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"This study offers a compelling and innovative exploration of colonoscopy quality, addressing the critical interplay between insertion time and withdrawal duration to optimize adenoma detection rate (ADR). The proposed "insertion-to-withdrawal" paradigm marks a significant departure from fixed withdrawal time standards, advocating for a personalized approach—a novel and practical advancement. The development of a Shiny app to deliver real-time, individualized guidance further enhances its clinical relevance, providing endoscopists with a valuable tool to improve outcomes.
Several aspects warrant deeper consideration. First, the hybrid SVM-XGBoost model's modest discriminative performance (AUC ≈ 0.64) suggests limitations in its current predictive power, likely due to unaddressed variables such as bowel preparation nuances, insertion difficulty, or segment-specific inspection times. Expanding the dataset with multicenter inputs and incorporating these factors could refine its accuracy. Second, while insertion time serves as a proxy for procedural complexity, its validation against objective difficulty scales or video analysis would bolster the mechanistic basis of the findings. Third, the personalized strategy’s generalizability remains untested; prospective multicenter validation across diverse demographics, endoscopist expertise, and regions is essential. Finally, evaluating real-world app adoption and its impact on ADR adherence would provide critical evidence of its efficacy.
Overall, this study lays a robust foundation for data-driven personalization in endoscopy, moving beyond uniform metrics. With further refinement and validation, it has the potential to transform clinical practice significantly."
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Xu BX, Xu CZ, Zhang HY, Chen XJ, Wei BN, Yang C. Personalizing withdrawal time by insertion time to achieve target adenoma detection rate in colonoscopy. World J Gastroenterol 2025; 31(38): 111364 [PMID: 41112006 DOI: 10.3748/wjg.v31.i38.111364]
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"I want to congratulate Yang-Yang Xiong for publishing an excellent study comparing Endoscopic Clip or EUS Coil-assisted glue for gastric varices. The authors have shown that EUS-guided therapy is more costly and involves high operating time; however, it has similar technical eradication of gastric varices and re-bleeding rates even in larger varices > 4 cm. The size comparison may not be uniform, as the Endoscopic group measured by endoscopic appearance, which may be as accurate as EUS measurement. The Authors have shown only a 5-day rebleeding rate; adding delayed rates could have been more impactful. There is a discrepancy in the table and image regarding post-injection ulcer; the Image shows a post-glue ulcer in both groups, whereas in the table, it was zero; these typographical errors could have been avoided. The eradication time frame is not mentioned; whether it is immediately or 5 days, as the rebleeding rate or any other time frame is not clear. The Follow up endoscopy data is not given; if done even after CT showing eradication of varices or for other GI Bleeding, the time at which it was done was not mentioned, and the procedure done when eradication is not established is also not given. Despite these limitations the study has provided a meaning ful comparison and can change my practice "
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Xiong YY, Li DW, Zhou TY, Ma H, Gao JG, Shen Z, Xu CF, Yu CH. Clip-assisted endoscopic cyanoacrylate injection vs endoscopic ultrasound-guided coil and cyanoacrylate injection for gastric varices: A propensity score-matched study. World J Gastroenterol 2025; 31(38): 111363 [PMID: 41112012 DOI: 10.3748/wjg.v31.i38.111363]
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"This article provides a timely and valuable overview of emerging therapeutic strategies for managing IBD. The integration of physical exercise and VNS as adjuncts to traditional pharmacological treatments is particularly relevant, as clinicians are increasingly seeking non-invasive and complementary approaches to help manage chronic inflammatory diseases. The article does an excellent job of explaining how these interventions may improve autonomic regulation, reduce inflammation, and promote gut health, which are all essential factors in managing the symptoms and progression of IBD. The focus on the vagus nerve’s role in regulating the immune system through the cholinergic anti-inflammatory pathway presents an interesting potential for VNS as a therapeutic tool. The idea that VNS could restore normal immune function, protect the intestinal barrier, and improve the composition of the gut microbiota is compelling, especially for patients who do not respond adequately to conventional treatments. This could open new avenues for clinical practice, offering patients a holistic approach to managing IBD.
However, one of the challenges noted in the article is the variability in response to these non-pharmacological interventions. The review highlights how factors such as exercise intensity, duration, and individual patient factors can influence outcomes. This reflects a common issue in clinical practice, where personalized approaches are often required to determine the best intervention for a given patient. While the evidence for the benefits of physical exercise and VNS in IBD is promising, further studies are needed to establish standardized protocols and validate these therapies in diverse patient populations. The inclusion of vagotomy as a counterpoint to VNS and exercise also brings an important clinical consideration into focus. The article explains how vagotomy, by disrupting the vagal pathway, may exacerbate intestinal inflammation and worsen IBD symptoms. This serves as a reminder of the delicate balance between parasympathetic and sympathetic nervous system function and the potential risks of interfering with this balance in patients with chronic inflammatory conditions."
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da Silva ACA, Severo JS, dos Santos BLB, Soares HS, Martins JA, Lima RSP, Gadelha KKL, Torres-Leal FL, Correia-de-Sá P, Magalhães PJC, Santos AA, da Silva MTB. Role of physical exercise, vagal nerve stimulation, and vagotomy in inflammatory bowel disease. World J Gastroenterol 2025; 31(38): 111252 [PMID: 41112001 DOI: 10.3748/wjg.v31.i38.111252]
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"This article offers a thorough and insightful overview of the transformative potential of multimodal AI in gastroenterology and hepatology. The application of AI across various clinical areas—from early diagnosis to precision treatment—holds great promise. However, the limitations in current AI models—such as lack of data standardization, poor model interpretability, and the need for large-scale, multi-center trials to validate findings—are all issues that would resonate with healthcare professionals. It is crucial for the clinical community to address these issues to ensure that AI technologies can be seamlessly integrated into practice without compromising patient safety or clinical outcomes."
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Wu YM, Tang FY, Qi ZX. Multimodal artificial intelligence technology in the precision diagnosis and treatment of gastroenterology and hepatology: Innovative applications and challenges. World J Gastroenterol 2025; 31(38): 109802 [PMID: 41112005 DOI: 10.3748/wjg.v31.i38.109802]
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"Gestational diabetes (GD) is a complex disorder with metabolic, inflammatory, genetic, and fetoplacental unit display. The screening is based on oral glucose tolerance tests (OGTT) (one-step and two-step), OGTT is limited by low sensetivity. I addition, it is combersome test and the recommendations and cut-off varied significantly between International Organization. GD is common and is associated with poor maternal and fetal outcomes and the development of type 2 diabetes. The intergration of metabolic, inflammatory, genetic, urinary, and placental biomarkers is highly relevant for the personalized approach among various women. The article is of great interset worldwide, I am very thrilled to write and editorial on this interesting manuscript.
Hyder Mirghani, Professor of Internal Medicine and Endocrine, University of Tabuk, Saudi Arabia
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Kaymak D, Ozgu-Erdinc AS. Advances in gestational diabetes mellitus screening: Emerging trends and future directions. World J Diabetes 2025; 16(10): 111309 [PMID: 41113482 DOI: 10.4239/wjd.v16.i10.111309]
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"Hu et al. (World J Gastroenterol. 2025;31:109528) presented a multicenter study evaluating image-guided thermal ablation (IGTA) for oligometastatic colorectal cancer (CRC) with lung involvement. Among 336 patients treated between 2014 and 2022, the 3- and 5-year overall survival rates were 59.5% and 41.0%, respectively, demonstrating meaningful long-term benefit. Extrapulmonary metastases, particularly in the bone and abdominal cavity, significantly worsened outcomes, whereas patients with liver-only metastases had comparatively favorable survival. Elevated tumor markers (CEA, CA19-9), greater tumor burden, and absence of systemic therapy were adverse prognostic factors. Notably, combining IGTA with systemic therapy improved overall survival. This study underscores IGTA as a viable, minimally invasive treatment for patients with oligometastatic CRC and highlights the prognostic relevance of metastatic distribution in guiding personalized therapy."
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Hu XF, Dong XJ, Gu XY, Hu JH, Li XH, Zhao FH, Xia XW, Fan HJ, Xu SF. Extrapulmonary metastases impact survival outcomes of thermal ablation for colorectal lung oligometastases: A multicenter study. World J Gastroenterol 2025; 31(38): 109528 [PMID: 41112004 DOI: 10.3748/wjg.v31.i38.109528]
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"Hyperuricemia and high density lipoproteins are imprortant metabolic and inflammatory biomarkers, they are easy to obtain. In addition, they are among the cardiovascular risk factors (among other ) and are component of the metabolic syndrome. Depression and tpe 2 diabetes are common health disorders with significant burden on the patients, healthcare system, and the community. When the above diseases present together they exacerbate each other serious consequences. Assessing the uric acid-to-high-density lipoprotein cholesterol ratio in diabetes and psychological disease is highly relevant because they are attainable and the literature on these important parameters is scarce.
Thank you very much for the invitation and I would like to publish a letter to the Editor on this interesting topic. "
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Xu H, He DJ, Luo C, Yu XM, Duan CZ, Sun D, Wu DJ, Mao XQ, Jiang WF. Association between uric acid to high-density lipoprotein ratio and mental health symptoms in people with type 2 diabetes. World J Diabetes 2025; 16(10): 110211 [PMID: 41113500 DOI: 10.4239/wjd.v16.i10.110211]
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"Cong et al. deliver a thorough and insightful overview of stem cell–driven cartilage regeneration, addressing the interdisciplinary progress achieved across biomaterials, cellular therapies, and translational research. Their review integrates recent developments in scaffold engineering, stem cell selection, and in vivo regeneration strategies, making it a valuable guide for researchers in this developing field. However, a few key aspects require more in-depth discussion to fully analyse the field’s complexity and clinical translation. For instance, extracellular vesicles—emerging as central mediators of regenerative signaling—warrant more detailed explanation regarding their standardization and underlying mechanisms. Expanding coverage of these areas would improve the depth of the review and strengthen its guidance toward improving reproducibility, safety, and durability in hyaline cartilage repair strategies based on stem cells. Overall, this comprehensive review by Cong et al. highlights that stem cell-based cartilage regeneration is a rapidly advancing and highly promising field, successfully bridging biological strategies and innovative engineering to offer definitive clinical solutions for challenging joint and cartilage defects."
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Cong B, Zhang FH, Zhang HG. Stem cell-based cartilage regeneration: Biological strategies, engineering innovations, and clinical translation. World J Stem Cells 2025; 17(9): 108523 [PMID: 41025101 DOI: 10.4252/wjsc.v17.i9.108523]
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"This manuscript is well-written and well-prepared.
The previous history of adjuvant chemotherapy might have an impact on the oligometastatic disease, particularly in colorectal cancer patients.For the long-term follow-up, this current modality of treatment should be considered as one of the options in giving the multimodality treatment in this case.
The methods is already clear."
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Hu XF, Dong XJ, Gu XY, Hu JH, Li XH, Zhao FH, Xia XW, Fan HJ, Xu SF. Extrapulmonary metastases impact survival outcomes of thermal ablation for colorectal lung oligometastases: A multicenter study. World J Gastroenterol 2025; 31(38): 109528 [PMID: 41112004 DOI: 10.3748/wjg.v31.i38.109528]
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"This study explored that the method of thermal therapy displayed a beneficial role in the prognosis of oligometastatic colorectal lung metastases in patients. It should present the histology features including clinical tumor formation and CT images especially in the determination of different tumor size and outcomes under patients after treatment as author mentioned in this study. In addition, the numbers of distinct groups used for comparison performed a large difference in the statistical analysis.
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Hu XF, Dong XJ, Gu XY, Hu JH, Li XH, Zhao FH, Xia XW, Fan HJ, Xu SF. Extrapulmonary metastases impact survival outcomes of thermal ablation for colorectal lung oligometastases: A multicenter study. World J Gastroenterol 2025; 31(38): 109528 [PMID: 41112004 DOI: 10.3748/wjg.v31.i38.109528]
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"Recent research has uncovered fascinating insights into how a protein called FLOT1 drives liver cancer growth. Scientists found that FLOT1 disrupts normal cellular processes by triggering stress in the Golgi apparatus, essentially giving cancer cells the green light to grow and spread more aggressively. While these findings are exciting and point to FLOT1 as a promising target for new cancer treatments, we still need clinical trials to validate them in patients. Despite this limitation, the study represents a meaningful step forward in our understanding of liver cancer and how we might fight it more effectively in the future."
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Mazziotta C, Rotondo JC. Unraveling the role of flotillin-1 in driving hepatocellular carcinoma progression through transcription factor E3-mediated Golgi stress response. World J Gastroenterol 2025; 31(38): 112489 [PMID: 41112003 DOI: 10.3748/wjg.v31.i38.112489]
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"Machine Learning in Surgical Decision-Making and Non-Surgical Treatment of Alveolar Echinococcosis
Fengying liu,Yongfang Xie
Introduce
Alveolar Echinococcosis (AE) is a chronic, progressive liver disease caused by the ingestion of Echinococcus multilocularis larvae, with foxes and wild dogs as definitive hosts and rodents as intermediate hosts1. It typically centers in the liver, slowly spreading and metastasizing, with an incubation period lasting 5 to 15 years. Due to early non-specific symptoms such as fever and weight loss, patients are often difficult to diagnose in the early stages. In the later stages, continuous asexual reproduction of Echinococcus multilocularis and severe inflammatory granulomatous infiltration around the parasite lead to widespread fibrosis and necrosis. Without timely treatment, the mortality rate of patients can reach 90% within 10 years1. Currently, radical surgery combined with adjuvant chemotherapy is the only curative treatment method2. However, most patients are diagnosed at advanced stages, missing the optimal timing for liver resection. Ex vivo liver resection and liver autotransplantation (ELRA)3 offer hope for these patients, but traditional surgical decision-making often relies on the clinical experience of surgeons, which can be subjective and prone to bias.
