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Diet and Gut Microbiota in Inflammatory Bowel Disease: A Clinical and Nutritional Perspective
No full textInflammatory bowel diseases, comprising Crohn’s disease and ulcerative colitis, represent chronic inflammatory disorders with rising global incidence, underscoring the pivotal role of modifiable environmental factors in disease pathogenesis. Diet and intestinal microbiota have emerged as critical bidirectional therapeutic targets through complex interactions with host immune responses. Epidemiological evidence demonstrates that healthy and high fiber diets reduce disease risk, while ultra-processed foods and inflammatory dietary patterns increase susceptibility. Therapeutic nutritional interventions, including exclusive enteral nutrition, the Crohn’s Disease Exclusion Diet combined with partial enteral nutrition, and the Mediterranean diet can induce and maintain clinical remission while promoting favorable microbiome modifications characterized by the enrichment of butyrate-producing taxa such as Faecalibacterium prausnitzii and Roseburia species, alongside a reduction in pathogenic Proteobacteria. Micronutrient deficiencies affect up to 78% of patients through malabsorption, chronic blood losses, dietary restrictions, and drug–nutrient interactions. Nutritional status significantly impacts surgical outcomes, with preoperative malnutrition and sarcopenia associated with increased postoperative complications, and it reciprocally influences biologic therapy response. Integration of personalized, microbiome-informed dietary strategies as complementary components of comprehensive treatment plans represents a promising therapeutic frontier, requiring multidisciplinary collaboration, rigorous clinical trials with standardized microbiome analyses, and precision nutrition algorithms accounting for disease phenotype, baseline microbial composition, and individual patient characteristics to optimize outcomes and improve quality of life
Artificial Intelligence for Gastroenterology Practice: A Modified Delphi Consensus
No full textThe American College of Gastroenterology (ACG) assembled a multidisciplinary task force to evaluate the current state and future direction of artificial intelligence (AI) in gastroenterology, hepatology, and endoscopy leading to the development of consensus-based recommendations for responsible AI integration in clinical practice.
A total of 32 subject-matter experts and 12 industry partners, representing diverse practice settings and expertise, conducted subgroup literature reviews across five key areas (endoscopy, practice management clinical applications, training and education, IBD and liver disease, ethics and equity). Draft statements were developed and rated on a 5-point Likert scale using a modified Delphi process. A consensus was set at ≥70% combined agreement. Non-consensus items were revised and re-voted electronically.
A total of 43 statements, 40 (93%) reached consensus in round 1 and the remaining 3 achieved consensus after round 2. Evidence supports computer-aided detection (CADe) improving adenoma detection rate and miss rate in controlled studies, with mixed "real-world" impact and insufficient long-term outcomes (e.g., interval colon cancer rate). Recommendations emphasize thorough validation and reduction of bias via heterogeneous datasets. Outside endoscopy, ambient AI scribes, NLP-enabled coding, workflow optimization, and prior authorization support show potential. Training recommendations endorse a structured AI curriculum while preserving independent procedural competence to avoid "deskilling". In IBD and hepatology, AI could help improve diagnostic accuracy, help predict risk for disease progression, and help guide therapy. Equity, governance, and reimbursement statements call for chain-of-custody data protections, specialty-society oversight, and payment models that reward quality and cost reduction.
