FNAC Diagnosis of Rare Port-Site Metastasis in Gallbladder Cancer Post-Cholecystectomy

BACKGROUND

Port-site metastasis (PSM) following laparoscopic cholecystectomy (LC) for unsuspected gallbladder carcinoma (GBC) is a rare occurrence. Fine Needle Aspiration Cytology is a simple and time-saving technique, thus it has proven useful in diagnosing such metastases.

CASE REPORT

We present a case of a 45-year-old female who developed painful, multinodular epigastric swellings 2 years post-LC, initially performed for presumed benign cholelithiasis. FNAC of the port-site swelling revealed hypercellular smears with malignant epithelial cells, leading to a diagnosis of poorly differentiated malignancy. Follow-up imaging and histopathology confirmed incidental primary gallbladder carcinoma.

DISCUSSION

Port site metastasis in gallbladder carcinoma has a poor prognosis; thus, early detection and intervention are essential. Advanced imaging and FNAC under guidance serve as critical tools for early diagnosis, especially in cases lacking prior histological examination.

CONCLUSION

This case highlights the critical role of vigilant post-surgical monitoring and comprehensive histopathological analysis following cholecystectomy, especially in areas with a higher incidence of gallbladder carcinoma. FNAC also plays a valuable diagnostic modality for early detection and management of Port site metastasis in unsuspected gallbladder carcinoma cases.

Concomitant use of autologous exosomes and Nd:YAG laser in post-reconstructive treatment of Bell's palsy: A case report

Background

Bell's palsy is the most common paralysis of the seventh cranial nerve. Recently, regenerative procedures have been proven to improve facial nerve function, reduce neuronal damage, enhance natural healing potential, and improve muscle function. Among these procedures, exosomes can be used as an effective regenerative therapeutic tool. This case presents a 49-year-old woman diagnosed with Bell's palsy grade IV with a ten-year history of left-side facial dysmorphia after facial nerve neuralgia and failed treatments.

Methods

The patient was treated with a combination of injected autologous exosomes released from preconditioned platelet-rich plasma (PRP) with the MCT System and Nd:YAG laser pulses. The treatment included three sessions, three months in between, and a follow-up visit one year after the first treatment (three months after the third treatment).

Results

The patient showed significant facial improvement one year after the first treatment. The paralysis degree, according to the House-Brackmann facial nerve grading scale, varied from stage IV to stage II. Changes observed were an increase in facial muscle strength, an improvement in eye closure, and an increase in smile symmetry.

Conclusions

The protocol applied, combining injected preconditioned autologous platelet-rich plasma and Nd:YAG pulses, was safe and well tolerated, and the results showed significant restoration of facial appearance and resolution of Bell's palsy symptoms.

Exosome-based approaches in cancer along with unlocking new insights into regeneration of cancer-prone tissues

Most eukaryotic cells secrete extracellular vesicles called exosomes, which are involved in intercellular communication. Exosomes play a role in tumor development and metastasis by transporting bioactive chemicals from cancerous cells to other cells in local and distant microenvironments. However, the potential of exosomes can be used by engineering them and considering different therapeutic approaches to overcome tumors. Exosomes are a promising drug delivery approach that can help decrease side effects from traditional treatments like radiation and chemotherapy by acting as targeted agents at the tumor site. The present review provides an overview of exosomes and various aspects of the role of exosomes in cancer development, which include these items: exosomes in cancer diagnosis, exosomes and drug delivery, exosomes and drug resistance, exosomal microRNAs and exosomes in tumor microenvironment, etc. Cancer stem cells release exosomes that nurture tumors, promoting unwanted growth and regeneration, and these types of exosomes should be inhibited. Ironically, exosomes from other cells, such as hepatocytes or mesenchymal stem cells (MSCs), are vital for healing organs like the liver and repairing gastric ulcers. Without proper treatment, this healing process can backfire, potentially leading to disease progression or even cancer. What can be found from various studies about the role of exosomes in the field of cancer is that exosomes act like a double-edged sword; on the other hand, natural exosomes in the body may play an important role in the process and progression of cancer, but by engineering exosomes, they can be directed towards target therapy and targeted delivery of drugs to tumor cells. By examining the role and application of exosomes in various mechanisms of cancer, it is possible to help treat this disease more efficiently and quickly in preclinical and clinical research.

Allo-lithocholic acid, a microbiome derived secondary bile acid, attenuates liver fibrosis

Secondary bile acids, lithocholic acid and deoxycholic acid (LCA and DCA), are dehydroxylated derivatives of primary bile acids. However, in addition to LCA and DCA the intestinal microbiota produced a variety of poorly characterized metabolites. Allo-LCA, a LCA metabolite, acts as a dual GPBAR1 agonist and RORγt inverse agonist and modulates intestinal immunity, although is not yet known whether allo-LCA exerts regulatory functions outside the intestine. In the present study we have therefore investigated whether administration of allo-LCA, 10 mg/kg/day, to mice administered a high fat/high fructose diet (HFD-F) and carbon tetrachloride (Ccl4), a model for metabolic dysfunction-associated steatohepatitis (MASH), protects from development of liver damage. In vitro allo-LCA functions as GPBAR1 agonist and RORγt inverse agonist and prevents macrophages M1 polarization and Th17 polarization of CD4 cells. In vivo studies, while exposure to a HFD-F/Ccl4 promoted insulin resistance and development of a pro-atherogenic lipid profile and liver steatosis and fibrosis, allo-LCA reversed this pattern by improving insulin sensitivity and liver lipid accumulation. The liver transcriptomic profile demonstrated that allo-LCA reversed the dysregulation of multiple pathways associated with immunological, inflammatory and metabolic signaling. Allo-LCA also restored bile acid homeostasis, reversing HFD/Ccl4-induced shifts in bile acid pool composition and restored adipose tissue histopathology and function by reducing the expression of leptin and resistin, two pro-inflammatory adipokines, and restored a healthier composition of the intestinal microbiota. In conclusion, present results expand on the characterization of entero-hepatic signaling and suggest that allo-LCA, a microbial metabolite, might have therapeutic potential in liver diseases.

Pancreatic cancer precursor lesions - Can immunotherapy prevent progression into pancreatic ductal adenocarcinoma?

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers, with a 5-year survival rate of only 12.5 %. Early detection of PDAC or addressing risk factors for PDAC development are ways to improve outcomes. PDAC can arise from precursor lesions, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), and less frequent, mucinous cystic neoplasm (MCN), and other rare precursor variants. High-risk precursor lesions harbor a substantial chance of evolving into PDAC. Such lesions can often be found in resected PDAC specimens adjacent to the cancer. Unfortunately, recognizing precursor lesions that need to be resected is often tricky, and resections frequently end in major surgical interventions. Thus, better ways to handle precursor lesions are desperately needed. We mapped the immune microenvironments (IMEs) of PanINs, IPMNs, and MCNs on a cellular level using multiplex immunofluorescence and computational imaging technology and compared the findings to PDACs and normal pancreatic tissues. We found distinct and potentially targetable mechanisms of immunosuppression between the two main precursor lesions, PanIN and IMPN. Immunosuppression in IPMNs seems partly mediated by programmed cell death protein 1 ligand (PD-L1) expression on antigen-presenting cells (APCs). By contrast, elevated numbers of regulatory T cells (Tregs) seem to be key players in the immunosuppression of PanINs. Thus, treating high-risk IPMNs with anti-PD-1 and high-risk PanINs with agents targeting Tregs, such as anti-lymphocyte associated protein 4 (anti-CTLA-4) antibodies, could reverse their immunosuppressive state. Reversal of immunosuppression will restore immunosurveillance and eventually prevent progression into PDAC. We also review relevant published and ongoing non-surgical treatment approaches for high-risk IPMNs and PanINs.

Advancing the frontier of artificial intelligence on emerging technologies to redefine cancer diagnosis and care

BACKGROUND

Artificial Intelligence (AI) is capable of revolutionizing cancer therapy and advancing precision oncology via integrating genomics data and digitized health information. AI applications show promise in cancer prediction, prognosis, and treatment planning, particularly in radiomics, deep learning, and machine learning for early cancer diagnosis. However, widespread adoption requires comprehensive data and clinical validation. While AI has demonstrated advantages in treating common malignancies like lung and breast cancers, challenges remain in managing rare tumors due to limited datasets. AI's role in processing multi-omics data and supporting precision oncology decision-making is critical as genetic and health data become increasingly digitized.

METHOD

This review article presents current knowledge on AI and associated technologies, which are being utilized in the diagnosis and therapy of cancer. The applications of AI in radiomics, deep learning, and machine learning for cancer screening and treatment planning are examined. The study also explores the capabilities and limitations of predictive AI in diagnosis and prognosis, as well as generative AI, such as advanced chatbots, in patient and provider interactions.

