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"This paper uses network pharmacology to explore the molecular mechanisms underlying the therapeutic effects of the Jianpi Huatan Quyu recipe on chronic heart failure with spleen Qi deficiency syndrome. However, there are several shortcomings. Firstly, the background is unclear; the chosen prescription is not a common treatment for heart failure, and the rationale for selecting this recipe is not explained. Additionally, the methods section is overly simplistic, lacking detailed descriptions of procedures and experimental conditions. Although the paper predicts multiple potential active ingredients and targets through network pharmacology, it lacks experimental validation, compromising the reliability and applicability of the conclusions. The results section misses further necessary analyses, such as core cluster analysis post-PPI and molecular docking following target identification. The discussion is not detailed, failing to connect the findings to clinical practice or previous research comprehensively. The authors rely on previous studies to support their findings, but the number of citations is insufficient, and the discussion lacks depth. Overall, the study suggests that the selected prescription may act on certain pathways to treat heart failure, but this is insufficient to provide robust clinical evidence. Further experimental validation and detailed analysis are needed to enhance the scientific rigor and practical relevance of the research."
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Li SQ, Min DY, Jiang JW, Li XY, Yang XN, Gu WB, Jiang JH, Chen LH, Nan H, Chen ZY. Network pharmacology-based exploration of molecular mechanisms underlying therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure with spleen Qi deficiency syndrome. World J Cardiol 2024; 16(7): 422-435 [DOI: 10.4330/wjc.v16.i7.422]
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"Enhancing Participation Rates: The Necessity of Optimizing Colorectal Cancer Screening Strategies
Introduction
Magie Tamraz et al.'s article in the World Journal of Gastroenterology delves into the critical issue of optimizing colorectal cancer (CRC) screening strategies. Despite the proven mortality benefits of screening, adherence to CRC screening guidelines remains low in many regions worldwide. This comment highlights the key points of the article and its significant contributions to CRC screening strategies.
Identifying High-Risk Groups
The article emphasizes the importance of identifying high-risk groups for screening, given the limited financial and human resources. This perspective is highly pragmatic as nationwide screening is not feasible in many countries. By focusing on screening high-risk individuals, resources can be utilized more effectively to minimize the burden of CRC.
Considering Population Variations
Implementing screening procedures requires consideration of variations within each population. This argument underscores the necessity of avoiding a "one-size-fits-all" approach in developing and implementing screening strategies. Each population has specific barriers and challenges, and addressing these is crucial for improving screening adherence. The authors suggest tackling these barriers in a targeted manner to enhance overall screening effectiveness.
Encouraging Patients with Comorbidities to Undergo Screening
The article points out that patients with comorbidities who regularly visit the hospital are often diagnosed with CRC at an early stage, similar to those undergoing periodic screening. This finding highlights the importance of encouraging patients with comorbidities who do not attend routine visits to undergo screening. This recommendation is significant for reducing the burden of late-stage CRC diagnosis, emphasizing the critical role of regular screening in early cancer detection.
Conclusion
Tamraz et al.'s article provides valuable insights into optimizing CRC screening strategies. Identifying high-risk individuals, considering population variations, and encouraging patients with comorbidities to undergo screening are key steps in improving screening adherence and reducing the burden of CRC. Implementing these optimized strategies can significantly enhance the efficiency and effectiveness of CRC screening, ultimately improving overall patient outcomes."
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Tamraz M, Al Ghossaini N, Temraz S. Optimization of colorectal cancer screening strategies: New insights. World J Gastroenterol 2024; 30(28): 3361-3366 [DOI: 10.3748/wjg.v30.i28.3361]
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"Managing PFCD requires a comprehensive, multidisciplinary approach. While conventional therapies have limitations, emerging treatments, particularly MSC therapy, offer hope for improved outcomes. Establishing effective surveillance programmes for anal cancer in perianal CD patients is crucial for early detection and better prognosis. Future research should focus on optimizing treatment protocols and validating new therapeutic strategies."
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Pacheco T, Monteiro S, Barros L, Silva J. Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer. World J Gastroenterol 2024; 30(28): 3373-3385 [DOI: 10.3748/wjg.v30.i28.3373]
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"The editorial is valuable by the conclusion that made, although CRC screening is a highly recommended strategy to detect the disease in its initial stages in individuals without signs or symptoms, this strategy is underused by the Japanese population, particularly for those who appear healthy, and generally do not use the available health services.
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Pérez-Holanda S. Non-participation of asymptomatic candidates in screening protocols reduces early diagnosis and worsens prognosis of colorectal cancer. World J Gastroenterol 2024; 30(26): 3198-3200 [DOI: 10.3748/wjg.v30.i26.3198]
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"The editorial comment on the multifaceted problem that includes not only HBV reactivation, but also participation of the virus in pathogenesis of autoimmune disorders and cancer.
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Morozov S, Batskikh S. Reactivation of hepatitis B virus infection – an important aspect of multifaceted problem. World J Gastroenterol 2024; 30(26): 3193-3197 [DOI: 10.3748/wjg.v30.i26.3193]
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"The editorial is highly relevant to gather and comprehensively present a summary of digesting gluten with oral endopeptidases to improve the management of celiac disease.
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Durham K, Ince MN. Digesting gluten with oral endopeptidases to improve the management of celiac disease. World J Gastroenterol 2024; 30(26): 3201-3205 [DOI: 10.3748/wjg.v30.i26.3201]
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" After the development of “NOTES” technology many years ago, there has been a significant boost in the improvement and development of technology for closing gastric and colonic iatrogenic perforations. The authors of the editorial provide sufficient and extensive commentary on this topic. I have also read the original article by Wang et al., which I believe helps endoscopists manage the safe closure of gastric wall defects after full-thickness resection of SELs.
However, the comments in the editorial do not fully achieve this. In fact, I miss editorial comments comparing the Double-nylon purse-string suture technique with more sophisticated and challenging methods such as through-the-scope suturing (TTSS) and OTSC, which are difficult to implement and learn and are scarce in many endoscopy units. Additionally, the editorial does not discuss the applicability and ease of implementation of these techniques in the typical workflow of an endoscopy unit in clinical practice, nor do they address the potential for their use in other areas, such as the rectum, colon, and duodenum.
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Walia A, Trasolini RP, Shahidi N. Double-nylon purse-string suture technique: Another addition to the endoscopist's toolbox for full-thickness defect closure. World J Gastroenterol 2024; 30(25): 3152-3154 [PMID: 39006385 DOI: 10.3748/wjg.v30.i25.3152]
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"The manuscript by Xie et al. presented a standard genetic analysis of a case with juvenile hemochromatosis caused by pathogenic variants in hemojuvelin (HJV). The author provided a detailed description of clinical phenotypes and genetic variations, and summarized the previously published literature. However, authors shoule better discuss the relationship between HJV mutant and liver fibrosis, diabetes, hypogonadotropic hypogonadism, hypophysis hypothyroidism, and skin hyperpigmentation. After all, these symptoms appeared in the same patient with a mutation in the HJV gene. Do the authors feel these symptoms may be part of the HJV-related phenotype or is it just a coincidence?
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Xie LD, Kong XM, Shen JX, Wang TL, Ma J, Zhang YF, Chen XP. Novel compound heterozygous mutations in the hemojuvelin gene in a juvenile hemochromatosis patient: A case report. World J Clin Cases 2024; 12(19): 3961-3970 [PMID: 38994316 DOI: 10.12998/wjcc.v12.i19.3961]
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"Congratulations to the authors for their significant contribution in developing a comprehensive algorithm for managing post-POEM (per-oral endoscopic myotomy) gastroesophageal reflux (GER). This article is highly important as it provides a detailed and structured approach for diagnosing and treating post-POEM GER. The identification of various predictive factors for GER after POEM highlights the complexity of the procedure and suggests that personalized approaches based on these factors could be crucial in minimizing complications and improving patient outcomes. This underscores the importance of ongoing research and tailored surgical techniques in enhancing the effectiveness of POEM. Nevertheless, one critique is that the article mainly depends on data from small-scale studies and single-center experiences, which might limit the broader applicability of the findings and recommendations. Future research should focus on larger, multicenter trials to validate the proposed algorithm, refine endoscopic techniques like POEM with fundoplication, and address technical challenges to ensure better clinical practice and patient care."
