Neuromodulation technologies improve functional recovery after brain injury: From bench to bedside

Spontaneous recovery frequently proves maladaptive or insufficient because the plasticity of the injured adult mammalian central nervous system is limited. This limited plasticity serves as a primary barrier to functional recovery after brain injury. Neuromodulation technologies represent one of the fastest-growing fields in medicine. These techniques utilize electricity, magnetism, sound, and light to restore or optimize brain functions by promoting reorganization or long-term changes that support functional recovery in patients with brain injury. Therefore, this review aims to provide a comprehensive overview of the effects and underlying mechanisms of neuromodulation technologies in supporting motor function recovery after brain injury. Many of these technologies are widely used in clinical practice and show significant improvements in motor function across various types of brain injury. However, studies report negative findings, potentially due to variations in stimulation protocols, differences in observation periods, and the severity of functional impairments among participants across different clinical trials. Additionally, we observed that different neuromodulation techniques share remarkably similar mechanisms, including promoting neuroplasticity, enhancing neurotrophic factor release, improving cerebral blood flow, suppressing neuroinflammation, and providing neuroprotection. Finally, considering the advantages and disadvantages of various neuromodulation techniques, we propose that future development should focus on closed-loop neural circuit stimulation, personalized treatment, interdisciplinary collaboration, and precision stimulation.

Role of endoscopic ultrasound as a predictor of histological healing in ulcerative colitis

BACKGROUND

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with rising global prevalence.Histological healing (HH) is a key treatment target associated with better long-term outcomes. Although endoscopic ultrasound (EUS) is known to be related to both clinical and endoscopic activity in UC, its role in defining HH remains unclear. Therefore, this study was aimed at investigating the association between EUS and histological activity (HA), as well as the predictive potential of EUS for HH.

METHOD

In this cross-sectional analysis, 68 UC adults underwent EUS and colonoscopy with biopsies. We used the Mayo Endoscopic Score (MES) for endoscopic activity, the Nancy Index (NI) for biopsy grading, and the Endoscopic Ultrasound-Ulcerative Colitis (EUS-UC) score for EUS analysis, defining endoscopic remission as MES ≤ 1 and HH as NI ≤ 1.A receiver operating characteristic (ROC) curve was employed to evaluate the ability of the indices to predict HH.

RESULTS

Totally 23 patients (33.80%) achieved HH, while 45 (66.20%) showed HA. The EUS-UC scores were significantly lower in the HH group (p < 0.001) and correlated strongly with NI (ρ = 0.73). EUS-UC score was an independent risk factor for HH (adjusted OR = 1.918, 95% CI: 1.195-3.080, p = 0.007). The EUS-UC score demonstrated a strong predictive value for HH, with an AUC of 0.840, a sensitivity of 75.56%, and a specificity of 78.26%.

CONCLUSION

The EUS-UC score has a significant correlation with histological outcomes and shows strong potential as a reliable, invasive predictor of HH in UC, with implications for improved disease monitoring.

The coping experiences in patients with hepatocellular carcinoma and their spouses following postoperative recurrence: A dyadic qualitative study

Objective

Dyadic coping practices can vary depending on cultural contexts, socioeconomic factors, and the stages of the cancer journey. This study aimed to explore the dyadic coping experiences of hepatocellular carcinoma (HCC) patients and their spouses following postoperative recurrence in the Chinese cultural context, where cancer recurrence is frequently seen as a death sentence, and family-centered care is prioritized.

Methods

A descriptive qualitative research design was used, involving face-to-face, in-depth semi-structured interviews with 13 pairs of hepatocellular carcinoma patients and their spouses at a tertiary cancer hospital from July to October 2023. The interview guide was designed based on the Actor-Partner Interdependence Model (APIM) framework. Data were analyzed using thematic analysis, and the study adhered to the COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

Results

Three themes were identified: (1) active coping strategies, (2) negative coping tendencies, and (3) the need for systematic coping support. The majority of couples perceived hepatocellular carcinoma recurrence as a death sentence, which prompted them-especially the spouses-to adopt proactive strategies, such as striving to seek advanced treatments and concealing unfavorable information. In contrast, patients, particularly those with a hereditary hepatocellular carcinoma background, often exhibited passivity, withdrawal, and contemplation of treatment abandonment. Spouses frequently felt overwhelmed and unable to alleviate their partners' anxiety about recurrence and death, particularly in the absence of support from health care professionals. They expressed a strong need for professional guidance and targeted interventions to address end-of-life concerns, emphasizing the need for increased financial support, empowerment through knowledge, and access to peer support networks.

Conclusions

This research emphasizes the importance of recognizing the interdependent coping experiences of recurrent HCC patients and their spouses. Health care professionals are encouraged to implement culturally sensitive, dyadic interventions that foster collaborative coping, address death-related anxiety, and empower couples in managing recurrence together, thereby enhancing their coping strategies and confidence.

A real-world study on the influence of unplanned reoperations on hospitalized patients using the diagnosis-related group

OBJECTIVE

The issue of unplanned reoperations poses significant challenges within healthcare systems, with assessing their impact being particularly difficult. The current study aimed to assess the influence of unplanned reoperations on hospitalized patients by employing the diagnosis-related group (DRG) to comprehensively consider the intensity and complexity of different medical services.

METHODS

A retrospective cohort study of surgical patients was conducted at a large tertiary hospital with two hospital districts employing data sourced from a DRG database. Hospital length of stay (LOS) and hospitalization costs were measured as the primary outcomes. Discharge to home was measured as the secondary outcome. Frequency matching based on DRG, regression modeling, subgroup comparison and sensitivity analysis were applied to evaluate the influence of unplanned reoperations.

RESULTS

We identified 20820 surgical patients distributed across 79 DRGs, including 188 individuals who underwent unplanned reoperations and 20632 normal surgical patients in the same DRGs. After DRG-based frequency matching, 564 patients (188 with unplanned reoperations, 376 normal surgical patients) were included. Unplanned reoperations led to prolonged LOS (before matching: adjusted difference, 12.05 days, 95% confidence interval [CI] 10.36-13.90 days; after matching: adjusted difference, 14.22 days, 95% CI 11.36-17.39 days), and excess hospitalization costs (before matching: adjusted difference, $4354.29, 95% CI: $3,817.70-$4928.67; after matching: adjusted difference, $5810.07, 95% CI $4481.10-$7333.09). Furthermore, patients who underwent unplanned reoperations had a reduced likelihood of being discharged to home (before matching: hazard ratio [HR] 0.27, 95% CI 0.23-0.32; after matching: HR 0.31, 95% CI 0.25-0.39). Subgroup analyses indicated that the outcomes across the various subgroups were mostly uniform. In high-level surgery subgroups (levels 3-4) and in relation to complex diseases (relative weight ≥ 2), the increase in hospitalization costs and LOS was more pronounce after unplanned reoperations. Similar results were observed with sensitivity analysis by propensity score matching and excluding short LOS.

CONCLUSIONS

Incorporating the DRG allows for a more effective assessment of the influence of unplanned reoperations. In managing such reoperations, mitigating their influence, especially in the context of high-level surgeries and complex diseases, remains a significant challenge that requires special consideration.

