Cross-sectional association of fitness, fatness, and dyslipidemia with metabolic syndrome in youth

BACKGROUND

The prevalence of metabolic syndrome (MetS) in adolescents is rising, correlating with the global increase in obesity and physical inactivity.

AIM

To examine the individual and combined associations of fitness, fatness, visceral adiposity index (VAI), and lipid ratios with MetS risk in Nigerian adolescents.

METHODS

This cross-sectional study included a sample of 403 adolescents (201 girls and 202 boys) aged 11-19 years. Participants were assessed for cardiorespiratory fitness, body mass index (BMI), VAI, triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and total cholesterol-to-high-density lipoprotein cholesterol ratio (TC/HDL-C). Regression models adjusted for age and sexual maturity were used to determine the associations between these health markers and MetS risk.

RESULTS

Among the 177 high-risk adolescents, 56.6% were at risk of central obesity, 49.1% had low fitness, 33.3% had dyslipidemia, and 11.7% were obese. After controlling for confounding variables, all health markers were independently and jointly associated with MetS risk, with VAI displaying the strongest explanatory power (girls: β = 1.308, P < 0.001; boys: β = 2.300, P < 0.001). Unfit girls were 5.1% more likely to be at risk of MetS, while the odds of unfit boys being at risk of MetS is 3.6. Boys with elevated VAI were 22.3 times more likely to be at risk of MetS, while the likelihood of girls with elevated VAI developing MetS risk is 2.78.

CONCLUSION

Health markers were independently and jointly associated with MetS risk in adolescents, with VAI and dyslipidemia contributing most significantly. Promoting healthy eating and also aerobic activities among adolescents is crucial for improving metabolic health.

Analysis of fatal outcomes of patients with mucopolysaccharidosis type II according to the Russian mucopolysaccharidosis registry

BACKGROUND

Mucopolysaccharidosis type II (MPS II) is a chronic inherited disease with multiorgan involvement, a progressive course, and restricted life expectancy.

AIM

To evaluate the predictors of fatal outcomes in MPS II patients.

METHODS

In the retrospective cohort study, the clinical, laboratory data and enzyme replacement therapy (ERT) (84.2%) of about 160 patients were extracted and analyzed from the Russian MPS II registry, with death as a primary outcome. We compared patients who died (n = 20; 12.5%) with severe form (n = 13; 68.4%) and attenuated form (n = 6, 31.6%) to 140 alive patients.

RESULTS

Fatal outcomes occurred in 5%, 35%, 20%, and 40% of patients before 10, 10-14, 15-19, and ≥ 20 years. The most common causes of death were cardiovascular (29.4%), respiratory failure (17.6%), including pneumonia (17.6%), and their associations (17.6%) and MPS II progression (11.8%). Acute or chronic respiratory failure was in 53%. Died patients had higher birth weight, higher age of diagnosis, and start of ERT. Hydrocephalus, hydrocephalus bypass surgery, epilepsy, difficulty swallowing, and impaired movement after 12 years of age were significantly more common in the deceased patients. Cox regression analysis has revealed the following time-dependent covariates of the lethal outcome: 1^st-year psychomotor development delay, delayed mental and speech development, hydrocephalus, swallow disorders, impossible walking at age > 12 years, respiratory disorders, tracheostomy, neuronopathic form.

CONCLUSION

Increased birth weight, delayed diagnosis and the start of ERT, and development of neuronopathic form with impossible walking after 12 years were the main predictors of the fatal outcome.

Diagnostic and management challenges in a partially infarcted borderline phyllodes tumor in an adolescent female: A case report and review of literature

BACKGROUND

Fibroadenomas (FA) and phyllodes tumors (PT) are fibroepithelial neoplasms and are difficult to differentiate radiographically and histologically. We present a partially infarcted borderline PT in an adolescent with rapid tumor enlargement within 24 hours. Tumor infarction made the diagnostic work-up difficult. Complete surgical excision is the standard of care for PTs. There is controversy regarding margin re-excision for borderline PTs. In this report, we discuss the diagnostic challenges of PT and the evolving concept of margin status on PT recurrence rate.

