Advances in therapies using mesenchymal stem cells and their exosomes for treatment of peripheral nerve injury: state of the art and future perspectives

"Peripheral nerve injury" refers to damage or trauma affecting nerves outside the brain and spinal cord. Peripheral nerve injury results in movements or sensation impairments, and represents a serious public health problem. Although severed peripheral nerves have been effectively joined and various therapies have been offered, recovery of sensory or motor functions remains limited, and efficacious therapies for complete repair of a nerve injury remain elusive. The emerging field of mesenchymal stem cells and their exosome-based therapies hold promise for enhancing nerve regeneration and function. Mesenchymal stem cells, as large living cells responsive to the environment, secrete various factors and exosomes. The latter are nano-sized extracellular vesicles containing bioactive molecules such as proteins, microRNA, and messenger RNA derived from parent mesenchymal stem cells. Exosomes have pivotal roles in cell-to-cell communication and nervous tissue function, offering solutions to changes associated with cell-based therapies. Despite ongoing investigations, mesenchymal stem cells and mesenchymal stem cell-derived exosome-based therapies are in the exploratory stage. A comprehensive review of the latest preclinical experiments and clinical trials is essential for deep understanding of therapeutic strategies and for facilitating clinical translation. This review initially explores current investigations of mesenchymal stem cells and mesenchymal stem cell-derived exosomes in peripheral nerve injury, exploring the underlying mechanisms. Subsequently, it provides an overview of the current status of mesenchymal stem cell and exosome-based therapies in clinical trials, followed by a comparative analysis of therapies utilizing mesenchymal stem cells and exosomes. Finally, the review addresses the limitations and challenges associated with use of mesenchymal stem cell-derived exosomes, offering potential solutions and guiding future directions.

CNKSR2 interactome analysis indicates its association with the centrosome/microtubule system

JOURNAL/nrgr/04.03/01300535-202508000-00031/figure1/v/2024-09-30T120553Z/r/image-tiff The protein connector enhancer of kinase suppressor of Ras 2 (CNKSR2), present in both the postsynaptic density and cytoplasm of neurons, is a scaffolding protein with several protein-binding domains. Variants of the CNKSR2 gene have been implicated in neurodevelopmental disorders, particularly intellectual disability, although the precise mechanism involved has not yet been fully understood. Research has demonstrated that CNKSR2 plays a role in facilitating the localization of postsynaptic density protein complexes to the membrane, thereby influencing synaptic signaling and the morphogenesis of dendritic spines. However, the function of CNKSR2 in the cytoplasm remains to be elucidated. In this study, we used immunoprecipitation and high-resolution liquid chromatography-mass spectrometry to identify the interactors of CNKSR2. Through a combination of bioinformatic analysis and cytological experiments, we found that the CNKSR2 interactors were significantly enriched in the proteome of the centrosome. We also showed that CNKSR2 interacted with the microtubule protein DYNC1H1 and with the centrosome marker CEP290. Subsequent colocalization analysis confirmed the centrosomal localization of CNKSR2. When we downregulated CNKSR2 expression in mouse neuroblastoma cells (Neuro 2A), we observed significant changes in the expression of numerous centrosomal genes. This manipulation also affected centrosome-related functions, including cell size and shape, cell proliferation, and motility. Furthermore, we found that CNKSR2 interactors were highly enriched in de novo variants associated with intellectual disability and autism spectrum disorder. Our findings establish a connection between CNKSR2 and the centrosome, and offer new insights into the underlying mechanisms of neurodevelopmental disorders.

Comparative efficacy of hyperbaric bupivacaine vs hyperbaric ropivacaine in spinal anesthesia for cesarean section: A meta-analysis

BACKGROUND

Intrathecal bupivacaine is the traditional anesthetic drug used in spinal anesthesia for caesarean sections (CSs), but ropivacaine has emerged as a potential alternative. This meta-analysis compares the efficacy and safety of intrathecal hyperbaric bupivacaine vs hyperbaric ropivacaine for cesarean sections.

AIM

To systematically evaluate and compare the efficacy and safety of intrathecal hyperbaric bupivacaine and hyperbaric ropivacaine for spinal anesthesia in CSs.

METHODS

A thorough search of electronic databases was carried out to find pertinent randomized controlled trials (RCTs) comparing intrathecal hyperbaric ropivacaine and hyperbaric bupivacaine during CSs. PubMed, Cochrane database, Google Scholar, and Scopus were searched, and papers from January 2000 to January 2024 were deemed eligible and filtered using predetermined inclusion and exclusion criteria. Studies were assessed for methodological quality, and data were extracted for time to adequate anesthesia (sensory and motor blockade), duration of sensory and motor block, hemodynamic changes and side effect profile. The standardized mean difference with 95%CI was used for continuous data. Dichotomous variables were assessed using the Mantel-Haenszel test and the random effect model to compute the odds ratio.

RESULTS

Total 8 RCTs were selected from a pool of 119 search results for meta-analysis. The meta-analysis evaluated pooled effect sizes and assessed heterogeneity among the studies. The primary objective was to compare key outcomes to identify any significant variances in efficacy and safety profiles between two local anesthetics. The analysis revealed that the difference in the onset of sensory blockade between the two local anesthetics was statistically insignificant (P = 0.1586). However, the onset of motor blockade appeared to be faster with bupivacaine (P = 0.03589). Additionally, the regression of sensory and motor blockade occurred earlier in the ropivacaine group. Furthermore, the duration of the first analgesic effect was shorter with a significance level of P < 0.05. Regarding side effects profile, including hypotension, nausea, and shivering, the study did not observe any significant differences between the two groups.

CONCLUSION

This meta-analysis offers insights into the effectiveness and safety of hyperbaric bupivacaine vs ropivacaine for cesarean sections. Hyperbaric ropivacaine had a comparable safety profile and faster regression of sensory and motor blockade than hyperbaric bupivacaine, perhaps aiding early mobilization of parturient and facilitating mother-child bonding. Choosing ropivacaine may offer benefits beyond efficacy for cesarean section patients and short surgical procedures.

Strategic insights of telehealth platforms and strengths, weaknesses, opportunities, and threats analysis of Amazon's clinical endeavors

BACKGROUND

The adoption of telehealth services surged after the coronavirus disease 2019 pandemic, revolutionizing traditional healthcare delivery models. Amazon Clinic's recent nationwide launch marks a significant milestone in this trend. This study aims to offer a strengths, weaknesses, opportunities, and threats (SWOT) analysis of Amazon Clinic and compare its features with leading virtual healthcare platforms.

AIM

To evaluate Amazon Clinic's telehealth services through a SWOT analysis and compare its features with other leading virtual healthcare platforms.

METHODS

The initial search terms included were, amazon clinic odds ratio (OR) amwell OR Teladoc OR Walmart virtual health service OR CVS minute clinic OR CirrusMD OR brightside health, from 2000 to 2023. This search yielded 111 articles, from which duplicates were removed, and unrelated titles were filtered out. Eight articles were retained for a final review, including comparative studies, usability research, retrospective analyses, observational studies, and review articles. The data was organized and analyzed using Rayyan software and summarized in a table and PRISMA flowcharts.

