Litchi processing generates large quantities of seed by-products that are rich in starch and polyphenols but remain underutilized. In this study, the bioactivity and prebiotic potential of litchi seed vinegar (EHA-B-S1), a sustainable product derived from litchi seed by-products, were systematically evaluated. EHA-B-S1 displayed measurable in vitro antioxidant activity: total antioxidant capacity (4 mmol Trolox equivalents per mL), DPPH radical-scavenging of 50 µmol Vc equivalents per mL, and ABTS radical-scavenging activity of 1.0 mmol Vc equivalents per mL. EHA-B-S1 displayed moderate inhibitory capacity against α-amylase, α-glucosidase, and pancrelipase, and its performance was close to that of acarbose and orlistat. During probiotic-mediated fermentation, EHA-B-S1 rapidly acidified the fermentation environment, treatment resulted in higher measured biomass of Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactiplantibacillus plantarum, and partially sustained Bifidobacterium longum compared with the control. The increase in metabolic activity showed higher short-chain fatty acid production, especially acetic acid, and expanded flavonoid diversity from 36 to 47 detected compounds; total flavonoid content increased to approximately 176% of the initial level. Network pharmacology analysis further predicted that these flavonoids may be associated with multiple metabolic and inflammatory pathways, providing hypotheses for future mechanistic studies. Collectively, the experimentally observed in vitro activities and fermentation-associated metabolite changes support further investigation of litchi seed vinegar as an upcycled bioactive fermented-food candidate, whereas its molecular targets, physiological effects, and health relevance require targeted cellular and in vivo validation.

A 55-year-old man with prior subtotal gastrectomy was admitted with generalized edema, 16-kg weight gain, dyspnea, and frequent watery pale stools. Laboratory tests revealed severe hypoalbuminemia (1.0 g/dL), anemia, elevated myogenic enzymes, liver dysfunction, and markedly decreased pancreatic enzyme levels. Computed tomography showed bilateral pleural effusion, pulmonary edema, ascites, diffuse soft tissue edema, and marked pancreatic atrophy. Stool Sudan III staining was positive, and urinary para-aminobenzoic acid excretion was reduced. Although cardiac, renal, and hepatic disorders were considered, they did not adequately explain the presentation. Pancreatic exocrine insufficiency was diagnosed. Serum immunoglobulin G4 was elevated at 199 mg/dL, and previous imaging showed poor visualization of the hilar bile duct, gallbladder wall thickening, and gallbladder atrophy. Therefore, possible immunoglobulin G4-related pancreatobiliary disease was considered the leading possible etiology of pancreatic atrophy and exocrine insufficiency, with prior gastrectomy as a modifying factor. Treatment with albumin, diuretics, and pancrelipase (1,800 mg/day) rapidly improved the overall condition of the patient. This case highlights that pancreatic exocrine insufficiency can present with severe third-space fluid shift, pulmonary edema, and compartment syndrome-like findings, highlighting the need to assess multifactorial causes.

Supplements are commonly used by osteoarthritis (OA) patients, and eggshell membrane (ESM) proteins are widely advertised as natural bioactive compounds for joint health. Here, we evaluated the solubility, digestibility, and immunomodulatory potential of commercial ESM supplements under physiologically relevant conditions to assess their plausibility as anti-inflammatory agents. We analyzed three commercial ESM formulations (NEM[®], Torolis[®], and Biova[®]) using standardized extraction protocols. Protein solubility was assessed in physiological saline and under simulated gastric (pH 2) and intestinal (pH 5.8) conditions with controlled temperature, agitation, and digestive enzyme exposure. We examined the role of disulfide-crosslinked proteins in insolubility using dithiothreitol (DTT) and evaluated digestibility of proteins by SDS-PAGE after treatment with pepsin, pancrelipase (Creon[®]), or sequential digestion. Released peptides were identified by MALDI-TOF mass spectrometry, and immunomodulatory effects were tested using human peripheral blood mononuclear cells (PBMC) by measuring cytokine release after stimulation with lipopolysaccharide or Phorbol 12-myristate 13-acetate/Ionomycin, in the presence or absence of Biova[®]. NEM[®] and Torolis[®] showed extremely low solubility (< 0.3%) and remained insoluble under all conditions, including after DTT treatment. Although Biova[®] was highly soluble (~ 90%), simulated gastrointestinal digestion produced minimal peptide generation. Only non-physiological extraction yielded sporadic trace peptides, most lacking known anti-inflammatory relevance. In PBMC assays, Biova[®] increased IL-6 after lipopolysaccharide stimulation, showed a non-significant TNFα reduction, and had no effect on IL-17 A or granzyme B. Together, commercial ESM supplements are largely insoluble, resistant to digestion, and show no meaningful anti-inflammatory activity in human immune cells. These findings challenge the plausibility of orally administered ESM as a therapeutic intervention for osteoarthritis.