This consensus outlines how AI can augment rather than replace clinical expertise while promoting safety, transparency, interoperability, and equity. Priorities include pragmatic and prospective trials, multi-institutional data-sharing consortia, bias mitigation, and workforce training to enable trustworthy and clinically impactful AI adoption in GI, liver, and endoscopy care
Racial Bias and False Beliefs Among Doctor of Physical Therapy Students and Their Impact on Pain Management Decisions
No full textPurpose/Hypothesis This study aimed to determine (1) if DPT students evaluate and approach the management of pain differently based on the race of hypothetical patients, and (2) the prevalence of false beliefs about biological differences between Blacks and Whites among DPT students. Methods All DPT program directors across the United States were asked to distribute the survey to currently enrolled students. The survey consisted of questions on (1) the estimated pain intensity and treatment parameters for patient cases with randomized race (one with an ankle sprain and another with low back pain), as well as (2) beliefs of biological differences between races. Results Of 472 respondents, from 47 states, 72% were female and 80% were White non-Hispanic. Differences favored higher pain appraisals and treatment intensity for Black patients, but these differences were below the minimal detectable change threshold for pain appraisal. 71% held at least one false belief, and endorsement of false beliefs did not moderate differences in pain appraisals and treatment. Conclusions While DPT students appraised and proposed management differently for Black and White patients, these differences did not reach clinical significance. A majority of students held misconceptions regarding biological differences between races, which were not associated with clinical decisions. Study limitations include the use of a non-validated survey and demographic imbalance.</p
Accelerating the elimination of cervical cancer: cross-sectional examination of cancer prevention and control in Latin America and the Caribbean
No full textCervical cancer is a public health problem in Latin America and the Caribbean (LAC). The Cervical Cancer Elimination strategy sets three targets (90% HPV vaccination, 70% screening, 90% treatment) for countries to be in the path towards elimination. This study provides an overview of the current status of cervical cancer control in LAC, highlighting opportunities and challenges for cervical cancer elimination.
We conducted a descriptive analysis of the cervical cancer control status in LAC, using an online questionnaire completed by delegates from health authorities of 35 countries/territories.
We found marked advances in the development of national plans and cervical cancer elimination strategies, particularly in Latin America. Caribbean countries and territories face barriers in program organization and human resource provision. While HPV vaccination is systematically monitored, surveillance systems for screening and treatment are limited, reducing the ability to track program performance and progress. Transition to HPV testing is ongoing, but ensuring adequate funding and management of screen-positive females remain challenging. Gaps in histopathology and treatment —especially radiotherapy— are most pronounced in the Caribbean.
Regional collaboration, resource mobilization, and investment in information systems and workforce capacity are essential to achieve equitable access to cervical cancer prevention and care. This analysis provides a baseline to guide future studies to support LAC countries in achieving the 90-70-90 targets.
Work funded by the Spanish Agency for International Development Cooperation (AECID) and Gavi, the Vaccine Alliance
Structural basis of TACO1-mediated efficient mitochondrial translation
No full textTranslation elongation is a universally conserved step in protein synthesis, relying on elongation factors that engage the ribosomal L7/L12 stalk to mediate aminoacyl-tRNA delivery, accommodation, and ribosomal translocation. Using in organello cryo-electron microscopy, we reveal how the mitochondrial translation accelerator TACO1 promotes efficient elongation on human mitoribosomes. TACO1 binds the mitoribosomal region typically bound by elongation factor Tu (mtEF-Tu), bridging the large and small subunits via contacts with 16S rRNA, bL12m, A-site tRNA, and uS12m. While active throughout elongation, TACO1 is especially critical when translating polyproline motifs. Its absence prolongs mtEF-Tu residence in A/T states, causes persistent mitoribosomal stalling and premature subunit dissociation. Structural analyses indicate that TACO1 competes with mtEF-Tu for mitoribosome binding, stabilizes A-site tRNA, and enhances peptidyl transfer through a mechanism distinct from EF-P and eIF5A. These findings suggest that bacterial TACO1 orthologs may serve analogous roles, highlighting an evolutionarily conserved strategy for maintaining elongation efficiency during challenging translation events
Rheological and Structural Analysis of Hyaluronic Acid Fillers Used for Chin Augmentation
No full textChin contouring and projection represent some of the most frequently requested procedures in aesthetic practice using hyaluronic acid (HA) fillers. Variations in the physicochemical and viscoelastic properties of HA fillers may directly influence clinical performance. This study aimed to compare four commercially available HA gels specifically indicated for chin projection: JUVÉDERM
VOLUX, RESTYLANE
LYFT, PERFECTHA
SUBSKIN, and RESTYLANE
SHAYPE.