Peritoneal dialysis peritonitis due to Neisseria: clinicopathological features of 10 patients with a review of the literature

BACKGROUND

Peritoneal dialysis-associated peritonitis (PDAP) frequently arises as a complication in patients undergoing peritoneal dialysis. However, the understanding of the role of Neisseria, a gram-negative coccus, in PDAP is limited.

METHODS

This study retrospectively analyzed data for patients with Neisseria-associated PDAP who were treated at our center from January 2010 to June 2022. These patients were classified into the Neisseria group (Group N) and matched 1:2 by sex, age, dialysis duration, and residual kidney Kt/V with a coagulase-negative staphylococci group (Group CNS) and a Staphylococcus aureus group (Group S) as controls. Statistical analysis was conducted via SPSS 25.0 and was supplemented with a review of the relevant literature, to investigate clinical features, pathways of infection, and patient outcomes.

RESULTS

This study included 10 cases of Neisseria-associated PDAP, comprising 6 male and 4 female patients. The patients had an average age of 58.10 ± 14.52 years, and the average duration of peritoneal dialysis was 72.00 ± 46.99 months. Among these patients, 3 had first-time infections, while 7 had a prior history of PDAP. After treatment, 9 patients achieved medical cure, and 1 patient was transferred to hemodialysis (HD). Baseline comparisons across the 3 groups indicated notable differences in body temperature upon admission, which were statistically significant (p < 0.05), with patients in Group S having higher body temperatures compared to Group N and Group CNS. Compared with Group N, Group S presented a markedly elevated high-sensitivity C-reactive protein (hs-CRP) level, decreased serum albumin levels, reduced serum potassium levels, whereas Group CNS presented a significantly lower neutrophil percentage (N%) than did Group N (p < 0.05). Although survival analysis did not reveal statistically significant differences due to the limited sample size, Kaplan-Meier curves indicated a trend toward lower cure rates and slightly worse long-term outcomes in Group S than in Group N and Group CNS, with the latter 2 groups showing similar results.

CONCLUSION

Neisseria-associated PDAP generally has favorable outcomes, similar to those of CNS-related PDAP and better than those of S-related PDAP. Hypoalbuminemia, hypokalemia and elevated hs-CRP are key risk factors affecting outcomes, emphasizing the need to address them during treatment.

Impact of FcRn antagonism on vaccine-induced protective immune responses against viral challenge in COVID-19 and influenza mouse vaccination models

Antagonism of the neonatal Fc receptor through an engineered antibody Fc fragment, such as efgartigimod, results in a decrease in immunoglobulin G levels. This approach is being evaluated as a therapeutic strategy for the treatment of IgG-mediated autoimmune diseases. Our goal was to evaluate the impact of mFc-ABDEG, a mouse-adapted antibody Fc fragment with a mode of action highly similar to efgartigimod, on vaccine-induced protective immune responses against viral infections. Therefore, mouse vaccination models for COVID-19 and influenza were employed, utilizing an mRNA COVID-19 vaccine (COMIRNATY) and an adjuvanted, inactivated quadrivalent influenza vaccine (Seqirus+AddaVax), respectively. In both models, vaccination induced robust humoral responses. As expected, animals treated with mFc-ABDEG had lower levels of virus-specific IgG, while virus-specific IgM responses remained unaffected. The COVID-19 vaccine induced a strong Th1-type T cell response irrespective of mFc-ABDEG treatment. Influenza vaccination resulted in a poor T cell induction, regardless of mFc-ABDEG treatment, due to the Th2-biased response that inactivated influenza vaccines typically induce. Importantly, mFc-ABDEG treatment had no effect on protective immunity against live viral challenges in both models. Vaccinated animals treated with mFc-ABDEG were equally protected as the non-treated vaccinated controls. These non-clinical data demonstrate that FcRn antagonism with mFc-ABDEG did not affect the generation of vaccine-induced protective humoral and cellular responses, or protection against viral challenges. These data substantiate the clinical observations that, although IgG titers were reduced, FcRn antagonism with efgartigimod did not impair the ability to generate new specific IgG responses, regardless of the timing of vaccination.

Prevalence of attention deficit hyperactivity disorder in homeless children and adolescents: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aimed to examine the prevalence of Attention deficit hyperactivity disorder (ADHD) in homeless children and adolescents, and the factors that may influence its prevalence.

METHODS

Relevant publications in Medline, Web of Science, Scopus and PsycINFO were systematically searched to identify studies on the prevalence of ADHD in homeless children and adolescents (≤19 years). The extracted data were pooled using a random-effects model.

RESULTS

Thirteen studies involving 2878 homeless children and adolescents were included (mean age: 12.0 years, sex F/M: 0.43). The prevalence rates of ADHD vary considerably across studies, ranging from 1.6% to 64.5%. The pooled prevalence of ADHD was 22.8% (95% CI 12.9-34.4%, I2 =98%). Meta-regression analyses indicated that age (slope = 0.046; p = .042) significantly increased ADHD prevalence. The prevalence of ADHD in studies with a mean age ≥ 12 years (43.1%, 95% CI 26.5-60.4%) was higher than those with a mean age < 12 years (13.1%, 95%CI 4.3-25.6).

CONCLUSION

Despite the high heterogeneity of the studies, we observed that ADHD could affect almost a quarter of homeless children and adolescents. Reintegrating them into care systems and ensuring access to public health interventions tailored for homeless families and youth is imperative for breaking the cycle of homelessness and improving long-term trajectories.

Analyzing factors influencing hospitalization costs for five common cancers in China using neural network models

BACKGROUND

Malignant tumors are a major global health crisis, causing 25% of deaths in China, with lung, liver, thyroid, breast, and colon cancers being the most common. Understanding the factors influencing hospitalization costs for these cancers is crucial for public health and economics. This study aimed to identify key cost factors and develop a neural network model for predicting hospitalization costs, thereby providing tools to ease the financial burden on patients and healthcare systems.

METHODS

Data on hospitalization costs for 30,893 cancer patients from secondary or higher-level hospitals in Zhuhai, Guangdong Province, between 2017 and 2022, were analyzed. Neural network classification and feature importance analysis were used to determine the main factors influencing costs and to develop predictive models. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), with a 95% confidence interval (CI) calculated for the AUROC value.

RESULTS

The key factors influencing hospitalization costs for lung cancer are metastasis and malignant solid tumor (MST), with correlation coefficients of 0.126 and 0.086, respectively, both showing statistical significance (p < 0.05). For colon cancer, the key factors influencing hospitalization costs are mortality and coronary disease (CD), with correlation coefficients of 0.092 and 0.090, respectively, both demonstrating statistical significance (p < 0.05). The AUROC value for the lung cancer model is 0.9078 (95% CI = 0.8975-0.9186), and the AUROC value for the colon cancer model is 0.9017 (95% CI = 0.8848-0.9196).

CONCLUSION

This study confirmed the strong clinical applicability of the neural network predictive model in analyzing hospitalization costs for lung and colon cancer and revealed the factors that influence hospitalization costs for these cancers.

