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Background This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. Materials and methods Between January 2020 and April 2022, patients with failed or painful knee arthroplasty who were admitted to a tertiary referral institution undergoing the standardized diagnostic protocol to identify those with a periprosthetic joint infection (PJI) were analyzed. The 2018 International Consensus Meeting (ICM) criteria were used to classify patients with PJIs and aseptic joints. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve (AUC) of AGR were calculated to define the test’s diagnostic accuracy. Results The ROC curve showed that the optimal cutoff value of AGR was 1.43. AGR registered a sensitivity of 95% (95% CI 91–197%), a specificity of 63% (95% CI 56–69%), a positive predictive value of 75% (95% CI 69–81%), and a negative predictive value of 91% (95% CI 86–94%). Receiver operator curve analysis demonstrated an AUC of 0.85 (95% CI 0.77–0.88). Although body mass index (BMI), uremia, glutamic-oxaloacetic transaminase (GOT), international normalized ratio (INR), and alkaline phosphatase showed significant differences between the false positive cases and those cases affected by aseptic failure with AGR higher than 1.43, indicating potential confounding effects ( p  < 0.05), no parameter was found to be a significant predictor of false positives cases ( p  > 0.05). Conclusions For its high sensitivity, AGR showed potential as a screening tool for detecting infections in PJI diagnostics. Level of evidence : III.

Background: The disruption of the intestinal barrier and the imbalance of the gut microbiota (GM) seem to play a major role in the complex pathogenesis of irritable bowel syndrome (IBS). Specific microbial strains could improve the gut microenvironment, promoting anti-inflammatory pathways; similarly, vitamin D supplementation could play a role in enhancing the barrier integrity and modulating the immune response in the gut. This study aims to evaluate the efficacy of a new multistrain probiotic, combined with vitamin D, in improving gut barrier function in IBS without constipation. Methods: In this phase IIb double-blind randomized placebo-controlled, parallel-group, multicenter, clinical trial, 35 patients were treated for 12 weeks with OttaBac®, a high concentration multistrain probiotic plus cholecalciferol, or placebo and were followed up until week 16. Symptoms, quality of life, intestinal permeability, fecal biomarkers, and microbiota composition were evaluated at 0, 12, and 16 weeks. Results: Mean zonulin values showed a significant progressive reduction in the active group (−10.2 ng/mL at week 12, p = 0.0375; −19.5 ng/mL at week 16, p = 0.0002), with a significant difference between groups at week 16 in the per-protocol population (−19.01, p = 0.0053). The active group showed a more stable trend toward improvement in stool frequency and consistency at both week 12 and 16, with a significant improvement compared to the baseline and to the placebo group (−23.2, p = 0.0265, and 5.57 vs. −23.2, p = 0.0492, respectively). No differences were found in regards to the lactulose/mannitol ratio, Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) and Short Form Health Survey (SF-36) total scores, plasmalemmal vesicle associated protein-1 (PV-1), and citrulline levels. In the active group, Bifidobacterium animalis subsp. lactis and Streptococcus thermophilus levels were increased (p < 0.05), while those for Lachnospira were decreased (p < 0.05), and significant changes in Actinobacteria and Proteobacteria were observed (p < 0.05). Lactate (p < 0.01) and acetate (p < 0.05) levels increased post-treatment. Correlation analysis pointed out a significant association between the microbial biomarkers and the symptoms (p < 0.05). Conclusions: Probiotic plus vitamin D could improve IBS-associated symptoms through gut microbiota modulation and gut barrier enhancement, with persistent benefits after treatment discontinuation.

Background: The diagnostic accuracy of abdominal ultrasound (US) is operator-dependent and, therefore, influenced by inadequate training and lack of continuous medical education. To fill this gap, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has developed guidelines to identify minimum training requirements for US. The aim of our survey was to assess the self-reported overall US education level among young Italian gastroenterologists. Methods: The Italian Association of Young Gastroenterologists and Endoscopists (Associazione Giovani Gastroenterologi ed Endoscopisti Italiani, AGGEI) developed a web-based survey with a multiple-choice test with images, based on the EFSUMB recommendations. The survey was distributed via e-mail to AGGEI members. Results: The questionnaire was filled out by 110 participants from all over Italy. Most of the respondents worked in academic hospitals and were gastroenterology residents or PhD students. More than half (58.9%) learned US during their gastroenterology training and 8.2% attended specific courses. During their training participants performed a median number of 320 abdominal USs and 240 bowel USs. Participants receiving a longer training period ranked significantly better in the knowledge questionnaire. Conclusions: Young Italian gastroenterologists show heterogeneous training in residencies across the country. In the future learning and hands-on training courses endorsed by academies are needed to fill this knowledge and skill gap.

