Interaction between gut virome and microbiota on inflammatory bowel disease

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, is a chronic condition marked by recurring gastrointestinal inflammation. While immune, genetic, and environmental factors are well-studied, the gut virome has received less attention. This editorial highlights the work which investigates the gut virome’s role in IBD and its interactions with the bacterial microbiome and host immune system. The gut virome consists of bacteriophages, eukaryotic viruses, and endogenous retroviruses. Among these, Caudovirales bacteriophages are predominant and influence bacterial communities via lysogenic and lytic cycles. Eukaryotic viruses infect host cells directly, while endogenous retroviruses impact gene regulation and immune responses. In IBD, the virome shows distinct alterations, including an increased abundance of Caudovirales phages and reduced Microviridae diversity, suggesting a pro-inflammatory viral environment. Dysbiosis, chronic inflammation, and aberrant immune responses contribute to these changes by disrupting microbial communities and modifying virome composition. Phages affect bacterial dynamics through lysis, lysogeny, and horizontal gene transfer, shaping microbial adaptability and resilience. Understanding these interactions is crucial for identifying novel therapeutic targets and restoring microbial balance in IBD.

Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis

BACKGROUND

Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the most common modality for tissue acquisition from pancreatic masses. Despite high specificity, sensitivity remains less than 90%. Auxiliary techniques like elastography and contrast-enhanced EUS may guide tissue acquisition from viable tumor tissue and improve the diagnostic outcomes theoretically. However, data regarding the same have shown conflicting results.

AIM

To compare the diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions.

METHODS

The electronic databases of MEDLINE, EMBASE, and Scopus were searched from inception to February 2024 for all relevant studies comparing diagnostic outcomes of auxiliary-EUS-FNA/B to standard EUS-FNA/B for pancreatic lesions. A bivariate hierarchical model was used to perform the meta-analysis.

RESULTS

A total of 10 studies were identified. The pooled sensitivity, specificity, and area under the receiver-operated curve (AUROC) for standard EUS-FNA/B were 0.82 (95%CI: 0.79-0.85), 1.00 (95%CI: 0.96-1.00), and 0.97 (95%CI: 0.95-0.98), respectively. The pooled sensitivity, specificity, and AUROC for EUS-FNA/B with auxiliary techniques were 0.86 (95%CI: 0.83-0.89), 1.00 (95%CI: 0.94-1.00), and 0.96 (95%CI: 0.94-0.98), respectively. Comparing the two diagnostic modalities, sensitivity [Risk ratio (RR): 1.04, 95%CI: 0.99-1.09], specificity (RR: 1.00, 95%CI: 0.99-1.01), and diagnostic accuracy (RR: 1.03, 95%CI: 0.98-1.09) were comparable.

CONCLUSION

Analysis of the currently available literature did not show any additional advantage of EUS-FNA/B with auxiliary techniques for pancreatic solid lesions over standard EUS-FNA/B. Further randomized studies are required to demonstrate the benefit of auxiliary techniques before they can be recommended for routine practice.

Extracorporeal therapies for post-liver transplant recipient: The road less traveled

Extracorporeal therapies have a definite role in patients with acute liver failure, acute on-chronic liver failure, and progressive chronic liver disease. They act as a bridge-to-transplant in these patients. With the increasing success of liver transplantation, the immediate postoperative complication spectrum continues to expand. Extracorporeal therapies can play an important role in managing these complications. However, the literature on extracorporeal therapies in the post-liver transplant period is limited. This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes. These extracorporeal therapies can be divided into two subgroups: (1) Therapies for infective complications. Endotoxin and cytokine adsorption columns; and (2) Therapies for noninfective complications like small for size syndrome, primary allograft nonfunction, early allograft dysfunction, hyperacute rejection, hepatopulmonary syndrome, etc. (plasma exchange, double plasma molecular adsorption, molecular adsorbent recirculation system, and extracorporeal membrane oxygenation, among others).

Disparities in liver transplantation for metabolic dysfunction-associated steatohepatitis-associated hepatocellular carcinoma

BACKGROUND

Metabolic dysfunction-associated steatohepatitis (MASH) is increasingly common, as is hepatocellular carcinoma (HCC) in the background of MASH. Liver transplantation (LT) provides superior long-term survival for patients with unresectable MASH-HCC, but not all patients have equal access to transplant. MASH-HCC disproportionately affects Hispanic patients, but minorities are less likely to undergo LT for HCC. Additionally, females also undergo LT at lower rates than males.

AIM

To investigate whether race/ethnicity and sex affect LT waitlist outcomes.

METHODS

Records of adults with MASH-HCC in the United States Organ Procurement and Transplantation Network database listed for LT between 1/2015 and 12/2021 were analyzed.

RESULTS

Most of the 3810 patients waitlisted for LT for MASH-HCC were non-Hispanic (NH) white (71.2%) or Hispanic (23.4%), with only 49 (1.1%) NH Black candidates. Hispanics underwent LT at lower rates than NH whites (71.6% vs 78.4%, P < 0.001), but race/ethnicity did not affect waitlist mortality (P = 0.06). Patients with Hispanic [hazard ratio (HR) = 0.85, 95%CI: 0.77-0.95, P = 0.002] or Asian (HR = 0.79, 95%CI: 0.63-0.98, P = 0.04) race/ethnicity were less likely to undergo LT. Women were also less likely to receive LT (male: HR = 1.16, 95%CI: 1.04-1.29, P = 0.01). Patients in regions 1 and 9 were less likely to be transplanted as well (P = 0.07).

CONCLUSION

Hispanic patients are less likely to undergo LT for MASH-HCC, concerning given their susceptibility to MASH and HCC. There were very few NH Black candidates. Disparities were also unequal across regions, which is particularly concerning in states where at-risk populations have rising cancer incidence. Additional research is needed to identify strategies for mitigating these differences in access to LT for MASH-HCC.

Death after psychiatric contraindications to urgent liver transplant for paracetamol overdose

BACKGROUND

Paracetamol overdose (POD) is the most common cause of acute hepatic failure (AHF) in the United Kingdom. Without urgent orthotopic liver transplant (OLT), mortality is high. Psychiatric assessment for transplant is time-pressured and often undertaken by psychiatrists without transplant experience. Assessors may identify absolute psychiatric contraindications (APCIs) precluding transplant in otherwise medically suitable patients. It is unknown how often this occurs. The combination of high but unknown mortality, time pressure, and relative inexperience is likely to provoke anxiety in assessors. This study hypothesised that the proportion of POD patients assessed for OLT who die because psychiatric contraindications preclude transplant would be small but not negligible.

AIM

To determine the proportion of patients with paracetamol-induced AHF, for whom psychiatric contraindications preclude transplantation, and the consequent mortality.

METHODS

This is an 18-year single-centre retrospective cohort study based in a national liver transplant centre. 524 participants were identified from a departmental database and included if they had AHF from suspected POD and received a psychiatric assessment for OLT. For those who died before discharge, records were reviewed for medical and psychiatric contraindications to transplant, alongside age, sex, and primary psychiatric diagnosis. We calculated the proportion of patients assessed for whom APCIs precluded transplant, resulting in death.

RESULTS

Among 524 patients undergoing psychiatric assessment for OLT, there were 102 in-episode deaths (19.5%). APCIs were identified in 46 patients who were otherwise medically suitable for transplant and went on to die. This statistic represents 8.8% of the number of persons evaluated and 45% of the number of deaths. Within this subgroup, 27 (59%) were female, with a mean age of 44.6 years (ranging from 19-72 years). The most common primary psychiatric diagnosis was alcohol dependence syndrome, which accounted for 67% (n = 31).

CONCLUSION

8.8% of medically suitable patients with AHF following POD died with APCIs to transplant. This indicates a need for ongoing assessor training and support, and (inter) national comparisons of practice.

Living donor transplant: Right vs left kidney

Khan et al’ single-centre, retrospective study on the use of right or left kidneys in living-donor renal transplantation, offers the opportunity to further discuss a complex and debated topic in clinical transplantation. In brief, the authors confirm that, despite the historical preference for left kidneys, attributed to their anatomical advantages during donor nephrectomy and recipient transplantation, right kidneys can provide excellent outcomes when donors and recipients are carefully selected, and a meticulous surgical technique is applied in every step of the process. Usefully, the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation, such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis. Although limited by the selective use of minimally invasive (MI) nephrectomy for left kidneys, this work underscores the importance of expanding the living-donor pool, challenging the traditional taboos, and facilitating access to transplantation for a wider population of patients around the globe. Properly designed studies with larger sample size, comparable MI surgical techniques, prospective data collection, and long-term donor and recipient outcomes are warranted.