In recent years, machine learning has made significant progress in the medical field, especially in disease prediction, treatment selection, and clinical diagnosis, showing tremendous potential for development. By processing large amounts of clinical data, machine learning uncovers complex underlying relationships and assists doctors in making more accurate and objective decisions. Against this backdrop, I carefully reviewed the study published by Da-Long Zhu et al., and found that in the treatment of Alveolar Echinococcosis (HAE), machine learning not only aids in surgical decision-making but also provides valuable support for patients undergoing non-surgical treatments, driving the development of precision medicine4.
1.The Advantages and Challenges of Machine Learning in the Explainability of Surgical Decision-Making for HAE
1.1 Innovative Analysis of Machine Learning
Da-Long Zhu et al. conducted a retrospective cohort study based on data from the First Affiliated Hospital of Xinjiang Medical University, including 710 patients, of whom 545 underwent liver resection and 165 underwent ex vivo liver resection and ELRA. The authors innovatively applied three feature selection techniques—recursive feature elimination, minimum redundancy maximum relevance, and LASSO regression—with cross-validation to enhance the model. Ultimately, they identified 10 key features from the extensive clinical data, including lesion size, vascular invasion type, bile duct invasion degree, white blood cell count, platelet count, hemoglobin, indirect bilirubin, serum creatinine, γ-glutamyl transferase, and prothrombin time. These features are closely related to the prognosis of HAE and provide important data support for surgical decision-making.
Da-Long Zhu et al. systematically compared the performance and explainability of 11 machine learning models, ultimately selecting the XGBoost model and using Bayesian optimization for hyperparameter tuning.XGBoost5,as an efficient ensemble learning algorithm, demonstrates strong predictive ability in various classification and regression tasks. Model evaluation showed an AUC of 0.935 for the training set and 0.734 for the validation set, with a sensitivity of 93.6% and a specificity of 90.9%. Both the calibration curve and decision curve displayed good clinical utility, effectively predicting whether a patient is suitable for liver resection or ELRA. Furthermore, XGBoost, with its ensemble learning characteristics, reduces the risk of overfitting, providing a stable decision-making tool.
To improve the interpretability of the model, Da-Long Zhu et al. employed the SHAP analysis method5 to explain the contribution of each feature to the prediction. Further analysis of the results revealed that vascular invasion type is a key factor in choosing ELRA, while indicators such as platelet count, prothrombin time, and hemoglobin reflect the patient's coagulation function, liver reserve, and inflammatory status. For instance, when significant invasion of the hepatic vein and inferior vena cava is present, the choice of ELRA is more likely, whereas for patients with no vascular invasion or only portal vein involvement, liver resection is preferred. Through SHAP analysis, the model's prediction process became more transparent, enhancing clinicians' trust in the model.
1.2 Limitations and Challenges of the Model
It is commendable that Da-Long Zhu et al. accurately identified the clinical decision-making challenges in the surgical treatment of AE and achieved satisfactory results. However, the model still has some limitations. First, the sample size is relatively small, and the data comes from a single source, which may not fully represent patients from different regions or healthcare settings. Secondly, imaging examinations, such as CT scans, are an important tool for diagnosing HAE. However, the study did not conduct a deeper analysis and evaluation of the quantitative features extracted from imaging omics data, such as tumor morphology, texture, and other imaging features6. According to the research by Yener Aydin et al7, HAE often presents with characteristics such as pulmonary nodules, lesions, cavities, and metastatic tumors in imaging. In clinical practice, small solid nodules are easily confused with malignant tumors. Machine learning can help identify the differences and make accurate judgments. In addition to the XGBoost model used by Da-Long Zhu et al., other machine learning models also have their advantages in clinical prediction tasks. To facilitate the rational selection and comparison of models in this field, the following summary is provided (Table 1).
Table 1
Model Advantages Limitations
XGBoost8
Robust performance, accurate predictions, and comprehensive functionality, suitable for medium-sized data Slower training speed; risk of overfitting, requires regularization control
LightGBM9
Extremely fast training speed, high memory efficiency, suitable for large-scale data Higher risk of overfitting on small datasets
CatBoost10
Excellent handling of categorical features, high prediction accuracy, fast training speed, strong anti-overfitting ability Lower model flexibility
TabNet11
Attention-based deep learning framework, high performance potential, built-in interpretability Requires large datasets and computational power
Therefore, future research should focus on multi-center, large-sample validation to improve the external validity and generalizability of the model. Additionally, extracting quantitative features from imaging omics should be prioritized to enhance the clinical relevance and application value of the model.
2. The Prospects of Machine Learning in Non-Surgical Treatment of HAE
2.1 Current Non-Surgical Treatment Methods for HAE
The non-surgical treatment of HAE relies on albendazole-based medications12, which interfere with microtubule formation by binding to β-tubulin, thereby impairing nutrient absorption and parasite growth. However, albendazole does not kill the parasite and has significant hepatotoxicity. Therefore, although the medication can improve patient survival rates, its effectiveness remains limited, especially for patients who cannot undergo surgery. In such cases, prevention and continuous monitoring become crucial treatment strategies.
In addition to conventional drug therapy, the development of new drugs is also an important direction for non-surgical treatment. Mefloquine12 has shown certain advantages in terms of its anti-parasitic effect and lower hepatotoxicity.Furthermore, progress has been made in vaccine development, such as the recombinant Tetraspanin 3 vaccine13 , which induces strong local and systemic immune responses, effectively protecting humans from infections of Echinococcus multilocularis in the intestine, bloodstream, and liver. However, these studies have not yet undergone large-scale clinical trials and face challenges regarding individual variations in efficacy.
2.2 The Prospects of Machine Learning in HAE Non-Surgical Treatment Through Imaging and Multi-Omics Data
Machine learning also shows great potential in the non-surgical treatment of HAE. By deeply analyzing patients' imaging features and multi-omics data, machine learning can provide precise analysis in early disease diagnosis, treatment processes, and prognosis assessment. Since early symptoms of HAE are often atypical, making early detection difficult, machine learning can significantly enhance the accuracy of early intervention, treatment effectiveness, and prognosis prediction through the deep analysis of imaging features and multi-omics data.
CT scans and MRI images, as the most commonly used imaging tools, help doctors make judgments by analyzing features such as lesion size and shape. Machine learning can extract characteristics such as tumor morphology, size, density, and texture, allowing it to identify potential lesions even before clear clinical symptoms appear. By analyzing features like irregular tumor borders and vascular invasion, machine learning can alert clinicians to high-risk patients without obvious symptoms, assisting in decisions about whether to proceed with surgery or opt for non-surgical treatment. Additionally, features such as cavitation and cystic changes in imaging can reflect the prognosis of the disease.
In conjunction with imaging data, integrated multi-omics analysis (Table 2) can also help identify early biomarkers for HAE. Machine learning can extract features from miRNA1,lncRNAs14, transcriptomics15 and metabolomics , revealing molecular-level changes in the liver of HAE patients. The significant expression of certain miRNAs in HAE, as well as changes in the expression of liver fibrosis-related genes and immune factors, not only aid in early diagnosis but also allow for the detection of treatment responses, helping clinicians assess treatment efficacy and adjust treatment plans (Table 3).
Table 2
Application Methods/Techniques
Imaging Features U-Net16,SVM
Surgical Decision XGBoost,LightGBM,CatBoost
Multi-Omics Data SNF17,DeepProg17,FM
Table 3
Application Area Traditional Methods Machine Learning
Diagnosis Relies on imaging examinations and subjective judgment Automatically extracts imaging features, improving diagnostic accuracy and reducing subjective bias
Surgical Decision Relies on the experience and clinical judgment of surgeons Provides objective, data-driven decision support based on extensive clinical data
Personalization Lacks personalization Analyzes multi-omics and imaging data to revise treatment plans
Early Diagnosis
Relies on clinical symptoms
Combines imaging and omics data to identify potential lesions early
Summary
The study by Da-Long Zhu et al. applies machine learning to surgical decision-making in HAE, providing a more objective and accurate approach to disease treatment. By using various feature selection methods and the XGBoost model, the study successfully identified key features from a large amount of clinical data. The use of SHAP analysis enhanced the model's interpretability, increasing clinicians' trust in the machine learning model. These findings play a crucial role in surgical decision-making and provide strong data support for HAE treatment decisions. By combining imaging and multi-omics analysis, machine learning can play a significant role in both surgical and non-surgical treatment of HAE.
However, current research still faces challenges, such as small sample sizes and single-source data, which affect the external validity and generalizability of the model. Additionally, there is still a lack of feature extraction and in-depth analysis of imaging omics and multi-omics data. Future research should focus on multi-center, large-sample validation to further improve the model's interpretability and clinical relevance.
In conclusion, machine learning demonstrates enormous potential in the surgical and non-surgical treatment of HAE. In the future, it will provide data support and objective analysis for early diagnosis, treatment effectiveness evaluation, and long-term prognosis of HAE patients.
Citation
1. Boubaker, G. et al. Regulation of hepatic microRNAs in response to early stage Echinococcus multilocularis egg infection in C57BL/6 mice. PLoS Negl Trop Dis 14, e0007640 (2020).
2. Liu, H. et al. Induced hepatocyte-like cells derived from adipose-derived stem cells alleviates liver injury in mice infected with Echinococcus Multilocularis. Sci Rep 14, 26296 (2024).
3. McManus, D. P., Gray, D. J., Zhang, W. & Yang, Y. Diagnosis, treatment, and management of echinococcosis. BMJ 344, (2012).
4. Tang, T. et al. Interpretable machine learning model for predicting post-hepatectomy liver failure in hepatocellular carcinoma. Sci Rep 15, 15469 (2025).
5. Liang, D. et al. Perspective: Global Burden of Iodine Deficiency: Insights and Projections to 2050 Using XGBoost and SHAP. Adv Nutr 16, 100384 (2025).
6. Wang, Z. et al. Multiclassification of Hepatic Cystic Echinococcosis by Using Multiple Kernel Learning Framework and Ultrasound Images. Ultrasound Med Biol 50, 1034–1044 (2024).
7. Aydin, Y. et al. Relevance of Pulmonary Alveolar Echinococcosis. Arch Bronconeumol (Engl Ed) 56, 779–783 (2020).
8. Ellmann, S. et al. Tumor grade-titude: XGBoost radiomics paves the way for RCC classification. Eur J Radiol 188, 112146 (2025).
9. Yanagawa, R. et al. LightGBM outperforms other machine learning techniques in predicting graft failure after liver transplantation: Creation of a predictive model through large-scale analysis. Clin Transplant 38, e15316 (2024).
10. Han, Y. et al. Early prediction of sepsis associated encephalopathy in elderly ICU patients using machine learning models: a retrospective study based on the MIMIC-IV database. Front Cell Infect Microbiol 15, 1545979 (2025).
11. Jin, Y. et al. Classification of Alzheimer’s disease using robust TabNet neural networks on genetic data. Math Biosci Eng 20, 8358–8374 (2023).
12. Rufener, R. et al. Activity of mefloquine and mefloquine derivatives against Echinococcus multilocularis. Int J Parasitol Drugs Drug Resist 8, 331–340 (2018).
13. Dang, Z. et al. A Pilot Study on Developing Mucosal Vaccine against Alveolar Echinococcosis (AE) Using Recombinant Tetraspanin 3: Vaccine Efficacy and Immunology. PLoS Negl Trop Dis 6, e1570 (2012).
14. Nian, X. et al. Understanding pathogen–host interplay by expression profiles of lncRNA and mRNA in the liver of Echinococcus multilocularis-infected mice. PLoS Negl Trop Dis 16, e0010435 (2022).
15. Zhang, X. et al. Transcriptomic Profiling Reveals Gene Expression Changes in Mouse Liver Tissue During Alveolar Echinococcosis. Genes (Basel) 16, 839 (2025).
16. Yousef, R. et al. U-Net-Based Models towards Optimal MR Brain Image Segmentation. Diagnostics (Basel) 13, 1624 (2023).
17. Poirion, O. B., Jing, Z., Chaudhary, K., Huang, S. & Garmire, L. X. DeepProg: an ensemble of deep-learning and machine-learning models for prognosis prediction using multi-omics data. Genome Med 13, 112 (2021).
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Zhu DL, Tulahong A, Liu C, Aierken A, Tan W, Ruze R, Yuan ZD, Yin L, Jiang TM, Lin RY, Shao YM, Aji T. Identification of key factors and explainability analysis for surgical decision-making in hepatic alveolar echinococcosis assisted by machine learning. World J Gastroenterol 2025; 31(37): 111038 [PMID: 41025013 DOI: 10.3748/wjg.v31.i37.111038]
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"The quality of evidence is really poor in this article. Besides, there is a real conflict of interest: the author works as a speaker for the laboratory in Mexico, and this is an ethical issue. The conclusion is not valid without the statistical analysis. The sample size is very small, and readers should not believe that sylimarine is useful in MASLD"
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Martínez-Sánchez FD, Martínez-Vázquez SE, Gutiérrez-Monterrubio R, Muñoz-Martínez S, Garcia-Juarez I. Silymarin-alpha lipoic acid and metabolic dysfunction-associated steatotic liver disease: Insights and methodological considerations. World J Hepatol 2025; 17(9): 110162 [PMID: 41024889 DOI: 10.4254/wjh.v17.i9.110162]
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"Great subject, it is very difficult to define when autoimmune hepatitis is refractory and when we should change therapy to a second line. Most of the time, patients receive steroids for long periods, and that is unnecessary. It is very important to switch patients as soon as possible, instead of repeating steroid treatments for long periods, and second- and third-line options are safe and effective treatments, and hepatologists should not be afraid to use them"
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Malakar S, Shamsul Hoda U, Giri S, Samanta A, Roy A, Gupta R, Kumar SR, Agarwal M, Pawar A, Rungta S, Ghoshal UC. Difficult to treat and refractory autoimmune hepatitis: Recent advances in pharmacological management. World J Hepatol 2025; 17(9): 110264 [PMID: 41024881 DOI: 10.4254/wjh.v17.i9.110264]
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"After reading with great interest the recent article by Liu et al. (2025) comparing the safety and efficacy of 40 mg/day and 80 mg/day initial doses of lurasidone in acute schizophrenia. The study addresses a clinically relevant question regarding optimal dosing strategies, particularly in Chinese populations where approved doses may differ from international guidelines.
