Integrative analysis of exosomal ncRNAs and their regulatory networks in liver cancer progression

Background

Hepatocellular carcinoma (HCC) is a significant global health challenge with complex molecular underpinnings. Recent advancements in understanding the role of non-coding RNAs (ncRNAs) and exosomes in cancer biology have opened new avenues for research into potential diagnostic and therapeutic strategies.

Methods

This study utilized a comprehensive approach to analyze gene expression patterns and regulatory networks in HCC. We integrated RNA sequencing data gathered from both tissue samples and exosomes. The WGCNA and limma R packages were employed to construct co-expression networks and identify differentially expressed ncRNAs, including long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs).

Results

Our analysis demonstrated distinct expression profiles of various ncRNAs in HCC, revealing their intricate interactions with cancer-related genes. Key findings include the identification of a network of microRNAs that interact with selected lncRNAs and their potential roles as biomarkers. Moreover, exosomal RNA was shown to effectively reflect tissue-specific gene expression changes.

Conclusions

The results of this study highlight the significance of exosomal ncRNAs in the progression of liver cancer, suggesting their potential as both diagnostic biomarkers and therapeutic targets. Future research should focus on the functional implications of these ncRNAs to further elucidate their roles in HCC and explore their applications in clinical settings.

Diagnostic Accuracy of the LiverRisk Score to Detect Increased Liver Stiffness Among a United States General Population and Subgroups

Background

The LiverRisk score (LRS) has recently been proposed to predict liver fibrosis and future development of liver-related outcomes in the general population. Here, we performed an external validation of this score.

Methods

We used data from National Health and Nutrition Examination Survey 2017-2020, a United States population-based cohort to assess the diagnostic accuracy of the LRS to detect a liver stiffness measurement (LSM) ≥8 and ≥12 kPa. Performance was tested among the entire general population and clinically relevant subgroups.

Results

The cohort comprised 7,025 participants (aged 49 [33-63], 49% male), and 9.7% had an LSM ≥8 and 3.2% had an LSM ≥12 kPa. The area under the receiver characteristic operator curve (AUC) in the overall population was 0.73 (95% confidence interval [CI] :0.71-0.75) and 0.78 (95% CI: 0.74-0.81) to detect an LSM ≥8 and ≥ 12 kPa, respectively, significantly outperforming the fibrosis 4 index (FIB-4) but not the nonalcoholic fatty liver disease fibrosis score, steatosis-associated fibrosis estimator (SAFE), or metabolic dysfunction-associated fibrosis 5 (MAF-5). Performance was consistent among most subgroups, but AUC levels to detect an LSM ≥8 kPa decreased to <0.70 among participants aged 18-40 or 60-80 years, blacks, and individuals with diabetes or liver steatosis. The LRS categorized 80.5% as very low risk, 17.7% as low risk, and 1.8% as at risk, prevalence of an LSM ≥8 in these groups was 6.3%, 20.8%, and 50.5%, respectively. The sensitivity to detect an LSM ≥8 kPa was 47.3% in the overall population (but dropped to 21.3% for individuals aged 18-40 years) despite applying the lowest cut-off, which should yield the highest sensitivity.

Conclusion

The LRS score is a promising new tool to predict liver fibrosis; however, its diagnostic accuracy attenuates especially among patients aged 18-40 or 60-80 years. The overall sensitivity was only 47.3% at the lowest LRS cut-off. Further studies assessing cost-benefit ratios according to the LRS compared to FIB-4 and other risk scores such as MAF-5 and SAFE are required to determine its usefulness in referral strategies.

Association of Age-Related Macular Degeneration with Cholelithiasis

Purpose

Dysregulated lipid metabolism likely contributes to the pathogenesis of age-related macular degeneration (AMD). There is an overlap in risk factors between AMD and diseases of lipid metabolism, such as cholelithiasis, suggesting that an association between these diseases could provide insight into AMD pathogenesis. This study sought to determine if there is an association between cholelithiasis and AMD.

Design

A cohort study was conducted using patients in the Optum deidentified Clinformatics Data Mart database from January 1, 2000, to June 30, 2022.

Participants

Patients over the age of 55 with ≥2 years of data and no prior history of AMD were included. The exposed cohort included patients who had a history of cholelithiasis, cholecystitis, or cholecystectomy. The control cohort included patients with gastroesophageal reflux disease (GERD), matched for age ±3 years, sex, race, and year of index date.

Methods

Propensity scores were created using multivariable logistic regression and applied to inverse probability of treatment weighting (IPTW). Cox proportional hazard regression modeling with IPTW was used to compare progression to AMD in each cohort.

Main Outcome Measures

Progression to AMD for patients with cholelithiasis, cholecystitis, or a history of cholecystectomy.

Results

A total of 332 536 patients with cholelithiasis and 776 591 matched GERD controls were analyzed. After IPTW, the mean age (±standard deviation) was 66.6 ± 9.4 years in the cholelithiasis cohort and 67.5 (±10.3) years in the GERD cohort. Women comprised 58% of the cholelithiasis cohort and 57% of the GERD cohort. In the cholelithiasis cohort, 3511.7 (1.14%) were diagnosed with AMD, compared with 23 367.1 (2.92%) in the GERD cohort and corresponding to a significantly decreased hazard of AMD (adjusted hazard ratio [aHR] = 0.72, 95% confidence interval [CI]: 0.69-0.75, P < 0.0001). In the subanalysis, before IPTW weighting, AMD developed in 3809 of 275 897 (1.4%) patients with only cholelithiasis (aHR = 0.76, 95% CI: 0.73-0.80, P < 0.0001), 335 of 47 166 (0.71%) patients with cholecystitis (aHR = 0.54, 95% CI: 0.47-0.61, P < 0.0001), and 114 of 9473 (1.20%) patients who underwent cholecystectomy (aHR = 0.50, 95% CI: 0.41-0.63, P < 0.0001).

Conclusions

Cholelithiasis was associated with a 28% hazard reduction in AMD. More severe gallbladder disease conferred greater protection.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Drug delivery mechanism of isoniazid drug on Tetragonal aluminum nitride by DFT study

The current work employed DFT simulations to investigate both the reactivity and sensitivity of tetragonal aluminum nitride (T-AlN) as a nanocarrier towards isoniazid (INZ). The solvation effect, workfunction, quantum molecular descriptors (e.g., global softness), charge transports, and adhesion behaviour were analyzed to study the interactions between T-AlN and INZ. The adhesion of INZ onto T-AlN was robust. The adhesion energy in the aqueous phase was -21.89 kcal/mol and it was -40.56 in the gaseous phase. Based on the charge transport analyses, there was substantial charge transport throughout the adhesion. Also, there was a reduction of 59.32 % in the bandgap values for T-AlN following INZ attachment. Furthermore, the workfunction values and NBO analyses suggested that T-AlN can function as a promising nanocarrier for INZ. Additionally, the electronic attributes of T-AlN exhibited strong sensitivity towards the INH molecules. So, it is possible to use T-AlN for biosensing purposes and for tracing drugs through spectrophotometric methods in the human body.

Lactate transporter MCT4 regulates the hub genes for lipid metabolism and inflammation to attenuate intracellular lipid accumulation in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) patients have multiple metabolic disturbances, with markedly elevated levels of lactate. Lactate accumulations play pleiotropic roles in disease progression through metabolic rearrangements and epigenetic modifications. Monocarboxylate transporter 4 (MCT4) is highly expressed in hepatocytes and responsible for transporting intracellular lactate out of the cell. To explore whether elevated MCT4 levels played any role in NAFLD development, we overexpressed and silenced MCT4 in hepatocytes and performed a comprehensive in vitro and in vivo analysis. Our results revealed that MCT4 overexpression down-regulated the genes for lipid synthesis while up-regulating the genes involved in lipid catabolism. Conversely, silencing MCT4 expression or inhibiting MCT4 expression led to the accumulation of intracellular lipid and glucose metabolites, resulting in hepatic steatosis. In a mouse model of NAFLD, we found that exogenous MCT4 overexpression significantly reduced lipid metabolism and alleviated hepatocellular steatosis. Mechanistically, MCT4 alleviated hepatic steatosis by regulating a group of hub genes such as Arg2, Olr1, Cd74, Mmp8, Irf7, Spp1, and Apoe, which in turn impacted multiple pathways involved in lipid metabolism and inflammatory response, such as PPAR, HIF-1, TNF, IL-17, PI3K-AKT, Wnt, and JAK-STAT. Collectively, our results strongly suggest that MCT4 may play an important role in regulating lipid metabolism and inflammation and thus serve as a potential therapeutic target for NAFLD.

The role of glutathione S-transferases in human disease pathogenesis and their current inhibitors

Glutathione S-transferases (GSTs) are a family of enzymes detoxifying various harmful compounds by conjugating them with glutathione. While primarily beneficial, dysregulation of GST activity or specific isoforms can contribute to disease pathogenesis. The intricate balance of detoxification processes regulated by GSTs is pivotal in cellular homeostasis, whereby dysregulation in these mechanisms can have profound implications for human health. Certain GSTs neutralize carcinogens, shielding cells and potentially preventing tumorigenesis. Polymorphisms in specific GSTs may result in the accumulation of toxic metabolites, exacerbating oxidative stress, inflammation, and DNA damage, notably observed in neurodegenerative diseases like Parkinson's disease. They can also modulate signaling pathways involved in cell proliferation, survival, and apoptosis, with aberrant activity potentially contributing to uncontrolled cell growth and resistance to cell death, thus promoting cancer development. They may also contribute to autoimmune diseases and chronic inflammatory conditions. This knowledge is useful for designing therapeutic interventions and understanding chemoresistance due to GST polymorphisms. A variety of GST inhibitors have been developed and investigated, with researchers actively working on new inhibitors aimed at preventing off-target effects. By leveraging knowledge of the involvement of specific GST isoforms in disease pathogenesis across different populations, more effective and targeted therapeutics can be designed to enhance patient care and improve treatment outcomes.

