BACKGROUND Compared to standard hospital meals, nutritional intervention using recovery K5 (RK5), a concentrated liquid diet, offers a comprehensive immunonutritional profile, suggesting its potential effectiveness in preventing surgical site infections (SSIs) after gastrointestinal surgery. AIM To investigate the usefulness of RK5 in patients undergoing elective colorectal cancer surgery, focusing on postoperative infections and nutritional status. METHODS This single-center, open-label, randomized, parallel-group comparative trial was conducted at Department of Gastrointestinal Surgery, Nippon Medical School Hospital, between February 2023 and August 2024. Forty patients with colorectal cancer were randomly assigned in a 1:1 ratio to either the nutritional intervention or the control group. The intervention group received 800 kcal/day of RK5 administered orally instead of breakfast and dinner (400 kcal per serving) 2 days prior to surgery, whereas the control group received only standard meals. Postoperative infection, nutritional status, and bowel habits were assessed. RESULTS No cases of remote infection were observed. SSIs occurred in one of the 17 patients (5.9%) in the intervention group and six of the 18 patients (33.3%) in the control group, with an odds ratio of 0.125 (95% confidence interval: 0.013-1.181, P = 0.0695). Energy intake and percentage of target energy intake were significantly higher in the intervention group. No significant differences were observed between the two groups regarding nutritional status, bowel movement frequency, or the incidence of diarrhea. CONCLUSION Supplemental nutrition using RK5 may help prevent SSIs in patients undergoing elective colorectal cancer surgery and should be considered as a potential option for perioperative nutritional management.

Phytol enhances catalase-dependent ethanol metabolism in liver independent of PPARα.

Nutritional decline is a common challenge in head and neck cancer (HNC) patients undergoing concurrent chemoradiotherapy (CCRT). This study aimed to evaluate weekly trends in body weight and nutritional status to identify the timing and progression of malnutrition risk during treatment, thereby informing the timing of potential nutritional interventions. This observational longitudinal study enrolled 23 newly diagnosed HNC patients (87% male, median age 56.7years) receiving radiotherapy, with or without concurrent chemotherapy. Weekly weight measurements and Mini-Nutritional Assessment (MNA) scores were recorded throughout the 7-week treatment period. Nutritional counseling and general dietary advice were routinely provided as part of standard clinical care. Significant weight loss began in the 5th week of treatment, with an average total weight loss of 5.9% by the end of CCRT. MNA scores showed a clear decline from week 4 onward, and by week 7, most patients had entered the malnourished category. In parallel, 76% of patients required soft or liquid diets by the end of treatment, and the use of oral nutritional supplements increased from 10 to 96%. The results demonstrate that the risk of malnutrition increases rapidly during CCRT, particularly after the 4th week of treatment. Regular nutritional monitoring may be essential to detect early deterioration and guide the timing of nutritional support. Further studies are needed to evaluate the efficacy of structured nutritional interventions initiated early in the treatment course.

Metallothionein-dependent recovery of alcohol-related liver injury by zinc-glutathione.

This study aimed to determine the optimal timing and viscosity of thickened liquid intake for patients undergoing tongue and floor-of-mouth tumour resection with reconstruction, using VFSS to reduce nasogastric tube dependence, improve swallowing function, and the quality of life. This randomised controlled trial was conducted at a dental specialty hospital from September 2023 to November 2024. Forty-three patients who underwent free flap reconstruction for tongue and floor-of-mouth tumours were randomly divided into control (n = 22) and intervention groups (n = 21). Both received swallowing training, but the intervention group followed a structured oral intake protocol with thickened liquids. After tracheostomy removal, patients received 5 mL of medium-viscosity liquid. If no aspiration occurred, VFSS was performed using 5 mL each of medium-, low- and high-viscosity liquids. The liquid with the lowest PAS score was selected for oral intake. Nasogastric tubes were removed upon safe consumption of 200 mL within 20 min. Outcomes included tube duration, swallowing function, weight loss and quality of life. VFSS revealed increasing penetration risk with viscosity: 52.4% for low-viscosity, 23.8% for medium-viscosity and 19.0% for high-viscosity liquids. Low-viscosity liquids exhibited an aspiration rate of 14.3%, whereas no aspiration was observed with medium- or high-viscosity liquids. The intervention group had shorter nasogastric tube duration (9.2 vs. 15.6 days, p < 0.05), better swallowing function, less weight loss and higher quality of life (p < 0.05). A structured thickened liquid diet protocol safely reduces nasogastric tube dependence, enhances swallowing function and quality of life postoperatively.