CASE SUMMARY

A 14-year-old healthy female with no medical history presented with a painful right breast mass with no nipple discharge, trauma, or skin findings. The mass showed rapid enlargement over 24 hours, prompting a workup with ultrasound and core needle biopsy. The initial biopsy was limited due to large areas of infarction. Based on the scant viable tissue and considering the patient’s age, the mass was favored to be a juvenile FA. The patient underwent excision of the mass. Final pathology confirmed a borderline PT with positive surgical margins. The patient underwent margin re-excision, which did not show any residual tumor. At the 6-month post-op visit, there was a mass-forming lesion on the breast ultrasound. Subsequent core needle biopsy showed benign breast parenchyma with scar formation. The primary goal of evaluation in pediatric breast masses is to do no harm. However, rapidly growing and symptomatic masses require a more extensive work-up including biopsy and surgical excision. We present a rapidly growing breast mass in a 14-year-old female which was diagnosed as a borderline PT on her excision specimen. The mass rapidly enlarged over 24 hours. The initial biopsy pathology was limited due to a large area of infarction. The patient underwent excision of the mass. Final pathology confirmed a borderline PT that extended into the surgical margin, resulting in an additional re-excision procedure. Accurate diagnosis prior to surgical intervention is crucial to avoid additional procedures. Although histological morphology remains the gold standard for diagnosis, immunohistochemistry and molecular studies have recently shown to improve the accuracy of diagnosis of PTs. Long-term clinical and pathologic follow-up of PTs in adolescent patients should be collectively studied to examine whether our current diagnostic criteria for PT can reliably predict tumor behavior in this age group.

CONCLUSION

Accurate diagnosis of PTs requires surgical excision. Tumor infarction may lead to rapid tumor enlargement, hindering the correct diagnosis. More research is needed on margin status and recurrence rate, especially in adolescent patients, to help establish the best possible care for this age group.

Reevaluating health metrics: Unraveling the limitations of disability-adjusted life years as an indicator in disease burden assessment

In 1993, the World Bank released a global report on the efficacy of health promotion, introducing the disability-adjusted life years (DALY) as a novel indicator. The DALY, a composite metric incorporating temporal and qualitative data, is grounded in preferences regarding disability status. This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application. In contrast to the quality-adjusted life years approach, derived from multi-attribute utility theory, the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights. Claiming to rely on no mathematical or economic theory, DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators, notably content validity, reliability, specificity, and sensitivity. The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative, leading to numerous publications in international literature. Despite widespread adoption, the DALY synthetic indicator has prompted significant methodological concerns since its inception, manifesting in inconsistent and non-reproducible results. Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments, a reassessment is warranted. This reconsideration is imperative for enhancing the robustness and reliability of public health decision-making processes.

Burden landscape of hepatobiliary and pancreatic cancers in Chinese young adults: 30 years’ overview and forecasted trends

BACKGROUND

Hepatobiliary and pancreatic (HBP) cancers impose a considerable burden on young populations (aged 15 to 49 years), resulting in a substantial number of new cases and fatalities each year. In young populations, the HBP cancers shows extensive variance worldwide and the updated data in China is lacking.

AIM

To investigate the current status, trends, projections, and underlying risk factors of HBP cancers among young populations in China.

METHODS

The Global Burden of Disease Study 2019 provided data on the annual incidence, mortality, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALYs rate (ASDR) of HBP cancers in young Chinese adults between 1990 and 2019. Temporal trends were assessed using estimated annual percentage change and hierarchical clustering. Sex-specific mortality and DALYs caused by various risks were analyzed across China and other regions, with future trends until 2035 projected using the Bayesian age-period-cohort model.

RESULTS

From 1990 to 2019, incident cases, deaths, DALYs, ASIR, ASMR, and ASDR for liver cancer (LC) in young Chinese individuals decreased, classified into 'significant decrease' group. Conversely, cases of gallbladder and biliary tract cancer and pancreatic cancer rose, categorized as either 'significant increase' or 'minor increase' groups. The contribution of risk factors to mortality and DALYs for HBP tumors increased to varying degrees. Healthy lifestyle behaviors, such as tobacco control, weight management, alcohol moderation, and drug avoidance, could lower HBP cancers incidence. Moreover, except for LC in females, which is likely to initially decline slightly and then rise, the forecasting model predicted that the ASIR and ASMR for all HPB cancers subtypes by gender will increase among young adults.

CONCLUSION

HBP cancers burden among young adults in China is expected to increase until 2035, necessitating lifestyle interventions and targeted treatment strategies to mitigate the public health impact of these cancers.