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Tawheed A, Bahcecioglu IH, Yalniz M, El-Kassas M. Gastroesophageal reflux after per-oral endoscopic myotomy: Management literature. World J Gastroenterol 2024; 30(23): 2947-2953 [PMID: 38946871 DOI: 10.3748/wjg.v30.i23.2947]
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"Clear cell sarcoma of the pancreas, whether primary or metastatic, represents a rare and challenging subset of cancers. Primary pancreatic sarcomas, such as clear cell sarcoma, are notably uncommon compared to the predominant epithelial adenocarcinomas and neurogenic malignancies of the pancreas. They require careful differentiation from gastrointestinal and retroperitoneal sarcomas that may involve the pancreas secondarily.
The incidence of clear cell sarcoma across various databases ranges from 0.01 to 0.29 cases per 100,000 individuals annually, underscoring its rarity. This rarity poses diagnostic and therapeutic dilemmas, necessitating a nuanced approach in clinical practice.
Metastatic clear cell sarcoma of the pancreas, originating typically from distant sites like soft tissues or bones, further complicates management strategies. Treatment involves tailored systemic therapies aimed at the tumor's molecular profile, reflecting advancements in precision medicine.
In conclusion, clear cell sarcoma of the pancreas exemplifies a rare cancer phenotype, demanding heightened awareness among clinicians and researchers. Enhanced understanding of its distinctive characteristics is pivotal for accurate diagnosis and effective treatment strategies, ensuring optimal patient outcomes in this challenging oncological landscape."
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Cheng CY, Hao WR, Cheng TH. Unveiling significant risk factors for intensive care unit-acquired weakness: Advancing preventive care. World J Clin Cases 2024; 12(18): 3288-3290 [PMID: 38983419 DOI: 10.12998/wjcc.v12.i18.3288]
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"A well written short description of pancreatic inflammation and it's relationship to malignancy. "
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Vescio F, Ammendola M, Currò G, Curcio S. Relationship between mast cell, angiogenesis and pancreatic cancer: Our experience. World J Gastroenterol 2024; 30(23): 2927-2930 [PMID: 38946872 DOI: 10.3748/wjg.v30.i23.2927]
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"Letter to the editor regarding ‘Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma’
Chengzhi Bai1,2 Xiaoping Wang3, Shanhong Tang1*
1.Department of Gastroenterology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China 610083
2. Southwest Jiaotong University School of Medicine, Chengdu, China 610031
3. Suining Central Hospital, Suining, China 629000
* Correspondence: this work should be addressed to Shanhong Tang;
Dear Editor：
We read with interest the recent article by He and his team: Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma. The authors found that total tumor diameter (TTD, vascular invasion (VI), AFP and cytokeratin-18 epitopes M30 (CK18-M30) are important factors affecting the outcome of liver cancer patients after liver transplantation, and constructed corresponding nomogram prediction models, and verified the effectiveness of their models through calibration curves and decision curves [1]. We support and appreciate the authors' work and agree with their conclusions, but have some questions about some of the details in the article.
Firstly, all indexes are converted into binary variables, but the critical value of each variable is not explained. In addition, categorizing continuous variables can lead to less efficient and less reliable models [2]. Therefore, we believe that continuous variable data should be included in the analysis and the model should be built. The first is that it may improve the predictive effectiveness and reliability of the model, and the second is that it can provide more in-depth analysis of the critical values and changes of the indicators.
Secondly, AFP is a marker of liver cancer, but it also has great significance in the normal liver regeneration process. Previous studies by our team have confirmed that patients with higher AFP levels after artificial liver transplantation have a better prognosis, and AFP is also of high clinical value in predicting the prognosis of liver failure [3-4]. In this study, AFP is analyzed as a binary variable, and the potential value of this index is not deeply explored. Therefore, we suggest that it can be further analyzed as a continuity variable.
Finally, the study only included tumor markers and related indicators as factors for analysis. In fact, common clinical indicators also have high predictive value in analyzing its prognosis. Multidimensional evaluation of the prognosis after liver transplantation can predict the outcome more comprehensively. For example, the nutritional status of prealbumin and albumin is reflected, the compensatory capacity of the liver is reflected by liver function indexes such as bilirubin [5-6]. In addition, there are many differences between liver cancer patients in China and those in other countries, such as hepatitis B, which is common in liver disease patients in China. Therefore, consideration of the etiology of liver cancer should also be included in the prognostic risk analysis of liver transplantation [7]. We believe that the research can also add the above indicators to analyze and build a model to make the model more complete and reliable.
In conclusion, we believe that the study needs to address these issues to make the results more reliable.
References:
[1] He, L, Ji, W, Jin, H, et al. Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma WORLD J GASTROENTERO. 2024; 30 (21): 2763-2776. doi: 10.3748/wjg.v30.i21.2763.
[2] Schellingerhout, JM, Heymans, MW, de Vet, HC, et al. Categorizing continuous variables resulted in different predictors in a prognostic model for nonspecific neck pain. J CLIN EPIDEMIOL. 2009; 62 J CLIN EPIDEMIOL. doi: 10.1016/j.jclinepi.2008.10.010
[3] Wang, X, Shen, C, Yang, J, et al. Alpha-Fetoprotein as a Predictive Marker for Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure. CAN J GASTROENTEROL. 2018; 2018 1232785. doi: 10.1155/2018/1232785
[4] Wang, X, Shen, C, Yang, J, et al. Alpha-Fetoprotein as a Predictive Marker for Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure. CAN J GASTROENTEROL. 2018; 2018 1232785. doi: 10.1155/2018/1232785
[5] Li, J, Du, M, Li, H, et al. Low Prealbumin Levels Were Associated with Increased Frequency of Hepatic Encephalopathy in Hepatitis B Virus (HBV)-Related Decompensated Cirrhosis. Med Sci Monit. 2023; 29 e937772. doi: 10.12659/MSM.937772
[6] Cui, S, Cao, S, Chen, Q, et al. Preoperative systemic inflammatory response index predicts the prognosis of patients with hepatocellular carcinoma after liver transplantation. Front Immunol. 2023; 14 1118053. doi: 10.3389/fimmu.2023.1118053
[7] Li, X, Zhang, L, Pu, C, et al. Liver transplantation in Acute-on-Chronic liver failure: Timing of transplantation and selection of patient population. Front Med (Lausanne). 2022; 9 Front Med (Lausanne). doi: 10.3389/fmed.2022.1030336"
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He L, Ji WS, Jin HL, Lu WJ, Zhang YY, Wang HG, Liu YY, Qiu S, Xu M, Lei ZP, Zheng Q, Yang XL, Zhang Q. Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma. World J Gastroenterol 2024; 30(21): 2763-2776 [PMID: 38899335 DOI: 10.3748/wjg.v30.i21.2763]
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"The article caught my attention as it discusses the global healthcare burden of PUB, contributing to morbidity and mortality. This study sheds light on PUB within a Pakistani context, emphasizing regional factors and healthcare practices. It analyzed data from 142 patients with peptic ulcer bleeding, focusing on demographics, symptoms, hospital stay duration, mortality, re-bleeding rates, and Forrest classification. The findings suggest a correlation between antiplatelet use and increased early mortality, and a link between alternative medicines and early re-bleeding.
It appears contradictory that although alternative medicines are tied to early re-bleeding, and re-bleeding within 24 hours and 7 days is strongly linked to mortality after a week or a month, the study concludes that antiplatelet use correlates with higher mortality at 7 and 30 days.
Weak points to consider:
- Sample Size: The limited sample size constrains the study's power and its generalizability to a broader population.
- Single-Center Design: The study's single-center nature may not capture the varied experiences of other regions or healthcare environments.
- Lack of Detailed Medication Data: The lack of detailed information on patient medications hampers a more accurate assessment of their impact on outcomes.
Strong points of the study:
- Comprehensive Analysis: The study offers an in-depth analysis of the risk factors and outcomes of peptic ulcer bleeding in a Pakistani cohort, beneficial for local healthcare practices.
- Clinical Relevance: It examines clinically significant factors like antiplatelet use and comorbid conditions, providing valuable insights for healthcare decisions.
- Acknowledgment of Limitations: The authors acknowledge the study's limitations, including its small sample size and single-center approach, which could influence its generalizability."
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Butt N, Usmani MT, Mehak N, Mughal S, Qazi-Arisar FA, Mohiuddin G, Khan G. Risk factors and outcomes of peptic ulcer bleed in a Pakistani population: A single-center observational study. World J Gastrointest Pharmacol Ther 2024; 15(3): 92305 [PMID: 38846968 DOI: 10.4292/wjgpt.v15.i3.92305]
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"Although the subject is very interesting, the manuscript requires improvement.