Disclosure: H. Fujisawa: None. N. Iwata: None. M. Hasegawa: None. H. Kubota: None. H. Shoji: None. S. Hattori: None. H. Hagihara: None. Y. Seino: None. A. Mouri: None. T. Miyakawa: None. T. Nabeshima: None. A. Suzuki: None. Y. Sugimura: None.Hyponatremia is the most common clinical electrolyte disorder. Acute hyponatremia can cause neurological complications because of osmotically induced cerebral edema. In contrast to acute hyponatremia, chronic hyponatremia has previously been considered asymptomatic because the brain can successfully adapt to the condition. Recent evidence suggests that chronic hyponatremia may induce neurological manifestations, including psychological symptoms. However, the specific psychological symptoms induced by chronic hyponatremia, the mechanisms underlying these symptoms, and their potential reversibility remain unclear. Therefore, this study aimed to determine whether monoaminergic neurotransmission is associated with innate anxiety-like behaviors potentiated by chronic hyponatremia in a mouse model of chronic syndrome of inappropriate antidiuresis (SIAD). In the present study, we made SIAD model mice by continuously injecting desmopressin, and a liquid diet. These SIAD model mice showed significantly lower serum sodium concentrations (118.1±1.1 mEq/L) compared to the controls (141.0±1.5 mEq/L). Using these mice, we showed that sustained reduction of serum sodium ion concentrations potentiated innate anxiety-like behaviors in the light/dark transition and open field tests. We also found that serotonin and dopamine levels in the amygdala were significantly lower in mice with chronic hyponatremia than in the controls. The turnover of serotonin and dopamine in the amygdala were comparable between the control and chronic hyponatremia groups, suggesting that chronic hyponatremia impairs serotonin and dopamine synthesis. Phosphorylation of extracellular signal-regulated kinase (ERK) in the amygdala was also significantly reduced in mice with chronic hyponatremia, in accordance with previously reported rat and mouse models with potentiated anxiety-like behavior. Notably, after correcting hyponatremia by stopping desmopressin infusion and a liquid diet, increased innate anxiety-like behaviors, decreased serotonin and dopamine levels, and reduced phosphorylation of ERK in the amygdala were normalized. These findings further underscore the importance of treating chronic hyponatremia and demonstrate potential new therapeutic strategies for anxiety in patients with chronic hyponatremia, which will improve their quality of life.Presentation: Sunday, July 13, 2025