Activation of CXCR7 exerts an inhibitory effect on adipogenesis through regulation of β-arrestin2/Wnt and AKT signalling

CXCR7, an alternative receptor for the inflammatory chemokine SDF-1, is involved in cell proliferation and migration. Recent studies have reported that CXCR7 also plays a role in adipose tissue. However, evidence regarding the role of CXCR7 and its ligands in adipocyte differentiation is limited. In this study, we aimed to elucidate changes in CXCR7 expression during adipocyte differentiation and the role of the SDF-1/CXCR7/CXCR4 axis in adipogenesis using recombinant SDF-1, the CXCR7 ligand CCX771, and small interfering RNAs. The results indicated that the levels of SDF-1 and its receptors, CXCR7 and CXCR4, decreased during the early stages of adipogenesis. Treatment with recombinant SDF-1 and CCX771 inhibited adipogenesis and lipid accumulation by inducing β-arrestin2, Wnt expression, and AKT phosphorylation and downregulating C/EBPα, PPARγ, and FABP4 expression. In contrast, knockdown of SDF-1 and CXCR7 in preadipocytes downregulated the β-arrestin2/Wnt and AKT pathway, leading to the induction of adipogenesis. Meanwhile, knockdown of CXCR4 had no significant effect. In mice, basal gene expression levels of SDF-1 and CXCR7 were higher in the stromal vascular fraction compared to mature adipocytes and were significantly upregulated by a high-fat diet. Our results provide new insights into the local role of the SDF-1-CXCR7 axis in adipocytes and offer additional benefits for the prevention of obesity-related metabolic disorders.

Prenatal ultrasound for the diagnosis of the cerebellar abnormalities: a meta-analysis

OBJECTIVE

Fetal cerebellar abnormalities are associated with neurodevelopmental disorders and structural brain malformations. Accurate and early diagnosis is crucial for prenatal counseling and planning postnatal interventions. While prenatal ultrasound is a key tool for detecting fetal brain abnormalities, variations in diagnostic accuracy across studies necessitate a systematic evaluation of its effectiveness in diagnosing cerebellar abnormalities.

METHODS

A comprehensive literature search was conducted across major databases to identify relevant studies on prenatal ultrasound for diagnosing cerebellar anomalies. Inclusion criteria included studies with clear diagnostic outcomes, diverse patient populations, and standardized ultrasound protocols. Meta-analytic techniques were employed to assess overall diagnostic accuracy, sensitivity, specificity, and heterogeneity using Meta Disk. The quality of the included studies was evaluated using the QUADAS-2 tool.

RESULTS

The meta-analysis included fifteen studies involving 1,902 fetuses with suspected cerebellar abnormalities. The pooled sensitivity and specificity of prenatal ultrasound were 0.83 (95% CI: 0.80-0.86) and 0.97 (95% CI: 0.96-0.98), respectively. The positive likelihood ratio was 7.96 (95% CI: 3.23-19.64), the negative likelihood ratio was 0.18 (95% CI: 0.09-0.36), and the odds ratio was 46.76 (95% CI: 14.06-155.53). The combined area under the curve (AUC) reached 0.93, indicating robust diagnostic performance. Heterogeneity was observed, influenced by factors such as gestational age at screening, operator expertise, and ultrasound equipment quality.

CONCLUSIONS

Prenatal ultrasound is a reliable tool for detecting cerebellar abnormalities with high sensitivity and specificity. However, variability in diagnostic performance suggests the need for standardized protocols and advanced imaging techniques to enhance accuracy. Future research should focus on integrating multiple imaging modalities to optimize prenatal screening outcomes.

Association of serum N,N,N-trimethyl-5-aminovaleric acid, trimethylamine N-oxide, and trimethyllysine levels with gestational diabetes mellitus

OBJECTIVE

To investigate the association of serum N,N,N-trimethyl-5-aminovaleric acid (TMAVA), trimethylamine N-oxide (TMAO), and trimethyllysine (TML) levels with gestational diabetes mellitus (GDM).

METHODS

Seventy pregnant women from the Hunan Provincial Maternal and Child Health Care Hospital (March 2021 to October 2023) were enrolled in this study. Forty GDM patients with GDM were included in the GDM group (GDM), and 30 healthy controls were included (Con). Participants were further categorized into adverse and good outcome groups based on pregnancy outcomes. Serum TMAVA, TMAO, and TML levels were quantified using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Correlations between biomarker levels and clinical indicators were assessed using Pearson and Spearman analyses. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate risk factors and predictive value.

RESULTS

Serum TMAVA, TMAO, and TML levels were significantly higher in the GDM group. TMAVA levels were positively correlated with fasting plasma glucose (FPG), fasting insulin (FINS), creatinine (Cr), TMAO, and TML. TMAO and TML positively correlated with FPG, 2-h postprandial glucose (2h PG), FINS, Cr, and uric acid (UA) levels, while TMAO negatively correlated with triglyceride (TG). Combined TMAVA, TMAO, and TML predicted GDM with an area under the curve (AUC) of 0.940 (95% CI: 0.883-0.997). Elevated TMAVA levels were associated with adverse pregnancy outcomes in GDM, with an AUC of 0.757 (95% CI: 0.612-0.902).

CONCLUSIONS

Elevated serum levels of TMAVA, TMAO, and TML were significantly associated with the occurrence of GDM and adverse pregnancy outcomes. The combined detection of these three biomarkers demonstrated superior accuracy in predicting GDM. Among them, TMAVA demonstrated the highest predictive efficiency for adverse pregnancy outcomes in women with GDM. These findings provide new biomarkers for early screening and risk assessment of GDM, offering promising applications in clinical practice.

The mechanistic action of mogroside V in the alleviation of oxidative aging

INTRODUCE

Diseases related to oxidative ageing are becoming increasingly evident in younger individuals. In this study, we investigated the mechanisms underlying the actions of mogroside V when used to treat anti-oxidative ageing.

METHODS

We used D-galactose-induced LO2 cells and C57BL/6J mice as models to investigate the molecular mechanisms of mogroside V (MV) for the treatment of oxidative ageing. Network pharmacology was used to predict the targets of MV for the treatment of oxidative ageing.

RESULTS

By down-regulating the EGFR/p38/JNK pathway, MV significantly inhibited oxidative ageing and apoptosis in cells, reduced the levels of SA-β-galactosidase. In mice, compared with the model group, MV treatment (100 mg/kg·d) reduced MDA levels and significantly increased the levels of GSH and SOD; furthermore, the size and structure of the liver leaflet and glomeruli was arranged in a regular manner; the small intestine glands had decreased in size. Moreover, the expression levels of Ptp1b mRNA had increased significantly while the levels of c-Jun mRNA and protein were significantly reduced. MV also increased the proportion of beneficial bacteria in the small intestine, including Bacteroidales and Lactobacillaceae.

CONCLUSION

Our analyses revealed that MV can significantly reduce oxidative ageing caused by the accumulation of D-galactose.

Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Tibiofibular Diaphyseal Fracture: A Randomized Controlled Clinical Trial

BACKGROUND

In order to ascertain the safety and therapeutic efficacy of preoperative simulation in conjunction with three-dimensional (3D) printing modalities for the surgical management of tibiofibular diaphyseal fractures. We postulate that preoperative simulation and three-dimensional (3D) printing techniques have a significant impact on reducing the mean operative time, diminishing intraoperative blood loss, and decreasing the frequency of fluoroscopic.