English must be improved. "Pancreatic cancer continuous to be a dismal disease. " ???? No statistics showed. How many patients die because of pancreatic cancer? When is it mostly detected? Which symptoms are then observed? I would not cite other authors in the Introduction - it must be moved to another chapter. What chapter is after Introduction???? Last sentence in abstract - what is PADC ?
Only 25% of references is from last 5 years. Not enough.
Discussion - ........ requires improvement.
ERCP is not described what it is.
Morera-Ocon FJ. Early detection of pancreatic cancer. World J Clin Cases 2024; 12(17): 2935-2938 [DOI: 10.12998/wjcc.v12.i17.2935]"
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Morera-Ocon FJ. Early detection of pancreatic cancer. World J Clin Cases 2024; 12(17): 2935-2938 [PMID: 38898835 DOI: 10.12998/wjcc.v12.i17.2935]
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"The discussion in this paper is fascinating. However, the paper lacks detailed and specific data to support relevant discussions."
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Riccioni ME, Marmo C. Outpatient management of obscure gastrointestinal bleeding: A new perspective in high-risk patients. World J Gastroenterol 2024; 30(19): 2502-2504 [PMID: 38817662 DOI: 10.3748/wjg.v30.i19.2502]
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"Bone regeneration is a complex process requiring precise coordination of various cellular activities, including inflammation regulation, angiogenesis, and osteogenesis. Zhang et al.’s innovative approach utilizing BMSC-exos embedded in hydrogels addresses the critical need for effective bone repair strategies, particularly in the context of large bone defects, which are notoriously challenging for orthopedic surgeons to manage [1].
Study Highlights
The authors successfully fabricated a multifunctional hydrogel system capable of delivering BMSC-exos to the site of injury. This system demonstrated a robust capacity to modulate macrophage polarization towards an anti-inflammatory M2 phenotype, thereby creating a conducive environment for bone healing. Additionally, the incorporation of BMSC-exos significantly enhanced both angiogenesis and osteogenic differentiation in vitro, demonstrating the dual-role capability of BMSC-exos in directing cell fate. This was evidenced by increased migration and expression of both angiogenic and osteogenic markers in mouse osteoblast progenitor cells (mOPCSs). The hydrogel’s effectiveness was further validated in a murine fracture model, where it promoted significant bone regeneration and functional vascularization, underscoring its potential for clinical application.
Value and Limitations
In Figures 4E, 4F, and Figures 5G, 5H, showing that hydrogel + BMSC-exo promoted both osteogenesis and angiogenesis in mOPCSs, present intriguing findings that merit further research into the cellular fate transitions. Exosomes have been shown to play a dual role in promoting various differentiation pathways. For instance, exosomes derived from neural stem cells have been reported to regulate the differentiation of recipient neural stem cells into both neurons and glial cells, highlighting their versatility in neurogenesis [2, 3]. Similarly, tumor-associated macrophage-derived exosomes have been found to influence tumor progression by promoting both angiogenesis and immune cell modulation[4]. Exosomes from bone marrow stromal cells enhanced both osteogenic differentiation and angiogenesis in vitro and in vivo via releasing exosomal miR-1260a [5]. These evidence underscores the multifaceted roles of exosomes in cellular differentiation and intercellular communication, where the ability to direct multiple differentiation pathways can be particularly advantageous.
While the study provides evidence for the efficacy of BMSC-exo hydrogels in bone regeneration, it also highlights several areas for further investigation:
First, the lack of detailed descriptions for many experiments makes it challenging to replicate these studies. The authors mentioned, “For Transwell assays, after transfection and treatment with high glucose, mOPCSs with different treatments were seeded into the upper chamber of 12-well Transwell plates (2.5 × 10^3 cells/well).” It is unclear why the mOPCSs were transfected and treated with high glucose. The migration settings, including the dose of exosomes, location (upper chamber/lower chamber), and timing, should be described clearly. In the angiogenesis assay, the authors cultured mOPCSs cell-loaded hydrogel for 14 days, which is relatively long. It would be beneficial to assess cell viability after this period. Additionally, the purpose of setting up mOPCSs cell-loaded hydrogel needs clarification, especially as the study aims to demonstrate the osteogenic effects of hydrogel+BMSC-exo. The process of adding BMSC-exo during this experiment should be explicitly stated. The statement “When co-cultured with HUVECs, mOPCSs incubated on hydrogel + BMSC-exo exhibited enhanced proliferation and tube formation (Figure 5C and D)” lacks details. It is necessary to specify how the co-culture was performed and whether HUVECs or mOPCSs formed the tubes. The difference between Figure 4B and Figure 5E is unclear. The protein expression detection in Figure 6F should include details on the detection method and the tissue type analyzed.
In Supplementary Figure 1, the authors claim that the hydrogel exerted no side effects on biological processes, including osteogenesis, chondrogenesis, or adipogenesis. However, the experiment lacks details such as the dose of hydrogel added and the inclusion of control groups. Including different hydrogel doses and their effects on cell viability and proliferation would strengthen the findings. The authors mentioned, “the vital organs of mice were also not influenced by hydrogel treatment.” This experiment lacks details on how the hydrogel was administered and the time points for examination.
Most importantly, the selection of control groups does not adequately highlight the benefits of hydrogel+BMSC-exo compared to BMSC-exo alone. In Figure 4, the authors showed that hydrogel+BMSC-exo enhanced cell proliferation, migration, and osteogenesis compared to hydrogel alone. However, a BMSC-exo control group should be included to demonstrate the synergistic effects of hydrogel+BMSC-exo. Similar considerations apply to Figures 5 and 6.
The in vivo experiments did not evaluate the inflammation status, which is crucial for understanding the complete impact of the hydrogel+BMSC-exo treatment on the bone healing process.
There are minor typographical errors, such as in Figure 1E, where “PKH-26” should be used.
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Zhang S, Lu C, Zheng S, Hong G. Hydrogel loaded with bone marrow stromal cell-derived exosomes promotes bone regeneration by inhibiting inflammatory responses and angiogenesis. World J Stem Cells 2024; 16(5): 499-511 [PMID: 38817325 DOI: 10.4252/wjsc.v16.i5.499]
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"I read with great interest this article. It is a well-written interesting paper on endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction. It is of great importance particularly in those with intraperitoneal carcinomatosis for palliation of otherwise condemned patients. I express my satisfaction and congratulations to the authors for their nice work."
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Rosario-Morel MM, Soto-Solis R, Picazo-Ferrera K, Torres-Ruiz MI, Estradas-Trujillo JA, Gallardo-Ramírez MA, Darwich-del Moral GA, Waller-González LA. Endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction in Mexico. World J Surg Proced 2024; 14(3): 15-20 [DOI: 10.5412/wjsp.v14.i3.15]
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"The present study is of greater significance as it incorporates clinicopathological data from 200 colon cancer patients, conducts an analysis of factors influencing their survival, and constructs a prediction model to guide and predict T4N0M0 prognosis. However, there are certain limitations to this study. The prediction model derived from this study is specific to colon cancer patients with T4N0M0 and cannot be extrapolated to those in other stages of the disease. Additionally, being a single-center study, further validation through feasible multi-center research is necessary to verify the applicability of this prediction model.
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Liu B, Zhang ZX, Nie XY, Sun WL, Yan YJ, Fu WH. Clinical outcome and prognostic factors of T4N0M0 colon cancer after R0 resection: A retrospective study. World J Gastrointest Oncol 2024; 16(5): 1869-1877 [PMID: 38764842 DOI: 10.4251/wjgo.v16.i5.1869]
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"Dear Sirs, Thank you for the invitation to comment on the articles published in the World Journal of Gastroenterology as a reader (Reader ID: 02531272), from the reader's perspective
Article: Drug-induced mucosal alterations observed during esophagogastroduodenoscopy
The authors of this article presented Drug-induced mucosal alterations observed during esophagogastroduodenoscopy in an extraordinary way, with a methodologically and statistically very acceptable choice of articles used in the content of this work, a clear and high-quality description of pathophysiological changes, clinical picture and endoscopic findings of certain diseases of the gastrointestinal tract caused by long-term use of certain drugs in immediate practice.
The so far little-known endoscopic changes in the use of Olmesartan, lanthanum carbonate, zinc acetate hydrate, and changes in the use of PPI drugs are particularly noteworthy.