The samples were characterized using scanning electron microscopy, dynamic light scattering, zeta potential, and swelling factor (SF). Rheological assessments included frequency sweep, amplitude sweep, and cohesivity modulus (MOC). All tests were performed in triplicate.
JUVÉDERM
VOLUX exhibited the highest SF values (3.28-3.37), indicating greater swelling capacity, whereas RESTYLANE
LYFT showed the lowest (1.53-1.66), reflecting a denser and less expansive profile. Rheological analysis revealed that RESTYLANE
LYFT and RESTYLANE
SHAYPE had higher storage modulus (G') values at elevated frequencies. MOC was significantly higher for RESTYLANE
SHAYPE and PERFECTHA
SUBSKIN compared with JUVÉDERM
VOLUX, suggesting greater resistance to deformation.
Overall, RESTYLANE
SHAYPE demonstrated the most favorable balance, combining moderate SF, high G' values, and elevated MOC. However, patient-specific anatomy, aesthetic goals, and injector expertise remain critical in determining the most appropriate product for chin contouring
Association of MUTYH mutations with clinical outcomes in metastatic prostate cancer
No full text83Background: Identification of novel biomarkers that can better predict treatment outcome and prognosis in metastatic hormone sensitive prostate cancer (mHSPC) is needed. An independent study of 34 mHSPC patients treated at the University of Miami from 11/1/21 to 12/31/24 who underwent tumor sequencing via liquid biopsy revealed a significant association between mutant MUTYH and both shorter overall survival (OS) and time to castration resistance (TTCR). MUTYH is a DNA repair gene involved in base-excision repair of oxidative DNA damage. Based on the results of this discovery cohort, we hypothesized that mHSPC patients with mutant MUTYH will have shorter OS and TTCR compared to patients with wild-type MUTYH. Methods: This study used the nationwide (US-based) de-identified Flatiron Health-Foundation Medicine prostate cancer clinico-genomic database (FH-FMI CGDB), originating from approximately 280 US cancer clinics (~800 sites of care). Patients with advanced prostate cancer treated with ARPI (Androgen Receptor Pathway Inhibitor) or taxanes chemotherapy in the mHSPC setting and genomic profiling, by tissue or liquid NGS testing (minimum 1% ctDNA tumor fraction), were included. Differences among genomically-defined patient groups were evaluated with Cox PH models and visualized with Kaplan-Meier plots. Results: Of 6101 patients with mHSPC with longitudinal clinical data and NGS testing in the database, 4285 were excluded for not having treatment with either ARPI or taxane chemotherapy in the mHSPC setting and 414 for having tumor fraction < 1%. In the remaining 1402 patients included, 851 were treated with single-agent ARPI and 551 were treated with taxane chemotherapy without ARPI. Results of the univariate and multivariate Cox PH models are shown in the table. The multivariate models controlled for pre-treatment prognostic features including PSA, ECOG performance status, and socioeconomic status. Conclusions: The association between MUTYH mutation status and TTCR and OS in mHSPC observed in the University of Miami cohort was not validated in FH-FMI CGDB cohort in either the ARPI group or the taxane group. Additionally, no significant association was uncovered when accounting for potential confounding variables. Further investigation is ongoing to identify genomic signatures of prognostic value in mHSPC
Epidemiology of adult t-cell leukemia/lymphoma in people living with HTLV-1: A 30-year study in Peru
No full textAdult T-cell Leukemia/Lymphoma (ATL) is caused by human T-leukemia virus type 1 (HTLV-1). Over 10 million people are infected worldwide, but only up to 5% develop ATL. HTLV-1 infection is endemic in Peru; however, there are currently no reports focusing on the epidemiological characteristics of Peruvian individuals with ATL.
Data from the HTLV-1 Unit registry was retrospectively analyzed between June 1992 and November 2023. Clinical report forms and histopathology records from national referral cancer centers were reviewed. Descriptive statistics were used to characterize patients, and Kaplan-Meier methods assessed survival by ATL subtype.
