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"This is a well-designed and clearly articulated case-control study that investigates the psychological predictors of Diabetic Ketoacidosis (DKA) in children with Type 1 Diabetes Mellitus (T1DM) in Saudi Arabia. The authors use the Health Belief Model (HBM) as a theoretical framework but uniquely introduce and test "perceived understanding" as a key predictive construct. The central finding—that a caregiver's cognitive understanding of diabetes management is a more powerful predictor of adherence and DKA prevention than their emotional perceptions of severity or susceptibility—is both compelling and clinically significant. The study is methodologically sound for its design, and its findings offer a valuable, practical contribution to pediatric diabetes care and health behavior theory.
However, there are few weaknesses that can taken into account to further increase the value of the study.
1. Use of modified scales: The authors correctly acknowledge that they adapted items from existing validated tools. While they demonstrated good internal consistency for most scales, the Cronbach's alpha for "perceived susceptibility" was only 0.68. This is generally considered the lower limit of acceptability and may have weakened its potential predictive power in the model. To build on this excellent work, the authors should consider formally validating their modified "perceived understanding" scale in a larger, more diverse Saudi population to create a robust instrument for future studies.
2. Extremely high correlations: The correlation coefficients between perceived understanding and the three adherence behaviors (r = 0.93 to 0.95) are unusually high for psychosocial research. This could suggest a degree of tautology or item overlap between the "understanding" and "adherence" scales—that is, the questions used to measure the two constructs may be assessing very similar underlying concepts. While this does not invalidate the primary finding, it is a point of methodological consideration. The authors could briefly address the very high correlation in the discussion as a point of interest, perhaps speculating on the conceptual overlap and how future instruments could be refined to better distinguish between cognitive understanding and the enactment of that understanding (adherence).
3. Single-center study: The research was conducted at a single tertiary military hospital in Riyadh. This limits the generalizability of the findings to other regions in Saudi Arabia or to different types of healthcare settings (e.g., non-military, rural clinics) where educational resources and patient populations may differ.
4. Caregiver-reported data: The reliance on caregiver reports for adherence behaviors is a potential source of social desirability and recall bias. This is a common and often necessary limitation in pediatric research but remains a weakness compared to objective adherence data (e.g., glucometer downloads, pharmacy records). Future studies should aim to incorporate objective measures of adherence to complement the caregiver-reported data and strengthen the validity of the findings.
5. Longitudinal design: A prospective, longitudinal study could establish the temporal relationship between improving understanding and subsequent improvements in adherence and clinical outcomes (e.g., reduced DKA incidence), thereby moving from correlation to demonstrating causality."
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Alissa N, Al Zahrani S. Psychological predictors of diabetic ketoacidosis in children: Health belief model-based case-control study. World J Diabetes 2025; 16(8): 110088 [DOI: 10.4239/wjd.v16.i8.110088]
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"Sun present a valuable 10-year retrospective analysis of 3,256 pancreatic cancer patients across 14 Chinese hospitals. Key findings include a median overall survival of 183 days, late-stage diagnosis (56.9% Stage IV), and superior efficacy of combination therapies (e.g., gemcitabine + fluorouracil in adjuvant settings; HR = 0.35). The study underscores the urgent need for early detection and optimized chemotherapy in China’s clinical landscape."
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Sun WY, Zhang SS, Zhang SK, Qin RY, Zhou B, Liu J, Li SP, Chen RF, Wang CF, Fan JH. Treatment options in patients with pancreatic cancer: A 10-year multicenter epidemiological investigation in China. World J Gastrointest Oncol 2025; 17(8): 106447 [DOI: 10.4251/wjgo.v17.i8.106447]
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3
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"The article provides a review of the literature and the authors' own data on the problem of diagnosing acute hemorrhagic leukoencephalitis (AHLE), which is a rare but very dangerous disease with high mortality. The authors present data on the magnetic resonance imaging spectrum obtained from 4 patients and suggest that MRI data may be potential biomarkers for early diagnosis and choice of therapy for suspected AHLE. Noting the theoretical and practical significance of the research, I would like to note the following. According to modern concepts, AHLE can be an autoimmune disease, in particular, associated with the effects of viral infections and/or immunizations, including COVID. In this regard, it is of interest to provide a more detailed view of the range of tests performed in patients to detect viral markers, as well as information about vaccinations."
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Shukla A, Nayyar N, Kumari P, Kumar A, Takkar P. Magnetic resonance imaging spectrum of acute hemorrhagic leukoencephalitis: Four case reports. World J Clin Cases 2025; 13(28): 107759 [DOI: 10.12998/wjcc.v13.i28.107759]
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"The manuscript is very interesting, as the authors attempt to describe a rather important topic in arthroplasty practice that is the the outcomes from bilateral Total Hip Arthroplasty.
There is a clear lack of concesus on the topic, with advantages and disadvantages associated for both of the options ( single staged vs double) ; nevertheless the patients' general medical status and the expactations are of paramount importance for the final decision. "
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Sharma H, Verma R, Kumar L, Ali A, Khurana G, Gurnani V, Mittal S, Jajodia N. Single staged bilateral total hip replacement and its outcomes: A cross-sectional study. World J Orthop 2025; 16(8): 102298 [DOI: 10.5312/wjo.v16.i8.102298]
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5
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"This review article provides a comprehensive overview of the role of the gut microbiota (GM) in the pathogenesis and therapeutic intervention of dyslipidemia.
The gut microbiota produces metabolic byproducts such as short-chain fatty acids (SCFAs) and secondary bile acids, which act on the liver and adipose tissue to regulate lipid metabolism. SCFAs promote fatty acid oxidation, suppress lipid accumulation, and stimulate the secretion of appetite-suppressing hormones such as GLP-1 and PYY.
When the gut environment becomes imbalanced, the intestinal barrier function deteriorates, allowing lipopolysaccharides (LPS) to enter the bloodstream and cause metabolic endotoxemia. This, in turn, triggers chronic inflammation and exacerbates dyslipidemia. In addition, the gut microbiota modifies the composition of bile acids and regulates lipid metabolic pathways via the nuclear receptor FXR and the membrane receptor TGR5. Moreover, bacterial-derived exosomes and non-coding RNAs may induce epigenetic changes in host genes related to lipid metabolism.
Diet has a significant influence on the gut microbiota. High-fat, low-fiber diets disrupt its composition, whereas Mediterranean and plant-based diets have beneficial effects. Therapeutic strategies targeting the gut microbiota—such as probiotics, prebiotics, and fecal microbiota transplantation (FMT)—are promising, but personalization is required to achieve maximal benefit.
However, several challenges remain in this field:
• Many studies are observational, lacking experimental evidence to support causal relationships.
• Human studies are easily influenced by confounding factors such as genetic background, diet, and medications.
• Large interindividual differences in gut microbiota make standardized treatments difficult.
• Specific methods to achieve personalized medicine have not yet been established.
• The effects of probiotics and FMT tend to be short-term, with insufficient knowledge regarding their long-term efficacy or optimal timing of intervention.
• FMT carries the risk of introducing pathogens or antibiotic resistance genes, necessitating established donor criteria to ensure safety.
• Most studies investigate single strains over short periods, leaving the effects of multi-strain interventions and long-term administration unclear; interspecies differences must also be taken into account.
To overcome these limitations, it is considered essential to elucidate causal relationships through long-term and multifaceted research, establish personalized therapeutic approaches, and develop standardized protocols with an emphasis on safety.
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Lv J, Zhao HP, Yu Y, Wang JH, Zhang XJ, Guo ZQ, Jiang WY, Wang K, Guo L. From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention. World J Gastroenterol 2025; 31(30): 108680 [DOI: 10.3748/wjg.v31.i30.108680]
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"This study shows that endoscopic interventions involving the minor papilla, such as minor papilla cannulation, sphincterotomy, balloon dilation, stone extraction, and other procedures, is a feasible treatment modality for obstructive chronic pancreatitis. Adverse events from endoscopic minor papilla intervention are high, and these complex interventions should only be performed by experienced endoscopists. The study was a single center retrospective study, and the majority of the patients were male, which limits the generalizability of the results."
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Ren X, Qu YP, Xia T, Tang XF. Technical success, clinical efficacy, and safety of endoscopic minor papilla interventions for symptomatic pancreatic diseases. World J Gastroenterol 2025; 31(20): 100192 [PMID: 40495942 DOI: 10.3748/wjg.v31.i20.100192]
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"This study by Guilmoteau et al shows that the relatively newer endoscopic technique of simultaneous stent-beside-stent strategy for malignant hilar biliary obstruction has higher technical success rate when compared to sequential stent-beside-stent technique, and a similar technical success rate to sequential stent-inside-stent technique. Interestingly, there was no significant difference in clinical success or adverse events between these three groups, and the risk of recurrent biliary obstruction was not significant between the simultaneous and sequential groups. The study states that technical failure is associated with a higher rate of fatal cholangitis; however, the P value provided is 0.085 with the CI crossing 1 (CI 0.78-44.4) so this finding is not statistically significant. A valuable addition to this study would be to evaluate the rates of improvement in radiographic biliary dilatation between these three strategies, and if improvement in biliary dilatation was achieved bilaterally or unilaterally. Nevertheless, this is an interesting study which shows that simultaneous stent-beside-stent management of malignant hilar biliary obstruction may be favored over the sequential stent-beside-stent strategy as the former strategy has higher technical success rates."
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Guilmoteau T, Rouquette O, Buisson A, Cambier S, Abergel A, Poincloux L. Direct comparison of simultaneous and sequential endoscopic metallic bilateral stenting in malignant hilar biliary obstruction. World J Gastroenterol 2025; 31(19): 101913 [PMID: 40497097 DOI: 10.3748/wjg.v31.i19.101913]
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"On behalf of the reviewers, I am pleased to inform you that your manuscript has been evaluated and is recommended for acceptance in its current form. The study presents a well-designed methodology, robust results, and a significant contribution to the field of Specific Field. The clarity of presentation and adherence to journal guidelines are commendable. The manuscript has been reviewed and is deemed suitable for publication. The article describes the content clearly, possesses professionalism, and meets the acceptance criteria. Agree to accept.Agreed to receive the article, which is professional, clearly expressed, forward-looking, logically coherent and well-written.No further changes are required."
