Citations

ABSTRACT Anastomotic leaks following complex gastrointestinal surgeries pose a significant challenge, especially in patients unfit for further surgical intervention. We present a novel 3-staged endoscopic approach to restore gut continuity in a 55-year-old woman with multiple anastomotic leaks and discontinuous bowel segments following extensive abdominal surgeries. The procedure included stent placement, endoscopic ultrasound (EUS)-guided gastrojejunostomy with a lumen-apposing metal stent (LAMS), and fistula plug insertion with glue. Over 6 months, bowel continuity was restored, and at 6-year follow-up, the patient remains symptom free, tolerating oral intake. This case demonstrates the transformative potential of advanced endoscopic techniques in managing complex gastrointestinal disruptions without further surgery.

Summary: Anatomy is a critical component of surgical training; however, traditional resources—such as Netter’s Surgical Anatomy , Gray’s Anatomy , and anatomy applications—often fall short in delivering surgically relevant, 3-dimensional (3D) perspectives of facial anatomy. Although cadaveric dissection remains a valuable teaching tool, its accessibility is limited by cost, ethical concerns, and the lack of structured curricula, making it less feasible for ongoing surgical education. To address these limitations, this article introduced a novel educational approach that integrates 3D photogrammetry and virtual reality technology into the surgical anatomy curriculum for craniofacial and aesthetic surgery. Six fresh cadaveric specimens were meticulously dissected by a plastic surgeon to illustrate the intricate layered anatomy of the face and neck. At each stage of the dissection, a photogrammetry technique was used to capture 360-degree images using 5 digital single-lens reflex cameras alongside a 3D handheld camera. This approach not only ensured high-quality imaging but also facilitated the creation of detailed, lifelike virtual 3D models, enhancing the understanding of facial and neck anatomy within a surgical context. Additionally, we present some technical refinements of the 3D volume renderings to capture precise anatomical details during our dissections. Preliminary results from the use of this technology in anatomy courses and workshops indicated trainee engagement, a clearer grasp of the spatial anatomical relationships, and greater confidence in applying this knowledge to hands-on surgical procedures.

Abstract Teclistamab is an anti-CD3-/B-cell maturation antigen (BCMA) bispecific antibody approved for use in relapsed/refractory multiple myeloma. We undertook a retrospective study of post-approval, real-world outcomes with teclistamab in the US Multiple Myeloma Immunotherapy Consortium. Among 509 patients, 89% would have been ineligible for the MajesTEC-1 trial, primarily due to prior BCMA-directed therapy, cytopenias, or diminished performance status. Cytokine release syndrome occurred in 54% (1.4% grade ≥3) and immune effector cell–associated neurotoxicity syndrome in 11% (2.2% grade ≥3), with no fatal events. Infections occurred in 42% and contributed to death in 5%. Partial response (PR) or better was achieved in 53% and very good PR or better in 45%. With 10.1 months of median follow-up, the estimated median progression-free survival (PFS) was 5.8 months and 12-month overall survival was 61%. Independent predictors of less than very good PR and shorter PFS included BCMA-directed chimeric antigen receptor T-cell therapy in the previous 9 months, high disease burden, lymphopenia, and elevated ferritin. Significance: T cell–engaging bispecific antibodies such as teclistamab represent an important new treatment modality for multiple myeloma and other blood cancers. This study evaluates the real-world safety and efficacy of teclistamab, including its activity in populations not represented in the initial phase I/II study, and identifies clinical variables associated with treatment response. See related commentary by Zweegman et al., p. 542

ABSTRACTTissue‐specific gene manipulation using Cre/loxP or Flp/frt recombination systems is a cornerstone of genetically engineered mouse models. In this study, we aim to develop a novel hepatocyte‐specific, tamoxifen‐inducible Flp mouse line. BAC (bacterial artificial chromosome)‐Alb(albumin)‐FlpER2(estrogen receptor ligan binding domain) was developed by inserting IRES‐FlpER2 cDNA between the translation stop codon and 3′‐UTR of the mouse albumin gene in a bacterial artificial chromosome. Upon tamoxifen induction in mice crossed with reporter lines, western blotting, immunohistochemistry, immunofluorescence staining, and X‐gal staining (5‐bromo‐4‐chloro‐3‐indolyl‐β‐D‐galactopyranoside Staining) were used to verify the recombination efficiency and specificity of this mouse model. Recombination was highly efficient and specific in hepatocytes, with no recombination detected in intrahepatic cholangiocytes or other organs in this mouse model. We generated a new tamoxifen‐induced hepatocyte‐specific mouse model with highly efficient recombination specifically in hepatocytes, and this model can be used to generate tumor model lines.