RESULTS

The review included eight articles focusing on various aspects of telehealth. Comparative studies highlighted differences between Teladoc and traditional physician offices, noting lower diagnostic imaging orders and antibiotic prescriptions for Teladoc. User demographics for Teladoc showed younger, less engaged patients. Usability studies emphasized the importance of website design for telemedicine adoption. Tele-mental health platforms like Brightside showed superior outcomes in treating depression compared to traditional methods. Telemedicine for specialized fields like skin reconstruction demonstrated cost efficiency and reduced waiting times. The SWOT analysis identified Amazon Clinic's strengths, such as its vast consumer base and transparent pricing, and weaknesses like the lack of pediatric care. Opportunities included potential partnerships and service expansions, while threats involved competition and regulatory challenges.

CONCLUSION

Amazon Clinic's entry into the telehealth sector represents a significant development with various strengths and opportunities. However, it faces challenges from established healthcare providers and regulatory landscapes. The future success of Amazon Clinic will depend on strategic collaborations, addressing service gaps, and navigating competition and regulations. Telemedicine's impact will hinge on its ability to effectively leverage these opportunities and overcome inherent challenges in the ever-evolving healthcare landscape.

Therapeutic potential of exercise-hormone irisin in Alzheimer's disease

Irisin is a myokine that is generated by cleavage of the membrane protein fibronectin type III domain-containing protein 5 (FNDC5) in response to physical exercise. Studies reveal that irisin/FNDC5 has neuroprotective functions against Alzheimer's disease, the most common form of dementia in the elderly, by improving cognitive function and reducing amyloid-β and tau pathologies as well as neuroinflammation in cell culture or animal models of Alzheimer's disease. Although current and ongoing studies on irisin/FNDC5 show promising results, further mechanistic studies are required to clarify its potential as a meaningful therapeutic target for alleviating Alzheimer's disease. We recently found that irisin treatment reduces amyloid-β pathology by increasing the activity/levels of amyloid-β-degrading enzyme neprilysin secreted from astrocytes. Herein, we present an overview of irisin/FNDC5's protective roles and mechanisms against Alzheimer's disease.

Rapid improvement in postpartum pulmonary hypertension associated with hereditary hemorrhagic telangiectasia: A case report and review of literature

BACKGROUND

Postpartum pulmonary arterial hypertension (PAH) complicated with hereditary hemorrhagic telangiectasia (HHT) is a rare condition. Diagnosing and treating PAH in patients with HHT can be challenging. To the best of our knowledge, no previous reports have investigated the efficacy of pulmonary vasodilators in improving hemodynamics in postpartum patients with this disease.

CASE SUMMARY

In this paper, we report a postpartum case of HHT combined with PAH, presenting with worsening dyspnea. Genetic testing revealed that the patient carried a heterozygous variant of activin receptor-like kinase 1. The patient received various treatments, including diuretics, anticoagulants, sildenafil, macitentan, inhalation of nitric oxide, and iloprost. Changes in PaO₂/FiO₂, pulmonary artery systolic pressure as assessed by echocardiography, and N-terminus pro-brain natriuretic peptide levels suggested that, except for iloprost inhalation, the other treatments appeared to have limited efficacy.

CONCLUSION

To our knowledge, this is the first report on efficacy of pulmonary vasodilators in postpartum patients with HHT and PAH.

Predicting outcomes using neural networks in the intensive care unit

Patients in intensive care units (ICUs) require rapid critical decision making. Modern ICUs are data rich, where information streams from diverse sources. Machine learning (ML) and neural networks (NN) can leverage the rich data for prognostication and clinical care. They can handle complex nonlinear relationships in medical data and have advantages over traditional predictive methods. A number of models are used: (1) Feedforward networks; and (2) Recurrent NN and convolutional NN to predict key outcomes such as mortality, length of stay in the ICU and the likelihood of complications. Current NN models exist in silos; their integration into clinical workflow requires greater transparency on data that are analyzed. Most models that are accurate enough for use in clinical care operate as ‘black-boxes’ in which the logic behind their decision making is opaque. Advances have occurred to see through the opacity and peer into the processing of the black-box. In the near future ML is positioned to help in clinical decision making far beyond what is currently possible. Transparency is the first step toward validation which is followed by clinical trust and adoption. In summary, NNs have the transformative ability to enhance predictive accuracy and improve patient management in ICUs. The concept should soon be turning into reality.

High-grade pancreatic intraepithelial neoplasia: A commentary of magnetic resonance cholangiopancreatography findings

Commentary on the role of magnetic resonance cholangiopancreatography findings in diagnosing high grade pancreatic intraepithelial neoplasms.

Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and it does not exhibit mass lesions. It is suspected based on changes in the main pancreatic duct in magnetic resonance cholangiopancreatography. Sometimes only an unclear duct shows in magnetic resonance cholangiopancreatography with no focal strictures and upstream dilatation of the main pancreatic duct. Serial pancreatic juice cytology is valuable in diagnosis of those patients.

Schistosomal appendicitis: A serious and often misdiagnosed condition

Schistosomal appendicitis (SA) is a rare but serious complication of schistosomiasis, a parasitic disease affecting over 250 million people worldwide. A recent retrospective study by Wang et al provides important insights into the clinicopathological characteristics of SA. The study compared 136 cases of SA to 5418 cases of non-SA over a ten-year period. Key findings include a higher average age of SA patients (61.73 years vs 35.8 years for non-SA), a higher proportion of acute on chronic appendicitis (33.1% vs 16%), and a significantly higher incidence of colorectal cancer (11.7% vs 2.2%). Despite these differences, SA remains a diagnostic challenge due to its nonspecific clinical presentation and lack of specific laboratory findings. The study also highlights the persistent prevalence of SA, accounting for 1.6%-3.4% of all appendicitis cases each year from 2013 to 2023. These findings underscore the need for enhanced awareness, early detection, and prompt treatment of SA in endemic regions. Given the association with colorectal cancer, patients with SA require thorough screening and follow-up. Further research into the pathogenesis and diagnostic markers of SA is warranted. As the global battle against schistosomiasis continues, targeted efforts to diagnose and manage SA can significantly improve patient outcomes.

Recurrence rates and risk factors in obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding (OGIB), defined in 2010, involves bleeding from the GI tract that remains unexplained after standard diagnostic procedures. OGIB, which accounts for about 5% of all GI bleeds, poses diagnostic and management challenges, particularly due to the anatomical features of the small intestine. Advances in capsule endoscopy (CE) and balloon-assisted endoscopy have improved the diagnostic and therapeutic landscape for small intestinal lesions.

Objective

To determine the recurrence rate and identify risk factors for recurrence following diagnostic and therapeutic interventions using CE and balloon-assisted endoscopy in patients with OGIB.

Methods

A retrospective cohort study at Gifu University Hospital analyzed CE procedures for patients with OGIB from 2008 to 2022. Patients underwent CE with subsequent treatments based on the findings. Statistical analyses, including Kaplan-Meier and Cox proportional hazards models, were used to estimate cumulative recurrence rates and identify recurrence risk factors.

