H-Shaped Anatomical Titanium Plate: Biomechanical Validation and Clinical Application in the Treatment of Complex Posterior Wall/Column Acetabular Fractures

OBJECTIVE

Approximately 80% of acetabular fractures involve the posterior wall and posterior column, which are complex and challenging to treat. The H-shaped anatomical titanium plate (HTP) facilitates anatomical reduction, minimizes complications, and enhances safety, efficacy, and speed. This study aims to conduct biomechanical testing and clinical evaluation of HTP to assess its stability and efficacy in treating these fractures.

METHODS

In the biomechanical research, posterior column with posterior wall fractures was created on nine acetabular models procured from Sawbones, USA and were allocated to three fixation groups: (1) a single reconstruction plate combined with a single cortical screw (PCS), (2) double parallel reconstruction plates (2P), (3) HTP. Following anatomic reduction, cyclic loading and destructive experiments were conducted to assess the efficacy of different fixation devices under various loads for the posterior wall and column, as well as their peak load and structural stiffness. Additionally, we retrospectively analyzed the clinical data of 53 patients (46 males, 7 females; mean follow-up 24.6 ± 3.2 months) with the HTP at our hospital from April 2017 to January 2023. Clinical outcomes mainly included changes in postoperative pain, reduction quality (Matta criteria), hip function (Merle d'Aubigné Postel/Harris scores), and the incidence of complications.

RESULTS

Biomechanical results showed that in cyclic loading tests, the relative displacement of the posterior wall and the posterior column fixed with the HTP was smallest, with statistically significant differences (p < 0.05). In the destructive experiment, compared to the 2P group (2062.89 ± 375.45 N, 412.16 ± 25.87 N/mm) and the PCS group (1477.89 ± 161.57 N, 204.21 ± 34.94 N/mm), the HTP group (3342.67 ± 354.15 N, 652.52 ± 24.25 N/mm) demonstrated superior peak load and structural stiffness, with statistically significant differences (p < 0.05). Clinically, Postoperative Visual Analogue Scale scores significantly decreased, indicating effective pain management. 84.91% achieved anatomic reduction, with 92.45% and 90.56% good/excellent functional outcomes (Merle d'Aubigné Postel and Harris scores, respectively). The incidence of various complications was low, with no cases of implant failure observed.

CONCLUSIONS

The HTP demonstrates robust stability in biomechanical experiments, offering distinct advantages for clinical applications and widespread adoption. In the treatment of the posterior column/posterior wall fractures, the integrated fixation of HTP aligns with the physiological anatomy of the acetabulum and has the advantages of simple operation, short operation time, strong stability, minimal risk of vascular and nerve injury, and fewer complications.

Clinical usefulness of nutritional and immunological indices to distinguish gallbladder carcinoma from benign disease

BACKGROUND

It is challenging to accurately and preoperatively diagnose gallbladder carcinoma (GBC) because patients are often asymptomatic or present with nonspecific symptoms that mimic common benign diseases in radiological findings. In this study, we evaluated the clinical usefulness of nutritional and immunological indices to distinguish GBC from benign disease.

METHODS

This study included 113 patients who underwent surgical resection for suspected GBC (37 benign and 76 GBC cases by pathological diagnosis). As the nutritional and immunological indices, the geriatric nutritional risk index (GNRI), modified Glasgow prognostic score (mGPS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and prognostic nutrition index (PNI) were examined, and their usefulness in distinguishing GBC from benign disease was determined using logistic regression analyses.

RESULTS

GBC cases displayed significantly worse nutritional and immunological status in the GNRI, mGPS, NLR, PLR, and PNI compared with those of the benign cases. As the predictive factors to distinguish GBC from benign disease, age > 75 years, GNRI < 101.7, and PLR ≥ 1.76 were identified by multivariate logistic regression analyses.

CONCLUSION

Patients with GBC showed poor nutritional or immunological status compared with patients with benign disease, and a low GNRI and high PLR may be noninvasive predictors of GBC.

Advances in cancer immunotherapy: historical perspectives, current developments, and future directions

Cancer immunotherapy, encompassing both experimental and standard-of-care therapies, has emerged as a promising approach to harnessing the immune system for tumor suppression. Experimental strategies, including novel immunotherapies and preclinical models, are actively being explored, while established treatments, such as immune checkpoint inhibitors (ICIs), are widely implemented in clinical settings. This comprehensive review examines the historical evolution, underlying mechanisms, and diverse strategies of cancer immunotherapy, highlighting both its clinical applications and ongoing preclinical advancements. The review delves into the essential components of anticancer immunity, including dendritic cell activation, T cell priming, and immune surveillance, while addressing the challenges posed by immune evasion mechanisms. Key immunotherapeutic strategies, such as cancer vaccines, oncolytic viruses, adoptive cell transfer, and ICIs, are discussed in detail. Additionally, the role of nanotechnology, cytokines, chemokines, and adjuvants in enhancing the precision and efficacy of immunotherapies were explored. Combination therapies, particularly those integrating immunotherapy with radiotherapy or chemotherapy, exhibit synergistic potential but necessitate careful management to reduce side effects. Emerging factors influencing immunotherapy outcomes, including tumor heterogeneity, gut microbiota composition, and genomic and epigenetic modifications, are also examined. Furthermore, the molecular mechanisms underlying immune evasion and therapeutic resistance are analyzed, with a focus on the contributions of noncoding RNAs and epigenetic alterations, along with innovative intervention strategies. This review emphasizes recent preclinical and clinical advancements, with particular attention to biomarker-driven approaches aimed at optimizing patient prognosis. Challenges such as immunotherapy-related toxicity, limited efficacy in solid tumors, and production constraints are highlighted as critical areas for future research. Advancements in personalized therapies and novel delivery systems are proposed as avenues to enhance treatment effectiveness and accessibility. By incorporating insights from multiple disciplines, this review aims to deepen the understanding and application of cancer immunotherapy, ultimately fostering more effective and widely accessible therapeutic solutions.

Ligation of the intersphincteric fistula fract (LIFT) in complex anorectal fistulas: retrospective analysis of the outcomes in a tertiary hospital

Anal fistula treatment remains a surgical challenge. This study focuses on the efficiency and safety of the Ligation of Intersphincteric Fistula Tract (LIFT) procedure for high intersphincteric anorectal fistulas, aiming to identify prognostic factors for success and complications. A retrospective chart review was conducted on all patients who underwent LIFT procedure at a tertiary referral hospital between January 2013 and January 2021. The primary endpoint was the success rate of fistula closure, confirmed with clinical investigation. Secondary endpoints included postoperative complications, reintervention and self-reported incontinence. Logistic regression analyses were performed for assessing prognostic factors for fistula closure and postoperative complications. Ninety-two patients were included in the study; after a median follow-up of 19.3 months, fistula closure was achieved in 71% (n = 65) and in 89% (n = 82) after reinterventions. 46% (n = 42) reported persistent symptoms, although 83% of which (n = 32/42) had succesful fistula tract closure by clinical evaluation. One patient developed incontinency for gas. Smoking emerged as a significant risk factor for fistula closure failure, OR = 6.75, 95% CI = [1.65, 27.69], p = 0.030. Wound dehiscence was the most common complication, occuring in 25% (n = 23). Prolonged oral antibiotics demonstrated a significant protective effect against wound dehiscence, OR = 0.31, 95% CI = [0.10, 0.96], p = 0.036. The LIFT procedure is an efficient and safe treatment for complex perianal fistula. Patient satisfaction emerged as a crucial treatment goal, as patients can remain symptomatic after fistula closure. Emphasizing smoking cessation is integral to the treatment approach. The findings suggest prolonged antibiotic treatment as a potential preventive measure for wound dehiscence.

Furan Acids from Nutmeg and Their Neuroprotective and Anti-neuroinflammatory Activities

Nutmeg (Myristica fragrans) has been traditionally valued for its culinary and medicinal properties. In our ongoing efforts to discover pharmacologically active compounds from this spice, five new furan acids (2-6, jusahos B-F), one new neolignan (7, jusaho G), and six known compounds (1 and 8-12) were isolated from its nutmegs. The chemical structures of the compounds were elucidated using NMR spectroscopy and HRESIMS. Among them, compound 3 (jusaho C) demonstrated promising antineuroinflammatory and neuroprotective effects in BV2 and HT22 cells by modulating the MAPK/NF-κB signaling pathway, which was explored through network pharmacology, molecular docking, and experimental verification. Compound 3 also showed the improvement of locomotor activity in Caenorhabditis elegans model infected with Pseudomonas aeruginosa. These findings expand the phytochemical profile of M. fragrans, where only one furan acid was previously reported, and highlight nutmeg-derived compounds, particularly jusaho C, as potential functional food ingredients or nutraceuticals for managing neuroinflammatory conditions.

Top Ten Tips Palliative Care Clinicians Should Know About Total Pain

"Total pain" is a fundamental concept in palliative care. It emphasizes the multidimensional nature of pain and suffering in patients with advanced illnesses. Originally introduced by Dame Cicely Saunders, the spectrum of total pain extends beyond pure physical pain to further encompass psychological, social, and spiritual distress. By focusing on the above four components of total pain, clinicians can provide better care for their patients with advanced illnesses and ultimately improve their overall quality of life. Compiled by a multidisciplinary team of experts in the field, this article provides ten key strategies (tips) for palliative care clinicians to enhance their understanding and management of total pain in clinical settings.