Characterization and functional analysis of integrin αV in Sebastes schlegelii: Implications for apoptosis, adhesion, and migration in intestinal cells

Integrins, as essential cell adhesion molecules, consist of an α subunit and a β subunit that interact with extracellular matrix proteins and cell surface ligands to mediate cellular adhesion and signaling. The integrin αV subfamily is widely expressed on the cell surface and plays a critical role in regulating cell growth, apoptosis, and various cellular processes. To explore the function of integrin αV in teleosts, we retrieved the integrin αV (SsITGαV) sequences from the Sebastes schlegelii genome and assessed the tissue expression and response to Edwardsiella tarda stimuli of SsITGαV. We evaluated the effects of SsITGαV in the intestinal cell line on apoptosis, migration, and adhesion using flow cytometry, scratch assays, and cell adhesion experiments by overexpressing and RNA interference methods. The results showed that the coding sequence of SsITGαV comprises 1055 amino acids, containing a signal peptide and a transmembrane domain. SsITGαV is expressed in various tissues, with the highest expression observed in the gill. We investigated the expression pattern of SsITGαV in the head kidney post E. tarda stimulation and observed an increase in its expression. Subcellular localization revealed that SsITGαV predominantly resides in the extracellular matrix. SsITGαV facilitated apoptosis, enhanced cell adhesion, and promoted cell migration in the intestinal cell line. According to the qRT-PCR analysis, alterations in the expression levels of apoptosis-related genes caspase-3, caspase-8, and caspase-10, along with inflammatory factors IL-1 β, IL-6, and IL-8, were positively linked to changes in SsITGαV. These findings provide insights into the function of the integrin αV gene in teleosts, establishing a foundation for further investigation into the role of the integrin α subfamily in lower vertebrates.

Microenvironment responsive nanomedicine for acute pancreatitis treatment

Acute pancreatitis (AP) is an acute inflammation of the pancreas, which is considered a prevalent gastrointestinal emergency characterized by rapid progression and significant mortality. Currently available medications primarily serve as adjunctive therapies, yielding suboptimal therapeutic outcomes. Consequently, there remains a dearth of specific and efficient treatment modalities for AP. In recent years, nanomedicine-based treatment strategies have exhibited significant potential as drug therapy approaches for pancreatitis. The distinctive features of the AP microenvironment encompass aberrant activation of pancreatic enzymes, oxidative stress induced by elevated reactive oxygen species levels, and excessive production of pro-inflammatory cytokines; these factors offer promising targeted sites for early diagnosis and treatment using nanomedicine. This article comprehensively delineates the pathological microenvironmental characteristics associated with AP while highlighting the application of microenvironment-responsive strategies in nanodrug delivery systems for its treatment, thereby providing insights into future prospects.

Utility of Transient Elastography in Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis: A Prospective Observational Study

Background

Differentiating biliary atresia (BA) from non-BA is paramount, as their management and outcome differ. So far, BA is diagnosed by intraoperative cholangiogram (IOC) or liver biopsy. However, literature is sparse on the utility of transient elastography (TE) in neonatal cholestasis. We aimed to study the usefulness and accuracy of TE in differentiating BA from other causes of neonatal cholestasis (NCS).

Methods

A prospective observational study was conducted from June 2021 to February 2024; consecutive cases of NCS were recruited. Patients were grouped as BA and non-BA. All patients underwent clinical, laboratory, and radiological evaluation, along with TE. Receiver operating characteristic curve (ROC) analysis was performed to derive an LSM cutoff for diagnosing BA. The liver stiffness measurement (LSM) was correlated with histopathological fibrosis.

Results

We enrolled 135 patients, BA (n = 68) and non-BA (n = 67). The median LSM was higher in BA, 19.4 (12.9-38.75) kPa vs. 12.0 (8.4-17.9) kPa (P=<0.001). LSM positively correlated with the METAVIR fibrosis score (Spearman's correlation coefficient, r = 0.590, P < 0.001). We derived an LSM cutoff of 13.1 kPa to differentiate BA from non-BA (sensitivity 75%, specificity 61.2%, AUC 0.736). By adding ultrasound (USG) finding of a small gallbladder (<19 mm) to our LSM cutoff (13.1 kPa), the sensitivity improved to 97.0%, but specificity remained low (52.2%).

Conclusion

LSM correlates well with histopathological fibrosis in NCS. An LSM cut off of 13.1 kPa can be used to differentiate BA from non-BA with a sensitivity of 75%. In resource-constraint setting where liver biopsy and IOC may not be available, TE in combination with USG can be a good screening tool for BA (sensitivity 97%).

Development and validation of a machine learning prognostic model based on an epigenomic signature in patients with pancreatic ductal adenocarcinoma

BACKGROUND

In Pancreatic Ductal Adenocarcinoma (PDAC), current prognostic scores are unable to fully capture the biological heterogeneity of the disease. While some approaches investigating the role of multi-omics in PDAC are emerging, the analysis of methylation data is under exploited.

MATERIALS AND METHODS

We analyzed CpG sites from two publicly available datasets, the TCGA-PAAD used as discovery set and the CPTAC-PDA as external test set. Single mutations and co-mutation of KRAS and TP53 genes were identified as targets, and differentially methylated CpG sites (DMC) were detected accordingly. We trained and validated Random Forest (RF) models to predict each target. Area Under the Receiver Operating Characteristic curve (AUROC) and Area Under the Precision-Recall curve (AUPRC) were used as performance metrics. Then, we performed consensus clustering from the DMCs to identify novel patients' profiles. Finally, we trained and validated a combination of eXtreme Gradient Boosting (XGB) and tree models to select an epigenomic prognostic determinant.

RESULTS

From 598 DMCs extracted, an RF model predicted KRAS and TP53 co-mutation on the external test set with AUROC of 0.77 and AUPRC of 0.87. The consensus clustering allowed us to identify 4 clusters (C1, C2, C3, and C4) of patients. The C4 cluster captured a subgroup of patients with favorable Overall Survival (OS) with respect to others. The XGB model perfectly predicted C4 vs other clusters on the discovery set. In both cohorts, patients were stratified into two risk groups according to methylation levels of cg16854533, individuated as the most important CpG site.

CONCLUSION

We analyzed methylation data to develop a classifier for the TP53 and KRAS mutational status. Four prognostic clusters were pointed out and a prognostic model using a CpG site was validated in an independent cohort. Our results evidence that the proposed use of methylation data facilitates risk stratification for PDAC.

ACO/ARO/AIO-22 - External beam radiotherapy combined with endorectal high-dose-rate brachytherapy in elderly and frail patients with rectal cancer: A prospective multicentre trial of the German Rectal Cancer Study Group

Purpose

Rectal cancer disproportionately affects the elderly population, with more than half of cases diagnosed in individuals aged 70 years or older. Frail patients in this group often face significant challenges tolerating the standard treatment of total mesorectal excision (TME), due to elevated risks of surgical complications and perioperative morbidity. Advances in radiotherapy techniques offer a viable alternative, providing effective tumor control while minimizing treatment-related toxicity. Recent clinical trials, including OPERA and MORPEUS, have demonstrated that dose-escalated radiotherapy, which integrates external beam (chemo)radiotherapy (EBRT) with high-dose-rate endorectal brachytherapy (HDR-BT) or contact X-ray brachytherapy (CXB), can achieve high clinical response rates and facilitate organ preservation in younger, healthier patient cohorts. Building on these findings, the ACO/ARO/AIO-22 study seeks to adapt these innovative approaches to meet the needs of elderly and frail patients with rectal cancer.

Methods/Design

The ACO/ARO/AIO-22 trial is a prospective multicentre controlled trial. Elderly (age ≥70 years) and/or frail patients with non-metastatic rectal adenocarcinoma (cT1-3d N0/+ M0, mrCRM - / +) localized 0-16 cm from the ano-cutaneous line, unable to undergo radical surgery can be included. The initial treatment comprises an external beam radiation (EBRT) regime with 13 × 3 Gy (total: 39 Gy) over a period of two and a half weeks. Following initial restaging 6.5 weeks after completion of EBRT, endorectal HDR-BT will be delivered with 3 weekly fractions of 8 Gy to a total dose of 24 Gy (prescribed at the radial margin of the tumor; with a maximum prescription depth of 10 mm); alternatively, with CXB with 90 Gy in 3 weekly fractions. The primary objective is complete or near complete clinical response (cCR or ncCR) and the second primary endpoint is quality of life (QoL) measured with the EORTC QLQ-ELD14, both at 12 months after treatment start.

Discussion

The ACO/ARO/AIO-22 prospective multicentre trial will evaluate organ preservation rates and QoL after combining EBRT with endorectal HDR-BT in elderly and/or frail patients with rectal cancer.Trial Registration:Clinicialtrials.gov number: NCT06729645.