A total of 116 confirmed ATL cases were identified. There was a slight female predominance, with 52.6% women (n = 61) and 47.4% men (n = 55). The median age at diagnosis was 54 years (IQR 42-61), with 42.2% of patients diagnosed before age 50. Only 13.8% of patients (n = 16) were diagnosed with HTLV-1 infection before ATL development, and only 8 of those were diagnosed through routine screening. The most common ATL subtype was lymphomatous (65.5%), followed by smoldering/chronic (24.1%), and acute ATL (9.5%). With a median follow-up of 15.9 months, median survival times were 6.5, 12.5, and 89.6 months for acute, lymphomatous, and smoldering/chronic subtypes, respectively. One-year survival rates ranged from 37.5% in acute ATL to 84.6% in smoldering/chronic ATL. Comorbid HTLV-1-associated diseases included infective dermatitis (15.5%), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) (8.6%), and Strongyloides stercoralis hyperinfection (6.9%).
This is the first study to describe ATL epidemiology in Peru from an infectious disease perspective. Most patients were unaware of their HTLV-1 status before developing ATL, highlighting missed opportunities for earlier detection. Routine HTLV-1 testing should be considered in the evaluation of T-cell malignancies in endemic countries. In addition, screening high-risk populations could support earlier diagnosis and reduce transmission. Improving access to diagnostic tools, along with stronger collaboration between infectious diseases and oncology services could improve patient outcomes in endemic regions
Changes in Glutathione Metabolites and Reactive Oxygen Species from Baseline to Post-Treatment in Breast Cancer Survivors with Psychoneurological Symptoms Receiving Acupuncture
No full textHormone therapy use and duration with postoperative radiotherapy for recurrent prostate cancer: an individual patient data meta-analysis
No full textAdding hormone therapy to definitive radiotherapy in localised prostate cancer improves overall survival, but whether it similarly improves overall survival in the context of postoperative radiotherapy (PORT) after radical prostatectomy is unclear. Herein, we report an individual patient data (IPD) meta-analysis of randomised trials aimed at quantifying the benefit of adding hormonal therapy to PORT.
This was an IPD meta-analysis that identified randomised, phase 3 trials of PORT with or without hormone therapy. A systematic literature search of MEDLINE, Embase, trial registries, the Web of Science, Scopus, and relevant conference proceedings was done on Dec 15, 2024. IPD were available via the MARCAP consortium. The primary outcome was overall survival. Meta-analyses evaluated the benefit of adding hormone therapy, short-term hormone therapy (4-6 months), or long-term hormone therapy (24 months) to PORT. Tests for interaction based on pre-PORT prostate-specific antigen (PSA) and duration of hormone therapy were evaluated and non-linear associations between pre-PORT PSA and overall survival were modelled. This study was done under the master protocol of the MARCAP Consortium (PROSPERO registration CRD42019134376).
IPD were available for six randomised trials including 6057 patients with a median follow-up of 9·0 years (IQR 7·2-10·7 years). Adding hormone therapy to radiotherapy did not significantly improve overall survival (hazard ratio [HR] 0·87, 95% CI 0·76-1·01, p=0·06). There was no significant interaction between hormone therapy duration and this effect (p
=0·17), although there was a significant interaction with pre-PORT PSA greater than 0·5 ng/mL versus 0·5 ng/mL or less (p
=0·02). For all pre-PORT PSA values, the upper bounds of the 95% CI of the HR for overall survival crossed 1·0 for patients randomly assigned to PORT with or without short-term hormone therapy (n=3938). For patients randomly assigned to PORT with or without long-term hormone therapy (n=1088), the upper bounds of the 95% CI for overall survival HR fell below 1·0 at PSA greater than 1·6 ng/mL.
Our findings, we believe, provide the strongest level of evidence to date suggesting there might be no meaningful overall survival benefit to adding hormone therapy, either short-term or long-term hormone therapy, to PORT for PSA 0·5 ng/mL or less, with no apparent difference in efficacy for short-term versus long-term hormone therapy. There is an unmet need to identify biomarkers to predict potential hormone therapy benefit.
National Institutes of Health