End-of-Life Care Competency in Long-term Care Facilities for Care Providers in Thailand: A Delphi Study

The global shift toward an aging population, evident in Thailand, highlights the critical need for end-of-life care (EOLC) competencies among care providers in long-term care facilities (LTCFs). As the number of older people requiring complex and compassionate care at the end of life continues to rise, the competencies required for care providers in Thai LTCFs remain underexplored. This study aimed to identify the key competencies required to deliver effective EOLC in Thai LTCFs. A Delphi method was used, engaging a panel of 12 experts, including nurses, academics, and LTCF managers. The study achieved consensus on 7 core competencies, encompassing 32 subcompetencies essential for high-quality EOLC. These competencies include knowledge of EOLC, caregiving skills, communication, leadership, innovation, ethical decision-making, and professional development. This study provides a culturally relevant framework for EOLC competencies in Thai LTCFs, emphasizing the importance of integrating technical and interpersonal skills to enhance the quality of care for older people in their final stages of life. These findings can inform educational programs and policy development, ensuring that care providers are adequately prepared to meet the complex needs of this vulnerable population.

Anti-diabetes activity of (R)-gentiandiol in KKAy type 2 mice

Swertiamarin is a major component of many traditional Chinese Swertia herbs that show significant antidiabetic activity. (R)-Gentiandiol and (S)-gentiandiol are metabolites of swertiamarin found in vivo. The antidiabetic activity of swertiamarin and its nitrogen-containing metabolites (R)-gentiandiol and (S)-gentiandiol was evaluated in this research, and their mechanism of action was investigated after evaluating the serum metabolic profile of KK/Upj-Ay type 2 mice. The pharmaceutical effects of swertiamarin, (R)-gentiandiol, and (S)-gentiandiol were tested by biochemical indices and histopathological observations. Moreover, the mechanism underlying the action of three compounds against type 2 diabetes was elucidated using a metabolomic method. It was shown that (R)-gentiandiol significantly improved pathological changes in the kidney and pancreas. The levels of total cholesterol, triglyceride, and high-density and low-density lipoprotein cholesterol improved considerably after treatment with (R)-gentiandiol, compared to their levels in model mice. However, the levels of these compounds showed no improvement after treatment with (S)-gentiandiol. In total, 15 biomarkers were identified in KK/Upj-Ay type 2 mice, and the levels of 10 biomarkers were measured after treatment with (R)-gentiandiol. (R)-Gentiandiol reduced the abnormalities in metabolic pathways, including lipid metabolism, amino acid metabolism, carbohydrate metabolism, and nucleotide metabolism. Additionally, glycine, serine, and threonine metabolism related to the regulation of glycine was affected the most. The study indicated that the antidiabetic effects of Swertia herbs may due to (R)-gentiandiol which is a metabolite of swertiamarin in vivo. This study helps clarify the active metabolites of swertiamarin, provide greater insights into the clinical antidiabetic effects of Swertia herbs and bring novel ideas for developing new drugs from antidiabetic herbs.

Unveiling new insights into migraine risk stratification using machine learning models of adjustable risk factors

BACKGROUND

Migraine ranks as the second-leading cause of global neurological disability, affecting approximately 1.1 billion individuals worldwide with severe quality-of-life impairments. Although adjustable risk factors-including environmental exposures, sleep disturbances, and dietary patterns-are increasingly implicated in pathogenesis of migraine, their causal roles remain insufficiently characterized, and the integration of multimodal evidence lags behind epidemiological needs.

METHODS

We developed a three-step analytical framework combining causal inference, predictive modeling, and burden projection to systematically evaluate modifiable factors associated with migraine. First, two-sample mendelian randomization (MR) assessed causality between five domains (metabolic profiles, body composition, cardiovascular markers, behavioral traits, and psychological states) and the risk of migraine. Second, we trained ensemble machine learning (ML) algorithms that incorporated these factors, with Shapley Additive exPlanations (SHAP) value analysis quantifying predictor importance. Finally, spatiotemporal burden mapping synthesized global incidence, prevalence, and disability-adjusted life years (DALYs) data to project region-specific risk and burden trajectories through 2050.

RESULTS

MR analyses identified significant causal associations between multiple adjustable factors (including overweight, obesity class 2, type 2 diabetes [T2DM], hip circumference [HC], body mass index [BMI], myocardial infarction, and feeling miserable) and the risk of migraine (P < 0.05, FDR-q < 0.05). The Random Forest (RF)-based model achieved excellent discrimination (Area under receiver operating characteristic curve [AUROC] = 0.927), identifying gender, age, HC, waist circumference [WC], BMI, and systolic blood pressure [SBP] as the predictors. Burden mapping projected a global decline in migraine incidence by 2050, yet persistently high prevalence and DALYs burdens underscored the urgency of timely interventions to maximize health gains.

CONCLUSIONS

Integrating causal inference, predictive modeling, and burden projection, this study establishes hierarchical evidence for adjustable migraine determinants and translates findings into scalable prevention frameworks. These findings bridge the gap between biological mechanisms, clinical practice, and public health policy, providing a tripartite framework that harmonizes causal inference, individualized risk prediction, and global burden mapping for migraine prevention.

Textile Recycling's Hidden Problem: Surface-Modified Fiber Fragments Emitted at Every Stage

Chemical recycling methods for post-consumer textile waste are effective for sustainable textile waste management. However, recycling synthetic and blended (cotton and synthetic) textiles can contribute to the release of microplastic fibers (MPFs) into the environment. This study investigated MPF release across different stages of two chemical recycling approaches, acid and alkaline hydrolysis, of polyester/cotton-blended textiles. Recycling involves various stages, including dye removal, treatment stage, and product. In the treatment stage, acid hydrolysis breaks down cotton into cellulose, leaving the polyester (PET) intact, whereas alkaline hydrolysis degrades PET, allowing cotton recovery. Across all stages, dye removal generated the highest MPF count, averaging nearly 10,055 MPFs g-1 of textile waste. Statistical analysis confirmed that the recycling approach significantly affected MPF release (p < 0.05), whereas the fabric type did not (p > 0.05). Alkaline hydrolysis reduced MPF release during the treatment stage by 87.55% compared to acid hydrolysis, indicating that recovering cotton and chemically degrading PET can significantly minimize MPF emissions during recycling. Ridge regression analysis identified the reaction conditions as key factors in MPF fragmentation, with blend ratios influencing the number of released MPFs. Surface characterization revealed treatment-induced fiber alterations, raising concerns regarding MPF emissions throughout the process. These findings highlight the textile recycling industries can be a source of MPF release into the environment, but recovering PET through degradation or dissolution can help minimize this impact of the treatment stage.

Bivalirudin for anticoagulation in elderly acute coronary syndrome: Effects on myocardial microcirculation and adverse events

The management of acute coronary syndrome (ACS) in older patients remains challenging because standard anticoagulants often fail to yield optimal outcomes. Bivalirudin, a direct inhibitor of thrombin, serves as an alternative to traditional therapies. This drug is particularly effective in enhancing myocardial microcirculation and reducing adverse events after clinical interventions. The present article explores the findings of a recent study that highlighted the clinical benefits of bivalirudin by investigating its effects on myocardial microcirculation and adverse cardiac events after percutaneous coronary intervention in older patients with ACS. Compared with unfractionated heparin, bivalirudin markedly reduced the emergency response time and improved cardiac function indicators. It further mitigated the risks of cardiovascular events and recurrent myocardial infarctions. These findings suggest that bivalirudin can enhance myocardial perfusion and reduce bleeding complications, thus serving as a safe, effective anticoagulation agent for older patients with ACS. Nonetheless, further large-scale, high-quality trials are needed to establish optimal usage guidelines and assess long-term outcomes. Integrating bivalirudin into ACS treatment protocols for older patients may help optimize patient care, balancing efficacy and safety. Continual research and consensus building are necessary for the widespread clinical application of bivalirudin and the improvement of ACS outcomes in older patients.

