointestinal motility. Isovaleric acid (IVA) is a BCFA produced in the gut as a microbial metabolite, specifically by fermentation of branched-chain amino acid (leucine) by the gut microbiota. The authors state that IVA promotes relaxation of colonic smooth-muscle cells and "thereby improves GI motility". The physiological context of this claim in the literature is unclear, as smooth muscle relaxation typically inhibits contractions and delays transit. Explicitly addressing how a mechanism of muscle relaxation resolves a hypomotility disorder, or if it instead plays a role in resolving localized spasms to allow for coordinated peristalsis is insightful. The authors appropriately acknowledged the lack of Fecal Microbiota Transplantation (FMT) as a limitation for verifying the role of the gut microbiota. To provide more actionable future directions, the authors should also propose experiments to isolate the direct versus indirect effects of WDG, such as treating POI mice with broad-spectrum antibiotics before WDG administration. This would help determine if the therapeutic efficacy of WDG is strictly dependent on microbial metabolites (i.e., IVA) or if direct pharmacological effects (i.e., direct ERβ agonism by absorbed WDG compounds) independently drive recovery.
DECLARATIONS
Funding
This commentary did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author declares that no honorarium, grant, or other form of payment was given to anyone to produce the manuscript.
Conflict of interest
The author declares no conflict of interest exists.
Consent to publish
Not applicable.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Acknowledgment
N/A
REFERENCES
1 Wang T, Xu Y, Ou Y, Xiong W, Luo L, Li J, et al. Wuda granules target estrogen receptors and modulate gut microbiota to alleviate postoperative ileus: A multi-omics perspective. World J Gastroenterol. 2026;32:115995. [DOI: 10.3748/wjg.v32.i15.115995]
2 Candamo-Lourido M, Dopico-López A, López-Arias E, López-Amoedo S, Correa-Paz C, Chantada-Vázquez MP, et al. Comparative brain proteomic analysis between sham and cerebral ischemia experimental groups. Int J Mol Sci. 2024. 25;14:7538. [doi.org/10.1101/2023.12.21.572908] PMID: 39062782; PMCID: PMC11277324.
3 Candamo-Lourido M, López-Arias E, López-Amoedo S, Correa-Paz C, Bravo S, Bugallo-Casal A, et al. Relevance of sham control group in preclinical animal studies of cereberal ischemia. 2023. [doi.org/10.1101/2023.12.21.572908].
4 Eyster K. Methods Mol Biol. The Estrogen receptors: An overview from different perspectives. Methods Mol Biol. 2016;1366:1-10. [doi: 10.1007/978-1-4939-3127-9_1]. PMID: 26585122
5 Snyder MA, Smejkalova T, Forlano PM, Woolley CS. Multiple ERbeta antisera label in ERbeta knockout and null mouse tissues. J Neurosci Methods. 2010;188:226-34. [doi: 10.1016/j.jneumeth.2010.02.012]. PMID: 20170675; PMCID: PMC2854183.
6 Tomihara K, Soga T, Nomura M, Korach KS, Gustafsson JA, Pfaff DW, et al. Effect of ER-beta gene disruption on estrogenic regulation of anxiety in female mice. Physiol Behav. 2009;96:300-6. [doi: 10.1016/j.physbeh.2008.10.014.]. PMID: 18996135; PMCID: PMC2705464.
7 Hsu I, Chuang KL, Slavin S, Da J, Lim WX, Pang ST, et al. Suppression of ERbeta signaling via ERbeta knockout or antagonist protects against bladder cancer development. Carcinogenesis. 2014;35:651-61. [doi: 10.1093/carcin/bgt348].
8 Manente AG, Valenti D, Pinton G, Jithesh PV, Daga A, Rossi L, et al. Estrogen receptor beta activation impairs mitochondrial oxidative metabolism and affects malignant mesothelioma cell growth in vitro and in vivo. Oncogenesis. 2013;2:e72. [doi: 10.1038/oncsis.2013.32. PMID: 24061575; PMCID: PMC3816222].
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Wang T, Xu YH, Ou YH, Xiong WJ, Luo LJ, Li J, Peng YH, Chen Y, Zeng HP, Yu Y, Tang HP, Wang F, Yao HL, Wang W. Wuda granules target estrogen receptors and modulate gut microbiota to alleviate postoperative ileus: A multi-omics perspective. World J Gastroenterol 2026; 32(15): 115995 [DOI: 10.3748/wjg.v32.i15.115995]
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"The identification of the novel m.C15954T mutation in the mitochondrial tRNAThr/tRNAPro genes, as detailed in this study, represents a significant milestone in our understanding of the genetic landscape of Type 2 Diabetes Mellitus (T2DM). By employing a rigorous combination of pedigree analysis and cybrid cell modeling, the researchers have successfully linked a specific mitochondrial DNA mutation to a cascade of metabolic failures, including impaired ATP production, reduced membrane potential, and elevated oxidative stress. The positive significance of this work lies in its ability to pinpoint a precise molecular initiator for diabetes in a specific population, moving beyond general risk factors to a concrete, maternally inherited genetic driver. This discovery not only enriches the global database of mitochondrial pathogenic variants but also emphasizes the critical role of mitochondrial tRNA 3’-end processing in maintaining metabolic homeostasis.