Incidence, screening, and management of de novo malignancies in liver transplant patients: A review

Liver transplantation (LT) is the definitive treatment for end-stage liver disease, acute liver failure, and liver cancer. Although advancements in surgical techniques, postoperative care, and immunosuppressive therapies have significantly improved outcomes, the long-term use of immunosuppression has increased the risk of complications, including infections, cardiovascular disease, and cancer. Among these, de novo malignancies (DNMs) are a major concern, accounting for 20%-25% of deaths in LT recipients surviving beyond the early post-transplant period. Non-melanoma skin cancers, particularly squamous cell carcinoma are the most prevalent DNMs. Other significant malignancies include Kaposi's sarcoma, post-transplant lymphoproliferative disorders, and various solid organ cancers, including head and neck cancers. Compared to the general population, LT patients face a twofold increase in solid organ malignancies and a 30-fold increase in lymphoproliferative disorders. Risk factors for DNM include chronic immunosuppression, alcohol or tobacco use, viral infections, and underlying liver disease. Emerging evidence emphasizes the importance of tailored cancer screening and prevention strategies, including regular dermatological examinations, targeted screenings for high-risk cancers, and patient education on lifestyle modifications. Early detection through enhanced surveillance protocols has been shown to improve outcomes. Management of DNMs involves a combination of standard oncological therapies and adjustments to immunosuppressive regimens, with promising results from the use of mTOR inhibitors in select patients. The review highlights the critical need for ongoing research to refine risk stratification, optimize screening protocols, and improve treatment approaches to mitigate the burden of DNMs in LT recipients. By implementing personalized preventive and therapeutic strategies, we can enhance long-term outcomes and quality of life for this vulnerable population.

Assessment of antimicrobial properties of a curcumin-loaded nano-emulsion in reducing pathogen loads on cantaloupe surface (Cucumis melo L.)

Curcumin (CUR) exhibits antimicrobial properties but is hindered by chemical instability, limiting its direct application. This study evaluated the efficacy of curcumin nanoemulsions (CUR-NE) in reducing pathogenic microorganisms on cantaloupe rind surfaces. Two CUR-NE formulations, 1CUR-NE (0.05% CUR, w/w) and 2CUR-NE (0.10% CUR, w/w), were prepared by mixing CUR with medium-chain triglyceride (MCT) oil (3% w/w), polysorbate 80 (2% w/w), and polyethylene glycol (10% w/w), followed by a 15-min ultrasound treatment (175 W). The antimicrobial effects were assessed against Listeria innocua B-33016, Escherichia coli ATCC25922, aerobic bacteria, and yeast and mold. Inoculated cantaloupe surfaces were treated with CUR-NE, and microbial counts were analyzed on days 1, 3, 6, 9, and 12. The viscosity of 1CUR-NE and 2CUR-NE was 0.0030 ± 0.0001 Pa s and 0.0027 ± 0.0006 Pa s, with droplet sizes of 122.47 ± 3.06 nm and 137.67 ± 1.36 nm, respectively. Treatment with 2CUR-NE significantly reduced L. innocua growth on day 6 (2.50 ± 1.00 log CFU/cm2), with E. coli showing significant reductions on days 6 (1.55 ± 0.40 log CFU/cm2), 9 (1.91 ± 0.36 log CFU/cm2), and 12 (0.72 ± 0.26 log CFU/cm2). Scanning electron microscopy revealed a substantial decrease in microbial load after treatment. The results suggest that CUR-NE, particularly 2CUR-NE, effectively reduces pathogenic contamination on cantaloupe and offers a potential alternative to synthetic antimicrobial agents in food safety applications. Further studies are needed to explore the long-term efficacy and broader applications of CUR-NE in food systems.

Overcoming immunotherapy resistance in colorectal cancer through nano-selenium probiotic complexes and IL-32 modulation

BACKGROUND AND OBJECTIVE

Colorectal cancer (CRC) is a major global health burden, with immunotherapy often limited by immune tolerance and resistance. This study introduces an innovative approach using Selenium Nanoparticles-Loaded Extracellular Vesicles combined with Interleukin-32 and Engineered Probiotic Escherichia coli Nissle 1917 (SeNVs@NE-IL32-EcN) to enhance CD8+ T cell-mediated immune responses and overcome immunotherapy resistance.

METHODS

Single-cell RNA sequencing (scRNA-seq) and transcriptomic analyses were performed to identify key immune cells and regulators involved in CRC immunotherapy resistance, focusing on CD8+ T cells and the regulatory factor IL32. A humanized xenograft mouse model was used to evaluate the impact of IL32 and SeNVs@NE-IL32-EcN on tumor growth and immune responses. The SeNVs@NE-IL32-EcN complex was synthesized through a reverse micelle method and functionalized using extracellular vesicles. Its morphology, size, antioxidant activity, and safety were characterized using electron microscopy, dynamic light scattering (DLS), and in vitro co-culture assays.

RESULTS

Single-cell analyses revealed a significant reduction in CD8+ T cell infiltration in immunotherapy-resistant CRC patients. IL32 was identified as a key regulator enhancing CD8+ T cell cytotoxic activity through granzyme B and IFN-γ secretion. Treatment with SeNVs@NE-IL32-EcN significantly improved the proliferation and activity of CD8+ T cells and reduced tumor progression in humanized mouse models. In vitro and in vivo results demonstrated the complex's biocompatibility, antioxidant properties, and ability to enhance CRC immunotherapy while mitigating immune tolerance.

CONCLUSION

SeNVs@NE-IL32-EcN offers a novel nano-biomaterial strategy that integrates nanotechnology and probiotic therapy to enhance CD8+ T cell-mediated immunity and overcome CRC immunotherapy resistance. This study lays the foundation for future therapeutic applications in cancer treatment by advancing immune-modulating biomaterials.

Liver Transplantation for Non-hepatocellular Carcinoma: The Role of Immune Checkpoint Inhibitors

Colorectal cancer (CRC), gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN), and cholangiocarcinoma (CCA) exhibit high rates of morbidity and mortality once metastasized to the liver. Liver transplantation (LT) is a viable therapeutic approach for these cancers in highly selected patients; however, their invasive nature at late stages causes many patients to be delisted from transplantation or to require further downstaging. Immunotherapy with immune checkpoint modulators has revolutionized cancer research. Immune checkpoint inhibitors (ICI) leverage the chronic inflammatory state and the overexpression of cytotoxic T lymphocyte antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) by malignant cells and regulatory T cells, to block immune checkpoints and counteract tumor's ability to evade the immune system. However, the interaction between allograft PD-L1 and PD-1 on infiltrating T cells functions as a means of graft tolerance in cases of LT. Therefore, the application of ICIs might block this protective effect and induce graft rejection, a phenomenon particularly observed in PD-1/PD-L1 inhibiting ICIs. The risk of post-LT graft rejection can be mitigated by applying advanced biomarkers and specifying certain mutations that enhance patient selection criteria for pre-LT ICI use. Furthermore, the determination of optimal intervals of ICI administration pre- and post-LT, identification of ICI indications in de novo malignancies occurring after LT, and investigation of biomarkers for early rejection detection, pave the way for more promising LT outcomes in patients with CRC, GEP-NEN, or CCA. Therefore, this review aims to illustrate a comprehensive overview of the role of ICI therapy in the management of non-hepatocellular carcinoma transplant oncology cancers by demonstrating the potential for its application in both pre-and post-LT states, and pathways to reduce or timely detect ICI-associated graft rejection.