Morphological characteristics, mitochondrial oxidoreductase activity, and vascularization of human adipose tissues pre-and post-xenotransplantation into BALB/c female nude mice

This study aimed to evaluate the effect of different cryoprotectants on the histomorphological characteristics, oil ratio (OR) indices, mitochondrial oxidoreductase activities, and vascularization of human adipose tissues after thawing (pre-xenotransplantation), one month and three months post-xenotransplantation. For this purpose, we froze human adipose tissues in five experimental groups, including NCG (PBS without any cryoprotectants), FG1 (4 % DMSO+6 % Trehalose), FG2 (6 % Trehalose+2 % DMSO+9 % FBS), FG3 (2 % DMSO+4 % Trehalose+3 % Sucrose+9 % FBS), and FG4 (4 % DMSO+3 % Trehalose+3 % Sucrose) and compared them with the positive control group (PCG or fresh adipose tissue). Adipose tissues were frozen with a cooling rate of -1 °C/min and stored in a freezer at -20 °C until use. Three months after freezing, human adipose tissues were xenotransplanted into the BALB/c nude mice for one and three months. Then, xenografts were removed and evaluated for histopathological properties, OR indices, mitochondrial activities, and vascularization. After thawing (pre-xenotransplantation) and post-xenotransplantation (one- and three-month after xenografting), the NCG group demonstrated the most significant tissue damage including necrosis, multiple cysts, inflammatory cell invasion, cell rupture, fibrosis, necrosis and ECM disintegration (p ≤ 0.05). Pre-xenotransplantation, one- and three-month after grafting, the best structural integrity of adipose tissues with the least degeneration of adipocytes was detected in the FG2 and FG3 groups (p ≤ 0.05). Pre- and post-xenotransplantation, the highest and least OR indices and mitochondrial oxidoreductase activities were demonstrated in the NCG and FG2 groups, respectively (p ≤ 0.05). The least VEGF and CD31 expressions were shown in the NCG group at pre- and post-transplantation (p ≤ 0.05). The highest CD31 and VEGF expressions were detected in the FG3 and FG2 groups after thawing and grafting (both one- and three-month) (p ≤ 0.05).

Nanoparticle-based biosensor integrated with multiple cross-displacement amplification for visual and rapid identification of hepatitis B virus and hepatitis C virus

Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is a major contributor to liver-related morbidity and mortality worldwide. An accurate and rapid point-of-care (POC) diagnostic approach is the gateway for effective treatment and control of these infections. Here, for the first time, we integrated isothermal multiple cross-displacement amplification (MCDA) with a gold nanoparticle-based lateral flow biosensor (AuNPs-LFB) to successfully develop a novel HBV&HCV-MCDA-AuNPs-LFB assay for simultaneous accurate, sensitive, rapid, inexpensive, and visual identification of HBV and HCV agents. The two unique sets of MCDA degenerate primers were successfully designed targeting the S and 5' untranslated region (5'-UTR) genes from the major HBV genotypes (B, C, D, B/C recombinant, and C/D recombinant) and HCV subtypes in China (1b, 2a, 3a, 3b, and 6a), respectively. The optimal conditions for the MCDA reaction were confirmed to be 64°C for 35 min. The MCDA products were decoded visually using the AuNPs-LFB platform, which was devised for analyzing three targets, including HBV-MCDA, HCV-MCDA amplicons, and a chromatography control. The whole detection procedure, including rapid nucleic acid extraction (~10 min), MCDA reaction (35 min), and AuNPs-LFB interpretation (~2 min), can be completed within 50 min. The HBV&HCV-MCDA-AuNPs-LFB assay can detect the target genes (HBV-S and HCV-5'-UTR) with as low as 10 copies of gene-containing plasmid template per test and does not cross-react with other pathogens. Therefore, our preliminary results indicated that the HBV&HCV-MCDA-AuNPs-LFB assay developed in this study can potentially serve as a useful POC diagnostic tool for the identification of HBV and HCV infections.IMPORTANCEHepatitis B virus (HBV) and hepatitis C virus (HCV) infections have been regarded by the World Health Organization as major threats to human health, especially in low- and middle-income regions. Underdiagnosis of HBV/HCV is a particular challenge for achieving the World Health Organization's goal of eliminating HBV and HCV infections by 2030. Here, for the first time, we integrated isothermal multiple cross-displacement amplification (MCDA) with a gold nanoparticle-based lateral flow biosensor (AuNPs-LFB) to successfully develop a novel HBV&HCV-MCDA-AuNPs-LFB assay for simultaneous accurate, sensitive, rapid, inexpensive, and visual identification and differentiation of HBV and HCV agents.

Applying a Modified Version of the Prediction of Alcohol Withdrawal Severity Scale in a Canadian Community Withdrawal Management Setting

INTRODUCTION

Severe alcohol withdrawal syndrome (SAWS) can lead to significant morbidity and mortality. The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) has been validated in general acute care environments, but its efficacy in withdrawal management settings remains underexplored. This study aimed to assess the utility of a modified PAWSS and identify appropriate cutoff scores in a community withdrawal management setting in Vancouver, Canada.

METHODS

From October 2019 to September 2022, we reviewed charts at Vancouver Detox Centre. Modified PAWSS versions replaced question 9 on the original PAWSS with: (i) breath analysis readings; (ii) alcohol consumption in the previous 24 h; and (iii) clinical assessments. We performed receiver operating characteristic analysis and used Youden's index to determine modified PAWSS' diagnostic accuracy against SAWS presentation, defined by a score of 15 or greater on the Clinical Institute Withdrawal Assessment Alcohol, Revised, seizures or delirium tremens and/or benzodiazepine administration.

RESULTS

Among 228 individuals (165 male, 63 female), 175 (75%) met SAWS criteria during admission. For breath analysis readings, an optimal PAWSS cutoff score had 55% sensitivity (95% confidence interval [CI] 46%-63%) and 74% specificity (95% CI 54%-87%). For alcohol consumption in the last 24 h, a cutoff score of 7 had 44% sensitivity (95% CI 36%-51%) and 85% specificity (95% CI 70%-93%). For clinical assessment, a cutoff score of 6 had 53% sensitivity (95% CI 45%-61%) and 71% specificity (95% CI 58%-85%).

DISCUSSION AND CONCLUSIONS

Within a community withdrawal setting, the prevalence of SAWS was high, rendering the modified PAWSS less valuable. Although higher cutoff scores improved specificity, poor sensitivity hindered identification of low-risk SAWS individuals.

Validation of Drum Tower Severity Scoring (DTSS) System for Pyrrolizidine Alkaloid-Induced Hepatic Sinusoidal Obstruction Syndrome

OBJECTIVES

The Drum Tower Severity Scoring (DTSS) system is a novel tool designed for assessing the outcome of anticoagulation therapy and disease severity in patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). The aim of this study was to validate the predictive performance of the DTSS system in PA-HSOS patient outcome.

METHODS

We conducted a retrospective analysis of 111 PA-HSOS patients who received standard anticoagulation-transjugular intrahepatic portosystemic shunt (TIPS) stepwise therapy from six hospitals in China. Patients were categorized into two groups based on whether they responded to anticoagulation therapy. The predictive performance of the DTSS system was evaluated through the efficacy of anticoagulation therapy, the area under the receiver operating characteristic curve (AUROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) analysis.

RESULTS

The response rates to anticoagulation therapy varied among patients with DTSS of different severity, being 94.12% for mild, 57.81% for moderate, and 13.33% for severe cases. The DTSS system demonstrated a robust predictive performance, with an AUROC of 0.864. The calibration curve indicated a close match between the predicted and observed effects of the DTSS system. Good calibration was confirmed by the Hosmer-Lemeshow test (p = 0.704), and both the DCA and CIC analysis indicated high clinical utility of the DTSS system.

CONCLUSION

The DTSS system is a practical tool that uses easily accessible data to predict the initial response to anticoagulation therapy in PA-HSOS patients, showing robust predictive performance and significant clinical benefit in guiding personalized management strategies.

A qualitative report on the experiences of physicians during the pandemic of COVID-19

The COVID-19 pandemic posed unprecedented challenges to healthcare providers globally. The firsthand lived experiences of healthcare professionals who worked on the frontlines are invaluable. This study explores the experiences of frontline physicians during the early waves of the COVID-19 pandemic. This is a descriptive qualitative study conducted in Isfahan, Iran, during September and October 2020, in anticipation of the third wave of COVID-19 pandemic. Thirteen physicians from COVID-19-designated hospitals affiliated to the Isfahan University of Medical Sciences were purposively selected for semi-structured interviews. Data were analyzed using content analysis method. Our study identified seven main categories with 17 subcategories, encapsulating healthcare professionals' experiences during the pandemic. These categories include (1) clinical decision-making in fog, (2) an unprepared health system, (3) defects in the education and research system, (4) homecare as a missing component in the healthcare system, (5) culture as a barrier, (6) poor interdisciplinary collaboration, and (7) concerns and mental rumination due to COVID-19. The findings of this study provide valuable insight into the experiences and decision-making processes of healthcare professionals throughout the COVID-19 pandemic, emphasizing the need for comprehensive support and better preparedness for probable future health crises.

Rapid Identification of Esophageal Squamous Cell Carcinoma Biomarkers by MALDI-TOF MS Fingerprinting of Extracellular Vesicles

Esophageal cancer is a major global health challenge, with high incidence and mortality due to the lack of rapid and sensitive diagnostic tools and specific biomarkers. Cancer-cell-derived extracellular vesicles (EVs) carry unique proteins and nucleic acids, making them valuable sources of cancer biomarkers. We report an integrated method that combines an ultrafast exosome isolation system (EXODUS) with matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) to detect EVs and identify protein biomarkers for diagnosing and monitoring esophageal squamous cell carcinoma (ESCC). EVs derived from 20 mL culture medium supernatant of ESCC cells with varying degrees of differentiation serve as analysis models. We use EXODUS to isolate EVs rapidly. We then analyze the intact EVs using MALDI-TOF MS, which provides cell line-specific EV fingerprints in minutes. These protein fingerprints allow the discrimination of ESCC from normal control cells and enable the classification of ESCC based on the degree of cell differentiation. We explore critical EV biomarker peaks for ESCC diagnosis (5555 m/z, 8603 m/z, etc.) and monitoring (2268 m/z, etc.). Potential EV biomarker candidates, including YBX1, DIRAS2, HIST1H2AH, and MYBBP1A, are identified through tandem mass tag (TMT) proteomics. We tentatively assign the protein identities of EV marker peaks by correlation with the TMT proteomics. Applying this method to plasma-derived EVs shows promise for rapid, minimally invasive diagnosis and monitoring of ESCC.