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Imbrizi M, Azevedo MFC, Baima JP, Queiroz NSF, Parra RS, Ferreira SDC, Sassaki LY, Chebli JMF. Positioning and sequencing of advanced therapies in inflammatory bowel disease: A guide for clinical practice. World J Gastroenterol 2025; 31(29): 107745 [PMID: 40809925 DOI: 10.3748/wjg.v31.i29.107745]
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"Inflammatory bowel disease is a chronic, debilitating, lifelong disease with waxing and waning. Since the disease is chronic, long-term medical therapy is required. Often, a few patients may not be adherent to medications due to various reasons, and this study explored this aspect with the expansion of Withdrawal of drugs in IBD. Most of the patients who were not adherent may present with acute severe ulcerative colitis, and most of them will have recapture of the remission with steroids or original drugs. This Study also showed a similar picture, with only 1/4 requiring corticosteroids. This study is well-written, but in the era of treat-to-target, it notably overlooks the histological findings in patients with ASA withdrawal. Addition of Endoscopic and histopathological findings after withdrawal, even without relapse, would have given a better picture"
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Atay A, Ergul M, Ozturk O, Acun KC, Cagir Y, Durak MB, Yuksel I. Outcomes of 5-aminosalicylates withdrawal due to non-adherence in ulcerative colitis patients: A step toward evaluating intermittent therapy. World J Gastroenterol 2025; 31(30): 110112 [DOI: 10.3748/wjg.v31.i30.110112]
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"I was very impressed by the article "From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention". The authors of the review scientific publication carefully analyzed modern information on the problem of dyslipidemia pathogenesis, linked lipid metabolism with many factors of genetics, environment, and lifestyle. The authors also identified the cause-and-effect relationships between dyslipidemia and colonic microbiota."
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Lv J, Zhao HP, Yu Y, Wang JH, Zhang XJ, Guo ZQ, Jiang WY, Wang K, Guo L. From gut microbial ecology to lipid homeostasis: Decoding the role of gut microbiota in dyslipidemia pathogenesis and intervention. World J Gastroenterol 2025; 31(30): 108680 [DOI: 10.3748/wjg.v31.i30.108680]
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"This retrospective study aims to compare the feasibility, resection rates, and complications of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) to laparoscopic wedge resection (LWR) in the treatment of subepithelial lesions (SELs) arising from the muscularis propria at the esophagogastric junction (EGJ) or gastric cardia. Lee et al. show that ESD, STER, and LWR are all feasible methods for resecting these lesions. Interestingly, the R0 resection rate is lower for ESD and especially STER when compared to LWR, however this may be related to the greater proportion of leiomyomas found in the ESD and STER groups, and leiomyomas are typically benign with very low chance for progression to malignancy. It is unclear if these lesions were sampled with EUS-guided fine needle biopsy prior to deciding on ESD, STER, or LWR, as achieving en bloc resection is more important for lesions with malignant potential such as GIST. Nevertheless this study shows that endoscopic resection methods such as ESD and STER are viable alternatives to surgical resection of SELs at the EGJ and gastric cardia. It is important for patients to have a complete pre-procedural workup including EUS, fine needle biopsy when possible, and CT chest and abdomen prior to embarking on resection."
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Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH. Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia. World J Gastroenterol 2025; 31(23): 106261 [PMID: 40575341 DOI: 10.3748/wjg.v31.i23.106261]
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"This study investigates the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and diabetic gastric motility disorders (DGMD) in patients with type 2 diabetes mellitus (T2DM), using electrogastrogram (EGG) to assess gastric electrical rhythm. The findings suggest that MASLD is an independent risk factor for DGMD, with patients diagnosed with MASLD showing significant gastric motility abnormalities. This research is important for understanding the interplay between metabolic disorders and gastrointestinal complications, offering potential early indicators for clinicians to monitor and manage DGMD in T2DM patients. The study’s results are clinically significant, as they highlight the need for healthcare providers to be aware of gastric motility issues in T2DM patients with MASLD. Early intervention, including EGG testing, could help prevent the development of diabetic gastroparesis and improve patient care."
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Wang XX, Yan C, Wang SJ, Zhu H, Cao CC, Wu L, Wang S, Hu J, Zhang HH. Analysis of gastric electrical rhythm in patients with metabolic dysfunction-associated steatotic liver disease and type 2 diabetes mellitus. World J Hepatol 2025; 17(7): 109067 [PMID: 40747237 DOI: 10.4254/wjh.v17.i7.109067]
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"This article discusses the Triglyceride-Glucose-Waist Circumference (TyG-WC) index as a promising non-invasive biomarker for diagnosing and assessing metabolic dysfunction-associated steatotic liver disease (MASLD). It highlights the growing recognition of the TyG-WC index in identifying individuals at risk for MASLD and associated complications, such as cardiovascular disease and diabetes. The research outlines its strong diagnostic performance across diverse populations and underscores the importance of further studies to validate its predictive capacity. With its simplicity and affordability, the TyG-WC index holds significant potential in improving MASLD diagnosis and risk stratification, offering a practical tool for both clinicians and researchers. "
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Priego-Parra BA, Román-Calleja BM, Gallego-Duran R, Gracia-Sancho J, Velarde Ruiz-Velasco JA, Remes-Troche JM. Triglyceride-glucose-waist circumference index: A powerful tool for metabolic dysfunction-associated steatotic liver disease. World J Hepatol 2025; 17(7): 107668 [PMID: 40747214 DOI: 10.4254/wjh.v17.i7.107668]
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"The title "Deciphering the oncogenic role of Rac family small GTPase 3 (RAC3) in hepatocellular carcinoma (HCC) through multiomics integration" by Liu R et al., (2025) represents a good basic study that discuss RAC3 as a key HCC oncogenic driver; its overexpression links to poor prognosis/resistance. Targeting the RAC3/E2F1 axis offers a new therapy, which highlights RAC3 as a biomarker/target. the prognostic value of RAC3 protein expression in HCC but this study requires validation by clinical follow-up studies and the mechanistic interplay between E2F1 and RAC3 in HCC requires experimental confirmation. The Future work need in vitro and in vivo models to validate the E2F1/RAC3 axis, dissect its impact on cell-cycle dynamics, and explore its translational potential in overcoming therapy resistance."
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Liu R, Li JC, Li SD, Li JD, He RQ, Chen G, Feng ZB, Wei JL. Deciphering the oncogenic role of Rac family small GTPase 3 in hepatocellular carcinoma through multiomics integration. World J Hepatol 2025; 17(7): 106151 [PMID: 40747231 DOI: 10.4254/wjh.v17.i7.106151]
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"
The challenge of optimizing postoperative recovery and long-term outcomes in patients undergoing gastric cancer (GC) surgery continues to pose significant clinical and logistical hurdles, despite advancements in surgical techniques and perioperative care (1). In this study, Tang and Zhang present valuable findings on the integration of enhanced recovery after surgery (ERAS) protocols with a multidisciplinary collaboration model, highlighting its potential to improve gastrointestinal recovery, psychological status, and patient satisfaction in the postoperative setting.
In their retrospective analysis of GC patients undergoing radical gastrectomy, the authors demonstrated that those managed under a multidisciplinary ERAS model experienced significantly faster recovery of gastrointestinal function—as evidenced by earlier first flatus and defecation—alongside shorter postoperative hospital stays and reduced complication rates. Recent studies have further supported the beneficial effects of ERAS protocols on gastrointestinal function in patients with GC (2,3). In addition to these objective clinical metrics, the study also reported improvements in subjective outcomes, including lower anxiety and depression scores, better sleep quality, and higher overall patient satisfaction, suggesting that integrated perioperative care may positively impact both physiological and psychological recovery trajectories. Their work contributes to the extensive and growing body of literature demonstrating the benefits of ERAS in gastrointestinal surgery (4,5).
Despite the encouraging findings, several important methodological concerns warrant further discussion. First, the study is retrospective in design, yet the number of patients in the ERAS group and the control group was matched at a strict 1:1 ratio (n=60 each), a distribution that appears non-random and unexplained. Such parity raises the possibility of selective inclusion or post hoc group assignment, which can introduce bias and compromise the internal validity of the findings. Second, the authors did not specify whether any patients initially considered for ERAS management were excluded due to protocol deviation, medical contraindications, or perioperative complications. Without a transparent description of patient selection and exclusion criteria for the ERAS cohort, it is difficult to assess the generalizability and applicability of the results to broader clinical populations.
A significant limitation lies in its retrospective, single-center design. Without randomization or stratified analysis of critical confounders—such as comorbidity profiles, tumor stage, surgical approach, and baseline nutritional status—the validity of causal inferences is limited (8). Additionally, the absence of detailed compliance metrics for ERAS components (e.g., early feeding, ambulation targets, analgesia protocols) restricts reproducibility and hinders the evaluation of individual contributors to the observed outcomes.
In conclusion, this study reinforces the value of multidisciplinary ERAS pathways in GC surgery.
References
1. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2024 doi 10.3322/caac.21834.
2. Lee HJ, Kim J, Koo BW, Suh YS, Lee JM, Han DS, et al. Survey of Perioperative Practices in Gastric Cancer Surgery for Establishing an Enhanced Recovery After Surgery Program Across 10 Tertiary Hospitals in South Korea. J Gastric Cancer 2025;25(3):424-36 doi 10.5230/jgc.2025.25.e27.
3. Tian Q, Wang H, Guo T, Yao B, Liu Y, Zhu B. The efficacy and safety of enhanced recovery after surgery (ERAS) Program in laparoscopic distal gastrectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Med 2024;56(1):2306194 doi 10.1080/07853890.2024.2306194.
4. Wang J, Yuan T, Shi J. Application of Medical-Nursing Integration Multidisciplinary-Assisted Surgical Wound Nursing Mode in Improving the Quality of Wound Treatment. Emerg Med Int 2022;2022:9299529 doi 10.1155/2022/9299529.
5. Lee HJ, Kim J, Yoon SH, Kong SH, Kim WH, Park DJ, et al. Effectiveness of ERAS program on postoperative recovery after gastric cancer surgery: a randomized clinical trial. Int J Surg 2025;111(5):3306-13 doi 10.1097/js9.0000000000002328.
6. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997;78(5):606-17 doi 10.1093/bja/78.5.606.
7. Choi CI, Park JK, Chung JH, Lee SH, Hwang SH, Jeon TY, et al. The application of enhanced recovery after surgery protocol after distal gastrectomy for patients with gastric cancer: a prospective randomized clinical trial. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2024;28(6):791-8 doi 10.1016/j.gassur.2024.02.032.