Abstract Disclosure: B.A. Vista: None. O.C. Dampil: None. R.L. Dela Cruz: None. Background: Superior mesenteric artery (SMA) syndrome is a rare condition caused by duodenal compression between the aorta and the superior mesenteric artery, often resulting from the loss of mesenteric fat. Common triggers include rapid weight loss, malignancy, malabsorption, and other chronic conditions. Symptoms typically include postprandial epigastric pain, nausea and vomiting. Diagnosis is primarily radiologic, with CT imaging showing a reduced aortomesenteric angle (&amp;lt;22–28°) and distance (&amp;lt;8 mm).This case presents a Filipino patient with Type 2 Diabetes Mellitus and mixed anxiety and depressive disorder, diagnosed with SMA syndrome presenting as recurrent episodes of epigastric pain, nausea, and vomiting, following a significant weight loss of 10 kg over six months. Clinical Case: A 30-year-old female, with Type 2 Diabetes Mellitus and recently diagnosed with mixed anxiety and depressive disorder, presented with 1 month history of recurrent episodes of epigastric pain, nausea, vomiting, and significant weight loss of 10 kg over 6 months (42 kg from 52 kg). The patient reported that she was under considerable stress, which led to a poor appetite and a reduction in her food intake to only one meal per day. Physical examination revealed a BMI of 17 (Height 157 cm, weight 42 kg). Initial laboratory findings showed leukocytosis (WBC 13,150 mm3; Reference range 4800-10800), hypokalemia (K 3.1 mmol/L), normal renal function (Creatinine 0.66 mg/dL egFR 121), and normal lipase 22 U/L (Reference range 12-53 U/L). 12L ECG showed sinus rhythm, with nonspecific ST-T wave changes. Urinalysis was unremarkable and pregnancy test was negative. A whole abdominal CT scan with oral contrast revealed a reduced aorto-mesenteric angle, measuring 20.4°, with apparent compression of the left renal vein and the third portion of the duodenum. The patient was diagnosed with SMA syndrome. She was initially placed on NPO, received intravenous fluids, and underwent electrolyte replacement therapy. As her symptoms improved, she was gradually advanced to a clear liquid diet, followed by the introduction of oral medications and further dietary progression. At her 6-month follow-up, she achieved weight gain (54 kg from 42 kg, BMI 21.9) with resolution of symptoms and normalization of the aortomesenteric angle (34.2°). Conclusion: This case highlights the importance of recognizing SMA syndrome as a possible serious complication of rapid weight loss, particularly in patients presenting with gastrointestinal symptoms such as abdominal pain, nausea, and vomiting. The risk may be heightened in individuals with psychological conditions like mixed anxiety and depressive disorder, where significant weight loss may occur. Non-surgical intervention can be effective through early detection and prompt management. Presentation: Sunday, July 13, 2025

A 6-year-old Doberman cross-breed dog was presented at a primary veterinary care center in India with loss of appetite, irritability, and pain following a traffic accident. Upon examination there were unfavorable bilateral fractures of the body of the mandible, with ventral displacement of the symphysis due to pull from the geniohyoid and mylohyoid muscles. The fracture was reduced and fixed using circum-mandibular 18-gauge surgical orthopedic wire. Postoperatively, the dog was fed a soft and liquid diet for 3 weeks along with pain management and antibiotics. Despite there being semirigid fixation, prompt healing was observed. This article discusses the selection and use of mandibular fracture repair options and treatment for a bilateral mandibular fracture in a limited resource environment in a dog.

Purpose This study aimed to clinically evaluate the high-energy light-emitting device (Germinator) in preventing pain and oral mucositis in patients undergoing chemotherapy. Methods Sixty patients were selected, being randomly divided into two groups(n = 30), according to preventive protocol: G1(Lasertherapy)-conventional low-intensity red laser protocol; G2(Germinator)-protocol with high-energy light-emitting device. Before and after these protocols, the pain and oral mucositis degrees were recorded by visual analog scale(VAS) for pain and World Health Organization(WHO) classification for oral mucositis. The VAS was used to assess pain symptoms, where 0 represented the absence of pain and 10 the highest pain score. The oral mucositis scoring was performed according to the WHO classification: grade 0(none), grade I(oral soreness, erythema), grade II(oral erythema, ulcers, solid and liquid diet tolerated), grade III(oral ulcers, liquid diet only), and grade IV(oral alimentation impossible). Statistical analysis was performed by Mann-Whitney U test(α = 5%), in order to provide the intergroup comparison. Results The median (interquartile range-IQR) of pain score was 0.0(0.0-2.0) for G1 group(Lasertherapy), whereas it was 0.0(0.0-2.0) for G2 group(Germinator), revealing no statistically significant differences (p > 0.05). The median(minimum and maximum value) of the oral mucositis score was 0.0(0.0-1.0) for G1 group(Lasertherapy), whereas it was 0.0(0.0-1.0) for G2 group(Germinator), also revealing no statistically significant differences (p > 0.05). Both treatments proved equally effective in preventing and controlling these symptoms in patients undergoing chemotherapy, recognizing that no statistically significant difference was found between the two preventive modalities. Conclusions The high-energy light-emitting device(Germinator) appears promising in preventing pain and oral mucositis in patients undergoing chemotherapy.