Pancreatic exocrine insufficiency (PEI), presenting as bloating or diarrhea, affects 26%-100% of patients after gastrectomy, delaying recovery and impairing quality of life. Pancreatic enzyme replacement therapy (PERT) is the standard PEI management, yet its efficacy after gastric cancer surgery remains controversial. This study evaluates PERT's effectiveness in alleviating postoperative gastrointestinal symptoms.

Exocrine pancreatic insufficiency (EPI) in neonates is rare and challenging to diagnose, particularly in extremely preterm infants in whom physiologic pancreatic immaturity may mimic disease. Persistent malabsorption, poor growth, and repeatedly abnormal fecal elastase-1 (FE1) levels can help differentiate true EPI from transient developmental insufficiency. An extremely preterm female born at 25.0 weeks adjusted gestational age (AGA), weighing 775 g, developed feeding intolerance, direct hyperbilirubinemia, and growth failure during her neonatal intensive care unit course. Serial FE1 testing on days of life 47 and 67 showed persistently low values consistent with EPI. Despite nutritional optimization, including the use of medium-chain triglyceride (MCT)-containing formula and immobilized lipase, the patient exhibited inadequate weight gain. Pancreatic enzyme replacement therapy (PERT) with pancrelipase was initiated at 35.5 weeks AGA, leading to significant improvement in weight gain and normalization of direct bilirubin. Genetic testing identified three CFTR variants of uncertain clinical significance; parental studies confirmed carrier status, and rapid exome sequencing did not identify alternative etiologies. FE1 normalized by 40.6 weeks AGA, permitting discontinuation of PERT. The infant was medically stable for discharge at 42.5 weeks AGA following gastrostomy tube placement for feeding support. This case underscores the diagnostic complexity of distinguishing EPI from physiologic enzyme immaturity in extremely preterm infants. FE1 served as a useful biomarker when interpreted in the context of gestational age and feeding status. Nutritional strategies, including MCT supplementation, PERT, and immobilized lipase, support growth; however, their use should be reserved for infants with objective evidence of EPI. The presence of CFTR variants of uncertain significance underscores the importance of cautious interpretation of genetic results and ongoing monitoring for the development of pancreatic dysfunction. EPI should be considered in extremely preterm infants with persistent malabsorption and growth faltering beyond expected physiologic immaturity. Early identification through serial FE1 testing and targeted therapy can optimize nutritional outcomes. Further research is needed to clarify the clinical relevance of CFTR variants of uncertain significance and to refine evidence-based approaches to enzyme supplementation in this population.

Cutaneous squamous cell carcinoma (cSCC) is a common non-melanoma skin cancer with low rates of local recurrence or distant metastasis except for tumours with high-risk features, which result in significantly decreased rates of overall survival compared with low-risk lesions. Immune checkpoint inhibitors (ICIs) (cemiplimab and pembrolizumab) represent a promising therapeutic option for cases of unresectable or metastatic disease, but despite their benefit, they pose a risk of immune-related adverse effects. We present the case of a patient with recurrent cSCC on cemiplimab, who developed exocrine pancreatic insufficiency induced by ICI. She presented with symptoms related to malabsorption that improved with pancrelipase but did not exhibit hyperglycaemia, contrary to what is commonly described with ICI-exocrine pancreatic insufficiency (EPI). This case highlights the importance of recognising ICI-EPI as a potential adverse effect in patients with malabsorption while on ICI and to risk-stratify patients with high-risk cSCC for prompt treatment and improved outcomes.