8. Tian Y, Cao S, Li L, Yu W, Ding Y, Zhang G, et al. Three-year Survival Outcomes of Patients With Enhanced Recovery After Surgery Versus Conventional Care in Laparoscopic Distal Gastrectomy: The GISSG1901 Randomized Clinical Trial. Annals of surgery 2025;282(1):46-55 doi 10.1097/sla.0000000000006603."
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Tang YH, Zhang J. Clinical effect of enhanced recovery after surgery based on multidisciplinary collaboration model in postoperative gastric cancer surgery. World J Gastrointest Surg 2025; 17(7): 105387 [PMID: 40740921 DOI: 10.4240/wjgs.v17.i7.105387]
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"In the era of the investigation based management, Clinical examination is fast becoming absolute. The Authors in this paper have clearly explained the methods and utility of one of the important clincal examination in the gastroebterology practice. I conragulate the authors for writing this review and this will be important clinical guide for upcoming/ new trainees in the field of surgery/ gastroenterology"
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Zhu LJ, Zeng XL, Yang XD. Enhancing clinical practice: The role of digital rectal examination in diagnosing functional defecation disorders. World J Gastrointest Surg 2025; 17(7): 106471 [PMID: 40740891 DOI: 10.4240/wjgs.v17.i7.106471]
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"This research highlights the potential of NET-related markers as biomarkers for liver damage, offering a promising avenue for early diagnosis and therapeutic targeting. The study is particularly relevant given the global rise in metabolic diseases and liver conditions like MASLD. The inclusion of multiple models allows for a more comprehensive understanding of how different types of liver damage—fibrosis, steatohepatitis, and simple steatosis—affect systemic inflammation and NET formation. These findings could pave the way for novel treatment strategies focusing on regulating NETosis, which may be beneficial for clinical management of MASLD and related liver diseases."
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Feješ A, Belvončíková P, Bečka E, Strečanský T, Pastorek M, Janko J, Filová B, Babál P, Šebeková K, Borbélyová V, Gardlík R. Myeloperoxidase, extracellular DNA and neutrophil extracellular trap formation in the animal models of metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2025; 31(27): 106166 [PMID: 40741100 DOI: 10.3748/wjg.v31.i27.106166]
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"This paper provides an insightful contribution to the field of MAFLD by developing a machine learning-based model for early detection in high-metabolic-risk populations. The integration of clinical data and TCM features adds a unique, holistic perspective, which could enhance the model's diagnostic power. The use of advanced statistical methods, such as LASSO and RFE, strengthens the reliability of the predictive model. The XGBoost algorithm demonstrated superior performance, making it a promising tool for non-invasive MAFLD screening in clinical settings. Overall, the study presents a significant step towards improving MAFLD detection and has promising clinical implications, especially in cost-effective screening and early intervention for at-risk populations."
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Tian Y, Zhou HY, Liu ML, Ruan Y, Yan ZX, Hu XH, Du J. Machine learning-based identification of biochemical markers to predict hepatic steatosis in patients at high metabolic risk. World J Gastroenterol 2025; 31(27): 108200 [PMID: 40741101 DOI: 10.3748/wjg.v31.i27.108200]
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"Tian et al. (2025) present a compelling prospective observational study employing machine learning (ML) to identify biochemical and clinical markers predictive of hepatic steatosis in individuals at high metabolic risk. Metabolic-associated fatty liver disease (MAFLD) is prevalent yet frequently underdiagnosed, especially in early stages when traditional screening modalities like ultrasonography lack sensitivity. Thus, the authors’ development of a noninvasive, cost-effective ML-based predictive model is timely and clinically relevant, aiming for early identification and improved resource utilization.
A methodological strength of the study is its comprehensive use of multiple ML algorithms—XGBoost, Random Forest (RF), Support Vector Machine (SVM), and Logistic Regression (LR)—representing diverse modeling approaches. This allowed for robust comparative analysis, with each algorithm selected for specific strengths: XGBoost for nonlinear interactions, RF for overfitting resistance, SVM for high-dimensional data, and LR for baseline interpretability. This methodological breadth effectively balances predictive performance and clinical practicality.
To manage high-dimensional data (156 initial candidate features), the study employed dual feature selection techniques: recursive feature elimination (RFE) and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Combining these strategies yielded a robust set of ten core features, significantly reducing complexity while ensuring predictive accuracy. These final predictors, including the AST/ALT ratio, triglycerides, and waist circumference, are clinically meaningful and closely correlate with hepatic steatosis, reinforcing the validity of their selection.
Among the ML models evaluated, XGBoost demonstrated superior performance with an area under the ROC curve (AUC) of approximately 0.82, surpassing RF, SVM, and LR. XGBoost’s predictive strength was further validated through cross-validation (mean AUC ~0.918), suggesting robust internal consistency. Importantly, the model achieved high accuracy (84%) and an F1-score of 0.84, reflecting a balanced sensitivity and specificity crucial for clinical implementation.
Another innovative aspect was incorporating Traditional Chinese Medicine (TCM) indicators alongside conventional clinical metrics. Two TCM-derived features, greasy tongue coating and tongue edge redness, emerged prominently among the top predictors, bridging traditional holistic diagnostics and contemporary data analytics. These TCM indicators likely represent underlying metabolic dysregulation consistent with “damp-heat” conditions in TCM theory, aligning with inflammation and metabolic dysfunction commonly observed in MAFLD.
Incorporating TCM features provides valuable additional diagnostic perspectives, potentially capturing subtle clinical signs not represented in standard biomedical metrics. The quantitative integration of these features through digital analysis and expert validation represents a significant methodological innovation. However, several practical challenges must be considered. TCM diagnostic standardization and reproducibility outside controlled research settings may pose limitations. Differences in tongue appearance influenced by diet, hydration, and oral hygiene could introduce variability. Thus, ensuring consistent reproducibility and gaining broad clinical acceptance remain critical tasks for future research.
Clinically, the authors’ ML tool holds significant promise for noninvasive screening, particularly valuable in routine healthcare settings where expensive or invasive procedures like MRI-PDFF or liver biopsies are impractical. This model’s reliance on common biochemical and clinical data enhances its applicability, particularly in resource-limited settings. Stratification by predicted risk allows targeted use of advanced imaging or specialist follow-up, optimizing clinical workflows and resource allocation.
Nevertheless, the model’s limitations must be acknowledged. First, external validation in multicenter cohorts is essential, given the study’s single-center design and potential population-specific biases. Moreover, the lack of MAFLD subtyping overlooks disease heterogeneity, possibly limiting predictive accuracy for specific patient subsets (e.g., diabetic vs. non-diabetic patients, mild vs. severe steatosis). Addressing these nuances through subgroup-specific analyses or longitudinal follow-up studies will enhance interpretability and clinical utility.
Future research could expand the feature set to include advanced biomarkers or imaging modalities to enhance predictive precision. Further, refining TCM integration through sophisticated image analysis or correlating TCM features with biochemical markers would provide stronger mechanistic insights. Prospective studies evaluating clinical outcomes of model-driven interventions, such as lifestyle modification or TCM-based therapies, could demonstrate tangible patient benefits and validate real-world clinical impact.
In conclusion, Tian et al. present a robustly designed study introducing an innovative ML-based approach for early hepatic steatosis detection in high-risk populations. The inclusion of TCM diagnostic features exemplifies a novel integration of traditional medicine within contemporary predictive frameworks. Although initial results are promising, external validation, refinement for disease heterogeneity, and practical clinical integration remain critical next steps. This pioneering work significantly contributes to metabolic medicine and predictive hepatology, paving the way for improved, patient-centered management of fatty liver disease.
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Tian Y, Zhou HY, Liu ML, Ruan Y, Yan ZX, Hu XH, Du J. Machine learning-based identification of biochemical markers to predict hepatic steatosis in patients at high metabolic risk. World J Gastroenterol 2025; 31(27): 108200 [PMID: 40741101 DOI: 10.3748/wjg.v31.i27.108200]
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"This article provides forward-looking insights into liver disease treatment. It begins by accurately identifying the key factors contributing to chronic liver diseases such as alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease, and metabolic dysfunction-associated steatohepatitis, as well as the limitations of current treatments. This lays a solid foundation for subsequent innovative treatment ideas, helping readers clearly understand the existing challenges.When exploring solutions, it skillfully combines nanoparticles, gut microbiome modulation, and artificial intelligence, showcasing the immense potential of interdisciplinary integration. It lists various key types of nanocarriers, offering researchers abundant references, and elaborates on their diverse applications in modulating the gut microbiome for the treatment of chronic liver diseases, thereby broadening research perspectives.However, there is room for improvement in the details. For instance, the listed future challenges are somewhat vague. If each challenge were supported by more specific examples or data, the article would be more convincing. Additionally, a more in-depth explanation of how artificial intelligence precisely predicts treatment responses and enables personalized interventions could be beneficial, making it easier for readers without expertise in AI to understand.Overall, this article injects new vitality and hope into the field of liver disease treatment. It offers valuable insights for researchers and medical professionals. It is believed that these innovative therapeutic approaches will soon be applied in clinical practice, thereby enhancing patients' prognoses and quality of life. The article holds significant scientific and practical importance and is worthy of further research and attention."
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Khurana A, Hartmann P. Gut microbiome-specific nanoparticle-based therapeutics for liver diseases. World J Gastroenterol 2025; 31(27): 109105 [PMID: 40741099 DOI: 10.3748/wjg.v31.i27.109105]
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"In this commentary, we discuss the recent work by He et al. published in the World Journal of Gastroenterology, which identifies translocator protein (TSPO) as a novel player in the immunopathogenesis of inflammatory bowel disease (IBD), with a particular focus on neutrophil-driven ROS production and NET formation. The study highlights elevated TSPO expression in both the gut and peripheral neutrophils of IBD patients and further correlates this with increased neuroinflammatory signals in the brains of colitic mice.
We commend the authors for linking gut and brain inflammation via TSPO, a mitochondrial protein long implicated in innate immune regulation. However, we offer several points for deeper consideration. Prior studies have shown that TSPO knockout in mice worsens DSS-induced colitis by enhancing macrophage pyroptosis, suggesting that TSPO may have cell-type–dependent functions. This contrasts with He et al.'s findings that TSPO antagonism reduces neutrophil ROS and NETs, raising questions about the net effects of modulating TSPO. We propose that future studies adopt cell-specific knockout models to clarify these roles.