Small bowel (SB) capsule endoscopy (SBCE) is a key tool in patients with Crohn's disease (CD). Optimal bowel preparation remains debated. To compare the efficacy of a simplified preparation (clear liquid diet with 500 mL of water pre- and 1 L post-capsule ingestion) to a polyethylene glycol (PEG)-based preparation (24 h-residue-free diet with 2 L of PEG) in patients with established CD. In this randomised, controlled, single-blind, superiority, multicentre trial, patients were assigned 1:1 to either the simplified preparation or the PEG-based preparation. Intestinal cleanliness (quantified by the KODA score and qualitatively evaluated), patient acceptability, diagnostic yield, capsule completion rate, and SB transit time (SBTT) were compared between groups. With 142 SBCE, we observed no difference in intestinal cleanliness. Patients' acceptability of preparation and SBCE procedure was significantly higher with the simplified preparation. Diagnostic yield was similar, as well as the capsule completion rate and SBTT. The area under the receiver operating characteristic curve of the KODA score was 0.87 (95% CI: 0.84-0.90). Using a threshold of 2.25, the score allowed us to discriminate images with 'good' and 'fair or poor' cleanliness with accuracy, sensitivity, and specificity of 80%, 76%, and 84%, respectively. A simplified preparation consisting of a clear liquid diet and water is a viable alternative to a PEG-based preparation prior to SBCE in patients with CD, offering comparable SB cleanliness and diagnostic outcomes while improving acceptability. ClinicalTrials.gov identifier: NCT05117996 and the article was written in line with the Consolidated Standards of Reporting Trials (CONSORT) checklist.

Predation on Aphrophoridae and other olive tree pests makes Zelus renardii a candidate for biocontrol actions to limit Xylella fastidiosa infections while mitigating other olive tree pests. The opportunity drives the search for an effective mass rearing method of Z. renardii. Predator rearing on artificial diets greatly benefits from feed-effective formulation, preparation, storage, preservation, and delivery. Given the several oligidic, meridic, and holidic available formulations, we face the challenge of a proper diet processing for delivery. To understand how to obtain a large number of preservable and sterile diet portions while avoiding microbial contamination, we explore prilling/vibration techniques to rear Z. renardii. Prilling or vibrating the diets yields multicore microbeads or monocore microcapsules; water domains exist, whose arrangements are well-documented by the cryo-SEM study and represented in corresponding false-color images. Issues include the density interplay between low- or high-density alginate and the liquid diet formulation during prilling/vibration. Other options relate to alginate stickiness or consistency, which makes it difficult to disperse the diet domains in the microbeads or to obtain a single diet domain per microcapsule because of unpredictable wall thickness and core lateralization. We suggest options to make microbeads and microcapsule portions available for up to one year for predators, stored in cold, pure water.