VacA promotes pyroptosis via TNFAIP3/TRAF1 signaling to induce onset of atrophic gastritis

BACKGROUND

Atrophic gastritis (AG) is a chronic inflammation where gastric glandular cells are replaced by intestinal-type epithelium. Gastric epithelial cell loss is often linked to multiple cell death signaling pathways. While Helicobacter pylori (H. pylori) infection is the main cause of AG, its role in inducing cell death goes beyond apoptosis and autophagy. Pyroptosis could promote development of inflammation related cancers, but its involvement in H. pylori-induced malignant transformation remains unclear.

METHODS

The enrichment of pyroptosis signaling across pathological stages was assessed using immunohistochemistry and bioinformatic analysis. Gastric epithelial cells were co-cultured with VacA recombinant protein or VacA+H. pylori to investigate the role of VacA in pyroptosis, and its downstream targets. TNFAIP3 or TRAF1 was silenced/overexpressed in gastric epithelial cells to explore their impact on pyroptosis. Finally, the interaction between TNFAIP3 and TRAF1 was examined using Western Blot, immunofluorescence, co-immunoprecipitation and ubiquitin assays.

RESULTS

Expression of pyroptosis components and pyroptosis enrichment score were upregulated in AG and gastric cancer tissues compared to normal or non-atrophic gastritis tissues. Upon incubation with VacA recombinant protein or VacA+H. pylori, pyroptosis and TNFAIP3/TRAF1 were elevated in gastric epithelial cells. TRAF1 promoted expression of downstream pyroptosis components and release of IL-1β/IL18. TRAF1 ablation could reverse pyroptosis activation caused by VacA. Finally, we proved TNFAIP3 as deubiquitinating enzyme to increase TRAF1 stability, further inducing pyroptosis.

CONCLUSIONS

The VacA/TNFAIP3/TRAF1 signaling cascade facilitates pyroptosis in H. pylori- infected tissue. Overactivation of Pyroptosis caused the atrophy-like morphological changes of gastric epithelium, further inducing sustainable malignant transformation.

Evaluation of Controlled Attenuation Parameter as a Tool for Assessment of Hepatic Steatosis in Living Liver Donors

Background

Currently, there is an absence of a standardised protocol for the preoperative detection of hepatic steatosis (HS) in living liver donors. A steatotic liver graft jeopardises the outcome of the recipient with multiple potential complications. Vibration-controlled transient elastography (Fibroscan®) provides a controlled attenuation parameter (CAP), which we have utilised in our assessment of HS in living liver donors. This approach offers a promising avenue for the advancement of preoperative evaluation protocols.

Methods

In the period spanning from October 2022 to July 2024, a cohort of 67 liver donors were subjected to preoperative vibration-controlled transient elastography (Fibroscan®) and either preoperative or intraoperative liver biopsy. HS was defined as a fat content exceeding 10%. CAP readings were juxtaposed with liver biopsy results for the diagnosis of HS. Donors were categorised into three categories with HS <5%, 5-10% and those with HS >10% were rejected as per our institutional protocol. This facilitated a comprehensive evaluation of HS in the context of living donor liver transplantation.

Results

CAP was very accurate in detecting HS, with an area under the receiver operating characteristic curve of 0.99 (P < 0.05). Statistical analysis determined that a CAP cutoff value of 266 dB/m provides a sensitivity of 100% and a specificity of 98.4% for predicting HS >10%. Corresponding positive predictive value (PPV) is 85.71%, while the negative predictive value is 100%. Univariate analysis determined body mass index (BMI), age and serum triglyceride levels were associated with CAP; however, multivariate linear regression revealed an association with only BMI (P < 0.001) and age (P < 0.002). When a lower fat threshold of 5% was considered to define HS with the same cut off of CAP, the sensitivity reduced to 66.7% and specificity was 98.3% The recipients of donors with HS of 5%-10% did not show any negative outcomes.

Conclusion

CAP demonstrates significant potential as a predictive tool for hepatic steatosis (HS) in living liver donors. Notably, BMI and age have been identified as independent factors associated with CAP values.

The role of ICG NIRL fluorescence imaging in the surgical treatment of digestive system tumors (Review)

Indocyanine green (ICG) is a relatively non‑toxic fluorescent dye with a history of safe use, which has fueled the development of new applications for ICG. Research on the use of ICG near‑infrared light (NIRL) fluorescence imaging during oncologic surgery has increased, revealing its role in tumor identification and localization, lymph node navigational resection and blood perfusion assessment. The purpose of the present review was to provide a comprehensive overview of advances in the clinical application of ICG NIRL fluorescence imaging during gastrointestinal tumor surgery. The present review discusses the techniques, outcomes, limitations and key considerations necessary for clinical practice, aiming to provide a valuable resource for professionals in the field.

Generating research hypotheses to overcome key challenges in the early diagnosis of colorectal cancer - Future application of AI

We intend to explore the capability of ChatGPT 4.0 in generating innovative research hypotheses to address key challenges in the early diagnosis of colorectal cancer (CRC). We asked ChatGPT to generate hypotheses focusing on three main challenges: improving screening accuracy, overcoming technological limitations, and identifying reliable biomarkers. The hypotheses were evaluated for novelty. The experimental plans provided by ChatGPT for selected hypotheses were assessed for completion and feasibility. As a result, ChatGPT generated a total of 65 hypotheses. ChatGPT rated all 65 hypotheses, with 25 hypotheses receiving the highest rating (5) and 40 hypotheses receiving a rating of 4 or lower. The research team evaluated a total of 65 hypotheses, assigning them the following grades: hypotheses were rated as excellent (Grade 5), 16 were deemed suitable (Grade 4), 31 were classified as satisfactory (Grade 3), 12 were identified as needing Improvement (Grade 2), and one was considered poor (Grade 1). Additionally, the study determined that 17 of the generated hypotheses had corresponding publications. Out of the three experimental plans assessed, one was rated excellent (5) for feasibility, while the others received good (4) and moderate (3) ratings. Predicted outcomes and alternative approaches were rated as good, with some areas requiring further improvement. Our data demonstrate that AI has the potential to revolutionize hypothesis generation in medical research, though further validation through experimental and clinical studies is needed. This study suggests that while AI can generate novel hypotheses, human expertise is essential for evaluating their practicality and relevance in scientific research.

Temporal changes in computed tomography findings of a persimmon bezoar: A case report

BACKGROUND

Gastric bezoars are masses of indigestible material that accumulate in the stomach, causing nausea, abdominal pain, and vomiting. Persimmon bezoars (diospyrobezoars), which comprise tannins and fibers from persimmons, are relatively rare but may cause significant gastric complications, including gastric outlet obstruction or ileus. Although computed tomography (CT) is a useful imaging tool, diagnosing bezoars can be challenging because their density is similar to that of food debris and gastric content.

CASE SUMMARY

Here, we report the case of a 72-year-old woman with a persimmon bezoar that was diagnosed using serial CT imaging and confirmed by endoscopy. CT performed over several months revealed changes in the internal structure and density of the bezoar, suggesting progressive hardening. The patient had a history of a partial gastrectomy and excessive persimmon consumption, both of which are risk factors for bezoar formation. Endoscopic fragmentation of the bezoar successfully resolved symptoms.

CONCLUSION

Gastric bezoars, particularly persimmon bezoars, present diagnostic challenges because of their variable imaging characteristics. Serial CT can document temporal changes in bezoar density, potentially reflecting changes in hardness. Early diagnosis and endoscopic treatment are essential for effective management, particularly in patients with predisposing factors. This case underscores the importance of considering bezoars in the differential diagnosis of gastric masses, and highlights the value of CT for monitoring changes in bezoar characteristics over time.

Refractory Crohn's disease complicated with Guillain-Barré syndrome: A case report

BACKGROUND

Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory gastrointestinal disorders, including Crohn's disease (CD) and ulcerative colitis, with uncertain etiologies. The natural course of IBD can be accompanied by extraintestinal manifestations involving the skin, mucous membranes, musculoskeletal structures, eyes, cardiovascular system and nervous system. Guillain-Barré syndrome (GBS) is a type of peripheral neuropathy. However, the etiology and pathogenesis of IBD combined with GBS are unclear, and only a few clinical cases have been reported. Here, we report a case of refractory CD complicated by GBS and review the previous literature to improve the understanding of these diseases.

CASE SUMMARY

A 34-year-old man had a 9-year history of refractory CD. He became unresponsive to multiple drugs and experienced recurrent intestinal fistulas. After several abdominal surgeries and treatment with ustekinumab, he achieved clinical remission. Unfortunately, he developed GBS during maintenance treatment with ustekinumab. According to previous reports, in some patients with IBD combined with GBS, GBS may be a comorbidity, an extraintestinal manifestation of IBD, or an adverse reaction to IBD therapeutic drugs. After a comprehensive evaluation, we suspected that GBS might have been a comorbidity in this patient. To avoid fatal disease relapse after medication discontinuation, we concluded that ustekinumab should not be withdrawn. On the basis of a joint decision between doctors and the patient, we decided to continue maintenance treatment with ustekinumab along with intravenous immunoglobulin, dexamethasone and traditional Chinese medicine acupuncture, which resulted in a steady improvement in his GBS symptoms and sustained remission of CD.

CONCLUSION

When IBD is complicated by a neurological disease, it is first necessary to analyze the patient's condition and then choose the corresponding treatment strategy. If the neurological disease is a specific comorbidity, treatment of both IBD and the comorbid disease should be considered. For IBD patients with extraintestinal manifestations involving the nervous system, neurological manifestations tend to resolve when the active IBD is controlled. When an adverse drug reaction is suspected, the medication should be discontinued, and symptomatic treatment should be administered.