Results

Out of 417 patients, 65.2% had positive CE findings, leading to therapeutic interventions in 16.3% of cases. The cumulative recurrence rates at 12, 24, and 36 months were 4.3%, 9.0%, and 13.9%, respectively. Liver cirrhosis (hazard rate: 4.15, 95% confidence interval 1.88-9.18, p < 0.01) was identified as a significant risk factor for recurrence.

Conclusions

A significant recurrence rate in OGIB patients, with liver cirrhosis being a major risk factor. Despite diagnostic and therapeutic advances, a comprehensive approach including careful follow-up and consideration of risk factors is essential for management.

Outcomes of multi-hole self-expandable metal stents versus fully covered self-expandable metal stents for malignant distal biliary obstruction in unresectable pancreatic cancer

Objectives

The multi-hole self-expandable metal stent (MHSEMS) is a novel SEMS with multiple small side holes on the covering membrane to prevent stent migration while minimizing tumor ingrowth. This study aimed to evaluate the clinical outcomes of MHSEMS in comparison with conventional covered SEMS (c-CMS).

Methods

Consecutive patients with unresectable pancreatic cancer who underwent initial SEMS placement (MHSEMS or c-CMS) for malignant distal biliary obstruction were analyzed. Technical success, clinical success, causes of recurrent biliary obstruction (RBO), non-RBO adverse events, time to RBO (TRBO), and endoscopic reintervention were compared between groups.

Results

A total of 65 patients were included (MHSEMS: 27, c-CMS: 38). The technical success, clinical success, and non-RBO adverse event rates were similar between groups. Although stent migration was less frequently observed in the MHSEMS group (0% vs. 17.6%, p = 0.032), overall RBO rates were similar between groups (53.8% vs. 55.9%, p > 0.99). The most common cause of RBO within 14 days in the MHSEMS group was non-occlusion cholangitis. Median TRBO was significantly shorter in the MHSEMS group (101 vs. 227 days, p = 0.030) and MHSEMS was an independent predictor for shorter TRBO in multivariate analysis (hazard ratio, 2.27; 95% confidence interval, 1.06-4.86; p = 0.034). Outcomes after endoscopic interventio were not significantly different between groups. Stent removal was successful in all attempted cases in both groups.

Conclusions

MHSEMS was associated with a significantly shorter TRBO compared to c-CMS. Further modifications of the present MHSEMS may be needed.

Clinical assessment of computed tomography for detecting ingested blister packs: A single-center retrospective study

Objectives

Blister pack (BP) ingestion poses serious risks, such as gastrointestinal perforation, and accurate localization by computed tomography (CT) is a common practice. However, while it has been reported in vitro that CT visibility varies with the material type of BPs, there have been no reports on this variability in clinical settings. In this study, we investigated the CT detection rates of different BPs in clinical settings.

Methods

This single-center retrospective study from 2010 to 2022 included patients who underwent endoscopic foreign body removal for BP ingestion. The patients were categorized into two groups for BP components, the polypropylene (PP) and the polyvinyl chloride (PVC)/polyvinylidene chloride (PVDC) groups. The primary outcome was the comparison of CT detection rates between the groups. We also evaluated whether the BPs contained tablets and analyzed their locations.

Results

This study included 61 patients (15 in the PP group and 46 in the PVC/PVDC group). Detection rates were 97.8% for the PVC/PVDC group compared to 53.3% for the PP group, a significant difference (p < 0.01). No cases of BPs composed solely of PP were detected by CT. Blister packs were most commonly found in the upper thoracic esophagus.

Conclusions

Even in a clinical setting, the detection rates of PVC and PVDC were higher than that of PP alone. Identifying PP without tablets has proven challenging in clinical. Considering the risk of perforation, these findings suggest that esophagogastroduodenoscopy may be necessary, even if CT detection is negative.

Updated techniques and evidence for endoscopic ultrasound-guided tissue acquisition from solid pancreatic lesions

Endoscopic ultrasound-guided tissue acquisition (EUS-TA), including fine-needle aspiration (EUS-FNA) and fine-needle biopsy (EUS-FNB), has revolutionized specimen collection from intra-abdominal organs, especially the pancreas. Advances in personalized medicine and more precise treatment have increased demands to collect specimens with higher cell counts, while preserving tissue structure, leading to the development of EUS-FNB needles. EUS-FNB has generally replaced EUS-FNA as the procedure of choice for EUS-TA of pancreatic cancer. Various techniques have been tested for their ability to enhance the diagnostic performance of EUS-TA, including multiple methods of sampling at the time of puncture, on-site specimen evaluation, and specimen processing. In addition, advances in next-generation sequencing have made comprehensive genomic profiling of EUS-TA samples feasible in routine clinical practice. The present review describes updates in EUS-TA sampling techniques of pancreatic lesions, as well as methods for their evaluation.

Impact of the COVID-19 pandemic on the treatment of acute cholangitis caused by choledocholithiasis: A single-center retrospective study in Japan

Objectives

This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of acute cholangitis caused by choledocholithiasis.

Methods

The Japanese government declared a state of emergency in April 2020 due to the COVID-19 pandemic. We retrospectively reviewed the medical records of 309 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis caused by choledocholithiasis between April 2017 and December 2022.

Results

Patients were categorized into a pregroup (n = 134) and a postgroup (n = 175), depending on whether they were diagnosed before or after the state of emergency declaration. The total number of ERCP cases and the number of ERCP cases with endoscopic stone removals increased after the state of emergency declaration. Compared with the pregroup, the numbers of patients with performance status of 0-1 and surgically altered anatomy increased, whereas the numbers of patients taking oral antiplatelets or anticoagulants and those with cerebrovascular disease decreased in the postgroup. The number of single-stage endoscopic stone removals increased and hospital stays were significantly shorter in the postgroup. No differences in adverse event rates were detected between the two groups.

Conclusions

Although our hospital provides tertiary care, the number of patients with cholangitis in good general condition and no underlying disease increased after the state of emergency declaration. The COVID-19 pandemic resulted in an increase in the number of single-stage endoscopic treatments and shortened hospital stays for patients with acute cholangitis caused by choledocholithiasis. No safety issues with ERCP were detected, even during the pandemic.

Extraction of terminal ileal lipomas to cecum can facilitate endoscopic resection: A case series with video

Large ileal lipomas over 2 cm can cause symptoms, that may require a resection. Due to the narrow lumen and thin walls of the ileum, endoscopic treatments can have a high risk of adverse events and require technical expertise, thus surgical resection is currently the mainstay of treatment. To overcome the technical challenges, we developed a novel method to endoscopically resect terminal ileal lipomas. The technique involves extracting the lesion into the cecum, which creates sufficient space to maneuver, and a better field of view. The lipoma is resected with endoscopic mucosal resection or endoscopic submucosal dissection. The appearance of the lipoma protruding out of the ileocecal valve resembles that of a tongue sticking out of the mouth, thus we named this the "tongue out technique". To assess the technical feasibility of this method, we retrospectively analyzed seven cases of terminal ileal lipoma that were endoscopically resected using the "tongue out technique" at NTT Medical Center Tokyo between January 2017 and October 2023. Technical success was 100% and en bloc resection was achieved in all cases. The median size was 31 (14-55) mm. Three cases were resected with endoscopic mucosal resection while endoscopic submucosal dissection was performed on the other four cases. There was one case of delayed post-endoscopic mucosal resection bleeding, which was caused by clip dislodgement. There were no perforations. No recurrence of the lipoma or associated symptoms have been observed. This new technique can allow more ileal lipomas to be treated with minimally invasive and organ-preserving endoscopic procedures.