Totally laparoscopic total gastrectomy (TLTG) has not been widely used to date because of the risk of postoperative complications and difficulty in reconstructing the digestive tract. To address these issues, a modified esophagojejunostomy technique in TLTG was developed. This technique reduced the need for linear staplers by effectively using a barbed suture and made closing the entry hole faster and safer. It was referred to as the modified esophagojejunostomy entry hole suture technique. A knot-free automatic suture device made of barbed suture material is used. This barbed suture was used to close the full thickness of the common opening, reinforce the seromuscular layer, and embed the esophageal stump, serving as a modified method of closing the entry hole of esophagojejunostomy in TLTG. Retrospectively, data, including surgical results and postoperative outcomes, were collected from 38 patients who underwent TLTG at the First Affiliated Hospital of Soochow University between January 2017 and December 2024. All surgeries were performed successfully. The mean operation time was 221.03 min (range 170-360 min), the mean suture time for closing the entry hole of esophagojejunostomy was 13.15 min (range 9.25-19.22 min), and the mean estimated blood loss was 96.05 mL (range 50-300 mL). The patients tolerated a liquid diet for 4.50 days (±1.87 days) after surgery, and the mean total hospital stay was 12.54 days (range 10-59 days). Overall, 6 patients underwent postoperative blood transfusion. No anastomotic-related complications or surgical complications occurred, and only 1 patient developed pneumonia after surgery. In conclusion, this modified overlap method in TLTG provides satisfactory surgical results and overcomes several technical difficulties, which is encouraging and worth expanding. This indicates that the modified method for closing the entry hole of esophagojejunostomy (E-J) in TLTG is a safe and reproducible technique.

BackgroundAlcohol-induced peripheral neuropathy (AIPN) is a painful and prevalent condition associated with chronic alcohol use, yet its molecular underpinnings remain poorly understood. Because the analgesic effects of ethanol may reinforce alcohol consumption, elucidating the mechanisms driving AIPN is essential. This study aimed to identify ethanol-regulated gene expression patterns in the nervous system of a mouse model of AIPN.MethodsMale (n = 10) and female (n = 12) C57BL/6J mice were administered either an ethanol-containing Lieber-DeCarli liquid diet at 5% or an isocaloric control diet for four weeks. Ethanol consumption was recorded daily for the experimental group. After the drinking protocol, spinal cord and dorsal root ganglia tissues were collected for RNA sequencing.ResultsEthanol-regulated genes were identified for each sex-tissue group using DESeq2, and results were compared to known rodent neuropathic pain gene signatures. Weighted gene co-expression network analysis (WGCNA) identified modules of co-expressed genes associated with ethanol administration. Hub genes with high intramodular connectivity were identified for ethanol-correlated modules. Of the 14 identified hub genes, 10 have been previously implicated in pain or neuropathy, including Jmjd1c, Phf8, and Gas6, which emerged as particularly strong candidates for involvement in AIPN pathophysiology.ConclusionsThese findings provide novel insights into the gene networks underlying AIPN and nominate specific genes for future functional studies.

The management of recurrent weight gain (RWG) following Roux-en-Y Gastric Bypass (RYGB) should be individualized, considering endoscopic procedure treatment. The most common is argon plasma coagulation (APC). The aim was to evaluate the influence of the APC procedure and/or liquid diet intake on weight loss, body composition, satiety, gastrointestinal symptoms (GIS), and energy intake in patients with RWG after RYGB. A prospective, controlled, double-blind, randomized study was conducted to compare four groups: the APC procedure with a 7-day liquid diet, the APC procedure with a 20-day liquid diet, the sham procedure with a 7-day liquid diet, and the sham procedure with a 20-day liquid diet. Weight loss cases were analyzed using the χ2 test, while comparisons between procedures and diets were made using two-way ANOVA. Non-normally distributed variables were assessed using generalized linear models. Fifty-five patients were eligible to undergo the endoscopic procedure. The % total weight loss at the final time compared to baseline was 1.7% for patients in the sham procedure group and 5.1% for patients in the APC group. The APC procedure led to weight loss and body fat reduction in RWG patients after RYGB, regardless of the liquid diet period. Furthermore, APC improved the sensation of satiety, increased GIS, and showed no difference in energy and macronutrients intake.