Simultaneous quantification of methotrexate, 7-hydroxymethotrexate and creatinine in serum by LC-MS/MS for predicting delayed elimination

High-dose methotrexate (HDMTX) is widely accepted as the first-line chemotherapeutic agent for pediatric acute lymphoblastic leukemia (ALL). However, it exhibits significant pharmacokinetic variability among individuals, which may lead to delayed elimination of MTX. In this study, we innovatively developed a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of serum MTX, 7-hydroxymethotrexate (7-OHMTX) and creatinine. The analytes were isolated using a protein precipitation method and separated on an Agilent Poroshell 120 SB-C18 column (4.6 × 50 mm, 2.7 µm) using a gradient elution with methanol (B) and 0.1 % formic acid in water (A), at a flow rate of 0.5 mL/min. The assay was linear over the range of 20-2000 ng/mL (R2 ≥ 0.997) for MTX and 7-OHMTX and 1-70 μg/mL (R2 ≥ 0.997) for creatinine. Intra- and inter-day accuracy for all analytes ranged from 88.1 % to 109.8 % with corresponding precision of 1.0-14.5 %. No significant matrix effects were observed, and analyses were extracted from human serum with recoveries exceeding 93.4 %. The predictive performance of the MTX48 h, 7-OHMTX48 h, the 7-OHMTX/MTX48 h ratio, creatinine48 h and the combined test value of the four indicators was evaluated using area under the curve (AUC). Receiver operating characteristic (ROC) analysis revealed that MTX48 h exhibited superior predictive accuracy with sensitivity of 87.5 %, specificity of 93.1 % and AUC of 0.914 compared to 7-OHMTX48 h with a sensitivity of 50.0 %, specificity of 89.7 % and AUC of 0.683. This finding suggesting that MTX48 h is a better predictor of delayed elimination than 7-OHMTX48 h. The 7-OHMTX/MTX48 h ratio provide a more reliable prediction of delayed elimination compared to 7-OHMTX48 h alone, emphasizing the importance of metabolic rates in addition to concentration levels. The combined test values of these four indicators at 48 h demonstrated higher predictive accuracy with sensitivity of 93.8 %, specificity of 96.6 % and AUC of 0.963 than any individual index with sensitivity (ranging from 50.0 % to 87.5 %), specificity (ranging from 79.3 % to 93.1 %) and AUC (ranging from 0.683 to 0.914). Notably, this combined test identified delayed elimination at 48 h rather than 72 h, thus enabling timely adjustments to calcium folinate rescue regimens.

Bidirectional regulation of the brain-gut-microbiota axis following traumatic brain injury

JOURNAL/nrgr/04.03/01300535-202508000-00002/figure1/v/2024-09-30T120553Z/r/image-tiff Traumatic brain injury is a prevalent disorder of the central nervous system. In addition to primary brain parenchymal damage, the enduring biological consequences of traumatic brain injury pose long-term risks for patients with traumatic brain injury; however, the underlying pathogenesis remains unclear, and effective intervention methods are lacking. Intestinal dysfunction is a significant consequence of traumatic brain injury. Being the most densely innervated peripheral tissue in the body, the gut possesses multiple pathways for the establishment of a bidirectional "brain-gut axis" with the central nervous system. The gut harbors a vast microbial community, and alterations of the gut niche contribute to the progression of traumatic brain injury and its unfavorable prognosis through neuronal, hormonal, and immune pathways. A comprehensive understanding of microbiota-mediated peripheral neuroimmunomodulation mechanisms is needed to enhance treatment strategies for traumatic brain injury and its associated complications. We comprehensively reviewed alterations in the gut microecological environment following traumatic brain injury, with a specific focus on the complex biological processes of peripheral nerves, immunity, and microbes triggered by traumatic brain injury, encompassing autonomic dysfunction, neuroendocrine disturbances, peripheral immunosuppression, increased intestinal barrier permeability, compromised responses of sensory nerves to microorganisms, and potential effector nuclei in the central nervous system influenced by gut microbiota. Additionally, we reviewed the mechanisms underlying secondary biological injury and the dynamic pathological responses that occur following injury to enhance our current understanding of how peripheral pathways impact the outcome of patients with traumatic brain injury. This review aimed to propose a conceptual model for future risk assessment of central nervous system-related diseases while elucidating novel insights into the bidirectional effects of the "brain-gut-microbiota axis."

Precision Chemotherapy: Optimizing Calibration for Rapid Determination of Blood Methotrexate by Tandem Mass Spectrometry ± Liquid Chromatography

BACKGROUND

Rapid therapeutic monitoring of high-dose methotrexate (MTX) chemotherapy is essential to avoid toxicity. MTX concentrations are commonly monitored using immunoassays that are limited by narrow dynamic range and metabolite cross reactivity. Mass spectrometry may improve the molecular specificity of MTX analysis but is limited by slow throughput and extensive calibration. In this study, we examined the consequences of eliminating LC from MS/MS and foregoing external calibration to enable rapid determination of MTX.

METHODS

MTX (m/z 455 → 308), was assessed using UPLC-MS/MS or flow-injection MS/MS using a six-point external calibration scheme with a single deuterated internal standard, 4-point internal calibration using 13C5, 13C6, 13C11, and 13C14-MTX, or by single point calibration with the single deuterated internal standard. Accuracy, precision, and resistance to hemolysis, icterus, and lipemia were compared with immunoassay.

RESULTS

Across all six injection/calibration schemes, imprecision ranged from 2.5% to 10% (CV) from 0.05-10 μM. Regardless of calibration scheme, MS/MS ± LC was more resistant to interference from hemolysis and bilirubin than immunoassay. MS/MS ± LC determination of MTX was compared with immunoassay in 81-100 plasma specimens with MTX concentrations ranging from 0.05-81 μM. Intercept estimates all included zero with 95% confidence. Estimates of slopes versus immunoassay for each of the six analytic approaches ranged from 0.88 to 1.09.

CONCLUSIONS

Eliminating LC and external calibration enabled rapid, precise, and accurate determination of MTX concentrations in plasma. Minimalist but robust approaches such as these may enable the use of MS for routine MTX determination in time-sensitive clinical circumstances.

Plant-derived bioactive peptides and protein hydrolysates for managing MAFLD: A systematic review of in vivo effects

Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a growing health concern worldwide. Among the pursuit of therapeutic interventions, interest in natural bioactive compounds has intensified because of their potential hepatoprotective effects. This systematic review aims to evaluate the impact of plant-derived hydrolysates and peptides on MAFLD through the current literatures, encompassing their mechanisms of action. Key outcomes evaluated included changes in liver enzymes, liver lipid content, inflammation markers, and histopathological improvements. Preliminary findings suggest a potential beneficial effect of plant-derived hydrolysates and peptides on the improvement of MAFLD-related parameters, with mechanisms implicating antioxidant, anti-inflammatory, and lipid-lowering properties. This review highlights emerging evidence supporting the potential therapeutic role of plant-derived hydrolysates and peptides in the management of MAFLD. However, more well-designed clinical trials with larger sample sizes and longer durations are warranted to elucidate their efficacy, optimal dose, and long-term safety.

Combination treatment of SGLT2i and GLP-1RA associated with improved cardiovascular outcomes in type 2 diabetes patients with acute coronary syndrome: A propensity score-matched cohort study

BACKGROUND

Few studies have investigated the effect of the combined use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) on the cardiovascular (CV) composite outcomes in type 2 diabetes (T2D) patients with acute coronary syndrome (ACS).

METHODS

We retrospectively collected the data of 1325 T2D patients treated with SGLT2i for more than 3 months before ACS admission at Civil Aviation General Hospital. According to the initiative GLP-1RA use after admission, patients were divided into a combination group (SGLT2i and GLP-1RA) or a SGLT2i group. The primary CV composite outcomes were defined as the first occurrence of major adverse cardiovascular events (MACE) with 1-year, encompassing all cause death, CV death, non-fatal myocardial infarction or stroke, coronary revascularization or heart failure readmission. Propensity score-matched (PSM) was used to control the confounding factors.

RESULTS

After matching, 208 pairs were finally included. Compared with the SGLT2i group, the combination group demonstrated a 31.0 % reduced risk of MACE (HR = 0.690, 95 %CI: 0.488-0.976), attributed primarily to a substantial 22.9 % (HR = 0.771, 95 %CI: 0.599-0.992) reduction in all-cause mortality and a 36.3 % reduction in non-fatal stroke (HR = 0.637, 95 %CI: 0.413-0.982). Subgroup analyses indicated consistent CV benefits across different subgroups (P interaction values >0.05).

CONCLUSIONS

The combined use of SGLT2i and GLP-1RA was associated with a significantly decreased risk of MACE primarily driven by the lowering risks of all-cause mortality and nonfatal stroke in T2D patients with ACS, compared with SGLT2i use alone.