From the perspective of acupuncture and its potential for glycemic control (glucose lowering), this research offers profound mechanistic implications. While acupuncture is traditionally viewed through the lens of nervous system modulation, modern research increasingly suggests its capacity to influence cellular bioenergetics and mitochondrial health. The "potential value" of this study for the acupuncture field is twofold. First, it defines a specific "mitochondrial phenotype" of diabetes—characterized by high reactive oxygen species (ROS) and low oxidative phosphorylation—that could serve as a biological target for acupuncture intervention. Previous studies have indicated that electroacupuncture at specific acupoints like ST36 (Zusanli) or ST25 (Tianshu) can activate the SIRT1/PGC-1α signaling pathway, which is a master regulator of mitochondrial biogenesis and antioxidant defense. In patients carrying the m.C15954T mutation, acupuncture could potentially act as a "mitochondrial stabilizer," compensating for the genetic defect by enhancing the residual mitochondrial efficiency or promoting the clearance of dysfunctional mitochondria (mitophagy).
Second, this research supports the development of "precision acupuncture." By identifying patients with specific mitochondrial mutations, clinicians could theoretically predict who might respond best to acupuncture treatments aimed at metabolic regulation. For instance, if the m.C15954T mutation leads to systemic bioenergetic deficits, acupuncture’s role in Improving microcirculation and oxygen delivery (as seen in your previous research on VEGF-A pathways) might be particularly beneficial in mitigating the downstream tissue damage caused by these mitochondrial failures. Ultimately, this paper provides a robust molecular foundation for future clinical trials investigating whether acupuncture can bypass or alleviate the metabolic bottlenecks created by mitochondrial tRNA mutations, thereby offering a non-pharmacological pathway to restore lipid and glucose balance in genetically predisposed individuals."
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Xu L, Liu MT, He XM, Zhang SR, Yu DJ, Ding Y. Type 2 diabetes mellitus may be associated with a novel mitochondrial tRNAThr/tRNAPro mutation. World J Diabetes 2026; 17(4): 115842 [DOI: 10.4239/wjd.v17.i4.115842]
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"the article raises new paradigm in understanding the mechanisms that lead to DR in all types of diabetic patients pointing to the false or invalid dependence of conventional glucose biomarkers rather than looking to the glycemic instabiliuty as the major contributing factor that leads to DR.
the article did not discuss if this will have an impact on the prediabetic state or only glycemic instability effects apply to overt diabetic states.
the article included details of limitations and future prospective that will enhance future research. "
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Cappellani F, Capobianco M, Leonforte F, Avitabile A, Visalli F, Khouyyi M, Giglio R, Inferrera L, Tognetto D, D’Esposito F, Gagliano C, Zeppieri M. Underlying cause of diabetic retinopathy: Metabolic instability. World J Clin Cases 2026; 14(12): 120247 [DOI: 10.12998/wjcc.v14.i12.120247]
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"Chronic radiation proctitis (CRP) is a common delayed complication following pelvic radiotherapy, among which refractory bleeding is one of the most challenging issues. Currently, effective oral drugs are lacking, and treatment mostly relies on endoscopic argon plasma coagulation (APC), enema preparations, or surgery, which are associated with high recurrence rates and significant invasiveness. Therefore, exploring safe and effective oral therapeutic agents holds important clinical value.
This study focuses on thalidomide, an old drug with anti-inflammatory, immunomodulatory, and anti-angiogenic properties, for the treatment of refractory hemorrhagic CRP, filling a gap in clinical data on oral medications in this field."
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Huang XY, Zhong QH, Kuang YY, Li ZJ, Huang BJ, He YJ, Zhu MM, Guan Q, Li XY, Qin QY, Ma TH. Thalidomide for refractory hemorrhagic chronic radiation proctitis secondary to pelvic malignancy radiotherapy: A phase II clinical trial. World J Gastroenterol 2026; 32(14): 116529 [DOI: 10.3748/wjg.v32.i14.116529]
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"This cohort study has provided a review on the pediatric gastroenterology disease using genomic methods in Middle Eastern area.
Hope that the flowchart to collect the proper cases in this study can be explained in view of author's efforts. In addition, the total candidate patients number may be added for solid foundation if possible. "
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Alsarhan A, Alloush R, Jain R, Abou Tayoun A, Tzivinikos C. Clinical utility of genomic investigations in a Middle Eastern pediatric gastroenterology disease cohort. World J Gastroenterol 2026; 32(13): 115810 [DOI: 10.3748/wjg.v32.i13.115810]
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"The article is written at a high scientific level. The research topic is relevant and in demand. The study design is described in detail and fully meets its stated objectives. The statistical methods used are sound and enable an adequate evaluation of the results obtained. The data obtained are clearly presented in both tabular and graphical forms. The discussion of the obtained data is logical, and the resulting conclusions are well-reasoned. The only caveat: for an article of this caliber, more references to sources from recent years would be desirable – in this case, of the 44 references, only 50% are from the last five years."