CRISPR-based genetically modified scaffold-free biomaterials for tissue engineering and regenerative medicine

CRISPR-based genetically modified scaffold-free biomaterials, including extracellular vehicles, cell sheets, cell aggregates, organoids and organs, have attracted significant attention in the fields of regenerative medicine and tissue engineering in recent years. With a wide range of applications in gene therapy, modeling disease, tissue regeneration, organ xenotransplantation, modeling organogenesis as well as gene and drug screening, they are at a critical juncture from clinical trials to therapeutic applications. Xenografts have already been tested on non-human primates and humans. However, we have to admit that a series of obstacles still need to be addressed, such as immune response, viral infection, off-target effects, difficulty in mass production, and ethical issues. Therefore, future research should pay more attention to improving their safety, accuracy of gene editing, flexibility of production, and ethical rationality. This review summarizes various types of CRISPR-based genetically modified scaffold-free biomaterials, including their preparation procedures, applications, and possible improvements.

Life-threatening bleeding caused by artery pseudoaneurysm after endoscopic procedure successfully treated by artery embolization

The Kakinuma et al's case report shows that non-pregnancy-related arterial pseudoaneurysm is a relatively rare, little known by some gynecologists, endoscopists, surgeons or radiologists, which can cause massive bleeding. Arterial pseudoaneurysm is a condition in which the wall of a blood vessel collapses due to some invasive event, and the resulting leaked blood is engulfed by soft tissues, forming a cavity that is in communication with the vessel. It is a potentially life-threatening complication that could occurs after some deliveries and some gynecological invasive procedures. Remarkably, an undetermined percentage of pseudoaneurysms are asymptomatic, and in an asymptomatic patient it is difficult to predict the risk of haemorrhage and the attitude to follow, which depends on several factors, such as, the size and location of the vessel involved, changes in the size of the pseudoaneurysm, or the available therapeutic resources to be offered to patients, among others circumstances. The management of abdominal arterial pseudoaneurysm does not have consistent scientific evidence, but it seems that, regardless of the associated circumstances, the pseudoaneurysm could be treated at least initially, and mainly, through endovascular procedures, as done by Kakinuma et al.

Understanding the genetic architecture and phenotypic landscape of SPTB gene variants causing hereditary spherocytosis in an Indian cohort

Hereditary spherocytosis (HS) is a common form of haemolytic anaemia caused by defects or deficiencies in genes encoding erythrocyte membrane proteins, such as ANK1, SPTB, SLC4A1, EPB42, and SPTA1. Among these, ANK1 and SPTB mutations are the most frequent causes of HS worldwide. This study analysed 53 Indian HS patients, identifying 33 novel and 12 previously reported SPTB variants using targeted next-generation sequencing (t-NGS). The identified SPTB variants included frameshift (28%), missense (24%), nonsense (44%), and splicing (4%) types, with nonsense variants being the most common. These nonsense variants typically result in truncated proteins. The variants were widely distributed across the gene, with the highest density observed in the spectrin repeats and ankyrin-binding domain, while no variants were found in the tetramerization domain. All identified SPTB variants exhibited heterozygous inheritance, consistent with an autosomal dominant inheritance pattern of the gene causing HS. One patient, however, carried compound heterozygous variants, leading to severe anaemia, and five patients had de novo SPTB variants. This study expands the spectrum of SPTB variants, enhances the understanding of spectrin-related molecular defects, establishes genotype-phenotype correlations, and provides valuable insights for laboratories developing genetic tests for HS. The high number of identified variants highlights the importance of advanced technologies like NGS for accurate molecular diagnosis in HS disorder. This approach not only supports clinical diagnostics but also aids in family counseling for improved management of HS.

Comparison of 12- and 15-mm endoscopic papillary large balloon dilation combined with a limited endoscopic sphincterotomy for large bile duct stones: A propensity score-matched analysis

BACKGROUND AND STUDY AIMS

Endoscopic papillary large balloon dilation (EPLBD) combined with endoscopic sphincterotomy (EST) has been increasingly used to remove large common bile duct (CBD) stones. However, the clinical outcomes of stone extraction have rarely been investigated in regard to the size of the balloon. The aim of this study was to assess the short- and long-term outcomes of 12- and 15-mm EPLBD with a limited EST for large CBD stones.

PATIENTS AND METHODS

Patients without prior endoscopic retrograde cholangiopancreatography (ERCP) who received 12- or 15-mm EPLBD in combination with a limited EST for large CBD stones at our center between January 2013 and December 2020 were recruited. Matched pairs with 12- and 15-mm EPLBD were generated.

RESULTS

A total of 161 patients were included, with 50 patients successfully matched in each group. The total procedure time (36.8 min vs. 47.3 min, p = 0.003) and the tone removal time (30.5 min vs. 39.2 min, p = 0.008) were significantly lower in the matched 15-mm EPLBD group, while the initial and overall stone removal success rates were comparable between the two groups (p > 0.05). The matched 15-mm EPLBD group had a lower incidence of post-ERCP pancreatitis (PEP) compared to the matched 12-mm EPLBD group (2.0 % vs. 16.0 %, p = 0.031). The cumulative long-term biliary complications were not statistically different between the two groups (log-rank test p = 0.612).

CONCLUSION

15-mm EPLBD combined with a limited EST shortened the procedure time and reduced the incidence of PEP without increasing long-term biliary complications compared to 12-mm EPLBD combined with a limited EST.

A preliminary study of serum metabolomic profiling in male patients with acute brucellosis

Brucellosis is a significant zoonotic disease that may lead to metabolic profile changes, which remain insufficiently studied. This study utilized an ultra-high performance liquid chromatography coupled with Q Exactive-Orbitrap mass spectrometry (UHPLC-QExactive-Orbitrap MS/MS) to investigate serum samples of acute brucellosis in 32 male patients against 32 well-matched healthy controls. The results revealed nine differential metabolites that correlated with human acute brucellosis, all showing increased levels, except cis-4-hydroxy-D-proline, inosine, hypoxanthine and azelaic acid. These differential metabolites were predominantly involved in metabolic pathways, such as primary bile acid biosynthesis, purine metabolism, taurine and hypotaurine metabolism, and d-amino acid metabolism. This study identified potential metabolite biomarkers of acute brucellosis and laid the foundation for its early diagnosis and prognostic assessment, thus helping to prevent the chronicity of acute brucellosis.

Body roundness index trajectories in Chinese bariatric surgery patients: a retrospective longitudinal study

OBJECTIVE

To investigate the body roundness index (BRI) trajectory categories 12 months post-bariatric surgery and to explore the association between BRI and metabolic abnormalities.

DESIGN AND METHODS

Subject data were pooled from a tertiary hospital at baseline, 3 and 12 months post-surgery. Anthropometric measurements included the BRI and body mass index (BMI). Metabolic biomarkers comprised triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucose (GLU), and uric acid (UA). The BRI level was categorized using growth mixture model, and a multilevel logistic regression model was employed to explore the relationship between BRI and metabolic risk.

RESULTS

A total of 669 patients were included in this study, comprising 286 males (42.8%) and 383 females (57.2%), with an average age of 31.70 ± 9.53 years (range of 18 to 65 years). Patients were classified into three BRI trajectory categories. Compared to the Low-gradual decline group, the High-rapid decline group had an increased risk of abnormal HDL-C (OR = 2.84 [95% CI, 1.73 ~ 4.67]), and had the highest proportion of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (P < 0.001); while the High-gradual decline group had increased risk of abnormal TG (OR = 3.28 [95%CI,1.67-6.42]), HDL-C (OR = 4.30 [95%CI, 2.31 ~ 8.00]), LDL-C (OR = 2.10 [95%CI, 1.12 ~ 3.93]), and UA (OR = 2.33 [95%CI, 1.33 ~ 4.10]). After adjusting for demographics, lifestyle factors, and surgical procedures, the distribution of risk outcomes remained primarily consistent.

CONCLUSIONS

Sleeve gastrectomy (SG) plus procedures could potentially be associated with improvements in abdominal obesity and metabolic status in patients with high BRI. The post-bariatric trajectories based on BRI may offer insights into the metabolic risk levels of Chinese bariatric patients, but further research is needed to confirm these findings.

Compliance and Toxicity of Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Network Meta-analysis

PURPOSE

The individual chemotherapy- and radiotherapy-related toxicities between induction (iTNT) and consolidation total neoadjuvant therapy (cTNT) remain unclear. This network meta-analysis (NMA) comparing iTNT, cTNT, and traditional neoadjuvant chemoradiation (nCRT) evaluated the comparative treatment-related toxicities and compliance of the TNT schemas.