MATERIAL AND METHODS

Sixty patients with tibiofibular diaphyseal fracture were divided into the conventional surgery group (n = 30) and the 3D printing group (n = 30). In the 3D printing group, preoperative equal-ratio fracture models prepared using the 3D printing technique were used to perform preoperative simulation, guide the real surgical operation, examine implant reduction and placement as well as preoperative plate/screw size. The operation time, intraoperative bleeding, frequency of fluoroscopies, Visual Analog Scale (VAS), and Johner-Wruhs Scale were recorded.

RESULTS

The operation time, blood loss, and the frequency of fluoroscopy during operation in the group with preoperative simulation and 3D printing were less than that in the conventional surgery group (p < 0.001). Meanwhile, the Visual Analog Scale (VAS) and Johner-Wruhs Scale were also improved in both groups.

CONCLUSION

The findings indicated that preoperative simulation and three-dimensional (3D) printing may facilitate the treatment of tibiofibular diaphyseal fractures, potentially enhancing preoperative planning and contributing to the precision and personalization of the surgical procedure. Thus, the application of this technology possesses considerable promise for future utilization in clinical practice.

TRIAL REGISTRY

Name of the registry: This study was registered in the Chinese Clinical Trial Registry; Trial registration number: ChiCTR2100052379.

Membranous nephropathy concurrent with renal amyloidosis: a six-patient report and literature review

The KDIGO 2021 guidelines suggest that individuals who test positive for serum anti-phospholipase A2 receptor (anti-PLA2R) antibodies may not require a renal biopsy to establish a diagnosis of membranous nephropathy (MN). However, it is imperative to acknowledge that MN can coexist with other chronic kidney diseases. In instances where MN is comorbid with IgA nephropathy, diabetic nephropathy, or focal segmental glomerulosclerosis, the therapeutic approach tends to be analogous. Nevertheless, there is a significant disparity in both the treatment regimen and the prognosis between MN and renal amyloidosis, with variations existing even among distinct subtypes of renal amyloidosis. Given that both MN and renal amyloidosis exhibit a predilection for the geriatric population, it is prudent to consider the possibility of MN concurrent with renal amyloidosis in elderly patients who test positive for serum anti-PLA2R antibodies. This consideration should precede a straightforward MN treatment strategy. In this report, we present six patients with MN concurrent with renal amyloidosis identified at our center over the past 14 years; in five of whom were positive for serum anti-PLA2R antibodies. We further elucidated the divergent clinicopathological characteristics and prognostic implications of these cases.

Placental malaria induces a unique methylation profile associated with fetal growth restriction

Fetal growth restriction (FGR) is associated with perinatal death and adverse birth outcomes, as well as long-term complications, including increased childhood morbidity, abnormal neurodevelopment, and cardio-metabolic diseases in adulthood. Placental epigenetic reprogramming associated with FGR may mediate these long-term outcomes. Placental malaria (PM), characterized by sequestration of Plasmodium falciparum-infected erythrocytes in placental intervillous space, is the leading global cause of FGR, but its impact on placental epigenetics is unknown. We hypothesized that placental methylomic profiling would reveal common and distinct mechanistic pathways of non-malarial and PM-associated FGR. We analyzed placentas from a US cohort with no malaria exposure (n = 12) and a cohort from eastern Uganda, a region with a high prevalence of malaria (n = 12). From each site, 8 cases of FGR and 4 healthy controls were analyzed. PM was diagnosed by placental histopathology. We compared the methylation levels of over 850K CpGs of the placentas using Infinium MethylationEPIC v1 microarray. Non-malarial FGR was associated with 65 differentially methylated CpGs (DMCs), whereas PM-FGR was associated with 133 DMCs, compared to their corresponding controls without FGR. One DMC (cg16389901, located in the promoter region of BMP4) was commonly hypomethylated in both groups. We identified 522 DMCs between non-malarial FGR vs. PM-FGR placentas, independent of differing geographic location or cellular composition. Placentas with PM-associated FGR have distinct methylation profiles compared to placentas with non-malarial FGR, suggesting novel epigenetic reprogramming in response to malaria. Larger cohort studies are needed to determine the distinct long-term health outcomes in PM-associated FGR pregnancies.

Increased dialysis symptom index burden in maintenance hemodialysis patients during the COVID-19 lockdown period

PURPOSE

The high prevalence of dialysis-related symptoms in maintenance hemodialysis (MHD) patients severely affects their quality of life. Therefore, in this study, we assessed the dialysis symptom index (DSI) of MHD patients during the second wave of COVID-19, which triggered a health crisis, resulting in many cities in China opting for social isolation.

METHODS

A total of 106 MHD patients from our center were screened. DSI, sleep quality, and fatigue scales were investigated separately before and during lockdown. Demographic and laboratory data of MHD patients were collected. A nomogram was used to predict high DSI by combining multiple indicators. Additionally, internal validation was performed to reduce overfitting bias.

RESULTS

The mean age of patients was 56.0 years (SD 13.1). The prevalence and severity of DSI were significantly higher during lockdown than pre-lockdown. Notably, itching, trouble staying asleep, bone or joint pain, muscle cramps, feeling irritability, difficulty concentrating, headache, constipation, and feeling nervous were observed (p < 0.05). Multivariate logistic regression analysis identified longer dialysis vintage, lower albumin level, and lower Kt/V as predictors of high DSI. Nomogram showed good accuracy in estimating high DSI with a C-index and bootstrap-corrected index of 0.875 and 0.863, respectively. Calibration plots showed optimal consistency with the actual presence of high DSI.

CONCLUSION

We found a higher prevalence of DSI in MHD patients during the COVID-19 lockdown. Furthermore, patients with longer dialysis vintage, lower albumin levels, and Kt/V had a risk of developing high DSI.

High altitude renal syndrome: four elements or one source?

High Altitude Renal Syndrome (HARS) is a clinical syndrome characterized by polycythemia, hyperuricemia, hypertension, and albuminuria at high altitudes. This review emphasizes hypoxia-induced High Altitude Polycythemia (HAPC) as its core driver. In 2014, the 6th Qinghai International Conference on Mountain Medicine and High Altitude Physiology established international diagnostic criteria for HAPC (hemoglobin ≥210g/L in males, ≥190g/L in females). HAPC triggers systemic hypoxia, leading to hyperuricemia via uric acid overproduction and reduced renal excretion, hypertension from hemodynamic changes, and glomerular injury through erythrocytosis. Pathological mechanisms involve HIF-2α-mediated glomerular hypertrophy and podocyte damage. Treatment strategies target HAPC and downstream effects. Carbonic anhydrase inhibitors (e.g., acetazolamide) reduce hematocrit and improve oxygen saturation, but newer agents like methazolamide and dichlorphenamide offer equivalent efficacy with fewer side effects (e.g., reduced central nervous system toxicity). For severe cases, descending to lower altitudes remains the gold standard. Additional interventions include calcium channel blockers (nifedipine), urate-lowering drugs, and experimental therapies such as HIF-2α inhibitors (PT2385) and endothelin receptor antagonists (matitan). This analysis underscores HAPC as the primary etiology of HARS, advocating revised diagnostic criteria and treatment prioritization.