Outcomes and adverse events following intra-arterial chemotherapy for retinoblastoma: A single center study in South India

BACKGROUND

Intra-arterial chemotherapy (IAC) has become a first-line standard treatment for retinoblastoma (RB). However, studies describing its adverse events are sparse, especially from the developing world. Our study described the outcomes and adverse events from a single center in South India.

AIM

To describe the challenges, treatment outcomes, and complications of selective IAC for RB in Indian eyes.

METHODS

This study was a single center, retrospective study that included 17 patients with RB who underwent IAC using melphalan (5/7.5 mg) and topotecan (1/2 mg) (n = 12) or melphalan (5 mg) alone (n = 3) or triple therapy that included carboplatin (30 mg) along with these drugs (n = 2) between January 2018 and December 2023. In all, 17 IAC procedures were performed using selective ophthalmic artery cannulation. Treatment outcomes were evaluated in terms of tumor control, vitreous and subretinal seed control, complications, and globe salvage rates.

RESULTS

Out of the 17 patients, 11 were diagnosed with unilateral RB and 6 were diagnosed with bilateral RB. The mean age at the time of diagnosis was 19.8 months. The mean interval between the first symptom and presentation was 6.5 months. IAC was employed as the primary (n = 9) or secondary (n = 8) modality of treatment. Each eye received a mean of 1.5 IAC sessions (median: 1 session; range: 1-3 sessions). Eyes were classified according to the international classification of RB as group B (n = 5), group C (n = 1), group D (n = 4), and group E (n = 7). Following IAC, complete regression of the main tumor was seen in 15 eyes (88%) and partial regression in 2 eyes (12%). Globe salvage was achieved in 15 eyes (88%). Adverse effects included vitreous hemorrhage (n = 3), rhegmatogenous retinal detachment (n = 2), choroidal ischemia (n = 1), isolated subretinal hemorrhage (n = 2), retinal pigment epithelium degeneration (n = 2), forehead pigmentation (n = 1), third nerve palsy with complete ptosis (n = 1), and 30-degree exotropia (n = 1). The mean follow-up period was 28.6 months (median: 24 months, range: 1–72 months).

CONCLUSION

IAC is an effective way to control RB and globe preservation. In the Indian context we encountered many challenges highlighting the importance of case selection. Further studies in India are required to thoroughly understand IAC as a treatment for RB.

Weight regain after intragastric balloon for pre-surgical weight loss

BACKGROUND

Over one-third of Americans carry the diagnosis of obesity, many also with obesity-related comorbidities. This can place patients at increased risk of operative and postoperative complications. The intragastric balloon has been shown to aid in minor weight loss, however its weight recidivism in patients requiring short interval weight loss has not been well studied.

AIM

To evaluate weight loss, ability to undergo successful elective surgery after intragastric balloon placement, and weight management after balloon removal.

METHODS

This study is a retrospective review of patients in a single academic institution undergoing intragastric balloon placement from 2019-2023 to aid in weight loss prior to undergoing elective surgery. Clinical outcomes including weight loss, duration of balloon placement, successful elective surgery, weight regain post-balloon and post-procedure complications were assessed. Exclusion criteria included those with balloon in place at time of study.

RESULTS

Thirty-three patients completed intragastric balloon therapy from 2019-2023 as a bridge to elective surgery. All patients were required to participate in a 12-month weight management program to be eligible for balloon therapy. Elective surgeries included incisional hernia repair, umbilical hernia repair, inguinal hernia repair, and knee and hip replacements. The average age at placement was 53 years ± 11 years, majority (91%) were male. The average duration of intragastric balloon therapy was 186 days ± 41 days. The average weight loss was 14.0 kg ± 7.4 kg and with an average percent excess body weight loss of 30.0% (7.9%-73.6%). Over half of the patients (52.0%) achieved the goal of 30-50 lbs (14-22 kg) weight loss. Twenty-one patients (64%) underwent their intended elective surgery, 2 patients (6%) deferred surgery due to symptom relief with weight loss alone. Twenty-one of the patients (64%) have documented weights in 3 months after balloon removal, in these patients the majority (76%) gained weight after balloon removed. In patients with weight regain at 3 months, they averaged 5.8 kg after balloon removal in the first 3 months, this averaged 58.4% weight regain of the initial weight lost.