Rectal abscess secondary to foreign body insertion: A case report

BACKGROUND

Rectal foreign bodies, though uncommon, present diagnostic and therapeutic challenges, particularly when they result from accidental ingestion. The nonspecific symptoms and the potential for serious complications necessitate a thorough and methodical approach to diagnosis and treatment. This case report aims to highlight the diagnostic complexities and management strategies involved in treating a patient with a rectal foreign body, focusing on the use of advanced imaging techniques and the importance of a multidisciplinary approach.

CASE SUMMARY

A 48-year-old male with a history of hypertension presented with a one-year history of post-defecation anorectal pain and mild post-defecation rectorrhagia. Initial evaluation revealed hemodynamic stability and a tender, non-mucosal lesion in the anterior left rectal region. Imaging studies, including colonoscopy, magnetic resonance imaging, and endosonography, identified an erythematous, exophytic lesion and a perirectal abscess containing a foreign body. Surgical intervention revealed necrotic tissue and purulent material, along with two solid foreign body fragments (bone or plant matter). Postoperative follow-up showed the patient in good condition, and pathology confirmed the fragments as mature bone.

CONCLUSION

This case underscores the diagnostic challenges posed by rectal foreign bodies with nonspecific symptoms and no clear history of ingestion.

Use of OviTex 1S, reinforced tissue matrix, for the repair of post renal transplant incisional hernias: Four case reports

BACKGROUND

Incisional hernia is one of the known complications of renal transplant surgery, with a reported incidence between 1.1% to 3.8%. Depending on the site and extent of incisional hernia, it may require surgery particularly if it contains the transplanted kidney either partially or completely. The current common clinical practice is to repair incisional hernias using polypropylene meshes, which have their own risks and benefits. Biological meshes, which are made from human or animal-derived connective tissue, are also in use and have a less inflammatory response. Recently, hybrid meshes have been developed. These are composed of both biological and synthetic products. One such example is OviTex 1S permanent, which is a sterile reinforced tissue matrix composed of ovine (sheep) derived extracellular matrix and monofilament polypropylene. In this case report, we are sharing our experience with the use of OviTex 1S in the repair of post-renal transplant incisional hernias.

CASE SUMMARY

We report four cases of post-renal transplant incisional hernia with a median time of 27 months post-surgery. The median size of the defect was 15 cm long. There was no post-operative complication. One patient required renal transplant biopsy after mesh repair, which was easily performed compared with polypropylene meshes repaired hernias in the past.

CONCLUSION

The OviTex 1S mesh provides benefits in hernial repairs pKTx, but cost is an issue, and their long-term viability is unclear. Continued use and reporting will help build a more informed picture.

Echinococcus granulosus in atypical localizations: Five case reports

BACKGROUND

Hydatid cyst disease, caused by Echinococcus granulosus, primarily affects the liver and lungs, but it can also develop in rare locations such as the kidneys, thyroid, subcutaneous tissues, bones, and the mediastinum. These atypical presentations often pose diagnostic challenges, as they can mimic benign and malignant pathologies, leading to potential misdiagnoses and inappropriate treatments. Early and accurate detection of hydatid cysts in uncommon sites is crucial for optimal patient management.

CASE SUMMARY

This case report series presents five patients with hydatid cysts located in atypical anatomical regions: The kidney, lumbar subcutaneous tissue, gluteal soft tissue, posterior mediastinum, and thyroid gland. The patients exhibited diverse clinical symptoms, including hematuria, palpable masses, localized pain, and chronic cough. Diagnosis was confirmed through a combination of imaging techniques-ultrasound, computed tomography, and magnetic resonance imaging-along with serological testing. All cases were managed with antiparasitic therapy (albendazole), and in selected cases, surgical excision was performed to prevent complications such as cyst rupture or secondary infections. Post-treatment follow-up demonstrated complete resolution or stable cystic lesions, with no signs of recurrence.

CONCLUSION

Recognizing hydatid cysts in atypical locations is essential to avoid misdiagnosis and ensure appropriate treatment strategies. Radiological imaging plays a key role in distinguishing hydatid cysts from other cystic and neoplastic conditions, while serological tests can aid in confirmation, particularly in endemic regions. A multidisciplinary approach, integrating radiology, clinical evaluation, and surgical expertise, is critical for effective diagnosis and management. This report highlights the need for increased awareness of extrapulmonary and extravisceral hydatid disease, emphasizing its significance in differential diagnosis and clinical practice.

Hepatitis B virus genotype distribution and mutation patterns: Insights and clinical implications for hepatitis B virus positive patients

Hepatitis B virus (HBV) infection is still a major worldwide health concern, contributing to chronic liver disorders like hepatocellular carcinoma (HCC). This review comprehensively analyzes HBV genotype distribution, mutation patterns, and their clinical implications, focusing on diagnostic and therapeutic strategies for HBV-positive patients. The discussion begins with HBV virology, emphasizing its capacity for chronic hepatitis and its association with severe liver complications, notably HCC. Understanding HBV genotypes (A-J) and their distinct geographic distributions is crucial, as genotype variations influence disease progression and treatment responses. Genotypes like C are particularly linked to heightened HCC risk, highlighting the need for genotype-specific management strategies. The genomic structure of HBV, consisting of four open reading frames (ORFs) encoding essential viral proteins, is detailed, with emphasis on mutations within these ORFs influenced by host immune responses and antiviral therapies. These mutations contribute to viral resistance and virulence, impacting treatment outcomes through alterations in viral replication dynamics. Clinical implications are explored through genotype-specific impacts on disease outcomes and treatment approaches. Genotype and mutation analysis guide personalized treatment regimens, optimizing therapeutic efficacy while minimizing adverse effects and preventing drug resistance. Diagnostic molecular techniques such as polymerase chain reaction and sequencing are pivotal in genotype and mutation detection, facilitating tailored treatment decisions.

Effects of the regenerating gene family on DSS-induced ulcerative colitis in a mouse model

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by immune dysregulation and defective mucosal healing, predominantly affecting the colonic and rectal mucosa with diffuse inflammation and ulceration. Its pathogenesis involves genetic susceptibility, immune dysfunction, and environmental triggers. The regenerating gene (Reg) family, identified over four decades ago, is upregulated in IBD and has been implicated in anti-inflammatory responses, tissue regeneration, and mucosal barrier maintenance. Among these, Reg1 and Reg3 have been proposed as potential therapeutic targets due to their roles in promoting intestinal epithelial repair in both human and mice. In this study, we investigated the role of Reg1-3(Reg1, Reg2, Reg3a, Reg3b, Reg3d, Reg3g) genes using a dextran sulfate sodium (DSS)-induced UC mouse model. C57BL/6J wild-type (WT) and Reg1-3(Reg1, Reg2, Reg3a, Reg3b, Reg3d, Reg3g) knockout (Reg-/-) mice (6-11 weeks old; n=3-8 per group) were treated with 2 % DSS in drinking water for 5 days. Body weight, histological changes, gene expression (qRT-PCR), and protein levels (Western blotting, immunohistochemistry) were evaluated at day 7, day 14, and day 28. No significant differences were observed in inflammation, tissue damage, or repair between Reg-/- and WT mice, suggesting that Reg1-3 genes may not be essential in this model or that compensatory mechanisms might mitigate their loss. These findings highlight the need for further investigation into the functional redundancy and context-dependent roles of Reg genes in UC.

Mogroside V prevents ethanol-induced hangover and liver damage by reducing oxidative stress, steatosis and inflammation

Excessive alcohol consumption is a leading cause of alcohol-associated liver disease (ALD). Previous studies presented Mogroside V (MV) have protective effects on against nonalcoholic fatty liver disease. however, the effects of MV on ethanol-induced hangover and liver damage remains to be elucidated. Herein, we investigated the potential effects of MV in relieving hangover and mitigating liver injury induced by ethanol. MV significantly reduced blood ethanol, liver histological alterations and serum ALT, AST、TG levels in ethanol-treated mice. Moreover, MV accelerates alcohol metabolism by inhibiting the upregulation of CYP2E1 induced by ethanol, while enhancing the activity of ADH and ALDH, as well as upregulating the expression of ADH1 and ALDH2. MV mitigates oxidative stress by decreased hepatic malondialdehyde (MDA) levels, restored glutathione (GSH)、superoxide dismutase (SOD) and catalase (CAT) content in ethanol-induced mice. Mechanistically, MV activated the p-AMPK/SREBP-1/FASN pathway to decreased hepatic lipid accumulation and alleviated steatosis. Additionally, MV promoted nuclear translocation of Nrf-2 to attenuates oxidative stress and suppressed TLR4/MyD88/NF-κB signaling pathway to reduce Inflammatory responses triggered by ethanol in mice. In summary, this study highlights mogroside V's hangover relieving effect and its protective effects against ethanol-related liver damage through its lipid metabolism regulation, antioxidative action and anti-inflammatory properties. These results suggest that mogroside V could be developed as a potential therapeutic agent against ethanol-induced liver damage.

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.

Establishment and characterization of a new human gallbladder cancer cell line, OCUG-2

BACKGROUND

Gallbladder cancer (GBC) is a highly aggressive malignant tumor originating from the biliary tract. As one of the most common malignancies in the biliary system, GBC is particularly challenging due to its tendency to remain asymptomatic, which often results in delayed diagnoses even at advanced stages. Combined with its invasive potential and poor response to conventional therapies, GBC has a high mortality rate, highlighting the critical need for innovative therapeutic approaches. Identifying molecular biomarkers for early detection and discovering novel therapeutic targets might be essential to improving outcomes of patients with GBC.

