Euphorbia humifusa is a plant species with medicinal and food characteristics used to treat diarrhea and other intestinal diseases. This study investigated the prebiotic effects of E. humifusa-derived polysaccharides (EHPs) on human colonic microbiota and their regulatory effects on ulcerative colitis (UC). Structural characterization showed that EHPs mainly consisted of galactose, glucose, and glucuronic acid and were heteropolysaccharides having molecular weights of 7.70 × 10³ and 1.76 × 10² kDa, respectively. EHPs were identified as poorly absorbed macromolecules, verified by the apparent permeability coefficient values (Papp < 1.0 × 10⁻⁶ cm/s) and cellular uptake by Caco-2 cell monolayers. During in vitro fermentation studies, the contents of acetic, propionic, and valeric acids increased significantly in EHP-supplemented samples after 24 h compared to that in the control sample. Moreover, EHPs could alter the intestinal microbiota composition by increasing the relative abundance of Bifidobacterium and Holdemanella and reducing that of Escherichia-Shigella, Tyzzerella, and Parasutterella at the genus level. In a dextran sulfate sodium (DSS)-induced UC mouse model, EHPs alleviated UC symptoms by increasing the colon length, reversing the colon tissue damage and inhibiting pro-inflammatory cytokines. Overall, these results suggest that EHPs could be utilized as a potential prebiotic or a promising nutritional strategy for UC management.

Purpose. To evaluate the effect of puncture sites of the portal vein in transjugular intrahepatic portosystemic shunt (TIPS) on long-term clinical efficacy. Methods. A retrospective review was performed, including consecutive 171 patients who underwent TIPS with ePTFE-covered stents. All patients were divided into 3 groups according to the puncture site of the portal vein: intrahepatic bifurcation of the portal vein (group A, n=88), right branch of the portal vein (group B, n=48), and left branch of the portal vein (group C, n=35). The Kaplan-Meier analysis was performed to assess the effect of different puncture sites on primary patency, the incidence of hepatic encephalopathy (HE), and survival. Results. The primary restenosis rate was 29.8% (51/171). The total HE rate was 31.6% (54/171). The cumulative death rate was 19.3% (33/171). The Kaplan-Meier analysis showed that group C versus group A, group C versus group B, and group A versus group B were significantly different on the primary restenosis rate, respectively (χ2 = 11.49, P=0.001; χ2 = 4.54, P=0.033; and χ2 = 4.12, P=0.046), and group C is better than the other two groups. What is more, group C versus group A and group C versus group B were significantly different on the incidence of HE, respectively (χ2 = 8.07, P=0.004; χ2 = 9.44, P=0.002), and group C is better than the other two groups. There was no significant difference on survival. Conclusion. Choosing the left branch of the portal vein as the puncture site to create the shunt in TIPS with ePTFE-covered stents may decrease the incident of primary restenosis and HE significantly.

BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for managing complications of portal hypertension, particularly acute variceal bleeding (AVB). While effective in reducing portal pressure and preventing rebleeding, TIPS is associated with a considerable risk of overt hepatic encephalopathy (OHE), a complication that significantly elevates mortality rates. AIM To develop a machine learning (ML) model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset. METHODS This retrospective single-center study included 218 patients with AVB who underwent TIPS. The dataset was divided into training (70%) and testing (30%) sets. Critical features were identified using embedded methods and recursive feature elimination. Three ML algorithms-random forest, extreme gradient boosting, and logistic regression-were validated via 10-fold cross-validation. SHapley Additive exPlanations analysis was employed to interpret the model’s predictions. Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival (OS) between patients with and without OHE. RESULTS The median OS of the study cohort was 47.83 ± 22.95 months. Among the models evaluated, logistic regression demonstrated the highest performance with an area under the curve (AUC) of 0.825. Key predictors identified were Child-Pugh score, age, and portal vein thrombosis. Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS (P = 0.005). The 5-year survival rate was 78.4%, with an OHE incidence of 15.1%. Both actual OHE status and predicted OHE value were significant predictors in each Cox model, with model-predicted OHE achieving an AUC of 88.1 in survival prediction. CONCLUSION The ML model accurately predicts post-TIPS OHE and outperforms traditional models, supporting its use in improving outcomes in patients with AVB.