The authors should be commended for their pragmatic trial design, which incorporated a one-week fixed-dose period followed by flexible dosing—a approach that closely mirrors real-world clinical practice. The finding of no significant difference in discontinuation rates due to adverse events (3.03% vs 5.10%, P=0.707) between the two dosing strategies provides valuable evidence supporting the safety of initiating treatment at 80 mg/day.
Several aspects of the results deserve particular attention. The early advantage in PANSS positive subscale improvement observed in the 80 mg/day group at weeks 1 and 2 (P<0.05) suggests that higher initial dosing may offer more rapid control of psychotic symptoms—a potentially important consideration in acute care settings. Equally noteworthy was the paradoxical finding regarding weight change, with the 40 mg/day group showing significant weight gain (0.83 kg, P<0.01) compared to minimal change in the 80 mg/day group (-0.08 kg). This observation challenges conventional dose-response expectations and warrants further investigation.
However, some limitations should be considered when interpreting these findings. The open-label design, while pragmatic, introduces potential for assessment bias. Additionally, the relatively short 6-week duration limits understanding of long-term outcomes, and the sample size, though adequate for safety endpoints, may be underpowered for certain efficacy comparisons.
Despite these limitations, this study makes a valuable contribution to the literature by demonstrating that 80 mg/day initiation appears to be a viable and safe option that may offer early symptomatic benefits without increased metabolic risk. These findings should encourage clinicians to consider individual patient needs when selecting initial doses, particularly when rapid symptom control is prioritized.
Future research with longer follow-up and broader dose ranges would help further elucidate the optimal dosing strategies for lurasidone in diverse clinical populations."
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Liu Q, Qian MC, Liu ZF, Dong F, Liu DT, Li ML, Ning YP, Wang XP, Liu TB, Wu Q, Li T, Yu X. Safety and efficacy of different initial doses of lurasidone in the schizophrenia treatment: A multi-center, randomized, open-label study. World J Psychiatry 2025; 15(10): 110968 [PMID: 41112599 DOI: 10.5498/wjp.v15.i10.110968]
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"This study addresses a key technical challenge in the treatment of rectal neuroendocrine tumors (NETs) by innovatively evaluating the advantages of pretraction-assisted endoscopic submucosal dissection (p-ESD) over conventional endoscopic submucosal dissection (c-ESD). The encouraging findings provide valuable evidence for clinical practice. Through a rigorous retrospective cohort study, the authors demonstrated that the p-ESD technique significantly shortens dissection time, improves the R0 resection rates, and reduces the risk of intraoperative bleeding and muscularis propria injury. These results strongly align with the fundamental principle of traction-assisted endoscopic submucosal dissection: enhancing safety and efficiency by improving exposure of the submucosal plane. The concept of "pretraction" – establishing traction before mucosal incision – is particularly commendable. Compared to methods applying traction after incision, this approach may provide earlier and more sustained visualization, potentially representing the key innovation leading to the superior outcomes. While fully acknowledging the value of this study, we offer the following suggestions for consideration to strengthen the manuscript further: 1. Technical standardization and learning curve: The article notes that all procedures were performed by a single expert endoscopist, ensuring consistency but raising an important question. What is the learning curve for the p-ESD technique? For less experienced operators, how challenging is it to master the timing of device placement and tension control? Future studies involving operators with varying experience levels or providing standardized procedural videos and schematic diagrams would greatly promote the dissemination of this technique. 2. Comparison with other traction techniques: the discussion appropriately cites studies where other traction methods showed less pronounced benefits for rectal lesions. This highlights the potential uniqueness of the p-ESD technique described. A more in-depth comparison of the similarities and differences between various traction methods, in terms of mechanical principles and application scenarios, would help readers better understand why the pre-traction strategy employed in this study achieves such significant results. Overall, the study by Guo et al. presents a safer and more efficient option for the minimally invasive treatment of rectal NETs. We look forward to further prospective studies from this team and other centers to validate the broad applicability of this technique and explore its standardized training protocols."
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Guo XX, Zhang SH, Chen AJ, Chen YL, Chen FL. Efficacy and safety of pretraction-assisted endoscopic submucosal dissection for treating rectal neuroendocrine tumors. World J Gastrointest Endosc 2025; 17(9): 111734 [PMID: 40979064 DOI: 10.4253/wjge.v17.i9.111734]
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"Working towards improving transarterial chemoembolization (TACE) outcomes for hepatocellular carcinoma
Eduardo Segovia-Vergara, Arturo Alonso, Rodrigo Mansilla-Vivar
Abstract: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, and transarterial chemoembolization (TACE) is a cornerstone therapy for patients with intermediate or advanced disease. However, TACE outcomes are influenced by multiple clinical, imaging, and psychosocial factors. Recent studies highlight the value of a multidisciplinary approach to optimize post-TACE management. This includes assessing immune, coagulation, and biomarker responses to predict prognosis, applying magnetic resonance imaging bias field correction to improve tumor evaluation, and identifying risk factors for post-procedural complications such as infections. Together, these strategies work towards improving TACE results for HCC, emphasizing the need for integrated care that combines technological, clinical, and supportive interventions.
Dear Editor,
We read with great interest the recent articles addressing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), including the works by Song et al., Liu et al., Fu et al., and Shan et al. These studies provide valuable insights into the clinical, imaging, and systemic aspects of TACE, highlighting its therapeutic potential as well as the challenges in optimizing patient outcomes.
Taken together, these studies emphasize the value of integrating clinical, imaging, and systemic considerations to improve outcome prediction and manage complications in HCC patients undergoing TACE, and they motivate a discussion on strategies aimed at enhancing TACE efficacy through a multidisciplinary approach. Although these studies provide important insights, some are limited by retrospective designs, small sample sizes, among other limitations. Nevertheless, these findings underscore the need for coordinated, multidisciplinary strategies in HCC patients undergoing TACE.
Building on this evidence, this letter aims to discuss potential approaches to enhance TACE outcomes by integrating clinical evaluation, advanced imaging, complication management, and supportive care.
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Wei LL, Lai YL, Qiu KH, He X, Yang T. Clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer. World J Gastrointest Surg 2025; 17(9): 106995 [PMID: 41024826 DOI: 10.4240/wjgs.v17.i9.106995]
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"This guideline is a powerful and practical tool for the pluralistic management of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. This interesting tool, appropriate for making clinical decisions about IBD management in the United Arab Emirates, may be useful for addressing those chronic disorders elsewhere. The content is insightful. The work is interesting, and the text is well written."
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Al Awadhi S, Al Hassani A, El Ouali S, Alam MB, Azar C, Georgopoulos F, Jazzar AN, Khassouan AM, Koutoubi Z, Nathwani RA, Quraishi MN. Second United Arab Emirates consensus guidance on the diagnosis and management of inflammatory bowel disease. World J Gastroenterol 2025; 31(35): 109882 [PMID: 41024766 DOI: 10.3748/wjg.v31.i35.109882]
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"Reader Comments on “Cystatin C–based equations: Enhancing accuracy in kidney function tests for type 2 diabetes”
World Journal of Nephrology. 2025; 14(3): 102756. DOI: 10.5527/wjn.v14.i3.102756
Dear Editor,
Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) worldwide, I read with great interest this topic, which highlights the role of cystatin C–based equations in improving the accuracy of renal function assessment in patients with type 2 diabetes mellitus (T2DM).
Strengths of the article:
The paper clearly underscores the limitations of creatinine-based estimated glomerular filtration rate (eGFR), especially in diabetic patients where muscle mass may distort results.
The authors’ emphasis on cystatin C as a more reliable biomarker, along with advocacy for combined creatinine–cystatin C equations as recommended by KDIGO, reflects current evidence-based practice.
The discussion on integrating cystatin C into precision medicine approaches, particularly alongside artificial intelligence (AI), is forward-thinking and aligns with global efforts toward individualized care.
While cystatin C reduces creatinine-related biases, factors such as thyroid dysfunction, systemic inflammation, and corticosteroid use may also influence its levels.
Table 1 offers a concise and summary of the main methods for estimating GFR.
Points for further consideration:
Role of renal biopsy: The article notes the underutilization of renal biopsy in DKD diagnosis. Expanding on how cystatin C may complement, but not replace, biopsy in complex diagnostic scenarios could be useful.
Outcome validation: Future studies should demonstrate whether cystatin C–based eGFR translates into better clinical outcomes (e.g., reduced DKD progression, lower cardiovascular events, delayed dialysis initiation) beyond improved diagnostic precision.
AI applications: The proposed integration of cystatin C into AI-driven models is exciting. Specific examples or pilot studies where biomarker–AI integration has improved predictive accuracy would strengthen this vision.
Conclusion:
This editorial makes an important contribution by advocating for more accurate renal assessment in patients with T2DM. The call for cystatin C integration, particularly in high-risk populations, is well-justified and aligned with evolving guidelines. Broader validation, cost-effectiveness studies, and exploration of biomarker–AI synergy will be critical steps toward translating these insights into standard nephrology practice.
Sincerely,
[Rabie M Ibrahim, MD in urology]
Urology department, Faculty of medicine
Beni-Suef University, Beni-Suef, Egypt.
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Gembillo G, Sessa C, Santoro D. Cystatin C-based equations: Enhancing accuracy in kidney function tests for type 2 diabetes. World J Nephrol 2025; 14(3): 102756 [PMID: 41024961 DOI: 10.5527/wjn.v14.i3.102756]
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"This systematic review and meta-analysis highlight the importance of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections by providing a comprehensive analysis of randomized controlled trials (RCTs). It concluded that prehabilitation was associated with fewer postoperative complications compared to no prehabilitation, with a risk ratio (RR) of 0.79 (95% CI: 0.66-0.95, P = 0.01). Also there is tendency towards shorter hospital stay. No statistically significant differences were found between prehabilitation and no prehabilitation groups for postoperative readmission rates (RR: 1.31, 95% CI: 0.79-2.17, P = 0.29), major complications (RR: 1.08, 95% CI: 0.61-1.92, P = 0.78), length of stay (standardized mean difference: -0.11, 95% CI: -0.31 to 0.1, P = 0.29), or mortality (RR: 0.28, 95% CI: 0.01-6.51, P = 0.43). The study highlights that hepatobiliary and pancreatic cancers are highly lethal, and surgical intervention, though central to treatment, often leads to postoperative complications. Prehabilitation is proposed as a tool to optimize patients preoperatively, thereby reducing morbidity and improving recovery. Despite its findings, the authors acknowledge limitations, such as the relatively small sample size due to strict inclusion criteria of only RCTs, which may limit the generalizability. We found that the article does not explicitly address pulmonary complications, which are common in patients undergoing major abdominal surgeries, including hepatobiliary and pancreatic resections. This omission leaves a gap in understanding the full spectrum of prehabilitation's impact. The article notes that postoperative rehabilitative care varied between included trials, introducing heterogeneity. This makes it challenging to clearly differentiate between a 'prehabilitation' group and a 'standard care' group, especially since elements like nutritional support and pulmonary exercises are often considered standard preoperative care for these patients. The varied prehabilitation protocols (multimodal, nutritional, or exercise-based) further complicate this distinction. In conclusion, while this article provides valuable evidence that prehabilitation can reduce overall postoperative complications in hepatobiliary and pancreatic cancer resections, its limitations regarding sample size, protocol heterogeneity, lack of long-term data, and unaddressed specific complications like pulmonary issues highlight the need for more focused and standardized research in this critical area."
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Lubbad O, Mahmood WU, Shafique S, Singh KK, Khera G, Sajid MS. Effect of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections: A systematic review and meta-analysis. World J Gastrointest Endosc 2025; 17(9): 109029 [PMID: 40979053 DOI: 10.4253/wjge.v17.i9.109029]
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"Colorectal Strictures in Ulcerative Colitis
To the Editor,
I read with great interest the article by Shao et al., titled “Risk Factors and Long-Term Prognosis for Colorectal Strictures in Ulcerative Colitis” (1). The authors have provided valuable insights into the natural history and risk stratification of stricture formation in ulcerative colitis (UC). I would like to offer several comments and pose a few questions for further clarification and discussion.
First, Figure 1 in the article clearly illustrates that the risk of stricture formation increases with disease duration in UC. The graph appears to show a near-linear progression, with an estimated annual risk of approximately 1.2% per year post-diagnosis. This finding reinforces the understanding that strictures are a time-dependent complication of UC.
Second, stricture formation is generally considered a marker of chronic and progressive disease. Therefore, the increased frequency of certain clinical features—such as anemia and extraintestinal manifestations—among patients with strictures may reflect prolonged disease activity rather than being directly caused by the strictures themselves. Similarly, higher rates of corticosteroid use and steroid resistance could also be secondary to a more advanced disease state. In this context, the reported risk factors (older age, elevated ESR and CRP, prior steroid use) may be better interpreted as indirect indicators of disease chronicity rather than primary etiologic factors.
Third, it is not surprising that strictures most commonly occur in the sigmoid colon, given its status as the narrowest anatomical segment of the large intestine. Wall thickening in this region is more likely to result in significant luminal narrowing, potentially predisposing this site to stricture formation.