RESULTS

AI can improve the early diagnosis and treatment of high-incidence cancers like breast and lung cancer. However, its application in rare cancers is limited by insufficient data for training and validation. AI can effectively process large-scale multi-omics data from DNA and RNA sequencing, enhancing precision oncology. Predictive AI aids in risk assessment and prognosis, while generative AI tools improve patient-provider communication. Despite these advancements, further research and technological progress are needed to overcome existing challenges.

CONCLUSIONS

AI holds transformative potential for cancer therapy, particularly in precision oncology, early detection, and personalized treatment planning. However, challenges such as data limitations in rare cancers, the need for clinical validation, and regulatory considerations must be addressed. Future advancements in AI could significantly improve decision-support systems in oncology, ultimately enhancing patient care and quality of life. The review highlights both the opportunities and obstacles in integrating AI into cancer diagnostics and therapeutics, calling for continued research and regulatory oversight.

Intraocular injectable hydrogels for the delivery of cells and nanoparticles

The rising global life expectancy has led to a growing prevalence of ophthalmic diseases, while current treatments face important limitations in terms of efficacy, costs, and patient compliance. The use of injectable hydrogels as drug and cell carriers is a promising approach, compared to the injection of drug solutions or cell suspensions. This is because the hydrogel matrix may offer protection against clearance or degradation, may modulate drug/cell release, and provide a biomimetic substrate for differentiating cells while being minimally invasive. On one hand, injectable hydrogels for ocular drug delivery have been traditionally designed to host and release small drugs or proteins. However, limitations such as high burst release and difficulty of entrapping hydrophobic molecules led to the emergence of nanocomposite hydrogels, where the drug is entrapped in nanoparticles prior hydrogel incorporation. Composite systems offer great advantages over the injection of particle suspensions, improving particle fate and drug release kinetics. On the other hand, injectable hydrogels offer a cell-friendly environment to seek tissue regeneration, providing biomechanical and biochemical cues for cellular cross-talk, differentiation, and formation of new extracellular matrix. This review critically discusses recent advancements in the development of novel injectable hydrogels as delivery vehicles for drug-loaded nanoparticles and cells, with a major focus on the formulation components, administration routes, and other factors affecting performance, highlighting promising aspects and challenges to address in the future.

Effectiveness Study of a Cultural Adaptation of Cognitive-Behavioural Therapy-Based Application for Depressive Symptoms in College Students: A Randomised Controlled Trial

INTRODUCTION

Studies on mental health applications among college students lack empirical evidence regarding mobile application usage's intensity, duration and frequency.

AIM

To evaluate the effectiveness of a cognitive-behavioural therapy (CBT)-based mobile application in ameliorating depressive symptoms among college students.

METHODS

A randomised controlled trial was conducted at three universities. Undergraduates aged ≥ 20 years with self-reported depressive symptoms were recruited and randomly assigned to the control and intervention groups. The outcomes include changes in depressive symptoms, suicidal ideation, help-seeking attitudes and emotional self-awareness at 4 (T1), 8 (T2) and 12 (T3) weeks. An intention-to-treat analysis was conducted.

RESULTS

Of the 91 participants, 46 in the intervention group exhibited a significant decline in depressive symptoms at T1 and lower patterns of symptom changes at T2 and T3. No significant differences were observed in the other outcomes; however, higher help-seeking attitude, emotional self-awareness and lower suicidal ideation after T0 were observed for those who used the application for 12 weeks.

DISCUSSION

The advantages of a brief application-based intervention to promote college students' psychological health are outlined.

IMPLICATIONS

School nursing managers could use the application to improve the college mental health systems and support collegial teacher-student relationships.

RECOMMENDATIONS

Further studies should enhance application usage to manage depressive symptoms.

TRIAL REGISTRATION

The study was approved by the Research Ethics Committee of the National Taiwan University Hospital (No. 202108098RINB, Date of approval: Oct 27, 2021) and the National Institutes of Health (No. NCT05188950).

Unveiling the effects of micro and nano plastics in embryonic development

The improper disposal and degradation of plastics causes the formation and spread of micro and nano-sized plastic particles in the ecosystem. The widespread presence of these micro and nanoplastics leads to their accumulation in the biotic and abiotic components of the environment, thereby affecting the cellular and metabolic functions of organisms. Despite being classified as xenobiotic agents, information about their sources and exposure related to reproductive health is limited. Micro and nano plastic exposure during early developmental stages can cause abnormal embryonic development. It can trigger neurotoxicity and inflammatory responses as well in the developing embryo. In embryonic development, a comprehensive study of their role in pluripotency, gastrulation, and multi-differentiation potential is scarce. Due to ethical concerns associated with the direct use of human embryos, pluripotent cells and its 3D in vitro models (with cell lines) are an alternative source for effective research. Thus, the 3D Embryoid body (EB) model provides a platform for conducting embryotoxicity and multi-differentiation potential research. Pluripotent stem cells such as embryonic and induced pluripotent stem cells derived embryoid bodies (EBs) serve as a robust 3D in vitro model that mimics characteristics similar to that of human embryos. Thus, the 3D EB model provides a platform for conducting embryotoxicity and multi-differentiation potential research. Accordingly, this review discusses the significance of 3D in vitro models in conducting effective embryotoxicity research. Further, we also evaluated the possible sources/routes of microplastic generation and analyzed their surface chemistry and cytotoxic effects reported till date.

Proteomic insights into the molecular mechanism of anlotinib inhibition in TP53-mutated non-small cell lung cancer

OBJECTIVE

Tumor protein 53 (TP53) is the commonly mutated gene in non-small cell lung cancer (NSCLC) that is associated with poor prognosis, and anlotinib exerts inhibitory effects on TP53-mutated NSCLC. The aim of this study was to investigate the inhibitory effect of anlotinib on TP53-mutated NSCLC and its possible mechanism.

METHODS

The growth ability of TP53-mutated NSCLC cells were tested by Cell counting kit-8 assay. Proteins in TP53-mutated NSCLC cells treated with anlotinib were analyzed using label-free liquid chromatography-mass spectrometry. Differentially represented proteins were analyzed by KEGG, GO, and PPIs. TP53 pathway related proteins were verified using western blotting.

RESULTS

The cell viability was significantly reduced in TP53-mutated NSCLC cell as opposed to TP53 wild cell by anlotinib treatment. 126 differentially represented proteins (37 upregulated and 89 downregulated) were found between the anlotinib and control groups in TP53-mutated NSCLC cell. Bioinformatics analyses revealed that the differentially represented proteins were primarily involved in catalytic activity, cellular processes, and metabolite interconversion. PANTHER Classification System found that anlotinib mainly impacted the p53 signaling pathway, De novo purine biosynthesis and Integrin signaling. KEGG enrichment and PPI networks of the differentially represented proteins revealed cyclin-dependent kinase 1 (CDK1) and mitogen-activated protein kinase kinase 3 (MAP2K3) as the core protein, which are related to the p53 signaling pathway. Western blotting also revealed that anlotinib significantly suppressed the expression of CDK1 and MAP2K3 in TP53-mutated NSCLC cells, that indicated the possible mechanism may involve the MAP2K3/p53/CDK1 pathway.

CONCLUSIONS

Our findings showed that anlotinib selectively inhibited the growth of TP53-mutated NSCLC cells and downregulated the expression levels of CDK1 and MAP2K3. The MAP2K3/p53/CDK1 pathway may be the molecular mechanism underlying anlotinib's efficacy in TP53-mutated NSCLC.

STATEMENT OF SIGNIFICANCE

Tumor protein 53 (TP53) is the commonly mutated gene in non-small cell lung cancer (NSCLC) that is associated with poor prognosis, and anlotinib exerts inhibitory effects on TP53-mutated NSCLC. However, the action mechanism of anlotinib in the treatment of TP53-mutated NSCLC remains unclear. In this study, we used label-free quantitative proteomics to reveal the molecular mechanism of anlotinib inhibition in TP53-mutated NSCLC. We found that anlotinib significantly inhibited the growth of TP53-mutated NSCLC cells and downregulated the expression levels of CDK1 and MAP2K3. The MAP2K3/p53/CDK1 pathway may be the molecular mechanism underlying anlotinib's efficacy in TP53-mutated NSCLC. Our study promotes the use of anti-angiogenic drugs in TP53-mutated NSCLC. It provides new ideas for the treatment of TP53-mutated NSCLC.