Obesity paradox in patients with community-acquired pneumonia: Have you fully considered the confounding factors?

There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia. In other words, obese individuals with community-acquired pneumonia have a better prognosis. The study by Wang et al supports this claim, but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.

Differential diagnosis of uterine vascular anomalies: Uterine pseudoaneurysm as a cause of massive hemorrhage

In this article, we comment on the paper by Kakinuma et al published recently. We focus specifically on the diagnosis of uterine pseudoaneurysm, but we also review other uterine vascular anomalies that may be the cause of life-threating hemorrhage and the different causes of uterine pseudoaneurysms. Uterine artery pseudoaneurysm is a complication of both surgical gynecological and non-traumatic procedures. Massive hemorrhage is the consequence of the rupture of the pseudoaneurysm. Uterine artery pseudoaneurysm can develop after obstetric or gynecological procedures, being the most frequent after cesarean or vaginal deliveries, curettage and even during pregnancy. However, there are several cases described unrelated to pregnancy, such as after conization, hysteroscopic surgery or laparoscopic myomectomy. Hemorrhage is the clinical manifestation and it can be life-threatening so suspicion of this vascular lesion is essential for early diagnosis and treatment. However, there are other uterine vascular anomalies that may be the cause of severe hemorrhage, which must be taken into account in the differential diagnosis. Computed tomography angiography and embolization is supposed to be the first therapeutic option in most of them.

Relevance of epidemiology data in trauma management

Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden. Relevance of trauma care revolves round prevention, planning and execution of safety regulations. Acquisition of the actual data regarding the type of trauma, affected age group, timings of trauma occurrence, involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma. In succession, would be the measures directed towards avoidance of trauma and capacity building of trauma center.

Atezolizumab and bevacizumab combination in advanced hepatocellular carcinoma patients: The imperative for safety assessment studies

Hepatocellular carcinoma (HCC) is the most prevalent cancer of the hepatobiliary tract and the third leading cause of cancer-related mortality worldwide. Atezolizumab and bevacizumab combination is currently considered among the front-line treatment modalities for advanced unresectable HCC. Most studies examining this combination were focused on evaluating its effectiveness. Despite numerous case reports documenting some side effects, there is a limited number of large-scale studies assessing these side effects. In this article, we comment on the case report by Park et al published recently, reporting a fatal intra-tumoral hemorrhage in a patient with HCC who received systemic therapy in the form of the combination of atezolizumab and bevacizumab.

Advances in the treatment of autism spectrum disorder: Wharton jelly mesenchymal stem cell transplantation

BACKGROUND

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with multifaceted origins. In recent studies, neuroinflammation and immune dysregulation have come to the forefront in its pathogenesis. There are studies suggesting that stem cell therapy may be effective in the treatment of ASD.

AIM

To evolve the landscape of ASD treatment, focusing on the potential benefits and safety of stem cell transplantation.

METHODS

A detailed case report is presented, displaying the positive outcomes observed in a child who underwent intrathecal and intravenous Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) transplantation combined with neurorehabilitation.

RESULTS

The study demonstrates a significant improvement in the child’s functional outcomes (Childhood Autism Rating Scale, Denver 2 Developmental Screening Test), especially in language and gross motor skills. No serious side effects were encountered during the 2-year follow-up.

CONCLUSION

The findings support the safety and effectiveness of WJ-MSC transplantation in managing ASD.

Association of interleukin-6 with acute lung injury risk and disease severity in sepsis

Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs. Interleukin-6 (IL-6) is a significant component of the inflammatory response as part of the pathogenesis of sepsis. It aids in the development of Acute lung injury and, subsequently, multiple organ dysfunction syndrome. This letter probes into the correlation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with sepsis. While it shows promising results, limitations like its observational study design, a limited sample size, a single center involvement, single-time-point measurement, and a lack of a control group restrain its cogency. The study is a big step in identifying IL-6 as a biomarker to improve patient care.

Use of graphene nanocomposites for air disinfection in dental clinics: A game-changer in infection control

This manuscript features the promising findings of a study conducted by Ju et al, who used graphene nanocomposites for air disinfection in dental clinics. Their study demonstrated that, compared with conventional filters, graphene nanocomposites substantially improved air quality and reduced microbial contamination. This manuscript highlights the innovative application of graphene materials, emphasizing their potential to enhance dental clinic environments by minimizing secondary pollution. On the basis of the unique antimicrobial properties of graphene and the original study’s rigorous methodology, we recommend using graphene nanocomposites in clinical settings to control airborne infections.

Application of nanotechnology to dentistry: Impact of graphene nanocomposites on clinical air quality

Concerns about air quality in dental clinics where aerosol generation during procedures poses significant health risks, have prompted investigations on advanced disinfection technologies. This editorial describes the strengths and limitations of ventilation and aerosol control measures in dental offices, especially with respect to the use of graphene nanocomposites. The potential of graphene nanocomposites as an innovative solution to aerosol-associated health risks is examined in this review due to the unique properties of graphene (e.g., high conductivity, mechanical strength, and antimicrobial activity). These properties have produced promising results in various fields, but the application of graphene in dentistry remains unexplored. The recent study by Ju et al which was published in World Journal of Clinical Cases evaluated the effectiveness of graphene-based air disinfection systems in dental clinics. The study demonstrated that graphene-based disinfection techniques produced significant reductions in suspended particulate matter and bacterial colony counts, when compared with traditional methods. Despite these positive results, challenges such as material saturation, frequency of filter replacement, and associated costs must be addressed before widespread adoption of graphene-based disinfection techniques in clinical practice. Therefore, there is need for further research on material structure optimization, long-term safety evaluations, and broader clinical applications, in order to maximize their positive impact on public health.

Fatal risk in hysteroscopic surgery that should not be overlooked: Uterine artery pseudoaneurysm

This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm (UAP), as well as an analysis of UAP etiology. This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures. The patient underwent timely relevant examinations to confirm the diagnosis, allowing for crucial time required for her treatment. In this study, the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility, suggesting that the selection and implementation of dilatation catheters are some of the predisposing factors for UAP. In conclusion, this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment, offering valuable insights for the clinical diagnosis and management of UAP.

Management of gastrointestinal bleed in the intensive care setting, an updated literature review

Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.