Fourth, the relationship between UC and cigarette smoking remains one of the more intriguing and paradoxical findings in inflammatory bowel disease research (2). While smoking is generally associated with a reduced risk of developing UC, the absence of a significant difference in smoking status between patients with and without strictures in this study is noteworthy (3). Further exploration of this finding may yield important mechanistic insights.
Fifth, the higher incidence of bowel obstruction in patients with strictures is expected. However, the increased frequency of toxic megacolon in this group is particularly interesting. This could be explained either by the long-standing disease course or possibly by obstruction-induced colonic distension acting as a trigger for toxic megacolon.
In light of these observations, I would like to pose the following questions:
1. Is it feasible to classify colonic strictures in UC patients based on clinical parameters such as disease severity, prognosis, or response to treatment? Would such a classification have therapeutic or prognostic value?
2. Are there notable clinical differences between patients with solitary versus multiple strictures? For instance, do patients with multiple strictures have a longer disease duration or higher risk of complications such as colorectal cancer or toxic megacolon?
3. Among the eight patients in whom strictures resolved during follow-up, what were their clinical characteristics? Was remission attributed to specific therapies, or could patient-related factors (e.g., genetic or immunological profiles) have contributed? Furthermore, was the possibility of pseudo-strictures or diagnostic misclassification considered?
I commend the authors for their important contribution to our understanding of this complex and clinically relevant complication of UC and would appreciate any additional insights they may offer in response.
Sincerely,
Cuneyt Kayaalp MD, Professor, Istanbul Atlas University, Department of General Surgery, Istanbul, Turkiye
cuneytkayaalp@gmail.com, +90 533 4757434
Reference
1. Shao YP, Han TT, Lv H, Yang ST, Zhu QL, Li J, Li JN. Risk factors and long-term prognosis for colorectal strictures in ulcerative colitis. World J Gastroenterol. 2025 Sep 7;31(33):109938. doi: 10.3748/wjg.v31.i33.109938. PMID: 40933463; PMCID: PMC12417941.
2. Alperen CC, Soydas B, Serin E, Erbayrak M, Savas NA, Unler GK, Meral CE, Toprak U, Boyacioglu AS, Dagli U. Role of Environmental Risk Factors in the Etiology of Inflammatory Bowel Diseases: A Multicenter Study. Dig Dis Sci. 2024 Aug;69(8):2927-2936. doi: 10.1007/s10620-024-08491-w. Epub 2024 Jun 5. PMID: 38837110.
3. Harmandar F, Çekin AH. Preventive care in inflammatory bowel disease. Turk J Gastroenterol. 2017 Jul;28(4):307-310. doi: 10.5152/tjg.2017.190617. PMID: 28699605.
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Shao YP, Han TT, Lv H, Yang ST, Zhu QL, Li J, Li JN. Risk factors and long-term prognosis for colorectal strictures in ulcerative colitis. World J Gastroenterol 2025; 31(33): 109938 [PMID: 40933463 DOI: 10.3748/wjg.v31.i33.109938]
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"Inhibition of Hippo/YAP signaling pathways by levodopa as novel therapeutic approaches for liver fibrosis.
Jin-Bo Zhao1*, Gu-Qing Luo1*, Jia-Yun Lin1, Chi-Hao Zhang1, Guang-Bo Wu1, Hongjie Li1,Meng Luo1, Zheng-Hao Wu1#, Lei Zheng1#
1Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. *, # equal contribution.
Abstract
This commentary discusses a recently published article in the World Journal of Gastroenterology. Using a rat model of liver fibrosis induced by CCl4 Injection, the article confirms that Dopamine receptor D1 (DRD1) is closely associated with liver injury and the progression of liver fibrosis. To verify that the interaction between this receptor and the Yes-associated protein 1 (YAP1) signaling pathway plays a critical role in liver fibrosis, levodopa was administered in the CCl4 rat model to activate DRD1, which in turn inhibited the nuclear translocation of YAP1 protein. In previous studies, YAP1 has been shown to exert important functions in the process of liver injury repair. Therefore, the findings of this study demonstrate the interaction between DRD1, activated by levodopa treatment and the YAP1 signaling pathway, thereby providing evidence from animal experiments to support levodopa as a novel therapeutic strategy for liver fibrosis.
Key Words: Dopamine receptor D1; Liver fibrosis; Yes-associated protein 1, CCl4 rat model, G protein-coupled receptors
Core Tip: Based on the results of previous studies and preliminary experiments, this manuscript confirms a close association between the activation of DRD1 and the YAP1 signaling pathway. Notably, the nuclear translocation of YAP1 is a key mechanism for YAP1 to exert its biological functions. Activation of DRD1 by levodopa inhibits the nuclear translocation of YAP1, thereby alleviating liver injury and retarding the progression of liver fibrosis.
TO THE EDITOR
G protein-coupled receptors (GPCRs) constitute the largest family of membrane receptors encoded by the human genome and stand out as highly productive therapeutic targets—ligands targeting GPCRs represent over 30% of all clinically approved medications[1]. For fibrotic disorders, researchers have explored both GPCR inhibitors[2-5] and activators[6-8] to evaluate their therapeutic potential. Functionally, GPCRs interact with effector proteins associated with four major classes of G-proteins. Recent studies have clarified a key functional distinction: activation of GPCRs coupled to Gα12/13, Gαq/11, or Gαi/o subtypes promotes the nuclear translocation and transcriptional activity of YAP/TAZ; by contrast, GPCRs that couple to Gαs suppress YAP/TAZ nuclear localization and functional activity through increasing cyclic adenosine monophosphate (cAMP) levels[9]. Critically, GPCR expression exhibits significant heterogeneity—varying not only across different organs but also among adjacent cell types within the same tissue[10]. This expression pattern opens up the possibility of developing GPCR-directed therapies as a strategy for cell-selective inhibition of YAP/TAZ. Specifically, identifying and activating a GPCR that is selectively expressed on fibroblasts could provide a targeted approach: by inhibiting YAP/TAZ within the activated fibroblasts that drive disease progression, such a strategy could counteract multiple pro-fibrotic stimuli simultaneously.
In the present study, researchers identified the dopamine receptor DRD1 as a fibroblast-selective target. When activated (via agonism), DRD1 inhibits YAP/TAZ-mediated fibroblast activation, reduces extracellular matrix (ECM) deposition and stiffening, and ultimately reverses experimental liver fibrosis. Biologically, DRD1 exhibits selective coupling to Gαs, a interaction that drives cAMP elevation[11]. This coupling enables DRD1 to counteract both mechanical and biochemical pro-fibrotic signals that otherwise promote fibroblast activation. Functionally, this translates to a key phenotypic shift in fibroblasts: DRD1 agonism effectively converts fibroblasts from a state that supports ECM deposition and tissue stiffening to one that favors ECM degradation and tissue softening. Against this research background, the administration of levodopa in CCl₄ rat model effectively activated DRD1, which was followed by the inhibition of YAP1 nuclear translocation. This sequence of events significantly suppressed the role of YAP1 in the progression of liver fibrosis. This promising finding provides an opportunity for the clinical application of this therapeutic target.
MAIN FINDINGS OF THIS STUDY
In this study, the administration of levodopa in CCl₄-induced rat model initially demonstrated alleviation of liver injury and liver fibrosis. Meanwhile, by reducing the dose of levodopa, the severe side effects of levodopa in the rat model treatment were partially avoided. Subsequently, experimental assays confirmed the significant activation of DRD1 and the inhibition of YAP1. Furthermore, through the detection of phosphorylated YAP1 (p-YAP1), the study elaborated on the detailed mechanism underlying the inhibition of the YAP1 signaling pathway. Combining the experimental results with the basic insights from previous studies, and by detailing the protein signaling pathway mechanism, this research revealed the critical mechanism of DRD1 activation in the progression of liver fibrosis.
THE LIMITATIONS OF THIS STUDY
The findings of this study are limited to CCl₄-induced rat model, which cannot fully encompass the comprehensive pathogenesis of liver fibrosis and cirrhosis[12-14]. Therefore, further studies using other models and human samples are required to validate the therapeutic role of DRD1 in the progression of liver fibrosis. Moreover, the expression of YAP1 exhibits cellular heterogeneity in the liver: YAP1 is expressed at non-negligible levels in cholangiocytes[15], endothelial cells, and hepatocytes, where it exerts critical functions, and changes in its expression during disease have also been extensively investigated. Notably, the functions and mechanisms of YAP1 in different cell types correspond to distinct pathological phenotypes, thereby exerting diverse physiological effects on the progression of liver fibrosis[16]. Furthermore, in studies on the role of the YAP1 protein in liver fibrosis, researchers have used verteporfin and metformin to inhibit the intrahepatic fibrotic process. Meanwhile, at the cellular level, in-depth investigations have been conducted into the function of the YAP1 protein in cholangiocytes and hepatic stellate cells[17]. Therefore, in future research, the cell type-specific localization of functionally active DRD1 should be precisely identified, which will facilitate a more accurate understanding of the therapeutic target responsible for its anti-fibrotic effects.
CLINICAL SIGNIFICANCE OF THIS STUDY
Despite the limitations, this study still holds significant clinical implications: Using levodopa (a DRD1 agonist), the researchers demonstrated that activation of this receptor in the liver and inhibition of YAP1 nuclear translocation could be achieved. Based on previous studies investigating the mechanism of YAP1 action in various liver cell types, YAP1 has been shown to accelerate the development and progression of liver diseases[16]. Although this study failed to specifically target and inhibit YAP1 function in a single specific liver cell type, comprehensive inhibition of intrahepatic YAP1 function may effectively alleviate disease progression. Collectively, these findings provide a potential and effective therapeutic target for the clinical treatment of liver fibrosis.
CONCLUSION
Currently, the mechanism by which DRD1 activation improves liver function in patients with chronic liver disease and liver fibrosis remains insufficiently understood. In-depth exploration of this underlying mechanism will provide a new direction for the clinical translation of DRD1 activation strategies. Furthermore, conducting clinical studies to evaluate the safety of DRD1 activation for liver fibrosis treatment, standardizing the manufacturing process of DRD1 agonists, and developing novel DRD1 activators will offer evidence to validate the clinical application of DRD1-based therapies.
CONTRIBUTOR INFORMATION
Jin-Bo Zhao,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gu-Qing Luo,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Jia-Yun Lin,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Chi-Hao Zhang,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Guang-Bo Wu,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Hongjie Li,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Meng Luo, Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Zheng-Hao Wu,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Lei Zheng,Department of General Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.zl1055174020@163.com
REFERENCES
1 Hauser AS, Attwood MM, Rask-Andersen M, Schiöth HB, Gloriam DE. Trends in GPCR drug discovery: new agents, targets and indications. Nat Rev Drug Discov. 2017. 16(12): 829-842.