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Wang XY, Yin KH, Cheng L, Wang XY, Qiao Y, Tang XR, Wang B, Yan XJ, Chen SL. Efficacy and safety of lansoprazole combined with flupentixol-melitracen for functional dyspepsia: A randomized, double-blinded, placebo-controlled clinical trial. World J Gastroenterol 2026; 32(13): 117115 [DOI: 10.3748/wjg.v32.i13.117115]
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"The important value of this study lies in its clear finding that lean MASLD patients show no statistically significant differences from non-lean MASLD patients in terms of MASH, cardiovascular disease, and mortality risk, while their risks of cirrhosis, hypertension, and liver fibrosis are actually lower. The core clinical implication of this finding is that normal BMI should not be a reason to relax screening and risk assessment for MASLD and its complications. Of course, the study also has limitations: the definition of 'lean' varies across studies, which may introduce classification bias; and some outcomes (e.g., mortality, MASH, fibrosis) show high heterogeneity (I² > 90%), requiring cautious interpretation. Nevertheless, this is a study with direct practical guidance for clinical practice, particularly suitable for readers in hepatology, cardiology, endocrinology, and general medicine, as it helps shift MASLD screening strategies from an obesity-centered approach to multidimensional metabolic risk assessment."
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Mapouka M, Pabingui E, Tazinkeng NN, Gurmessa M, Vickos U, Ndemazie NB, Camengo Police SM. Outcomes of liver and cardiovascular metabolic diseases among lean vs non-lean individuals with metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 114657 [DOI: 10.3748/wjg.v32.i13.114657]
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"The authors integrated multiple GEO datasets, combined bioinformatics methods such as WGCNA and LASSO, and identified four exercise-responsive skeletal muscle genes (LAMA4, PECAM1, PXDN, THBS4), which were subsequently validated in an animal model. The study is clear in its approach and logically coherent. Its value lies in moving beyond the general attribution of exercise-induced improvement in MASLD to simply weight loss or metabolic improvement, instead attempting to pinpoint specific molecular mediators from the perspective of muscle–liver crosstalk. In particular, the detectability of PECAM1 and THBS4 in serum suggests their potential as liquid biopsy biomarkers or myokine-like candidates, offering reference value for the future development of exercise-mimetic drugs or precision intervention strategies."
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Zhang JH, Chen K, Zhu XM, Zhou H, Jiang JM, Zou YQ, Liu KR, Zhang L, Li Y. Exercise-responsive skeletal muscle genes mechanistically linked to metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 113985 [DOI: 10.3748/wjg.v32.i13.113985]
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"This is a well-organized and potentially meaningful study investigating exercise-responsive skeletal muscle biomarkers in MASLD. The integration of multiple GEO datasets, combined with WGCNA, LASSO modeling, validation cohort analysis, and animal experiments, represents a comprehensive approach. The identification of candidate genes involved in muscle-liver communication is of interest and may contribute to a better understanding of the mechanisms underlying the beneficial effects of exercise in MASLD. Nevertheless, one issue should be clarified. In the “Identification of DEGs” section and in Figure 1, the authors indicate that GSE161749, GSE48278, GSE156247, and GSE53598 were included. However, in Figure 2A/2B, the PCA legend appears to include GSE72462 instead of GSE156247. Please clarify which dataset was actually used and correct the figure or text accordingly."
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Zhang JH, Chen K, Zhu XM, Zhou H, Jiang JM, Zou YQ, Liu KR, Zhang L, Li Y. Exercise-responsive skeletal muscle genes mechanistically linked to metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(13): 113985 [DOI: 10.3748/wjg.v32.i13.113985]
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"The gut–muscle axis shares its conceptual underpinnings with the gut–lung axis, encompassing bidirectional crosstalk driven by gut dysbiosis, microbial translocation, immune dysregulation, and epigenetic modification. Short-chain fatty acids (SCFAs) — most notably butyrate — serve as the principal metabolic intermediary, promoting skeletal muscle protein synthesis and mitochondrial integrity through FFAR2/FFAR3 receptor signaling, AMPK–PGC-1α pathway activation, and PI3K/Akt/mTOR-mediated anabolism, while simultaneously exerting epigenetic regulation via histone deacetylase (HDAC) inhibition.
A mechanistically distinctive feature of the gut–muscle axis is robust retrograde signaling from muscle to gut. Exercise-derived lactate directly fuels SCFA-producing bacteria, and muscle-secreted myokines actively modulate microbial diversity — thereby constituting an actionable, bidirectional feedback loop with no clear counterpart in the gut–lung axis. Furthermore, gut microbiota-derived secondary bile acids activate farnesoid X receptor (FXR) and Takeda G protein-coupled receptor 5 (TGR5) in skeletal muscle, representing a pathway of particular relevance to gut–muscle biology.
Clinically, dysbiosis-driven SCFA depletion accelerates sarcopenia in aging populations, whereas patients with inflammatory bowel disease (IBD) face compounded muscle wasting attributable to chronic inflammation and nutrient malabsorption. Therapeutic strategies — encompassing probiotics, fecal microbiota transplantation (FMT), and butyrate supplementation — mirror those proposed for the gut–lung axis, with multi-omics integration and AI-driven analytics defining the shared frontier of precision medicine.