Endoscopic images are carefully selected and clearly show pathological changes for each of the individual diseases caused by drugs, which is of particular importance.
In total, the article is of such professional and scientific quality that it is of great interest for the acquisition of new knowledge about gastrointestinal changes caused by drugs, starting from family medicine specialists, internists, gastroenterologists and endoscopists and other doctors who deal with this issue.
Yours sincerely
Prof. Ph. D. Barbara Ebling, M.D.
Specialist in internal medicine
Subspecialist pulmonologist
Faculty of Dental Medicine and Health, University of Osijek Croatia
Osijek, May 4, 2024.
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Cui N, Dai T, Liu Y, Wang YY, Lin JY, Zheng QF, Zhu DD, Zhu XW. Laryngopharyngeal reflux disease: Updated examination of mechanisms, pathophysiology, treatment, and association with gastroesophageal reflux disease. World J Gastroenterol 2024; 30(16): 2209-2219 [PMID: 38690022 DOI: 10.3748/wjg.v30.i16.2209]
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"Introduction
Mesenchymal stem cells (MSCs) are among the most extensively utilized cell types in clinical settings due to their potent capabilities in self-renewal, multipotency, and immunomodulation. However, extensive evidence indicates that MSCs experience phenotypic aging with increased passage number, characterized by declines in proliferative, immunoregulatory, paracrine, and antioxidative stress capacities [1]. This aging process presents a critical bottleneck that limits the clinical utility and effectiveness of MSCs [2]. Understanding and mitigating the effects of senescence in MSCs are crucial for enhancing their therapeutic potential and ensuring sustained efficacy in regenerative medicine. We read with great interest the article by Almahasneh et al. published in World J Stem Cells, 2024 April 26; 16(4): 434-443, detailing the influence of high glucose and severe hypoxia on MSCs across different passages [3]. This article provides significant value to the field of regenerative medicine by exploring the effects of high glucose and severe hypoxia on MSCs at various passages. One of the key strengths of this study is its comprehensive analysis of the cellular responses to environmental stressors, providing insights that challenge conventional practices favoring the use of lower passage MSCs. By demonstrating the resilience and adaptability of higher passage MSCs under stress, the research opens new avenues for the practical application of these cells in therapeutic settings, especially under conditions mimicking diabetic or ischemic environments.
THE VALUE AND THE LIMITATION OF THE ARTICLE
While the study outlines the resilience of higher passage MSCs in stressful conditions, which challenges the prevalent clinical practice of using lower passage cells, we believe the discussion could further benefit from emphasizing the role of the cellular microenvironment in the therapeutic utility of MSCs. It is increasingly evident that the microenvironment, not just passage number, critically dictates MSC functionality and survival post-transplantation. Therefore, integrating microenvironmental modulation strategies could potentially enhance the practical utility of MSCs in regenerative medicine.
The study also presents certain limitations that warrant consideration for future research:
The article predominantly discusses shallow, phenomenological data. They discussed that the specific pathways involved in stress responses, such as the Akt/mTOR and p53 signaling pathways, invites further exploration into how these pathways might be strategically targeted to optimize MSC therapy. Targeting these pathways could help maintain or even enhance the regenerative capabilities of MSCs under stress conditions, such as those mimicked in their study.
The study utilizes commercially purchased hADSCs from Lonza and bases its data on a single cell line, which may not represent a broader cell type, thus limiting the generalizability of the findings. Additionally, the authors did not provide specific details about the cell line used, such as the age or sex of the donor, which are significantly linked to the cellular state. For instance, it has been reported that MSCs derived from elderly individuals may exhibit senescent phenotypes as early as passage three [4], highlighting the importance of this information in evaluating cell behavior and functionality.
The focus on apoptosis and senescence, while important, overlooks other critical aspects such as the differentiation potential and paracrine effects of MSCs under stress conditions.
Additionally, the research primarily relies on in vitro experiments, which may not fully replicate the complex interactions and responses occurring in vivo. This gap highlights the need for further studies incorporating in vivo models to validate the translational relevance of the findings. Such studies would help in understanding the full scope of MSC utility and limitations when exposed to similar stressors in a clinical context.
Prevailing evidence suggests that MSCs primarily exert their therapeutic effects through paracrine mechanisms, such as secreting growth factors, chemokines, and exosomes [5]. The article does not address the measurement of these capabilities, which are highly pertinent to MSC function. Relying solely on in vitro data from a single cell line may not provide meaningful insights for clinical application.
Additionally, the quality of data presentation is suboptimal; for instance, in figure 4, the representative images of annexin V staining do not show the total cell count, making it difficult to assess the overall apoptotic condition of the cells.
CONCLUSION
In conclusion, the work presented by Almahasneh et al. offers some interesting insights and data for the selection of MSC passages in clinical settings. However, the limitations of this study should be addressed to enhance its clinical relevance. The research, while providing foundational data, is somewhat superficial and does not extend into the complex in vivo interactions that are critical for clinical applications. The use of a single commercial cell line limits the generalizability of the results across different MSC types. Furthermore, the study focuses primarily on in vitro assessments, which may not accurately reflect the in vivo environment where MSCs operate. Therefore, future studies should aim to include more diverse cell models and in vivo experiments to validate these findings comprehensively. This approach would enable a more robust understanding of MSC utility and optimization for clinical use under various pathological conditions.
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Almahasneh F, Abu-El-Rub E, Khasawneh RR, Almazari R. Effects of high glucose and severe hypoxia on the biological behavior of mesenchymal stem cells at various passages. World J Stem Cells 2024; 16(4): 434-443 [PMID: 38690519 DOI: 10.4252/wjsc.v16.i4.434]
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"Hepatocellular carcinoma patients with cirrhosis have a poor prognosis and a high recurrence rate after hepatectomy. Therefore, it is important to construct a predictive model to predict ER in such patients. In this paper, five different machine learning algorithms were used to compare the performance of three different models of clinical radiology, radiomics and combinatorics, and finally a combined model under the KNN algorithm was constructed to predict ER of such patients and stratify the overall survival (OS) of patients. This means that individual therapies can be targeted to patients with hepatocellular carcinoma in the context of cirrhosis.
The advantage of this paper is to compare the AUC values of different models under a variety of different machine learning algorithms, so as to select the model with the most predictive power to predict early relapse in patients. The disadvantage is that the included sample size is small, which limits the accuracy of machine learning."
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Triantafillidis JK, Zografos CG, Konstadoulakis MM, Papalois AE. Combination treatment of inflammatory bowel disease: Present status and future perspectives. World J Gastroenterol 2024; 30(15): 2068-2080 [PMID: 38681984 DOI: 10.3748/wjg.v30.i15.2068]
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"This article focuses on fecal microbial transplantation (FMT) as a potential intervention for the treatment of irritable bowel syndrome (IBS), explores the mechanisms of FMT effect, factors influencing its effectiveness, and the challenges of applying FMT in the treatment of IBS. By analyzing randomized controlled trials and meta-analyses, the article highlights the divergences in the findings. The importance of donor selection, patient inclusion criteria, FMT administration route and dose in determining its efficacy was emphasized. The article introduces the concept of "super donors" and the need for meticulous donor selection based on different clinical and genetic criteria, and also delves into the potential mechanisms of FMT in alleviating IBS symptoms, as well as the role of short-chain fatty acids and serotonin in stool. Overall, the article highlights the complexity and subtleties involved in using FMT to treat IBS, and also suggests that further research is needed to enhance its efficacy as a treatment for patients with IBS.
However, there are some problems in the article that need to be revised, including:
As for the effect of FMT in the treatment of IBS, there are significant differences in the results of different studies, and the causes and solutions need to be further explored. The criteria for selecting an effective donor are still unclear, including the route of administration, the optimal dose and the frequency of treatment, etc. It is still unclear whether FMT is effective in all IBS patients or only in some subgroups. There is some concern about the long-term side effects of FMT and more research is needed"
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Dai C, Huang YH, Jiang M. Fecal microbiota transplantation for irritable bowel syndrome: Current evidence and perspectives. World J Gastroenterol 2024; 30(16): 2179-2183 [PMID: 38690018 DOI: 10.3748/wjg.v30.i16.2179]
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"The name change of non-alcoholic fatty liver disease (NAFLD) was explained, but NAFLD was frequently emphasized in the article. It would have been more elegant if MAFLD was used after the definition of metabolic disorder-associated fatty liver disease (MAFLD). However, the article was readable fluently and provided clear scientific information."