2 Swigris JJ, Brown KK. The role of endothelin-1 in the pathogenesis of idiopathic pulmonary fibrosis. BioDrugs 2010; 24: 49-54 [PMID: 20055532 DOI: 10.2165/11319550-000000000-00000]
3 Tager AM, LaCamera P, Shea BS, Campanella GS, Selman M, Zhao Z, Polosukhin V, Wain J, Karimi-Shah BA, Kim ND, Hart WK, Pardo A, Blackwell TS, Xu Y, Chun J, Luster AD. The lysophosphatidic acid receptor LPA1 links pulmonary fibrosis to lung injury by mediating fibroblast recruitment and vascular leak. Nat Med 2008; 14: 45-54 [PMID: 18066075 DOI: 10.1038/nm1685]
4 Ikeda H, Yatomi Y. Autotaxin in liver fibrosis. Clin Chim Acta 2012; 413: 1817-1821 [PMID: 22820036 DOI: 10.1016/j.cca.2012.07.014]
5 Rodríguez-Pascual F, Busnadiego O, González-Santamaría J. The profibrotic role of endothelin-1: is the door still open for the treatment of fibrotic diseases. Life Sci 2014; 118: 156-164 [PMID: 24378671 DOI: 10.1016/j.lfs.2013.12.024]
6 Polat B, Halici Z, Cadirci E, Karakus E, Bayir Y, Albayrak A, Unal D. Liver 5-HT7 receptors: A novel regulator target of fibrosis and inflammation-induced chronic liver injury in vivo and in vitro. Int Immunopharmacol 2017; 43: 227-235 [PMID: 28043031 DOI: 10.1016/j.intimp.2016.12.023]
7 McBride A, Hoy AM, Bamford MJ, Mossakowska DE, Ruediger MP, Griggs J, Desai S, Simpson K, Caballero-Hernandez I, Iredale JP, Pell T, Aucott RL, Holmes DS, Webster SP, Fallowfield JA. In search of a small molecule agonist of the relaxin receptor RXFP1 for the treatment of liver fibrosis. Sci Rep 2017; 7: 10806 [PMID: 28883402 DOI: 10.1038/s41598-017-10521-9]
8 Huang S, Wettlaufer SH, Hogaboam C, Aronoff DM, Peters-Golden M. Prostaglandin E(2) inhibits collagen expression and proliferation in patient-derived normal lung fibroblasts via E prostanoid 2 receptor and cAMP signaling. Am J Physiol Lung Cell Mol Physiol 2007; 292: L405-413 [PMID: 17028262 DOI: 10.1152/ajplung.00232.2006]
9 Yu FX, Zhao B, Panupinthu N, Jewell JL, Lian I, Wang LH, Zhao J, Yuan H, Tumaneng K, Li H, Fu XD, Mills GB, Guan KL. Regulation of the Hippo-YAP pathway by G-protein-coupled receptor signaling. Cell 2012; 150: 780-791 [PMID: 22863277 DOI: 10.1016/j.cell.2012.06.037]
10 Insel PA, Snead A, Murray F, Zhang L, Yokouchi H, Katakia T, Kwon O, Dimucci D, Wilderman A. GPCR expression in tissues and cells: are the optimal receptors being used as drug targets. Br J Pharmacol 2012; 165: 1613-1616 [PMID: 21488863 DOI: 10.1111/j.1476-5381.2011.01434.x]
11 Flock T, Hauser AS, Lund N, Gloriam DE, Balaji S, Babu MM. Selectivity determinants of GPCR-G-protein binding. Nature 2017; 545: 317-322 [PMID: 28489817 DOI: 10.1038/nature22070]
12 Berumen J, Baglieri J, Kisseleva T, Mekeel K. Liver fibrosis: Pathophysiology and clinical implications. WIREs Mech Dis 2021; 13: e1499 [PMID: 32713091 DOI: 10.1002/wsbm.1499]
13 Kannt A, Wohlfart P, Madsen AN, Veidal SS, Feigh M, Schmoll D. Activation of thyroid hormone receptor-β improved disease activity and metabolism independent of body weight in a mouse model of non-alcoholic steatohepatitis and fibrosis. Br J Pharmacol 2021; 178: 2412-2423 [PMID: 33655500 DOI: 10.1111/bph.15427]
14 Bosch J, Iwakiri Y. The portal hypertension syndrome: etiology, classification, relevance, and animal models. Hepatol Int 2018; 12: 1-10 [PMID: 29064029 DOI: 10.1007/s12072-017-9827-9]
15 Zhang J, Lyu Z, Li B, You Z, Cui N, Li Y, Li Y, Huang B, Chen R, Chen Y, Peng Y, Fang J, Wang Q, Miao Q, Tang R, Gershwin ME, Lian M, Xiao X, Ma X. P4HA2 induces hepatic ductular reaction and biliary fibrosis in chronic cholestatic liver diseases. Hepatology 2023; 78: 10-25 [PMID: 36799463 DOI: 10.1097/HEP.0000000000000317]
16 Lee NY, Choi MG, Lee EJ, Koo JH. Interplay between YAP/TAZ and metabolic dysfunction-associated steatotic liver disease progression. Arch Pharm Res 2024; 47: 558-570 [PMID: 38874747 DOI: 10.1007/s12272-024-01501-5]
17 Ye L, Ziesch A, Schneider JS, Ofner A, Nieß H, Denk G, Hohenester S, Mayr D, Mahajan UM, Munker S, Khaled NB, Wimmer R, Gerbes AL, Mayerle J, He Y, Geier A, Toni EN, Zhang C, Reiter FP. The inhibition of YAP Signaling Prevents Chronic Biliary Fibrosis in the Abcb4(-/-) Model by Modulation of Hepatic Stellate Cell and Bile Duct Epithelium Cell Pathophysiology. Aging Dis 2024; 15: 338-356 [PMID: 37307826 DOI: 10.14336/AD.2023.0602]
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Wang HY, Qi MM, Zhang K, Zhu YZ, Zhang J. Dopamine receptor D1-mediated suppression of liver fibrosis via Hippo/Yes-associated protein 1 signaling in levodopa treatment. World J Gastroenterol 2025; 31(34): 108617 [PMID: 40937451 DOI: 10.3748/wjg.v31.i34.108617]
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"The study by Özcan and Düzgün provides valuable real-world evidence on the timing of diverting loop ileostomy closure after rectal resection. The authors show that early closure is associated with similar complication rates compared to late closure, while offering advantages such as fewer readmissions for dehydration and improved psychosocial recovery. The manuscript is clearly structured, the methods are adequately described, and the results are consistent with prior randomized controlled trials suggesting that early closure may be safe in selected patients.
The main limitation is its retrospective single-center design, which introduces potential selection bias and limits long-term conclusions. Nonetheless, the findings contribute meaningful data that reinforce the need for further multicenter randomized trials. Overall, this is a timely and clinically relevant study that highlights the potential benefits of early ileostomy closure when applied selectively."
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Özcan P, Düzgün Ö. Comparison of complication rates after early and late closure of loop ileostomies: A retrospective cohort study. World J Gastrointest Surg 2025; 17(8): 109432 [PMID: 40949372 DOI: 10.4240/wjgs.v17.i8.109432]
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"To the Editor,
We read with great interest the editorial by Elshahhat and Almekoud entitled “Radial head arthroplasty: A pillar of stability in complex elbow fractures” (World J Orthop 2025;16(9):110433). The authors provide a comprehensive synthesis of the current literature on radial head arthroplasty (RHA) in Mason type III and IV fractures, emphasizing its biomechanical rationale, implant design evolution, and complication spectrum. Their analysis convincingly reinforces the notion of RHA as a cornerstone in the management of irreparable radial head fractures where elbow stability is threatened. We would like to commend the authors for highlighting the lateral column’s biomechanical role and for proposing a pragmatic treatment algorithm that can guide clinical decision-making in these challenging injuries. At the same time, we wish to offer additional perspectives and constructive critiques to further enrich the ongoing discussion.
First, we strongly support the emphasis placed on the biomechanical significance of the radial head. As the authors correctly point out, the radial head acts as a secondary stabilizer to valgus stress and contributes to posterolateral rotatory stability, especially in the setting of collateral ligament insufficiency [1]. In our own clinical practice, we have observed that restoration of the radial head through arthroplasty often serves as the linchpin for achieving functional stability when addressing terrible triad injuries or fracture-dislocations [2]. However, one aspect that merits further elaboration is the interaction between implant morphology and patient-specific anatomy. Morphometric studies have shown considerable variability in radial head dimensions, offsets, and orientations [3,4], which makes the “one-size-fits-all” approach potentially problematic. While modular systems address some of these concerns, the risk of overstuffing or malalignment persists, underscoring the need for preoperative three-dimensional imaging and possibly patient-specific templating [5].
Second, we agree with the authors’ assessment that RHA has largely supplanted resection in the context of ligamentous injuries, given the deleterious consequences of proximal radial migration and valgus overload [6]. Nevertheless, the long-term durability of RHA remains an unresolved issue. Although multiple meta-analyses suggest high short- to mid-term survivorship rates [7,8], registry-level and long-term prospective studies are scarce. In younger, high-demand patients, the balance between preserving stability and risking implant-related complications is particularly delicate. The current literature is underpowered to definitively establish whether RHA provides sustained benefits in this subgroup, and this gap deserves acknowledgment.
Third, we wish to expand on the discussion of prosthetic designs. The evolution from monobloc silicone implants to modular metallic and pyrocarbon systems is well outlined in the editorial [9]. However, the clinical significance of design differences is still debated. Comparative studies have reported heterogeneous outcomes, with no single design emerging as definitively superior [10,11]. This variability suggests that surgical technique, intraoperative sizing, and postoperative rehabilitation may play equally crucial roles in outcomes as prosthesis selection itself. Moreover, future directions such as three-dimensional printed implants and truly anatomic designs with variable offset and curvature hold promise in minimizing complications like capitellar erosion and overstuffing [12]. Incorporating additive manufacturing and preoperative CT-based templating could allow for more accurate replication of native radial head morphology and better restoration of kinematics.
Fourth, we wish to highlight the underappreciated role of imaging and intraoperative assessment in preventing common complications. As the authors describe, overstuffing remains one of the most problematic failure modes. In addition to intraoperative fluoroscopy and reference to the lesser sigmoid notch, we advocate for routine use of preoperative CT-based planning to predict optimal head height and offset [13]. Furthermore, dynamic intraoperative assessment of forearm rotation and radiocapitellar congruence can be valuable adjuncts to radiographic evaluation in achieving correct implant positioning [14].
In terms of complication analysis, the editorial rightly emphasizes aseptic loosening, stiffness, heterotopic ossification, and overstuffing as recurring problems. We believe it is also important to contextualize these complications by differentiating between radiographic findings and clinically significant failures. For example, radiolucent lines in press-fit systems may not always herald mechanical loosening but may instead represent benign adaptive remodeling [15]. Similarly, limited stiffness may respond well to soft tissue release or rehabilitation without necessitating revision [16]. Such nuances are critical to avoid unnecessary reoperations and to optimize resource utilization.
A final point relates to cost-effectiveness. The authors correctly note that upfront implant costs must be weighed against long-term revision and rehabilitation burdens. Indeed, recent database studies have suggested that RHA may be economically favorable compared to open reduction and internal fixation (ORIF) when considering reoperation rates and return-to-function timelines [17]. However, most of these analyses have been conducted in Western healthcare systems. Comparative cost-effectiveness data from low- and middle-income countries remain sparse yet are crucial to determining the global applicability of RHA as the preferred treatment [18].
In conclusion, we applaud Elshahhat and Almekoud for their timely and comprehensive editorial on the pivotal role of RHA in Mason type III and IV radial head fractures. We fully concur that RHA represents a biomechanically sound and clinically reliable solution in unreconstructible fractures, particularly when stability is compromised. At the same time, we advocate for more individualized, imaging-guided approaches, longer-term outcome studies, and exploration of emerging technologies such as three-dimensional printed implants to optimize patient outcomes. Future research should aim to stratify indications by patient age, activity level, and associated injuries, thereby refining the treatment algorithm proposed by the authors.
We thank the authors for advancing the discourse on this important topic and hope our perspectives contribute to further refining the role of RHA in contemporary elbow trauma care.
Sincerely,
Baojian Song, MD, PhD
Department of Orthopaedics, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China
References:
1. Karbach LE, Elfar J. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. J Hand Surg Am 2017;42:118-126.
2. Leigh WB, Ball CM. Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow. J Shoulder Elbow Surg 2012;21:1336-1341.
3. King GJ, Zarzour ZD, Patterson SD, Johnson JA. An anthropometric study of the radial head: implications in the design of a prosthesis. J Arthroplasty 2001;16:112-116.
4. Swieszkowski W, Skalski K, Pomianowski S, Kedzior K. The anatomic features of the radial head and their implication for prosthesis design. Clin Biomech (Bristol) 2001;16:880-887.
5. Gupta GG, Lucas G, Hahn DL. Biomechanical and computer analysis of radial head prostheses. J Shoulder Elbow Surg 1997;6:37-48.
6. Antuña SA, Sánchez-Márquez JM, Barco R. Long-term results of radial head resection following isolated radial head fractures in patients younger than forty years old. J Bone Joint Surg Am 2010;92:558-566.
7. Sun H, Duan J, Li F. Comparison between radial head arthroplasty and open reduction and internal fixation in patients with radial head fractures (modified Mason type III and IV): a meta-analysis. Eur J Orthop Surg Traumatol 2016;26:283-291.
8. De Mauro D, Chakra SA, Liuzza F, Smakaj A, Rovere G, Maccauro G, El Ezzo O. Radial head arthroplasty vs. open reduction and internal fixation in Mason III fractures: meta-analysis of prospective trials. JSES Int 2025;9:260-267.
9. Laumonerie P, Tibbo ME, Reina N, Pham TT, Bonnevialle N, Mansat P. Radial head arthroplasty: a historical perspective. Int Orthop 2019;43:1643-1651.
10. Rotini R, Marinelli A, Guerra E, et al. Radial head arthroplasty: monopolar vs. bipolar prostheses. Musculoskelet Surg 2012;96 Suppl 1:S69-S75.
11. Gramlich Y, Klug A, et al. Comparative outcomes of monopolar vs bipolar radial head arthroplasty. Arch Orthop Trauma Surg 2020;140:1025-1034.
12. Heijink A, Morrey BF, et al. Current concepts in radial head arthroplasty. J Hand Surg Am 2014;39:210-218.
13. Gauci MO, Winter M, et al. The “delta river sign” for overstuffing in radial head arthroplasty. J Shoulder Elbow Surg 2016;25:2023-2029.
14. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 2004;86:1730-1739.
15. Rotini R, Marinelli A, Guerra E, et al. Radiographic radiolucency in radial head prostheses: clinical significance. Musculoskelet Surg 2012;96 Suppl 1:S69-S75.
16. Amaro C, et al. Management algorithm for stiffness following radial head arthroplasty. J Shoulder Elbow Surg 2018;27:1104-1112.
17. Reinhardt D, Toby EB, Brubacher J. Reoperation rates and costs of radial head arthroplasty versus ORIF: a database study. Hand (N Y) 2021;16:115-122.
18. Barakat A, McDonald C, Singh H. Current concepts in the management of radial head fractures: a national survey. Ann R Coll Surg Engl 2023;105:469-475.
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Elshahhat A, Almekoud M. Radial head arthroplasty: A pillar of stability in complex elbow fractures. World J Orthop 2025; 16(9): 110433 [PMID: 40979143 DOI: 10.5312/wjo.v16.i9.110433]
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"With the aid of deep learning, specifically the convolutional neural network, the paradigm of operator dependent endoscopy shifts towards operator independence, being one of the most important/impactful aspects of AI – assisted endoscopic analysis that this minireview focuses on. As stated in this review, there are 3 most common used models of machine learning in clinical applications. So, in order for them to perform at its’ highest capacity, one must master the ability of choosing between them for the clinical applications. Regarding image enhancement, algorithms such as GANs, U-Net variants and DnCNN, have revolutionized endoscopy. Moreover, the shift from 2D to 3D reconstruction technology, allows for on-site evaluations of disease status, therefore providing and enhanced clinical diagnosis. A probably more impactful aid AI provided in endoscopy, is the early diagnosis of malignant tumors, decrease the rate of missed diagnoses, specifically gastric cancer. Trials conducted by Shi et al (1), Arai et al (2), and Chen et al (3), reported remarkable sensitivity and specifity integrated with risk factors, thus providing providing personalized follow up strategies post upper endoscopy.
However, regarding both detecting and classifying colon polyps, Namikawa et al revealed that AI showed superior sensitivity, outperforming experts, albeit with slighty less specificity in a study comparing the capabilities of AI against human experts. Having that in mind, a thorough evaluation and then integration of AI in the decision making process algorithm.