Pediatric gliomas immunity challenges and immunotherapy advances

Pediatric gliomas, the most frequent brain tumors in children, are characterized by heterogeneity and a unique tumor immune microenvironment. They are categorized into different subtypes, including low-grade gliomas like pilocytic astrocytomas and high-grade gliomas such as diffuse midline gliomas and diffuse intrinsic pontine gliomas, each exhibiting distinct immunological profiles. The tumor immune microenvironment in pediatric gliomas is shaped by cellular and non-cellular components, including immune cells, cytokines, and the extracellular matrix, involved in tumor progression, immune evasion, and response to therapy. While pediatric low-grade gliomas often display an immunosuppressed microenvironment, high-grade gliomas are characterized by complex immune infiltrates and intricate immunosuppressive mechanisms. The blood-brain barrier further obscures immune cell recruitment and therapeutic delivery. Despite advances in understanding adult gliomas, the immunobiology of pediatric tumors is poorly investigated, with limited data on the interactions between glioma cells and immune populations such as T and natural killer cells, as well as tumor-associated macrophages. Herein, we provide an update of the current knowledge on tumor immune microenvironment interactions in pediatric gliomas, highlighting the immunosuppressive mechanisms and emerging immunotherapeutic strategies aiming at overcoming these barriers to improve clinical outcomes for affected children.

Stoma occlusion caused by abdominal cocoon after abdominal abscess surgery: A case report

BACKGROUND

Abdominal cocoons (ACs) lack characteristic clinical manifestations and are mainly intestinal obstructions that are difficult to distinguish from intestinal obstruction caused by other causes, resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment. There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.

CASE SUMMARY

Here, we report a 16-year-old female patient with intestinal obstruction due to AC. She was treated with abdominal surgery three times. First, she underwent a laparotomy for peritonitis after trauma from a traffic accident. During the procedure, pelvic empyema, severe intestinal adhesions, and damage to the serous layer of the rectum were found, but no significant intestinal rupture and perforation were found. As a precaution, she underwent a prophylactic ileostomy after a flush in her abdomen. The second and third surgeries were for treatment of recurrent stoma obstruction. The patient’s condition was complicated for a long period, but after comprehensive treatment by our department, the patient was successfully discharged from the hospital and is currently recovering well.

CONCLUSION

Currently, abdominal contrast-enhanced computed tomography is the best imaging modality for preoperative evaluation of AC, but most patients are diagnosed only after intraoperative exploration. For the treatment of typical or severe ACs, the primary method of removal and healing of ACs is complete removal of the abdominal fibrous membrane. Finding a breakthrough in the anatomy is the key to the success of the surgery.

Evolution of autoimmune diagnostics over the past 10 years: lessons learned from the UK NEQAS external quality assessment EQA programs

OBJECTIVES

External quality assessment (EQA) programs play a pivotal role in harmonizing laboratory practices, offering users a benchmark system to evaluate their own performance and identify areas requiring improvement. The objective of this study was to go through and analyze the UK NEQAS "Immunology, Immunochemistry and Allergy" EQA reports between 2012 and 2021 to assess the overall level of harmonization in autoimmune diagnostics and identify areas requiring improvement for future actions.

METHODS

The EQA programs reviewed included anti-nuclear (ANA), anti-dsDNA, anti-centromere, anti-extractable nuclear antigen (ENA), anti-phospholipids, anti-neutrophil cytoplasm (ANCA), anti-proteinase 3 (PR3), anti-myeloperoxidase (MPO), anti-glomerular basement membrane (GBM), rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), mitochondrial (AMA), liver-kidney-microsomal (LKM), smooth muscle (ASMA), APCA, and celiac disease antibodies.

RESULTS

In the analyzed period, the number in participating laboratories showed an increase for almost all programs. Among solid phase methods, the use of ELISA techniques showed a progressive reduction, while new technologies, such as the fluoroenzymatic immunoassay, chemiluminescence immunoassay, Luminex and immunoblot showed an increased number of users. The number of results complying with the expected negative or positive target slightly increased for almost all antibodies in the last decade. A description of the most frequent causes of mistakes or misinterpretation for each specific test and method is also provided in this study.

CONCLUSIONS

Although numerous challenges need to be addressed in the area of autoantibody detection to enhance testing quality and attain higher harmonization, the period analyzed revealed that the ever-expanding range of autoantibodies, coupled with the introduction of new tests and methodologies and the advent of automated platforms, has brought about significant changes in autoimmune diagnostics.

Improving cancer patients’ prognosis by incorporating mindfulness intervention into the treatment strategy

This letter discusses the study by Liu et al recently published in World Journal of Psychiatry, which examines the benefits of combining epirubicin (EPI) with mindfulness interventions for patients with urinary system tumors and depression. The study included 110 patients and compared an experimental group receiving EPI and a mindfulness intervention strategy with a control group treated with mitomycin and standard care. Results showed that the experimental group had significant improvements in immune function, tumor markers, depression severity, quality of life, cancer-related fatigue, and nursing satisfaction. Despite acknowledging the study limitations such as a relatively small sample size and a short duration, the study highlights the efficacy of integrating mindfulness interventions into cancer treatment strategies to enhance patient outcomes and address psychological distress.

Microcystin-LR induces lung injury in mice through the NF-κB/NLRP3 pathway

Microcystin-LR (MC-LR) a cyclic toxin produced by cyanobacterial species is known to exert detrimental effects on various organs, including lung. Several investigators demonstrated that MC-LR exerts pulmonary toxicity, but the underlying mechanisms remain unclear. This study aimed to investigate whether exposure to MC-LR-induced lung inflammation and examine the underlying mechanisms. Thirty specific pathogen-free (SPF) male mice were allocated into control and MC-LR treatment groups. Mice were intraperitoneally injected with physiological saline or MC-LR (20 μg/kg) daily for a total of 21 days. Our findings indicated that exposure to MC-LR-produced histopathological changes in lung tissue, including thickening of alveolar walls and inflammatory infiltration. MC-LR was found to upregulate mRNA expression levels of pro-inflammatory cytokines TNFα, IL-6, IL-1β, and IL-18. Further, MC-LR significantly elevated the expression levels of proteins associated with the NF-κB/NLRP3 pathway p-NF-κB, NLRP3, Caspase-1, ASC. The activation of NF-κB/NLRP3 pathway further promoted the release of inflammatory cytokine IL-1β and cleavage of pyroptosis-associated GSDMD protein. These findings indicate that MC-LR may induce lung inflammation by promoting cell pyroptosis via the activation of the NF-κB/NLRP3 pathway.

Factors influencing anxiety and depression in advanced hepatocellular carcinoma patients and their impact on quality of life

BACKGROUND

Patients with middle and advanced hepatocellular carcinoma (HCC) frequently experience significant anxiety and depression, severely affecting their quality of life.

AIM

To examine the anxiety and depression status of patients with middle and advanced HCC, the influencing factors, and the correlation between these psychological factors and quality of life.

METHODS

We collected baseline data from 100 patients with HCC, assessing anxiety and depression levels using the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD). Quality of life was evaluated with the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire. Multivariate logistic regression analyzed clinical and psychosocial factors affecting anxiety and depression, while Pearson correlation assessed relationships among HAMA, HAMD, and Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire scores.

RESULTS

Results indicated that 64% of patients exhibited anxiety and 65% showed depression symptoms. Key influencing factors included Barcelona Clinic Liver Cancer C stage, multiple tumors, social support, prior treatments (such as liver resection and transcatheter arterial chemoembolization/hepatic artery infusion chemotherapy), as well as HAMA and HAMD scores. Anxiety and depression correlated negatively with quality of life, with coefficients of -0.671 and -0.575 for HAMA and HAMD, respectively.

CONCLUSION

Anxiety and depression are prevalent among patients with middle and advanced HCC, impacting quality of life. This underscores the need for psychological health considerations in liver cancer treatment and establishing psychological interventions is essential.

Insight into the efficacy and safety of pirfenidone: The treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) has a poor prognosis if left untreated; therefore, early treatment with pirfenidone is crucial. Lei et al conducted a retrospective analysis to evaluate the effectiveness of early pirfenidone treatment on lung function in 113 patients with IPF. In addition to other research, pirfenidone has demonstrated efficacy in patients at all stages of IPF once correct diagnosis has been made. In advanced IPF, we include the requirement for pirfenidone. Therefore, it is essential to choose an appropriate method of administration method, such as inhalation. This may circumvent the drawbacks of the high cost and possible adverse effects of this drug.

Synaptotagmin-7 deficit causes insulin hypoactivity and contributes to behavioral alterations in mice

Synaptotagmin-7 (Syt7) KO mice show diurnal fluctuations of mania- and depression-like behavioral abnormalities. Although GluN2B-NMDAR hypoactivity has been shown to be involved in the induction of mania-like behaviors of the Syt7 KO mice in the dark phase, the reasons for the depression-like behaviors in the light phase and behavioral fluctuation remain unknown. Here, we show that bipolar I disorder (BDI)-patient-induced pluripotent stem cell (iPSC)-derived islet-like organoids exhibited Syt7-dependent insulin secretion defects; moreover, Syt7-deficiency-induced insulin hyposecretion generated depression-like behaviors in Syt7 KO mice in the light phase. Furthermore, pancreatic insulin secretion and neuronal activity showed opposite diurnal patterns, in which the Syt7-deficiency-induced disequilibrium induced periodic antagonistic shifts in the mania- and depression-like behaviors. Finally, using RNA sequencing (RNA-seq) analysis, we explored downstream pathways that might underlie the diurnal fluctuation of behaviors. Therefore, Syt7-deficiency-induced insulin hypoactivity contributed to light-phase depression-like behaviors and diurnal behavioral fluctuations in the mice.