Evaluating the anti-inflammatory and antioxidant efficacy of complementary and alternative medicines (CAM) used for management of inflammatory bowel disease: a comprehensive review

Inflammatory bowel disease (IBD) is a chronic autoimmune condition whose pathogenesis has not been fully elucidated, and current treatments are not definitive and often carry several side effects. The Complementary and Alternative Medicine (CAM) offers a new approach to conventional medicine. However, their clinical application and mechanisms remain limited.Objective: The aim of this review is to evaluate the anti-inflammatory, impact on microbiota and antioxidant efficacy of currently available CAM for IBD.Methods: The literature collection was obtained from Google Scholar, MEDLINE, PubMed and Web of Science (WOS). Studies in both human and animal models, published in English language between 2018 and 2024, were selected. Sixty-seven studies were included in the current review after inclusion and exclusion screening processes.Results: Mostly, studies showed significant anti-inflammatory, gut microbiota restoring, antioxidant effects of polyphenols, polysaccharides, emodin, short-chain fatty acids (SCFA; including butyrate, propionate and acetate), and probiotics although some contrasting results were noted. Current evidence shows that polyphenols exhibit the most consistent result in alleviating IBD pathophysiology, primarily due to their significant SCFA-elevating effect.Discussion: Future studies may focus on human studies, narrowing down on individual factors which may change natural product's metabolism. Further research studies are also essential to obtain therapeutic recommendations.

Diverse processes in rotavirus vaccine development

Rotavirus is a major cause of severe diarrhea and mortality in children under five years of age, leading to approximately 128,500 deaths annually.1-3 Vaccination is the most effective strategy for preventing rotavirus infection. While two widely used vaccines, Rotarix and RotaTeq, have shown good efficacy in high-income countries, their effectiveness is lower in low- and middle-income countries due to factors such as malnutrition and poor sanitation.4-6 These challenges include complex vaccination schedules and high production costs. Researchers are working on novel vaccines, including inactivated virus and viral protein-based options, as well as virus-like particles and recombinant proteins.7-9 Improving vaccine stability and applicability is crucial for resource-limited settings, and global vaccination strategies are expected to significantly reduce infection burdens, improve child health, and contribute to the achievement of global health goals.10-14.

Solid and cystic intrapancreatic accessory spleen: report of 10 cases in a single institution

BACKGROUND

Precise diagnosis of intrapancreatic accessory spleen (IPAS) remains challenging due to its rarity and diverse presentations. Despite comprehensive examinations, including radiography and other diagnostic methods, the potential for malignancy cannot be excluded, often leading to unnecessary pancreatic surgeries. We review our institutional experience to provide insights for accurately distinguishing IPAS.

METHODS

We retrospectively reviewed 10 patients who underwent distal pancreatectomy for the lesion in the pancreas tail which was determined to be IPAS on final pathology at our institution between January 2020 and April 2024. The presenting symptoms, medical history, preoperative imaging, operative therapy, final pathology and postoperative course were evaluated.

RESULTS

Patient ages ranged from 30 to 72 (median 55.5), including six women and four men. Most patients were asymptomatic. One patient had the medical history of splenectomy. Lesions ranged from 1.4 to 7.3 cm (mean 2.9 cm). All lesions were located in the pancreatic tail. On radiologic evaluation, these lesions had both solid and cystic presentations. The most common operative approach was laparoscopic distal pancreatectomy and splenectomy. Four patients were diagnosed with epidermoid cysts arising in intrapancreatic accessory spleen (ECIPAS) on final pathologic evaluation.

CONCLUSIONS

IPAS are predominantly benign lesions which have solid and cystic presentations commonly mistaken for pancreatic neoplasms. Combining CT, MRI, EUS-FNA and nuclear medicine may enhance IPAS detection, though no definitive diagnostic method exists. Increased awareness of IPAS in the differential diagnosis of pancreatic tail tumors, coupled with advancements in imaging techniques could improve diagnostic accuracy and exclude malignancy, preventing unnecessary surgeries.

Hepatocellular carcinoma: what are the differential costs compared to the general population?

INTRODUCTION

Hepatocellular carcinoma (HCC), which accounts for about 90% of all primary liver cancer cases, is the fifth most common malignancy and the second leading cause of cancer-related mortality worldwide. This study aims to analyse the differential costs of HCC-related hospital admissions compared to the general population in Spain.

METHODS

A retrospective multicenter study analyzed inpatient admissions from a Spanish national discharge database, covering 90% of hospitals between 2010 and 2022. HCC-related admissions were identified using ICD-9 and ICD-10 codes, while control admissions were selected from the general population in the same database without an HCC diagnosis. The direct hospitalization cost was included, covering medical examinations, procedures, medications, surgeries, personnel and equipment. Statistical methods, including nearest-neighbor matching, propensity score matching, and a generalized linear model, were used to estimate differential costs and to ensure comparability based on age, gender, and Charlson Comorbidity Index (CCI).

RESULTS

A total of 199,670 HCC-related hospital admissions and 200,000 control admissions were analyzed. Most HCC-related admissions involved male patients (78%) aged 66-85 years, with an average CCI of 5.18. HCC-related admissions incurred significantly higher costs, with an estimated differential cost of €1,303.68 using GLM, €1,804.25 via propensity score matching, and €1,767.77 using nearest-neighbor matching. Total costs per HCC admission ranged between €1,000 and €31,000.

CONCLUSIONS

HCC-related hospital admissions impose a significantly higher economic burden due to the complexity of care. Given the high mortality and resource utilization, advancements in early detection, treatment, and cost-effective interventions are needed to improve patient outcomes and reduce healthcare costs.

From PD-1/PD-L1 to tertiary lymphoid structures: Paving the way for precision immunotherapy in cholangiocarcinoma treatment

Cholangiocarcinoma (CCA) is a highly malignant hepatobiliary tumor characterized by limited treatment options and poor prognosis. The recent rise of immunotherapy has significantly influenced research in this field. This study presents a bibliometric analysis of 416 articles retrieved from the WOSCC, Wan fang Data, CNKI and VIP databases, spanning contributions from 32 countries, 589 institutions and 3,200 authors. The analysis identified "PD-L1," "PD-1" and "pembrolizumab" as central research foci, while "immune checkpoint inhibitors," "tumor immune microenvironment," "tertiary lymphoid structures" and "durvalumab" emerged as key areas of interest. These findings emphasize the pivotal role of immunotherapy in improving survival outcomes for CCA, and they highlight the significance of tertiary lymphoid structures within the tumor microenvironment as a promising target for future research. This study offers a strategic overview of the evolving landscape of CCA immunotherapy, providing valuable insights to guide future scientific endeavors in this domain.

The global epidemiology of acquired factor X deficiency

OBJECTIVES

To summarize available data and contribute to a broader understanding of the global incidence and prevalence of acquired factor X deficiency.

METHODS

A comprehensive review of English-language publications from PubMed and Embase was conducted. The majority of publications on acquired factor X deficiency were associated with light-chain (AL) amyloidosis. Therefore, this review is structured to assess publications reporting on (1) acquired factor X deficiency associated with AL amyloidosis or (2) acquired factor X deficiency associated with other causes.