As for non malignant diseases, the most importanat challenge is data heterogeneity and insufficient clinical validation. However, the application of machine learning in inflammatory bowel disease (IBD) shows promise in objective grading of IBD, in reshaping the monitoring paradigm, converging into an “active early warning” system. Moreover, AI models, benefit the IBD clinical trials, by improved endoscopy quality, consistent, valid, real -time assessment of IBD severity at site level, improved patient recruitment, increased sensitivity to responde and patient response to treatment (4).
As with all important innovations, limitations arise, specifically data privacy and annotation quality that hinder model traninig. A study conducted by Buedgens et al (5) reported that weakly supervised AI systems can achieve a high performance and maintain explainability in end-to-end image analysis in GI endoscopy. This shows that manual annotations are not necessarily a bottleneck for future clinical applications of AI.
Finally, in order to provide a much smoother clinical translation of machine learning, expert bodies, such as ASGE and ESGE have provided position statements as for priorities for artificial intelligence in GI endoscopy and expected value of artificial intelligence in gastrointestinal endoscopy, respectively (6,7), therefore offering standardization."
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Ding JC, Zhang J. Endoscopic image analysis assisted by machine learning: Algorithmic advancements and clinical uses. Artif Intell Gastrointest Endosc 2025; 6(3): 108281 [DOI: 10.37126/aige.v6.i3.108281]
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"The article title "B cell CLL/lymphoma 10 promotes colorectal cancer cell proliferation and regulates cuproptosis sensitivity through the NF-κB signaling pathway" by Xiao et al. discussed B cell CLL/lymphoma 10 promotes colorectal cancer growth and regulates the sensitivity of Colorectal cancer cells to cuproptosis by activating the NF-κB signaling pathway and modulating DLAT expression. The study provide a molecular basis for developing B cell CLL/lymphoma 10-targeted therapies for colorectal cancer. Further studies are needed to determine whether NF-κB signaling is essential for BCL10 on cuproptosis sensitivity or whether additional mechanisms are involved. Moreover, future study should explores whether NF-κB influences other cellular pathways or targets that contribute to cuproptosis sensitivity. The future study should also explores the safety and effectiveness of such therapeutic interventions.
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Xiao PT, Li CF, Liu YD, Zhong J, Cui XL, Liu C, Yang W. B cell CLL/lymphoma 10 promotes colorectal cancer cell proliferation and regulates cuproptosis sensitivity through the NF-κB signaling pathway. World J Gastroenterol 2025; 31(34): 109825 [PMID: 40937457 DOI: 10.3748/wjg.v31.i34.109825]
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"This study on the potential therapeutic effects of levodopa for liver fibrosis provides a novel perspective in the treatment of hepatic conditions, particularly in the context of liver injury induced by carbon tetrachloride (CCl4) in rats. The findings are promising, showing that levodopa not only reduces fibrosis markers like collagen deposition but also modulates key signaling pathways involved in liver regeneration. These results could pave the way for repurposing levodopa in treating liver diseases, especially given the lack of universally approved treatments for liver fibrosis."
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Wang HY, Qi MM, Zhang K, Zhu YZ, Zhang J. Dopamine receptor D1-mediated suppression of liver fibrosis via Hippo/Yes-associated protein 1 signaling in levodopa treatment. World J Gastroenterol 2025; 31(34): 108617 [PMID: 40937451 DOI: 10.3748/wjg.v31.i34.108617]
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"This paper on ultrasound-guided percutaneous thermal and non-thermal ablation techniques for intrahepatic cholangiocarcinoma (iCCA) provides a well-rounded discussion on the safety, efficacy, and clinical indications of these advanced methods, particularly for patients who are ineligible for surgery. The article not only details the mechanisms and procedural aspects of these treatments but also critically evaluates their outcomes, such as survival rates and potential complications. It highlights how these therapies can provide an alternative to surgery, especially for patients with small, localized tumors or those with poor liver function. For clinicians, this paper serves as an important resource in understanding the evolving landscape of locoregional treatments for iCCA. It also underscores the need for personalized treatment strategies based on tumor characteristics, liver function, and patient comorbidities. In conclusion, this review effectively provides evidence-based insights into these promising ablation techniques, with an emphasis on improving patient outcomes while managing risks."
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Giorgio A, Ciracì E, De Luca M, Stella G, Rollo VC, Montesarchio L, Giorgio V. Ultrasound-guided percutaneous thermal and non-thermal ablation of intrahepatic cholangiocarcinoma. World J Gastroenterol 2025; 31(34): 108623 [PMID: 40937452 DOI: 10.3748/wjg.v31.i34.108623]
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"EFX, a fibroblast growth factor 21 analogue, shows promising potential for improving liver fat, liver injury markers, fibrosis, and several metabolic parameters in individuals with MASH. The paper offers significant insights, especially given the limited therapeutic options available for MASH. From a clinical standpoint, the review highlights the dual benefits of EFX in addressing both liver and metabolic dysfunctions, including improvements in hepatic fat content, liver enzymes, fibrosis markers, and insulin resistance. The finding that EFX significantly reduces liver fat while improving metabolic outcomes such as HbA1c and triglycerides is particularly relevant in the management of MASH, which often coexists with metabolic syndrome and type 2 diabetes. In conclusion, this review emphasizes EFX’s potential as a promising treatment for MASH, particularly in managing both hepatic and metabolic dysfunctions. This paper is a timely contribution to the field, providing a comprehensive understanding of EFX's role in MASH management."
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Kamrul-Hasan ABM, Borozan S, Jena S, Nagendra L, Dutta D, Bhattacharya S, Islam MS, Pappachan JM. Safety and efficacy of efruxifermin in metabolic dysfunction-associated steatohepatitis: A systematic review. World J Gastrointest Pharmacol Ther 2025; 16(3): 110709 [PMID: 40937291 DOI: 10.4292/wjgpt.v16.i3.110709]
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"The article is comprehensive, presenting both the beneficial effects and the challenges associated with GLP-1RAs, especially their gastrointestinal adverse events such as nausea, vomiting, and diarrhea.From a clinical perspective, the paper underscores the need for personalized approaches in prescribing GLP-1RAs, considering the varying responses to treatment and the potential risks in certain patient populations. The authors also provide practical management strategies for these side effects, which is highly relevant for clinical practice. In summary, this paper offers a balanced view of the evolving landscape of obesity management with GLP-1RAs. It is a timely contribution to the field, especially for healthcare providers looking to enhance treatment outcomes while managing side effects effectively."
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Ismail A, Amer MS, Tawheed A. Glucagon-like peptide-1 receptor agonists: Evolution, gastrointestinal adverse effects, and future directions. World J Gastrointest Pharmacol Ther 2025; 16(3): 107148 [PMID: 40937289 DOI: 10.4292/wjgpt.v16.i3.107148]
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"The article provides a comprehensive review of the interplay between endocrine disorders and liver dysfunction, offering insightful perspectives on how various hormonal imbalances contribute to liver diseases such as metabolic liver disease and cirrhosis. From a clinical standpoint, the paper emphasizes the bidirectional nature of this relationship, with endocrine dysfunction not only exacerbating liver conditions but also liver damage impacting hormone metabolism. The article goes beyond theoretical mechanisms, proposing multidisciplinary management strategies that could improve patient outcomes, especially in conditions like non-alcoholic fatty liver disease (NAFLD) and cirrhosis. The therapeutic approaches outlined, including the integration of endocrine evaluation in liver disease care, underline the importance of a holistic treatment model for more personalized and effective interventions. Overall, this review is an essential resource for researchers and clinicians aiming to refine treatment protocols for patients with complex liver-endocrine disorders, providing a deeper understanding of the underlying pathophysiology and offering practical recommendations for integrated care."
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Vargas-Beltran AM, Armendariz-Pineda SM, Martínez-Sánchez FD, Martinez-Perez C, Torre A, Cordova-Gallardo J. Interplay between endocrine disorders and liver dysfunction: Mechanisms of damage and therapeutic approaches. World J Gastroenterol 2025; 31(32): 108827 [PMID: 40900772 DOI: 10.3748/wjg.v31.i32.108827]
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"This retrospective study provided a useful method using MRI and deep learning to analyze the diagnosis for liver cancer in patients with better efficacy after image reconstruction. Although the statistical and flowchart data was applied to present the general map of this combined method, the critical presentation of direct image in HCC and normal group under artificial technology treatment was not enough to be displayed in the full manuscript and supplementary document. Suggest that author can provide these supportive images with feature indication for other ways such as data-bank online or subsequent demonstration submission using letter to the editor. "
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Wang ZZ, Song SM, Zhang G, Chen RQ, Zhang ZC, Liu R. Multiparametric magnetic resonance imaging of deep learning-based super-resolution reconstruction for predicting histopathologic grade in hepatocellular carcinoma. World J Gastroenterol 2025; 31(34): 111541 [PMID: 40937458 DOI: 10.3748/wjg.v31.i34.111541]
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"PTBD and ERCP are the commonly used methods for biliary drainage. In low-income settings, advanced techniques such as EUS-guided therapies are often unavailable, limiting clinicians' options. This study compares the efficacy of PTBD and ERCP in a low-income country. Both groups showed good therapeutic success, but the PTBD group had low clinical success. This difference may be due to the type of patients enrolled in PTBD, most likely those with Bismuth type 3/4, for which PTBD is typically used. The authors did not specify the aetiology (benign vs malignant) or the level of obstruction in their patients. Complications were more frequent in PTBD patients and were mainly non-biliary related, possibly indicating that sicker patients underwent interventions. These confounding factors should be considered before concluding that PTBD is less effective than ERCP for severe cholangitis. The outcome was based solely on the resolution of cholangitis; including the normalisation of bilirubin levels would have been more informative."
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Karim MM, Moatter S, Amin M, Parkash O. Comparison of endoscopic retrograde cholangiopancreatography drainage vs percutaneous transhepatic biliary drainage in severe cholangitis: A study from low-middle income country. World J Gastrointest Pharmacol Ther 2025; 16(3): 107167 [PMID: 40937286 DOI: 10.4292/wjgpt.v16.i3.107167]
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"The manuscript addresses a highly relevant topic and is enriched with numerous references. The distinction between management strategies for cT1–2 versus cT3–4 disease is particularly valuable. However, the actual role of interventions in the setting of pT3–4 tumors remains to be fully clarified. A broader discussion could be warranted regarding the clinical implications of omental metastases identified post-resection (on the surgical specimen) in patients with cT3–4 disease. Should this finding prompt a more complete disease staging? Could it provide a rationale for referring patients to intraperitoneal therapies (HIPEC, NIPEC, PIPAC)? We eagerly await the results of ongoing trials to better define these aspects."
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Ilhan E, Yildirim M. Current debate in gastric cancer surgery: Omentectomy? World J Gastrointest Surg 2025; 17(8): 108110 [PMID: 40949383 DOI: 10.4240/wjgs.v17.i8.108110]
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"This timely basic study by Groover et al. (WJG 2025; 31: 104277) investigates sex‑based differences in liver expression of estrogen receptors (ERα/ERβ) and tumor necrosis factor-alpha (TNF‑α), elucidating their roles in hepatitis C virus (HCV) pathogenesis. Leveraging human explant tissues from HCV-related cirrhosis and hepatocellular carcinoma (HCC) alongside normal controls, the authors perform RT‑qPCR and Western blot analyses to reveal differential expression patterns by sex and disease state. These findings advance our understanding of why HCV disease progression may diverge between males and females.
The study is commendable for its focus on human tissue specimens and its dual molecular and protein-level methodology, enhancing translational relevance. Additionally, exploring both ER subtypes and TNF-α offers a multifaceted view of hormonal and inflammatory interplay in HCV-mediated liver pathology. The observations pave the way for sex-informed therapeutic strategies and risk stratification.
Nonetheless, the commentary could be strengthened by more detailed insights into downstream signaling pathways, such as NF-κB or apoptosis pathways, which are alluded to but not fully dissected. Moreover, whether the observed ER and TNF-α alterations are causative or reactive remains open. Future investigations integrating functional assays, prospective cohorts, and multi-omics profiling would significantly bolster mechanistic clarity and clinical translation.
In summary, Groover et al. deliver a valuable contribution linking sex-specific molecular expression to HCV pathogenesis, highlighting promising directions for future research."
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Groover S, Addison S, Nicks S, Mwangi M, Brooks A, Kaul A, Kaul R. Sex based relative expression of estrogen receptors and tumor necrosis factor-alpha in liver affects hepatitis C virus viral pathogenesis. World J Gastroenterol 2025; 31(32): 104277 [PMID: 40900774 DOI: 10.3748/wjg.v31.i32.104277]
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"This review takes the bidirectional relationship between the endocrine system and liver function as its starting point and systematically outlines the roles of the thyroid, parathyroid, pancreas, adrenal glands, and sex hormones in liver diseases. It not only summarizes the interactions between common endocrine disorders (such as hypothyroidism, insulin resistance, and Cushing’s syndrome) and hepatic injury, but also provides mechanistic insights into key processes, including lipid metabolism disorders, oxidative stress, and hormone conversion. In addition, the article discusses emerging therapeutic approaches, highlighting the potential of TRβ agonists, GLP-1 receptor agonists, and SGLT2 inhibitors. By emphasizing the mutual reinforcement between endocrine disorders and liver diseases, this review offers valuable references for clinicians in the management of MASLD/NASH, cirrhosis, and hormone-related conditions. Importantly, it reminds us that future strategies for liver disease treatment should not be confined to the liver itself, but must also integrate the broader endocrine context.