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Samanta A, Sen Sarma M. Metabolic dysfunction-associated steatotic liver disease: A silent pandemic. World J Hepatol 2024; 16(4): 511-516 [PMID: 38689742 DOI: 10.4254/wjh.v16.i4.511]
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"I have read with interest the article by Batta and Hatwal concerning Left bundle branch pacing, which provides the reader with a comprensive review of conduction system pacing.
Although well-summarised in tablet 1, I would have discussed in more depth the ongoing RCTs, preliminary and expected results.
It would be of interest to delineate more clearly the differences between His and Left bundle branch pacing, and the technical modalities and difficulties in achieving the correct placement of the electrodes. Moreover, It would be important to describe the main criteria to identify correct LBB pacing and the specific complications connected with the procedure.
In conclusion, we fully agree with the main messages of the authors that LBB pacing Is a promising pacing modality and we await with fervid expectations for the results of ongoing RCTs. It would be useful, also from the persopective of the general cardiologist, to be provided with a more on-field and pragmatic approach to LBB pacing in practice.
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Batta A, Hatwal J. Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy? World J Cardiol 2024; 16(4): 186-190 [PMID: 38690215 DOI: 10.4330/wjc.v16.i4.186]
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"very good"
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Viswanathan DJ, Bhalla AS, Manchanda S, Roychoudhury A, Mishra D, Mridha AR. Characterization of tumors of jaw: Additive value of contrast enhancement and dual-energy computed tomography. World J Radiol 2024; 16(4): 82-93 [PMID: 38690548 DOI: 10.4329/wjr.v16.i4.82]
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"The manuscript is well-written and provides a thorough overview of a complex and important topic in gastroenterology. The topic of combination treatment for inflammatory bowel disease (IBD) is highly relevant given the complexity of managing IBD, especially in cases of severe or refractory disease. The manuscript addresses a significant clinical challenge and offers insights into current and future treatment strategies, which is important for the gastroenterology community. The authors offer a balanced view by discussing both the potential benefits and the risks associated with combination treatments. The objectives are clearly stated, focusing on the present status and future perspectives of combination treatments for IBD. The authors summarize existing data by searching on electronic databases such as PubMed, Medline, and Cochrane CENTRAL, which is a standard approach, and on combination therapies and propose thoughts for future applications, including the potential use of biomarkers and artificial intelligence. The presentation is structured, with tables summarizing the results of clinical trials, which aids in the readability and understanding of the findings. This manuscript contributes valuable insights into the treatment of IBD and would be of interest to clinicians and researchers in the field."
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Triantafillidis JK, Zografos CG, Konstadoulakis MM, Papalois AE. Combination treatment of inflammatory bowel disease: Present status and future perspectives. World J Gastroenterol 2024; 30(15): 2068-2080 [PMID: 38681984 DOI: 10.3748/wjg.v30.i15.2068]
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"I read with great interest this Editorial article. It is a well-written interesting paper on carcinoembryonic antigen as a tumor marker for hepatic colorectal metastasis. I agree absolutely with the aspect that every gradual increase of CEA during follow-up, despite it remaining at normal levels (<5 ng/ml), necessitates immediate imaging preferably by MRI (magnetic resonance imaging) or even MRI-PET (positron emission tomography) scan. I express my satisfaction and congratulations to the authors for their nice work."
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Dilek ON, Arslan Kahraman Dİ, Kahraman G. Carcinoembryonic antigen in the diagnosis, treatment, and follow-up of focal liver lesions. World J Gastrointest Surg 2024; 16(4): 999-1007 [PMID: 38690060 DOI: 10.4240/wjgs.v16.i4.999]
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"Letter to the Editor
Name of Journal: World Journal of Gastroenterology
Manuscript Type: LETTER TO THE EDITOR
Managing Immune Checkpoint Inhibitor-Associated Gastritis: Insights and Strategies
Li-Li Yu, Zhilin He, Xinlai Qian
Li-Li Yu, Zhilin He, Xinlai Qian School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang 453003, Henan Province, China;
The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang453003, Henan, China.
Supported by
This work was supported by grants from the National Natural Science Foundation of China (81671226), Natural Science Foundation of Henan Province (232300421047), Science and Technology Innovation Talents in Universities of Henan Province (24HASTIT067), and Henan Province Young and Middle-aged Health Science and Technology Innovation Talent Project (JQRC2023001).
Corresponding author ：Lili Yu, PhD
Mailing address: School of Basic Medical Sciences, Xinxiang Medical University, #601 Jinsui Road, Xinxiang, Henan, P.R. China 453003
Contact Number: Tel: +86-373-3831165 Fax: +86-373-3029887
E-mail address: merrys222@126.com
Abstract
Immune checkpoint inhibitors (ICIs) are widely used due to their effectiveness in treating various tumors. Immune-related adverse events (irAEs) are defined as adverse effects resulting from ICI treatment. Gastrointestinal irAEs are a common type of irAEs characterized by intestinal side effects, such as diarrhea and colitis, which may lead to the discontinuation of ICIs.
Key words: Immunotherapy, Immune checkpoint inhibitor, Immune checkpoint inhibitor-related gastritis
Core tip: Immune checkpoint inhibitor (ICI)-related gastritis is rare but may lead to serious complications such as gastrorrhagia. The strategies such as early identification, pathological diagnosis, management interventions, and immunotherapy reactivation are discussed to enable clinicians to better manage irAE gastritis and improve the prognosis of these patients.
TO THE EDITOR
I am writing to express my concern regarding the recently published paper titled “Immune checkpoint inhibitor-associated gastritis: Patterns and management” by Jing Lin, Zhong-Qiao Lin et al in the World Journal of Gastroenterology. In this manuscript, the authors systematically summarize the occurrence patterns and management strategies of immune checkpoint inhibitor-associated gastritis, which provides important evidence for research and practice in this field.
Over the last decade, the emergence of immune check-point inhibitor (ICI) therapy has revolutionized the treatment of a growing number of malignancies.[1] Immune-related adverse events (irAE) refer to a set of side-effects in the patients receiving ICIs similar to autoimmune responses.[2] ICI-related gastritis is rare but may lead to serious complications such as gastrorrhagia. The most common abnormality reported on endoscopy is erythema followed by erosions. Other findings like granularity, sloughing, exudates, ulcer, atrophy, and rarely, severe hemorrhagic gastritis, have been reported. [3-5]
A common mechanism by which ICIs exert their effects involves activation of effector T cells by inhibition of PD-1, PD-L1, and CTLA-4.[6] It is also proposed that the proliferation of activated T cells and increase in cytokine production, caused by a lack of self-tolerance, may result in irAEs.[7, 8] However，the detailed mechanisms underlying manifestation of irAEs remain unclear. Therefore, the treatment decisions for ICI-related gastritis are based on individual clinical presentations.
However, the article does not adequately address individualized treatment options for different patient populations. Considering the patient's immune status, gastritis severity and other factors, the formulation of individualized treatment plan is particularly important. For example，in patients with a personal or familial history of autoimmune disease, or in those who presented signs or symptoms suggestive of an underlying autoimmune disease, screening for autoantibodies may be considered before starting an ICI as these patients have an enhanced risk of developing a full autoimmune disease after treatment.[9] Second, the article fails to mention the evaluation and monitoring strategies prior to immune checkpoint inhibitor therapy when discussing preventive measures, which are important for reducing the risk of gastritis.
In addition, the problem of re-provocation after ICI treatment should be focused. Paticularly the risk of recurrence of gastritis needs to be carefully considered. After the complete resolution of irAEs, resumption of immunotherapy is of crucial importance for treatment and prognosis for patients, as is the risk of relapse of irAEs.
In the future, we need to continue to deepen our understanding of irAE gastritis, so as to diagnose and treat it appropriately in a timely manner and provide guidance for clinicians in the treatment of ICI-related gastritis and improve the prognosis of patients.
REFERENCES
1. Pardoll, D.M., The blockade of immune checkpoints in cancer immunotherapy. Nature Reviews Cancer, 2012. 12(4): p. 252-264.
2. Zhou, X., et al., Are immune-related adverse events associated with the efficacy of immune checkpoint inhibitors in patients with cancer? A systematic review and meta-analysis. BMC Med, 2020. 18(1): p. 87.