Effect of beinaglutide, a thrice-daily GLP-1 receptor agonist, on body weight and metabolic parameters: A systematic review and meta-analysis

BACKGROUND

Beinaglutide, a short-acting glucagon-like polypeptide-1 receptor agonist, has shown variable efficacy in weight reduction and metabolic control in randomized controlled trials (RCTs).

AIM

To summarize the therapeutic effects of beinaglutide in patients with overweight/obesity with/without type 2 diabetes.

METHODS

RCTs involving patients receiving beinaglutide in the intervention arm and placebo or active comparator in the control arm were searched through multiple electronic databases. The change from baseline in body weight was the primary outcome; secondary outcomes included changes in body mass index (BMI), waist circumference (WC), blood pressure, glycemic parameters, lipids, and adverse events (AEs). RevMan web was used to conduct meta-analysis using random-effects models. Outcomes were presented as mean differences (MDs), odds ratios (ORs), or risk ratios (RRs) with 95% confidence intervals (95%CIs).

RESULTS

Six RCTs (n = 800) with mostly some concerns about the risk of bias were included. Over 12-24 weeks, beinaglutide 0.1-0.2 mg thrice daily was superior to the control group in reducing total (MD = -3.25 kg, 95%CI: -4.52 to -1.98, I² = 84%, P < 0.00001) and percent (MD = -4.13%, 95%CI: -4.87 to -3.39, I² = 54%, P < 0.00001) body weight reduction. Beinaglutide also outperformed the control group in achieving weight loss by 5% (OR 4.61) and 10% (OR = 5.34). The superiority of beinaglutide vs the control group was also found in reducing BMI (MD = -1.22 kg/m², 95%CI: -1.67 to -0.77) and WC (MD = -2.47 cm, 95%CI: -3.74 to -1.19]). Beinaglutide and the control group had comparable impacts on blood pressure, glycemic parameters, insulin resistance, hepatic transaminases, and lipid profile. Beinaglutide posed higher risks of treatment discontinuation due to AEs (RR = 3.15), nausea (RR = 4.51), vomiting (RR = 8.19), palpitation (RR = 3.95), headache (RR = 2.87), and dizziness (RR = 6.07) than the control. However, the two groups had identical risks of total and serious AEs, diarrhea, fatigue, and hypoglycemia.

CONCLUSION

Short-term data from RCTs suggested that beinaglutide causes modest benefits in reducing body weight, BMI, and WC, with no significant difference in glycemic and other metabolic endpoints compared to the control arm. Safety data were consistent with those of the other drugs in the glucagon-like polypeptide-1 receptor agonist class. Larger RCTs are warranted to prove the longer-term metabolic benefits of beinaglutide.

Electrosprayed core-shell microspheres co-deliver fibronectin and resveratrol for combined treatment of acute lung injury

The facile development of advanced formulations capable of scavenging excess reactive oxygen species (ROS) and sustainably inhibiting inflammatory cytokine secretion is imminent for effective treatment of acute lung injury (ALI), but still remains a great challenge. This study presents an innovative core-shell carrier system via electrospray technology, characterized by a shell of poly(lactic acid-co-glycolic acid) (PLGA) and a core consisting of polycaprolactone-polyethylene glycol (PCL-PEG) micelles encapsulating resveratrol (Res), and surface modified with fibronectin (FN). The created drug-loaded core-shell microspheres (for short, RPG@FN) with a size of 1.30 μm, are stable under physiological conditions and specifically target macrophages through the Arg-Gly-Asp peptide sequence of FN. We show that the RPG@FN microspheres can synergistically reduce inflammatory responses through ROS scavenging and macrophage M2 polarization, thus facilitating mitochondrial homeostasis restoration and modulating NF-κB and PI3K/Akt pathways by virtue of the integrated antioxidant and anti-inflammatory properties of FN and Res. In an ALI mouse model, the developed RPG@FN significantly alleviates pulmonary edema and inflammatory cell infiltration, while repairing the inflammatory lung injury. This innovative RPG@FN system fully capitalizes on the therapeutic benefits of Res and FN with improved bioavailability, thus offering a promising option for effective ALI treatment.

Glucocorticoids as emerging pollutants in surface water: A systematic review on their global occurrence and distribution

Glucocorticoids (GCs) are synthetic drugs widely used for treating several diseases with inflammatory pathophysiology. In general, 1-20% of the concentration of GCs initially administered is eliminated unchanged in the urine while still in its active form, and therefore, fractions of GCs are constantly released in effluents. Currently, water treatment plants do not have sufficiently effective technologies to remove these substances completely, favoring the presence of these emerging pollutants in the effluents of wastewater treatment plants. In this context, we conduct a systematic review to identify studies that found GCs in surface water. The general data of the included studies, the GCs found and their concentration, the water body where the GCs were found, and the place and date of sampling were summarized. GCs have already been found in the surface water of 24 countries, mainly China, Malaysia, and the United States. Countries with the highest concentrations of GCs found in surface water were Mexico, India, and Brazil. Betamethasone, budesonide, corticosterone, cortisol, cortisone, dexamethasone, fludrocortisone, fluticasone, hydrocortisone, methylprednisolone, prednisolone, prednisone, and triamcinolone were reported at concentrations ranging from 0.00098 to 24760 ng/L, including in water for human consumption. Revised data showed that the real presence of these substances worldwide is still underestimated, requiring further studies to determine their real distribution. Furthermore, we believe that some strategies can be adopted to mitigate surface water contamination by GCs, such as the intensification of public programs about educational activities related to the rational use of medicines, and the urgent need to improve and expand the water treatment methods.

Intelligent hydrogel-based dressings for treatment of chronic diabetic wounds

Diabetic wounds represent a significant challenge in the medical field, significantly impacting patient quality of life and imposing a heavy burden on healthcare systems. Intelligent hydrogel dressings have attracted significant attention in diabetic wound treatment due to their unique properties. This review systematically explores the three main categories of intelligent hydrogels (natural, synthetic, and composite), dissecting their composition, structure, and the mechanisms that enable their intelligent responses. The crucial roles of these dressings in maintaining a moist wound environment, efficiently absorbing exudate, and precisely delivering drugs are expounded. Moreover, their application advantages in combating bacteria and infections, regulating inflammation and immunity, promoting angiogenesis and tissue regeneration, as well as enabling real-time monitoring and personalized treatment, are explored in depth. Additionally, we discuss future research directions and the prospects for personalized precision medicine in diabetic wound care, aiming to inspire innovation and provide a comprehensive theoretical basis for the development of next-generation intelligent dressings.

Bifidobacterium bifidum 1007478 derived indole-3-lactic acid alleviates NASH via an aromatic hydrocarbon receptor-dependent pathway in zebrafish

AIMS

This study investigates the potential of Bifidobacterium bifidum 1007478 (BB478) and its metabolite indole-3-lactic acid (ILA) in alleviating non-alcoholic steatohepatitis (NASH) induced by a high-fat diet (HFD) and fructose exposure.

MATERIALS AND METHODS

A zebrafish model of NASH was established by exposure to HFD and fructose. BB478 was administered, and the effects on liver lipid accumulation, oxidative stress, and inflammation were assessed. ILA production by BB478 was confirmed, and its impact on hepatic lipogenesis and inflammatory pathways was evaluated. The involvement of the aromatic hydrocarbon receptor (AhR) was also examined using an AhR inhibitor.

KEY FINDINGS

BB478 supplementation inhibited lipid accumulation in the liver, reduced triglycerides (TG) and total cholesterol (TC), and mitigated oxidative stress, as evidenced by lower levels of reactive oxygen species (ROS) and malondialdehyde (MDA). ILA, produced by BB478, could alleviate the hepatic damage and fat deposition in liver. Mechanistically, it suppressed hepatic lipogenesis by downregulating lipogenesis-related genes, including sterol response element binding protein 1 (SREBP1) and fatty acid synthase (FASN). ILA also inhibited the expression of pro-inflammatory cytokines to suppress inflammation. The therapeutic effects of ILA were reversed by the AhR inhibitor, indicating that ILA's actions are AhR-dependent.

SIGNIFICANCE

These findings reveal the potential of ILA, produced by Bifidobacterium bifidum, as a therapeutic agent for NASH. The mechanistic insights into AhR-mediated effects provide a foundation for further exploration of ILA as a novel approach for managing liver diseases.