Total adenosine deaminase cases as an inflammatory biomarker of pleural effusion syndrome

BACKGROUND

Although inflammatory diseases commonly affect the pleura and pleural space, their mechanisms of action remain unclear. The presence of several mediators emphasizes the concept of pleural inflammation. Adenosine deaminase (ADA) is an inflammatory mediator detected at increased levels in the pleural fluid.

AIM

To determine the role of total pleural ADA (P-ADA) levels in the diagnosis of pleural inflammatory diseases.

METHODS

157 patients with inflammatory pleural effusion (exudates, n = 124, 79%) and non-inflammatory pleural effusion (transudates, n = 33, 21%) were included in this observational retrospective cohort study. The P-ADA assay was tested using a kinetic technique. The performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.

RESULTS

The transudates included congestive heart failure (n = 26), cirrhosis of the liver with ascites (n = 3), chronic renal failure (n = 3), and low total protein levels (n = 1). The exudate cases included tuberculosis (n = 44), adenocarcinoma (n = 37), simple parapneumonic effusions (n = 15), complicated parapneumonic effusions/empyema (n = 8), lymphoma (n = 7), and other diseases (n = 13). The optimal cutoff value of P-ADA was ≥ 9.00 U/L. The diagnostic parameters as sensitivity, specificity, positive and negative predictive values, positive and negative likelihood values, odds ratio, and accuracy were 77.69 (95%CI: 69.22-84.75); 68.75 (95%CI: 49.99-83.88); 90.38 and 44.90 (95%CI: 83.03-95.29; 30.67-59.77); 2.48 and 0.32 (95%CI: 2.21-11.2; 0.27-0.51); 7.65 (95%CI: 0.78-18.34), and 75.82 (95%CI: 68.24-82.37), respectively (χ² = 29.51, P = 0.00001). An AUC value of 0.8107 (95%CI: 0.7174-0.8754; P = 0.0000) was clinically useful. The Hosmer-Lemeshow test showed excellent discrimination.

CONCLUSION

P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.

Rosuvastatin inhibits carcinogenesis through Ca2+ triggered endoplasmic reticulum stress pathway in pancreatic cancer

BACKGROUND

Pancreatic cancer remains one of the most challenging malignancies to treat due to its late-stage diagnosis, aggressive progression, and high resistance to existing therapies. Rosuvastatin (ROV), known for its hypolipidemic effects, which significantly inhibited clonogenic capacity and epithelial-mesenchymal transition (EMT) in prostate cancer cells. However, the anti-cancer mechanisms of ROV in PC have not yet been fully explored.

PURPOSE

This study aimed to investigate the potential anti-cancer effects of ROV on PC cells and to elucidate the underlying mechanisms.

METHODS

Cytotoxicity was detected via MTT assay, while epithelial-mesenchymal transition (EMT) markers, Ca2+ levels, and endoplasmic reticulum (ER) stress were observed with fluorescence microscopy. RNA-seq analysis was used to identify significantly changed mRNA expression following ROV treatment. Additionally, western blotting and immunohistochemistry (IHC) were conducted to examine proteins involving in the cell cycle, EMT, Ca2+ signaling, and endoplasmic reticulum stress (ERS) in vitro and in vivo.

RESULTS

ROV inhibited PC cell proliferation by arresting the cell cycle at the G1/S phase and partially reducing cell mobility during the EMT process. A total of 1336 significantly different RNAs (P < 0.05 and |logFC|>1) were identified and analyzed through RNA-seq, revealing the Ca2+ and ER pathways in PC cells treated with ROV. ROV treatment significantly altered the level of intracellular Ca2+, triggering the ERS pathway and modulating the Ca2+/CaM/CaMKII/ERK pathway. Furthermore, ROV inhibited key proteins within the Ca2+ and ERS pathways, leading to reduced cell proliferation, mobility and G1/S phase arrest. In tumor tissues, the expression of Ki67, EMT markers, Calmodulin, and ATF6 corroborated the in vitro findings.

CONCLUSION

ROV inhibited proliferation and metastasis in PC cells by inhibiting the EMT process through the Ca2+/CaM/CaMKII/ERK and Ca2+-mediated ERS pathways, highlighting its potential as a prophylactic and therapeutic agent for PC.

Management of malignant inferior vena cava syndrome (IVCS) by endovascular bridging stent placement

A 73-year-old male patient was admitted to the emergency department with dyspnea and severe edema in the lower extremities. The patient had been diagnosed with extensive small-cell lung cancer 15 months previously. Contrast-enhanced CT revealed suprahepatic compression of the inferior vena cava (IVC) at the level of its entry into the right atrium, caused by a space-occupying, infiltrating right lung lesion. Inferior vena cava syndrome (IVCS) occurs after obstruction of venous flow through the IVC. Trunk and lower limb edema are the most common manifestations of this syndrome, whereas cardiac function may be compromised in more severe cases. Given the patient's performance status, disease stage, and symptom acuity, endovascular stenting of the IVC was preferred over surgery or radiotherapy. The superior vena cava (SVC)-to-IVC bridging stent approach was employed to address the severe mass effect and location of the IVC stenosis at its junction with the right atrium. Three uncovered self-expandable stents were deployed in tandem from the SVC to the IVC. Overlap between stents minimized the risk of collapse within the right atrium, possibly leading to cardiac conduction disorders or even perforation of the heart wall. The patient experienced alleviation of IVCS symptoms over the next 48 h but unfortunately passed away 8 days later from his primary disease. Although primarily palliative in oncologic cases, SVC-to-IVC stenting can offer rapid and safe relief of symptoms in patients with advanced oncologic disease by restoring venous return to the heart.

Proniosomal encapsulation of olive leaf extract for improved delivery of oleuropein: Towards the valorization of an agro-industrial byproduct

Olive leaf, a by-product of the olive oil industry, is rich in bioactive compounds, including the antioxidant and anti-inflammatory oleuropein. Olive leaf extracts have been explored for nutraceutical applications, but oleuropein's low bioavailability and stability limit its use in food and supplements. This work aimed to mitigate these issues by nano-encapsulating the olive leaf extract in proniosomes-free-flowing powders that form niosomes upon hydration. These niosomes can then be further processed into dosage forms or incorporated into functional foods. Proniosomes based on lactose or mannitol were developed and characterized. Hydration of the proniosomes yielded niosomes with high oleuropein loading and antioxidant activity. These niosomes controlled oleuropein release in simulated gastric and intestinal fluids, protecting it from degradation. Furthermore, niosomal encapsulation enhanced protection against oxidative stress in intestinal cells compared to the unformulated extract, suggesting improved intracellular delivery and making this formulation a suitable candidate as a functional food ingredient.

Re-imagining human cell culture media: Challenges, innovations, and future directions

The development of optimized culture media is pivotal to advancements in human cell culture, underpinning progress in regenerative medicine, cell therapies, and personalized medicine. While foundational formulations like Eagle's Minimum Essential Medium (MEM) and Dulbecco's Modified Eagle Medium (DMEM) have historically enabled significant biological research, these media were primarily designed for non-human cells and do not adequately address the unique metabolic and functional requirements of human cells. This review examines the evolution of cell culture media, identifying persistent challenges in reproducibility, scalability, and ethical concerns, particularly regarding the reliance on animal-derived components such as fetal bovine serum (FBS). We highlight innovations in serum-free and chemically defined media that offer promising alternatives by enhancing consistency, aligning with Good Manufacturing Practices, and addressing ethical concerns. Emerging approaches, including omics-based profiling, high-throughput screening, and artificial intelligence (AI)-driven media design, are reshaping media optimization by enabling precise tailoring to the needs of specific human cell types and patient-derived cells. Furthermore, we discuss economic and regulatory challenges, emphasizing the need for cost-effective and scalable solutions to facilitate clinical translation. Looking forward, integrating advanced biotechnological tools such as 3D bioprinting, organ-on-a-chip systems, and personalized media formulations presents a transformative opportunity for human cell culture. These innovations, aligned with ethical and clinical standards, can drive the development of human-specific media systems that ensure reproducibility, scalability, and enhanced therapeutic potential, thereby advancing both research and clinical applications.