3. Rao, B.B., S. Robertson, and J. Philpott, Checkpoint Inhibitor-Induced Hemorrhagic Gastritis with Pembrolizumab. Am J Gastroenterol, 2019. 114(2): p. 196.
4. Nishimura, Y., et al., Severe Gastritis after Administration of Nivolumab and Ipilimumab. Case Rep Oncol, 2018. 11(2): p. 549-556.
5. Kobayashi, M., et al., Acute hemorrhagic gastritis after nivolumab treatment. Gastrointest Endosc, 2017. 86(5): p. 915-916.
6. Chan, K.K. and A.R. Bass, Autoimmune complications of immunotherapy: pathophysiology and management. Bmj, 2020. 369: p. m736.
7. Ribas, A. and J.D. Wolchok, Cancer immunotherapy using checkpoint blockade. Science, 2018. 359(6382): p. 1350-1355.
8. Postow, M.A., R. Sidlow, and M.D. Hellmann, Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med, 2018. 378(2): p. 158-168.
9. Ramos-Casals, M., et al., Immune-related adverse events of checkpoint inhibitors. Nat Rev Dis Primers, 2020. 6(1): p. 38.
Footnotes
Conflict-of-interest statement: The authors declare no conflicts of interest.
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Lin J, Lin ZQ, Zheng SC, Chen Y. Immune checkpoint inhibitor-associated gastritis: Patterns and management. World J Gastroenterol 2024; 30(14): 1941-1948 [PMID: 38681126 DOI: 10.3748/wjg.v30.i14.1941]
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"Portal hypertension (PHT) is when increased pressure in the portal vein system causes various clinical syndromes, mainly seen in advanced cirrhosis. The Transjugular Intrahepatic Portosystemic Shunt (TIPS) is commonly used to treat PHT and its complications. However, there's still a risk of further health decline and death after TIPS, highlighting the need for accurate models to predict patient outcomes and improve survival rates. Current models for predicting survival after TIPS are not comprehensive, missing some critical factors and their interactions. It is essential to analyze these factors thoroughly to refine prognosis predictions, aiming to better treatment approaches and patient outcomes.
The authors utilized a Bayesian networks（BNs） model combined with clinical data to construct a predictive model for patient survival after TIPS. The meticulous selection of variables through Cox and least absolute shrinkage and selection operator regression methods strengthens the model's reliability. The inclusion of key factors such as age, ascites, hypertension, and postoperative portal vein pressure, among others, ensures a comprehensive assessment of patient prognosis. The model's impressive accuracy, precision, recall, and F1 score, coupled with its ability to predict 2-year survival, make it a valuable tool for clinicians in strategizing treatment and evaluating prognosis. By creating a BN-based model to predict survival, this study marks a big step forward in personalized medicine. It helps the clinical physicians better understand how different factors affecting PHT interact and influence patient outcomes.
However, there are certain limitations to this study. Firstly, the training and verification data used in the model were obtained from the same hospital, which lacks external validation and may introduce selection bias. Additionally, the sample size is limited, necessitating further confirmation of its predictive universality through prospective studies in the future. Secondly，recent research has indicated a close association between sarcopenia and postoperative outcomes in tips procedures. Therefore, it is necessary to investigate whether sarcopenia can be incorporated into this prognostic model in future studies. Furthermore，all existing postoperative prediction models for tips fail to consider how heterogeneity within tips surgeries impacts prognosis. It would be worthwhile exploring whether variables related to tips surgery can be integrated into this prognostic model as well."
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Chen R, Luo L, Zhang YZ, Liu Z, Liu AL, Zhang YW. Bayesian network-based survival prediction model for patients having undergone post-transjugular intrahepatic portosystemic shunt for portal hypertension. World J Gastroenterol 2024; 30(13): 1859-1870 [PMID: 38659484 DOI: 10.3748/wjg.v30.i13.1859]
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"Real-world studies evaluating the effectiveness and adverse effects of tofacitinib have been conducted, affirming its clinical efficacy in moderate to severe ulcerative colitis, mainly in western countries. With this in mind, we have read with great interest the manuscript submitted by Kojima et al. In their retrospective unicentric study involving 111 Asian patients diagnosed with moderate to severe ulcerative colitis, the authors demonstrated tofacitinib was efficient in both inducing and maintaining clinical remission, with a safety profile consistent with other real-world studies. The manuscript is well-written. However, a few suggestions could improve the manuscript. While it was not the primary or secondary outcome of this study, it would have been valuable to include data about other recognizable treatment targets, particularly fecal calprotectin and endoscopic healing. Moreover, inclusion of data regarding the frequency of serious adverse events resulting in hospitalization would be of interest. "
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Kojima K, Watanabe K, Kawai M, Yagi S, Kaku K, Ikenouchi M, Sato T, Kamikozuru K, Yokoyama Y, Takagawa T, Shimizu M, Shinzaki S. Real-world efficacy and safety of tofacitinib treatment in Asian patients with ulcerative colitis. World J Gastroenterol 2024; 30(13): 1871-1886 [PMID: 38659488 DOI: 10.3748/wjg.v30.i13.1871]
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"The study exhibits a robust scientific methodology, utilizing retrospective analysis of clinical data from a substantial sample size of 393 patients. The selection of variables through Cox regression and least absolute shrinkage and selection operator regression methods enhances the credibility of the findings. The establishment of a Bayesian network-based survival prediction model reflects an innovative approach to address the limitations of existing prognostic models. Moreover, the model's validation through cross-validation techniques adds to its reliability. However, further validation studies in diverse patient populations would strengthen the generalizability of the model."
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Chen R, Luo L, Zhang YZ, Liu Z, Liu AL, Zhang YW. Bayesian network-based survival prediction model for patients having undergone post-transjugular intrahepatic portosystemic shunt for portal hypertension. World J Gastroenterol 2024; 30(13): 1859-1870 [PMID: 38659484 DOI: 10.3748/wjg.v30.i13.1859]
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"I believe the authors have made an important review regarding the historical and the current knowledge about chronic gastritis. This minireview focuses on key milestones which were adequately mentioned. English language is adequate and the references represent the most important papers in this regard. I am pleased to have the opportunity of reading this manuscript.
The overall scientific/language quality are adequate considering the high standards of World Journal of Gastroenterology."
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Bordin D, Livzan M. History of chronic gastritis: How our perceptions have changed. World J Gastroenterol 2024; 30(13): 1851-1858 [PMID: 38659477 DOI: 10.3748/wjg.v30.i13.1851]
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"The introduction of the concept of DC is extremely relevant and justified. Many doctors have long tried to achieve comprehensive remission of the disease and the development of clear criteria - which is considered to be DC - will greatly help doctors around the world to prescribe drugs more clearly and track the results. DC also significantly reduces the risk of developing complications of the disease. It is important that the manuscript presents the results of a Systematic Review and Expert Consensus about Disease Clearance as a New Outcome in Ulcerative Colitis. Any infornation of the results of such consensuses in medical journals is useful for expanding the knowledge of doctors"
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Hassan SA, Kapur N, Sheikh F, Fahad A, Jamal S. Disease clearance in ulcerative colitis: A new therapeutic target for the future. World J Gastroenterol 2024; 30(13): 1801-1809 [PMID: 38659483 DOI: 10.3748/wjg.v30.i13.1801]
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"The study conducted by Senchukova, Kalinin, and Volchenko offers a valuable contribution to the field of oncology, particularly in understanding the recurrence of lung squamous cell carcinoma (LSCC) following radical resection and adjuvant chemotherapy. By focusing on stage IIb-IIIa LSCC patients, the research provides insights that are not only relevant but critical for improving patient outcomes in a subset of lung cancer characterized by its challenging prognosis.
The identification of predictors such as a low degree of tumor differentiation, regional lymph node metastases, the presence of loose, fine-fiber connective tissue in the tumor stroma, and fragmentation of the tumor solid component, furnishes clinicians with a more nuanced understanding of recurrence risks. These findings underscore the importance of considering tumor biology and the microenvironment in the post-surgical management of LSCC patients.
Moreover, the use of univariate and multivariate analyses to identify these predictors, along with the application of receiver operating characteristic curves, highlights the study's methodological rigor. The survival analysis further adds to its significance, offering a stark depiction of how these predictors influence disease-free and overall survival rates.
However, it's worth noting that while the study's methodology and its focus on a homogenous patient cohort enhance its validity, the single-center nature and relatively small sample size may limit the generalizability of the findings. Future multicenter studies with larger cohorts are essential to validate these predictors and potentially uncover additional factors influencing LSCC recurrence. Additionally, integrating these predictors into a broader prognostic model, possibly incorporating genetic and molecular markers, could offer a more comprehensive tool for tailoring patient management strategies post-resection.