Additionally, we address the translational relevance of TSPO imaging in the CNS. In rodents, TSPO is upregulated in activated microglia; however, human data suggest that TSPO levels correlate more with immune cell density than activation state. This distinction is crucial when interpreting PET signals in IBD-associated brain inflammation. Moreover, astrocytic TSPO expression may contribute to these findings and deserves further discussion.
We also suggest validating the current results in larger human cohorts, including through single-cell RNA sequencing and TSPO-PET studies. Investigating the behavioral and cognitive consequences of colitis-induced brain TSPO changes would further elucidate the gut-brain inflammatory axis. Finally, given the contradictory effects of different TSPO ligands (e.g., PK11195 vs. flunitrazepam), a pharmacological exploration of TSPO modulators with improved selectivity and safety is warranted.
In conclusion, this letter supports the innovative perspective introduced by He et al., while also emphasizing the complexity of TSPO’s role across immune cell types and organ systems. A more nuanced understanding of TSPO biology may yield novel insights into both intestinal and neuroimmune pathologies."
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He Q, Wu XH, Jiang DL, Lin RT, Xie F, Guan YH, Fei AH. Translocator protein facilitates neutrophil-mediated mucosal inflammation in inflammatory bowel diseases. World J Gastroenterol 2025; 31(27): 109239 [PMID: 40741102 DOI: 10.3748/wjg.v31.i27.109239]
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"This study has applied a combined method of machine learning and regression analysis to evaluate the critical biomarkers in the diagnosis of Metabolic-associated fatty liver disease in patients. There are many correlated factors in this subsequent calculation under authors' efforts. We have considered these results to find a phenomenon that all these correlated factors coefficient values are not high. Hope that the author can explain them with scientific viewpoint.
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Tian Y, Zhou HY, Liu ML, Ruan Y, Yan ZX, Hu XH, Du J. Machine learning-based identification of biochemical markers to predict hepatic steatosis in patients at high metabolic risk. World J Gastroenterol 2025; 31(27): 108200 [PMID: 40741101 DOI: 10.3748/wjg.v31.i27.108200]
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"Crohn's disease (CD) is a chronic, relapsing inflammatory bowel disease that requires long-term treatment. Infliximab (IFX) plays an important role in inducing remission and maintaining treatment. However, the high incidence of secondary loss of response (SLOR) poses a significant challenge to disease control. Currently, clinical prediction methods for SLOR are limited, and traditional clinical indicators and imaging examinations are not precise enough for prediction. This study, through radiomics technology, integrates the features of the intestinal wall and creeping fat to develop a prediction model that may help identify high-risk patients in advance. This could facilitate earlier adjustment of treatment plans in clinical practice, prevent disease relapse or exacerbation due to SLOR, and reduce unnecessary treatment delays and waste of medical resources.
In terms of research methodology, the retrospective analysis used in this study is feasible in practice and makes full use of existing clinical and imaging data. The clinical independent predictors identified through univariate and multivariate analyses, such as white blood cell count, disease duration, and Harvey-Bradshaw Index, are easily obtainable in daily clinical work and are consistent with the factors we clinically observe to be related to SLOR. This makes the study results more easily applicable in clinical practice. The extraction and analysis of radiomics features are also scientifically sound and reasonable. By considering both the intestinal wall and creeping fat, the study fully takes into account the pathological characteristics of Crohn's disease. Creeping fat, as one of the characteristic pathological changes of CD, is increasingly recognized for its role in disease progression and treatment response. Including it in the analysis provides new insights into understanding the pathophysiological mechanisms of CD.
The research results are encouraging. The combined prediction model shows good predictive performance in both the training and validation cohorts, indicating high predictive accuracy. This means that the model is highly reliable in practical applications and can provide accurate SLOR risk assessments for clinicians. Through this model, patients can be divided into high-risk and low-risk subgroups to achieve individualized treatment management. For high-risk patients, we can strengthen monitoring, shorten follow-up intervals, and adjust treatment plans in a timely manner, such as increasing IFX dosage or shortening dosing intervals. For low-risk patients, the standard treatment plan can be maintained to avoid overtreatment. This individualized treatment strategy is expected to improve treatment outcomes and patient prognosis.
However, the study also has some limitations. The sample size is relatively small, with only 220 patients from two centers included, which may limit the generalizability of the model. In actual clinical applications, patients from different regions and medical centers may vary, so further validation of the model's stability and accuracy is needed in larger-scale multicenter studies. In addition, the study did not include some biomarkers that may have predictive value for SLOR, such as fecal calprotectin. These biomarkers are commonly used in clinical practice to assess intestinal inflammation activity. Including them in the prediction model may further improve its predictive performance. Future studies should consider integrating more clinical indicators and biomarkers to develop a more comprehensive prediction model.
Overall, this study provides new ideas and tools for the management of Crohn's disease. As a gastroenterologist, I look forward to further validation and application of this study in clinical practice. Through radiomics technology, we may be able to more accurately predict secondary loss of response to IFX, thereby providing more individualized treatment plans for patients and improving the long-term prognosis of patients with Crohn's disease. At the same time, I also hope that future studies can overcome existing limitations and further optimize the prediction model to provide stronger support for clinical treatment decisions."
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Li S, Zhu C, Tong L, Zheng XM, Rong C, Gao YK, Yuan DC, Wu XW. Correlation between radiomic features of Crohn's disease and secondary loss of response to infliximab. World J Gastroenterol 2025; 31(27): 109459 [PMID: 40741098 DOI: 10.3748/wjg.v31.i27.109459]
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"This study aims to address the issues of time-consuming interpretation and reliance on the experience of readers when using small bowel capsule endoscopy (SBCE) to evaluate obscure gastrointestinal bleeding (OGIB). An AI model was developed to automatically distinguish the small intestine, stomach, and colon, and diagnose small intestinal abnormalities such as erosions, ulcers, vascular malformations, and bleeding. Using 87,005 images from 101 SBCE videos as the dataset, the researchers built models based on DenseNet161 and DenseNet201 convolutional neural networks, trained them through preprocessing and data augmentation, and validated their clinical utility on 32 external videos. The results showed that the model achieved over 99% accuracy in organ localization (AUC > 0.99) and 99.4% to 99.9% accuracy in lesion detection in internal testing. The AI-assisted reading time was significantly reduced to an average of 8.7 minutes (compared to 53.9 minutes traditionally), and the diagnostic performance was comparable to traditional reading. The discussion pointed out that the model significantly improved efficiency while maintaining high accuracy, but limitations included the dataset mainly consisting of Asian patients, being limited to a specific platform (MiroCam), having a small external validation sample (32 cases), incomplete coverage of lesion types, and the lack of advanced image enhancement techniques. The conclusion is that AI-assisted SBCE reading can reduce time and maintain performance, making it suitable for clinical implementation to improve consistency and efficiency. Readers believe this can help clinicians improve work efficiency and reduce misdiagnosis. Future research should expand the sample size, cover more lesion types, adapt to different platforms, and integrate advanced technologies to optimize diagnostic capabilities."
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Kwon YS, Park TY, Kim SE, Park Y, Lee JG, Lee SP, Kim KO, Jang HJ, Yang YJ, Cho BJ. Deep learning-based localization and lesion detection in capsule endoscopy for patients with suspected small-bowel bleeding. World J Gastroenterol 2025; 31(27): 106819 [PMID: 40741104 DOI: 10.3748/wjg.v31.i27.106819]
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"The manuscript is well organized, written in clear language and using scientific terms. The information presented is accurate, but there are several gaps, including the very small sample size which makes the results not significant. For the medical treatment to be of an impact significance, the study should be conducted on an importantly significant sample size. Also, the factors studied are important, but a wider variety of factors should be taken into consideration to give a powerful significant for the study.
Aswell, the recurrence rate of VAs after sirolimus treatment is a very crucial factor. This factor is important to determine the efficacy of the treatment and its impact on controlling the medical condition. Aswell, it is important to present the long-term adverse effects of sirolimus treatment and emphasize on gastrointestinal, cardiac, and pulmonary side effects based on its mechanism of action. In conclusion, sirolimus is an effective medically treatment of vascular anomalies, but the limitations of the study classify it as not significant due mainly to the very small sample size included."
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Sun Q, Wu JC, Chen X, Li DH, Li BR, Xiao NJ, Wang XY, Tu XZ, Ning SB, Sun T. Efficacy and safety of sirolimus in the treatment of gastrointestinal angiodysplasias. World J Gastroenterol 2025; 31(25): 105677 [PMID: 40656607 DOI: 10.3748/wjg.v31.i25.105677]
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"The authors gave a comprehensive review of sedation protocols, factors associated with successful cannulation, various biliary cannulation techniques, accessories, potential complications related to ERCP, and endoscopic ultrasound-guided ERCP. They also gave a fantastic pictorial representation of the same. However, the authors have not included the Erlanger technique and Burdick’s technique of cannulation, which can be used in appropriate settings. One additional variation in the technique described for free-hand access sphincterotomy using a needle knife, which is employed in our institute, involves a change in direction. Specifically, rather than cephalad, if the direction is caudal from the roof, the complication rates may decrease, with an increase in the rate of cannulation. We also described this variation in this letter: https://doi.org/10.1007/s12664-025-01772-w. Overall, this review provided an exhaustive review of the available literature and techniques for improving successful biliary cannulation."
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Ismail A, Abdelwahab MM, Ozercan M, Elnahas O, Bahcecioglu IH, Yalniz M, Tawheed A. Strategies for achieving successful cannulation in endoscopic retrograde cholangiopancreatography: A technical overview. World J Gastrointest Endosc 2025; 17(7): 107810 [PMID: 40677566 DOI: 10.4253/wjge.v17.i7.107810]
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"To the Editor,
We read with great interest the article by Ren et al. [1], published in World Journal of Gastroenterology, which investigates serum exosomal hsa-let-7f-5p as a potential non-invasive biomarker for detecting metastatic pancreatic cancer. The research presents a compelling advancement in the molecular diagnostics of one of the most aggressive malignancies. This study is both timely and relevant, considering the dismal survival rates in pancreatic cancer due to delayed diagnosis and poor response to conventional therapies [1, 2].
In this letter, we aim to provide a critical appraisal of the study design and methodology, place the findings in the context of the current scientific literature, evaluate the novelty and translational potential of hsa-let-7f-5p, and recommend avenues for future research.