Abstract The prescribing of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has surged for the treatment of diabetes and obesity, with more than 15 million users worldwide. These medications also delay gastric emptying through neural mechanisms, increasing the risk for perioperative aspiration during anaesthesia and sedation. This narrative review aims to bridge the gap between evidence and clinical practice regarding the use of GLP-1 RAs in the perioperative period by critically evaluating changing clinical recommendations to inform a balance between the risks of aspiration and the potential surgical benefits. Important conclusions drawn from recent meta-analyses involving over 300,000 patients report that while the retained gastric contents are significantly increased (fivefold to tenfold increase; odds ratio 3.35–36.97), rates of pulmonary aspiration (0.1% to 0.2%) remain quite low, with no significant increase in comparison to control groups. Guidelines have evolved considerably from routine medication cessation in 2023 to GLP-1 RA continuation with individualised risk assessment in 2024–2025, illustrating increasing acknowledgment that certain theoretical risks may be underestimated. The evidence supports shared decision-making frameworks, where patient needs, procedure timeframes, and other management approaches, such as liquid diets, ultrasound evaluation of the stomach preoperatively, or anaesthetic modification tailored techniques, are considered primary drivers for care rather than rigid guidelines. The principle under which GLP-1 RAs should be managed has shifted to strategy layering—restoring calculator systems tailored to patients, rather than blanket medication cessation triggers that dominated prior models’ suspension approach.

Abstract Introduction Psychogenic dysphagia is a rare swallowing disorder with psychological origins, classified under Avoidant/Restrictive Food Intake Disorder (ARFID) in the DSM-5. It often leads to significant social withdrawal, malnutrition, and weight loss, and is commonly associated with anxiety, depression, and PTSD. Case presentation This case involves a 21-year-old Palestinian female who developed phagophobia after a choking incident at age 11. Over time, her fear of choking led to the avoidance of solid foods and a shift to a liquid diet. Her condition worsened, resulting in significant weight loss (55–46 kg) and severe malnutrition. She also experienced daily panic attacks and had a history of generalized anxiety disorder and other phobias. Investigation and diagnosis Comprehensive medical investigations, including neck ultrasound, blood tests, upper endoscopy, and flexible endoscopic evaluation of swallowing (FEES), revealed no structural abnormalities, rolling out organic causes. Psychiatric assessment confirmed a diagnosis of eating phobia. Management and outcome Treatment included pharmacotherapy (SSRIs, antipsychotics, anxiolytics) and Cognitive Behavioral Therapy (CBT). After three months, the patient reported a 30% improvement in symptoms and dietary intake. Long-term follow-up was recommended. Conclusion This case highlights the importance of recognizing psychogenic dysphagia as a psychological disorder with physical manifestations. Early intervention with pharmacotherapy and Cognitive Behavioral Therapy can significantly improve symptoms and dietary intake, emphasizing the need for a multidisciplinary approach in managing such complex cases.

Robotic-assisted surgery has transformed the field of bariatric surgery by enhancing precision, ergonomics, and visualization. Telesurgery, where the surgeon operates remotely via robotic interface, represents the next frontier in expanding access to expert surgical care. The SSI Mantra system, developed in India, is a cost-effective, multi-arm robotic platform now deployed for tele-surgical applications. To assess the feasibility, safety, and early outcomes of tele-surgical robotic One Anastomosis Gastric Bypass (OAGB) procedures using the indigenously developed SSI Mantra system. In this prospective case series conducted in July 2025, ten patients underwent tele-robotic OAGB at Mohak Bariatrics and Robotics Center, Indore. All telesurgeries were performed with the patient cart stationed at Mohak Bariatrics and Robotics Center, Indore, while the robotic consoles were operated remotely two cases from the SSI Headquarters in Gurgaon (900 km away) and eight cases from IRCAD-India, Indore (1.5 km away). A five-port standardized robotic OAGB technique was employed. Operative metrics, connectivity stability, and perioperative outcomes were analyzed. All ten procedures were completed successfully without intraoperative complications or conversions. The mean operative time was 59 ± 2min and mean robotic console time was 42 ± 5min. The tele surgical connection remained stable throughout all cases. All patients were mobilized on the same day of surgery, tolerated a liquid diet, and were discharged after an average stay of 2.4 ± 0.7days. No adverse events, readmissions, or technical failures were observed. This case series establishes the feasibility and clinical safety of long-distance tele-robotic bariatric surgery using an indigenous robotic system. With stable connectivity, precise execution, and favorable early outcomes, this first-in-world experience opens a new chapter in digitally connected metabolic surgery.