Genetic and epigenetic alterations associated with gestational diabetes mellitus and adverse neonatal outcomes

Gestational diabetes mellitus (GDM) is a metabolic disorder, recognised during 24-28 weeks of pregnancy. GDM is linked with adverse newborn outcomes such as macrosomia, premature delivery, metabolic disorder, cardiovascular, and neurological disorders. Recent investigations have focused on the correlation of genetic factors such as β-cell function and insulin secretary genes (transcription factor 7 like 2, potassium voltage-gated channel subfamily q member 1, adiponectin etc.) on maternal metabolism during gestation leading to GDM. Epigenetic alterations like DNA methylation, histone modification, and miRNA expression can influence gene expression and play a dominant role in feto-maternal metabolic pathways. Interactions between genes and environment, resulting in differential gene expression patterns may lead to GDM. Researchers suggested that GDM women are more susceptible to insulin resistance, which alters intrauterine surroundings, resulting hyperglycemia and hyperinsulinemia. Epigenetic modifications in genes affecting neuroendocrine activities, and metabolism, increase the risk of obesity and type 2 diabetes in offspring. There is currently no treatment or effective preventive method for GDM, since the molecular processes of insulin resistance are not well understood. The present review was undertaken to understand the pathophysiology of GDM and its effects on adverse neonatal outcomes. In addition, the study of genetic and epigenetic alterations will provide lead to researchers in the search for predictive molecular biomarkers.

Biologics in the management of pediatric inflammatory bowel disease: When and what to choose

Pediatric inflammatory bowel disease (PIBD) is a chronic inflammatory disorder of the gastrointestinal tract, with rising global incidence and prevalence. Over the past two decades, biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease. The available biologics include monoclonal antibodies which target inflammatory cytokines (anti-tumor necrosis factor alpha, anti-interleukin 12/23) or recruitment of leucocytes to the gastrointestinal tract (anti-alpha4beta7 integrin) and small molecules (Janus kinase inhibitors, sphingosine 1-phosphate-inhibitors) which modify the proinflammatory signaling. Considering their potential disease-modifying ability, recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach. Although real-world studies are available regarding the clinical efficacy of biologics in PIBD, there is paucity of long-term outcome and safety data in children. Also, little information is available about the best approach in the newly industrialized - developing countries where PIBD is rising but at the same time, infections are prevalent and resources are limited. In this review, we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD, especially in the developing world, and future directions.

Systematic comparison of Kawasaki disease Z-score formulas: Enhancing diagnostic accuracy and clinical applicability across populations

This study aims to evaluate the performance of six distinct Z-score formulas in diagnosing coronary artery dilation in Kawasaki disease (KD) patients, with a focus on their clinical applicability across diverse populations. A retrospective analysis was conducted using comparative statistical methods to assess the sensitivity and specificity of each formula. The Kobayashi and Dallaire formulas demonstrated the highest sensitivity in China, particularly in younger patients with prolonged fever duration. Our findings provide evidence-based recommendations for selecting Z-score formulas to optimize diagnostic precision in KD patients.

Physical rehabilitation for sensorineural hearing loss in childhood: Progress and challenges

Early intervention for sensorineural hearing loss (SNHL) in childhood is crucial for auditory and language development. In recent years, innovative auditory stimulation techniques and speech therapy strategies, such as middle ear implants, cochlear implants, auditory brainstem implants, and midbrain implants, have provided new avenues for improving patient outcomes. Additionally, basic research advancements in cell reprogramming and regeneration, stem cell therapy, and targeted drug delivery offer promising approaches to meet the individualized needs of children with SNHL. However, many challenges and unresolved issues remain in the treatment of SNHL. This article comments on the case report, which describes a female pediatric patient with SNHL who underwent foot reflexology which led to the normalization of hearing thresholds. Reflexology is considered to have potential benefits in physical rehabilitation, but its efficacy in hearing restoration requires further scientific validation through rigorous clinical trials and large-scale prospective studies.

Foot reflexology in autoimmune diseases: Effectiveness and mechanisms

Foot reflexology (FR) is a Chinese-originated and non-invasive complementary therapy increasingly used by functional, alternative and para-medical professionals. Enhance attempts are made to study FR in non-functional organic conditions. The present invited Editorial discusses the application of FR in autoimmune diseases (AD), highlighting a few successful studies demonstrating symptomatic relief and objective improvements. Despite promising results, the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases, including AD, is highly recommended.

Intersection of two rare conditions: Clinical reflection on tuberous sclerosis combined with primary lymphedema

This editorial discusses a case report recently published in the World Journal of Clinical Cases. The report describes the clinical presentation, imaging, diagnosis, and treatment of a patient with tuberous sclerosis complex (TSC) combined with primary lymphedema (PLE). Additionally, it retrospectively analyzes the data of 16 previously reported cases of children with TSC combined with PLE to summarize the epidemiology, genetic diagnosis, and current main treatments of these patients. The report also speculates on the pathological and physiological mechanisms underlying TSC combined with PLE. TSC combined with PLE is rare; therefore, the report provides a theoretical basis for understanding the pathophysiological mechanisms and treatment options for patients with TSC and PLE. Comprehensive clinical management of TSC is essential due to the diverse and multiorgan nature of its manifestations, often requiring a multidisciplinary approach for newly diagnosed cases.

Effect of esketamine on reducing postpartum pain and depression

In this editorial, we comment on a recent article by Chen et al, that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section. Poor management of post-cesarean pain is associated with decreased maternal care for the baby, longer hospitalization, and higher risk of developing postpartum depression. Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies. However, due to its potential adverse effects on the neurological and hemodynamic status of patients, it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain. Before any recommendation for routine perioperative use of esketamine, more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.

Oxygen-ozone therapy for myocardial ischemic stroke and cardiovascular disorders

Cardiovascular diseases (CVDs) represent a major concern for human health worldwide. Emergencies in this field include wide repertories of studies dealing primarily with CVD prevention. In addition to dietary habits and lifestyles, medical knowledge is fully needed to improve public educational programs toward cardiovascular risk factors and to enrich the endowment of pharmaceutical options and therapies to address CVDs, particularly for ischemic damage due to an impairment in the endothelial-myocardial relationship. Because ozone is a stimulator of the endothelial nitric oxide synthase/nitric oxide pathway, ozone therapy has been widely demonstrated to have the ability to counteract endothelial-cardiac disorders, providing a novel straightforward opportunity to reduce the impact of CVDs, including atrial fibrillation. In this review, we attempt to establish a state-of-the-art method for the use of ozone in CVD, suggesting that future remarks be addressed to provide fundamental insights into this issue. The purpose of this study was to highlight the role of ozone in the adjunctive medical treatment of cardiovascular pathologies such as acute myocardial infarction due to ischemic disorders.

Serious adverse events associated with conservative physical procedures directed towards the cervical spine: A systematic review

BACKGROUND

Previous reviews on serious adverse events (SAEs) following physical interventions involving the neck have focused on vascular SAEs or those related to cervical manipulation.

OBJECTIVE

To review the evidence for all serious adverse events associated with any physical cervical procedures and describe SAE characteristics.

METHODS

Searches were conducted in PubMed, EMBASE, CINAHL, Scopus, Cochrane, Web of Science and Index to Chiropractic Literature from inception to May 2023 for studies reporting characteristics of SAE following any neck intervention and patient demographics.