Ren et al. successfully shown that hsa-let-7f-5p is considerably higher in the serum exosomes of patients with metastatic pancreatic cancer than in those with localized illness. They discovered 42 differently expressed miRNAs using high-throughput sequencing and verified hsa-let-7f-5p using qRT-PCR, providing strong support for their result. These findings are consistent with a growing body of data that exosomal miRNAs, due to their stability in circulation and tumor selectivity, have intriguing diagnostic capacities in malignancies [3-5]. The reason for using serum exosomal miRNAs as biomarkers is widely understood. Exosomes are small vesicles released by nearly all cells, including tumor cells, that carry molecular cargo specific to their cell of origin. Previous research has demonstrated the usage of exosomal miRNAs such as miR-21, miR-1246, and miR-10b in pancreatic cancer [6-8]. However, few studies have focused on distinguishing metastatic from non-metastatic pancreatic cancer, which is an important clinical differential.
One of the major strengths of Ren et al.'s work is the comprehensive pipeline employed for exosome isolation, characterization, and miRNA profiling. The authors validated exosomes using well-established techniques such as transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA), and western blotting. This multiparametric validation boosts the credibility of their results.
The let-7 family of miRNAs is known for its tumor-suppressive and context-dependent oncogenic roles. While most members inhibit proliferation and metastasis, emerging evidence shows that specific let-7 members, such as let-7f-5p, can be upregulated in certain cancers and are associated with worse outcomes [9]. Ma et al. reported that hsa-let-7f-5p was highly expressed in pulmonary carcinoid tumors and regulated HMGA2, a protein involved in chromatin remodeling and EMT [10]. In prostate cancer, Valera et al. found higher hsa-let-7f-5p expression in older patients, suggesting its possible role in tumor progression with age [11]. Ren et al.’s results extend these findings to pancreatic cancer, highlighting the utility of hsa-let-7f-5p as a stage-specific biomarker rather than merely a diagnostic one.
The strength of hsa-let-7f-5p as a diagnostic marker for metastasis is promising, but a comparative evaluation with other known biomarkers would enrich the discussion. For instance:
miR-21 has been extensively validated as an oncogenic miRNA in pancreatic cancer and is known to promote invasion and resistance to gemcitabine [12]. miR-155 and miR-196a have been associated with poor prognosis and have been considered for early diagnostic panels [13].
In this investigation, I discovered many weaknesses. The first is a small sample size (n=36), and the lack of longitudinal follow-up data limits the findings' generalizability and prognostic application. Multicenter trials with larger and more diverse cohorts are required to verify hsa-let-7f-5p as a clinical biomarker. Furthermore, only four miRNAs were validated, leaving the other 38 (including 34 unique ones) untested. Some of these may have even greater discriminatory strength or synergistic benefit when integrated into multi-miRNA signatures, a method that has demonstrated increased accuracy in other malignancies.
Moreover, the biological activities of hsa-let-7f-5p in encouraging metastasis warrant additional investigation. Functional research using in vitro invasion tests and in vivo metastasis models could help determine whether this miRNA is simply a marker or a mechanistic component to metastatic spread. Another topic to look at is if exosomal hsa-let-7f-5p levels alter in response to treatment. If so, this could lead to real-time, non-invasive therapy monitoring, which is critical in pancreatic oncology.
The authors recommend using hsa-let-7f-5p in routine surveillance to detect metastases in pancreatic cancer patients, possibly in conjunction with imaging. We support this objective and urge that commercial assay kits be developed and clinically validated in accordance with CLIA/CAP requirements. Given that the majority of pancreatic cancer patients come with late-stage disease, a non-invasive technology for early detection of metastases can have a considerable impact on treatment decisions, such as avoiding non-curative surgery or starting systemic therapy earlier. Furthermore, including such biomarkers into AI-driven diagnostic pipelines has the potential to improve risk classification algorithms and customize treatment regimens, in line with precision medicine concepts.
Ren et al. provide a valuable contribution to the field by identifying serum exosomal hsa-let-7f-5p as a potential diagnostic biomarker for metastatic pancreatic cancer. The study is technically sound, analytically robust, and biologically plausible. Nevertheless, broader validation, mechanistic studies, and clinical comparisons with existing biomarkers are necessary to cement its place in clinical practice.
We commend the authors for their innovative and methodologically rigorous work and look forward to seeing the next phase of this research. Their findings not only enhance our understanding of pancreatic cancer metastasis but also pave the way for more personalized, non-invasive diagnostic tools in oncology.
Reference:
1. Verma, H.K., et al., A Retrospective Look at Anti-EGFR Agents in Pancreatic Cancer Therapy. Curr Drug Metab, 2019. 20(12): p. 958-966.
2. Golivi, Y., et al., Small molecular inhibitors: Therapeutic strategies for pancreatic cancer. Drug Discovery Today, 2024. 29(7): p. 104053.
3. Wu, J. and Z. Shen, Exosomal miRNAs as biomarkers for diagnostic and prognostic in lung cancer. Cancer Med, 2020. 9(19): p. 6909-6922.
4. Lohajová Behulová, R., et al., Circulating exosomal miRNAs as a promising diagnostic biomarker in cancer. Physiol Res, 2023. 72(S3): p. S193-s207.
5. Li, C., et al., The role of Exosomal miRNAs in cancer. Journal of Translational Medicine, 2022. 20(1): p. 6.
6. Uddin, M.H., et al., Exosomal microRNA in Pancreatic Cancer Diagnosis, Prognosis, and Treatment: From Bench to Bedside. Cancers (Basel), 2021. 13(11).
7. Jafari, A., et al., The Emerging Role of Exosomal miRNAs as Biomarkers for Early Cancer Detection: A Comprehensive Literature Review. Technol Cancer Res Treat, 2023. 22: p. 15330338231205999.
8. Xu, Y., et al., The role of exosomal microRNAs in pancreatic cancer. Stem Cell Investigation, 2020. 7.
9. Gilles, M.E. and F.J. Slack, Let-7 microRNA as a potential therapeutic target with implications for immunotherapy. Expert Opin Ther Targets, 2018. 22(11): p. 929-939.
10. Ma, Q., et al., HMGA2 promotes cancer metastasis by regulating epithelial-mesenchymal transition. Front Oncol, 2024. 14: p. 1320887.
11. Valera, V.A., et al., microRNA Expression Profiling in Young Prostate Cancer Patients. J Cancer, 2020. 11(14): p. 4106-4114.
12. Chen, C., L. Demirkhanyan, and C.S. Gondi, The Multifaceted Role of miR-21 in Pancreatic Cancers. Cells, 2024. 13(11).
13. Yuan, W., et al., New combined microRNA and protein plasmatic biomarker panel for pancreatic cancer. Oncotarget, 2016. 7(48).
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Ren S, Song LN, Zhao R, Tian Y, Wang ZQ. Serum exosomal hsa-let-7f-5p: A potential diagnostic biomarker for metastatic pancreatic cancer detection. World J Gastroenterol 2025; 31(26): 109500 [PMID: 40678708 DOI: 10.3748/wjg.v31.i26.109500]
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"This paper provides an interesting exploration of Chinese medicine monomers in regulating autophagy for the prevention and treatment of HCC. The review highlights the potential of various compounds in modulating key signaling pathways involved in autophagy, offering new insights into the development of therapeutic strategies for HCC. The integration of traditional Chinese medicine with modern pharmacology is an exciting approach that could open up novel treatment avenues for cancer. However, the study mainly focuses on preclinical findings, and the lack of clinical trial data limits its immediate application. Despite this, the research is highly relevant for both basic and clinical oncology, offering promising directions for future studies and therapeutic development."
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Zheng SH, Xue TY, Wang QY, Ye YA, Zhang P. Chinese medicine monomers for hepatocellular carcinoma: New ideas related to autophagy. World J Gastroenterol 2025; 31(26): 106113 [PMID: 40678709 DOI: 10.3748/wjg.v31.i26.106113]
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"This paper provides valuable insights into the potential of endocytoscopy as a real-time diagnostic tool for UC. The study highlights the effectiveness of the ECSS and ELECT score in assessing both endoscopic and histological activity. The findings suggest that endocytoscopy can offer a faster, non-invasive alternative to traditional histopathological methods, potentially improving clinical decision-making in UC management. However, the study is limited by its small sample size and single-center design, which may affect the generalizability of the results. Despite these limitations, the paper shows the promising role of endocytoscopy in assessing UC activity, with potential implications for more efficient and timely disease management in clinical practice."
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Chaemsupaphan T, Shir Ali M, Fung C, Paramsothy S, Leong RW. Endocytoscopy in real-time assessment of histological and endoscopic activity in ulcerative colitis. World J Gastrointest Endosc 2025; 17(7): 108082 [PMID: 40677581 DOI: 10.4253/wjge.v17.i7.108082]
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"This paper provides valuable insights into the complementary roles of VCE and SBE in diagnosing small bowel disorders. By comparing both techniques, the study highlights VCE’s superiority for non-invasive initial evaluations and SBE’s utility in therapeutic interventions and obtaining histopathological confirmation. The findings are clinically significant, especially in managing obscure gastrointestinal bleeding and small bowel tumors, offering a more structured approach for clinicians. However, the study could benefit from a discussion on emerging technologies and larger, prospective studies to further validate its findings. Overall, this paper is a useful reference for clinicians involved in small bowel diagnostics."
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Gadour E, Miutescu B, Okasha HH, Ghiuchici AM, AlQahtani MS. Diagnostic yield of video capsule endoscopy vs simple balloon enteroscopy in small intestinal disorders: A systematic review. World J Gastrointest Endosc 2025; 17(7): 108264 [PMID: 40677578 DOI: 10.4253/wjge.v17.i7.108264]
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"### Review of the Article “Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease” published in the World Journal of Gastroenterology
This article represents a significant advancement in the non-invasive diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) and offers valuable insights for clinical practice.
#### Clinical Application Value
The study introduces a non-invasive assessment method based on multiparametric ultrasound, which holds great significance for clinical practice. Given the large number of MASLD patients, traditional liver biopsy is not only costly but also associated with sampling errors and risks of complications. The introduction of multiparametric ultrasound provides clinicians with a safer and more convenient diagnostic tool, effectively reducing the need for liver biopsies and minimizing patient discomfort and medical costs.
#### Innovation
For the first time, this study compares viscosity measurements (Vi.PLUS) with the histopathological features of MASLD and finds that viscosity is closely related to the degree of inflammation and ballooning in MASH. This finding offers a new perspective for the non-invasive diagnosis of MASLD and paves the way for future research and clinical applications.
#### Methodological Rigor
The study employs a single-center, prospective, cross-sectional design with 120 patients, all of whom underwent liver biopsy as the reference standard. This rigorous study design and methodology ensure the reliability and scientific validity of the results.