CONCLUSION

Intragastric balloon placement is an option for short-term weight management, as a bridge to elective surgery in patients with body mass index (BMI) > 35. Patients lost an average of 14 kg with the balloon, allowing two-thirds of patients to undergo elective surgery at a healthy BMI. However, most patients regained an average of 58% of the original weight lost after balloon removal. The intragastric balloon successfully serves as a tool for rapid weight loss, though patients must be educated on the risks including weight regain.

Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast

BACKGROUND

Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039.

AIM

To comprehensively investigate IBD data, providing further insights into the management of this chronic disease.

METHODS

We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1).

RESULTS

North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases.

CONCLUSION

As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.

Evaluating combined bevacizumab and XELOX in advanced colorectal cancer: Serum markers carcinoembryonic antigen, carbohydrate antigen 125, carbohydrate antigen 199 analysis

BACKGROUND

Colorectal cancer ranks third and second among common and fatal cancers. The treatment of metastatic colorectal cancer (mCRC) is generally based on XELOX in clinical practice, which includes capecitabine (CAP) and oxaliplatin. Serum tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 125 and CA199 are prognostic factors for various tumors.

AIM

To investigate evaluating combined bevacizumab (BEV) and XELOX in advanced colorectal cancer: Serum markers CEA, CA125, CA199 analysis.

METHODS

In this retrospective study, a total of 94 elderly patients diagnosed with mCRC were recruited and subsequently categorized into two groups based on the distinct treatment modalities they received. The control group was treated with XELOX plus CAP (n = 47), while the observation group was treated with XELOX plus CAP and BEV (n = 47). Several indexes were assessed in both groups, including disease control rate (DCR), incidence of adverse effects, serum marker levels (CEA, CA125, and CA19) and progression-free survival (PFS).

RESULTS

After 9 wk of treatment, the serum levels of CEA, CA199 and CA125 in the observation group were significantly lower than those in the control group (P < 0.05). Moreover, the PFS of the observation group (9.12 ± 0.90 mo) was significantly longer than that of the control group (6.49 ± 0.64 mo). Meanwhile, there was no statistically significant difference in the incidence of adverse reactions and DCR between the two groups during maintenance therapy (P > 0.05).

CONCLUSION

On the basis of XELOX treatment, the combination of BEV and CAP can reduce serum tumor marker levels and prolong PFS in patients with mCRC.

Current standard values of health utility scores for evaluating cost-effectiveness in liver disease: A meta-analysis

BACKGROUND

Health utility assessments have been developed for various conditions, including chronic liver disease. Health utility scores are required for socio-economic evaluations, which can aid the distribution of national budgets. However, the standard health utility assessment scores for specific health conditions are largely unknown.

AIM

To summarize the health utility scores, including the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), EuroQol-visual analogue scale, short from-36 (SF-36), RAND-36, and Health Utilities Index (HUI)-Mark2/Mark3 scores, for the normal population and chronic liver disease patients.

METHODS

A systematic literature search of PubMed and MEDLINE, including the Cochrane Library, was performed. Meta-analysis was performed using the RevMan software. Multiple means and standard deviations were combined using the StatsToDo online web program.

RESULTS

The EQ-5D-5L and SF-36 can be used for health utility evaluations during antiviral therapy for hepatitis C. HUI-Mark2/Mark3 indicated that the health utility scores of hepatitis B patients are roughly 30% better than those of hepatitis C patients.

CONCLUSION

The EQ-5D-5L is the most popular questionnaire for health utility assessments. Health assessments that allow free registration would be useful for evaluating health utility in patients with liver disease.

Update on synthetic biomaterials combined with fibrin derivatives for regenerative medicine: Applications in bone defect treatment: Systematic review

BACKGROUND

Bone regeneration is a central focus of regenerative medicine, with applications in orthopedics and dentistry, particularly for treating bone defects caused by trauma, infection, or congenital anomalies. Synthetic biomaterials, often combined with fibrin derivatives, offer promising solutions for bone healing and restoration.

AIM

To Explore the increasingly important role of the association of synthetic biomaterials with fibrin in bone regeneration.