RESULTS

Two hundred and thirty-three studies describing 334 SAE cases were identified. Forty-one were reported in the last 5 years. The results confirmed findings of past reviews with most events being vascular (58%) and mainly arterial dissection or vertebral artery related and the majority involving manipulation (75%). However lesser-known SAES ie neurological (25%), combined vascular/neurological (12%) and others (5%) which included cases such as cerebrospinal fluid leaks, phrenic nerve palsies and retinal detachments were identified. Further, some followed procedures such as vestibular testing, gentle mobilization, exercises, acupuncture or even massage. Initial symptoms included sharp increases in headache/neck pain, nausea, vomiting, dizziness and altered sensation, during treatment or within 48 h, often preceding neurological signs. Most recovered favourably (62%), 16% with disability, 6% died, the rest were unspecified.

CONCLUSION

Most SAEs were vascular and associated with manipulation but awareness of potential neurological and orthopaedic injuries and other procedures should be raised. Monitoring for early signs of SAEs for up to 48 h post-intervention is advisable if a SAE is suspected.

Metastasis of clear cell renal cell carcinoma to hyalinizing trabecular tumor of the thyroid: A case report

Renal cell carcinoma (RCC) is the most common malignancy that metastasizes to the thyroid; however, metastasis of RCC to a primary tumor of the thyroid is rare. The present study reports the case of RCC that had metastasized to the primary thyroid tumor; namely, a hyalinizing trabecular tumor (HTT). Notably, the RCC was resected 2 years prior. A 60-year-old female patient was referred to Ningbo Beilun District People's Hospital with radiographic findings indicating thyroid nodules. The patient's previous medical history included a left nephrectomy for the treatment of clear cell (cc)RCC in February 2021. No other distant metastases were identified as of the latest follow-up in April 2023. No abnormalities were observed during thyroid function tests prior to thyroid surgery. The surgical specimen appeared as a multinodular goiter with a solid nodule measuring 55×41×33 mm on the left lobe of the thyroid. Microscopic examination revealed a gray-yellow area inside the capsule of the largest nodule of the left lobe, which was composed of clear cells arranged in a solid pattern. Notably, tumor cells in other areas exhibited trabecular, nested and island patterns. Results of an immunohistochemical examination revealed that the clear cell lesion was negative for thyroid transcription factor-1 and calcitonin, and strongly positive for carbonic anhydrase IX, common acute lymphoblastic leukemia antigen and vimentin. To the best of our knowledge, the present study is the first to report a case of ccRCC that had metastasized to a HTT. A preliminary analysis of the potential mechanisms underlying ccRCC metastasis was performed. Following total thyroidectomy, the patient was treated with levothyroxine, underwent anti-programmed death-1 monoclonal antibody immunotherapy and small molecule tyrosine kinase inhibitor targeted therapy. An enhanced computed tomography scan revealed no evidence of metastatic disease to other organs. As of the latest follow-up, the patient was in a good condition with no sign of metastasis or recurrence.

Summary of the current guidelines for managing iatrogenic colorectal perforations and the evolving role of endoluminal vacuum therapy

Colonoscopy represents a safe procedure that is widely used in medical practice either to diagnose or treat various gastrointestinal diseases. During the last few years, the incidence rate of perforations in colonoscopic procedures has increased, especially in therapeutic colonoscopies. The recent advancements in endoscopic techniques and gastrointestinal tumoral resection procedures such as endoscopic mucosal resection, endoscopic full-thickness resection, and endoscopic submucosal dissection (ESD) could be a risk factor for this increased risk. The incidence rate of mortality of serious colonoscopic perforations is 7.1%. The management plan for these perforations starts with conservative treatment in mild cases, endoscopic closure, and surgical management in severe cases. Recently, endoluminal vacuum therapy was found to be effective in the management of colorectal perforations and this has been reported in multiple case reports. This editorial provides an overview of the current guidelines for the management of iatrogenic colorectal perforations. These insights are from the perspectives of endoscopists and gastroenterologists. We also present a management algorithm based on the guidelines of the European Society of Gastrointestinal Endoscopy, the American Gastroenterological Association, and the World Society of Emergency Surgery. We also discussed in brief the use of endoluminal vacuum therapy in colorectal perforations.

Advancements and challenges in neuroimaging for the diagnosis of intracranial aneurysms: Addressing false positive diagnoses and emerging techniques

Despite advancements in neuroimaging, false positive diagnoses of intracranial aneurysms remain a significant concern. This article examines the causes, prevalence, and implications of such false-positive diagnoses. We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms, particularly in the anterior circulation. The article compares various imaging modalities, including computer tomography angiogram, magnetic resonance imaging/angiography, and digital subtraction angiogram, highlighting their strengths and limitations. We emphasize the importance of accurate differentiation to avoid unnecessary surgical interventions. The potential of emerging technologies, such as high-resolution vessel wall imaging and deep neural networks for automated detection, is explored as promising avenues for improving diagnostic accuracy. This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.

Depression diagnosis: EEG-based cognitive biomarkers and machine learning

Depression is a complex mental illness that has significant effects on people as well as society. The traditional techniques for the diagnosis of depression, along with the potential of nascent biomarkers especially EEG-based biomarkers, are studied. This review explores the significance of cognitive biomarkers, offering a comprehensive understanding of their role in the overall assessment of depression. It also investigates the effects of depression on various brain regions, outlines promising areas for future research, and emphasizes the importance of understanding the neurophysiological roots of depression. Furthermore, it elucidates how machine learning and deep learning models are integrated into EEG-based depression diagnosis, emphasizing their importance in optimizing personalized therapeutic protocols and improving diagnostic accuracy with EEG data analysis.

Link between caries, periodontitis, and pregnancy: The role of personalized oral hygiene

Optimal health during pregnancy is crucial for ensuring the well-being of the mother and the developing fetus. This article is focused on the impact of oral health and the role of personalized oral hygiene management in addressing prevalent dental issues among pregnant women, with particular emphasis on periodontal disease and dental caries. Despite the high prevalence of these dental problems and their association with obstetric complications such as pre-term birth and low birth weight, many pregnant women do not receive adequate dental care. This gap in care is often due to misconceptions about the safety of dental treatments during pregnancy and lack of awareness on the part of healthcare professionals. Appreciations of the impacts of oral health and personalization of oral hygiene strategies such as tailored education and support, have proven effective in improving oral health in this population. Significant reductions in the incidence of caries and periodontal disease may be achieved by adapting care to the specific needs of each patient, thereby enhancing maternal and fetal health outcomes. Integration of personalized oral hygiene management into maternal health programs and enhancement of ongoing education for pregnant women and healthcare professionals are essential steps in the reduction of pregnancy-related risks and improvement of maternal and neonatal well-being.

Virtual reality based apps are the future of patient: Counseling

The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment. It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient. It also reduces burden on nursing staff and counsellors. Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population. It may be difficult to apply this tool on elderly patients with failing eyesight, multiple physical comorbidities. Also, there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling. We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.