Chemical components, health-promoting effects and industrial application of a Chinese bitter tea (Kuding tea): A comprehensive review

Kuding tea (KT), a traditional Chinese bitter tea, has long been recognized as Food & Medicine Homology product, known for its various active components and health benefits. However, research on KT is fragmented, lacking a comprehensive review of its key chemical constituents, health-promoting effects, and potential future applications. This review outlines the development history and nutritional components of KT while examining its functional benefits and industrial applications. KT is a promising and cost-effective product, containing numerous bioactive constituents, including polyphenols, triterpenoids, phenylethanoids, and polysaccharides, which exhibit strong antioxidant, anti-obesity, anti-diabetic, anti-inflammatory, neuroprotective, and anti-cancer activities. We summarized the researches on the health-promoting effects of KT and emphasized its practical applications in the food, agricultural, and pharmaceutical industries. Overall, this review presents a forward-looking viewpoint on creative KT applications and offers insights into KT's potential for future sustainable growth.

Extracellular vesicles and the lung: from disease pathogenesis to biomarkers and treatments

Nanosized extracellular vesicles (EVs) are released by all cells to convey cell-to-cell communication. EVs, including exosomes and microvesicles, carry an array of bioactive molecules, such as proteins and RNAs, encapsulated by a membrane lipid bilayer. Epithelial cells, endothelial cells, and various immune cells in the lung contribute to the pool of EVs in the lung microenvironment and carry molecules reflecting their cellular origin. EVs can maintain lung health by regulating immune responses, inducing tissue repair, and maintaining lung homeostasis. They can be detected in lung tissues and biofluids such as bronchoalveolar lavage fluid and blood, offering information about disease processes, and can function as disease biomarkers. Here, we discuss the role of EVs in lung homeostasis and pulmonary diseases such as asthma, chronic obstructive pulmonary disease, cystic fibrosis, pulmonary fibrosis, and lung injury. The mechanistic involvement of EVs in pathogenesis and their potential as disease biomarkers are discussed. Finally, the pulmonary field benefits from EVs as clinical therapeutics in severe pulmonary inflammatory disease, as EVs from mesenchymal stem cells attenuate severe respiratory inflammation in multiple clinical trials. Further, EVs can be engineered to carry therapeutic molecules for enhanced and broadened therapeutic opportunities, such as the anti-inflammatory molecule CD24. Finally, we discuss the emerging opportunity of using different types of EVs for treating severe respiratory conditions.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Unraveling the potential of bioengineered microbiome-based strategies to enhance cancer immunotherapy

The human microbiome plays a pivotal role in the field of cancer immunotherapy. The microbial communities that inhabit the gastrointestinal tract, as well as the bacterial populations within tumors, have been identified as key modulators of therapeutic outcomes, affecting immune responses and reprogramming the tumor microenvironment. Advances in synthetic biology have made it possible to reprogram and engineer these microorganisms to improve antitumor activity, enhance T-cell function, and enable targeted delivery of therapies to neoplasms. This review discusses the role of the microbiome in modulating both innate and adaptive immune mechanisms-ranging from the initiation of cytokine production and antigen presentation to the regulation of immune checkpoints-and discusses how these mechanisms improve the efficacy of immune checkpoint inhibitors. We highlight significant advances with bioengineered strains like Escherichia coli Nissle 1917, Lactococcus lactis, Bifidobacterium, and Bacteroides, which have shown promising antitumor efficacy in preclinical models. These engineered microorganisms not only efficiently colonize tumor tissues but also help overcome resistance to standard therapies by reprogramming the local immune environment. Nevertheless, several challenges remain, such as the requirement for genetic stability, effective tumor colonization, and the control of potential safety issues. In the future, the ongoing development of genetic engineering tools and the optimization of bacterial delivery systems are crucial for the translation of microbiome-based therapies into the clinic. This review highlights the potential of bioengineered microbiota as an innovative, personalized approach in cancer immunotherapy, bringing hope for more effective and personalized treatment options for patients with advanced malignancies.

Anaplastic thyroid cancer: Genetic roles, targeted therapy, and immunotherapy

Anaplastic thyroid cancer (ATC) stands as the most formidable form of thyroid malignancy, presenting a persistent challenge in clinical management. Recent years have witnessed a gradual unveiling of the intricate genetic underpinnings governing ATC through next-generation sequencing. The emergence of this genetic landscape has paved the way for the exploration of targeted therapies and immunotherapies in clinical trials. Despite these strides, the precise mechanisms governing ATC pathogenesis and the identification of efficacious treatments demand further investigation. Our comprehensive review stems from an extensive literature search focusing on the genetic implications, notably the pivotal MAPK and PI3K-AKT-mTOR signaling pathways, along with targeted therapies and immunotherapies in ATC. Moreover, we screen and summarize the advances and challenges in the current diagnostic approaches for ATC, including the invasive tissue sampling represented by fine needle aspiration and core needle biopsy, immunohistochemistry, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. We also investigate enormous studies on the prognosis of ATC and outline independent prognostic factors for future clinical assessment and therapy for ATC. By synthesizing this literature, we aim to encapsulate the evolving landscape of ATC oncology, potentially shedding light on novel pathogenic mechanisms and avenues for therapeutic exploration.

Giant lipoma in the anterior region of the neck: A case report of a rare condition and review of literature

Lipomas are benign and very common subcutaneous tumors of adipose tissue, which may occur anywhere in the body. Lipomas in head and neck regions are extremely rare. A giant neck lipoma is classified as a lesion greater than 10 cm in one dimension or weighing more than 1000 g. In this case report and review of the literature, a 66-year-old male with likely diagnosis of neck lipoma was under 5-year surveillance prior to development of giant neck lipoma. Computed tomography provided critical insight in the extent of neck mass in relation to surrounding structures in assessing possibility of malignancy and in guiding appropriate management.

Eating Disorders and Later Incidence of Cancer: A Nationwide Longitudinal Study in Denmark

Background

We examined the incidence of cancer types among individuals with eating disorders (EDs).

Methods

A nationwide longitudinal study of 6,807,731 individuals born between 1940 and 2015 was conducted using the Danish National Registries. Cox models with ED diagnosis as exposure and cancer diagnoses as outcomes were used to estimate hazard ratios (HRs) and 95% CIs while adjusting for sex, birth year, and comorbidities. The primary analysis comprised ICD-8 and ICD-10 codes for anorexia nervosa (AN) and other ED (OED). The secondary analysis comprised ICD-10 codes and included AN, bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS).

Results

AN was associated with a reduced incidence of breast cancer while adjusting for sex and birth year (HR, 0.80; 95% CI, 0.66-0.97) and elevated incidence of respiratory (HR, 1.59; 95% CI, 1.24-2.04), cervical (HR, 1.45; 95% CI, 1.05-1.98), and esophageal (HR, 4.77; 95% CI, 2.82-8.06) cancers. OED was associated with an elevated incidence of respiratory (HR, 1.57; 95% CI, 1.20-2.06) and cervical (HR, 1.60; 95% CI, 1.20-2.14) cancers. ICD-10-only analyses confirmed the association of AN with reduced incidence of breast cancer and elevated incidence of respiratory and cervical cancers. BN was associated with reduced incidence of breast cancer in sensitivity analysis. EDNOS was associated with reduced incidence of breast cancer and elevated incidence of respiratory and cervical cancers.

Conclusions

All EDs were associated with a reduced incidence of breast cancer. All EDs except BN were associated with a higher incidence of respiratory and cervical cancers. AN was associated with a higher incidence of esophageal cancer.

Hyperforin-induced gut microbiota metabolite carbocysteine protects against depressive-like behaviors in mice by modulating the colonic mucus barrier

OBJECTIVE

Depression affects millions, and current treatments have limitations, necessitating new approaches. Earlier research confirms Hyperforin's ability to reduce anhedonic behaviors in mice and modulate gut microbiota. This study aims to identify specific metabolic changes induced by Hyperforin that could illuminate its impact on gut microbiome metabolism, possibly uncovering novel metabolites for developing antidepressant therapies.

METHODS

Following the chronic stress model, untargeted metabolomic analysis of fecal samples was conducted to identify metabolic changes induced by Hyperforin. Bioinformatics tools analyzed the origins of differentially expressed metabolites and their correlation with Akkermansia muciniphila and Muribaculum intestinale. The significant metabolite Carbocysteine was further investigated for its antidepressant effects using behavioral assays in a mouse model of depression. Additionally, the response of the colonic mucus barrier was evaluated using Periodic Acid-Schiff (PAS) staining, scanning electron microscopy (SEM), and enzyme-linked immunosorbent assays (ELISA).