METHODS

Search terms included: “synthetic biomaterials AND fibrin sealant”, “hydroxyapatite AND fibrin sealant”, “tricalcium phosphate AND fibrin sealant”, and “synthetic biomaterials AND platelet-rich fibrin (PRF)”, resulting in 67 articles. After rigorous screening, 21 articles met the inclusion criteria.

RESULTS

The reviewed studies assessed biomaterials like hydroxyapatite (HA), β-tricalcium phosphate (β-TCP), and fibrin-based products. Key findings highlighted the enhanced osteoconductivity and biocompatibility of HA and β-TCP, especially when combined with fibrin sealants. These composites show significant potential for improving cellular adhesion, promoting osteogenic differentiation, and accelerating bone regeneration. The antimicrobial properties and structural support for cell growth of certain biomaterials indicate a promising potential for clinical applications.

CONCLUSION

This systematic review emphasizes the growing role of fibrin-based biomaterials in bone regeneration and urges continued research to improve their clinical use for complex bone defects.

Advantages of new generation colonoscopes on adenoma detection: A propensity-score matching study

BACKGROUND

Recently, Olympus Corporation released new scopes (XZ1200/EZ1500). However, there have been few reports on this topic, although improvement in adenoma detection rate (ADR) by texture and color enhancement imaging (TXI) or computer-aided detection system (CAD) has been reported.

AIM

To investigate the effects of the scope on the detection of adenomas and sessile serrated lesions (SSLs).

METHODS

The subjects were patients who underwent pancolonic chromoendoscopy using the EVIS X1 video system center between May 2023 and October 2024. The patients were divided into the new (CF-XZ1200/CF-EZ1500) and 290 series (CF-HQ290Z/PCF-H290Z) groups. Propensity score matching was performed for age, sex, examination purpose, endoscopist, preparation, TXI use, and CAD use. The effects of the scope were analyzed in terms of the ADR, SSL detection rate (SDR), and mean number of adenomas per colonoscopy (APC).

RESULTS

Of the 7014 patients enrolled, 2138 pairs were extracted by propensity score matching (mean age 55.4 years, 45.5% male). The new scopes group had a significantly higher ADR than the 290 series group [51.5% vs 45.5%, odds ratio (OR) = 1.27, 95%CI: 1.13-1.43, P < 0.001]. Similarly, the new scopes group had significantly higher SDR (7.8% vs 5.7%, OR = 1.41, 95%CI: 1.11-1.80, P = 0.005) and APC (0.90 vs 0.76, OR = 1.11, 95%CI: 1.05-1.17, P < 0.001) than the 290 series group.

CONCLUSION

In conclusion, the new scope (CF-XZ1200/CF-EZ1500) enhanced the detection of adenomas and SSLs compared to the old ones (290 series).

Pituitary metastasis from lung adenocarcinoma

Pituitary tumor is a common neuroendocrine tumor, but there are also rare clinical metastases at this site, which are generally transferred from extrabellar tumors. Although the clinical incidence is low, the prognosis is poor. The purpose of this editorial is to discuss further the relevant knowledge of pituitary metastases and remind clinicians to prevent missed diagnosis and improve the prognosis of these patients.

Gastric cancer in children infected with Helicobacter pylori

BACKGROUND

This retrospective study aimed to define associations between Helicobacter pylori(H. pylori) in childhood and risk factors for gastric cancer with special emphasis on the role of family history of cancer.

AIM

To define associations between H. pylori in childhood and risk factors for gastric cancer with special emphasis on the role of family history of cancer.

METHODS

Details of 600 children who were subjected to upper gastrointestinal endoscopies at our institution are analyzed. Children were classified into positive and negative groups for H. pylori infection based on biopsy and rapid urease tests. The occurrences of gastric carcinoma, chronic superficial gastritis, glandular atrophy, and intestinal metaplasia among the groups are compared.

RESULTS

In our study, among the overall population, 330 children tested positive for H. pylori, which constituted 55% of the study population. The group denoting H. pylori positivity was found to have strikingly higher frequencies of chronic superficial gastritis (78.8% vs 5.9%), gastric atrophy (39.4% vs 7%), and intestinal metaplasia (0.9% vs 0%), as compared to the H. pylori-negative group. It is interesting to observe that there were a few but statistically significant cases of H. pylori-positive children having a family history of gastric cancer (1.2%), whereas no such cases were reported in children who were H. pylori-negative.

