Introduction: Chronic constipation is common, but its characteristics and impact on various aspects of daily life remain unclear. This study examined patient characteristics and assessed how background factors, constipation symptoms, and defecation status impact daily life dissatisfaction, quality of life (QOL), and psychological states. Methods: A multicenter, prospective, observational study on outpatients with moderate to severe chronic constipation was conducted. The Chronic Constipation-Therapeutic Efficacy and Satisfaction Test (CC-TEST) and validated questionnaires such as the Hospital Anxiety and Depression Scale (HADS) and Short Form Health Survey-8 (SF-8) were administered to assess symptoms, defecation status, and daily life. Correlation and multiple regression analyses explored factor relationships. Results: The analysis included 201 participants. Despite treatment, with over half using magnesium oxide, many patients remained dissatisfied. Younger patients and females reported more severe abdominal symptoms, while older patients experienced greater defecation difficulty. All constipation symptoms correlated with daily life dissatisfaction, with abdominal discomfort showing the strongest association. Abdominal symptoms were significantly associated with the Mental Component Summary (MCS) of the SF-8, HADS anxiety, and HADS depression scores. Most defecation status components showed no correlation with SF-8 MCS, HADS anxiety, or HADS depression scores. Multivariate analysis revealed that abdominal symptoms, especially discomfort, significantly impacted daily life dissatisfaction, and reduced SF-8 MCS scores. Conclusions: Many patients with moderate to severe chronic constipation experience long-term symptoms and remain dissatisfied with treatment. Abdominal symptoms such as discomfort and pain significantly affect their daily life, QOL, and psychological well-being. Reducing abdominal symptoms may be crucial for improving treatment outcomes.

Introduction: Acute pancreatitis is a significant complication of endoscopic retrograde cholangiopancreatography (ERCP) with no established prevention strategy. Recent studies suggest that rectal indomethacin may reduce the incidence of post-ERCP pancreatitis (PEP), but its effectiveness varies with patient risk levels and the concurrent use of pancreatic stenting. This updated meta-analysis evaluates the efficacy of rectal indomethacin in preventing PEP. Methods: A systematic search of PubMed, Embase, and Scopus up to April 2025 identified randomized controlled trials (RCTs) comparing rectal indomethacin with placebo for PEP prevention. Random-effects meta-analysis, meta-regression, and subgroup analysis were conducted using the R Meta package v8.0–2. Cochrane’s ROB2 and Egger’s regression test are used to assess the risk of bias. Results: The analysis included 15 RCTs representing a total of 4,962 patients. Rectal indomethacin significantly reduced the incidence of PEP compared to placebo (risk ratio [RR]: 0.58; 95% confidence interval [CI], 0.45–0.73; p < 0.01) with no increased risk for bleeding complications (RR: 0.95, 95% CI: 0.64–1.41, p = 0.76). Subgroup analysis showed that indomethacin was effective, especially when given concurrently with a pancreatic stent (RR: 0.4539, 95% CI: 0.26–0.79). However, a high risk of bias was observed in nearly 25% of the overall assessment; there was evidence of a small-study effect, as suggested by Egger’s regression test (p < 0.01). Conclusion: Prophylactic rectal indomethacin appears to be effective in preventing PEP, with no increased risk for bleeding. Future studies should focus on combining other prophylactic options to achieve better prevention of PEP.

Introduction: Colorectal cancer screening relies on effective bowel preparation before a colonoscopy. Walking has emerged as a potential adjunct strategy to achieve bowel cleansing prior to colonoscopy. We investigated the efficacy of walking as a potential adjunct strategy to bowel preparation methods. Methods: Our search encompassed Embase, Medline, Cochrane, and Scopus databases. Search results underwent screening utilizing Covidence based on predefined criteria. Data extraction performed by independent reviewers involved general characteristics, baseline patient characteristics, and outcome measures. Risk of bias evaluation employed the RoB 2 tool for randomized controlled trials (RCTs). Statistical analysis utilized RevMan v5.3, employing mean differences and random-effects models. Statistical significance was indicated by p value <0.05. Heterogeneity was assessed with I2 tests. Results: Our meta-analysis included four RCTs with a total of 1,218 patients. We found that walking did not yield a significant difference in total BBPS score compared to control groups. Walking led to statistically significant improvements in ascending, transverse, and descending colon BBPS scores. Walking did not significantly affect cecal intubation time or total procedure time. While there was no significant difference in the time to first diarrhea, the total number of diarrheal episodes was significantly impacted. Conclusion: While walking did not significantly affect total BBPS scores, procedural timelines, or cecal intubation, it demonstrated significant improvements in ascending, transverse, and descending colon BBPS scores and diarrheal instances. These findings suggest that walking may have a beneficial effect on specific aspects of bowel preparation for colonoscopy, highlighting its potential as an adjunctive strategy in enhancing colonoscopy outcomes.