Enhancing immunogenicity and release of in situ-generated tumor vesicles for autologous vaccines

In situ vaccination (ISV) strategies offer an innovative approach to cancer immunotherapy by utilizing drug combinations directly at tumor sites to elicit personalized immune responses. Tumor cell-derived extracellular vesicles (TEVs) in ISV have great potential but face challenges such as low release rates and immunosuppressive proteins like programmed death ligand 1 (PD-L1) and CD47. This study develops a nanoparticle-based ISV strategy (Combo-NPs@shGNE) that enhances TEV release and modulates cargo composition. This approach combines Andrographolide, Icariside II, and shRNA targeting UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase (GNE), which accumulates in the tumor region, resulting in the regulation of immunosuppressive pathways and the reduction of sialic acid production. Decreasing the level of sialylation on the membrane through necroptosis and inhibition of sialic acid synthesis decreased the loading of PD-L1 and CD47 on vesicles, while increasing the loading of heat shock protein 70 and high mobility group box 1 on vesicles, and induced the release of highly immunogenic TEVs from the cancer cells, with a 56.44 % release, 9.57 times higher than that of blank nanoparticle-treated cells. In vivo studies demonstrate that Combo-NPs@shGNE enhances TEV yield, tumor growth, reduces metastases, and improves survival in an osteosarcoma mouse model. It promotes dendritic cell maturation, increases CD4+ and CD8+ T cell infiltration, and alters the microenvironment by reducing myeloid-derived suppressor cells and enhancing immunostimulatory factors. Additionally, it transitions tumor-associated macrophages from M2 to an M1 phenotype, thereby augmenting tumor immunity. Overall, Combo-NPs@shGNE offers a promising method for transforming tumors into personalized autologous vaccines, potentially advancing cancer treatment strategies.

Surfactant protein B-derived peptides as endosomal escape enhancers for pulmonary delivery of siRNA

Respiratory diseases still cause significant mortality and morbidity worldwide, highlighting the need for new inhalable drugs. RNA therapeutics, which have the potential to modulate the expression of virtually any gene, could address this unmet medical need. Nevertheless, clinical translation requires the design of RNA formulations able to overcome the extra- and intracellular barriers in the lung. We previously discovered that the endogenous cationic amphiphilic surfactant protein B (SP-B) promotes cytosolic delivery of small interfering RNA (siRNA) in lung-related cell types via endosomal membrane fusion. However, to bypass drawbacks related to the use of animal-derived SP-B, there is a keen interest in developing synthetic SP-B analogues with comparable activity. Here, we show that native SP-B can successfully be replaced by smaller peptides, with the N-terminal heptapeptide and amphipathic helix being minimally required to promote siRNA-induced gene silencing. Peptidolipid-coated nanogels were designed and demonstrated equivalent siRNA delivery efficacy compared to state-of-the-art lipid nanoparticles (LNPs). Moreover, they exhibit enhanced resistance to vibrating mesh nebulization and reduced inflammatory activation of bronchial epithelial cells. Collectively, the discovery of SP-B peptides as RNA delivery enhancers holds promise for developing potent inhalable RNA formulations with favorable safety profiles, of value for the treatment of chronic inflammatory pathologies.

They Not Like Us: Evaluating the Diverse Strategies in Locally Advanced Rectal Cancer Treatment

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

EYA3 regulation of NF-κB and CCL2 suppresses cytotoxic NK cells in the premetastatic niche to promote TNBC metastasis

Triple-negative breast cancer cells must evade immune surveillance to metastasize to distant sites, yet this process is not well understood. The Eyes absent (EYA) family of proteins, which are crucial for embryonic development, become dysregulated in cancer, where they have been shown to mediate proliferation, migration, and invasion. Our study reveals an unusual mechanism by which EYA3 reduces the presence of cytotoxic natural killer (NK) cells in the premetastatic niche (PMN) to enhance metastasis, independent of its effects on the primary tumor. We find that EYA3 up-regulates nuclear factor κB signaling to enhance CCL2 expression, which, in contrast to previous findings, suppresses cytotoxic NK cell activation in vitro and their infiltration into the PMN in vivo. These findings uncover an unexpected role for CCL2 in inhibiting NK cell responses at the PMN and suggest that targeting EYA3 could be an effective strategy to reactivate antitumor immune responses to inhibit metastasis.

Hepatic phenomena associated with SARS-CoV-2: Acute liver injury, autoimmune hepatitis and post-vaccination

The infection with SARS-CoV-2, primarily recognized for its respiratory effects, reveals itself as a multifaceted clinical phenomenon, extending beyond the pulmonary realm. Accompanied by gastrointestinal, neurological, thromboembolic, cardiovascular, and immune-related manifestations, the complexity of the systemic repercussions of the disease becomes apparent. Genetic predisposition is a significant factor in the development of autoimmune hepatitis, as both viruses, such as SARS-CoV-2, and drugs, including vaccines, can act as triggers in genetically susceptible individuals. A profound understanding of these mechanisms is essential to effectively address the clinical complexity of SARS-CoV-2 infection.

Development of a nomogram for predicting the risk of carcinoma in chronic atrophic gastritis

OBJECTIVE

To construct a machine learning (ML) model to predict the progression of chronic atrophic gastritis (CAG) to gastric cancer (GC), given its precancerous significance.

METHODS

Using medical records from the Affiliated Hospital of Qingdao University, common laboratory indicators were extracted. LASSO regression identified 10 core risk factors, which were further analyzed using binary logistic regression to develop a nomogram model in R. The model's performance was evaluated using receiver operating characteristic (ROC) curves, the concordance index (C-index), calibration curves, and decision curve analysis (DCA).

RESULTS

The model showed excellent performance, with a C-index of 0.887. The key factors included sex, coagulation, blood cell indexes, and blood lipid levels. The ROC areas were 0.892 (quantitative) and 0.853 (qualitative), confirming model reliability.

CONCLUSION

A new nomogram model for assessing GC risk in CAG patients was successfully developed. However, due to data collection and time limitations, future studies should expand the sample size, perfect the validation process, and optimize the model to achieve more accurate risk prediction.

Fast screening of COVID-19 inpatient samples by integrating machine learning and label-free SERS methods

BACKGROUND

Advances in bio-analyte detection demonstrate the need for innovation to overcome the limitations of traditional methods. Emerging viruses evolve into variants, driving the need for fast screening to minimize the time required for positive detection and establish standardized detection. In this study, a SERS-active substrate with Au NPs on a regularly arranged ZrO2 nanoporous structure was utilized to obtain the SERS spectrum of inpatient samples from COVID-19 patients. Two analytical approaches were applied to classify clinical samples - empirical method to identify peak assignments corresponding to the target SARS-CoV-2 BA.2 variant, and machine learning (ML) method to build classifier models.

RESULTS

Comparison of spectral profiles of pure BA.2 variant and inpatient samples showed significant differences in the occurrence of SERS peaks, requiring the selection of regions of interest for further analysis through the empirical method. SERS spectra are classified into CoV (+) and CoV (-) using both empirical and machine learning methods, each demonstrating a sensitivity of 85.7 % and a specificity of 60 %. The former method relies on peak assignment, which is performed manually relying on established and results in a longer turnaround time. In contrast, the latter method is based on the mathematical correlations between variables across the entire spectrum. The machine must continuously learn from larger datasets, and the response time for interpretation is short. Nonetheless, both methods demonstrated their suitability in classifying clinical samples.

SIGNIFICANCE

This study demonstrated that a more comprehensive discussion can be formed with the integration of machine learning classification with biochemical profiling with the empirical analysis approach. Further improvement is expected by combining these two methods by utilizing only the regions of interest instead of the entire spectrum as input for machine learning, as a feature extraction technique.

Edaravone alleviates Pseudomonas aeruginosa associated-acute lung injury by inhibiting inflammation and promoting anti-microbial peptide production

Acute respiratory distress syndrome (ARDS) is the most common respiratory emergency and one of the most severe clinical syndromes. Bacterial and viral infections are the frequent etiological factors. Pseudomonas aeruginosa (PA) is the most significant gram-negative pathogen associated with pneumonia and ARDS in critically ill patients with respiratory diseases. However, multi-drug resistance and biofilm formation pose significant challenges to the clinical treatment of PA-associated pulmonary infections. In this study, we focused on edaravone (EDA), a brain-protective agent and free-radical scavenger commonly used in neurology, and examined its role in PA-ALI. We found EDA significantly mitigated pulmonary pathological damage, inflammatory responses and Reactive Oxygen Species (ROS) generation induced by PA in vivo. The in-vitro assays revealed EDA inhibited the transcription and secretion of pro-inflammatory factors induced by PA in RAW264.7 cells by targeting the TLR4/MyD88/NF-κB signaling pathways. Additionally, EDA reduced the production of intracellular ROS and cell death. EDA treatment enhanced the transcription of antimicrobial peptides, including defensin beta 1 (Defb1), defensin beta 2 (Defb2), CC motif chemokine ligand 20 (Ccl20), secretory leukocyte peptidase inhibitor (Slpi), and lactotransferrin (Ltf), with a significant upregulation of Defb1 expression. We also explored the role of EDA in lung endogenous stem cells using Sftpc-DreER; Scgb1a1-CreER; R26-TLR mice. Our findings indicated that EDA promoted the regeneration of club cells in response to PA stimulation by promoting their proliferation. And also, EDA inhibited PA infection induced cell apoptosis in lung tissues. In conclusion, EDA acts as a protective agent in PA-ALI. It not only inhibits inflammatory responses induced by PA but also enhances the expression of antimicrobial peptides and promotes club cell regeneration. Therefore, EDA may serve as an adjunctive treatment for PA-ARDS.