Nevertheless, the review also has certain limitations. Some sections remain primarily descriptive and observational, with relatively limited exploration of molecular pathways and immune-metabolic interactions. Furthermore, the discussion of sex hormones and the parathyroid axis is relatively brief and lacks incorporation of the latest clinical evidence. Looking ahead, integration of multi-omics technologies with large-scale clinical datasets will be essential to further advance knowledge in this field and to promote the development of interdisciplinary diagnostic and therapeutic strategies."
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Vargas-Beltran AM, Armendariz-Pineda SM, Martínez-Sánchez FD, Martinez-Perez C, Torre A, Cordova-Gallardo J. Interplay between endocrine disorders and liver dysfunction: Mechanisms of damage and therapeutic approaches. World J Gastroenterol 2025; 31(32): 108827 [PMID: 40900772 DOI: 10.3748/wjg.v31.i32.108827]
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"Dear Author,
We read with great interest the case report by Zhang et al. describing a rare invasive inflammatory fibrotic polyp (IFP) of the duodenum with subserosal involvement. This first documented case of duodenal IFP extending beyond the muscularis propria (Figure 5A) provides valuable insights into the potential invasiveness of this entity. However, two key limitations warrant attention to enhance the clinical applicability of this finding:
The preoperative evaluation revealed limitations: Biopsy limitations: Initial endoscopic biopsies yielded only necrotic tissue, failing to sample viable tumor areas (Figure 1). EUS-FNA not attempted: Despite EUS identifying muscularis propria involvement (Figure 2), fine-needle aspiration (FNA) was not performed to obtain diagnostic material. This led to misdiagnosis as a stromal tumor and unnecessary radical surgery (distal gastrectomy + lymphadenectomy). Current guidelines recommend EUS-FNA for submucosal duodenal masses to avoid overtreatment[1]. As shown in Figure 2B, the lesion size (37.1 mm × 24.5 mm) was amenable to FNA, which could have provided adequate tissue for CD34/SMA immunohistochemistry and potentially prevented surgery.
In conclusion, this case report fills the gap in the understanding of invasive duodenal IFP, but the above aspect need further improvement to better reveal the biological nature of the lesion and guide clinical practice. We look forward to seeing more in-depth studies on this rare disease in the future.
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Zhang FM, Ning LG, Wang JJ, Zhu HT, Feng MB, Chen HT. Invasive inflammatory fibrotic polyp of the duodenum: A case report. World J Gastrointest Surg 2025; 17(8): 107558 [PMID: 40949391 DOI: 10.4240/wjgs.v17.i8.107558]
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"Dear Editor,
We read with great interest the article “Changes in liver and spleen stiffness after transjugular intrahepatic portosystemic shunt and their relationship with prognosis” by Liu et al. This study provides valuable insights into the dynamic changes of liver and spleen stiffness post-transjugular intrahepatic portosystemic shunt (TIPS) and their prognostic value, filling an important gap in non-invasive monitoring of TIPS outcomes. However, three aspects could be further refined to enhance the study’s clinical relevance and evidence robustness.
First, the study lacks analysis of the impact of TIPS shunt patency on changes in liver and spleen stiffness. The authors report that spleen stiffness decreases significantly post-TIPS and correlates with portal pressure gradient (PPG), but they do not clarify whether these stiffness changes are influenced by shunt function (e.g., stenosis or occlusion). Clinically, TIPS shunt dysfunction (a common complication) can lead to re-elevated portal pressure, which may reverse the initial reduction in spleen stiffness. Without documenting shunt patency status (e.g., via Doppler ultrasound or venography) at each follow-up time point and stratifying stiffness trends by patency, it is difficult to determine whether the observed stiffness changes are purely due to TIPS-induced hemodynamic improvement or confounded by shunt dysfunction. This gap limits the ability to interpret stiffness trends as reliable indicators of long-term TIPS efficacy.
Second, the study does not explore the relationship between changes in liver/spleen stiffness and the severity of overt hepatic encephalopathy (OHE). Although logistic regression shows no correlation between baseline stiffness and post-TIPS OHE, the dynamic changes in stiffness (e.g., the magnitude of spleen stiffness reduction) may still be associated with OHE risk. For example, a more pronounced decrease in spleen stiffness might reflect better portal decompression, potentially reducing the risk of OHE by altering gut-liver axis function or ammonia metabolism. Additionally, the study only includes OHE of grade ≥2, excluding milder grades (grade 1), which are clinically relevant for early intervention. Analyzing stiffness changes in relation to OHE severity and including all OHE grades would provide a more comprehensive understanding of how stiffness correlates with this key TIPS complication.
Third, the study’s subgroup analysis of liver cirrhosis etiology is insufficient to inform the etiology-specific prognostic value of stiffness. The cohort includes patients with viral, alcoholic, and immunological cirrhosis, but the authors do not stratify survival outcomes or stiffness trends by etiology. Previous studies have shown that cirrhosis etiology affects liver stiffness progression and TIPS prognosis—for instance, alcoholic cirrhosis may be associated with more rapid stiffness changes due to ongoing inflammation, compared to viral cirrhosis. Without etiology-specific subgroup analyses, it is unclear whether the identified liver stiffness cutoff (35.15 kPa) or the prognostic role of stiffness applies uniformly across different etiologies. This limits the study’s ability to guide personalized TIPS assessment for patients with distinct cirrhosis causes.
In conclusion, Liu et al.’s work makes a meaningful contribution to non-invasive monitoring of TIPS outcomes. Addressing the above issues—by integrating shunt patency data, analyzing stiffness changes with OHE severity, and exploring etiology-specific effects—would further strengthen the study’s scientific rigor and clinical utility. We look forward to seeing supplementary analyses or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Liu XF, Huang XC, Ye QJ, Yuan LJ, Gao GF, Li JY, Feng DP. Changes in liver and spleen stiffness after transjugular intrahepatic portosystemic shunt and their relationship with prognosis. World J Gastrointest Surg 2025; 17(8): 109884 [PMID: 40949390 DOI: 10.4240/wjgs.v17.i8.109884]
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"Dear Editor,
We read with great interest the article “Morphomics in esophageal cancer: Validation and association with muscular and cardiorespiratory fitness” by Tseng et al. This study innovatively explores the correlation between computed tomography (CT)-based morphomics and functional assessments (bioelectrical impedance analysis [BIA], hand grip strength [HGS], cardiopulmonary exercise testing [CPET]) in esophageal cancer patients, providing valuable evidence for preoperative physical fitness evaluation. However, three aspects could be further refined to enhance the study’s clinical applicability and evidence robustness.
First, the study lacks analysis of the impact of tumor stage and neoadjuvant therapy on the relationship between morphomics and functional indicators. The cohort includes newly diagnosed esophageal cancer patients, but the article does not specify the distribution of tumor stages (e.g., T stage, N stage) or whether patients received neoadjuvant chemotherapy/radiotherapy before CT and functional assessments. Clinically, advanced tumor stages may directly affect muscle mass (via malnutrition or tumor-related inflammation), while neoadjuvant therapy can cause treatment-related muscle loss (cachexia) or changes in cardiorespiratory fitness. Without stratifying outcomes by tumor stage or adjusting for neoadjuvant therapy status, it is difficult to determine whether the observed correlations between morphomics (e.g., dorsal muscle group [DMG] volume) and CPET/BIA results are confounded by these factors. This gap limits the ability to generalize the findings to patients at different disease stages or treatment phases.
Second, the study does not clarify the clinical significance of morphomic parameter thresholds for predicting low cardiorespiratory fitness (CRF). The authors report that morphomics (combining bone mineral density [BMD], visceral fat [VF] area, and DMG volume) predicts low ventilatory anaerobic threshold normalized by body weight (VAT/BW < 11 mL/kg/min) with an optimism-corrected AUC of 0.778. However, they do not provide specific cutoff values for the key morphomic variables (e.g., how much VF area or DMG volume increases/decreases the risk of low CRF) or validate these thresholds in clinical practice. For example, if a VF area > X cm² or DMG volume < Y cm³ is associated with a significantly higher risk of low CRF, such thresholds would help clinicians quickly identify high-risk patients via routine CT scans. Without defining these actionable cutoffs, the predictive model’s practical value for preoperative screening remains limited.
Third, the homogeneity of the cohort (98% male, Taiwanese population) raises concerns about generalizability, yet the study does not discuss or address potential sex- or ethnicity-related differences in morphomics-functional correlations. Previous studies have shown that body composition (e.g., muscle-fat distribution) and its association with physical fitness vary by sex—for instance, women may have different muscle density thresholds or fat-mass impacts on CRF compared to men. Additionally, ethnic differences in body composition (e.g., Asian vs. Western populations) could affect morphomic parameter norms and their correlation with BIA/CPET results. By excluding female patients and focusing solely on a Taiwanese cohort, the study’s findings may not apply to more diverse populations. Exploring sex-stratified analyses (if feasible with additional data) or acknowledging these limitations with suggestions for multicenter, multiethnic validation would strengthen the study’s external validity.
In conclusion, Tseng et al.’s work makes a meaningful contribution to integrating morphomics into esophageal cancer preoperative assessment. Addressing the above issues—through stratification by tumor stage/neoadjuvant therapy, defining clinical thresholds for predictive morphomic parameters, and expanding cohort diversity—would further enhance the study’s scientific rigor and clinical translational value. We look forward to seeing supplementary analyses or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Tseng WHS, Huang SC, Wang SC, Lin J, Zhang P, Liu YC, Chao YK, Chiu CH. Morphomics in esophageal cancer: Validation and association with muscular and cardiorespiratory fitness. World J Gastrointest Surg 2025; 17(8): 108600 [PMID: 40949397 DOI: 10.4240/wjgs.v17.i8.108600]
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"Dear Editor,
We read with great interest the article “Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction” by Zhou et al. This study pioneers the evaluation of a novel combination therapy for advanced hilar malignant biliary obstruction (MBO), a clinical challenge with limited treatment options, and reports promising technical success and safety profiles. However, three aspects could be further clarified or expanded to enhance the study’s validity and clinical translational value.
First, the study lacks subgroup analysis of outcomes based on stent configuration types and primary disease etiology. The authors employed four stent configurations (Type X, T, Y, and Tandem) tailored to different biliary obstruction patterns, yet they did not compare key endpoints—such as median overall survival (OS), stent patency, or complication rates—across these configurations. For example, Type Y stents (used in 41.2% of patients) may have distinct drainage efficiency or patency durability compared to Tandem stents, which could guide clinicians in selecting the optimal configuration for specific Bismuth subtypes. Additionally, the cohort includes patients with diverse primary diseases (13 with hilar cholangiocarcinoma, 2 with gallbladder cancer liver metastasis, etc.), but no analysis was conducted to determine if the therapy’s efficacy varies by tumor type. Given that different malignancies have distinct biological behaviors (e.g., gallbladder cancer tends to be more aggressive than hilar cholangiocarcinoma), stratifying outcomes by etiology would help identify patient subgroups most likely to benefit from this treatment.
Second, the impact of concurrent systemic anticancer therapy on survival outcomes was not adequately addressed. The study mentions that 6 of 17 patients received sequential systemic treatments (e.g., lenvatinib, hepatic artery infusion chemotherapy). These therapies are known to improve survival in advanced biliary tract cancers, yet the current analysis does not adjust for their potential confounding effect—for instance, whether patients receiving systemic therapy had longer OS independent of the combination stent-seed treatment. Without subgroup comparisons (e.g., OS between patients with vs. without concurrent systemic therapy) or multivariate analysis incorporating these treatments as covariates, it is difficult to isolate the true efficacy of the 125I seed strip-double stent regimen. This gap limits the ability to conclude whether the observed survival benefit (median OS 189 days) is primarily driven by the local intervention or concurrent systemic therapy.
Third, the study provides insufficient details on long-term radiation-related safety and late complications. While the authors report no severe early complications and only one case of seed strip migration, they do not mention long-term monitoring for radiation-induced adverse events—such as bile duct stricture progression, liver parenchyma damage, or secondary malignancies—despite 125I’s half-life of 60.1 days and cumulative absorbed dose of 82.3–83.6 Gy. Additionally, the definition of “late complications” is unclear, and the follow-up period (final follow-up July 31, 2023) is not specified in terms of median duration for surviving patients. For a therapy involving radioactive seeds, documenting long-term radiation safety (e.g., imaging evidence of liver injury, changes in liver function over time) is critical to assessing its overall risk-benefit profile, especially for patients with prolonged survival (e.g., the 3 surviving patients with patent stents).
In summary, Zhou et al.’s study makes a valuable contribution to the management of advanced hilar MBO by introducing a novel combination therapy. Addressing the above issues—through subgroup analyses of stent configurations and etiology, adjustment for concurrent systemic therapy, and detailed long-term safety monitoring—would further strengthen the study’s evidence base and provide more actionable guidance for clinical practice. We look forward to seeing supplementary data or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Zhou CG, Zhang Y, Li H, Liu KY, Yang XY, Gao K. Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction. World J Gastrointest Surg 2025; 17(8): 108579 [PMID: 40949385 DOI: 10.4240/wjgs.v17.i8.108579]
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41
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"Dear Editor,
We read with great interest the article “Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes” by Zhang et al. This study provides valuable insights into the association between obstructive jaundice and sarcopenia, as well as the subsequent effects on postoperative outcomes, which fills an important gap in clinical research on hepatobiliary-pancreatic diseases. However, three aspects could be further refined to enhance the depth of evidence and clinical applicability of the findings.
First, the study lacks analysis of the impact of preoperative biliary drainage (PBD) on sarcopenia and postoperative outcomes. The article mentions that PBD is recommended for patients with total bilirubin (TBIL) levels exceeding 34-51 μmol/L, yet it does not specify how many patients in the obstructive jaundice group underwent PBD, nor does it explore whether PBD affects sarcopenia-related indicators (such as grip strength, walking speed, and appendicular skeletal muscle index) or modifies the association between jaundice severity and sarcopenia. Clinically, PBD can alleviate cholestasis, improve nutritional absorption, and reduce systemic inflammation—factors that may mitigate muscle loss. Without stratifying outcomes by PBD status, it is difficult to determine whether PBD could serve as an intervention to reduce sarcopenia risk in patients with severe jaundice, which limits the study’s guidance for preoperative management.