#### Practicality of the Results
The study demonstrates that the VAS-MASH-US score, based on multiparametric ultrasound, has good sensitivity and specificity for diagnosing MASH. This scoring system provides clinicians with a practical tool to better identify high-risk patients who need liver biopsy, while reducing unnecessary invasive examinations for low-risk patients.
#### Limitations of the Study
Despite the significant findings, the study has some limitations. For example, it is a single-center study with a relatively small sample size, and the results have not yet been validated in an independent cohort. Additionally, differences in ultrasound equipment and techniques across centers may affect the generalizability of the results.
#### Implications for Future Research
This study provides new ideas and methods for the non-invasive diagnosis of MASLD, but further research is needed to validate these findings. For instance, multicenter studies in larger populations could verify the universality and accuracy of the VAS-MASH-US score. Moreover, exploring the combination of other non-invasive techniques with multiparametric ultrasound could further improve the diagnostic accuracy of MASLD.
In summary, this article represents an important step forward in the non-invasive diagnosis of MASLD. Its innovation and practicality are commendable. It is hoped that more research will be conducted in the future to further refine this field and provide better medical services for MASLD patients."
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Liguori A, Ainora ME, Di Gialleonardo L, Viceconti N, Petrucci L, Esposto G, Giustiniani MC, Mignini I, Borriello R, Galasso L, Paratore M, Garcovich M, Riccardi L, Pompili M, Grieco A, Gasbarrini A, Miele L, Zocco MA. Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2025; 31(25): 105518 [PMID: 40656616 DOI: 10.3748/wjg.v31.i25.105518]
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"Good case report of involvement of thyroid cartilage, however, it is a very rare incidence.
Language quality is good. Content is ok IHC report images should also be included to solidify the diagnosis and not just mentioning the report of IHC findings.
Study stated to look for the distant metastasis including the thyroid/cartilage. However, hematogenous spread to more common distant organ should be more focused on rather than the rare ones. Especially-- liver, bone etc.
Metastasis to thyroid cartilage- a poor prognostic factor--mentioned in the study. However, could not get any information/data for that"
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Ai MM, Lin T, Guo RY, Zhang YY, Yu F. Unexpected metastasis of thyroid cartilage involvement from lung adenocarcinoma: A case report. World J Clin Cases 2025; 13(25): 107471 [DOI: 10.12998/wjcc.v13.i25.107471]
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"Good case report of involvement of thyroid cartilage, however, it is a very rare incidence.
Language quality is good.
Content is ok
IHC report images should also be included to solidify the diagnosis and not just mentioning the report of IHC findings.
Study stated to look for the distant metastasis including the thyroid/cartilage. However, hematogenous spread to more common distant organ should be more focused on rather than the rare ones. Especially-- liver, bone etc.
Metastasis to thyroid cartilage- a poor prognostic factor--mentioned in the study. However, could not get any information/data for that. "
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Ma TT, Lyu HR. Post-endoscopic retrograde appendicitis therapy stent impaction leading to exacerbation of appendicitis: A case report. World J Clin Cases 2025; 13(25): 106587 [DOI: 10.12998/wjcc.v13.i25.106587]
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"tertiary care hospital over the last 7 years from the Himalayan and Sub-Himalayan regions of India.
Studys aim--To analyze the demography, clinical presentation, complications, and mortality risk factors in presumptive leptospirosis patients admitted--- was fulfilled, however, limited to one single center study and observation only.
2018-2024 data were collected based on Modified Faine’s criteria with ELISA diagnosis. \
Sample size is small. 62 number
Study found- equal number of distribution of cases irrespective of sex.
Complications include thrombocytopenia and liver involvement and AKI. MDS was serious complication observed in 66% of cases.
Studies have also highlighted that early administration of antibiotics and aggressive supportive care can improve survival outcomes in critically ill patients with leptospirosis
Limitation—only single center study with possible some selection bias.
Overall Language quality and content-- Excellent. "
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Das D, Ponnampurathu S, Panda PK, Mathuria YP. Different clinical profile of leptospirosis in a tertiary care Indian hospital: A Himalayan experience. World J Clin Cases 2025; 13(25): 106335 [DOI: 10.12998/wjcc.v13.i25.106335]
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"Study conducted from 1985 to 2022--total 47 patients included with PDTC. some of them lost on follow up.
Good analysis of risk factors and outcome.
Good standard of article
The scientific quality of very good
The language quality is also professional and clear.
The data analysis and charts are upto the mark. "
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Hsu CW, Hsueh C, Lu YL, Hsu CJ, Wong RJ, Lin SF. Risk factors and outcomes of metastatic poorly differentiated thyroid carcinoma. World J Clin Cases 2025; 13(25): 105204 [DOI: 10.12998/wjcc.v13.i25.105204]
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"This paper reports on a clinical trial assessing the efficacy and safety of sirolimus in the treatment of gastrointestinal angiodysplasia (GIAD). The results indicate that sirolimus is effective in reducing bleeding, improving hemoglobin levels, decreasing transfusion dependence, and improving lesion outcomes. Additionally, the adverse effects were mild and manageable. However, it should be noted that while patients with various underlying conditions were included, those with chronic kidney disease were not represented. This is a concern, as patients with chronic kidney disease often experience recurrent gastrointestinal bleeding due to angiodysplasia. Further studies involving a larger number of patients, including those with chronic kidney disease, are warranted."
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Sun Q, Wu JC, Chen X, Li DH, Li BR, Xiao NJ, Wang XY, Tu XZ, Ning SB, Sun T. Efficacy and safety of sirolimus in the treatment of gastrointestinal angiodysplasias. World J Gastroenterol 2025; 31(25): 105677 [PMID: 40656607 DOI: 10.3748/wjg.v31.i25.105677]
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"This paper provides an interesting exploration of the gut microbiota and its potential role in autoimmune overlap syndrome (OS), combining features of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). The study integrates multi-omics data, focusing on microbial profiles and serum metabolites, to provide new insights into the pathophysiology of OS. The findings are clinically relevant, particularly in the context of identifying biomarkers for earlier and non-invasive diagnosis of OS, which could improve clinical management. However, the study is limited by its small sample size and lack of a healthy control group, which restricts the generalizability of the results. Despite these limitations, the paper opens up promising avenues for future research in microbiota-based diagnostics and therapeutic strategies for autoimmune liver diseases."
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Wang Q, Sun LN, Shi H, Ma XY, Gao W, Xu B, Lin X, Liu YM, Huang CY, Jin RH. Multi-omics analysis reveals gut microbiota-metabolite interactions and their association with liver function in autoimmune overlap syndrome. World J Gastroenterol 2025; 31(25): 106371 [PMID: 40656611 DOI: 10.3748/wjg.v31.i25.106371]
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"This study presents a comprehensive investigation into the use of multiparametric ultrasound (US) for the non-invasive assessment of liver steatosis, fibrosis, and inflammation in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). The authors employed various advanced ultrasound techniques, including 2D shear-wave elastography (SWE), sound speed and attenuation imaging, and viscosity plane-wave ultrasound (Vi.PLUS), alongside traditional methods like FibroScan. The study's findings are promising, demonstrating that multiparametric ultrasound can effectively assess liver conditions such as fibrosis and steatosis, and even disease activity related to inflammation and ballooning. The diagnostic performance of the viscosity index (Vi.PLUS) and the VAS-MASH-US score was found to be good, especially for identifying patients with metabolic dysfunction-associated steatohepatitis (MASH). This approach could help reduce unnecessary liver biopsies, thereby minimizing costs and procedural risks, which is a significant clinical advantage."
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Liguori A, Ainora ME, Di Gialleonardo L, Viceconti N, Petrucci L, Esposto G, Giustiniani MC, Mignini I, Borriello R, Galasso L, Paratore M, Garcovich M, Riccardi L, Pompili M, Grieco A, Gasbarrini A, Miele L, Zocco MA. Multiparametric ultrasound for non-invasive assessment of liver steatosis, fibrosis, and inflammation in metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2025; 31(25): 105518 [PMID: 40656616 DOI: 10.3748/wjg.v31.i25.105518]
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"Hepatocellular carcinoma (HCC) remains a major global health burden, ranking as the sixth most common cancer and the third leading cause of cancer-related mortality worldwide. Despite advances in surveillance, early diagnosis, and the emergence of molecular-targeted and immunotherapeutic agents, the prognosis for many patients with HCC remains poor. This is particularly true in advanced-stage disease, where therapeutic resistance and immune escape mechanisms hinder durable responses. As our understanding of HCC pathogenesis deepens, the tumor microenvironment (TME) has emerged as a critical determinant of disease progression and therapeutic outcome.
Among the key regulators in this microenvironment are galectins (Gals)—a family of glycan-binding proteins with various immunomodulatory and tumor-regulatory functions. Gal-1, Gal-3, Gal-4, and Gal-9 have attracted significant attention for their diverse roles in HCC. These proteins guide important cellular processes vital for tumor development, including inflammation, immune evasion, angiogenesis, epithelial–mesenchymal transition (EMT), proliferation, and metastasis. What sets galectins apart is their functional duality—their effects depend on their cellular location, expression levels, and the tumor microenvironment (TME). This complexity highlights their potential as both biomarkers and therapeutic targets in HCC. They coordinate processes like inflammation, angiogenesis, EMT, tumor growth, and spread. Importantly, galectins display dynamic, context-dependent behavior, capable of exerting both tumor-promoting and tumor-inhibiting effects depending on their expression, cellular localization, and the surrounding microenvironment.
Recent studies, including the comprehensive review by Gajovic and colleagues (WJG 2025; 31:107260), highlight the diverse functions of Galectins in liver cancer. For instance, Gal-1 and Gal-3 are consistently associated with aggressive tumor features such as vascular invasion, immunosuppression, and poor prognosis. Conversely, Gal-4 and Gal-9 appear as favorable prognostic indicators in specific HCC subtypes, possibly due to their roles in immune activation and metastasis suppression. This duality not only reflects the complexity of Galectin biology but also encourages the development of improved biomarkers and personalized therapeutic strategies.