In summary, the gut–muscle axis both extends and substantively complements the gut–lung axis paradigm. Crucially, physical activity emerges as a uniquely potent bidirectional therapeutic modality, making it particularly suited for addressing muscle wasting in IBD and aging populations.
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Huang HJ, Liu PP, Dong DF. Research progress on comorbidity between gastrointestinal and pulmonary diseases from the perspective of the gut-lung axis. World J Gastroenterol 2026; 32(11): 115846 [DOI: 10.3748/wjg.v32.i11.115846]
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"I thank Khan et al for conducting this meta-analysis and finding out that hypoalbuminemia is a risk factor for mortality in cholangitis. I have a few comments that have to be taken into account while interpreting this study. First, this meta-analysis includes only retrospective studies. Second, there is no subgroup analysis by benign versus malignant aetiology of acute cholangitis. The outcomes of cholangitis depend on aetiology, which is not studied. This indicates whether hypoalbuminemia is due to cholangitis as an acute-phase reactant, or whether any underlying aetiology needs to be identified. Whether any intervention in acute cholangitis with hypoalbuminemia has any role in the outcome has not been studied. However, this meta-analysis provides meaningful research questions for future prospective studies."
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Khan RTY, Ahsam S, Kumar SK, Khan K, Kakar MT, Hyder A, Malik W, Mubarak M, Luck NH. Hypoalbuminemia as a predictor of mortality in patients with acute cholangitis: A systematic review and meta-analysis. World J Gastrointest Pathophysiol 2026; 17(1): 113373 [PMID: 41884201 DOI: 10.4291/wjgp.v17.i1.113373]
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"Sheriefet al. [1]demonstrated dual parametric evaluation to assess diagnostic performance for Hepatocellular carcinoma (HCC), discriminating from Hepatitis C-related liver Cirrhosis and Healthy control cohorts via plasma in a single centred Egyptian population.This study [1] revealed two leading biomarkers with exceptional accuracy (AUC >0.99); hsa-miR-21-5p (Sensitivity and Specificity of 98.6% and 96.7%, respectively) and Leukocyte-associated immunoglobulin-like receptor-1(LAIR-1) mean fluorescence intensity (MFI) (Sensitivity and Specificity of 100 % and 98.3%, respectively).
Sherief et al. [1]aims to address one of the clinically challenging issues i.e. lack of sensitive, specific circulatory biomarker/s for early diagnosis of Hepatocellular Carcinoma (HCC).Commentary noted several strengths of the study by Sherief et al. [1],such as; looks technicallymoderatein study design, methodology and innovation level i.e. prospective study, minimally invasive sample collection, exploration of dual parameters: tumour derived circulatory micro-RNA and immune related marker. Additionally, study employed rigorous statistical analysis for diagnostic performance assessment including ROC curve analysis, comparative Sensitivity/Specificity,revealed promising findings that may pave for future research towards biomarkers validation and discovery.
However,present commentary observed several concerns for the study by Sherief et al. [1]; (i) Lack of mechanistic cascade exploration including causal pathway/s.(ii) Median age of HCC cohort is significantly higher than Hepatitis C-related liver Cirrhosis and Healthy control, may be a biasing factor in expression pattern. (iii) Since study did not include follow up subjects that limits for probing of prognostic markers. (iv) Paucity of multi-centric involvement for diversified population, may limit the findings for generalized conception. (v) Validation of findings through blinded samples may demonstrate a better decision regarding applicability. (vi) Authors used word ‘noninvasive’, for plasma-based markers investigation(vii) Global Cancer statistics 2022,wasalready published in 2024[2], still authors used GLOBOCON 2020 [3] reference in epidemiological outline in the manuscript [1], latest reference can provide contemporary status.
The article by Sherief et al. [1], demonstrated balanced and structured scientific contents along with logical explanations. However, addition of graphical abstract to present the study in nutshell may improve the visibility for readers.
A large sample sized, multi-centered,longitudinal study, involving diversified geographical and ethnic population of HCC, Hepatitis C-related liver Cirrhosis, Healthy control cohorts, and mechanistically relevant subgroups, using common protocol, validation through blinded samples, may provide potential edge for HCCdiagnosticsto achieve common consensus and identification of prognostic biomarkers. Integrated nomogram ofhsa-miR-21-5p with LAIR-1 MFI, may be explored for possible better diagnosticsetup. Application of Artificial Intelligence (AI) may be explored for diagnostic performance as well as high throughput outcomes.
References:
1. Sherief DE, Shehata HH, Nosair N, Othman AAA, Sadaka E, Elgamal R. Dual-parameter liquid biopsy using plasma miR-21-5p and T cell LAIR-1 mean fluorescence intensity for hepatocellular carcinoma diagnosis in a high-risk Egyptian cohort. World J Gastrointest Oncol 2026 March 15a; 18(3): 116567.
2. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for36 cancers in185 countries. CA Cancer J Clin. 2024; 74:229–263
3. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249
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Sherief DE, Shehata HH, Nosair N, Othman AAA, Sadaka E, Elgamal R. Dual-parameter liquid biopsy using plasma miR-21-5p and T cell LAIR-1 mean fluorescence intensity for hepatocellular carcinoma diagnosis in a high-risk Egyptian cohort. World J Gastrointest Oncol 2026; 18(3): 116567 [DOI: 10.4251/wjgo.v18.i3.116567]
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"I read with ken interest about the following article. As a reader I have few comments/ suggestions also.
Alok Bharadwaj, Manas Taneja, Sneha Dubey, Aditya Saxena. Very low-density lipoprotein and the human health. World J Exp Med 2026;16(1): 117024 [DOI: 10.5493/wjem.v16.i1.117024]
Abstract
Apo B100, TGL and cholesterol are present in LDL in addition to VLDL. But the ratio of TGL: cholesterol may vary.
PATHOLOGICAL ROLE OF VLDL:
Metabolism-associated fatty liver disease and liver disease:
Distinction between NAFLD, MAFLD and MASLD may be provided
Following the classification of metabolic dysfunction-associated fatty liver disease (MAFLD), non-alcoholic fatty liver disease (NAFLD) has recently been redefined again as metabolic dysfunction-associated steatotic liver disease (MASLD). Both MASLD and MALFD were linked to higher all-cause mortality risk, but MASLD identified a greater number of individuals compared to MAFLD. (Song R, Li Z, Zhang Y, Tan J, Chen Z. Comparison of NAFLD, MAFLD and MASLD characteristics and mortality outcomes in United States adults. Liver Int. 2024;44:1051-1060. doi:10.1111/liv.15856)
Metabolic-associated fatty liver disease (MAFLD) exhibits a raised VLDL secretion rate attributed to increased intrahepatic TGs hydrolysis. They apparent the absence of immediate VLDL secretion reduction yet maintained a consistent apo B100 secretion rate, as informed by previous studies/
I would like to reframe this sentence: in the presence of elevated counter-regulatory hormones, lipolysis takes place in the adipose tissue releasing free fatty acids into circulation. Majority of these fatty acids are take up liver and converted into triglycerides. If VLDL secretion from liver is not proportionate to the level of fatty acid entry into liver, fatty acids may get accumulated in the liver causing different forms of fatty liver.
In individuals with insulin resistance and higher body weight, there is an elevation in apo C-III levels within VLDL.
Apo CIII is an inhibitor of lipoprotein lipase, thus inhibiting lipolysis of TGL in VLDL, thus increasing VLDL concentration in blood.
Insulin resistance and MetS
Insulin-hampered VLDL production, along with insulin resistance, leads to increased and decreased production of VLDL, often associated with hypertriglyceridemia
Does VLDL increase or decrease with insulin resistance
Hepatic VLDL production is decreased by glucagon
Mechanism behind this
Alterations of VLDL in various disorders have been explained well.
All the mechanistic pathways have been adequately addressed
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Bharadwaj A, Taneja M, Dubey S, Saxena A. Very low-density lipoprotein and the human health. World J Exp Med 2026; 16(1): 117024 [PMID: 41883448 DOI: 10.5493/wjem.v16.i1.117024]
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"This letter to the Editor notes the potential significance of clinical situation in patients who suffer from emphysematous pyelonephritis. This is very important. Clinical findings and symptoms must be the cornestone in these conditions in order to avoid the worse outcomes of patients.
In addition, the Modified National Early Warning Score 2 based on physiological situation of patient shoud be very helpfull, as well as computed tomography findings."
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Sevik C, Erbin A, Canat HL. Integrating Modified National Early Warning Score 2, computed tomography staging, and laboratory markers for enhanced prognostic stratification in emphysematous pyelonephritis. World J Nephrol 2026; 15(1): 113952 [PMID: 41884236 DOI: 10.5527/wjn.v15.i1.113952]
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40
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"This manuscript defined as Editorial is generally good, but it mildly offers new lights in concept of diabetic nephropathy complications and its progression in death.
Pathophysiology paragragh is better than the other parts of manuscript. Addiotionally, inequalities and differences between racial and ethic groups were noted, which is not usual in other published manuscripts."
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Gembillo G, Ricca MF, Santoro D. Diabetes-related renal complications: Insights on the impact of diabetic kidney disease on mortality. World J Nephrol 2026; 15(1): 108432 [PMID: 41884250 DOI: 10.5527/wjn.v15.i1.108432]
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"Reader’s code: 00106360
Commentary on the Article
Impact of metabolic dysfunction-associated steatotic liver disease on liver metastasis and survival in pancreatic cancer
The study by Chon HY et al. examines the impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on liver metastasis and survival in patients with Pancreatic Ductal Adenocarcinoma. Using a large retrospective cohort of 2123 patients, the authors assessed hepatic steatosis primarily through the hepatic steatosis index (HSI) and additionally validated findings using CT-based measurements of liver fat. The study found no significant association between MASLD and the presence of liver metastasis at diagnosis or during follow-up, suggesting that hepatic steatosis may not be a key determinant of metastatic spread in pancreatic cancer (Chon et al., 2026).