Pancreatic cancer: Future challenges and new perspectives for an early diagnosis

This editorial is a commentary on the case report by Furuya et al focusing on the challenging diagnosis of early pancreatic adenocarcinoma and new tools for an earlier diagnosis. Currently, pancreatic cancer still has a poor prognosis, mainly due to late diagnosis in an advanced stage. Two main precancerous routes have been identified as pathways to pancreatic adenocarcinoma: The first encompasses a large group of mucinous cystic lesions: intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, and the second is pancreatic intraepithelial neoplasia. In the last decade the focus of research has been to identify high-risk patients, using advanced imaging techniques (magnetic resonance cholangiopancreatography or endoscopic ultrasonography) which could be helpful in finding “indirect signs” of early stage pancreatic lesions. Nevertheless, the survival rate still remains poor, and alternative screening methods are under investigation. Endoscopic retrograde cholangiopancreatography followed by serial pancreatic juice aspiration cytology could be a promising tool for identifying precursor lesions such as intraductal papillary mucinous neoplasm, but confirming data are still needed to validate its role. Probably a combination of cross-sectional imaging, endoscopic techniques (old and new ones) and genetic and biological biomarkers (also in pancreatic juice) could be the best solution to reach an early diagnosis. Biomarkers could help to predict and follow the progression of early pancreatic lesions. However, further studies are needed to validate their diagnostic reliability and to establish diagnostic algorithms to improve prognosis and survival in patients with pancreatic cancer.

Importance of etiologies of secondary diabetes: How often do we think off in clinical practice?

The article "Secondary diabetes due to different etiologies: Four case reports" by Song et al, published in the World Journal of Clinical Cases, delves into the identification of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions. Failure to do so can result in treatment delays and compromised patient outcomes. The article discusses specific types of diabetes, including maturity onset of diabetes in young, pancreas-related diseases, endocrinopathies, drug-induced diabetes, infections, and congenital genetic syndromes associated with diabetes mellitus. Case summaries highlight how patients with secondary diabetes, stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma, often exhibit distinct characteristics overlooked in clinical practice. The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention, including genetic tests and antibody detection. Increased awareness and education are crucial for timely identification and proper management, ultimately improving patient well-being. These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes, facilitating better glycemic control and overall patient care.

Rethinking the diagnosis and treatment of renal anastomotic hemangioma after partial nephrectomy

Renal anastomotic hemangioma (AH) is a rare, benign vascular tumor with unique histopathological features, a disease that is clinically rare, and existing clinical cases offer different treatment options. As reported in the text, this is a very unusual case of renal AH with AH secondary to residual renal tissue after renal clear cell carcinoma, describing a rare renal AH and a history of renal clear cell carcinoma, including ultrasound, computed tomography and magnetic resonance imaging. However, the available imaging data and the literature do not provide an effective basis for the diagnosis of the disease, raising the lack of understanding and misdiagnosis, where the patient eventually underwent nephrectomy, but the author is not the most appropriate surgical treatment. The postoperative pathological results of the patient are benign lesions, and it is undeniable that nephrectomy is suspected to be overtreated. By reading the literature, we provide different insights into the treatment of the patient, and we hope that this paper can provide some help for the future clinical diagnosis and treatment.

Root canal therapy combined with endoscopic sinus surgery for odontogenic sinusitis: Efficacy comparison in a cohort study

BACKGROUND

Odontogenic maxillary sinusitis, often triggered by dental issues like periapical periodontitis, significantly contributes to chronic sinusitis, mainly affecting adults around 50 years old, emphasizing the need for a multidisciplinary diagnostic and treatment approach.

AIM

To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal therapy in the treatment of severe odontogenic maxillary sinusitis caused by periapical periodontitis.

METHODS

The clinical data, diagnosis, and treatment of 200 patients with severe odontogenic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively. Among them, 63 patients were treated with simple root canal therapy as the control group, and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group. The therapeutic effect, Lund-Kennedy endoscopic score, paranasal sinus Lund-Mackay score, complication rate, recurrence rate, and patient satisfaction were compared between the two groups.

RESULTS

First, we compared the effective rates: 23 cases were cured, 22 were improved, and 8 were ineffective in the control group, yielding a total effective rate of 84.90%. Meanwhile, 97 cases were cured, 34 improved, and 6 were ineffective in the observation group, resulting in a total effective rate of 95.62%. The observation group had a higher total effective rate compared with the control group (P < 0.05). Second, we compared the Lund–Kennedy endoscopic score. Before treatment, no significant difference (P > 0.05) was observed in this score between the two groups. After treatment, the Lund–Kennedy endoscopic score decreased in both groups. The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group (P < 0.05). Third, we compared the Lund–Mackay score of paranasal sinuses. Before treatment, there was no significant difference in this score between the two groups (P > 0.05). After treatment, the Lund–Mackay scores of paranasal sinuses decreased in both groups. The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group (P < 0.05). Fourth, we compared the incidence and recurrence rate of complications. Three months after treatment, no significant difference was found in the incidence and recurrence rate of complications between the observation group (6.56%) and the control group (9.52%) (P > 0.05). However, 6 mo after treatment, the incidence and recurrence rate of complications in the observation group (2.91%) was significantly higher compared to that of the control group (12.69%) (P < 0.05). Fifth, we compared patient satisfaction. Six months after treatment, the patient satisfaction of the observation group (93.43%) was significantly better than that of the control group (84.12%) (P < 0.05).

CONCLUSION

Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis, and it can reduce the injury of maxillary sinus mucosa and bone, and significantly reduce the incidence of complications and recurrence rate. Meanwhile, it has high patient satisfaction and remarkable therapeutic effect, which is suggested to be popularized and applied in clinic.

Mycoplasma pneumoniae pneumonia in children

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen that causes community-acquired pneumonia in children. The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases. Complications may occur, such as necrotizing pneumonia and respiratory failure. Extrapulmonary complications, including encephalitis, myocarditis, nephritis, hepatitis, or even multiple organ failure, can also arise. In this editorial, we discuss the clinical implications of the significant findings from the article "Serum inflammatory markers in children with M. pneumoniae pneumonia and their predictive value for mycoplasma severity" published by Wang et al. They reported that measuring lactic dehydrogenase, interleukin-6 levels, and D-dimer effectively predicts refractory M. pneumoniae pneumonia cases.

Tongluo Jiedu as an adjuvant therapy for oral cancer

Oral cancer is one of the malignant neoplasms that present major global health challenge. It is the sixth most prevalent type of cancer in the world, with a high incidence and mortality rate. This letter is a review of the study by Yin et al which was published in the World Journal of Clinical Cases (2024). The study evaluated the effect of Tongluo Jiedu as an adjuvant treatment for oral cancer. Over the years, there has been a continuous search for effective and less invasive treatments for oral cancer. This article emphasizes and discusses various therapeutic options currently available, and it highlights that early intervention and multidisciplinary management are crucial for improving outcomes. Traditional Chinese medicine, particularly Tongluo Jiedu, presents potential complementary approach to conventional oral cancer therapies. Future research on Tongluo Jiedu should be focused on validation of its efficacy and safety through large, well-designed clinical trials, as well as better understanding of the molecular mechanisms involved, and optimization of therapeutic combinations. Additionally, continuous education of health professionals is key to the effective and safe integration of this traditional medicine into clinical practice. Continuous research is essential for optimization of therapeutic strategies and for addressing the challenges presented by this neoplasm.

Plantamajoside improves type 2 diabetes mellitus pancreatic β-cell damage by inhibiting endoplasmic reticulum stress through Dnajc1 up-regulation

BACKGROUND

Plantamajoside (PMS) has shown potential in mitigating cell damage caused by high glucose (HG) levels. Despite this, the precise therapeutic effects of PMS on type 2 diabetes mellitus (T2DM) and the underlying regulatory mechanisms require further exploration.