In conclusion, this study not only advances our understanding of LSCC recurrence but also prompts further research into personalized treatment adjustments based on specific risk factors. Its implications for improving patient surveillance and identifying candidates for more aggressive adjuvant therapies are particularly noteworthy, marking a step forward in the quest to enhance survival outcomes for LSCC patients.
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Senchukova MA, Kalinin EA, Volchenko NN. Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer: A retrospective analysis. World J Exp Med 2024; 14(1): 89319 [PMID: 38590307 DOI: 10.5493/wjem.v14.i1.89319]
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"I recently read a manuscript titled "Therapeutic role of yoga in hypertension" by Joshi AM, Raveendran AV, and Arumugam M, published in the World Journal of Methodology in 2024, volume 14, issue 1.
I would like to congratulate the authors for providing detailed information about the benefits of yoga in managing hypertension. Practicing yoga is one of the lifestyle modifications in addition to pharmacotherapy for managing high blood pressure.
The term "Yoga" means union, and signifies the merging of Atman, which is the individual consciousness, with Paramatman, the universal consciousness. Yoga originated and practiced since ancient times in India, and it is increasingly being practiced worldwide. Hypertension, which is a medical condition characterized by high blood pressure, is one of the major causes of premature deaths worldwide. It accounts for approximately 14% of total deaths. In this manuscript, the authors describe the beneficial role of yoga practice for people suffering from hypertension. They explain in detail the various components, steps, and stages of yoga, which can help to reduce blood pressure.
Yoga is composed of various components, stages, and steps. These include internal cleansing practices (Shatkriya), warm-up practices (Sharir Sanchalana), Sun salutation (Surya Namaskara), yoga postures (Asana), regulated breathing practices (Pranayama), subtle gestures/body positions (Mudra), meditation/concentration (Dhyana), and effortless relaxation/yogic sleep or body and mind relaxation techniques. These practices are described in detail and designed to promote overall physical and mental well-being including lowering the blood pressure.
Reading through the full article, a few things are clear and everyone must realize and understand that;
1. Yoga practice is not a substitute for pharmacotherapy for hypertension,
2. Yoga is not for any emergency medical conditions,
3. It must be practiced under the supervision of a trained yoga professional,
4. There are no standard yoga components/yoga techniques, and it is not possible to formulate for all,
5. Self-motivation is a must, and sustaining the yoga practice is the real concern,
6. Yoga practice is relatively safe, but may have minor adverse effects like pain, muscle injuries, fatigue,
Overall, to obtain maximum benefit from practicing yoga, it all depends upon the individual’s mental and physical well-being, blood pressure status (mild, moderate, or severe), presence or absence of associated medical/surgical illness, duration of the yoga performed, etc. The literature also supports that yoga helps in reducing blood pressure. Yoga is also helpful in improving the overall well-being of an individual, reducing anxiety and stress, and helping with sleep disorders and a few other medical conditions.
Tanking you all,
With sincere regards,
"
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Joshi AM, Raveendran AV, Arumugam M. Therapeutic role of yoga in hypertension. World J Methodol 2024; 14(1): 90127 [PMID: 38577206 DOI: 10.5662/wjm.v14.i1.90127]
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"Good and interesting editorial article. From my point of view conclusioni is too long and cumbersome, making it not easy to read and understand. Though it does not diminish the value of this article. "
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Xu SX, Yang F, Ge N, Guo JT, Sun SY. Role of albumin-bilirubin score in non-malignant liver disease. World J Gastroenterol 2024; 30(9): 999-1004 [PMID: 38577181 DOI: 10.3748/wjg.v30.i9.999]
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"Good article, interesting to read. "
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Jiang YL, Li J, Zhang PF, Fan FX, Zou J, Yang P, Wang PF, Wang SY, Zhang J. Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models. World J Gastroenterol 2024; 30(9): 1164-1176 [PMID: 38577177 DOI: 10.3748/wjg.v30.i9.1164]
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"The paper is good, But a paragraph on diagnosis of various complications like perianal complications,intestinal strictures can be diagnosed many times by science and symptoms.
Since in many part of the world, including India, we don’t have access to such advanced investigations. Even an ultrasound seems to be a boon for rural part of the world. It’s always better to add a small paragraph about how a good history and clinical examination surpasses. All of these investigations, especially where they are not available."
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Hudson AS, Wahbeh GT, Zheng HB. Imaging and endoscopic tools in pediatric inflammatory bowel disease: What’s new? World J Clin Pediatr 2024; 13(1): 89091 [PMID: 38596437 DOI: 10.5409/wjcp.v13.i1.89091]
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"I value the thoughtful insights presented by Zhang et al. However, the latest iterations of ChatGPT (i.e., GPT-4) are still only able to provide basic personalized suggestions. Moreover, these suggestions are not always evidence-based. Overall, artificial intelligence has a long way to go before it can offer highly targeted and meaningful advice. For now, its recommendations should be taken as a preliminary reference rather than genuine guidance."
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Zhang YF, Liu XQ. Using ChatGPT to promote college students’ participation in physical activities and its effect on mental health. World J Psychiatry 2024; 14(2): 330-333 [PMID: 38464770 DOI: 10.5498/wjp.v14.i2.330]
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"The study, based on a nationwide population, explored comprehensive epidemiological data on IBD in South Korea from 2010 to 2018. This is probably the first study to analyze the epidemiology of IBD in an Asian population. The large sample size of this study provides reliable epidemiological data for IBD studies in Asia."
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Kim S, Lee HJ, Lee SW, Park S, Koh SJ, Im JP, Kim BG, Han KD, Kim JS. Recent trends in the epidemiology and clinical outcomes of inflammatory bowel disease in South Korea, 2010-2018. World J Gastroenterol 2024; 30(9): 1154-1163 [PMID: 38577186 DOI: 10.3748/wjg.v30.i9.1154]
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"Remimazolam, a new ultra-short acting benzodiazepine, was recently approved for procedural sedation and general anesthesia. This study analyze the risk of adverse effects of remimazolam and propofol in the older adults under gastroenteroscopy. As a reader, I am puzzled by the study. The incidence of hypotension in elderly patients is closely related to the dose of sedative drugs, so the dose of remimazolam and propofol in each study should be indicated. Only one study included time to discharge, but in the results Fig 4A, there were two study included it. In the results Fig 4C, only one study (liu 2023) shown the successful sedation rate after administration of remimazolam was lower than propofol, the author should given more detail about that. In the discuss, these contradictory results should be discussed further."
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Li FZ, Zhao C, Tang YX, Liu JT. Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients: A meta-analysis. World J Clin Cases 2024; 12(7): 1272-1283 [PMID: 38524507 DOI: 10.12998/wjcc.v12.i7.1272]
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"Article could have been more descriptive and focussed more on predicting factors of IPN"
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Lv C, Zhang ZX, Ke L. Early prediction and prevention of infected pancreatic necrosis. World J Gastroenterol 2024; 30(9): 1005-1010 [PMID: 38577189 DOI: 10.3748/wjg.v30.i9.1005]
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"Dear Authors,
We would like to congratulate with you for the publication of the article “Transcatheter arterial chemoembolization combined with PD-1 inhibitors and Lenvatinib for hepatocellular carcinoma with portal vein tumor thrombus.” on World Journal of Gastroenterology.
We really much appreciated your work as it reinforces the modern concept that multimodal treatment of advance HCC is of utmost importance to achieve good survival outcomes in a setting featured with dismal prognosis. Still, we believe that some comments are in order.