The findings contrast with previous research in other malignancies, such as colorectal and breast cancers, where hepatic steatosis has been reported to influence liver metastasis risk or metastasis-free survival (van Saane et al., 2019; Wu et al., 2020). In the present study, tumor size and elevated CA19-9 levels were the main predictors of liver metastasis, while diabetes mellitus was associated with improved survival outcomes, possibly reflecting earlier detection among diabetic patients (Chon et al., 2026).
Critical Appraisal of the Study
The study by Chon HY and colleagues evaluates the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and liver metastasis in patients with Pancreatic Ductal Adenocarcinoma. Using a large retrospective cohort of 2123 patients, the authors investigated whether hepatic steatosis, measured by the hepatic steatosis index (HSI), influences the development of liver metastasis and overall survival.
Strengths
One of the major strengths of this study is its large sample size and long study period (2006–2021), which enhances the statistical power and reliability of the findings. The authors used robust statistical methods, including logistic regression and Cox proportional hazards models, to analyze risk factors for both baseline and newly developed liver metastases. Another notable strength is the additional CT-based validation in a subgroup of patients, which helps corroborate the HSI-based assessment of hepatic steatosis. The study also carefully adjusted for multiple potential confounders such as age, BMI, diabetes, lipid profile, tumor size, and CA19-9 levels.
Limitations
Despite these strengths, several limitations should be considered. First, the retrospective design limits the ability to establish causal relationships. Second, the primary assessment of hepatic steatosis relied on the HSI, an indirect surrogate marker derived from BMI and liver enzyme ratios, which may be influenced by cancer-related factors such as cachexia, inflammation, or biliary obstruction. Third, important pathological variables (e.g., lymph node status, lymphovascular invasion, and perineural invasion) were not consistently available and therefore could not be included in the multivariate models. Additionally, the CT-based validation was limited to a subset of patients, which may introduce selection bias.
Clinical Implications
Clinically, the findings suggest that MASLD may not be a significant determinant of liver metastasis in pancreatic cancer, contrasting with observations in other malignancies. Instead, established markers such as tumor size and elevated CA19-9 levels appear to remain more reliable predictors of metastatic risk and mortality. These results highlight the aggressive biological behavior of pancreatic cancer, where tumor-driven mechanisms may outweigh the influence of underlying hepatic metabolic conditions. Future prospective studies incorporating advanced imaging, histologic confirmation, and molecular analysis of the tumor–liver microenvironment are needed to further clarify the role of MASLD in pancreatic cancer progression.
Despite its strengths, including a large sample size and robust statistical modeling, the retrospective design and reliance on HSI rather than histologic confirmation limit the ability to establish causality. Nevertheless, this study contributes important evidence suggesting that the relationship between MASLD and metastasis may be cancer-specific and biologically complex.
Reference
Chon HY, Rhee H, Kim J, et al. Impact of metabolic dysfunction-associated steatotic liver disease on liver metastasis and survival in pancreatic cancer. World Journal of Gastroenterology. 2026;32(11):115488.
van Saane AM, et al. Non-alcoholic fatty liver disease and colorectal liver metastasis risk. Liver International. 2019.
Wu W, et al. Hepatic steatosis and liver metastasis-free survival in breast cancer. Cancer Medicine. 2020.
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Chon HY, Rhee H, Kim J, Leem G, Jo JH, Chung MJ, Park JY, Bang S, Park SW, Kim SU, Lee HS. Impact of metabolic dysfunction-associated steatotic liver disease on liver metastasis and survival in pancreatic cancer. World J Gastroenterol 2026; 32(11): 115488 [DOI: 10.3748/wjg.v32.i11.115488]
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"Esophageal variceal bleeding is one of the most severe complications of cirrhotic portal hypertension, associated with high rates of rebleeding and mortality. Although endoscopic variceal band ligation (EVBL) is currently the standard treatment, its reliance on repeated endoscopic follow-up presents challenges, including invasiveness, high resource consumption, and poor patient tolerance.
This study focuses on the potential application of multiparametric ultrasound (MP-US) in predicting outcomes following EVBL, proposing a novel follow-up strategy that is noninvasive, individualized, and reproducible, with significant promise for clinical translation.
The article begins with the clinical burden of EVB, progressively introduces the limitations of current diagnostic and therapeutic approaches, and naturally transitions to the technical advantages and research evidence supporting MP-US, culminating in future research directions. The structure is well-organized, and the logic is rigorous. The critical analysis of existing technologies is insightful. The article objectively highlights the limitations of HVPG and repeated endoscopy, particularly their inaccessibility in resource-limited settings. It also provides a reasonable evaluation of the shortcomings of noninvasive tools such as the Baveno criteria and elastography in predicting postprocedural outcomes, reflecting the authors' deep understanding of clinical realities. The analysis of MP-US's clinical application is thorough. By integrating measurements of liver stiffness, spleen stiffness, and perfusion imaging, MP-US enables a comprehensive assessment of portal hypertension from both structural and hemodynamic perspectives, overcoming the limitations of traditional single-parameter prediction models. Citing data from Ainora et al, the study demonstrates the potential of MP-US in predicting variceal eradication and guiding individualized follow-up. The outlook on future research directions is instructive. The article notes that current studies are mostly small-sample, single-center designs lacking standardized operating and interpretation protocols, and calls for multicenter, prospective studies to validate the clinical value of MP-US—a recommendation with practical significance. Figure 1 is highly informative, clearly illustrating the evolutionary pathway from invasive to noninvasive diagnostic tools, facilitating readers' understanding of technological advancements.