METHODS

A systematic review of randomized clinical trials and nonrandomized studies of interventions was performed as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. A Bayesian NMA was conducted, and odds ratios (OR) with 95% credible intervals (CrI) are reported for all outcomes.

RESULTS

Eighteen studies including 5730 patients were identified. iTNT ranked highest on rate of rectal bleeding (cTNT: OR 0.23 95% CrI 0.05-0.93; nCRT: OR 0.33, 95% CrI 0.09-0.96), proctitis (cTNT: OR 0.2, 95% CrI 0.06-0.55; nCRT: OR 0.2, 95% CrI 0.06-0.51), and postoperative diarrhea (cTNT: OR 0.37, 95% CrI 0.18-0.73; nCRT: OR 0.33, 95% CrI 0.15-0.71); cTNT ranked highest on rate of vomiting (iTNT: OR 0.24, 95% CrI 0.05-0.96; nCRT: OR 0.29, 95% CrI 0.06-0.89) and a higher rate of lymphopenia than iTNT (iTNT: OR 0.56, 95% CrI 0.34-0.99). Radiotherapy compliance was highest in cTNT (iTNT: OR 0.23, 95% CrI 0.05-0.72; nCRT: OR 0.18, 95% CrI 0.04-0.58). There was no difference in overall toxicity and mortality, chemotherapy compliance, and remaining individual system-based toxicities and postoperative complications.

CONCLUSIONS

Across all treatment strategies, iTNT had higher radiation-related gastrointestinal toxicities and postoperative diarrhea; cTNT had higher vomiting and lymphopenia rates. While no treatment strategy was superior in chemotherapy compliance, radiotherapy compliance was ranked highest in cTNT.

Octreotide attenuates experimental severe acute pancreatitis through inhibiting pyroptosis and modulating intestinal homeostasis

Severe acute pancreatitis (SAP) is a common clinical condition characterized by acute abdominal symptoms. Octreotide (OCT) is a commonly prescribed treatment for acute pancreatitis (AP). Recent research shows that pyroptosis and intestinal homeostasis significantly contribute to the progression of AP. However, it remains unclear whether OCT treats SAP through modulating pyroptosis and intestinal microbiota. Our study aimed to investigate and validate the potential therapeutic effects of OCT on SAP and underlying mechanisms. The inhibition of pyroptosis in mice using disulfiram was investigated to elucidate the role of pyroptosis in AP. Molecular biology experiments confirmed that OCT effectively inhibited the expression of pyroptosis-related markers. Additionally, the composition, abundance, and functionality of the intestinal microbiota were analyzed using 16S rRNA sequencing, while short-chain fatty acids (SCFAs) were quantified by targeted metabolomics. Our study demonstrated that the administration of OCT significantly mitigated the severity of SAP in a dose-dependent manner. Furthermore, the inhibition of pyroptosis in mice attenuated SAP, thereby highlighting the critical role of pyroptosis in this condition. OCT administration was observed to suppress the expression of key pyroptosis markers. Additionally, there was a notable reduction in intestinal permeability and bacterial translocation. OCT reverses gut dysbiosis caused by SAP, increasing beneficial bacteria while inhibiting pathogenic strains. Furthermore, OCT administration enhanced the levels of SCFAs, including propanoic acid, acetic acid, and butyric acid. Our findings indicate OCT has the potential to alleviate SAP by suppressing pyroptosis and restoring intestinal homeostasis.

GSK621 ameliorates lipid accumulation via AMPK pathways and reduces oxidative stress in hepatocytes in vitro and in obese mice in vivo

INTRODUCTION

Metabolic-dysfunction-associated fatty liver disease (MAFLD) represents a broad spectrum of liver lipid metabolism disorders associated with metabolic homeostasis, inflammation, oxidative stress, and fibrogenesis. The incidence of MAFLD has increased in recent years, but there is a lack of effective treatment strategies. GSK621 shows potential as a novel adenosine-monophosphate-activated protein kinase (AMPK) agonist; however, its function in lipid metabolism has not yet been confirmed.

OBJECTIVES

This study aimed to determine the effects of GSK621 on liver lipid accumulation in vitro and vivo and explore the underlying mechanism of these effects.

METHODS

The function of GSK621 in lipid deposition was investigated in vitro with HepG2 cells and normal mouse liver cells (AML12), and in vivo using C57BL/6 J mice fed with a high-fat diet (60 % fat) for 8 weeks to establish a model of MAFLD, followed by GSK621 treatment for a further 8 weeks.

RESULTS

GSK621 treatment significantly improved hepatocyte steatosis via the AMPK-carnitine palmitoyl transferase 1 (CPT1A) pathway and decreased levels of reactive oxygen species (ROS) in cells, accompanied by elevated expression of antioxidative stress proteins. MAFLD mice showed significant improvements in liver steatosis after GSK621 treatment, as well as increased expression of liver proteins related to the AMPK pathway and antioxidative stress.

CONCLUSION

GSK621 can improve hepatocytes steatosis in vitro and vivo via the AMPK-CPT1A pathway by increasing lipid metabolism and augmenting expression of antioxidant-stress-related proteins to reduce ROS deposition.

Oral microbiota signature predicts the prognosis of colorectal carcinoma

Emerging evidence links oral-derived gut microbes to colorectal cancer (CRC) development, but CRC prognosis-related microbial alterations in oral remain underexplored. In a retrospective study of 312 CRC patients, we examined the oral microbiota using 16S rRNA gene full-length amplicon sequencing to identify prognostic microbial biomarkers for CRC. Neisseria oralis and Campylobacter gracilis increased CRC progression risk (HR = 2.63 with P = 0.007, HR = 2.27 with P = 0.001, respectively), while Treponema medium showed protective effects (HR = 0.41, P = 0.0002). A microbial risk score (MRS) incorporating these species effectively predicted CRC progression risk (C-index = 0.68, 95% CI = 0.61-0.76). When compared to a model constructed solely from clinical factors, including tumor stage, lymphatic metastasis, and perineural invasion, the predictive accuracy significantly improved with the addition of the MRS, resulting in a C-index rising to 0.77 (P = 2.33 × 10-5). Our findings suggest that oral microbiota biomarkers may contribute to personalized CRC monitoring strategies, their implementation in clinical surveillance necessitates confirmatory studies.

Brain Effects of Iron Deficiency-Related Pagophagia

ABSTRACT

Pagophagia, defined as compulsive ice eating or ice chewing, is a common form of an eating anomaly (pica) caused by iron deficiency and is treated with iron replacement therapy. The physiological characteristics of pagophagia are reviewed. In one study, iron-deficient subjects were deficient in a test of attention, and ice consumption improved the subjects' response time relative to those drinking tepid water, an effect attributed to increased blood perfusion to the brain and heart. Several studies show that cold stimuli applied to the mouth increase blood flow velocity in the middle cerebral artery, increase peripheral blood pressure, and cause bradycardia. It is possible that pagophagia facilitates attention by elevating cerebral blood flow or by providing more oxygen to the brain. More research effort should be paid to the neurobehavioral impact of cold stimuli ingestion in humans and animals.

Obesity management before and after pancreas transplantation

PURPOSE OF REVIEW

We provide a review on the incidence, consequences, and management of obesity in patients before and after pancreas transplant.

RECENT FINDINGS

Obesity is common in patients with both type 1 and type 2 diabetes. Obesity at the time of pancreas transplant is associated with worse graft and patient survival, while weight gain after transplant is associated with insulin resistance and posttransplant diabetes. Currently, lifestyle interventions are the backbone of obesity management and can improve insulin sensitivity, but result in only modest weight loss. Metabolic and bariatric surgery (MBS) offers the potential for substantial and durable weight loss. Laparoscopic sleeve gastrectomy is the procedure of choice and can be performed safely both before and after pancreas transplant. Antiobesity medications (AOMs) may also be effective, but concerns remain regarding determine the safety and efficacy when used in pancreas transplant recipients. More evidence is needed to guide the use of AOMs and MBS in pancreas transplant recipients.

SUMMARY

Lifestyle interventions, MBS, and AOMs each have a role in managing obesity after pancreas transplantation. In light of limited evidence and unique challenges in pancreas transplant patients, obesity management in pancreas transplant patients requires an individualized approach that leverages multidisciplinary expertise.

Ion channel expression and function in glioblastoma multiforme (GBM): pathophysiological mechanisms and therapeutic potential

Glioblastoma Multiforme (GBM) is a highly malignant and diffusely invasive WHO Grade IV brain tumor arising from glial and neural stem cells. GBM is characterized by rapid proliferation and migration, aggressive invasion of local brain parenchyma, a hypoxic microenvironment, resistance to apoptosis and high vascular remodeling and angiogenesis. These hallmarks contribute to a near universal tumor recurrence after treatment or resection and poor patient prognosis. Ion channels, a superfamily of proteins responsible for permitting ion flux across otherwise impermeant membranes, show extensive remodeling in GBM with aberrant function mechanistically linked to manipulation of each of these hallmarks. In this review, we will discuss the known links between ion channel expression and activity and cellular processes that are enhanced or perturbed during GBM formation or progression. We will also discuss the extent to which basic or translational findings on ion channels in GBM samples or cell lines have shown preclinical promise towards the development of improved therapeutics against GBMs.