Introduction: After total pancreatectomy, patients inevitably develop pancreatogenic diabetes with marked glycemic variability and high risk of malnutrition due to both endocrine and exocrine insufficiency. Weight loss and malnutrition can occur even in those with adequate dietary intake and plausible pancreatic enzyme replacement. We hypothesized that glycemic variability is associated with nutritional decline. Methods: We retrospectively analyzed 14 patients who underwent continuous glucose monitoring (CGM) after total pancreatectomy. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), and patients were classified into malnutrition-risk progression or nutrition-maintaining groups. Then, we evaluated glycemic indices, dietary intake, anthropometry, and pancreatic enzyme replacement therapy (PERT). Results: Insulin use, PERT dose, and dietary intake were approximately comparable between groups. In contrast, the malnutrition-risk progression group showed significantly higher mean glucose and time above range, and lower time in range (TIR). Importantly, TIR consistently showed an inverse association with malnutrition-risk progression across models adjusted for clinical covariates, including time since pancreatectomy, primary diagnosis, insulin regimen, and pancrelipase dose. These findings indicate that the observed relationship between lower TIR and worsening GNRI was independent of dietary intake and adequacy of enzyme replacement therapy, underscoring TIR as a clinically meaningful indicator of nutritional decline in this population. Conclusions: Hyperglycemia and reduced TIR were significantly associated with worsening GNRI after total pancreatectomy, independent of dietary intake or PERT. CGM-based glycemic metrics may help identify patients at risk of malnutrition and guide postoperative management.

The therapeutic application of Pancrelipase spans several key gastroenterological conditions, ranging from chronic pancreatitis to genetic disorders such as cystic fibrosis. Consequently, pancreatic enzyme replacement therapy (PERT) is applicable in a variety of clinical settings, managing pancreatic insufficiency. Beyond chronic pancreatitis, PERT has also shown effectiveness in addressing malabsorption associated with pancreatic surgery, gastrointestinal malignancies, and various dysmetabolic conditions. This review aims to provide a comprehensive overview of the therapeutic applications of PERT and its clinical role in managing both surgical and non-surgical conditions, beyond chronic pancreatitis. PERT has proven crucial in improving patient outcomes, addressing gastrointestinal symptoms, and supporting long-term health in patients with pancreatic insufficiency. While more research, particularly from randomized controlled trials, is required to optimize dosing strategies and establish standardized PERT protocols, clinicians should consider tailoring PERT to individual patient needs based on the available evidence across various clinical scenarios.

Cinnamon essential oil (CEO) and proanthocyanidin (PC), natural food-grade materials, show potential for managing hyperglycemia and hyperlipidemia. In this study, a surfactant-free ultrasonic method was used to prepare the self-assembled CEO-PC colloidal dispersion (CEO-PC-CD), with the optimal concentrations of CEO and PC determined to be 20.0 and 10.0 mg/mL, respectively. The CEO and PC self-assembled into spherical nanoparticles, which were predominantly stabilized in the aqueous phase by π-π stacking and hydrogen bonding interactions. The in vitro antioxidant capacity of CEO-PC-CD, along with its inhibitory effects on α-amylase, α-glucosidase, and pancrelipase, was found to be more potent than those of the individual components. During the simulated in vitro digestion process, CEO-PC-CD effectively inhibited glucose, reducing sugar, and free fatty acid generation, with maximum inhibition rates of 54.46 %, 88.13 %, and 54.25 %, respectively. This study offers a novel carrier-free strategy for developing functional foods with enhanced glycemic control potential.