AIM

To establish a novel GBC cell line to investigate the molecular mechanisms underlying GBC progression and evaluate potential therapeutic targets.

METHODS

We developed a unique GBC cell line, named OCUG-2, derived from a metastatic peritoneal implant, and verified its authenticity using short tandem repeat (STR) profiling. RT-PCR and RNA sequencing (RNA-seq) were performed to assess gene expression profiles, with functional enrichment analyzed through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The MTT cell proliferation assay and an invasion assay were performed to evaluate response to nine inhibitors. Immunohistochemistry (IHC) was conducted on 34 GBC samples to analyze insulin-like growth factor 1 receptor (IGF1R) expression.

RESULTS

OCUG-2 cells displayed adhesive growth with dendritic morphology and a 30-hour doubling time. Subcutaneous inoculation of OCUG-2 cells into mice confirmed their tumorigenic potential. STR analysis authenticated the cell line, and there was high mRNA and protein expression of IGF1R in OCUG-2 cells. The IGF1R inhibitor picropodophyllotoxin significantly inhibited OCUG-2 cell proliferation, yielding an IC₅₀ of 0.49 μM. RNA-seq analysis identified gene fusions, and GO/KEGG functional enrichment analyses revealed pathways implicated in cancer progression. IHC analysis showed IGF1R positivity in 18 of 34 GBC cases, with significant association between IGF1R expression and poor prognosis. In invasion assays, an IGF1R inhibitor effectively reduced OCUG-2 cell invasiveness.

CONCLUSION

IGF1R might be a promising target for GBC. The newly established OCUG-2 cell line serves as a valuable model for investigating the molecular mechanisms of GBC and evaluating therapeutic strategies.

Unraveling the nutritional challenges in epilepsy: Risks, deficiencies, and management strategies: A systematic review

BACKGROUND

Malnutrition and epilepsy share a complex bidirectional relationship, with malnutrition serving as a potential risk factor for epilepsy development, while epilepsy, in turn, often exerts profound effects on nutritional status. Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.

AIM

To explore the multifaceted associations between malnutrition and epilepsy, structured into three primary sections: (1) Elucidating the impact of malnutrition as a risk factor for epilepsy onset; (2) Examining the reciprocal influence of epilepsy on nutritional status, and (3) Evaluating diverse nutritional interventions in the management of epilepsy.

METHODS

A systematic search was conducted across PubMed, Scopus, and Web of Science databases utilizing defined keywords related to malnutrition, epilepsy, and nutritional interventions. Inclusion criteria encompassed various study types, including clinical trials, animal models, cohort studies, case reports, meta-analyses, systematic reviews, guidelines, editorials, and review articles. Four hundred sixteen pertinent references were identified, with 198 review articles, 153 research studies, 21 case reports, 24 meta-analyses, 14 systematic reviews, 4 guidelines, and 2 editorials meeting the predefined criteria.

RESULTS

The review revealed the intricate interplay between malnutrition and epilepsy, highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies. Findings underscored the importance of nutritional interventions in managing epilepsy, showing their impact on seizure frequency, neuronal function, and overall brain health.

CONCLUSION

This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment. The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.

Vestigial-like family member 1 (VGLL1): An emerging candidate in tumor progression

Vestigial-like family member 1 (VGLL1), a product of an X-linked gene (VGLL1), belongs to a family of transcriptional co-activators including VGLL2, VGLL3 and VGLL4. These proteins are called vestigial-like because of the structural and functional similarities with the Drosophila ortholog vestigial (vg). VGLL1 is usually expressed in human placenta, and has also been detected in many aggressive cancers. For this reason, it is called an onco-placental protein. It can bind and activate the TEA-domain containing transcription factors TEAD1-4, and the interaction is mediated through a conserved 'valine-x-x-histidine-phenylalanine' domain (VxxHF, x denotes any amino acid) present in VGLL1 protein. Prior studies indicate a pro-tumorigenic role for this protein in several cancers including carcinoma of the breast. This review aims at summarizing our present knowledge about the functions of VGLL1, and the mechanisms that regulate its expression in cancer.

Gut virome: New key players in the pathogenesis of inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic inflammatory illness of the intestine. While the mechanism underlying the pathogenesis of IBD is not fully understood, it is believed that a complex combination of host immunological response, environmental exposure, particularly the gut microbiota, and genetic susceptibility represents the major determinants. The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans. The gut virome varies greatly among individuals and is influenced by factors including lifestyle, diet, health and disease conditions, geography, and urbanization. The majority of research has focused on the significance of gut bacteria in the progression of IBD, although viral populations represent an important component of the microbiome. We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.

Integrative review of the gut microbiome’s role in pain management for orthopaedic conditions

The gut microbiome, a complex ecosystem of microorganisms, has a significant role in modulating pain, particularly within orthopaedic conditions. Its impact on immune and neurological functions is underscored by the gut-brain axis, which influences inflammation, pain perception, and systemic immune responses. This integrative review examines current research on how gut dysbiosis is associated with various pain pathways, notably nociceptive and neuroinflammatory mechanisms linked to central sensitization. We highlight advancements in meta-omics technologies, such as metagenomics and metaproteomics, which deepen our understanding of microbiome-host interactions and their implications in pain. Recent studies emphasize that gut-derived short-chain fatty acids and microbial metabolites play roles in modulating neuroinflammation and nociception, contributing to pain management. Probiotics, prebiotics, synbiotics, and faecal microbiome transplants are explored as potential therapeutic strategies to alleviate pain through gut microbiome modulation, offering an adjunct or alternative to opioids. However, variability in individual microbiomes poses challenges to standardizing these treatments, necessitating further rigorous clinical trials. A multidisciplinary approach combining microbiology, immunology, neurology, and orthopaedics is essential to develop innovative, personalized pain management strategies rooted in gut health, with potential to transform orthopaedic pain care.

Significance of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio as prognostic predictors after liver transplantation

BACKGROUND

The use of biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-platelet ratio (NPR), has shown promise in evaluating early outcomes after medical, interventional, and surgical treatments. NLR has emerged as an indicator of systemic inflammation and physiological stress. NPR has emerged as a potential indicator of inflammation and thrombotic risk in the context of surgical and radiological procedures.

AIM

To analyze the correlation of NLR and NPR with the development of post-liver transplantation (LT) early complications after stratification for hepatocellular carcinoma diagnosis.

METHODS

Consecutive patients undergone LT between January 2019 and December 2023 were enrolled. Data regarding the concentration of hemoglobin and the differential leukocyte count on postoperative days (POD) 0, 1, 3, and 5 were collected.

RESULTS

The dataset included 161 consecutive patients undergone LT. Clavien-Dindo IV-V complications had a good correlation with NLR POD 1 (P = 0.05), NLR POD 3 (P < 0.001), NLR POD 7 (P < 0.001), NPR POD 3 (P < 0.001). In addition, the NPR ratio on POD 3 correlated with the onset of 30-day hemorrhage (P = 0.009). Finally, 30-day mortality had a significant association with the NLR POD 1 (P = 0.03) and with NLR POD 7 (P = 0.004), while NPR had a significant correlation with 30-day mortality in NPR POD 7 (P = 0.004).

CONCLUSION

The analysis of NLR and NPR are strictly correlated with Clavien-Dindo IV-V complications and 30-day post-LT death.

Shared neoantigens for cancer immunotherapy

Exploration of neoantigens holds the potential to be productive in immuno-oncotherapy. Among tumor-specific antigens, neoantigens result from genetic instability that gives rise to non-synonymous somatic mutations, highly specific to tumor cells. In addition to point mutations, gene rearrangements, indels leading to frameshifts, chromosomal translocations or inversions that may lead to fusion proteins, alternative mRNA splicing, and integration of genetic material of oncogenic viruses into the host genome provide consistent sources of neoantigens that are absent in healthy tissues. Out of these alterations, 2%-3% may generate T cell neoepitopes, possibly detectable by TCRs. Neoantigens are absent in healthy tissues and are thus at low risk of triggering autoimmunity. In addition, the host lymphocytes have not been rendered tolerant toward them and it is possible to induce immune responses against them. Here, we overview the two categories of neoantigens, i.e., private and shared, and their use in immuno-oncotherapy in selected pre-clinical and clinical studies. The vast majority of commonly occurring tumor-specific mutations are cancer causing and are permanently expressed by all malignant tumor cells, preventing the latter from escaping vaccine-induced anti-neoantigen immunity. The use of public neoantigens combined with efficient vaccine platforms can provide non-personalized "off-the-shelf" therapeutic vaccine candidates for broad-spectrum immunotherapy purposes.