CONCLUSION

Our study finds that H. pylori infection in childhood is associated with an increased risk of precancerous gastric conditions and that family history might provide an additional risk. These insights recommend the necessity of early H. pylori detection and intervention and management strategies in childhood, especially in those families with histories of gastric cancer.

Primary squamous cell carcinoma of the descending colon with pancreatic metastasis: A case report

BACKGROUND

Squamous cell carcinoma (SCC) of the colon is a rare malignant tumor with an unclear pathogenesis. Its clinical presentation is similar to that of adenocarcinoma, and there are no standard treatment guidelines. Treatment for SCC of the colon is mainly based on the protocols for colon adenocarcinoma. In advanced stages, colon SCC is highly invasive, prone to distant metastasis, and has a worse prognosis than adenocarcinoma. Furthermore, pancreatic metastasis from colon SCC is even rarer.

CASE SUMMARY

The patient presented with abdominal pain and was diagnosed with SCC of the descending colon following colonoscopy. Preoperative examinations did not reveal any obvious metastasis to other organs, and the patient underwent laparoscopic radical resection of the descending colon cancer. During surgery, suspicious metastases to the pancreatic body and tail, splenic vessels, and splenic hilum were found, leading to combined resection of the pancreatic body and tail along with the spleen. Postoperative pathology confirmed moderately to poorly differentiated SCC with nerve invasion. The patient developed postoperative complications, including abdominal cavity infection, acute myocardial infarction, and deep vein thrombosis in the lower limbs. Despite active symptomatic treatment and stabilization of the patient’s vital signs, the patient did not undergo adjuvant chemotherapy due to an Eastern Cooperative Oncology Group score of 3. The patient passed away 3 months postoperatively due to multiple organ failure.

CONCLUSION

This case highlights the aggressive nature of colorectal SCC with atypical metastasis and underscores the necessity for multidisciplinary perioperative management.

Associations between food insecurity with gestational diabetes mellitus and maternal outcomes mediated by dietary diversity: A cross-sectional study

BACKGROUND

Food insecurity (FI) during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), resulting in adverse outcomes for both mother and baby.

AIM

To investigate the relationships between FI and pregnancy outcomes, particularly GDM and PIH, while also examining the mediating role of the dietary diversity score (DDS).

METHODS

A cross-sectional study was undertaken to examine this relationship, involving 600 pregnant women. Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes. The FI was measured via the Household Food Security Survey Module, with GDM defined as fasting plasma glucose levels of ≥ 5.1 mmol/L or a 2-hour oral glucose tolerance test value of ≥ 8.5 mmol/L. The DDS is determined by evaluating one's food consumption based on nine distinct food groups. A logistic regression model was used to explore the relationship between FI and PIH, and GDM.

RESULTS

Seventeen percent of participants reported experiencing FI during pregnancy. The study found a significant association between FI and an elevated risk of GDM [odds ratio (OR) = 3.32, 95%CI: 1.2-5.4]. Once more, food-insecure pregnant women had higher rates of PIH (OR = 0.10, 95%CI: 0.02-0.45) and they also faced a higher likelihood of neonatal complications, such as neonatal intensive care unit's admissions and the birth of infants with extremely low birth weight. The FI was further linked to metabolic disruptions, such as elevated fasting blood sugar (FBS), low-density lipoprotein cholesterol, and triglyceride levels. Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM. In particular, the mediation analysis showed that approximately 65% of the effect was mediated through DDS (P = 0.002).

CONCLUSION

These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health. Additionally, the study explored how DDS mediates the relationship between FI and the incidence of GDM.

Human milk oligosaccharide secretion dynamics during breastfeeding and its antimicrobial role: A systematic review

BACKGROUND

Human milk oligosaccharides (HMOs) are bioactive components of breast milk with diverse health benefits, including shaping the gut microbiota, modulating the immune system, and protecting against infections. HMOs exhibit dynamic secretion patterns during lactation, influenced by maternal genetics and environmental factors. Their direct and indirect antimicrobial properties have garnered significant research interest. However, a comprehensive understanding of the secretion dynamics of HMOs and their correlation with antimicrobial efficacy remains underexplored.

AIM

To synthesize current evidence on the secretion dynamics of HMOs during lactation and evaluate their antimicrobial roles against bacterial, viral, and protozoal pathogens.