Second, the correlation between sarcopenia and long-term outcomes (e.g., in-hospital mortality, long-term survival) was not investigated. The current analysis focuses on short-term outcomes such as postoperative hospital stay and complication rates, but it does not mention in-hospital mortality data or follow-up results beyond discharge. Previous studies have shown that sarcopenia is associated with reduced long-term survival in patients undergoing abdominal surgery, such as hepatectomy or pancreaticoduodenectomy. For patients with obstructive jaundice (especially those with malignant etiologies), clarifying whether sarcopenia predicts long-term prognosis would provide more comprehensive evidence for clinical decision-making—for example, guiding the intensity of follow-up or the need for long-term nutritional interventions. The absence of such data weakens the study’s ability to address the full clinical impact of sarcopenia.
Third, the study does not explore the potential mediating role of inflammatory or nutritional biomarkers in the relationship between obstructive jaundice and sarcopenia. The discussion hypothesizes that jaundice-induced inflammation (e.g., elevated TNF-α, IL-6) and malnutrition contribute to muscle loss, but the study did not measure these biomarkers (e.g., cytokine levels, vitamin D, or amino acid profiles) or analyze their mediating effects. For instance, if patients with severe jaundice have higher IL-6 levels that are independently associated with sarcopenia, this would support inflammation as a key mechanism linking jaundice to muscle wasting. Without such analyses, the proposed pathophysiological pathway remains speculative, and it is difficult to identify potential targets for interventions (e.g., anti-inflammatory therapies or vitamin D supplementation) to prevent sarcopenia in this population.
In conclusion, Zhang et al.’s study makes a meaningful contribution to understanding the prevalence and short-term impact of sarcopenia in patients with obstructive jaundice. Addressing the above issues would further strengthen the study’s scientific rigor and clinical relevance, providing more actionable guidance for preoperative assessment and intervention in this patient group. We look forward to seeing supplementary analyses or follow-up studies to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital"
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Zhang RN, Cui JY, Zhao ZH, Li YT, Liu ZW, Zhang JY, Wei Q, Lu YM, Chen QP. Prevalence of sarcopenia in patients with surgical obstructive jaundice and its impact on clinical outcomes. World J Gastrointest Surg 2025; 17(8): 107209 [PMID: 40949366 DOI: 10.4240/wjgs.v17.i8.107209]
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42
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"Letter to the Editor
Dear Editor,
We read with great interest the article “Clinical observation of combined transarterial chemoembolization and targeted therapy in postoperative recurrent colorectal cancer with liver metastasis” by Liu et al., which provides valuable insights into the efficacy and safety of multimodal therapy for this challenging clinical condition. The study’s focus on survival outcomes and quality of life offers meaningful references for clinical practice, yet there are three aspects that we believe could be further refined to enhance the robustness and interpretability of the findings.
First, the article lacks detailed analysis of the impact of prior treatment history on study outcomes. As shown in Table 1, 26.7% of patients received prior systemic chemotherapy, and 13.3% had prior targeted therapy. These prior treatments may influence the response to the combined TACE-targeted therapy regimen—for example, patients with prior exposure to anti-VEGF or anti-EGFR agents might develop drug resistance, thereby affecting OS, PFS, and adverse event profiles. However, the current study does not stratify outcomes by prior treatment status or adjust for this factor in multivariate analysis. Clarifying whether prior treatment history is an independent confounding variable would help readers better understand the applicability of the study’s conclusions to different patient subgroups (e.g., treatment-naive vs. pretreated patients).
Second, the description of TACE procedure standardization and dose adjustments is insufficient. The study mentions that TACE was repeated every six weeks based on tumor response and patient tolerance, but it does not specify key details such as the criteria for modifying the number of TACE sessions (e.g., how “tumor response” or “tolerance” was objectively defined) or adjustments to chemotherapeutic agent doses (e.g., whether doxorubicin/cisplatin doses were reduced in patients with liver dysfunction). Additionally, 93.3% of patients received doxorubicin and 86.7% received cisplatin, suggesting potential overlapping use of these two agents, yet the study does not explain the rationale for combined vs. single-agent selection. Variability in TACE protocols could introduce bias in outcome comparisons between treatment groups; standardizing and detailing these procedures would improve the reproducibility of the study results.
Third, the quality of life (QoL) assessment lacks long-term follow-up and subgroup analysis of symptom dynamics. The study evaluates QoL only at baseline and six months post-treatment, but cancer therapy-related QoL changes may be dynamic—for instance, some patients might experience delayed improvements or worsening of symptoms (e.g., fatigue, pain) after six months. Extending QoL follow-up to 12 or 24 months would provide a more comprehensive understanding of the sustained impact of treatment on patient well-being. Furthermore, while the study notes greater QoL improvements in the bevacizumab group, it does not analyze QoL differences based on clinical characteristics such as the number of liver metastases or ECOG performance status. For example, patients with multiple metastases might derive less benefit in QoL despite similar survival outcomes, which would be clinically relevant for treatment decision-making.
Overall, Liu et al.’s study makes a valuable contribution to the field of postoperative recurrent colorectal cancer with liver metastasis. Addressing the above issues would further strengthen the study’s scientific rigor and clinical relevance, providing more comprehensive guidance for clinical practice. We look forward to seeing additional data or supplementary analyses to address these points.
Sincerely,
Xiong Yuezhihong
Yichang Central People's Hospital "
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Erkek A, Yıldırak MK, Yıldız A, Sevinç B. Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease. World J Gastrointest Surg 2025; 17(8): 107476 [PMID: 40949368 DOI: 10.4240/wjgs.v17.i8.107476]
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43
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"The figures are attactive and interesting.
I would like to suggest the authors to look into the binding sites (such as 5'UTR and 3'UTR) of the RNA bining proteins, and compare the contribution of these binding sites.
It will be interesting to identify effects of exercise based on types, intensity, duration and frequency."
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Lu Y, Kong JD, Zhao LN. Role of RNA-binding proteins in exercise-induced mRNA regulation: Unveiling biomarkers and therapeutic targets for schizophrenia. World J Psychiatry 2025; 15(9): 107498 [PMID: 40933155 DOI: 10.5498/wjp.v15.i9.107498]
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44
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"The paper, "Advances in transcranial magnetic stimulation for psychological symptom management in Parkinson's disease," offers a comprehensive overview of how transcranial magnetic stimulation (TMS) can effectively address the non-motor symptoms of Parkinson's disease (PD). Beyond the motor deficits, PD patients frequently experience a triad of debilitating non-motor symptoms: psychological issues (depression, anxiety), chronic pain, and cognitive impairment. The efficacy of TMS in treating this diverse range of symptoms suggests a unifying mechanism rooted in the modulation of shared, dysfunctional neural circuits. This paper provides important insights into the treatment and management of Parkinson's disease using rTMS, so I hope many readers will read it. Furthermore, I would like to add that rTMS has recently been applied to the frequent emergence of chronic pain disorders as non-motor disorders in Parkinson's disease, and write a letter discussing the common target brain circuits for these disorders."
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Zhou XL, Li Y, Xia W, Zheng YY, Wu AP. Advances in transcranial magnetic stimulation for psychological symptom management in Parkinson’s disease. World J Psychiatry 2025; 15(9): 108497 [PMID: 40933148 DOI: 10.5498/wjp.v15.i9.108497]
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45
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"This study addresses an important and timely issue in the management of Helicobacter pylori infection, particularly given the rising problem of drug resistance. The authors have clearly explained the challenges with conventional susceptibility testing, which is slow and laborious due to the bacterium’s fastidious growth. The new chromogenic medium-based method they propose is interesting and practical, as it uses urease activity to visually identify resistant strains while suppressing susceptible ones with antibiotics. The methodology is described in a clear and detailed manner, and the inclusion of standard reference strains as controls adds credibility. The results are impressive, showing that resistance can be detected in just 28-36 hours—far quicker than the usual 11-day protocol—without compromising accuracy. The high detection rate (90.5%) and strong agreement with standard microdilution testing make a strong case for the method’s reliability. The study rightly points out the simplicity and potential clinical usefulness of this approach, which could help doctors make faster treatment decisions and improve patient outcomes. Some minor points that could be addressed include how well the method performs in samples with mixed infections or varying urease activity, and a discussion on its cost-effectiveness and feasibility for routine use in clinical labs. Overall, this is a well-conducted and valuable study with strong translational potential."
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Guan AX, Yang SY, Wu T, Zhou WT, Chen H, Huang ZS, Luo PP, Huang YQ. Novel chromogenic medium-based method for the rapid detection of Helicobacter pylori drug resistance. World J Gastroenterol 2025; 31(32): 106424 [PMID: 40900768 DOI: 10.3748/wjg.v31.i32.106424]
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46
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"Dear Author(s),
I read with interest your clinical study on clinical results of stapled hemorrhoidopexy in the surgical treatment of grade 4 hemorrhoids. It is quite interesting that the recurrence rates of stapled hemorrhoidopexy were found to be high in your study. I think it is a very good study that contributes to the literature. Congratulations and I wish you continued successful studies.
Best Regards,
Dr.Adnan Özpek"
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Erkek A, Yıldırak MK, Yıldız A, Sevinç B. Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease. World J Gastrointest Surg 2025; 17(8): 107476 [PMID: 40949368 DOI: 10.4240/wjgs.v17.i8.107476]
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47
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"Dear Author(s),
I read with interest your clinical study on temporary protective loop ileostomy closure time. It is quite interesting that there is no statistical difference between early and late closure. I think it is a very good study that contributes to the literature. Congratulations and I wish you continued successful studies.
Best Regards,
Dr.Adnan Özpek"
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Özcan P, Düzgün Ö. Comparison of complication rates after early and late closure of loop ileostomies: A retrospective cohort study. World J Gastrointest Surg 2025; 17(8): 109432 [PMID: 40949372 DOI: 10.4240/wjgs.v17.i8.109432]
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48
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"This paper presents an insightful exploration into the potential of miR-126-3p as a predictive biomarker for treatment response in patients with primary biliary cholangitis (PBC) who are refractory to ursodeoxycholic acid (UDCA). The study highlights the variability in therapeutic responses among PBC patients and proposes miR-126-3p as a reliable marker for distinguishing between UDCA-sensitive and resistant individuals. This could be a game-changer in personalized medicine, allowing for more tailored and effective treatment strategies. The use of a cohort-based approach with rigorous statistical analysis, including ROC curve evaluation, enhances the credibility of the findings. From a clinical perspective, the identification of miR-126-3p as a biomarker with high sensitivity and specificity (82.4% sensitivity and 84.6% specificity) for predicting UDCA responsiveness is highly promising. It could facilitate earlier interventions for non-responders, preventing the progression of the disease and reducing the need for liver transplantation. The findings of this study are particularly important in clinical settings where timely adjustments in treatment are critical for improving patient outcomes."
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Pan SD, Xiong CY, Shen YJ, Tian JH, Wang YL, Wang JN, Wang SY, Li FY, Wang LF, Qiu Q, Yang L, Liu XM, Luan JQ, Zou ZS, Wang FS, Meng FP. MicroRNA-126-3p as a predictive biomarker for patients with primary biliary cholangitis refractory to ursodeoxycholic acid. World J Gastroenterol 2025; 31(31): 109828 [PMID: 40901689 DOI: 10.3748/wjg.v31.i31.109828]
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49
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"This article presents a detailed study on the role of TSC22D1 in LSEC dysfunction and its impact on macrophage polarization in non-alcoholic fatty liver disease (NAFLD). The authors successfully highlight TSC22D1 as a key regulator of LSEC dysfunction and its involvement in macrophage M1 polarization, exacerbating liver fibrosis through the TWEAK/FN14 signaling pathway. The findings provide novel insights into the mechanisms underlying NAFLD progression and suggest that TSC22D1 could serve as a promising therapeutic target for managing NAFLD-related fibrosis. From a clinical perspective, the study is highly relevant as it addresses the complex interplay between endothelial dysfunction, inflammation, and fibrosis in NAFLD, a condition that is increasing in prevalence globally. The paper’s strength lies in its integration of single-cell transcriptomic data and in vivo experimental validation, making it an important contribution to the understanding of NAFLD pathogenesis. The potential for targeting TSC22D1 to modulate these pathways offers exciting therapeutic possibilities."
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Ding W, Xu XQ, Wu LL, Wang Q, Wang YQ, Chen WW, Tan YL, Wang YB, Jiang HJ, Dong J, Yan YM, Xu XZ. TSC22D1 promotes liver sinusoidal endothelial cell dysfunction and induces macrophage M1 polarization in non-alcoholic fatty liver disease. World J Gastroenterol 2025; 31(31): 109605 [PMID: 40901684 DOI: 10.3748/wjg.v31.i31.109605]
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50
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"The article is well written, explaining the uses of hybrid technique using laparoscopy and endoscopy for gastric and also duodenal, colon and rectal lesions.
It describes laparoscopic endoscopic cooperative surgery in a comprehensive manner. The technique is very well explained with the help of illustrations.
The future for robotic laparoscopic endoscopic cooperative surgery and combining it with artificial intelligence will surely expands its role in coming years. "
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Parikh KS, Kaw P, Kumar A. Laparoendoscopic surgery in gastrointestinal diseases: Status and future perspectives. World J Gastrointest Endosc 2025; 17(8): 107617 [PMID: 40838165 DOI: 10.4253/wjge.v17.i8.107617]
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