Background: Currently, medications and behavioral modifications have limited success in the treatment of functional constipation (FC). An individualized diet based on microbiome analysis may improve symptoms in FC. In the present study, we aimed to investigate the impacts of microbiome modulation on chronic constipation. Methods: Between December 2020–December 2021, 50 patients fulfilling the Rome IV criteria for functional constipation were randomized into two groups. The control group received sodium picosulfate plus conventional treatments (i.e., laxatives, enemas, increased fiber, and fluid intake). The study group underwent microbiome analysis and received an individualized diet with the assistance of a soft computing system (Enbiosis Biotechnology^®, Sariyer, Istanbul). Differences in patient assessment constipation–quality of life (PAC-QoL) scores and complete bowel movements per week (CBMpW) were compared between groups after 6-weeks of intervention. Results: The mean age of the overall cohort (n = 45) was 31.5 ± 10.2 years, with 88.9% female predominance. The customized diet developed for subjects in the study arm resulted in a 2.5-fold increase in CBMpW after 6-weeks (1.7 vs. 4.3). The proportion of the study group patients with CBMpW > 3 was 83% at the end of the study, and the satisfaction score was increased 4-fold from the baseline (3.1 to 10.7 points). More than 50% improvement in PAC-QoL scores was observed in 88% of the study cohort compared to 40% in the control group (p = 0.001). Conclusion: The AI-assisted customized diet based on individual microbiome analysis performed significantly better compared to conventional therapy based on patient-reported outcomes in the treatment of functional constipation.

Background/Objectives: Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) is a validated surrogate endpoint in HER2-positive and triple-negative breast cancer. Most work on blood-count-derived inflammatory indices has examined a single pretreatment value rather than change during treatment. We tested whether an early reduction in the pan-immune-inflammation value (PIV) predicts pCR. Methods: We studied 272 patients with HER2-positive or triple-negative stage II–III breast cancer treated at one centre: a discovery cohort treated in 2018–2021 (n = 191) and a temporally independent validation cohort treated in 2022–2023 (n = 81). Early ΔPIV was the proportional change between the baseline complete blood count and the count before the second or third cycle. The 30% reduction threshold was fixed before the analysis for clinical interpretability. Reporting followed STROBE and TRIPOD. Results: pCR occurred in 157 patients (57.7%). The median early ΔPIV was −0.44 in patients with pCR and −0.11 in those without (p < 0.001). The area under the curve was 0.80 (95% CI 0.73–0.86) in the discovery cohort and 0.84 (0.75–0.93) in validation. pCR was reached by 78.6% of patients with a ≥30% early reduction versus 37.6% without it in the discovery cohort, and by 77.8% versus 27.8% in the validation cohort. In the primary three-variable model, the adjusted odds ratio was 6.45 (2.90–14.32; p < 0.001) in the discovery cohort and 27.85 (3.93–197.36; p < 0.001) in the validation cohort. Adding early PIV reduction to clinicopathologic factors raised the area under the curve from 0.69 to 0.80 (difference 0.111, 95% CI 0.047–0.175; p < 0.001). Conclusions: Early PIV reduction is associated with pCR and adds information beyond established factors. At 69% sensitivity and 73% specificity it is a candidate adjunct rather than a decision rule, and prospective multicentre validation is required.

Objective: This study aimed to determine whether acute diverticulitis can still be regarded solely as a disease of the elderly and to compare colonic localization, disease severity, and inflammatory indices between patients younger than 50 years and patients aged 50 years and older. Materials and Methods: This retrospective cross-sectional study included 132 patients older than 18 years who were diagnosed with acute diverticulitis confirmed by contrast-enhanced abdominal computed tomography (CT) at Istanbul Haseki Training and Research Hospital between January 2017 and December 2021. Patients were divided into two groups: those younger than 50 years (n=64) and those aged 50 years and older (n=68). Diverticulitis localization was classified as distal (rectosigmoid/sigmoid/descending colon) or proximal (cecum/ascending colon/hepatic flexure). Disease severity was assessed according to the Hinchey classification, and Hinchey stage 1B or higher was defined as complicated diverticulitis. Demographic characteristics, comorbidities, laboratory parameters, and hemogram-derived inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), and C-reactive protein (CRP)-to-albumin ratio were analyzed. Groups were compared using the Chi-square test, Fisher’s exact test, and Mann–Whitney U test. Results: The overall mean age was 49.8±14.7 years. Male sex predominated among patients younger than 50 years (64.1%), whereas female sex predominated among patients aged 50 years and older (67.6%). Distal colonic involvement was similar in both groups (81.2% vs 82.4%; p=1.0). Overall, 82.6% of patients had Hinchey 1A disease. Although complicated diverticulitis appeared more frequent in younger patients, the difference was not statistically significant (20.3% vs 14.7%; p=0.536). Hypertension, cardiac disease, and previous abdominal surgery were significantly more common in patients aged 50 years and older. CRP levels and NLR showed a tendency to be higher in the older group, whereas the CRP-to-albumin ratio was significantly higher (1.14 [0.44–2.67] vs 1.78 [1.13–3.19]; p=0.045). PLR, SII, LMR, and length of hospital stay were similar between groups. Most patients were managed conservatively, consistent with the predominance of uncomplicated disease in the cohort. Conclusion: Colonic localization of acute diverticulitis was similar in younger and older patients. Although complicated diverticulitis appeared numerically more frequent in younger patients, systemic inflammatory burden, particularly the CRP-to-albumin ratio, was more pronounced in patients aged 50 years and older. The comparable number of younger and older patients in the same center suggests that acute diverticulitis should no longer be regarded solely as a disease of the elderly. Larger prospective studies are needed to confirm these findings and to further clarify age-related differences in treatment and outcomes.

Background/Objectives: The CRP–albumin–lymphocyte (CALLY) index is promoted both as a marker of postoperative morbidity and as a prognostic factor for survival. These claims are rarely tested together, thresholds usually come from the dataset in which they are then tested, and the index is seldom compared against its components. We examined both in one minimally invasive esophagectomy cohort. Methods: Consecutive esophagectomies with a thoracoscopic or robotic thoracic phase at one centre were reviewed. The index was derived from the preoperative albumin, C-reactive protein, and lymphocyte count. Short-term endpoints were major morbidity (Clavien–Dindo grade ≥ 3) and anastomotic leak; survival was analysed by Kaplan–Meier and Cox methods, with internal cut-points stress-tested by bootstrapping. Results: Of 154 esophagectomies screened, 22 open or transhiatal procedures and one exploration without resection were excluded, leaving 131 patients. Major morbidity occurred in 39 (29.8%), and leak in 21 (16.0%). The index discriminated neither: area under the curve 0.556 (95% CI: 0.450–0.663) and 0.481 (95% CI: 0.339–0.623). Over a median follow-up of 31.0 months, there were 39 deaths, and median survival was 62.1 months. Here, the index behaved differently: each unit of log-CALLY carried a hazard ratio of 0.776 (95% CI: 0.643–0.936, p = 0.008), and three-year survival rose from 48.5% in the lowest tertile to 77.1% in the highest (trend p = 0.020). The association held after adjustment for stage and nodal status (0.749, 95% CI: 0.609–0.922, p = 0.006), lifting the concordance index of a stage-based model from 0.699 to 0.741. However, entered with CRP, the index lost significance. Conclusions: The index said nothing useful about early surgical morbidity yet was independently associated with survival, although that signal did not survive adjustment for CRP alone. It belongs with prognostic markers rather than perioperative risk scores.