Areas for improvement and suggestions: The issue of MP-US technical standardization requires further clarification. Although the article mentions that MP-US is influenced by factors such as operator experience and equipment variability, it does not delve deeply into how to achieve standardized operation and interpretation; future research should focus on this aspect. A cost-effectiveness analysis is lacking. While MP-US has the potential to reduce the frequency of endoscopic examinations, its high equipment costs and reliance on contrast agents may limit its widespread adoption in certain regions. Future studies should incorporate health economic evaluations. The integration of AI with MP-US warrants further exploration. The article mentions the application of AI in endoscopic measurement but does not explore the possibility of combining AI with MP-US. Future research could investigate AI-based automated analysis of MP-US images and risk prediction models.
This study, with its clear logic, solid literature support, and forward-looking perspective, systematically elaborates on the potential application of MP-US in post-EVBL follow-up. It not only provides clinicians with new diagnostic and therapeutic insights but also points future researchers toward promising directions. If further advancements are made in MP-US standardization, multicenter validation, and AI integration, it holds the potential to achieve truly noninvasive, precise, and individualized management of portal hypertension in patients with cirrhosis."
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Martínez-Díaz FM, Jiménez-Cuevas EA, Morales-Galicia AE, Ramírez-Mejía MM, Qi XS, Poo JL, Méndez-Sánchez N. Toward noninvasive prediction of treatment outcomes in patients with variceal bleeding. World J Gastroenterol 2026; 32(11): 115723 [DOI: 10.3748/wjg.v32.i11.115723]
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"This systematic review of 8 randomized trials (1758 participants) rigorously evaluates adjunctive pharmacotherapies for diuretic resistance in acute decompensated heart failure (ADHF), adhering to PRISMA guidelines and using Cochrane’s RoB 2.0 for bias assessment. Key findings show proximal nephron-targeted agents (acetazolamide, SGLT2 inhibitors) and distal thiazide diuretics effectively boost decongestion: acetazolamide raises successful decongestion rates (42.2% vs 30.5%), SGLT2 inhibitors enhance urine output and reduce worsening HF, while thiazides prompt greater weight loss but increase renal dysfunction risk. Notably, older agents (high-dose spironolactone, low-dose dopamine/nesiritide) yield no meaningful clinical benefits. The review’s strength lies in its exclusive focus on randomized trials, but heterogeneity in endpoints and short follow-up limit generalizability. It provides a mechanistically guided, stepwise clinical framework for ADHF management, emphasizing personalized adjunct selection, and identifies the need for large head-to-head trials and long-term outcome research to address existing evidence gaps."
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Patel V, Zameer R, Kumar B, Das M. Adjunctive pharmacologic therapies for diuretic resistance in acute decompensated heart failure: Systematic review of randomized trials. World J Meta-Anal 2026; 14(1): 118496 [DOI: 10.13105/wjma.v14.i1.118496]
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"The article raises critical issues regarding healthcare expenditure and the anesthesiologist’s responsibility in cost containment. While the narrative is informative, a more quantitative economic comparison and inclusion of updated guidelines or contemporary practice data would strengthen the conclusions. Additionally, deeper exploration of medico-legal concerns and institutional resistance could enhance its practical impact. Nevertheless, the review addresses a clinically meaningful topic."
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Karim HMR. Healthcare delivery cost and anesthesiologists: Time to have a greater role and responsibility. World J Anesthesiol 2019; 8(3): 19-24 [DOI: 10.5313/wja.v8.i3.19]
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"
I read with great interest the study by Khalifa et al. published in the World Journal of Orthopedics, evaluating the impact of surgeon handedness on radiological and functional outcomes following primary total knee arthroplasty (TKA). The authors should be commended for addressing an underexplored yet clinically relevant surgeon-related variable in arthroplasty practice.
The finding that overall limb alignment and functional outcomes were not significantly influenced by operating on the dominant versus non-dominant side is reassuring. However, the increased incidence of tibial component malalignment (MPTA outliers) on the non-dominant side highlights an important technical nuance that may have implications for implant longevity, particularly in mechanically aligned TKA performed with conventional instrumentation.
The subgroup analysis comparing intramedullary and extramedullary tibial guides is particularly interesting, suggesting that technique selection may interact with laterality. These findings underscore the potential value of ergonomic optimization and heightened intraoperative vigilance when operating on the non-dominant side.
Future prospective studies incorporating sagittal and rotational alignment parameters, inclusion of left-handed surgeons, and long-term survivorship data would further clarify the clinical significance of these observations. Additionally, evaluating whether navigation or robotic assistance mitigates the subtle asymmetries associated with surgeon handedness could provide valuable insights.
Overall, this study contributes meaningfully to the ongoing discussion regarding modifiable surgeon-related factors influencing TKA precision and outcomes."