METHODS

A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library focused on studies investigating natural and synthetic HMOs, their secretion dynamics, and antimicrobial properties. Studies involving human, animal, and in vitro models were included. Data on HMO composition, temporal secretion patterns, and mechanisms of antimicrobial action were extracted. Quality assessment was performed using validated tools appropriate for study design.

RESULTS

A total of 44 studies were included, encompassing human, animal, and in vitro research. HMOs exhibited dynamic secretion patterns, with 2'-fucosyllactose (2'-FL) and lacto-N-tetraose peaking in early lactation and declining over time, while 3-fucosyllactose (3-FL) increased during later stages. HMOs demonstrated significant antimicrobial properties through pathogen adhesion inhibition, biofilm disruption, and enzymatic activity impairment. Synthetic HMOs, including bioengineered 2'-FL and 3-FL, were structurally and functionally comparable to natural HMOs, effectively inhibiting pathogens such as Pseudomonas aeruginosa, Escherichia coli, and Campylobacter jejuni. Additionally, HMOs exhibited synergistic effects with antibiotics, enhancing their efficacy against resistant pathogens.

CONCLUSION

HMOs are vital in antimicrobial defense, supporting infant health by targeting various pathogens. Both natural and synthetic HMOs hold significant potential for therapeutic applications, particularly in infant nutrition and as adjuncts to antibiotics. Further research, including clinical trials, is essential to address gaps in knowledge, validate findings, and explore the broader applicability of HMOs in improving maternal and neonatal health.

Thrombolysis in dysfunctional valve and stroke

BACKGROUND

Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality. The prevalence of at least moderate valvular heart disease is 2.5% across all age groups, but its prevalence increases with age. Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context, respectively. Surgical valve replacement (or mitral valve repair) is the standard of care for treating heart valve disease. However, the replacement of a prosthetic heart valve can lead to complications, either in the peri-procedural phase or in the long-term follow-up period.

CASE SUMMARY

We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy. She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology. A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs. Furthermore, a possible microthrombotic lesion was suspected. Therefore, systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.

CONCLUSION

This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.

Redefining haemostasis: Role of rotational thromboelastometry in critical care settings

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

Human liver chimeric mouse model based on diphtheria toxin-induced liver injury

AIM

To establish an inducible liver injury mouse model and transplant human hepatocytes to obtain liver-humanized mice.

METHODS

We crossed three mouse strains, including albumin (Alb)-cre transgenic mice, inducible diphtheria toxin receptor (DTR) transgenic mice and severe combined immune deficient (SCID)-beige mice, to create Alb-cre/DTR/SCID-beige (ADSB) mice, which coincidentally harbor Alb-cre and DTR transgenes and are immunodeficient. As the Cre expression is driven by the liver-specific promoter Alb (encoding ALB), the DTR stop signal flanked by two loxP sites can be deleted in the ADSB mice, resulting in DTR expression in the liver. ADSB mice aged 8-10 wk were injected intraperitoneally (i.p.) with diphtheria toxin (DT) and liver damage was assessed by serum alanine aminotransferase (ALT) level. Two days later, mouse livers were sampled for histological analysis, and human hepatocytes were transplanted into the livers on the same day. A human ALB enzyme-linked immunosorbent assay was performed 7, 14, 21 and 28 d after transplantation. Human CD68 immunohistochemistry was performed 30 and 90 d after transplantation.

RESULTS

We crossed Alb-cre with DTR and SCID-beige mice to obtain ADSB mice. These mice were found to have liver damage 4 d after i.p. injection of 2.5 ng/g bodyweight DT. Bodyweight began to decrease on day 2, increased on day 7, and was lowest on day 4 (range, 10.5%-13.4%). Serum ALT activity began to increase on day 2 and reached a peak value of 289.7 ± 16.2 IU/mL on day 4, then returned to background values on day 7. After transplantation of human liver cells, peripheral blood human ALB level was 1580 ± 454.8 ng/mL (range, 750.2-3064.9 ng/mL) after 28 d and Kupffer cells were present in the liver at 30 d in ADSB mice.

CONCLUSION

Human hepatocytes were successfully repopulated in the livers of ADSB mice. The inducible mouse model of humanized liver in ADSB mice may have functional applications, such as hepatocyte transplantation, hepatic regeneration and drug metabolism.