The current therapeutic landscape of HCC—although expanded by immune checkpoint inhibitors and molecularly targeted agents—remains inadequate for many patients, especially those with advanced disease. In this context, Galectin-targeted therapies show considerable promise. Gal-3 inhibitors and Gal-3C fusion proteins, for example, are actively being studied for their ability to reverse immune suppression, disrupt tumor–stromal interactions, and improve the effectiveness of existing treatments. Meanwhile, profiling Galectin expression may help predict treatment responses and guide personalized therapy strategies. Elevated levels of Gal-1 and Gal-3 in serum or tumor tissue have consistently been associated with aggressive clinical features, such as vascular invasion, immune evasion, and poor overall survival. Conversely, Gal-4 and Gal-9 expression have been linked to favorable prognostic indicators in some patient groups, highlighting the biological diversity of HCC and the complex roles that galectins play in disease progression.
The therapeutic implications are equally compelling. Galectin-targeted agents—such as Gal-3 inhibitors and Gal-3C fusion proteins—are being studied for their ability to modify the TME, boost anti-tumor immunity, and overcome resistance to current therapies. At the same time, integrating galectin profiling into clinical practice could improve risk assessment, enhance prognostic models, and support more personalized treatment approaches. However, these promising advancements must be accompanied by rigorous clinical validation. The dual and sometimes conflicting roles of galectins in cancer emphasize the importance of context—what may be beneficial in one cellular environment could be detrimental in another. Large-scale, well-controlled clinical trials and mechanistic research are critical for fully understanding the therapeutic potential of galectin modulation in HCC.
Galectins are an area of study within the field of HCC biology and therapeutics that has not been extensively researched. In addressing treatment resistance and disease heterogeneity, galectins have potential for the development of biomarkers and targeted therapies. Including galectins in future HCC management strategies may contribute to more effective and personalized treatment methods.
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Gajovic NM, Jovanovic IP, Jocic MV, Stojanovic B, Corovic IF, Todorovic N, Simovic Markovic BJ, Amedei A. Exploring the impact of galectins on liver cancer: From immunopathogenesis to potential targets. World J Gastroenterol 2025; 31(25): 107260 [PMID: 40656613 DOI: 10.3748/wjg.v31.i25.107260]
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"This study demonstrates that reduced NRF2 activity contributes to ER stress and senescence in adipose-derived mesenchymal stem cells (ASCs) from hypertrophic obese mice, primarily through downregulation of MFN2.
The use of multiple approaches, including NRF2/MFN2 knockdown and rescue, ChIP-qPCR, Co-IP, immunofluorescence, and IP-MS, adds robustness to the findings. Importantly, the functional relevance is strengthened by transplantation experiments, showing that disruption of NRF2 or MFN2 impairs the therapeutic potential of ASCs in insulin resistance, highlighting translational significance.
However, while the authors suggest an interaction between MFN2 and BIP, the evidence remains indirect. Biochemical confirmation such as GST pull-down or FRET would be needed to verify a direct interaction. Additionally, NRF2 may affect ER stress and senescence through other targets beyond MFN2, which were not explored in this study.
Future work should aim to clarify the structural basis of MFN2–BIP interaction and its functional consequences. Given the known role of MFN2 in mitochondrial dynamics and ER-mitochondrial tethering, investigating how this axis influences mitochondrial morphology, mitochondria-associated membranes integrity, and calcium signaling could provide further mechanistic insights."
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Fang J. Reduced NRF2/Mfn2 activity promotes endoplasmic reticulum stress and senescence in adipose-derived mesenchymal stem cells in hypertrophic obese mice. World J Stem Cells 2025; 17(6): 104367 [PMID: 40585950 DOI: 10.4252/wjsc.v17.i6.104367]
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"Dear Editor,
I read with great interest the editorial by Papadakos et al. on the evolving immunotherapeutic landscape in gastrointestinal stromal tumors (GISTs). The authors provide a comprehensive overview of the tumor microenvironment (TME), challenges in immunotherapy response, and emerging strategies. I would like to offer several complementary insights and suggest future directions for translational and clinical research.
1. Stratifying GISTs Through Immune Profiling:
The authors rightly emphasize the immunosuppressive TME in GISTs. Building on this, emerging evidence from proteomic and transcriptomic studies supports the existence of distinct immune clusters ranging from inflamed “hot” tumors (TLS⁺/B-cell-rich) to immune-desert “cold” phenotypes. These immune subtypes have shown clear prognostic and predictive value for checkpoint inhibitor response, with objective response rates reaching 50% in TLS-rich subgroups. Integration of spatial profiling and CXCL13 expression as biomarkers may refine patient selection for PD-1/PD-L1 blockade.
2. 2. Rationale for Combination Strategies:
While the editorial correctly notes the modest activity of ICIs in unselected patients, combinatorial approaches offer promise. For example, pegylated interferon-alpha-2b (PegIFNα2b) in conjunction with imatinib significantly enhances immune infiltration and suppresses PI3K/mTOR signaling, achieving remarkable response rates in early trials. Similarly, imatinib’s ability to reverse immunosuppression via IDO downregulation and Treg reduction provides a mechanistic rationale for synergy with ICIs, particularly in PDGFRA D842V-mutant GISTs.
3. Targeting Tumor Antigens and TME Components:
Antibody-based therapies like SR1 (anti-KIT) have demonstrated macrophage-dependent cytotoxicity even in imatinib-resistant models. This offers a novel route to bypass TKI resistance. Additionally, novel modalities such as bispecific antibodies targeting KIT or PDGFRA in conjunction with CD3⁺ T cell engagement may overcome immune exclusion in “cold” tumors.
4. Addressing IDO Inhibitor Failures:
The editorial notes the challenges with IDO1-targeted therapies. We propose that resistance may stem from spatial heterogeneity and compensatory activation of AhR and TDO2 pathways. Poly-pathway blockade, rather than IDO inhibition alone, may be essential to overcome this resistance.
5. Moving Forward: Future success in GIST immunotherapy will depend on Immune subtyping based on TLS, B cell density, and proteomic clusters (Im-I to Im-IV), Rational combination trials of TKIs + ICIs ± TME-modifying agents, Validation of biomarkers such as CXCL13, CD276, and KIT-derived neoantigens in prospective cohorts.
In conclusion, the editorial provides an excellent foundation for discourse. We advocate for multi-center, biomarker-driven clinical trials to translate these emerging insights into tailored immunotherapy regimens for GIST patients.
Sincerely,
Fen Wang
Oncology Department, Peking University Shenzhen Hospital."
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Papadakos SP, Argyrou A, Karniadakis I, Vogli S, Theocharis S. Immunotherapy in gastrointestinal stromal tumors: Current landscape and future horizons. World J Clin Oncol 2025; 16(6): 104314 [PMID: 40585823 DOI: 10.5306/wjco.v16.i6.104314]
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"Pulmonary fibrosis (PF), a chronic and fatal lung disease affecting millions of people worldwide, urgently needs more effective means. In this paper, the effect of cells vesicles in improving PF was verified through cell lines and rat models, and the possible pathways through which this effect was exerted were investigated. Anyway, there are still some aspects of the article that deserve further discussion. Most importantly, whether the therapeutic effect is exerted through the said signaling pathway needs to be further confirmed. In addition, the text has problems such as writing errors, suspected incompleteness of ethics, and relatively weak research significance."
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Wang LL, Ouyang MY, Yang ZE, Xing SN, Zhao S, Yu HY. Mesenchymal stem cells-derived exosomes alleviate radiation induced pulmonary fibrosis by inhibiting the protein kinase B/nuclear factor kappa B pathway. World J Stem Cells 2025; 17(6): 106488 [PMID: 40585959 DOI: 10.4252/wjsc.v17.i6.106488]
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"We read with great interest the work of Abdelsamie and colleagues, who describe the characteristics of acute myocardial infarction (AMI) in young patients, including presentation, risk factors, coronary angiography findings, and management strategies.1
While AMI is predominantly observed in individuals over 45, its occurrence in younger adults has garnered increasing attention due to its distinct risk factors and long-term consequences. When it occurs, early-onset AMI is often associated with substantial morbidity, psychosocial impact, and economic burden for patients and their families.2 We commend the authors for addressing this important topic, we would like to offer several suggestions that may help to further strengthen the clarity and clinical applicability of the study.
First, the Methods section of the manuscript appears concise and would benefit from additional details to enhance reproducibility. Specifically, the Subjects subsection could provide a more comprehensive account of the exclusion criteria. While inclusion criteria are described, it remains unclear whether important conditions, such as severe cardiomyopathy, rheumatic heart disease, or malignancy, were excluded. Clarifying these aspects would strengthen the credibility and interpretability of the study findings. Additionally, more structured descriptions of Clinical data collection are warranted. It would be helpful to specify how many categories of clinical data were collected (e.g., demographic, biochemical, echocardiographic, electrocardiographic), which variables were included in each, and at what time points they were assessed (e.g., at admission, post-intervention, at discharge).
Second, while the authors correctly note that single-vessel disease predominates among young AMI patients and present the distribution of culprit vessels, the severity and characteristics of the lesions remain insufficiently detailed. Specifically, the lack of ACC/AHA lesion classification and TIMI flow grading limits the angiographic assessment. These indices are clinically relevant for guiding intervention strategy and risk stratification and would add valuable context to the findings.
Third, although the study aims to explore the presentation, risk factors, angiographic findings, and management of young AMI patients, it is noteworthy that clinical symptoms at presentation are not detailed. Given the clinical importance of symptom characterization for early recognition and diagnosis, including this information would help clinicians recognize such cases more effectively. Regarding the management domain, further elaboration on pharmacological therapy, particularly the use of beta-blockers, statins, and antiplatelet agents, would enhance the clinical relevance of the study. It also raises the question of whether young AMI patients tend to present with higher heart rates, and if so, whether adequate heart rate control was achieved during hospitalization or at discharge. As heart rate plays a crucial role in the progression and prognosis of coronary artery disease, such information would provide valuable insight into the effectiveness of secondary prevention strategies in this specific population.
Finally, we appreciate the authors’ observation that obesity, hyperlipidemia, and smoking are prominent in young AMI patients. However, to strengthen this conclusion, we encourage the authors to consider a prospective cohort study design with multivariable adjustment, which could formally assess whether these are independent risk factors for early-onset AMI. Such analysis would increase the translational value of their findings and potentially guide targeted prevention strategies in this unique population.
In conclusion, this study brings attention to a clinically important and under-explored population. We hope that the authors will consider these suggestions to further refine their methodological and clinical insights in future work.