Lonicerin regulates AMPK/SIRT1/autophagy pathway to attenuate heat stress intestinal injury and inhibit inflammation

Intestinal injury is one of the most prevalent complications following heat stress (HS) in both humans and animals. Autophagy has been shown to maintain intestinal homeostasis, and modulation of autophagy may help alleviate intestinal injury caused by HS. Lonicerin (LN) are flavonoids known to have enhanced autophagy and anti-inflammatory effects. However, how LN prevent intestinal damage and regulate autophagy after HS remains unknown. The aim of this study was to elucidate the potential regulatory effects of LN on intestinal inflammation and intestinal barrier function in a HS model, and to elucidate the underlying molecular mechanisms. Firstly, we searched for the same inflammatory cytokines in the drug and disease targets through network pharmacology, and in vitro and in vivo experiments showed that LN significantly inhibited the production of pro-inflammatory cytokines. Then it was demonstrated that LN alleviates HS induced intestinal mucosal barrier damage by repairing tight junctions, goblet cells, and mucins in the colon of rats, consistent with the findings of in vitro experiments. In addition, LN reversed HS-induced reduced autophagic flux and maintained autophagic homeostasis via the AMP-activated protein kinase (AMPK)-Silent information regulator 1 (SIRT1) pathway in intestinal epithelial cells and intestinal system. In summary, this study demonstrated that LN exert intestinal protective and immunomodulatory effects by inhibiting the production of pro-inflammatory cytokines, maintaining the integrity of the intestinal mucosal barrier, and the level of AMPK-SIRT1 autophagy.

[Prehabilitation and enhanced recovery after surgery protocols for head and neck cancer : Value and application of these concepts]

Prehabilitation is gaining traction in complex oncological interventions and treatments. This CME article is focused on the basic principles of prehabilitation. We discuss the objective evaluation of physical fitness and how to improve it by physio- and speech therapy. Thereafter, we explain how to judge nutritional status, especially in oncological patients, and discuss modes of nutritional supplementation. Finally, the enhanced recovery after surgery concept is briefly explained and its current value in head and neck cancer patients discussed.

Study on the comorbid mechanisms of sarcopenia and late-life depression

The increasing global aging population has brought greater focus to age-related diseases, particularly muscle-brain comorbidities such as sarcopenia and late-life depression. Sarcopenia, defined by the gradual loss of muscle mass and function, is notably prevalent among older individuals, while late-life depression profoundly affects their mental health and overall well-being. Epidemiological evidence suggests a high co-occurrence of these two conditions, although the precise biological mechanisms linking them remain inadequately understood. This review synthesizes the existing body of literature on sarcopenia and late-life depression, examining their definitions, prevalence, clinical presentations, and available treatments. The goal is to clarify the potential connections between these comorbidities and offer a theoretical framework for the development of future preventive and therapeutic strategies.

OTULIN orchestrates NCOA4-FTH1 complex to alleviate APAP-induced hepatocyte Ferroptosis

BACKGROUND

Acetaminophen (APAP) overdose is a leading cause of drug-induced liver injury (DILI) and can progress to acute liver failure (ALF). Hepatocyte death is widely recognized as the central event in APAP-induced liver injury; however, the underlying mechanisms are complex and not yet fully elucidated. Ferroptosis, a recently identified form of programmed cell death characterized by glutathione (GSH) depletion and disruption of cellular redox homeostasis, shares key features with APAP-induced hepatotoxicity. This study aimed to investigate the role of ferroptosis in APAP-induced liver injury and to explore potential therapeutic targets.

EXPERIMENTAL APPROACHES

C57BL/6 mice were administered APAP to evaluate ferroptosis and hepatic injury in vivo through histological and biochemical analyses. A range of molecular techniques, along with the establishment of stable cell lines, were employed to elucidate the underlying mechanisms in vitro.

RESULTS

We demonstrated that APAP disrupts iron homeostasis and promotes hepatocyte ferroptosis. OTULIN, a deubiquitinase involved in linear ubiquitination, was found to regulate the ubiquitination modification of NCOA4, leading to NCOA4 depletion and FTH1 accumulation. This process enhanced the resistance and adaptability of hepatocytes to APAP-induced damage.

CONCLUSION

Our findings reveal that OTULIN modulates the NCOA4-FTH1 complex to protect against APAP-induced hepatocyte ferroptosis. Targeted upregulation of OTULIN in hepatocytes may represent a promising therapeutic strategy for APAP-induced DILI.

Distribution of Lymph Node Metastasis and Prognosis in Duodenal Bulb Tumors: A Multicenter Retrospective Study

BACKGROUND

The optimal surgical procedure for primary duodenal cancer has not been established because of its low incidence. The purpose of this study was to examine the distribution of lymph node (LN) metastasis in duodenal bulb tumors. Specifically, in tumors with submucosal invasion, we aimed to evaluate the feasibility of distal gastrectomy with duodenal bulb resection combined with lymphadenectomy of regional gastric LNs.

METHODS

Data from patients who underwent surgery for either adenocarcinoma or neuroendocrine tumors located in the duodenal bulb between 2000 and 2020 were retrospectively analyzed from five high-volume centers in Japan. Patient background, clinicopathological factors, type of surgery, distribution of LN metastasis, and long-term outcomes were evaluated.

RESULTS

The frequency of LN metastasis in tumors with submucosal invasion was 18%. Metastatic LNs were identified in T1b adenocarcinomas for #6, #8a, #8p, with similar results for neuroendocrine tumors. The 3-year overall survival rate for adenocarcinoma in stages T1a, T1b, and T2-4 was 100%, 81%, and 56%, respectively. Neuroendocrine tumors were 100% at all depths of invasion. Regarding LN tumors with submucosal invasion, while three patients had a recurrence, two cases were observed in distant organs without regional LNs, and one patient who underwent pancreaticoduodenectomy had metastasis in the gastric regional LNs.

CONCLUSION

For duodenal bulb tumors, based on the distribution of LN metastasis with tumors with submucosal invasion, distal gastrectomy with duodenal bulb resection and regional LN dissection is considered a curative treatment. Conversely, pancreaticoduodenectomy is recommended for tumors invading the muscularis propria and beyond.

Sini Powder Alleviates Stress Response and Suppresses Hepatocellular Carcinoma Development by Restoring Gut Microbiota

OBJECTIVES

To explore the underlying pharmacological mechanisms and its potential effects of Chinese medicine herbal formula Sini Powder (SNP) on hepatocellular carcinoma (HCC).

METHODS

The active components of SNP and their in vivo distribution were identified using ultraperformance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Construction of component-target-disease networks, protein-protein interaction network, Gene Ontology function and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and molecular docking were employed to analyze the active components and anti-HCC mechanisms of SNP. Cell viability assay and wound healing assay were utilized to confirm the effect of SNP-containing serum (2.5%, 5.0%, 10%, 20%, and 40%), isoprenaline or propranolol (both 10, 100, and 1,000 µ mol/L) on proliferation and migration of HepG 2 or Huh7 cells. Meanwhile, the effect of isoprenaline or propranolol on the β 2 adrenergic receptor (ADRB2) mRNA expression on HepG2 cells were measured by real-time quantitative reverse transcription (RT-qPCR). Mice with subcutaneous tumors were either subjected to chronic restraint stress (CRS) followed by SNP administration (364 mg/mL) or directly treated with SNP (364 mg/mL). These two parallel experiments were performed to validate the effects of SNP on stress responses. Stress-related proteins and hormones were quantified using RT-qPCR, enzyme-linked immunosorbent assay, and immunohistochemistry. Metagenomic sequencing was performed to confirm the influence of SNP on the gut microbiota in the tumor-bearing CRS mice.