Background: Functional dyspepsia (FD) is currently defined as episodic or recurrent epigastric pain or discomfort in the absence of organic diseases, lasting at least 4 weeks. FD is estimated to affect 7.2% of the worldwide population. Due to the underlying complex pathogenetic mechanisms, the therapy for FD is generally prescribed to treat the main symptoms experienced by the patient. Summary: Recently, a new herbal formulation has been proposed for treating FD. This plant-based preparation, called STW 5-II, is a fixed combination of six hydroethanolic herbal extracts from bitter candy tuft, peppermint leaf, chamomile flower, licorice root, caraway fruit, and melissa leaf. STW 5-II has been shown to be more effective than placebo in several controlled studies and clinical scenarios, allowing for its recent introduction into several European markets. Key Messages: This review aimed to describe the mechanisms of action of this herbal drug, its current and potential clinical indications, and to explore future perspectives for its use.

Introduction: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors globally. Macrophages, as essential components of the immune system, play crucial roles in immune regulation, inflammation modulation, and antitumor activity. However, it remains unclear whether tumor-associated macrophages can serve as prognostic markers for HCC. Methods: First, we identified tumor-associated macrophages based on single-cell data from GSE140228. Then, using a machine learning approach with a combination of 101 module genes, we constructed an optimal prognostic model. Subsequently, we compared our constructed model with other published prognostic models for HCC. Finally, we utilized the generated model score to predict the response to chemotherapy and immune therapy. Results: First, we identified clusters of tumor-associated macrophages using single-cell data. Subsequently, we calculated the tumor-associated macrophage score based on module genes from the previous step. Compared to traditional clinical indicators, tumor-associated macrophage signature (TAMS) exhibits significant advantages. The TAMS C-index not only predicts overall survival, but also recurrence-free survival in HCC patients. Additionally, there was a higher prevalence of TP53 mutations in HCC patients with high TAMS. Furthermore, patients with low TAMS showed greater sensitivity to immunotherapy compared to those with high TAMS. Notably, the number and intensity of interactions between TAM and other T lymphocytes were significantly higher than those involving other cell populations. Interestingly, the high TAMS group exhibited significantly elevated levels of immune checkpoint markers and M2 macrophage markers. Conclusion: TAMS can serve as a novel and potent tool, offering improved treatment options and prognostic assessment for patients with HCC.

Introduction: The Baveno criteria for assessing advanced liver fibrosis were mainly determined by transient elastography (TE), and its pathology-based validation studies in two-dimensional shear wave elastography (2D-SWE) remain limited. We aimed to validate the Baveno criteria through use of 2D-SWE. Method: Consecutive patients who underwent liver biopsies for various benign liver diseases were prospectively recruited. Liver stiffness measurement (LSM) was simultaneously evaluated by TE and 2D-SWE. The optimal cutoff value to predict advanced liver fibrosis was determined by the Youden Index, and the diagnostic performance was estimated using area under the receiver operating characteristic (AUROC) analysis. Results: A total of 101 patients were enrolled having a median age of 55.0 (IQR: 46.0–63.5) years, with 53 (52.48%) of them being male. Using <9 and >14 kPa as the optimal dual cutoffs, the AUROC values in TE and 2D-SWE were 0.92 (95% CI: 0.83–0.97) and 0.93 (95% CI: 0.84–0.98), respectively (p = 0.61). The sensitivity and specificity of LSM by TE/2D-SWE achieved rates of 94.44%/94.44% and 86.00%/88.00%, respectively. However, using the Baveno criteria, the AUROC values in TE and 2D-SWE could remain achieving 0.91 (95% CI: 0.82–0.97) and 0.93 (95% CI: 0.84–0.98), respectively (p = 0.36). The sensitivity and specificity in TE/2D-SWE were 88.24%/88.24% and 86.79%/90.57%, respectively. Conclusion: This study establishes the compatibility of the Baveno dual cutoff criteria with 2D-SWE, positioning it as an easily used criteria in clinical practice and research.

Introduction: The objective of our study was to develop a nomogram to predict overall survival (OS) and cancer-specific survival (CSS) in patients with gastric signet ring cell carcinoma (GSRCC). Methods: A total of 3,408 GSRCC patients between 1975 and 2017 were screened from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation cohorts. Univariate and multivariate Cox analyses were conducted to identify independent prognostic factors for the construction of a nomogram. The performance of the model was then assessed by the concordance index (C-index), calibration plot, and area under the receiver operating characteristic curve (AUC). Then, the novel nomogram was further assessed by 64 GSRCC patients from our hospital as the external cohort. Results: We identified age, tumor lymph node metastasis (TNM) staging system, surgery, and chemotherapy as significant independent elements of prognosis. On this basis, a nomogram was constructed, with a C-index of OS in the training and validation cohorts of 0.763 (95% CI: 0.751–0.774) and 0.766 (95% CI: 0.748–0.784) and a C-index of CSS of 0.765 (95% CI: 0.753–0.777) and 0.773 (95% CI: 0.755–0.791), respectively. The AUCs of the nomogram for predicting 2- and 5-year OS were 0.848 and 0.885, respectively, and those for predicting CSS were 0.854 and 0.899, respectively, demonstrating the excellent predictive value of the constructed nomogram compared to the traditional AJCC staging system. Similar results were also observed in both the internal and external validation sets. Conclusion: The nomogram provided an accurate tool to predict OS and CSS in patients with GSRCC, which can assist clinicians in making predictions about individual patient survival.