Changes of abdominal wall tension across various resistance exercises during maximal and submaximal loads in healthy adults: a cross-sectional study

INTRODUCTION

Resistance exercises are effective for maintaining health and activating stabilizing muscles, as they trigger abdominal wall tension responses. This study compared the effects of multi-joint and single-joint, upper-body and lower-body exercises (Lat pulldown, Rows, Peck deck, Chest press, Biceps curls, Triceps extensions, French-Press, Step up, Hip abduction/adduction, Squat, Leg press, Romanian deadlift, Hamstring curls) performed at maximal and submaximal intensities.

METHODS

This cross-sectional study included 12 men and 18 women (age:47.8 ± 5.9 years, height:174.8 ± 10.2 cm, weight: 77.7 ± 15.4 kg, BMI:25.3 ± 3.6), who wore a noninvasive sensor Ohmbelt to measure abdominal wall tension performing exercises at 15 repetition maximum (RM), 10RM, 5RM, and 1RM. Differences across exercises and sex were compared by Friedman test with Durbin-Conover post-hoc, and intensities were analyzed by Wilcoxon test.

RESULTS

The study found significant differences (p < 0.05) in abdominal wall tension changes based on the type of exercise and training intensity. Multi-joint lower-body exercises, such as the Romanian deadlift, dumbbell front squat, and leg press, led to the greatest increases in abdominal tension in both sexes in comparison to single-joint upper-body exercises. Males had higher abdominal wall tension changes than females (p < 0.05) at 1RM, 5RM, and 10RM. However, no significant difference was found at 15RM, indicating that lower intensities produce similar abdominal wall tension changes in both sexes.

CONCLUSIONS

This study showed that multi-joint lower-body exercises were found to produce greatest abdominal wall tension increases, especially compared to single-joint upper-body exercises. The abdominal wall tension was higher in males than females due to higher loads, emphasizing the need for exercise-specific approaches.

The anti-diabetic PPARγ agonist Pioglitazone inhibits cell proliferation and induces metabolic reprogramming in prostate cancer

Prostate cancer (PCa) and Type 2 diabetes (T2D) often co-occur, yet their relationship remains elusive. While some studies suggest that T2D lowers PCa risk, others report conflicting data. This study investigates the effects of peroxisome proliferator-activated receptor (PPAR) agonists Bezafibrate, Tesaglitazar, and Pioglitazone on PCa tumorigenesis. Analysis of patient datasets revealed that high PPARG expression correlates with advanced PCa and poor survival. The PPARγ agonists Pioglitazone and Tesaglitazar notably reduced cell proliferation and PPARγ protein levels in primary and metastatic PCa-derived cells. Proteomic analysis identified intrinsic differences in mTORC1 and mitochondrial fatty acid oxidation (FAO) pathways between primary and metastatic PCa cells, which were further disrupted by Tesaglitazar and Pioglitazone. Moreover, metabolomics, Seahorse Assay-based metabolic profiling, and radiotracer uptake assays revealed that Pioglitazone shifted primary PCa cells' metabolism towards glycolysis and increased FAO in metastatic cells, reducing mitochondrial ATP production. Furthermore, Pioglitazone suppressed cell migration in primary and metastatic PCa cells and induced the epithelial marker E-Cadherin in primary PCa cells. In vivo, Pioglitazone reduced tumor growth in a metastatic PC3 xenograft model, increased phosho AMPKα and decreased phospho mTOR levels. In addition, diabetic PCa patients treated with PPAR agonists post-radical prostatectomy implied no biochemical recurrence over five to ten years compared to non-diabetic PCa patients. Our findings suggest that Pioglitazone reduces PCa cell proliferation and induces metabolic and epithelial changes, highlighting the potential of repurposing metabolic drugs for PCa therapy.

The Recent Applications of Stem Cell-Derived Exosomes and Hydrogels in Neurological Disorders

Neurological disorders such as Alzheimer's disease, Parkinson's disease, and stroke pose significant challenges for conventional therapy due to the complexities of the blood-brain barrier (BBB) and the restricted delivery of drugs to the central nervous system. Exosomes, a type of small extracellular vesicle secreted by nearly all cell types, hold substantial promise as delivery vehicles for therapeutic agents in treating these conditions. Notably, stem cell-secreted exosomes have emerged as particularly effective due to their regenerative potential and natural ability to cross the BBB. Similarly, hydrogels have gained recognition as versatile biomaterials capable of supporting sustained release and targeted delivery of therapeutics. The combination of the regenerative properties of stem cell-derived exosomes (SC-Exos) with the structural and functional benefits of hydrogels offers a promising approach for enhancing neurogenesis, modulating neuroinflammation, and facilitating tissue repair. This review explores the origin, structure, and modifications of exosomes as well as the synthesis and incorporation methods of hydrogels in the therapeutic context for debilitating neurological disorders. It highlights recent advancements in using SC-Exos and hydrogels for therapeutic delivery, addressing both current challenges and future applications. Improving our understanding of hydrogels loaded with SC-Exos for cargo transportation and neural tissue regeneration may pave the way for novel therapeutic strategies.

Cellular crosstalk in fibrosis: insights into macrophage and fibroblast dynamics

Pathological fibrosis, the excessive deposition of extracellular matrix and tissue stiffening that causes progressive organ dysfunction, underlies diverse chronic diseases. The fibrotic microenvironment is driven by the dynamic microenvironmental interaction between various cell types; macrophages and fibroblasts play central roles in fibrotic disease initiation, maintenance, and progression. Macrophage functional plasticity to microenvironmental stimuli modulates fibroblast functionality by releasing pro-inflammatory cytokines, growth factors, and matrix remodeling enzymes that promote fibroblast proliferation, activation, and differentiation into myofibroblasts. Activated fibroblasts and myofibroblasts serve as the fibrotic effector cells, secreting extracellular matrix components and initiating microenvironmental contracture. Fibroblasts also modulate macrophage function through the release of their own pro-inflammatory cytokines and growth factors, creating bidirectional crosstalk that reinforces the chronic fibrotic cycle. The intricate interplay between macrophages and fibroblasts, including their secretomes and signaling interactions, leads to tissue damage and pathological loss of tissue function. In this review, we examine macrophage-fibroblast reciprocal dynamic interactions in pathological fibrotic conditions. We discuss the specific lineages and functionality of macrophages and fibroblasts implicated in fibrotic progression, with focus on their signal transduction pathways and secretory signalling that enables their pro-fibrotic behaviour. We then finish with a set of recommendations for future experimentation with the goal of developing a set of potential targets for anti-fibrotic therapeutic candidates. Understanding the cellular interactions between macrophages and fibroblasts provides valuable insights into potential therapeutic strategies to mitigate fibrotic disease progression.

Serum hepatitis B virus RNA in low-level viremia of chronic hepatitis B: clinical features and association with virological response

BACKGROUND

The role of hepatitis B virus (HBV) RNA in the management of patients with chronic hepatitis B (CHB) experienced with low-level viremia (LLV) remains poorly defined. This study was designed to evaluate the prognostic utility of serum HBV RNA as a biomarker for predicting treatment outcomes in this population.

METHODS

A retrospective cohort analysis was conducted on 117 pediatric patients with LLV (mean age: 13.14 years; 34% female) treated with continuous entecavir (ConT) or modified regimens (switching to or combining with tenofovir disoproxil fumarate) for ≥ 120 weeks. Virological response was defined as HBV DNA < 10 IU/mL at week 120.

RESULTS

No significant baseline differences existed between ConT and modified regimen groups. Compared to ConT, modified regimens achieved greater reductions in serum HBV DNA, HBV RNA, and quantitative HBsAg, with higher cumulative undetectable rates at week 120 (HBV DNA: ≥ 80.0%; HBV RNA: ≥ 54.8%; P < 0.05). Notably, qHBsAg levels remained elevated in most patients, with only 3 individuals achieving undetectable levels (< 0.05 IU/mL). Multivariate analysis identified higher HBV RNA levels at week 48 as an independent risk factor for non-virological response (adjusted odds ratio: 5.86; 95% confidence interval: 1.40-24.62; P = 0.016). Although HBV RNA alone was less predictive than HBV DNA (area under the receiver operating characteristic curve [AUC]: 0.76 vs. 0.80; P = 0.459), combining both markers improved prediction accuracy (AUC: 0.82; P < 0.05 vs. single markers).

CONCLUSIONS

In children with LLV, serum HBV RNA level is an independent risk factor for non-virological response and may serve as a complementary biomarker to HBV DNA for guiding antiviral therapy adjustments.