RESULTS

The distribution of the 12 active components of SNP was confirmed in various tissues and feces. Network pharmacology analysis confirmed the anti-HCC effects of the 5 active components. The potential anti-HCC mechanisms of SNP may involve the epidermal growth factor receptor (EGFR), proto-oncogene tyrosine-protein kinase Src (SRC) and signal transducer and activator of transcription 3 (STAT3) pathways. SNP-containing serum inhibited the proliferation of HepG2 and Huh7 cells at concentrations of 2.5% and 5.0%, respectively, after 24 h of treatment. Furthermore, SNP suppressed tumor progression in tumor-bearing mice exposed to CRS. SNP treatment also downregulated the expressions of stress-related proteins and pro-inflammatory cytokines, primarily by modulating the gut microbiota. Specifically, the abundance of Alistipes and Prevotella, which belong to the phylum Bacteroidetes, increased in the SNP-treated group, whereas Lachnospira, in the phylum Firmicutes, decreased.

CONCLUSION

SNP can combat HCC by alleviating stress responses through the regulation of gut microbiota.

Metabolic-associated fatty liver disease (MAFLD) promotes the progression of hepatocellular carcinoma by enhancing KIF20A expression

BACKGROUND

Compared to other HCC, those related to MAFLD exhibit distinct prognostic differences. This article aims to elucidate the impact of MAFLD on HCC prognosis through the lens of KIF20A, thereby providing a theoretical foundation for targeted therapies in MAFLD-related HCC.

METHODS

We employed the Weighted gene co-expression network analysis (WGCNA) method alongside the Mime package to identify key genes associated with MAFLD-related HCC. Subsequently, we utilized OCLR and CytoTRACE algorithms to evaluate the relationship between these genes and HCC stemness. The R package was employed to conduct immunological analyses on both mRNA sequencing and single-cell data. We validated the effects of core genes on HCC through experimental approaches, including cell culture, Transwell assays, Western Blot, and proliferation assays. Finally, we predicted potential therapeutic drugs using the OncoPredict software package.

RESULTS

WGCNA identified the cyan module associated with MAFLD in GSE135251 and the blue module linked to HCC in TCGA. Further analysis identified KIF20A as the core gene in MAFLD-related HCC. Utilizing the OCLR and CytoTRACE algorithms, KIF20A was found to correlate with mRNA stemness index (mRNAsi). Analysis of public databases revealed that KIF20A promotes immune tolerance through the SPP1-CD44 pathway and drives HCC progression via the G2M checkpoint. Experimental results demonstrated that lipotoxic damage in HCC cells and small extracellular vesicles (sEVs) derived from these cells upregulate KIF20A, thereby accelerating HCC progression. Finally, OncoPredict and AutoDock were employed to predict drugs targeting KIF20A.

CONCLUSION

MAFLD-related HCC can elevate KIF20A levels and promote tumor proliferation and migration.

Five Lessons in Feeding Following Abdominal Surgery in Children: Can We Discontinue Unnecessary Fasting?

Fasting children after gastrointestinal surgery is traditionally thought to reduce complications. However, over the last two decades, there has been increasing interest in feed commencement within 24 h of operation, termed 'early enteral nutrition'. Evidence is now demonstrating that this approach to feeding aligns more closely with value-based healthcare principles than traditional postoperative fasting. This is reflected in the fact that early feeding can be safely offered and is associated with earlier return of bowel function, with shorter time to stool, quicker progression to full feeds and reduced length of stay. There is higher patient satisfaction, and no increase in complications. Because of this, early enteral nutrition is a key component of enhanced recovery after surgery protocols, which are being integrated into paediatric surgical practice.

Intracranial Rhizomucor Pusillus Mucormycosis in an Adolescent Triggering a Stroke Alert: A Case Report and a Systematic Review of Pediatric Cases

Mucormycosis is a rare, life-threatening opportunistic infection primarily affecting immunocompromised patients. The available literature on Rhizomucor pusillus (R pusillus) infections of the central nervous system (CNS) in children is very limited. We present the case of an immunocompromised adolescent with intracranial mucormycosis due to R pusillus manifesting with stroke-like symptoms. This case highlights this rare condition's diagnostic complexity and management challenges. We include a review of the available literature on pediatric R pusillus CNS infections to increase awareness among health care providers.

4-Aminopyridine Promotes BMP2 Expression and Accelerates Tibial Fracture Healing in Mice

BACKGROUND

Delayed bone healing is common in orthopaedic clinical care. Agents that alter cell function to enhance healing would change treatment paradigms. 4-aminopyridine (4-AP) is a U.S. Food and Drug Administration (FDA)-approved drug shown to improve walking in patients with chronic neurological disorders. We recently showed 4-AP's positive effects in the setting of nerve, wound, and even combined multi-tissue limb injury. Here, we directly investigated the effects of 4-AP on bone fracture healing, where differentiation of mesenchymal stem cells into osteoblasts is crucial.

METHODS

All animal experiments conformed to the protocols approved by the Institutional Animal Care and Use Committee at the University of Arizona and Pennsylvania State University. Ten-week-old C57BL/6J male mice (22 to 28 g), following midshaft tibial fracture, were assigned to 4-AP (1.6 mg/kg/day, intraperitoneal [IP]) and saline solution (0.1 mL/mouse/day, IP) treatment groups. Tibiae were harvested on day 21 for micro-computed tomography (CT), 3-point bending tests, and histomorphological analyses. 4-AP's effect on human bone marrow mesenchymal stem cell (hBMSC) and human osteoblast (hOB) cell viability, migration, and proliferation; collagen deposition; matrix mineralization; and bone-forming gene/protein expression analyses was assessed.

RESULTS

4-AP significantly upregulated BMP2 gene and protein expression and gene expression of RUNX2, OSX, BSP, OCN, and OPN in hBMSCs and hOBs. 4-AP significantly enhanced osteoblast migration and proliferation, collagen deposition, and matrix mineralization. Radiographic and micro-CT imaging confirmed 4-AP's benefit versus saline solution treatment in mouse tibial fracture healing (bone mineral density, 687.12 versus 488.29 mg hydroxyapatite/cm 3 [p ≤ 0.0021]; bone volume/tissue volume, 0.87 versus 0.72 [p ≤ 0.05]; trabecular number, 7.50 versus 5.78/mm [p ≤ 0.05]; and trabecular thickness, 0.08 versus 0.06 mm [p ≤ 0.05]). Three-point bending tests demonstrated 4-AP's improvement of tibial fracture biomechanical properties versus saline solution (stiffness, 27.93 versus 14.30 N/mm; p ≤ 0.05). 4-AP also increased endogenous BMP2 expression and matrix components in healing callus.

CONCLUSIONS

4-AP increased the healing rate, biomechanical properties, and endogenous BMP2 expression of tibiae following fracture.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

The impact of suicide prevention training for nursing assistant students: Knowledge and willingness to intervene

Nursing assistants frequently encounter individuals at risk of suicidal behavior in various healthcare settings. This study aims to assess the impact of suicide prevention training materials on nursing assistant students' knowledge of, and willingness to intervene in suicidal behavior. Pre- and post-training assessments were conducted using the Revised Facts on Suicide Quiz and the Willingness to Intervene against Suicide Questionnaire measuring students' knowledge of and willingness to intervene in suicidal behavior. Repeated measures analyses were used to assess changes before and after the use of teaching materials. Students significantly improved overall scores on the Revised Facts on Suicide Quiz (from a pretest mean of 9.55 ± 2.97 to a posttest mean of 13.28 ± 2.51, (p < .001) and the Willingness to Intervene against Suicide Questionnaire (from a pretest mean of 85.63 ± 8.22 to a posttest mean of 92.28 ± 8.93, (p < .001.). Attitudes were not a significant predictor of intention to intervene. These findings underscore the importance of training nursing assistants in suicide prevention as a means of early intervention of suicide behavior. Fostering a proactive attitude and willingness to intervene is crucial for nursing assistants in early identification and intervention in cases of suicidal behavior within healthcare settings. Finally, the results underscore the importance of targeted suicide prevention curricula in social and health-related vocational programs.

Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis

OBJECTIVE

The objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.

METHODS

The reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case-control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle-Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.

RESULTS

Our study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I2 = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36-3.72, I2 = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15-4.24, I2 = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84-11.38, I2 = 96%), male gender (OR 3.56, 95% CI = 1.50-8.42, I2 = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83-3.66, I2 = 0%), COPD (OR 4.72, 95% CI = 3.80-5.86, I2 = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58-4.69, I2 = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29-7.49, I2 = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51-7.06, I2 = 90%), and hypertension (OR 2.21, 95% CI = 1.29-3.79, I2 = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25-1.83, I2 = 90%), advanced age (OR 1.91, 95% CI = 1.42-2.58, I2 = 94%), nutritional status (OR 2.62, 95% CI = 1.55-4.44, I2 = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17-2.21, I2 = 79%).

CONCLUSIONS

This study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.