Immunotherapy and liver transplantation for hepatocellular carcinoma: Current and future challenges

Despite existing curative options like surgical removal, tissue destruction techniques, and liver transplantation for early-stage hepatocellular carcinoma (HCC), the rising incidence and mortality rates of this global health burden necessitate continuous exploration of novel therapeutic strategies. This review critically assesses the dynamic treatment panorama for HCC, focusing specifically on the burgeoning role of immunotherapy in two key contexts: early-stage HCC and downstaging advanced HCC to facilitate liver transplant candidacy. It delves into the unique immunobiology of the liver and HCC, highlighting tumor-mediated immune evasion mechanisms. Analyzing the diverse immunotherapeutic approaches including checkpoint inhibitors, cytokine modulators, vaccines, oncolytic viruses, antigen-targeting antibodies, and adoptive cell therapy, this review acknowledges the limitations of current diagnostic markers alpha-fetoprotein and glypican-3 and emphasizes the need for novel biomarkers for patient selection and treatment monitoring. Exploring the rationale for neoadjuvant and adjuvant immunotherapy in early-stage HCC, current research is actively exploring the safety and effectiveness of diverse immunotherapeutic approaches through ongoing clinical trials. The review further explores the potential benefits and challenges of combining immunotherapy and liver transplant, highlighting the need for careful patient selection, meticulous monitoring, and novel strategies to mitigate post-transplant complications. Finally, this review delves into the latest findings from the clinical research landscape and future directions in HCC management, paving the way for optimizing treatment strategies and improving long-term survival rates for patients with this challenging malignancy.

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.

Ten years of a pediatric living donor liver transplantation program in Brazil

BACKGROUND

Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease. Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.

AIM

To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.

METHODS

We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023. Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.

RESULTS

A total of 25 and 48 patients underwent transplantation in the first (2013-2017) and second period (2018-2023), respectively. Portal vein and hepatic artery thrombosis occurred in 11 (15.1%) and seven (9.6%) patients, respectively. Biliary complications were observed in 39 of 73 patients (53.4%). A lower warm ischemia time was observed in the second period compared to the first (32.6 ± 8.6 minutes vs 38.4 ± 9.8 minutes, P = 0.018, respectively). Patient survival rates at 1 and 5 years were 84% in the first period and 91.7% in the second period, with no significant difference (P = 0.32).

CONCLUSION

The reported indications and outcomes align with the current literature. Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.

Prevalence and risk of progression of pancreatic cystic lesions in immunosuppressed patients: A systematic review and meta-analysis

BACKGROUND

Pancreatic cystic lesions are common in patients eligible for solid organ transplantation. It has been shown that the need for immunosuppression after organ transplantation increases the rate of malignancies in organ recipients. However, the impact of immunosuppression on pancreatic cystic lesions is yet unknown.

AIM

To evaluate the prevalence of pancreatic cystic lesions and the risk of cyst progression in immunosuppressed patients.

METHODS

A systematic literature search was performed in relevant databases. Studies reporting either on the prevalence and/or the incidence of pancreatic cyst progression compared to a control group were implemented in the first systematic review and meta-analysis on this topic.

RESULTS

The prevalence of pancreatic cystic lesions was comparable with 7% (95%CI: 5%-11%) in the immunosuppressed cohort and 9% (95%CI: 5%-16%) in the control cohort. The mean cyst size increase in the immunosuppression group was 3.2 mm (range 1.0-5.2mm) compared to 3.5 mm (1.0-6.9) in the control group (standardized mean difference 0.0 mm, 95%CI: -0.3-0.2 mm, P = 0.72). There was also no significant increase in the development of resection criteria or worrisome features under immunosuppression either [relative risk 1.1 (fixed effect model), 1.2 (random effects model), P = 0.61].

CONCLUSION

Immunosuppression does not increase the prevalence of pancreatic cystic lesions, nor does it increase the risk of cyst progression in terms of cyst size and development of resection criteria. Therefore, pancreatic cystic lesions in transplant candidates should not be a contraindication for solid organ transplantation.

Burden, stress and depression in caregivers of cirrhosis patients before and after liver transplantation

BACKGROUND

Family caregivers of cirrhosis patients (CPs) often experience burden, stress, and depression. Investigating whether these conditions improve following the patient undergoing liver transplantation (LT) is crucial, as it would elucidate the comprehensive benefits of the procedure and demonstrate the positive impacts not only on the patients but also on their caregivers and society.

AIM

To compare the levels of burden, stress and depression among family caregivers of cirrhotic and liver transplant patients.

METHODS

This cross-sectional observational study evaluated caregivers of CPs and LT recipients at a quaternary Brazilian hospital. Instruments included identification cards, interview scripts, the caregiver burden scale Inventory, Lipp’s Stress Symptom Inventory, and the Beck Depression Inventory-Second Edition. Psychometric analyses involved confirmatory factor analysis and calculation of McDonald’s omega and composite reliability. Factor scores were compared with the Mann-Whitney U test, with effect size as the rank-biserial correlation coefficient (r). Statistical analysis was performed with R software (P < 0.05).

RESULTS

Seventy-seven CP caregivers and 65 LT recipient caregivers were included. Most were female (CP: 85.7% vs LT: 84.6%) and the patients’ spouses (76.6% vs 63.1%). The median age and caregiving duration were 55.4 (23.3-76.3) vs 54.6 (25.7-82.1) and 3.9 (1-20) vs 8 (1.5-24) years, respectively (P = 0.001). LT caregivers were less likely to be at risk of overload (21.5% vs 49.4%), to be under stress (33.8% vs 36.4%) and to show symptoms of depression (15.4% vs 35.1%). Compared with LT caregivers, CP caregivers had greater median factor scores for burden (general tension, P = 0.012; isolation, P = 0.014; disappointment, P = 0.004), depression (P = 0.008), and stress (P = 0.047), with small to moderate effect sizes. The disappointment (r = 0.240) and depression (r = 0.225) dimensions had the largest effect sizes.

CONCLUSION

Family caregivers of LT recipients are less likely to exhibit symptoms of burden, stress, and depression, suggesting that the benefits of LT extend to the patients’ family members.

Causal relationship between gut microbiota, lipids, and neuropsychiatric disorders: A Mendelian randomization mediation study

BACKGROUND

Numerous studies have shown an interconnection between the gut microbiota and the brain via the "gut-brain" axis. However, the causal relationships between gut microbiota, lipids, and neuropsychiatric disorders remain unclear. This study aimed to analyze potential associations among gut microbiota, lipids, and neuropsychiatric disorders-including AD, PD, ALS, MS, SCZ, MDD, and BD-using summary data from large-scale GWAS.

METHODS

Bidirectional Mendelian randomization (MR) with inverse variance weighting (IVW) was the primary method. Supplementary analyses included sensitivity analyses, Steiger tests, and Bayesian weighted MR (BWMR). Mediation analyses used two-step MR (TSMR) and multivariable MR (MVMR).

RESULTS

The analyses revealed 51 positive correlations (risk factors) (β > 0, P < 0.05) and 47 negative correlations (protective factors) (β < 0, P < 0.05) between gut microbiota and neuropsychiatric disorders. In addition, 35 positive correlations (β > 0, P < 0.05) and 22 negative correlations (β < 0, P < 0.05) between lipids and neuropsychiatric disorders were observed. Assessment of reverse causality with the seven neuropsychiatric disorders as exposures and the identified gut microbiota and lipids as outcomes revealed no evidence of reverse causality (P > 0.05). Mediation analysis indicated that the effect of the species Bacteroides plebeius on MDD is partially mediated through the regulation of phosphatidylcholine (16:0_20:4) levels (mediation proportion = 10.9 % [95 % CI = 0.0110-0.2073]).

CONCLUSION

This study provides evidence of a causal relationship between gut microbiota and neuropsychiatric disorders, suggesting lipids as mediators. These findings offer new insights into the mechanisms by which gut microbiota may influence neuropsychiatric disorders.

Stage-specific characterization of "early-onset colorectal cancer": Localized and synchronous metastatic disease

Early-onset colorectal cancer (EOCRC) is an alarming entity worldwide. Yet, stage-specific characteristics and prognosis in localized and synchronous metastatic EOCRC are not well-defined. Two cohorts of CRC patients (localized and synchronous metastatic) were evaluated, defining EOCRC as the diagnosis <50 years old. Five hundred sixty-eight patients were included (n = 432 localized, 14.4% [n = 62] EOCRC and n = 136 synchronous metastatic, 20.6% [n = 28] EOCRC). 93.5% of localized and 96.5% of synchronous metastatic EOCRC patients were symptomatic at diagnosis. Among localized patients, female gender (58.1% vs. 40%, p = .008), perineural invasion (41.9% vs. 24.9%, p = .005), folinic acid, 5-fluorouracil, and oxaliplatin chemotherapy (45.2% vs. 25.2%, p = .003), and perioperative chemotherapy cycles (9.21 [± 3.10] vs. 7.98 [± 2.92], p = .006) were higher in EOCRC compared with ≥50-year. Median recurrence-free survival (RFS) and overall survival were not reached in either group (p = .234 and p = .831). Only RAS mutant status was associated with RFS (Hazard ratio: 7.09 [95% confidence interval (CI): 1.87-26.76], p < .001) in EOCRC. Among synchronous metastatic patients, urgent surgery (32.1% vs. 11.1%, p = .014) and local treatments (39.3% vs. 20.4%, p = .037) were more frequent in EOCRC. Median progression-free survival and overall survival in the EOCRC and ≥50 years were 8.07 months (95% CI: 5.03-12.97) vs. 10.03 months (95% CI, 8.40-13.10) (p = .450) and 18.57 months (95% CI, 13.33-43.03) vs. 19.83 months (95% CI, 16.07-27.30) (p = .833), respectively. Synchronous metastatic EOCRC more frequently underwent urgent surgery (32.1% vs. 8%, p = .008) and had RAS mutation (43.5% vs. 16.7%, p = .032) than localized EOCRC. This study suggests that localized and synchronous metastatic EOCRC patients may have different characteristics than average onset, without survival differences. Implementation of stage-specific characteristics into daily practice is necessary for decision-making processes in these young patients.