As far as methodology of the study is concerned, it is needless to say that the quality of the evidence that can be drawn from a retrospective study is dismal. Hence, we would recommend not to state that a superiority of the triple regimen TACE, PD-1 inhibitor, Lenvatinib has been proven. In fact, as you mentioned in the section dedicated to the limits of the article, the small dimension of the study population, its heterogeneity, the retrospective nature of the study along with the selection bias jeopardize the possibility to apply your conclusion to a specific population of HCC patients. In particular, we would suggest, for future research, to select a more specific population of advanced HCC. Although you showed a statistical homogeneity between the two study groups, it must be highlighted that the rate of patients with extra-hepatic disease in the two groups tends to statistical significance and it could be supposed that, with a higher numerosity, the difference could have reached it. This would have meant that one of the possible reasons for the inferiority of the dual regiment in terms of oncological outcomes could be attributed to the greater biological aggressiveness or advanced stage of HCC rather than to the true inferiority of the treatment. Moreover, it could be objectionable the reason why TACE was performed in patients with HCC with very advanced neoplastic portal vein thrombosis and distant metastasis. We would suggest to apply more stringent selection criteria such as exclusion of metastatic HCC and PVTT type III and IV. This would help identify a specific population of HCC patient that could benefit from the advantages you advocate a triple regimen seems to provide them with. Another suggestion to improve the applicability of the study would be to limit the use of immune-check point inhibitors to a single specific drug rather than to a wide group of different molecules and to specify the criteria that prompt the use of a specific molecule over another. Finally, it has to be noted that the vast majority of the population was affected by HBV-related liver cirrhosis. We know about the trend in changing prevalence of the etiology of liver cirrhosis in Western countries, with increasing rate of dysmetabolic and alcoholic etiologies over the viral ones, mainly due to the efficacy and wide distribution of the treatment of HCV with DAA. One could postulate that HCC harbored on HBV-related cirrhosis could be differently aggressive compared to other etiologies making it difficult to draw similar conclusion in a Western setting, where other etiologies are more prevalent and related HCC can possibly have different biological profile.
From a mere linguistic point of view, we would suggest the following correction:
- Line 3 of the introduction, change “concerning” with “accounting for”.
- Inclusion criteria n° 9: we would express this concept saying that the presence of extra-hepatic disease would not represent an exclusion criterion.
- In Table 1, the unit for bilirubin is clearly expressed in mmol/l rather than mg/dl.
- There is no agreement between the Figure 2C (p = 0.029) and what expressed in table 3 (p = 0.009).
- In the last line of first paragraph on page 852, we would rephrase as following “such association was not investigated”.
- Line 5 and 6 on the same paragraph, we would rephrase as following: “It means that patients with TACE-induced sever liver injury may have limited efficacy as liver function deterioration can hinder the administration of systemic drugs”.
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Wu HX, Ding XY, Xu YW, Yu MH, Li XM, Deng N, Chen JL. Transcatheter arterial chemoembolization combined with PD-1 inhibitors and Lenvatinib for hepatocellular carcinoma with portal vein tumor thrombus. World J Gastroenterol 2024; 30(8): 843-854 [PMID: 38516240 DOI: 10.3748/wjg.v30.i8.843]
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44
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"Good article. It posts questions from everyday practice that are sometimes hard to answer. Probably readers would like to see more details and regimens. But this editorial shows directions in new era settings."
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Zhong JH. Adjuvant therapy for hepatocellular carcinoma: Dilemmas at the start of a new era. World J Gastroenterol 2024; 30(8): 806-810 [PMID: 38516235 DOI: 10.3748/wjg.v30.i8.806]
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45
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"Very interesting editorial article. Authors underlined features of article of Zhang et al. Refrences are prettyt new and relevant. Discussion and conclusions are accurate and include future perspectives."
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Ramírez-Mejía MM, Méndez-Sánchez N. From prediction to prevention: Machine learning revolutionizes hepatocellular carcinoma recurrence monitoring. World J Gastroenterol 2024; 30(7): 631-635 [PMID: 38515945 DOI: 10.3748/wjg.v30.i7.631]
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46
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"Dear Editor,
Greetings for the day. First and foremost, I would like to express my gratitude for granting me the opportunity to submit reader's comments in your esteemed journal.
While reading the article with keen interest, I have noted several points that require clarification:
In the Materials and Methods section, inclusion criteria number 5 states, "thyroid function showing normal range of free T4 (FT4) and thyroid stimulating hormone (TSH) levels (< 10 Uiu/L), which was not treated after the initial diagnosis." However, in Table 2 of the Results section, all three groups exhibit TSH levels greater than >10 mU/L. This contradiction needs clarification, and if there is a discrepancy in units mentioned between the Materials and Methods section and the Results, it should be rectified for consistency.
In Table 4, the levels of LDL-C have increased in all three groups (controls, test A & B). However, the Discussion section fails to address this result adequately.
In the Discussion, the following statement appears: "As we all know, dyslipidemia in T2DM patients is mainly manifested by increased levels of TC, TG, and LDL-C and decreased levels of LDL-C." This statement seems to contain a typographical error as it contradicts itself by referring to both an increase and decrease in LDL-C levels in the same sentence.
In the Conclusion section, the final statement is ambiguous: "The elevated 25 (OH) D3, FT4, and TGAB levels were reduced." However, in the results section of the article with intervention, 25 (oh) D3 levels increased, FT4 increased, and TGAB levels decreased. This contradiction requires clarification and correction.
I trust that addressing these points will enhance the clarity and accuracy of the article, thereby contributing to the integrity of the research findings.
Thank you for considering my feedback.
Sincerely,
Dr Kotha Sugunakar Reddy
AIIMS - Bibinagar, Hyderabad, INDIA"
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Feng F, Zhou B, Zhou CL, Huang P, Wang G, Yao K. Vitamin D, selenium, and antidiabetic drugs in the treatment of type 2 diabetes mellitus with Hashimoto's thyroiditis. World J Diabetes 2024; 15(2): 209-219 [PMID: 38464371 DOI: 10.4239/wjd.v15.i2.209]
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47
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"This review describes potential interactions between genetic polymorphisms and dietary factors regarding T2DM susceptibility and disease progression, it elaborates novel genotype-based dietary strategies for the prevention and clinical management of T2DM, and also hypothesises future directions including the integration of genetics with another histological tool. This article develops new genotype-based dietary strategies to improve T2DM control, and these studies help to explain the heterogeneity of T2DM susceptibility and the development of associated systemic complications, as well as understanding the relevance of human genomic studies to disease stratification and precision nutrition. Certainly, this article provides a systematic account of genetic studies and precision nutrition in T2DM populations, and although the article has described glycaemic indicators in patients with T2DM in different countries and ethnic populations based on genotypes and diets, the article needs more studies to expand and confirm the effects of genes and diets of ethnic minorities in other regions on T2DM, and it can also provide further detailed explanations on the clinical management of the T2DM population can also be further explained in detail."
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Ramos-Lopez O. Genotype-based precision nutrition strategies for the prediction and clinical management of type 2 diabetes mellitus. World J Diabetes 2024; 15(2): 142-153 [PMID: 38464367 DOI: 10.4239/wjd.v15.i2.142]
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48
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"It is well known that H. pylori infection is a common infection worldwide and the treatment of H. pylori remains a global concern due to the prevalence of antimicrobial resistance. This study was a single-center, prospective, open-label, randomized study comparing the efficacy of optimized sequential therapy for 14 days with that of combination therapy for 10 days and 14 days. Data analysis showed that the use of optimized sequential therapy improved the eradication rate of H. pylori infection and reduced the incidence of adverse reactions. This provides us clinicians with more radical treatment options for H. pylori infection. It is expected that this study can be further verified in multi-center and multi-region studies."
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Seddik H, Benass J, Berrag S, Sair A, Berraida R, Boutallaka H. Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial. World J Gastroenterol 2024; 30(6): 556-564 [PMID: 38463026 DOI: 10.3748/wjg.v30.i6.556]
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49
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"In this paper, an early screening model was established to identify the high-risk population of colorectal cancer, and the model was internally validated using bootstrapping resampling technique. The data analysis was detailed and rigorous, and the results were reliable. Compared with traditional screening methods, the advantages of this method are that it is simple, rapid, and can be completed without invasive procedures, and it is better carried out in healthy people. More sample size and multi-center data analysis are expected."
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Xu LL, Lin Y, Han LY, Wang Y, Li JJ, Dai XY. Development and validation of a prediction model for early screening of people at high risk for colorectal cancer. World J Gastroenterol 2024; 30(5): 450-461 [PMID: 38414586 DOI: 10.3748/wjg.v30.i5.450]
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50
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"The study and its results are valuable and can be readily applied in clinical practice, however the use of a different PPI solely on the sequential therapy group makes it difficult to assess if the difference in edificacy/cost is due to concomitant vs sequential or Omeprazole vs Rabeprazole"
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Seddik H, Benass J, Berrag S, Sair A, Berraida R, Boutallaka H. Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial. World J Gastroenterol 2024; 30(6): 556-564 [PMID: 38463026 DOI: 10.3748/wjg.v30.i6.556]
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