Preparation and characterization of surfactant-modified chitosan micelles loaded with curcumin for their use as drug delivery system

Surfactant-modified chitosan derivatives were prepared using Brij-35, a non-ionic surfactant, and low molecular weight chitosan (CS), with the aim of developing new nanocarriers of poor water-soluble compounds. First, surfactant Brij-35 was functionalized with succinic anhydride (SA) to give Brij-SA, which reacted with CS through an amidation reaction. The synthesized amphiphilic CS derivatives were characterized by proton nuclear magnetic resonance, infrared spectroscopy, X-ray diffraction, and thermogravimetric analysis. In addition, the particle size of CS-g-Brij-35 micelles was determined by dynamic light scattering, while the critical micelle concentration (CMC) was determined through different techniques, including surface tension, conductivity, and pH. Afterward, CS-g-Brij-35 micelles were loaded with curcumin and the release profiles were studied at two pH values (7.4 and 5.0). Results showed that the grafting of surfactant onto CS depended on the molar ratio of Brij-35:CS, obtaining values from 3 to 21 %. The CS-g-Brij-35 micelles showed an average size of ~225 nm and CMC value of ~0.1 mg/mL. Finally, a sustained release during the first 10 h was observed with an increase of the release percentage at pH 5.0, which could make them suitable as nanocarriers of hydrophobic drugs.

Novel evidence in vivo: Berberine ameliorated glucocorticoid-induced post-natal growth retardation by regulating the GH/IGF-1 axis through KMT1A downregulation

BACKGROUND

Glucocorticoids (GCs) are widely used anti-inflammatory agents that inhibit growth in children. However, their mechanisms and effect on the growth hormone (GH)/insulin-like growth factor (IGF)-1 axis remain unclear.

PURPOSE

This study, we aimed to establish a mouse model of GC-induced growth retardation during the critical growth period and explore the underlying mechanisms. Additionally, we aimed to identify novel biomarkers and potential therapeutic agents for GC-induced growth impairment.

METHODS

Four-week-old mice were treated with GCs for two weeks and subsequently assessed for body length, weight, and body composition. Immunohistochemical analysis of the growth plate in the proximal tibia and biochemical assays of blood were performed to evaluate changes in growth plate length and GH/IGF-1 axis. KMT1A expression and its effects on Ghr expression were examined, and the impact of berberine on GC-induced growth retardation was assessed.

RESULTS

GCs significantly reduced growth by impairing growth plate expansion, disrupting the GH/IGF-1 axis, and downregulation of the GH receptor (Ghr) and Igf-1 levels in the liver. These changes were attributed to the upregulation of the H3K9 trimethyltransferase KMT1A, which decreased Ghr transcription in the liver. In vitro screening of natural compounds revealed that berberine chloride hydrate decreased the KMT1A levels and increased GHR levels. Berberine chloride hydrate also effectively ameliorated GC-induced growth retardation by restoring Ghr expression via KMT1A inhibition, thereby enhancing the circulating IGF-1 levels.

CONCLUSION

Overall, our findings highlight the potential of targeting KMT1A using berberine chloride hydrate as an epigenetic modifier to treat GC-induced growth impairment.

Research on Classification Criteria for the Reducibility and Irreducibility of Intertrochanteric Femoral Fractures

OBJECTIVE

The current classification of intertrochanteric femoral fractures primarily follows the AO/OTA system, which guides treatment but fails to accurately predict preoperative reduction difficulty. Since reduction quality directly impacts fracture healing, internal fixation success, and patient rehabilitation, developing a classification standard that aids in predicting reduction difficulty holds significant clinical implications for achieving optimal outcomes. The purpose of this study was to develop classification criteria for femoral intertrochanteric fractures based on their reducibility and irreducibility and to provide a reference standard for preoperative predictions of the level of difficulty likely to accompany the fracture.

METHODS

Four hundred thirty-seven patients with intertrochanteric fractures of the femur treated at the Affiliated Hospital of Jining Medical University and several county hospitals from January 2015 to August 2023 were reviewed. The fractures were divided into irreducible and reducible types according to actual intraoperative reduction. The imaging data were collated and analyzed, the type of fracture that may have affected the reduction was selected, the data were collated according to the type of fracture as well as the AO type, unconditional univariate logistic regression analysis was performed, and the OR values were calculated.

RESULTS

Logistic regression revealed that the risk factors leading to irreducibility were 31A3, 31A3.3, 31A1 (with obvious separation displacement), 31A2 (with anterior angular exostosis) and 31A2 (with a concomitant proximal femur fracture) fractures. Intertrochanteric fractures were typed according to the risk factors suggested by the statistical results and the specific intraoperative imaging manifestations, with irreducibility divided into 3 types and reducibility divided into 2 types, each with their respective subtypes. The accuracy of this typing in predicting the degree of difficulty of intraoperative restoration was 78.4% (343/437), and the test of consistency showed kappa = 0.573 (moderate consistency).

CONCLUSION

Classifying intertrochanteric fractures into reducible and irreducible types can accurately preoperatively predict the difficulty of reduction for the vast majority of reducible fractures and most irreducible fractures, guide treatment, and predict the prognosis of the fracture.

The risk factors affecting effect of extracorporeal shock wave lithotripsy for pancreatic duct stones

OBJECTIVES

This study aimed to investigate the factors affecting effect of extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones.

MATERIALS AND METHODS

The data of 160 patients who underwent ESWL for pancreatic duct stones in Department of Gastroenterology, First People's Hospital of Hangzhou, Westlake University School of Medicine, from July 2017 to June 2023, were retrospectively analyzed. The age and sex of the patients were recorded. All patients underwent spiral computed tomography (CT) abdominal plain scan. The placement of the pancreatic duct stent was recorded. The maximum CT value of stones was manually measured. The regions of interest (ROI) was delineated using ITK-SNAP software, and the stone volume was recorded. According to the size of residual stones after lithotripsy, 99 patients were included in the complete lithotripsy group (CL Group) and 61 patients in the incomplete lithotripsy group (ICL Group). SPSS 26.0 software was used for processing and analysis. A P value < 0.05 was considered statistically significant.

RESULTS

The Sex, maximum CT value, and volume of pancreatic duct stones were statistically significant in both groups. Binary logistic regression analysis showed that female sex, maximum CT value, and volume of pancreatic duct stones were independent risk factors affecting incomplete ESWL fragmentation in pancreatic duct stones. ICL group had a higher mean number of treatments and mean number of impacts than CL group.

CONCLUSION

The Sex, maximum CT value, and volume of stones were related to the therapeutic effect of ESWL. Female sex, maximum CT value, and volume of stones were independent risk factors affecting incomplete stone fragmentation.

Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy Compared with Chemotherapy as First-Line Treatment for Advanced PD-L1-Positive Triple-Negative Breast Cancer from a Japanese Healthcare Perspective

BACKGROUND AND OBJECTIVES

Pembrolizumab has been approved for the immunotherapy of programmed death ligand 1 (PD-L1)-positive triple-negative breast cancer (TNBC) based on the KEYNOTE-355 trial. However, cost-effectiveness evidence is limited. The purpose of this study was to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy compared with chemotherapy alone for patients with PD-L1-positive inoperable or metastatic TNBC from a Japanese healthcare perspective.

METHODS

The cost-effectiveness analysis was performed for pembrolizumab, of which the drug price was determined at 214,498 Japanese yen (JPY), or 1631 US dollars (USD) (1 USD = 131.5 JPY) for KEYTRUDA® (100 mg), using a partition survival model based on the KEYNOTE-355 trial subgroup analysis in Japan. The comparison was made using quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). One-way deterministic and probabilistic sensitivity analyses (PSA), which evaluate the impact of parameter uncertainty, were performed to assess the robustness and calculate the acceptable probability, defined as the probability of the ICER being below the willingness-to-pay (WTP).

RESULTS

Pembrolizumab plus chemotherapy provided an additional 0.676 QALYs at an incremental cost of 8,503,072 JPY. The ICER for pembrolizumab plus chemotherapy compared with conventional chemotherapy was 12,577,178 JPY (95,644 USD) per QALY. The ICER per QALY was below the willingness-to-pay threshold of 15,000,000 JPY. PSAs revealed that the acceptable probability was 83.9% at 15,000,000 JPY.

CONCLUSIONS

The pembrolizumab plus chemotherapy is likely to be a cost-effective option compared with conventional chemotherapy for patients with PD-L1-positive inoperable or metastatic TNBC in a Japanese medical environment from a healthcare system.

Defining Clinical Remission in Severe Asthma: Expert Opinion from the Gulf Region Using the Modified Delphi Method

The introduction of biologics into the asthma management landscape and the adoption of patient-centricity and outcomes principles drive the need to revise clinical goals and targets while treating asthma patients. This necessitates a deeper understanding of asthma phenotypes, endotypes, pathophysiology, and clinical cutoff points depicting an operational definition of clinical remission in asthma. This publication represents a step in this direction, through systemically gathering and analyzing insights from experts in pulmonology and immunology from the Gulf Countries. A pre-workshop survey, scientific workshop, and two rounds of Delphi surveys constituted the analysis process and resulted in agreed-upon comprehensive criteria defining clinical remission in severe asthma. While constructing the Delphi expert opinion addressing the concept of on treatment remission, the following factors were agreed to be the main defining criteria: The sustained absence of asthma symptoms, the sustained absence of asthma exacerbations, stable lung function, and zero systemic corticosteroids for the treatment of asthma for at least 12 months.