Abstract Background Fecal microbiota transplantation (FMT) is emerging as a potential treatment modality for individuals living with inflammatory bowel disease (IBD). Despite its promise, the effectiveness of FMT for treating IBD, particularly for ulcerative colitis (UC), still requires thorough clinical investigation. Notwithstanding differences in methodologies, current studies demonstrate its potential for inducing remission in UC patients. Therefore, standardized and robust randomized clinical trials (RCTs) are needed to further support its efficacy for managing UC. The aim of the second Rome Consensus Conference was to address gaps and uncertainties identified in previous research regarding FMT and to offer a robust framework for future studies applied to the treatment of UC. Methods Global experts in the field of clinical IBD, mucosal immunology, and microbiology (N = 48) gathered to address the need for standardized clinical trials in FMT investigation. The group focused on key issues, such as stool donation, donor selection, characterization of fecal biomass, potential administration routes, as well as the process of induction, maintenance, and endpoint readouts. Results and Conclusions The consensus achieved during this conference established standardization of methods and protocols to enhance the current quality of research, with the aim of eventual implementation of FMT in managing UC and the ultimate goal of improving patient outcomes. Lay Summary The aim of this consensus was to establish a standardized framework and to discuss critical methodological issues to enhance evidence-based quality of procedure and define the role of future fecal microbiota transplantation trials in managing patients living with ulcerative colitis.

Background Histopathological interpretation is crucial for diagnosing inflammatory bowel disease (IBD), distinguishing between Crohn's Disease (CD), Ulcerative Colitis (UC), IBD‐Unclassified (IBD‐U), and Non‐IBD colitis (NIBDC). However, interobserver variability and limited expertise can reduce diagnostic accuracy. Large Language Models (LLMs) such as GPT‐5 may offer clinical support in interpreting histology reports. Methods We analyzed 100 real‐life histological reports from ileo‐colonoscopies, equally representing CD, UC, IBD‐U, and NIBDC, collected across five Italian healthcare centers, including both IBD‐specialized and non‐specialized hospitals. A reference standard was established by an expert pathologist. Independent classifications were generated by GPT‐5, five gastrointestinal pathologists, five IBD‐expert gastroenterologists (GIs), and five non‐expert GIs. Diagnostic performance (accuracy, recall, precision, F1‐score), agreement with the reference standard (Cohen's κ), and inter‐rater reliability (Fleiss' κ) were assessed. Results GPT‐5 achieved the highest agreement with the reference standard with the highest accuracy (76.0%), compared to pathologists (68.6%), IBD‐experts (69.2%), and non‐experts (63.2%). Agreement with the reference standard was substantial for GPT‐5 (κ = 0.671) and moderate for human groups (κ = 0.508–0.588). GPT‐5 showed perfect recall for CD and UC, high recall for NIBDC (96.0%), but poor performance for IBD‐U (recall 8.0%, F1‐score 14.3%). Fleiss' κ indicated moderate agreement among pathologists and IBD‐experts, and fair agreement among non‐experts. Conclusion GPT‐5 demonstrated reliable performance in interpreting IBD histological reports, exhibiting high accuracy and strong agreement with the reference standard. While unreliable for IBD‐U, GPT‐5 may serve as a supportive tool in histopathological interpretation of IBD, particularly in centers with limited access to expert pathologists or IBD‐specialists. Key Summary Summarise the established knowledge on this subject ◦ Histopathological assessment is central to diagnosing inflammatory bowel disease (IBD), but interpretation is challenging and interobserver variability is common. What are the significant and/or new findings of this study ◦ This study shows that GPT‐5 achieved the highest agreement with the reference standard with higher overall accuracy in classifying IBD histological reports. ◦ In detail, GPT‐5 showed excellent performance in classifying Crohn's disease, ulcerative colitis, and non‐IBD colitis, but poor performance for IBD‐Unclassified (IBD‐U). ◦ GPT‐5 may support clinicians by reducing diagnostic variability and providing timely assistance, especially in settings lacking IBD expertise, while reinforcing the need for multidisciplinary review in IBD‐U.