RESULTS

Hyperforin significantly altered fecal metabolite profiles in stressed mice, with a notable shift in 239 metabolites mainly associated with co-metabolism pathways and microbiota-specific processes. Among these, Carbocysteine emerged as a key metabolite linked to beneficial bacteria Akkermansia muciniphila and Muribaculum intestinale, with its levels significantly elevated following Hyperforin treatment. Behavioral assessments indicated that Carbocysteine supplementation ameliorated depressive-like behaviors in the chronic restraint stress mouse model. It also enhanced colonic mucus production and integrity.

CONCLUSION

Our research highlights Hyperforin's role in modulating gut microbiota metabolism and identifies Carbocysteine as a potential antidepressant. These findings advance our understanding of the gut-brain axis (GBA) in depression and pave the way for developing new therapeutics.

Novel insights into differences in the whey proteome of porcine and human colostrum and mature milk

Many mothers are unable to exclusively breastfeed for several reasons. Other mammalian milks should be explored as human milk supplements. Pigs and humans are physiologically similar. Therefore, we hypothesized that the whey protein composition and functions of porcine and human milk are similar. This study aimed to compare and analyze the whey proteomes of porcine and human milk during lactation. Totally, 3390, 3275, 3587, and 3463 whey proteins were identified in porcine colostrum, porcine mature milk, human colostrum, and human mature milk, respectively. Complement components and serotransferrin, which are related to the immune system process were highly expressed in porcine milk. Porcine and human whey proteins were enriched in similar Gene Ontology annotations and Kyoto Encyclopedia of Genes and Genomes pathways. These results revealed that the biological functions of porcine and human whey proteins were similar, which contributes to the development of porcine whey proteins.

Ferroptosis meets inflammation: A new frontier in cancer therapy

Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has emerged as a critical player in cancer pathogenesis. Concurrently, inflammation, a key biological response to tissue injury or infection, significantly influences cancer development and progression. The interplay between ferroptosis and inflammation represents a promising yet underexplored area of research. This review synthesizes recent advances in understanding the molecular mechanisms governing their interaction, emphasizing how ferroptosis triggers inflammatory responses and how inflammatory mediators, such as TNF-α, regulate ferroptosis through iron metabolism and lipid peroxidation pathways. Key molecular targets within the ferroptosis-inflammation axis, including GPX4, ACSL4, and the NF-κB signaling pathway, offer therapeutic potential for cancer treatment. By modulating these targets, it may be possible to enhance ferroptosis and fine-tune inflammatory responses, thereby improving therapeutic outcomes. Additionally, this review explores the broader implications of targeting the ferroptosis-inflammation interplay in disease treatment, highlighting opportunities for developing innovative strategies to combat cancer. By bridging the gap in current knowledge, this review provides a comprehensive resource for researchers and clinicians, offering insights into the therapeutic potential of this intricate biological relationship.

Unexpected contralateral axillary lymph node metastasis without ipsilateral involvement in triple-negative breast cancer: A case report and review of literature

BACKGROUND

Breast cancer is a leading cause of cancer-related mortality among women worldwide, with invasive ductal carcinoma (IDC) being the most prevalent subtype. Lymph node metastasis is the primary prognostic indicator, typically evaluated via biopsy of the ipsilateral sentinel or axillary lymph nodes. Contralateral axillary metastasis (CAM) without ipsilateral involvement is exceedingly rare, particularly in early-stage breast cancer. This report presents a case of CAM in a patient with triple-negative breast cancer (TNBC), underscoring diagnostic and therapeutic complexities.

CASE SUMMARY

A 73-year-old female presented with left-sided early-stage IDC in February 2023. Despite a modified radical mastectomy and pathologically negative ipsilateral lymph nodes, a postoperative positron emission tomography (PET) scan detected fluorodeoxyglucose-avid nodes in the contralateral axilla. Biopsy confirmed metastatic ductal carcinoma with triple-negative status, resulting in an upstaged diagnosis of metastatic breast cancer, stage IV, M1. The patient underwent six cycles of adjuvant chemotherapy, with follow-up PET imaging showing regression of the contralateral lesion. This case highlights the importance of advanced imaging in TNBC for precise staging and treatment optimization.

CONCLUSION

This case highlights the aggressive nature of TNBC and the need for advanced imaging to ensure accurate staging and effective management.

Advances in the pathophysiology and treatment of focal segmental glomerulosclerosis: The importance of a timely and tailored approach

Focal segmental glomerulosclerosis (FSGS) is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease. Its incidence is rising globally, necessitating timely and personalized management strategies. This paper aims to provide an updated overview of the pathophysiology, diagnosis, and therapeutic strategies for FSGS, emphasizing the importance of early interventions and tailored treatments. This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS. Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients. Advances include novel biomarkers, genetic testing, and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS. Effective management of FSGS requires a combination of timely diagnosis, evidence-based therapeutic strategies, and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.

Fecal microbiota transplantation in allergic diseases

Microorganisms such as bacteria, fungi, viruses, parasites living in the human intestine constitute the human intestinal microbiota. Dysbiosis refers to compositional and quantitative changes that negatively affect healthy gut microbiota. In recent years, with the demonstration that many diseases are associated with dysbiosis, treatment strategies targeting the correction of dysbiosis in the treatment of these diseases have begun to be investigated. Faecal microbiota transplantation (FMT) is the process of transferring faeces from a healthy donor to another recipient in order to restore the gut microbiota and provide a therapeutic benefit. FMT studies have gained popularity after probiotic, prebiotic, symbiotic studies in the treatment of dysbiosis and related diseases. FMT has emerged as a potential new therapy in the treatment of allergic diseases as it is associated with the maintenance of intestinal microbiota and immunological balance (T helper 1/T helper 2 cells) and thus suppression of allergic responses. In this article, the definition, application, safety and use of FMT in allergic diseases will be discussed with current data.

Advancements in diabetic retinopathy: Insights and future directions

This editorial discusses recent advancements and ongoing challenges in diabetic retinopathy, as reviewed by Morya et al in their comprehensive analysis. In their review, Morya et al discussed the pathophysiology of diabetic retinopathy and explored novel treatment modalities. This editorial highlights the importance of these advancements and emphasizes the need for continued research and innovation for the enhanced management of diabetic retinopathy. It also reflects upon the implications of the authors’ review findings for clinical practice and future research directions, underscoring the potential of emerging therapies for improving patient outcomes and providing a deeper understanding of disease mechanisms.

Diagnostic value of ultrasonography for post-liver transplant hepatic vein complications

Liver transplantation (LT) is the most effective treatment for patients with end-stage liver disease, and maintaining vascular patency of the transplanted liver is one of the crucial prerequisites for surgical success. Despite hepatic vein complications following LT occurring at a relatively low frequency, ranging between 2% to 11%, delayed diagnosis and treatment may lead to graft dysfunction and even patient mortality. Clinical manifestations of hepatic vein complications are often subtle and nonspecific, posing challenges for early diagnosis. Signs may initially present as mild abnormalities in liver function, delayed recovery of liver function, unexplained ascites, lower limb edema, and perineal edema. Prolonged duration of these complications can lead to hepatic sinusoidal dilatation and eventual liver failure due to prolonged hepatic congestion. Ultrasonography has become the preferred imaging modality for post-liver transplant evaluation due to its convenience and non-invasiveness. Although hepatic vein complications may manifest as disappearance or flattening of the hepatic vein spectrum on routine ultrasound imaging, these findings lack specificity. Contrast-enhanced ultrasound that visualizes the filling of contrast agent in the hepatic veins and dynamically displays blood flow perfusion information in the drainage area can, however, significantly improve diagnostic confidence and provide additional information beyond routine ultrasound examination.

Utility of liver stiffness for the classification of portopulmonary hypertension in precapillary pulmonary hypertension

BACKGROUND

Invasive right heart catheterization plays a central role in identifying pulmonary hypertension (PH) disorders. However, non-invasive biomarkers of portopulmonary hypertension (PoPH) are required. Liver stiffness evaluated by FibroScan® is useful for the assessment of liver fibrosis in patients with chronic liver diseases. This study sought to investigate the utility of liver stiffness for the classification of PoPH among precapillary PH patients.

METHODS

A total of 46 patients [38 females, median (interquartile range) age 63.0 (50.8-72.0) years old] with precapillary PH were divided into a PoPH group (N = 6) and a non-PoPH group (N = 40) based on the presence of portosystemic shunts and/or portal hypertension with hepatic venous pressure gradient >5 mmHg.