Acid reflux medication use among adults with depressive symptoms

Emotional stress, including depression, may contribute to increased gastroesophageal reflux disease symptoms. In this paper, we aim to evaluate the associations between depressive symptoms, depressive symptom severity, and symptom clusters with acid reflux medication use, considering the potential interaction effect of sex. Data from the 2007-2018 National Health and Nutrition Examination Survey were used. Participants aged 18 years or older were included if they responded to the depressive symptoms and prescription medication questionnaires. This study included 31,444 participants, of whom 2871 had depressive symptoms. Participants with depressive symptoms had significantly higher odds of using antacids (aOR = 1.735; p < 0.001), histamine-2 receptor antagonists (H2RAs) (aOR = 1.653; p < 0.001), and proton pump inhibitors (PPIs) (aOR = 1.723; p < 0.001). A positive association was also found between depressive symptom severity and the use of antacids (aOR = 1.054; p < 0.001), H2RAs (aOR = 1.048; p < 0.001), and PPIs (aOR = 1.053; p < 0.001). Moreover, increases in cognitive-affective and somatic scores were associated with higher odds of using antacids (aOR = 1.080 for cognitive, 1.102 for somatic; p < 0.001), H2RAs (aOR = 1.078 for cognitive, 1.083 for somatic; p < 0.001), and PPIs (aOR = 1.075 for cognitive, 1.105 for somatic; p < 0.001). No significant sex interaction effects were observed. Adjusted models demonstrated no significant associations between depressive symptoms and the duration of medication use. This study provides evidence of an association between depressive symptoms and acid reflux medication use, highlighting the need to screen for related symptoms in patients with depressive symptoms.

Unveiling the potential of xanthines, discovery of potential 7-benzyl-1,3-dimethyl-3,7-dihydro-1H-purine-2,6-dione derivatives with antifibrotic activity for liver injury

A new series of xanthine-based derivatives were designed, synthesized, and investigated to achieve promising antifibrotic and antioxidant agents for management of liver injury. Structure-based optimizations of the methylxanthine-based KMUP-1 (IX) were performed for inhibiting NF-κB activation pathway. All the newly designed xanthine derivatives 3, 4, 5, 6a-d, 7a-d, and 9a-d were in vitro screened for the antioxidant activity using the DPPH method. Compounds 4 and 5 showed the highest antioxidant activity with an IC50 of 28.02 and 36.02 μM, respectively. Compounds 9c and 9d retained a promising interception of the NF-κB activation pathway in molecular docking simulations within I-κB kinase α (IKKα) crystal structure (PDB ID: 5EBZ). Subsequently, compounds 9c and 9d were evaluated for their in vivo antifibrotic and chemoprotective activity using CCl4-induced hepatic fibrosis rat model. Compounds 9c and 9d successfully ameliorated liver fibrosis, as evidenced by the improved liver histopathological examination and liver enzyme activity levels. Compounds 9c and 9d were evaluated for their effects on mRNA expression levels of key genes involved in liver fibrosis via real-time PCR assays. Compound 9c exhibited a greater inhibitory effect on the expression levels of NF-κB and HIF-1α and a more pronounced stimulation of Nrf2 than compound 9d. Moreover, all the new xanthine derivatives were screened for the cytotoxic activity against the NCI tumor cell lines. Compounds 9c and 9d revealed a non-significant cytotoxic activity against all the assayed tumor cell lines, which indicate their selectivity for the antifibrotic activity. While compounds 6a and 6c displayed promising selective activity against melanoma SK-MEL-5 cell line (GI = 125.6, 90.3 %, respectively), and breast T-47D cell line (GI =87.8, 80.6 %, respectively). The utilized design approach unveiled the versatility of xanthine scaffold to deliver potential antioxidant, liver antifibrotic and chemoprotective agents, along with anticancer candidates via structure modification and optimization.

Emodin-8-O-β-D-glucopyranoside alleviates cholestasis by maintaining intestinal homeostasis and regulating lipids and bile acids metabolism in mice

Cholestatic liver disease(CLD) is caused by impaired bile flow due to obstruction of the biliary tract, and long-term exposure to bile acids in the liver triggers inflammation, eventually leading to liver toxicity and liver fibrosis. Emodin-8-O-β-D-glucopyranoside(EG) is anthraquinone compound that is widely found in traditional Chinese medicine. It possessed antioxidative and anti-inflammatory activities. However, the effect of EG on cholestatic liver injury(CLI) has not been explored. In this study, Alpha-naphthyl isothiocyanate(ANIT)-induced CLI mice were used to investigate the anti-cholestasis and hepatoprotective effects of EG through serum biochemical index detection, non-targeted metabolomics, lipidomics, and intestinal flora 16S rRNA sequencing. The results suggested that EG restores homeostasis of the gut microbiome while regulating bile acids metabolism and lipid-related metabolic pathways to reduce liver damage in ANIT-induced cholestasis. This study provides a new perspective on the mechanism of EG, and help offer a more natural approach to managing liver damage.

Taurine ameliorates liver fibrosis by repressing Fpr2-regulated macrophage M1 polarization

Liver fibrosis is a reversible pathophysiological condition characterized by excessive extracellular matrix deposition that can progress to cirrhosis and liver failure if left untreated. Taurine, a sulfur-containing amino acid, protects the liver from damage. However, the effects of taurine on liver fibrogenesis have not been completely elucidated. In this study, we used amino acid metabolomics, gene expression microanalysis, and single-cell RNA sequencing (scRNA-seq) to investigate the roles of taurine, formyl peptide receptor 2 (Fpr2), and proinflammatory macrophages in liver fibrosis in human fibrotic sections and two distinct mouse models of liver fibrosis. Taurine transporter SLC6A6 wild-type and knockout littermate models and critical element inhibitors were also used. We found that taurine levels were significantly reduced in both human and murine fibrotic sections and that exogenous taurine supplementation alleviated fibrosis via SLC6A6. Furthermore, gene expression microarray analysis and scRNA-seq analyses demonstrated that exogenous taurine mitigated liver fibrosis, mainly by regulating Fpr2-related macrophage status. WRW4-mediated inhibition of Fpr2 ameliorated M1 macrophage polarization and alleviated liver fibrosis. Additionally, exogenous taurine suppressed Fpr2-modulated macrophage M1 polarization and the production of associated proinflammatory cytokines by repressing NF-κBp65 phosphorylation; moreover, SLC6A6 deficiency or treatment of liver fibrosis mouse models with an NF-κB inhibitor, BAY, impaired this protective effect of taurine. Therefore, taurine exerts a protective effect against liver fibrosis by repressing Fpr2/NF-κBp65-regulated macrophage M1 polarization, highlighting its potential therapeutic agent.

Synthesis, structure activity relationship and biological evaluation of indole sulfonohydrazide derivatives as antagonists of P2Y1 and P2Y6 receptors

The P2Y receptors play a significant role in regulating various physiological functions, such as neurotransmission and inflammatory response. They are also considered promising therapeutic targets for the treatment and prevention of conditions like neurological disorders, pain, cardiovascular diseases, thrombosis, and cancer. Active research is ongoing to identify antagonists of P2Y receptor. Although extensive research has been conducted on P2Y receptors inhibitors, only a limited number of P2Y receptors antagonists have been identified and approved by regulatory authority. In the current research, new indole sulfonohydrazide derivatives (3a-3 k) were synthesized in good yield. Based on toxicity assays performed on h-1321 N1 astrocytoma cell line, these low molecular weight compound showed a safe toxicity profile. The synthesized derivatives were also screened against tP2Y1 and rP2Y6 receptors using a calcium mobilization assay. The results showed that compounds 3a, 3b, 3 h and 3 k were potent against tP2Y1 with IC50 values of 9.91 ± 1.01 μM, 3.49 ± 0.31 μM, 9.72 ± 0.82 μM, and 6.14 ± 0.17 μM, respectively. Additionally, three compounds, i.e., 3d, 3f, and 3 h, exhibited potency against rP2Y6 with IC50 value of 9.22 ± 1.10 μM, 16.25 ± 0.27 μM, and 1.89 ± 0.11 μM, respectively. Molecular docking study was conducted to support the in vitro analysis, which revealed that the tested compounds showed favorable interaction with the amino acids of the target P2Y1 receptor, including Phe62, Phe66, Leu102, Thr103, Pro105, Ala106, Phe119 and Met123. An in silico pharmacokinetic study was also performed, which revealed that the synthesized compounds met all the criteria for favorable gastrointestinal absorption, indicating potential for oral bioavailability. The stability and reactivity of compounds were determined by using the Guassian09 programme in which the density functional theory (DFT) calculations were performed by using the B3LYP/SVP level.

Maternal N-acetylcysteine supplementation in lactation ameliorates metabolic and cognitive deficits in adult offspring exposed to maternal obesity

Maternal obesity in pregnancy and lactation is linked to metabolic disturbances and neurodevelopmental problems in offspring, increasing the risk of psychiatric disorders in adulthood. We proposed that maternal N-acetyl cysteine (NAC) supplementation during lactation, a critical period for neurodevelopment, potentially protects offspring from developing cognitive impairment in adulthood. Fifteen young female ICR mice were randomly allocated to different experimental groups: high-fat diet (HFD; 60.3% fat before mating, during pregnancy and lactation), HFD-NAC of 300 mg/kg/day during lactation, CD (high-fat diet before mating, during pregnancy, and regular chow control diet of 8.2% fat during lactation), CD-NAC of 300 mg/kg/day during lactation and control group consuming regular chow diet. The serum inflammatory markers of the offspring were evaluated post-weaning, while metabolic markers, microglial density, and cognitive performance were assessed in adulthood using the novel Object Recognition and Morris Water Maze tests. Our results demonstrate maternal obesity during gestation and lactation increased body weight, hepatic steatosis, and microglial cell density in the dentate gyrus (DG) and cortex. Furthermore, these offspring exhibited reduced spatial learning abilities in adulthood, regardless of sex. However, maternal NAC administration during lactation and maternal diet intervention significantly reduced brain microglial density and improved both male and female offspring metabolic profiles. More importantly, NAC supplementation during lactation, regardless of maternal diet, enhanced male offspring's learning ability in adulthood. Our findings indicate that administering NAC to obese mothers during the critical lactation period may offer protection against metabolic disturbances and cognitive deficits in adult offspring previously exposed to maternal obesity.