References
1. Ahmed Hegazi Abdelsamie HOA, Ahmed Taha Abdelwahed. Acute myocardial infarction in the young: A 3-year retrospective study. World Journal of Cardiology 2025;17(6) doi: 10.4330/wjc.v17.i6.106445
2. Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016;8(12):728-34. doi: 10.4330/wjc.v8.i12.728
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Hegazi Abdelsamie A, Abdelhadi HO, Abdelwahed AT. Acute myocardial infarction in the young: A 3-year retrospective study. World J Cardiol 2025; 17(6): 106445 [PMID: 40575428 DOI: 10.4330/wjc.v17.i6.106445]
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"The manuscript by Camille Kass and co-authors focuses on the issue of eating disorders following bariatric surgery that may be associated with physical and physiological changes, as well as various psychological phenomena related to the effects of the surgery and dietary modifications. Diagnosis and treatment of these disorders require appropriate categorization within disease classification systems, particularly the DSM-5. However, creating such a classification with the inclusion of new categories in the existing list or expanding the diagnostic criteria requires a requires the accumulation of a sufficiently large database. The presented article describes a case of eating disorder after bariatric surgery with a detailed description of symptoms and their dynamics in the course of complex therapy. Based on the data obtained and the results of literature analysis, the authors conclude that the observed disorder is the closest to avoidant/restrictive food intake disorder according to DSM-5. At the same time, the results of the patient's follow-up confirm the opinions expressed by other authors about the need to include body dysmorphia, and the loss of personal identity associated with severe weight loss, in the diagnostic criteria for ARFID. The presented article has some relevance for the development of a diagnostic system for eating disorders. However, it should be noted that the authors did not practically consider the possible influence of the patient's premorbid background (generalized anxiety disorder) and its interaction with the effects of bariatric surgery on the observed eating disorders. In general, it seems reasonable and interesting to conduct such an analysis using author’s own results and data from the literature. "
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Cass K, Leggett A, Gibson DG. Diagnostic dilemma of avoidant/restrictive food intake disorder after bariatric surgery: A case report and review of literature. World J Clin Cases 2025; 13(24): 106941 [DOI: 10.12998/wjcc.v13.i24.106941]
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"This article is a study on the development and validation of a visceral adipose tissue (VAT)-based delta radiomics model to predict secondary loss of response to infliximab therapy in patients with Crohn’s disease. Both VAT and mesenteric adipose tissue are types of fat tissue that influence the pathogenesis and treatment outcomes in Crohn’s disease, but each has distinct characteristics. VAT refers to a broad range of adipose tissue and affects systemic inflammation and treatment outcomes. In contrast, mesenteric adipose tissue is specifically located around the intestines and is deeply involved in local inflammation and the progression of intestinal pathology. Although mesenteric adipose tissue is considered a part of VAT, its specific role in Crohn’s disease has attracted particular attention. Abnormal proliferation of mesenteric adipose tissue has been suggested to contribute to complex conditions, including intestinal fibrosis, strictures, and perforation. In the future, further investigation into the relationship between VAT and mesenteric adipose tissue is warranted."
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Li X, Song FL, He HF, Zeng SM, Feng ZC, Rong PF. Longitudinal computed tomography-based delta-radiomics of visceral adipose tissue predicts infliximab secondary loss of response in Crohn’s disease patients. World J Gastroenterol 2025; 31(21): 105895 [PMID: 40538512 DOI: 10.3748/wjg.v31.i21.105895]
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"Commentary on articles published in World Journal of Gastroenterology
Reader Perspective
Prof. Zeinab Nabil Ahmed Said
Reader’s code: 02441096)
Prevalence and risk factors of Helicobacter pylori infection in Xinjiang Uygur Autonomous Region: A cross-sectional study of all age groups
Jiang Q, Liu WD, Hui WJ, Kong WJ, Feng Y, Kuerbanjiang A, Huang XL, Gao F. Prevalence and risk factors of Helicobacter pylori infection in Xinjiang Uygur Autonomous Region: A cross-sectional study of all age groups. World J Gastroenterol 2025; 31(21): 106033 [PMID: 40538506 DOI: 10.3748/wjg.v31.i21.106033]
The study is a cross sectional prevalence study to evaluate the H. pylori infection and risk factors in one of the large province in China that located in the northwest of the country with multiethnic aggregation. Such studies pave the way for policy makers for effective implementation of prevention and control strategies. The study involves 15 regions with 18951708 population. A total of 4665 people were surveyed, with questionnaire surveys and H. pylori antibody blood tests were conducted. 4361 were tested for H. pylori antibody. Social, economic factors, public health conditions, as well as dietary and living habits among different areas were evaluated to identify risk factors associated with H. pylori prevalence in different regions.
Methodology:
The reason for having blood samples in the morning on an empty stomach is not clarified. Also, the type of tested Ig must be mentioned. IgG is denoting previous exposure not current infection. Active infection is detected by urea breath tests and stool antigen tests.
Results:
It is better to say overall H pylori prevalence rather than infection.
Tables: Significant p value is better to be marked, by *for example.
Discussion:
This section is well organized and theoretical analysis of data is well presented, however, to avoid the limitation of some missing data, sensitivity analysis is better to be done.
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Zhang Y, Tang YW, Zhou J, Wei YR, Peng YT, Yan Z, Yue ZH. Electroacupuncture at ST36 ameliorates gastric dysmotility in rats with diabetic gastroparesis via the nucleus tractus solitarius-vagal axis. World J Gastroenterol 2025; 31(21): 107395 [PMID: 40538511 DOI: 10.3748/wjg.v31.i21.107395]
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"Dear Editor,
Thank you for inviting me to review the manuscript entitled "Efficacy Comparison of Intravenous Proton Pump Inhibitors versus Oral Potassium-Competitive Acid Blockers Before Endoscopic Therapy for Bleeding Peptic Ulcers." Upon review, I am particularly impressed by the study's advancements and strengths in the following areas:
Focused and Clinically Relevant Topic: This study directly addresses a critical question in gastroenterological practice: optimizing the management strategy for acute upper gastrointestinal bleeding before endoscopic intervention. Comparing the widely used intravenous PPIs with the emerging oral PCABs renders the topic highly timely and of significant clinical value, providing valuable evidence to inform optimal treatment decisions.
Clinically Aligned Study Design: The authors employed a retrospective single-center design, effectively capturing the real-world scenario where physicians select medication (PPI or PCAB) based on individual patient circumstances. Such research based on real-world data yields results with greater direct relevance for guiding routine clinical practice.
Sophisticated Statistical Methodology: Recognizing the potential for confounding inherent in retrospective observational studies, the authors proactively applied Propensity Score Matching (PSM), an advanced statistical technique, to mitigate potential confounders and balance inter-group differences. This demonstrates the authors' commitment to methodological rigor and enhancing the reliability of the findings.
Focus on Core Clinical Outcomes: Selecting rebleeding rate as a primary endpoint is a key strength. This is a robust indicator directly reflecting treatment efficacy and patient safety. Focusing on this core outcome ensures the results possess clear clinical relevance and directly serve the fundamental goal of improving patient prognosis.
Introduction of an Innovative Concept: The proposed "Green Endoscopy" hypothesis – suggesting oral PCABs might reduce waste associated with intravenous drug administration – represents a highly forward-thinking and innovative perspective. This reflects the authors' attention not only to efficacy but also to the sustainability and environmental impact of medical practice, thereby broadening the dimensions of treatment strategy evaluation and opening a valuable new direction for future research.
Clear Data Presentation and Defined Core Findings: The core methodology and results sections are presented clearly, enabling readers to grasp the study's framework and principal findings. Particularly noteworthy is the preliminary indication of comparable efficacy between intravenous PPIs and oral PCABs on key observational metrics, which in itself provides valuable information for clinical practice.
Overall Readability: The manuscript is generally well-written and fluent, effectively communicating the main content and intent of the research, ensuring the efficient transmission of scientific information.
Summary:
Scientific Quality: Grade B
Language Quality: Grade B
Recommendation: Meets publication standards
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Lim NR, Chung WC. Intravenous proton pump inhibitors vs oral potassium competitive acid blockers before endoscopic treatment of bleeding peptic ulcers. World J Gastrointest Endosc 2025; 17(6): 104234 [PMID: 40547546 DOI: 10.4253/wjge.v17.i6.104234]
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"The retrospective study on Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia by Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH is well conducted and written.
It very nicely describes the three techniques ESD, STER and LSW for lesions of the esophagus with excellent illustrations of all the three techniques with figures.
It paves the path for feasibility of further studies will large number of sample size. "
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Lee AY, Lim SG, Cho JY, Kim S, Lee KM, Shin SJ, Noh CK, Lee GH, Hur H, Han SU, Son SY, Song JH. Comparison of treatment strategies for submucosal tumors originating from the muscularis propria at esophagogastric junction or cardia. World J Gastroenterol 2025; 31(23): 106261 [PMID: 40575341 DOI: 10.3748/wjg.v31.i23.106261]
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"This paper provides a systematic review of artificial intelligence (AI) models in the diagnosis of irritable bowel syndrome (IBS), highlighting the potential of AI to improve diagnostic accuracy using complex biomarkers such as the fecal microbiome, gas chromatography, neuroimaging, and protease activity. The review comprehensively summarizes the performance of AI models across various studies, showing promising diagnostic accuracy, particularly in models using fecal microbiome analysis. The findings are clinically relevant, as AI has the potential to overcome the limitations of current symptom-based diagnostic frameworks like the Rome IV criteria, offering a more objective and precise approach to IBS diagnosis."
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Bhagavathula AS, Al Qady AM, Aldhaleei WA. Diagnostic accuracy and quality of artificial intelligence models in irritable bowel syndrome: A systematic review. World J Gastroenterol 2025; 31(23): 106836 [PMID: 40575334 DOI: 10.3748/wjg.v31.i23.106836]
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50
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"This paper provides a timely and insightful review on the application of machine learning (ML) in diagnosing and treating esophageal disorders, including conditions like GERD, esophageal cancer, and achalasia. The study highlights the potential of AI in enhancing diagnostic accuracy and personalizing treatment strategies, which could greatly improve patient outcomes in gastroenterology. The comprehensive synthesis of current literature and the focus on ML’s role in automating diagnosis and optimizing treatment are highly relevant for clinical practice. The manuscript offers significant value by showing how ML can transform the management of esophageal diseases and improve patient care."
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Liu SW, Li P, Li XQ, Wang Q, Duan JY, Chen J, Li RH, Guo YF. Recent advances in machine learning for precision diagnosis and treatment of esophageal disorders. World J Gastroenterol 2025; 31(23): 105076 [PMID: 40575335 DOI: 10.3748/wjg.v31.i23.105076]
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