RESULTS

The PoPH group showed higher cardiac index and lower pulmonary vascular resistance than the non-PoPH group. Other hemodynamic variables and liver fibrosis biomarkers such as fibrosis-4 index and albumin-bilirubin score were comparable between the 2 groups. Liver stiffness measurements in the PoPH group were significantly higher than those in the non-PoPH group [12.8 kPa (9.4-17.3 kPa) vs 4.15 kPa (3.30-5.50 kPa), p < 0.001]. The cut-off value for the classification of PoPH was 8.50 kPa from the receiver operating characteristic curve (area under curve 0.979, 95 % Confidence interval 8.50 kPa - 11.00 kPa).

CONCLUSIONS

Liver stiffness evaluated by transient elastography may be a non-invasive biomarker to detect the liver status that caused PoPH among precapillary PH patients.

Genetic adjuvants: A paradigm shift in vaccine development and immune modulation

The COVID-19 pandemic underscored the urgency of developing effective vaccines to combat infectious diseases, especially in vulnerable populations such as the elderly and immunocompromised. While recombinant protein vaccines offer safety, their poor immunogenicity highlights the need for advanced vaccination platforms. New genetic/nucleic acid vaccine formulations like plasmid DNA and mRNA showed efficiency and safety in preclinical and clinical studies; however, they demand innovative adjuvants because their mechanism of action differs from traditional protein vaccines. Genetic adjuvants-encoded by nucleic acids within DNA, RNA, or viral vectors-emerge as a promising solution by targeting and modulating specific immune pathways, including antigen presentation, T cell activation, and memory formation. These innovative adjuvants enhance vaccine efficacy by fine-tuning innate and adaptive immune responses, overcoming immune senescence, and addressing the challenges of CD8+ T cell activation in immunocompromised populations. This review explores the potential of genetically encoded adjuvants, including cytokines, chemokines, and other immune modulators. By comparing these adjuvants to traditional formulations, we highlight their capacity to address the limitations of modern vaccines while discussing their integration with emerging technologies like RNA-based vaccines. As genetic adjuvants advance toward clinical application, understanding their mechanisms and optimizing their delivery is pivotal to unlocking next-generation immunization strategies.

Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders

BACKGROUND

Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.

AIM

To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.

METHODS

A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.

RESULTS

The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children’s vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.

CONCLUSION

Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.

Redefining haemostasis: Role of rotational thromboelastometry in critical care settings

Management of patients with acute hemorrhage requires addressing the source of bleeding, replenishing blood volume, and addressing any coagulopathy that may be present. Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges. In these patients, transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality. Moreover, ratio-based concepts do not stop bleeding; instead, they just give physicians more time to identify the bleeding source and plan management strategies. In clinical practice, standard laboratory coagulation tests (SLCT) are frequently used to assess various aspects of blood clotting. However, these tests may not always offer a comprehensive understanding of clinically significant coagulopathy and the severity of blood loss. Furthermore, the SLCT have a considerable turnaround time, which may not be ideal for making prompt clinical decisions. In recent years, there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelastometry, which provide real-time, dynamic information about clot formation and dissolution.

Challenges in using virtual reality technology for pain relief

The present paper addresses two issues pertaining to the use of virtual reality (VR). One issue pertains to the equipment utilized. VR technology can be classified into two main categories: Immersive and non-immersive. The immersive type of technology necessitates the use of substantial equipment, yet it is demonstrably efficacious. Furthermore, the efficacy of this approach is enhanced when combined with relaxation and biofeedback techniques. The other issue is that the efficacy of this approach is diminished when applied to chronic pain, in comparison to acute pain. The relief of chronic pain is a challenging endeavor due to the diminished functionality of the medial prefrontal cortex (mPFC) within the default mode network. Given the close relationship between the mPFC and the reward system dopamine, it is essential to develop a program that activates the reward system dopamine through the use of VR technology.

Territories of mourning: Addressing submerged problems of grief through multidisciplinary care

Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care. Caregivers play a crucial role in supporting individuals through this difficult journey, often balancing their own grief with the need to provide care. This paper explores the experiences of mourning and grief in hospice settings, with a focus on the emotional challenges faced by both patients and caregivers during the grieving process. Psychological support plays a crucial role at the end of life in a multidisciplinary care approach. By addressing the complex interplay between biological disease and psychological well-being, healthcare professionals can provide more comprehensive and compassionate care. A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams, ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.

Micronanoplastic exposure due to cardiopulmonary bypass in children: A prospective observational study

Cardiopulmonary bypass (CPB) is widely used in cardiac operations. However, it remains unclear whether a CPB circuit, which is mainly made of plastics, can release micronanoplastics (MNPs) into the bloodstream. We conducted a prospective observational study involving children undergoing congenital heart disease repair with CPB support. Blood samples were collected before and after CPB and analyzed using pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) and laser direct infrared spectroscopy (LDIR) in combination with scanning electron microscopy. A total of 22 patients were involved in this study. The Py-GC/MS analysis revealed a significant increase in total MNPs after CPB support (p < 0.0001). Notably, CPB support significantly increased the levels of polystyrene (p = 0.046), polyethylene (p = 0.038), polypropylene (p < 0.0001), polyvinyl chloride (p < 0.0001), and polyamide 6 (p = 0.027). CPB time was positively correlated to MNP exposure (r = 0.43, p = 0.047). Increases in MNP exposure were positively correlated to an increase in white blood cells (r = 0.52, p = 0.013) and neutrophils (r = 0.46, p = 0.029). The LDIR analysis found that the post-CPB count of MNPs was significantly higher than the pre-CPB count (p = 0.015). In conclusion, CPB support significantly increases exposure to MNP in children undergoing cardiac operations. Further investigations are warranted to clarify the long-term health risks of MNP exposure caused by CPB support.

Harnessing the human microbiome and its impact on immuno-oncology and nanotechnology for next-generation cancer therapies

The integration of microbiome research and nanotechnology represents a significant advancement in immuno-oncology, potentially improving the effectiveness of cancer immunotherapies. Recent studies highlight the influential role of the human microbiome in modulating immune responses, presenting new opportunities to enhance immune checkpoint inhibitors (ICIs) and other cancer therapies. Nanotechnology offers precise drug delivery and immune modulation capabilities, minimizing off-target effects while maximizing therapeutic outcomes. This review consolidates current knowledge on the interactions between the microbiome and the immune system, emphasizing the microbiome's impact on ICIs, and explores the incorporation of nanotechnology in cancer treatment strategies. Additionally, it provides a forward-looking perspective on the synergistic potential of microbiome modulation and nanotechnology to overcome existing challenges in immuno-oncology. This integrated approach may enhance the personalization and effectiveness of next-generation cancer treatments, paving the way for transformative patient care.

Fungal dimeric xanthones as anticancer agents by novelly stimulating sodium-calcium exchanger 1

Multitude of natural products have the ability to demonstrate inhibitory effects on cancer cells by regulating ion channels/transporters functions. Eighteen xanthone dimers (Xds), including five new dimers diaporxanthones H, I, J-L (1, 2, and 12-14), were isolated and characterized through co-culture and chemical conversion methods. ECD Cotton effect analyses and chemical communication method provided fundamental role in addressing the challenges of elucidating their absolute configurations. Structure-activity relationship (SAR) analysis showed that eight xanthone-xanthone Xds (2-7, 15 and 16) demonstrated marked cytotoxic effects against gastric cancer (GC) cell line AGS, with undetectable inhibition on human colon cancer cells. The anti-proliferative potency of Xds was 2-5 fold higher than positive control drug cisplatin. Mechanistic studies were conducted on a high-yield compound, 12-O-deacetyl-phomoxanthone A (4). Compound 4 activated Na+/Ca2+ exchanger 1 (NCX1), thereby causing an increase in cellular Ca2+ signaling and subsequent inhibition of the downstream PI3K/AKT/β-catenin pathway, ultimately leading to GC cell death. Like anti-GC, Xds also possessed anti-melanoma activity in vitro and in vivo. We demonstrate Xds have effective cytotoxic actions against GC and melanoma by targeting NCX1/Ca2+ signaling in cancer cells.