RESULTS

The literature includes case reports, case-series, and limited population-based reports of the epidemiology of acquired factor X deficiency. Though no definitive global incidence or prevalence estimates for AL-amyloidosis-associated acquired factor X deficiency were identified, the finding that roughly 6-14% of patients with AL amyloidosis have factor X activity levels below 45-50% of normal highlights the rarity of acquired factor X deficiency associated with AL-amyloidosis. Indeed, AL amyloidosis itself is a rare disorder with an estimated annual incidence of ∼10 cases per million population. Only case reports were available to inform the epidemiology of acquired factor X deficiency not associated with AL amyloidosis. We identified 35 cases from 29 papers published from around the globe. At least 25 of those patients experienced a bleeding event, with factor X activity levels ranging from <1% to 39%.

CONCLUSION

More population-based data are needed to understand the epidemiology of acquired factor X deficiency; however, the limited data seem to indicate this condition is quite rare. The variation across papers in thresholds used to define deficiency highlights the need for a standardized definition to better inform drug development, resource allocation, and regulatory decision-making.

Comparison of the value of transvaginal ultrasonography and MRI in the diagnosis of cesarean scar pregnancy: a meta-analysis

OBJECTIVE

To compare the diagnostic value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in cesarean scar pregnancy (CSP) by a method of meta-analysis.

METHODS

Studies on TVS and MRI for CSP were collected from PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang data, and Chinese Scientific Journal Database (VIP database) until April 1, 2024. Stata 15.0 software was used for data analysis. Mann-Whitney U-test was applied to compare the diagnostic efficiency of the TVS and MRI groups.

RESULTS

Nine articles with 713 subjects were involved in this review. The pooled sensitivity (0.96, 95%CI: 0.94-0.97), specificity (0.90, 95%CI: 0.84-0.94), and DOR (197.28, 95%CI: 99.71-390.31) in the MRI group were higher than those (Sensitivity = 0.83, 95%CI: 0.77-0.87; Specificity= 0.74, 95%CI: 0.63-0.83; DOR = 13.66, 95%CI: 7.84-23.79) in the TVS group. The positive likelihood ratio and negative likelihood ratio of the MRI group were 9.56 (95%CI: 8.82-15.72) and 0.05 (95%CI: 0.03-0.07), while those of the TVS group were 3.21 (95%CI:2.18-4.74) and 0.24 (95%CI: 0.18-0.31), respectively. In the MRI and TVS groups, the area under the curve (AUC) of the summary receiver operating characteristic was 0.9497 and 0.86, respectively. The results of Mann-Whitney U-tests of the two groups showed significant differences in the pooled sensitivity (Z= -3.311, p < 0.001), specificity (Z= -2.123, p = 0.034), and DOR (Z= -3.272, p = 0.001).

CONCLUSION

Both MRI and TVS can effectively diagnose CSP. However, compared with TVS, MRI has better diagnostic accuracy for CSP, with higher sensitivity and specificity. Considering the good diagnostic accuracy of ultrasound, patients with ultrasound suspicion of CSP should be sent to a reference center where MRI can express its full diagnostic potential regarding depth, topography of invasion and myometral residue, which is useful for subsequent management.

Exploring the key ingredients and mechanisms of Banxia Xiexin decoction for the treatment of polycystic ovary syndrome based on network pharmacology and experimental validation

PURPOSE

This study aimed to investigate the key bioactive constituents and polypharmacological mechanisms of Banxia Xiexin Decoction (BXD) against polycystic ovary syndrome (PCOS) through integrated network pharmacology and experimental validation.

METHODS

Network pharmacology was used to determine the key ingredients, potential targets and signaling pathways. 3-week-old female mice were injected subcutaneously with DHEA (6mg/100g body weight) daily to construct a PCOS model and administered different doses BXD and its key ingredients for intervention. Ovarian pathology, vaginal smears, oxidative stress-related indicators, and hub genes were tested to evaluate its therapeutic effects.

RESULTS

We identified 3 key ingredients and 99 potential targets for BXD treatment of PCOS. Biological functions of these targets were mainly enriched in oxidative stress, hormone response and apoptosis. KEGG analysis showed they were mainly involved in signaling pathways such as PI3K-AKT, MAPK, HIF-1 and IL17. By PPI and algorithmic analysis, we identified 8 hub genes, 5 of which (JUN, MAPK1, MAPK3, FOS, TP53) were related to oxidative stress. Further analysis indicated that quercetin, glycyrrhetinic acid A and naringenin are the three key ingredients of BXD, and they have superior binding effects on the hub genes. Animal experiments demonstrated that BXD and its three key ingredients significantly ameliorated the PCOS symptoms, oxidative stress-related indicators and the expression of hub genes.

CONCLUSIONS

Five oxidative stress-related hub targets of BXD for PCOS were identified, including FOS, JUN, MAPK3, TP53 and HSP90AA1, while three key ingredients of BXD, quercetin, glycyrrhetinic acid A and naringenin, were uncovered.

An ideal portrait of the professional competence of clinical research nurses: A qualitative study

Objective

This study aims to identify and define the ideal professional competencies of Clinical Research Nurses (CRNs) in China, focusing on the essential knowledge, skills, and personal attributes required for effective practice in clinical trials.

Methods

Interviews were conducted with CRNs, Nurse Managers (NMs), Principal Investigators (PIs), Sub-Investigators (SIs), Clinical Research Coordinators (CRCs), Clinical Research Associates (CRAs), and subjects. Thematic analysis was performed using Colaizzi's seven-step method to analyze interview data and identify key competencies.

Results

The study identified four primary themes that characterize the ideal CRN profile: (1) theoretical knowledge ability, (2) practical technical ability, (3) professional quality and ability, and (4) personal traits. A total of 21 specific indicators were delineated, reflecting the diverse expectations of various stakeholders in clinical trials.

Conclusions

The findings highlight the multifaceted nature of CRN competencies, emphasizing the importance of comprehensive training programs tailored to the needs of CRNs. This study provides a foundational framework for enhancing CRN training and professional development in China.

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.

Portable SERS for salivary-based detection of oral pre-malignant lesions and carcinomas: a step toward clinical implementation

The rising incidence of oral cancer has emerged as a serious menace to our civilization. Modern dietary habits, lack of awareness, and delays in early detection are major contributing factors to the global spread of this issue. This work reports the promising findings for diagnostic accuracy of oral cancer in pre-malignant stages by analyzing surface enhanced Raman spectroscopy (SERS) profiles of different stages of oral cancer combined with multivariate analysis. Using 99 clinical samples from which 39 samples were from malignant stage, 28 from pre-malignant and 32 from healthy controls, SERS analysis was carried out by employing label-free silver nanorods as SERS substrates. The SERS spectra of malignant and pre-malignant samples manifest distinct peaks associated with varying concentrations of inorganic metabolites and proteins. Primarily, the elevated level of thiocyanate dominates the SERS spectra in malignant samples while antioxidants like uric acid, xanthine and hypoxanthine's are the key elements in the pre-malignant samples. A ratio-metric analysis of 2130 and 1435 cm-1 peak revealed that the pre-malignant lesions consistently lie between 2 and 3, whereas malignant samples have ratio greater than 3 due to higher intensity of thiocyanate peak. The multivariate analysis successfully separates between oral cancer positive and negative samples with a sensitivity and specificity of 93.5 and 92.7 % respectively. This study presents promising results for the early detection of oral cancer, which could assist clinicians in saving lives.