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Khalifa AA, Abdelaal AM, Moustafa MM. Does surgeon handedness affect the outcomes after primary total knee arthroplasty? A retrospective cohort study. World J Orthop 2026; 17(2): 113696 [PMID: 41695728 DOI: 10.5312/wjo.v17.i2.113696]
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"I would like to congratulate the authors on this clinically relevant study. The authors provided a conclusion that differs from previously published results. ETV is generally considered renal-neutral and is commonly used in DCLD due to its renal safety. The statement that ETV is associated with a greater decrease in GFR than TMV is overfitting, as it is a retrospective study. The Difference in decline of approximately 4 mL/min/1.73 m² is very small and may not be clinically meaningful in patients with normal GFR, even though it is statistically significant. The conclusion should be interpreted with caution and requires additional long-term prospective studies to substantiate this claim. Furthermore, the authors did not report any additional adverse events during the study period. "
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Ma SP, Wang L, Zhang YL, Wan X, Liu Q, Tang YL, Malhi LR, Ge SF. Effects of tenofovir amibufenamide and entecavir on estimated glomerular filtration rate in treatment-naïve patients with chronic hepatitis B. World J Hepatol 2026; 18(2): 114346 [PMID: 41809484 DOI: 10.4254/wjh.v18.i2.114346]
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"I congratulate the authors on this relevant study on this study. As the authors pointed out, Klebsiella is the leading cause of liver abscesses in Asia and is increasingly prevalent in India. It is important to have culture reports at various time points, as they will help us in deciding empirical antibiotics. The authors have shown that the isolated organisms are highly resistant to ampicillin and have low resistance to cephalosporins and carbapenems. With this large amount of data, the authors would have identified the poor prognostic predictors of PLA and treatment outcome. The authors did not present the data on complications of these abscess such as biliary fistula "
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Mai-Phan TA, Thai KP, Le KL, Pham TN, Tran MQ, Pham PC, Duong NNQ, Trinh MT, Le NK. Klebsiella pneumoniae as leading cause of pyogenic liver abscess: Three years study in Southern Vietnam. World J Hepatol 2026; 18(2): 113695 [PMID: 41809471 DOI: 10.4254/wjh.v18.i2.113695]
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"Wang and Pan present an editorial that meaningfully extends the discussion of ERAS in elderly gastric cancer patients beyond feasibility toward biologically grounded recovery. Building on prior evidence by Li et al. demonstrating the safety and protocol adherence of ERAS in older adults. The authors appropriately emphasize physiological heterogeneity, frailty, and resilience as key determinants of postoperative outcomes rather than chronological age alone.
The proposed multidomain framework integrating nutritional inflammatory balance, circadian regulation, psychological resilience, and digital monitoring, offers an important conceptual advance. However, many of these strategies rely on resource intensive multidisciplinary teams, biomarker surveillance, and wearable technologies, which may limit generalizability outside high-volume or well-resourced centers.
Future efforts may benefit from parallel development of simplified, scalable ERAS adaptations for elderly patients. Overall, this editorial provides a valuable roadmap for evolving ERAS from protocol compliance toward patient-centered, biologically informed recovery in an aging surgical population."
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Wang G, Pan SJ. From feasibility to biological recovery: Reframing enhanced recovery pathways after surgery in elderly gastric cancer patients. World J Gastroenterol 2026; 32(7): 116264 [PMID: 41694491 DOI: 10.3748/wjg.v32.i7.116264]
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"This Editorial thoroughly explores the field of AI use in diagnostic radiology.
It provides a complete overview of the potential and the current applications of AI in the field with great potential, strong diagnostic performance but in my opinion it does spotlight with the due consideration the potential drawbacks coming from the extensive use of AI in the clinical field.
The enthusiasm generated from the high precision and performance and the consequent advantages in terms of resource and time save for operators outpaced evaluation of broader consequences. Concerns include trainee deskilling, automation bias, unclear medicolegal accountability, and inequitable access due to infrastructure demands. The authors emphasize that technical accuracy alone is insufficient and call for longitudinal studies, training models that preserve independent reasoning, and deployment strategies that address equity. Without systematic assessment of professional, clinical, and societal impacts, AI adoption risks being driven by non-evidence-based factors."
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He ZX, Wang J, Yang JS. Expanding the applications of artificial intelligence in emergency radiology: Advancing precision medicine and resource efficiency. World J Radiol 2026; 18(1): 117814 [PMID: 41640709 DOI: 10.4329/wjr.v18.i1.117814]
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"This study demonstrates that presenilin-1 (PS-1) is significantly associated with β-catenin activation, PTEN phosphorylation, advanced tumor stage, and poor survival in gastric cancer. The combination of clinical data and functional assays strengthens the evidence for the PS-1/β-catenin/p-PTEN axis in promoting invasion and metastasis. These findings highlight a potential therapeutic target for gastric cancer treatment."
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Lin X, Lin GF, Gu FT, Li YL. Increasing expression of presenilin 1, β-catenin, and p-PTEN and its regulatory roles on cell invasion in gastric cancer. World J Gastrointest Oncol 2026; 18(2): 115689 [PMID: 41695939 DOI: 10.4251/wjgo.v18.i2.115689]
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