Essential competencies of nurses working with AI-driven lifestyle monitoring in long-term care: A modified Delphi study

BACKGROUND

As more and more older adults prefer to stay in their homes as they age, there's a need for technology to support this. A relevant technology is Artificial Intelligence (AI)-driven lifestyle monitoring, utilizing data from sensors placed in the home. This technology is not intended to replace nurses but to serve as a support tool. Understanding the specific competencies that nurses require to effectively use it is crucial. The aim of this study is to identify the essential competencies nurses require to work with AI-driven lifestyle monitoring in long-term care.

METHODS

A three round modified Delphi study was conducted, consisting of two online questionnaires and one focus group. A group of 48 experts participated in the study: nurses, innovators, developers, researchers, managers and educators. In the first two rounds experts assessed clarity and relevance on a proposed list of competencies, with the opportunity to provide suggestions for adjustments or inclusion of new competencies. In the third round the items without consensus were bespoken in a focus group.

FINDINGS

After the first round consensus was reached on relevance and clarity on n = 46 (72 %) of the competencies, after the second round on n = 54 (83 %) of the competencies. After the third round a final list of 10 competency domains and 61 sub-competencies was finalized. The 10 competency domains are: Fundamentals of AI, Participation in AI design, Patient-centered needs assessment, Personalisation of AI to patients' situation, Data reporting, Interpretation of AI output, Integration of AI output into clinical practice, Communication about AI use, Implementation of AI and Evaluation of AI use. These competencies span from basic understanding of AI-driven lifestyle monitoring, to being able to integrate it in daily work, being able to evaluate it and communicate its use to other stakeholders, including patients and informal caregivers.

CONCLUSION

Our study introduces a novel framework highlighting the (sub)competencies, required for nurses to work with AI-driven lifestyle monitoring in long-term care. These findings provide a foundation for developing initial educational programs and lifelong learning activities for nurses in this evolving field. Moreover, the importance that experts attach to AI competencies calls for a broader discussion about a potential shift in nursing responsibilities and tasks as healthcare becomes increasingly technologically advanced and data-driven, possibly leading to new roles within nursing.

Modification of the Adjustment Disorder New Module20 (ADNM-20) for Use in Military Environments (ADNM-20-MIL): A Delphi and Pilot Study

OBJECTIVES

Despite its high prevalence and strong linkages with dangerous health outcomes, research on Adjustment Disorder (AjD) is hindered by lack of diagnostic clarity. AjD is categorized as a stress-related disorder, highlighting the important role of the stressor(s) on AjD symptom onset and severity. The military community shows increased risk for AjD, and existing tools do not capture the stressors most relevant and appropriate to this unique community. A diagnostic assessment tool developed specifically for this specialized population may provide critical capability to clinical assessment.

METHODS

A Delphi method was used to create a military-specific version of the standard assessment for Adjustment Disorders (ADNM-20), named ADNM-20-MIL. This tool was pilot-tested in a sample of U.S. Active Duty Service Members (ADSMs) with AjD diagnoses.

RESULTS

Throughout the Delphi process, military-specific stressors were identified and integrated into the ADNM-20-MIL, then refined and validated, ensuring their applicability and relevance to the military context.

CONCLUSIONS

The ADNM-20-MIL will enable timely diagnosis and targeted treatment for AjD, which remains a highly prevalent and destabilizing diagnosis in ADSMs.

A scientometric analysis and visualization of research on fatty liver diseases in Iran from 2003 to 2023

Background

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and is now a major global health threat. Due to the mechanistic links between these conditions, along with the rising prevalence of fatty liver disease, diabetes, and obesity, MAFLD (metabolic-associatedfatty liver diseases) was introduced as a new terminology and then updated to MASLD (Metabolic Dysfunction-associated Steatotic Liver Disease. These changes reflect a growing recognition of the importance of fatty liver and its associated health risks.

Methods

This scientometric study analyzed publications on "fatty liver diseases" (FLD) indexed in Scopus from 2003 to 2023 in Iran. Online Analysis Platforms and VOSviewer were used to assess publication trends and identify research hotspots.

Results

We retrieved 1,857 English articles on fatty liver diseases published between 2003 and 2023. The Journal of Hepatitis Monthly was notable for Iranian publications on fatty liver disease. Most publications were original articles and Dr. Sahebkar AH was the most prolific author. Iranian researchers primarily collaborated with scholars from the United States. The leading institution in terms of productivity was Tehran University of Medical Sciences.

Conclusion

This study reveals an increasing trend in both the number of Iranian publications and the citations of articles in the field of FLD. We believe this study can serve as a roadmap for future research and policy development on fatty liver diseases, which are a significant public health concern in Iran. Additionally, new strategies are needed to foster multi-disciplinary research and enhance international cooperation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01606-8.

New insights into Gremlin-1: A tumour microenvironment landscape re-engineer and potential therapeutic target

Gremlin-1 (GREM1), a well-known bone morphogenetic protein (BMP) antagonist, is highly expressed in various malignant tumours. However, the specific role of GREM1 in tumours remains controversial and may be attributed to the heterogeneity and complexity of the tumour microenvironment (TME). It is currently believed that GREM1 regulates the complex landscape of the TME, primarily by antagonising BMP signalling or BMP-independent pathways. Both GREM1 and BMP play dual roles in tumour progression. Therefore, the mutual crosstalk between tumour cells and tumour-associated fibroblasts and the regulation of various secreted factors in the TME affect the secretion level of GREM1, which in turn regulates the amplitude balance between GREM1 and BMP, affecting tumour progression. The inhibition of GREM1 activity in the TME can disrupt this amplitude balance and prevent the formation of a tumour-supportive microenvironment, demonstrating that GREM1 is a potential therapeutic target. In this study, we reviewed the specific signalling pathways via which GREM1 in the TME regulates epithelial-mesenchymal transition, construction of the tumour immune microenvironment, and maintenance of tumour cell stemness via BMP-dependent and BMP-independent regulation, and also summarised the latest clinical progress of GREM1.

Preoperative Prognostic Factors in Resectable Pancreatic Cancer: State of the Art and Prospects

BACKGROUND

Only 15% to 20% of patients with pancreatic ductal adenocarcinoma (PDAC) have access to surgical resection, which represents the only chance of curative treatment. Current resection classifications are almost exclusively anatomic and do not correlate sufficiently with patient survival. It is essential to develop preoperative prognostic factors to distinguish patients at high risk of early postoperative recurrence from those who will have prolonged survival after surgery. In some cases, PDACs may present biomolecular differences reflecting their aggressiveness that are not yet assessable by the current clinical-biologic assessment. This study aimed to assess the preoperative prognostic factors that are already available and the future perspectives being developed.

METHOD

This study reviewed the literature using the PubMed public database for preoperative prognostic factors for resectable PDAC.

CONCLUSION

Validated preoperative prognostic factors, whether clinical, biologic, radiologic, or histologic, are very important in anticipating the course of each patient's disease. The identification of potential new prognostic biomarkers such as genomic, transcriptomic, and proteomic analyses and the dosage of circulating tumor DNA are very serious avenues to be developed, but the extraction and analysis techniques as well as the interpretation of their results need to be standardized in prospective studies.

Genome-wide transcriptome and DNA methylome profiling of acquired cystic disease-associated renal cell carcinoma

Acquired cystic disease (ACD)-associated renal cell carcinoma (RCC) develops uniquely and frequently in patients receiving long-term dialysis for end-stage renal disease (ESRD). In our previous study, the molecular alteration profiles of ACD-associated RCC were partially similar to those of papillary RCC (PRCC). However, the specific profiles of molecular alterations in ACD-associated RCC and their pathogenic mechanisms remain largely unknown. Therefore, we compared genome-wide transcription and DNA methylation profiles of 12 ACD-associated RCC and 26 PRCC samples, which comprised eight ESRD-induced and 18 sporadic (arising in non-dialysis kidney) PRCC samples. RNA-seq and Infinium Methylation EPIC were used to identify the unique genetic and epigenetic profiles in ACD-associated RCC. ACD-associated RCC harboured a unique expression profile from that of PRCC. Its profile was characterised by the upregulation of pathways related to amino acid metabolism. In addition, ACD-associated RCC exhibited a unique DNA methylation profile that was characterised by the hypomethylation of pathways related to amino acid metabolism. This reflected a significant difference between the expression profiles of ACD-associated RCC and PRCC. The present genome-wide transcriptome and DNA methylome profiling revealed that aberrant activation of amino acid metabolism-related pathways, potentially induced by DNA hypomethylation, may be involved in the pathogenesis of ACD-associated RCC.