Rapid detection of procalcitonin using dual-color carbon quantum dots as fluorescent probes in FRET assay

FRET, known as Förster Resonance Energy Transfer, serves as a versatile technique enabling precise quantitative assessment of protein concentrations with minimal disruption to biological processes. In this study, we have developed two types of fluorescent carbon quantum dots, B-CDs and G-CDs, serving as donor and acceptor probes, respectively, for FRET-based procalcitonin (PCT) detection. The B-CDs exhibit strong blue fluorescence (excitation/emission peaks at 360/442 nm) as donors, while the G-CDs display faint green fluorescence (excitation/emission peaks at 449/520 nm) as acceptors. These CDs are conjugated with PCT antibodies to form immune probes. Upon antigen binding, the antibody quickly binds and reacts with the antigen. Concurrently, the fluorescence energy from the donor is transferred to the acceptor, leading to a decrease in the blue fluorescence intensity emitted by B-CDs. The ratio of the fluorescence intensity between the green probe (G-CDs-Ab2) and the blue probe (B-CDs-Ab1) exhibited a positive correlation with the concentration of PCT antigen in the low concentration range of 0.5 to 5 ng/mL. Consistent results were observed in both phosphate-buffered saline (PBS) and diluted human serum. In the concentration range of 0.5-5 ng/mL in PBS buffer, the linear equation is expressed as FA/FD = -0.0045 × c [PCT]^2 + 0.0021 × c [PCT] + 0.3232, with a limit of detection (LOD) of 0.1 ng/mL based on 3σ K-1. For concentrations spanning from 5-80 ng/mL, the equation is FA/FD = 0.0021 × c [PCT] + 0.4212. These findings suggest that carbon dot-labeled immune probes could offer a novel approach for sensitive detection of disease biomarkers.

Multidisciplinary management of pituitary macroadenoma

BACKGROUND

Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations. This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas, integrating neurosurgery, endocrinology, radiology, and pathology perspectives.

AIM

To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis, management, and rehabilitation of individuals with pituitary adenomas, to add to already preexisting knowledge, in managing these cases enhancing better ocular and systemic outcomes.

METHODS

A search was conducted on an online publication database (PubMed) using the term “pituitary adenoma” including all results published over twenty years (2004-2024). Results were sorted for relevance, language, and completeness.

RESULTS

A total of 176 records were returned. The guidelines of the PRISMA 2020 statement were followed in this study. A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates. Another 17 records were not available as full-length articles and were also excluded. The references of each included record was further searched for relevant publications. A total of 141 records were therefore used in this minireview.

CONCLUSION

Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact, modern therapeutic strategies offer effective management options. Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life. Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future

Translating animal models of SARS-CoV-2 infection to vascular, neurological and gastrointestinal manifestations of COVID-19

Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initiated a global pandemic resulting in an estimated 775 million infections with over 7 million deaths, it has become evident that COVID-19 is not solely a pulmonary disease. Emerging evidence has shown that, in a subset of patients, certain symptoms - including chest pain, stroke, anosmia, dysgeusia, diarrhea and abdominal pain - all indicate a role of vascular, neurological and gastrointestinal (GI) pathology in the disease process. Many of these disease processes persist long after the acute disease has been resolved, resulting in 'long COVID' or post-acute sequelae of COVID-19 (PASC). The molecular mechanisms underlying the acute and systemic conditions associated with COVID-19 remain incompletely defined. Appropriate animal models provide a method of understanding underlying disease mechanisms at the system level through the study of disease progression, tissue pathology, immune system response to the pathogen and behavioral responses. However, very few studies have addressed PASC and whether existing models hold promise for studying this challenging problem. Here, we review the current literature on cardiovascular, neurological and GI pathobiology caused by COVID-19 in patients, along with established animal models of the acute disease manifestations and their prospects for use in PASC studies. Our aim is to provide guidance for the selection of appropriate models in order to recapitulate certain aspects of the disease to enhance the translatability of mechanistic studies.

Exploring Multimorbidity Patterns in older hospitalized Norwegian patients using Network Analysis modularity

BACKGROUND

Understanding Multimorbidity Patterns (MPs) is crucial for planning healthcare interventions, allocating resources, and improving patients' outcomes.

OBJECTIVE

We aim to demonstrate the use of Network Analysis (NA) to explore the MPs in hospitalized Norwegian older patients.

METHODS

We utilized data from the Norwegian Patient Registry (NPR) of all admissions between 2017 and 2019. The study population included patients ≥ 65 years old with two or more different conditions. Multimorbidity was defined as the co-occurrence of two or more associated chronic conditions. Chronic conditions were identified using the Chronic Condition Indicator Refined (CCIR) list. The association between chronic conditions was determined by calculating Relative Risk (RR) and Phi-correlation to detect pairs of conditions that co-occur beyond chance. A multimorbidity network was created, and MPs were detected using Louvain method for community detection. We suggested a clinical interpretation for these MPs.

RESULTS

A total of 539 chronic conditions were used to create a multimorbidity network revealing several MPs. These modules included patterns of vision and hearing disorders, cardiorenal syndrome, metabolic and cardiovascular disorders, respiratory disorders, endocrine and skin conditions, autoimmune and musculoskeletal disorders, as well as mental and behavioral disorders. Using NA centrality measures, we identified the most influential conditions in each module. An interactive network and sunburst graphs for each module are publicly available.

CONCLUSION

The study demonstrates the use of NA modularity detection in identifying MPs. The findings highlight the complex interaction of chronic conditions in the elderly and the potential of NA methodology in exploring these relationships.

Development of a fluorescence-based assay for screening of urate transporter 1 inhibitors (II): Optimization of fluorescent substrates and structure-activity relationships analysis

Urate transporter 1 (URAT1) inhibitors represent a promising therapeutic approach for hyperuricemia and gout. A non-radioactive cell-based platform for screening URAT1 inhibitors using 6-carboxyfluorescein (6-CFL) was previously established by our team. In this study, aiming to optimize our testing platform, 10 potential fluorescent substrates were screened from the commercially available fluoresceins using molecular docking and pKa prediction. Among them, dibromofluorescein (DBF) and diiodofluorescein (DIF) were identified as specific transport substrates for UTAR1 with significant fluorescence changes in cellular uptake. DBF and DIF exhibited Km values similar to that of 6-CFL. Using DBF or DIF as substrates, the IC50 values of the URAT1 inhibitors benzbromarone and lesinurad remained within the same order of magnitude as those obtained by 6-CFL. Notably, DBF enables visual detection, further extending the utility of this non-radioactive platform for in vitro screening of URAT1 inhibitors. Molecular dynamics (MD) simulations and free energy calculations were employed to compare the interactions and binding affinities of 6-CFL, DBF, and DIF with URAT1, respectively. Finally, structure-activity relationships (SARs) analysis was conducted to preliminarily identify substituents modulating the binding affinity of commercially available fluoresceins.