AIM

To investigate PMS therapeutic effects on T2DM in mice and elucidate its mechanisms of action through in vivo and in vitro experiments.

METHODS

An in vitro damage model of MIN6 cells was established using HG and palmitic acid (PA). PMS's protective effect on cell damage was assessed. Next, transcriptomics was employed to examine how PMS treatment affects gene expression of MIN6 cells. Furthermore, the effect of PMS on protein processing in endoplasmic reticulum and apoptosis pathways was validated. A T2DM mouse model was used to validate the therapeutic effects and mechanisms of PMS in vivo.

RESULTS

PMS intervention ameliorated cell injury in HG + PA-induced MIN6 cell damage. Transcriptomic analysis revealed that protein processing in the endoplasmic reticulum and apoptosis pathways were enriched in cells treated with PMS, with significant downregulation of the gene Dnajc1. Further validation indicated that PMS significantly inhibited the expression of apoptosis-related factors (Bax, CytC) and endoplasmic reticulum stress (ERS)-related factors [ATF6, XBP1, Ddit3 (CHOP), GRP78], while promoting the expression of Bcl-2 and Dnajc1. Additionally, the inhibitory effects of PMS on ERS and apoptosis were abolished upon Dnajc1 silencing. Furthermore, in vivo experiments demonstrated that PMS intervention effectively improved pancreatic damage, suppressed the expression of apoptosis-related factors (Bax, CytC), and ERS-related factors [ATF6, XBP1, Ddit3 (CHOP), GRP78], while promoting the expression of Bcl-2 and Dnajc1 in a T2DM model mice.

CONCLUSION

PMS intervention could alleviate pancreatic tissue damage effectively. The mechanism of action involves Dnajc1 activation, which subsequently inhibits apoptosis and ERS, ameliorating damage to pancreatic β-cells.

Investigating the possible mechanism of Cornus officinalis in the therapy of ischemic stroke by UHPLC-Q-TOF-MS, network pharmacology, molecular docking, and experimental verification

ETHNOPHARMACOLOGICAL RELEVANCE

Cornus officinalis is a conventional Chinese medicine for tonifying liver and kidney in ancient China. The active ingredients from Cornus officinalis can delay the progression of cerebral aneurysms, alleviate experimental autoimmune encephalomyelitis, and show a good intervention effect on brain diseases. Loganin, the active ingredient of Cornus officinalis, has a neuroprotective effect on cerebral ischemia-reperfusion injury in mice. It is yet unknown, nevertheless, how Cornus officinalis works to treat ischemic stroke.

AIM OF THE STUDY

Based on ultra-high performance liquid chromatography-quadrupole/time-of-flight mass spectrometry (UHPLC-Q-TOF-MS), network pharmacology and molecular docking, Cornus officinalis's mechanism of intervention in ischemic stroke is explored and verified by experiments.

MATERIALS AND METHODS

To examine the chemical components of Cornus officinalis, UHPLC-Q-TOF-MS was used. The network pharmacology was used to construct the "active ingredient-core target-main pathway" network of Cornus officinalis. Then, the link between the main active components and the key protein targets, as determined by network pharmacology, was verified through the application of molecular docking. The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model used in this study was created using the suture technique. The pharmacological effects of Cornus officinalis were explored by neurological function score, behavior, TTC staining, ultrasound and flow cytometry. Western blot and qPCR were used to confirm the core target.

RESULTS

The outcomes of the investigation demonstrated that Cornus officinalis had a potent anti-ischemic stroke effect. UHPLC-Q-TOF-MS method was used to determine 24 chemical constituents in Cornus officinalis, of which 22 components had a close relationship with protein targets relevant to ischemic stroke. The 27 protein targets screened by "active ingredient-core target-main pathway" may be the possible targets of Cornus officinalis in the therapy of ischemic stroke. Most of the 27 protein targets had to do with the inflammatory response, apoptosis and energy metabolism. KEGG enrichment analysis showed that AGE/RAGE ranked high and was closely related to inflammatory response. Molecular docking predicted that the top 10 components in the network diagram had good binding with inflammatory factors IL6, IL-1β and TNF-α protein targets. Western blot research outcomes stated that Cornus officinalis could firmly impede the production of AGE, RAGE, and P-NFκB P65. Cornus officinalis had the potential to prevent ischemic stroke by drastically inhibiting the production of TNF-α, IL-1β, and IL-6, according to the results of qPCR study.

CONCLUSION

This study found that Cornus officinalis can improve the brain injury, motor ability and blood flow velocity of MCAO/R rats and suppress the inflammatory reaction through the AGE/RAGE/NFκB pathway to exert the therapeutic effect on ischemic stroke.

The significance of exosomal non-coding RNAs (ncRNAs) in the metastasis of colorectal cancer and development of therapy resistance

Colorectal cancer (CRC) represents a common type of carcinoma with significant mortality rates globally. A primary factor contributing to the unfavorable treatment outcomes and reduced survival rates in CRC patients is the occurrence of metastasis. Various intricate molecular mechanisms are implicated in the metastatic process, leading to mortality among individuals with CRC. In the realm of intercellular communication, exosomes, which are a form of extracellular vesicle (EV), play an essential role. These vesicles act as conduits for information exchange between cells and originate from multiple sources. By fostering a microenvironment conducive to CRC progression, exosomes and EVs significantly influence the advancement of the disease. They contain a diverse array of molecules, including messenger RNAs (mRNAs), non-coding RNAs (ncRNAs), proteins, lipids, and transcription factors. Notably, ncRNAs, such as microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), are prominently featured within exosomes. These ncRNAs have the capacity to regulate various critical molecules or signaling pathways, particularly those associated with tumor metastasis, thereby playing a crucial role in tumorigenesis. Their presence indicates a substantial potential to affect vital aspects of tumor progression, including proliferation, metastasis, and resistance to treatment. This research aims to categorize exosomal ncRNAs and examine their functions in colorectal cancer. Furthermore, it investigates the clinical applicability of novel biomarkers and therapeutic strategies in CRC. Abbreviations: ncRNAs, non-coding RNAs; CRC, Colorectal cancer; EV, extracellular vesicle; mRNAs, messenger RNAs; miRNAs, microRNAs; lncRNAs, long non-coding RNAs; circRNAs, circular RNAs; HOTTIP, HOXA transcript at the distal tip; NSCLC, non-small cell lung cancer; 5-FU, 5-fluorouracil; OX, Oxaliplatin; PDCD4, programmed cell death factor 4; Tregs, regulatory T cells; EMT, epithelial-mesenchymal transition; PFKFB3, 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3; USP2, ubiquitin carboxyl-terminal hydrolase 2; TNM, tumor node metastasis; TAMs, tumor-associated macrophages; RASA1, RAS p21 protein activator 1; PDCD4, programmed cell death 4; ZBTB2, zinc finger and BTB domain containing 2; SOCS1, suppressor of cytokine signaling 1; TUBB3, β-III tubulin; MSCs, mesenchymal stem cells.