Gut Microbiota and Exercise: Probiotics to Modify the Composition and Roles of the Gut Microbiota in the Context of 3P Medicine

Prolonged and intense physical activity can trigger stress response mechanisms across various physiological systems-including the cardiovascular, respiratory, gastrointestinal, musculoskeletal, and neuroendocrine systems-disrupting energy metabolism, immune function, redox balance, and hormonal regulation. Critically, when not accompanied by adequate recovery, such exertion may impair rather than enhance athletic performance. In parallel, there has been growing interest in probiotics as natural, safe, and accessible dietary supplements with the potential to support performance and recovery. Emerging evidence highlights the pivotal role of the gut microbiome in mediating communication along the gut-brain and gut-muscle axes, thereby influencing not only metabolic and immune functions but also neuromuscular adaptation and fatigue resistance. This review explores the mechanisms through which probiotics may enhance exercise performance, mitigate exercise-induced fatigue, and improve physiological adaptation via modulation of inflammation, oxidative stress, and metabolic signaling pathways. Framed within the context of predictive, preventive, and personalized medicine (3P medicine), this paper emphasizes the diagnostic and therapeutic potential of personalized probiotic strategies in optimizing athletic performance through the qualitative and quantitative assessment of microbiota and host responses.

Unveiling the differences: infection disorders associated with tumor necrosis factor α inhibitors in pediatric patients-a pharmacovigilance study (2004-2023)

The increasing use of tumor necrosis factor inhibitors (TNFi) in pediatric patients has raised concerns about their potential impact on the immune system and related adverse events. Infection-related adverse events (AEs) caused by TNFi have already raised widespread concerns in real-world settings. This study aims to comprehensively analyze and summarize the infection-related AEs associated with TNFi in pediatric patients. A retrospective pharmacovigilance study was conducted to identify cases of TNFi-related infections reported to the FDA Adverse Event Reporting System (FAERS) database between Q1 2004 and Q1 2023. TNFi reports were carefully reviewed to exclude confounding factors like other AEs, concomitant medications, and prescription indications. Proportionality analysis was conducted by comparing TNFi reports to the entire FAERS database to identify infection-related AEs significantly associated with TNFi use. Infection-related AEs accounted for 8.36% of all TNFi-related adverse event reports in the FAERS database. A total of 8050 cases of TNFi-associated infections were identified in the pediatric population, with 2.57% of reports resulting in fatalities. Infliximab and golimumab showed a stronger association with infection-related AEs compared to other TNFi. Notably, only adalimumab shows a lower risk of viral infections, while it exhibits an increased risk of bacterial and mycobacterial infections, similar to other TNFi.

CONCLUSIONS

This study identified a significant association between TNFi use and infection-related AEs in pediatric patients, providing the foothold for further research. However, due to its retrospective nature, further investigations are warranted to confirm these findings and identify potential risk factors in a controlled, prospective study setting.

WHAT IS KNOWN

• There is sufficient evidence to demonstrate the infection risk associated with TNFi in adult patients. • Pediatric patients, whose immune systems are still developing, are more vulnerable to certain infections.

WHAT IS NEW

• There is a significant association between TNFi use and infection-related adverse events in pediatric patients, and different TNFi have distinct infection profiles.

Nomogram prediction of molecular characteristics in WHO grade 3-4 diffuse gliomas based on fractal analysis and VASARI features

Effective prediction of molecular features is crucial for the prognostic assessment of glioma patients. This study aims to develop a nomogram model using fractal analysis and Visually AcceSAble Rembrandt Images (VASARI) features to predict the molecular characteristics of WHO Grade 3-4 diffuse gliomas. Retrospective analysis of clinical data and VASARI features of patients with WHO grade 3-4 diffuse gliomas confirmed by pathology between January 2020 and December 2023 at our institution. Preoperative T1-weighted contrast-enhanced and T2-weighted images were used to delineate the tumor and surrounding edema regions on 3D-Slicer. Fractal dimension (FD) and lacunarity of both the tumor and surrounding edema were extracted using ImageJ software. Univariate and multivariate logistic regression analyses were performed to identify independent predictive factors for the Ki_67 proliferation index (PI), p53, and telomerase reverse transcriptase promoter (TERTp) mutations. Based on these findings, a nomogram prediction model was constructed. Model performance was comprehensively assessed using the receiver operating characteristic curve (ROC), calibration curve (CRC), and decision curve analysis (DCA). Sex, Proportion Enhancing, and Pial invasion were identified as independent predictive factors for the Ki_67 PI. FD of the tumor (FD(T)) was an independent predictor for p53 expression. FD(T), Enhancement Quality, and Definition of the enhancing margin were independent predictors for TERTp mutations. The areas under the ROC for each nomogram model were 0.791, 0.739, and 0.601, respectively. Sensitivities were 68.75%, 78.12%, and 51.43%, and specificities were 81.03%, 64.86%, and 71.00%, respectively. CRC showed a high degree of concordance between predicted probabilities and actual observed values, while DCA demonstrated favorable net benefits for all models. VASARI features and fractal analysis effectively predict the Ki_67 PI, p53, and TERTp mutations in WHO grade 3-4 diffuse gliomas. Furthermore, combining these two approaches enhances the predictive performance for TERTp mutations.

Pathogenesis and Systemic Treatment of Hepatocellular Carcinoma: Current Status and Prospects

Hepatocellular carcinoma (HCC) remains one of the major threats to human health worldwide. The emergence of systemic therapeutic options has greatly improved the prognosis of patients with HCC, particularly those with advanced stages of the disease. In this review, we discussed the pathogenesis of HCC, genetic alterations associated with the development of HCC, and alterations in the tumor immune microenvironment. Then, important indicators and emerging technologies related to the diagnosis of HCC are summarized. Also, we reviewed the major advances in treatments for HCC, offering insights into future prospects for next-generation managements.

Impairment of Esophageal Barrier Integrity: New Insights into Esophageal Symptoms in Post-COVID-19

BACKGROUND

The COVID-19 pandemic, caused by SARS-CoV-2, has unveiled a range of symptoms beyond the respiratory system, including significant gastrointestinal manifestations.

AIMS

This study explores the prevalence and intensity of gastroesophageal symptoms in post-COVID-19 patients and the integrity of the esophageal epithelial barrier.

METHODS

We conducted a prospective longitudinal cohort study with 55 patients hospitalized due to COVID-19 at a University Hospital. Patients were evaluated during hospitalization and between 3 and 6 months post-discharge, using validated questionnaires for gastrointestinal and gastroesophageal reflux symptoms. Additionally, 25 of these patients underwent upper digestive endoscopy, with esophageal mucosal biopsies analyzed for transepithelial electrical resistance (TER), permeability, and expression of inflammatory cytokines and cell junction proteins. Data expressed as mean EPM, inference by two-way ANOVA.

RESULTS

Results were considered statistically significant at p < 0.05. There were significant increases in heartburn and acid reflux symptoms in post-COVID-19 patients, as measured by the GSRS questionnaire. Biopsies from post-COVID patients revealed increased esophageal permeability when compared to non-COVID patients in acidic media (pH 2: non-COVID-19: 717.8 ± 168.2 vs. post-COVID-19: 1377.6 ± 316.4), suggesting compromised mucosal barrier. Furthermore, IL-8 levels and expression of Claudin-2 were elevated in these patients.

CONCLUSIONS

The data suggested that COVID-19 infection may cause lasting damage to the esophageal epithelial barrier, increasing its permeability and provoking an exacerbated inflammatory response. These changes may explain the prevalence of post-infection gastroesophageal symptoms. Our findings underscored the importance of continuous monitoring and the development of therapeutic strategies to mitigate gastroesophageal effects in patients recovering from COVID-19.

Acute aortic dissection in a patient with Hereditary Hemorrhagic Telangiectasia associated with Juvenile Polyposis due to SMAD4 mutation: case report and literature review

OBJECTIVE

We present a novel case of concurrent Hereditary Hemorrhagic Telangiectasia-Juvenile Polyposis Syndrome (HHT-JP), resulting in a fatal aortic dissection. Given rarity of the case, we aimed to perform a comprehensive review of the existing literature to better characterize this clinical complication in this population.

METHODS

We conducted a literature review on HHT-JP syndrome using PubMed, focusing on English-language articles published between 2010 and 2024, specifically case reports and small series. Search terms "Hereditary Hemorrhagic Telangiectasia", "Osler-Weber-Rendu syndrome" and "Juvenile Polyposis" were used. Exclusion criteria included population studies lacking detailed individual characteristics related to Hereditary Hemorrhagic Telangiectasia (HHT) or Juvenile Polyposis (JP). Duplicate articles were removed, and data were extracted on patient demographics, clinical presentations, diagnostic criteria (Curaçao criteria for HHT, Jass criteria for JP), treatments, and outcomes.

RESULTS

Fifty-six individuals with the MADH4 mutation met the inclusion criteria and were compared to our patient. The age range of the total cohort of fifty-six participants spanned from 6 to 66 years, with a distribution between men and women. The typical clinical presentation of HHT-JP was observed in most cases. Notably, only one patient from previous literature exhibited aortic dissection, aligning with our patient's presentation. Additionally, three other patients had aortic aneurysms. Musculoskeletal and other cardiovascular anomalies were also identified and described.

DISCUSSION

While aortic aneurysms prevail in HHT-JP syndrome, aortic dissection cases are extremely rare. This case highlights the need for vigilant screening to identify aortic anomalies in this specific patient subset, emphasizing the severe complications associated with this syndrome combination.