Comparison between flexible and navigable suction ureteral access sheath and standard ureteral access sheath during flexible ureteroscopy for the management of kidney stone: systematic review and meta-analysis

OBJECTIVES

Flexible ureteroscopy (FURS) is a commonly chosen technique for kidney stone treatment. The use of ureteral access sheaths (UAS) enhances both access and the procedure's effectiveness. This study performs a systematic review and meta-analysis to assess the efficacy and safety of flexible and navigable suction UAS (FANS-UAS) versus standard UAS (S-UAS) in FURS.

METHODS

This systematic review and meta-analysis involved searching databases such as PubMed/Medline, Scopus, Embase, Cochrane, and Web of Science until October 2024. The results were categorized into two groups: FANS-UAS as the intervention and S-UAS as the control. The outcomes measured included stone-free rate (SFR), duration of lithotripsy, length of hospitalization, and incidence of complications.

FINDINGS

Eight studies were incorporated into the analysis. The findings revealed that the SFR on the first day in the intervention group was over twice that of the control group (RR = 2.12, 95% CI: 1.13-3.98, P = 0.019). Furthermore, the SFR during follow-up was 15% greater in the intervention group than in the control group (RR = 1.15, 95% CI: 1.06-1.25, P = 0.0008), with these differences being statistically significant. However, the standardized mean differences for the outcomes of duration of lithotripsy and postoperative hospitalization between the groups were minimal and not statistically significant (P > 0.05). The intervention group had 67% fewer fevers (RR = 0.33, 95% CI: 0.22-0.48, P < 0.001) and 43% fewer cases of sepsis (RR = 0.57, 95% CI: 0.23-1.39, P = 0.215) than the control group.

CONCLUSION

Use of FANS-UAS significantly improves both first-day SFR and follow-up SFR. It is superior to S-UAS in minimizing postoperative complications. Both these factors contribute to significantly improved perioperative outcomes in flexible ureteroscopy.

Red flags for remote cognitive diagnostic assessment: A Delphi expert consensus study by the Canadian Consortium on Neurodegeneration in Aging

Despite the potential benefits of remote cognitive assessment for dementia, it is not appropriate for all clinical encounters. Our aim was to develop guidance on determining a patient's suitability for comprehensive remote cognitive diagnostic assessment for dementia. A multidisciplinary expert workgroup was convened under the auspices of the Canadian Consortium on Neurodegeneration in Aging. We applied the Delphi method to determine 'red flags' for remote cognitive assessment of dementia. This resulted in 14 red flags that met the predetermined consensus criteria. We then developed a novel clinical decision-making infographic that integrated these findings to support multidisciplinary clinicians in determining a patient's readiness to undergo comprehensive remote cognitive assessment.

Renal Arterial Anatomy: Implications for Normothermic Machine Perfusion in Renal Transplantation

Normothermic machine perfusion (NMP) is a novel technology that has shown potential in viability assessment and reconditioning of donor organs. Normothermic machine perfusion is technically more challenging in kidneys with multiple renal arteries (RAs). This study aimed to characterize the anatomical variation in RAs with a view to the development of optimal equipment for RA cannulation in NMP. Magnetic resonance angiograms obtained from all potential living donors at our centre between 2018 and 2022 were evaluated with PACS 3D with vessel analysis. Three independent reviewers measured RA characteristics (number, cross-sectional area, diameter, distance, angulation). A total of 618 kidneys were included for analysis. Kidneys were categorized into five groups based on the anatomical configuration of arteries. 75.4% had a single RA (group one). One quarter of kidneys were found to have multiple RAs, with inferior accessory arteries the commonest variation. Of the 139 kidneys with multiple RAs (24.6%): 5.3% had two equal sized RAs (group two), 5.5% had a superior accessory artery (group three), 11.7% an inferior accessory artery (group four), and 2.1% had three RAs (group five). Left RAs were of larger diameter, but right RAs were longer (p < 0.001). The number of arteries supplying the right kidney significantly predicted the number of arteries supplying the left kidney (β = 0.15). 23.7% of kidneys with two RAs and 30.8% with three RAs had distances between vessels > 28 mm (length of the existing clamp used for perfusion). 19.1% of main RAs had originated from the aorta at angles ≥ 135°. These findings highlight the insufficiencies with existing NMP equipment for cannulation of the RA. A larger clamp may facilitate perfusion of more kidneys with multiple vessels, whilst soft, flexible cannulae are likely to be needed to accommodate the wide range in angulation of RA origin demonstrated.

Comparing Artificial Intelligence-Generated and Clinician-Created Personalized Self-Management Guidance for Patients With Knee Osteoarthritis: Blinded Observational Study

BACKGROUND

Knee osteoarthritis is a prevalent, chronic musculoskeletal disorder that impairs mobility and quality of life. Personalized patient education aims to improve self-management and adherence; yet, its delivery is often limited by time constraints, clinician workload, and the heterogeneity of patient needs. Recent advances in large language models offer potential solutions. GPT-4 (OpenAI), distinguished by its long-context reasoning and adoption in clinical artificial intelligence research, emerged as a leading candidate for personalized health communication. However, its application in generating condition-specific educational guidance remains underexplored, and concerns about misinformation, personalization limits, and ethical oversight remain.

OBJECTIVE

We evaluated GPT-4's ability to generate individualized self-management guidance for patients with knee osteoarthritis in comparison with clinician-created content.

METHODS

This 2-phase, double-blind, observational study used data from 50 patients previously enrolled in a registered randomized trial. In phase 1, 2 orthopedic clinicians each generated personalized education materials for 25 patient profiles using anonymized clinical data, including history, symptoms, and lifestyle. In phase 2, the same datasets were processed by GPT-4 using standardized prompts. All content was anonymized and evaluated by 2 independent, blinded clinical experts using validated scoring systems. Evaluation criteria included efficiency, readability (Flesch-Kincaid, Gunning Fog, Coleman-Liau, and Simple Measure of Gobbledygook), accuracy, personalization, and comprehensiveness and safety. Disagreements between reviewers were resolved through consensus or third-party adjudication.

RESULTS

GPT-4 outperformed clinicians in content generation speed (530.03 vs 37.29 words per min, P<.001). Readability was better on the Flesch-Kincaid (mean 11.56, SD 1.08 vs mean 12.67 SD 0.95), Gunning Fog (mean 12.47, SD 1.36 vs mean 14.56, SD 0.93), and Simple Measure of Gobbledygook (mean 13.33, SD 1.00 vs mean 13.81 SD 0.69) indices (all P<.001), though GPT-4 scored slightly higher on the Coleman-Liau Index (mean 15.90, SD 1.03 vs mean 15.15, SD 0.91). GPT-4 also outperformed clinicians in accuracy (mean 5.31, SD 1.73 vs mean 4.76, SD 1.10; P=.05, personalization (mean 54.32, SD 6.21 vs mean 33.20, SD 5.40; P<.001), comprehensiveness (mean 51.74, SD 6.47 vs mean 35.26, SD 6.66; P<.001), and safety (median 61, IQR 58-66 vs median 50, IQR 47-55.25; P<.001).

CONCLUSIONS

GPT-4 could generate personalized self-management guidance for knee osteoarthritis with greater efficiency, accuracy, personalization, comprehensiveness, and safety than clinician-generated content, as assessed using standardized, guideline-aligned evaluation frameworks. These findings underscore the potential of large language models to support scalable, high-quality patient education in chronic disease management. The observed lexical complexity suggests the need to refine outputs for populations with limited health literacy. As an exploratory, single-center study, these results warrant confirmation in larger, multicenter cohorts with diverse demographic profiles. Future implementation should be guided by ethical and operational safeguards, including data privacy, transparency, and the delineation of clinical responsibility. Hybrid models integrating artificial intelligence-generated content with clinician oversight may offer a pragmatic path forward.

The use of metagenomics to enhance diagnosis of encephalitis

INTRODUCTION

Encephalitis has a broad etiology, including infectious and auto-immune causes. In infectious encephalitis, the breadth of causative organisms results in incomplete testing and low diagnostic yields.Metagenomics sequences all DNA and RNA allowing untargeted detection of all organisms in a single specimen; this is of particular use in diagnosis of encephalitis with a broad etiology.

AREAS COVERED

We review the literature and discuss metagenomics workflows, host depletion and pathogen enrichment methods, bioinformatics analysis and potential analysis of the host transcriptome to aid diagnosis. We discuss the clinical use of metagenomics for diagnosis of neurological infection including time to result, cost, quality assurance, patient cohorts in whom metagenomics adds the most value, recommended specimen types, limitations and review published cases in which metagenomics has been used to diagnose encephalitis.

EXPERT OPINION

There is good evidence for the utility of metagenomics to diagnose infection in encephalitis. Due to infections with rare, unexpected or novel pathogens, metagenomics adds most value to diagnosis in immunocompromised patients and the greatest diagnostic yield is in brain biopsies. Technical advances are needed to reduce the complexity, cost and time to result which will enable wider adoption in clinical laboratories and use as a first-line test.