Abstract INTRODUCTION When cerebrospinal fluid (CSF) and positron emission tomography (PET) measurements for amyloid‐beta‐peptide (Aβ) related pathology are discordant, therapeutic decision‐making becomes uncertain. METHODS Using data from patients with mild cognitive impairment ( n = 541) from the Alzheimer's Disease Neuroimaging Initiative, we examined baseline characteristics and longitudinal clinical outcomes in persons grouped according to normal/abnormal Aβ via concurrent CSF and PET determinations using standard cutpoints. RESULTS Discordant groups for brain Aβ status (CSF+/PET− and CSF−/PET+) each represented about 5% of the mild cognitive impairment (MCI) population. Longitudinally, neither discordant group declined more than the CSF−/PET− group on either a memory measure or the Clinical Dementia Rating Sum of Boxes scores over a median 4 years of observation, while the CSF+/PET+ group exhibited worsening on both measures. DISCUSSION In contrast to the clinical decline observed in the CSF+/PET+ group, persons with MCI and CSF+/PET− or CSF−/PET+ brain amyloid patterns did not exhibit incipient decline. Highlights Discrepant abnormal cerebrospinal fluid (CSF) and positron emission tomography (PET) brain amyloid indicators are uncommon in mild cognitive impairment (MCI). CSF‐PET discrepant persons with MCI tend to have less abnormal values initially. CSF‐PET discrepant persons with MCI have a benign prognosis at 4 years.

Minimally invasive esophageal cellular collection devices such as the Capsule Sponge may offer the potential for targeted screening of high-risk patients. The capsule sponge has been shown to be a safe, accurate and effective means of detecting Barrett’s esophagus. Here, we explore two potential real-life scenarios that could occur in a future screening or case finding programme. Firstly, when the capsule sponge test result is positive but confirmatory endoscopy demonstrates <1cm of columnar epithelium and secondly when subsequent endoscopy identifies gastric intestinal neoplasia. We discuss the clinical implication of the result and suggest how these patients could potentially be followed up in the future.

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP1RAs) are increasingly used to treat obesity and other metabolic conditions; however, they are known to inhibit gastrointestinal motility. Since gastrointestinal microbial overgrowth (MO) can arise in states of intestinal stasis, we sought to investigate the potential association between GLP1RA use and MO. Methods: We analyzed data from 99 patients prescribed GLP1RAs who subsequently underwent testing for MO via intestinal aspirate culture or glucose or lactulose breath tests. Results: Most patients had diabetes. Among patients who underwent culture, 76.2% tested positive for small intestinal bacterial overgrowth (SIBO) at a threshold of ≥10³ CFU/mL, with a significant association found between proton pump inhibitor (PPI) use and SIBO. At ≥10 5 CFU/mL, 33.3% tested positive for SIBO, and neither PPI use nor surgical history was associated. Breath testing revealed a 30.6% positivity rate for MO, predominantly characterized by intestinal methanogen overgrowth (IMO). There was no association between control of diabetes and positive MO tests. Conclusion: GLP1RA use is associated with SIBO, although diabetes may be a confounder.

Abstract Endoscopic bariatric and metabolic therapies (EBMTs) are increasingly recognized as valuable tools for managing obesity and related metabolic disorders. As the prevalence of obesity continues to rise globally, there is a growing demand for effective, safe, and less invasive treatment options. This review provides a comprehensive summary of the available EBMTs, including both stomach-targeted and small-bowel-targeted devices. The review details the various devices, outlines the techniques for their proper use, and discusses their indications. It also presents data on their efficacy and safety, and the management of adverse events and weight regain, as well as anticipated future developments. The paper emphasizes the necessity for additional high quality randomized controlled trials and long-term outcome data to better define the role of these therapies within obesity treatment protocols. Overall, this review serves as an authoritative resource for endoscopists, bariatric specialists, and the wider healthcare community involved in obesity care, promoting best practices and guiding the appropriate implementation of EBMTs in clinical settings.