Mechanism analysis of periostin in osteoclasts differentiation of dental follicle: Two case reports

BACKGROUND

This study analyzed the dental follicle and alveolar bone of two patients with tooth eruption disorders, aiming to provide some reference for exploring the etiology and selecting treatment plans of this disease from the perspective of the influence of extracellular matrix on osteoclasts differentiation in dental follicle.

CASE SUMMARY

Collect dental follicle and alveolar bone tissue from one patient with single tooth eruption disorder and one patient with full permanent tooth eruption disorder, respectively. Simultaneously collect the dental follicle and alveolar bone tissue of obstructed teeth that need to be extracted due to orthodontic treatment as the control group. Hematoxylin and eosin (HE) staining was used to observe the morphology of dental follicle cells. Immunohistochemical staining was used to observe the expression of periostin, receptor activator of nuclear factor kappa B ligand (RANKL), and osteoprotegerin (OPG) protein in dental follicle and alveolar bone tissue. And observe the eruption of teeth after removing resistance from the crown of the permanent tooth germ.

CONCLUSION

HE staining of two cases of dental follicle tissues showed that the volume of dental follicle cells decreased, the nuclei were condensed, and there seemed to be cellular fibrosis. The immunohistochemical staining showed that both the dental follicle and alveolar bone tissue exhibited increased expression of periostin, decreased expression of RANKL and OPG proteins, and decreased RANKL/OPG ratio. After removing resistance, the permanent tooth germ often appears to have normal eruption. Tooth eruption disorders may be accompanied by abnormal remodeling of periostin, which affects the differentiation function of osteoclasts in the dental follicle and leads to metabolic imbalance of alveolar bone, resulting in tooth eruption disorders. Whether it is a single or full permanent tooth eruption disorder, once the coronal resistance is removed, the teeth can often erupt normally.

Intersections between innate immune response and gastric cancer development

Worldwide, gastric cancer (GC) is the fifth most commonly diagnosed malignancy. It has a reduced prevalence but has maintained its poor prognosis being the fourth leading cause of deaths related to cancer. The highest mortality rates occur in Asian and Latin American countries, where cases are usually diagnosed at advanced stages. Overall, GC is viewed as the consequence of a multifactorial process, involving the virulence of the Helicobacter pylori (H. pylori) strains, as well as some environmental factors, dietary habits, and host intrinsic factors. The tumor microenvironment in GC appears to be chronically inflamed which promotes tumor progression and reduces the therapeutic opportunities. It has been suggested that inflammation assessment needs to be measured qualitatively and quantitatively, considering cell-infiltration types, availability of receptors to detect damage and pathogens, and presence or absence of aggressive H. pylori strains. Gastrointestinal epithelial cells express several Toll-like receptors and determine the first defensive line against pathogens, and have been also described as mediators of tumorigenesis. However, other molecules, such as cytokines related to inflammation and innate immunity, including immune checkpoint molecules, interferon-gamma pathway and NETosis have been associated with an increased risk of GC. Therefore, this review will explore innate immune activation in the context of premalignant lesions of the gastric epithelium and established gastric tumors.

Understanding the molecular crossroads in acute liver failure: A pathway to new therapies

In this editorial we comment on the article published in a recent issue of the World Journal of Gastroenterology. Acute liver failure (ALF) is a critical condition characterized by rapid hepatocellular injury and organ dysfunction, and it often necessitates liver transplant to ensure patient survival. Recent research has elucidated the involvement of distinct cell death pathways, namely ferroptosis and pyroptosis, in the pathogenesis of ALF. Ferroptosis is driven by iron-dependent lipid peroxidation, whereas pyroptosis is an inflammatory form of cell death; both pathways contribute to hepatocyte death and exacerbate tissue damage. This comprehensive review explores the interplay between ferroptosis and pyroptosis in ALF, highlighting the role of key regulators such as silent information regulator sirtuin 1. Insights from clinical and preclinical studies provide valuable perspectives on the dysregulation of cell death pathways in ALF and the therapeutic potential of targeting these pathways. Collaboration across multiple disciplines is essential for translating the experimental insights into effective treatments for this life-threatening condition.

Advancing treatment strategies: Insights from network meta-analysis of hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma

This study examines the pivotal findings of the network meta-analysis of Zhou et al, which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma (HCC). This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments. The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC. Additionally, this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.