BackgroundIn patients with medication-related osteonecrosis of the jaw (MRONJ), the use of nasogastric tubes (NGTs) after surgery is recommended to allow adequate nutrition without food interfering with oral wound healing. However, NGT therapy is often perceived as irritating and rejected by some patients. This study evaluates the effect of NGT feeding on oral wound healing and patients' oral health-related quality of life (OHRQoL) after surgical treatment of MRONJ.MethodsWe assessed early wound healing in 68 patients after Surgery for MRONJ. Postoperative comparison was made between patients with NGT feeding and a matched control group receiving an oral clear liquid diet. At 14 days postoperatively, the healing of the surgical site was morphologically classified as “complete” or “incomplete”. The Early Healing Score (EHS) and the Inflammatory Proliferative Remodeling (IPR) Scale were examined on Days 1, 5 and 14 after surgery. The German version of the Oral Health Impact Profile-14 (OHIP-G 14) was used to assess OHRQoL.ResultsNo significant difference was observed in the rate of complete wound healing in patients receiving NGT feeding (61.1%) compared to patients receiving an oral clear liquid diet (62.5%) at 14 days postoperatively. The mean total EHS and the IPR Scale were not significantly different between patients on NGT feeding (EHS: 18.08 ± 5.35, IPR Scale: 14.36 ± 3.08) and patients on an oral clear liquid diet (EHS: 18.03 ± 5.26, IPR Scale: 14.66 ± 3.24). Furthermore, there was no significant difference in the mean OHIP-G 14 total score regardless of NGT therapy or consumption of an oral clear liquid diet.ConclusionsThe results indicate that postoperative NGT feeding has no beneficial effect on wound healing after surgical treatment of MRONJ. It can be assumed that NGT feeding can be replaced by an oral clear liquid diet after surgery for MRONJ without compromising oral wound healing. Additionally, our data suggest that there is no difference in OHRQoL between patients treated with an NGT and those treated with an oral clear liquid diet. Therefore, patients' negative perceptions of NGTs do not appear to affect OHRQoL.Trial registration.The trial was retrospectively registered with the German Clinical Trials Register on February 26, 2024 (DRKS00033706).

Spring-mediated distraction enterogenesis has shown success in intestinal lengthening, with spring confinement achieved by external plication with sutures to reduce the lumen diameter at both ends of the intestinal segment. Endoscopic spring placement would minimize the morbidity associated with device insertion. This study investigates the use of submucosal injection of engineered hydrogel to temporarily confine a compressed spring within an intestinal segment. Engineered hydrogels were composed of hyaluronic acid (HA) alone or HA with elastin-like protein (HELP). To simulate endoscopic injection in six juvenile pigs, hydrogel was injected into the submucosa in everted jejunum, followed by the placement of a gelatin-encapsulated, compressed nitinol spring. The jejunum was then unfolded over the spring, and hydrogel was injected distally into the submucosa. Sutures were placed as fiducial markers. After 7 days on a liquid diet, the pigs were euthanized, and their intestinal segments were analyzed for lengthening and histological changes. The spring-containing jejunal segments expanded in all animals, lengthening to 132% in the HA group and 188% in the HELP group. HELP hydrogels exhibited slower biodegradation than HA-only hydrogels. Histological analysis showed increased crypt width and decreased crypt density in the spring-containing segments compared to controls. Hydrogel effectively provides temporary spring confinement within intestinal segments without adverse effects. The mechanical stimulation from the spring induces crypt fission, expanding the intestinal epithelium. These results support the feasibility of gel-enabled, spring-mediated distraction enterogenesis for intestinal lengthening.

HRD1 promotes chronic alcoholic liver disease by mediating ACSL3 ubiquitination and degradation.