Exploring the mechanisms of Yinchenhao decoction against ANIT-induced cholestatic liver injury by lipidomics, metabolomics and network pharmacology

Yinchenhao decoction (YCHD) has been used for the treatment of cholestasis for more than 1000 years with clear clinical efficacy. However, its active compounds and pharmacological mechanism against cholestasis are unclear. In this study, an integrated strategy of network pharmacology, lipidomics, metabolomics, and molecular docking were performed to elucidate the mechanism of YCHD's anti-cholestasis effect. Network pharmacology demonstrated YCHD mainly modulated lipid and atherosclerosis signaling pathways with the involvement of NF-κB, TNF, MAPK, and PI3K/AKT signaling pathways. In vivo experiments, male C57BL/6 J mice model of cholestasis was established by alpha-naphthyl isothiocyanate (ANIT), and were treated with different dosages (3 g/kg and 9 g/kg) of YCHD for one week. Ursodeoxycholic acid (UDCA) was used as a positive control. The in vivo experiments verified the ameliorative effect of YCHD on inflammation, hepatocellular injury and cholestasis. Furthermore, lipidomics and metabolomics research showed that YCHD could improve the metabolism disorder of glycerolipid, glycerophospholipid and amino acids. Subsequently, further WB and molecular docking validation experiments showed that the active compounds in YCHD have regulatory effects on the PPARγ/NF-κB/JNK pathway, the core pathway in lipid and atherosclerosis pathways, thereby inhibiting inflammatory response and improving lipid metabolism disorders. This study could provide evidence of the molecular mechanism and material basis of YCHD in treating cholestasis. This study also provided new research ideas for the discovery of active ingredients in traditional Chinese medicine formulas for the treatment of cholestasis.

Separation of virus-like particles and nano-emulsions for vaccine development by Capillary Zone Electrophoresis

BACKGROUND

Nano-emulsions with immunogenic properties can be incorporated into vaccines to act as an adjuvant where they can enhance the immune response of a given vaccine. Analytically, studying vaccine antigens, such as Virus-Like Particles (VLPs), in the presence of adjuvants, like nano-emulsions, is very challenging as they are both heterogenous nano species of similar sizes but very different physiochemical properties. Therefore, typical analysis of nanoparticles using separation approaches such as Size Exclusion Chromatography (SEC) and Field-Flow Fractionation (FFF) is difficult due to the size similarities among these nano-species which complicates their separation.

RESULTS

In this study, a Capillary Zone Electrophoresis (CZE) method was developed, which utilizes a separation mechanism based on the charge-to-size ratio of the analytes. The method was used to quantify VLPs of the Human Papilloma Virus (HPV) and Squalene Nano-Emulsion (SNE) adjuvant mixtures while also measuring buffer excipients, chloride and histidine. The method was assessed according to International Conference on Harmonization (ICH Q2) guidelines with respect to linearity, ranges, accuracy (87-109 %), precision (≤20 %), quantitation and detection limits.

SIGNIFICANCE

This study was conducted to prove the feasibility of utilizing CZE to characterize VLPs and SNE mixtures with dilution as the only sample preparation. The CZE conditions are simpler than other CZE conditions suggested for VLPs and easily transferred between users. Similar CZE methods could also be developed for other vaccine and adjuvant mixtures as well as other emulsion and nanoparticle-based systems.

Design, synthesis, and evaluation of 1,4-benzodioxane-hydrazone derivatives as potential therapeutics for skin cancer: In silico, in vitro, and in vivo studies

In the pursuit of novel chemotherapeutic agents for skin cancer, we synthesized a series of 1,4-benzodioxane-hydrazone derivatives (7a-l) using the Wolff-Kishner reaction. These compounds were initially screened against the NCI-60 oncological cell lines in a one-dose assay at 10 μM. Among them, compound 7e emerged as a potent inhibitor of cancer cell growth across 56 cell lines, with an average GI50 of 6.92 μM. Notably, it exhibited enhanced efficacy in melanoma cell lines, including MDA-MB-435, M14, SK-MEL-2, and UACC-62, with GI50 values of 0.20, 0.46, 0.57, and 0.27 μM, respectively. Apoptosis assay and cell cycle analysis studies revealed that compound 7e induced apoptosis and caused S-phase arrest in MDA-MB-435 cells. Furthermore, an in vitro enzyme inhibition assay against mTOR kinase yielded an IC50 of 5.47 μM, while molecular docking studies of compound 7e (docking score: -8.105 kcal/mol) supported its binding affinity. Compound 7e adhered to Lipinski's rule of five and displayed favourable ADMET properties. In vivo studies demonstrated its safety and efficacy in ameliorating skin cancer in a mice model when administered intraperitoneally at 20 mg/kg. Structure-activity relationships were established through in vitro, in vivo, molecular docking, and molecular dynamics analysis. Collectively, these findings highlight 1,4-benzodioxane-hydrazone derivatives as promising scaffold for the development of novel chemotherapeutic agents for skin cancer.

Human breath analysis; Clinical application and measurement: An overview

Human breath has been recognized as a complex yet predictive mixture of volatile organic compounds (VOCs) and inorganic gas species that can be utilized to non-invasively diagnose common diseases. Current laboratory techniques such as gas chromatography/mass spectrometry (GC/MS) and high-performance liquid chromatography (HPLC), are capable of VOC detection down to ppm concentrations. However, these methods are expensive, non-portable, require pre-processing of the exhaled VOCs, and expert operators, making them unsuitable for wide-spread use. Portable gas sensors have various advantages over other methods used in gas analysis, including ease of transportation, reduced treatment costs, fast results, and improved patient experience. Recent advancements in gas sensing technologies have enabled such devices to be used to diagnose, predict, and monitor a wide range of diseases and conditions, however, many challenges need still need to be addressed (i.e., sensitivity and selectivity) before they can be employed for such applications. Although nanotechnology has greatly improved the performance of gas sensor materials and their capacity to detect VOCs in human breath, issues around repeatability and accuracy remain, as well as adequateness due to the close proximity of the human body and the sensor device. This review focuses on how recent advancements in nanotechnology and solid-state materials have enabled VOC gas sensors to evolve into miniaturized, sensitive and selective devices for monitoring human breath in clinical applications. An introduction to the key aspects of breath analysis, including sources of VOCs in human breath and their role in disease diagnosis, is discussed. Furthermore, the current limitations and future prospects of such gas sensors for breath monitoring applications are also discussed in detail.

Unveiling EIF5A2: A multifaceted player in cellular regulation, tumorigenesis and drug resistance

The eukaryotic initiation factor 5A2 gene (EIF5A2) is a highly conserved and multifunctional gene that significantly influences various cellular processes, including translation elongation, RNA binding, ribosome binding, protein binding and post-translational modifications. Overexpression of EIF5A2 is frequently observed in multiple cancers, where it functions as an oncoprotein. Additionally, EIF5A2 is implicated in drug resistance through the regulation of various molecular pathways. In the review, we describe the structure and functions of EIF5A2 in normal cells and its role in tumorigenesis. We also elucidate the molecular mechanisms associated with EIF5A2 in the context of tumorigenesis and drug resistance. We propose that the biological roles of EIF5A2 in regulating diverse cellular processes and tumorigenesis are clinically significant and warrant further investigation.

The association between uric acid to high-density cholesterol ratio and depression: A population-based cross-sectional study

BACKGROUND

Depression is associated with inflammation, and the uric acid to HDL-C cholesterol ratio (UHR) has emerged as a potential marker of increased inflammation; however, the association between UHR and depression is unclear. Therefore, we aimed to explore this association in a sample from the general US population.

METHODS

We conducted a cross-sectional study of 11,444 participants ≥20 years of age from the 2009-2014 NHANES database. We conducted weighted multivariate logistic regression analyses and restricted cubic spline function (RCS) models exploring the association between UHR and risk of depression, as well as subgroup analyses and tests of interaction.

RESULTS

UHR was positively associated with depression, especially in participants who drank alcohol (interaction P < 0.05).The prevalence of depression increased by 4 % for each 1-unit increase in UHR (OR = 1.04, 95 % CI = 1.02, 1.07, P = 0.003). After dividing the UHR into quartiles compared with the lowest reference group for UHR, participants in the fourth quartile had a significantly increased risk of depression after full adjustment (OR = 1.36, 95 % CI = 1.03, 1.80, P = 0.033).There was a linear dose-response relationship between the UHR and the risk of depression (P for nonlinear = 0.744).

LIMITATIONS

As this was a cross-sectional study, we could not determine a causal relationship between UHR and depression.

CONCLUSION

The UHR is positively associated with an increased prevalence of depression among adults in the U.S.