Utility of clinical metagenomics in complex infections: Cryptococcal meningitis complicated by Nocardia brain abscess

Nocardia farcinica brain abscess (BA) is a rare yet life-threatening infection of the central nervous system (CNS) that predominantly affects immunocompromised patients. Its nonspecific symptoms often lead to delayed diagnosis and poor outcomes. Early diagnosis and precise treatment are essential to improve the prognosis of patients. We report the rare case of a 75-year-old man with IgG4-related disease undergoing long-term methylprednisolone therapy who presented with a N. farcinica brain abscess. The patient initially presented with cryptococcal meningitis but exhibited persistent symptoms despite standard antifungal treatment. Follow-up neuroimaging revealed new intracranial abscess formations. Metagenomic next-generation sequencing (mNGS) of brain tissue and cerebrospinal fluid (CSF) identified abundant N. farcinica-specific sequences, confirming a concurrent Nocardia brain abscess complicating the cryptococcal infection. The patient's condition gradually improved with timely antibiotic treatment and is currently in recovery. This case underscores the heightened risk of sequential opportunistic infections in immunocompromised individuals and exemplifies the clinical value of mNGS in detecting rare infectious diseases. We further conducted a systematic review of patients with Nocardia central nervous system infections confirmed by mNGS, analyzing their clinical presentations, laboratory parameters, therapeutic regimens, and prognostic outcomes. In summary, our study demonstrates that mNGS offers significant diagnostic advantages compared to conventional microbiological methods for uncommon infections. These findings provide clinically actionable, evidence-based guidance for the diagnosis and management of Nocardia brain abscesses.

Hepatic epithelioid hemangioendothelioma managed with minimally invasive surgery: A case report

BACKGROUND

Hepatic epithelioid hemangioendothelioma (HEHE) is a rare malignant vascular liver tumor diagnosed by histopathological evaluation. Standardized treatment is challenging because of its rarity; hepatectomy is preferred for solitary lesions and multiple transplantations. There is no consensus on the optimal treatment for HEHE; however, surgical excision is often considered effective. This report presents a case of initially suspected cholangiocarcinoma or renal cell carcinoma (RCC) metastasis, which was later confirmed as HEHE, with no recurrence during follow-up.

CASE SUMMARY

A 52-year-old man with a history of left nephrectomy for RCC presented with an incidentally detected liver mass and nonspecific abdominal discomfort. Imaging revealed a 3-cm centripetal enhancing lesion in the right hepatic dome with indeterminate malignant potential. The patient underwent a laparoscopic right anterior sectionectomy and remained recurrence-free without complications during the 3-year follow-up period.

CONCLUSION

Managing HEHE is challenging. Accurate diagnosis and surgical options, such as resection or transplantation, are essential with tailored multidisciplinary follow-up. The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).

Abdominal cocoon syndrome in a 10-year-old young adolescent after abdominal operation: A case report and review of literature

BACKGROUND

Sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome, is rare in children. The etiology of primary SEP is believed to be associated with retrograde menstruation or viral peritonitis in young adolescent girls, whereas secondary SEP refers to SEP caused by other factors such as surgery, peritoneal dialysis, or tuberculosis. Secondary SEP is rare and lack diagnostic specificity in children. Given the potential to cause acute intestinal obstruction, surgical intervention is often required.

CASE SUMMARY

We report the case of a 10-year-old girl with secondary SEP who was admitted to our center with acute bowel obstruction.

CONCLUSION

In this report, we emphasized the imaging manifestations, diagnosis, and operative management of the case. Although postoperative SEP in children is rare, the long-term prognosis is favorable when accompanied with accurate diagnosis, appropriate perioperative management, and timely follow-up.

Are current scales adequate for assessing quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis. Although these treatments can be lifesaving, patients often experience a significant decrease in their overall quality of life (QoL), especially in the early stages of recovery, owing to the physical burden of surgery and the effects of chemotherapy. Many traditional QoL questionnaires have been used to measure CRS and HIPEC. However, these classical current QoL assessment tools often fail to capture the unique challenges faced by this population, including bowel dysfunction, stoma-related distress, and long-term survivorship issues. Therefore, additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.

Adenosine deaminase in pleural effusion: Bridging diagnosis and the pathophysiology of inflammation

This editorial underscores the importance of Maranhão et al’s study, which investigates pleural adenosine deaminase (P-ADA) as a biomarker for inflammatory pleural effusions. Despite advances in imaging, distinguishing between inflammatory and non-inflammatory causes of pleural effusion remains a diagnostic challenge. The authors conducted a rigorous retrospective cohort analysis of 157 patients (124 with inflammatory exudates and 33 with non-inflammatory transudates), establishing a robust cutoff value of P-ADA ≥ 9.00 U/L for diagnosing inflammatory diseases using receiver operating characteristic curve analysis and internal statistical calibration. This is the first study to define a standardized P-ADA threshold in a Brazilian cohort, addressing previous inconsistencies in cutoff values. Furthermore, the authors delved into the pathophysiological mechanisms underlying elevated P-ADA, linking it to purinergic signaling pathways and immune cell activation, particularly emphasizing the role of ADA2 isoforms in macrophages and lymphocytes. Their findings support P-ADA as a non-invasive, cost-effective biomarker for early diagnosis, treatment stratification, and minimizing the need for invasive procedures such as thoracentesis. This has particular relevance in resource-limited settings, where streamlined diagnostics can reduce healthcare costs and improve patient outcomes. Future studies must prioritize global validation, explore the integration of adenosine deaminase with additional biomarkers (e.g., interleukin 6, C-reactive protein), and support the development of point-of-care technologies.

Acute pancreatitis after total aortic arch replacement leading to walled-off necrosis: A case report and review of literature

BACKGROUND

Although acute pancreatitis and walled-off necrosis (WON) are rare complications following aortic surgery, they are serious risk factors for postoperative mortality. Considering the poor general condition of the postoperative patient, more effective and less invasive treatments are favorable.

CASE SUMMARY

A 67-year-old man was referred to our hospital for the treatment of WON after acute pancreatitis. He had undergone total aortic arch replacement due to aortic arch aneurysm and coronary artery bypass grafting due to angina pectoris 6 weeks prior in another hospital. On the second postoperative day, laboratory data and computed tomography showed that the patient had developed acute pancreatitis. Although conservative management (antibiotics, hydration, etc.) had helped in relieving the symptoms of acute pancreatitis, peripancreatic fluid collection (PFC) persisted, accompanied by duodenal obstruction and vomiting. Contrast-enhanced computed tomography showed that the heterogeneous enhancement and fluid collection in the pancreatic body and tail had increased, consistent with walled-off WON. We therefore performed endoscopic ultrasound-guided transluminal drainage for the PFC. As a result, the WON resolved gradually, resulting in improved oral intake.

CONCLUSION

Acute pancreatitis is a rare gastrointestinal complication following thoracic and thoracoabdominal aortic aneurysm surgery. To the best of our knowledge, this is the first case of WON after aortic arch surgery treated with endoscopic ultrasound-guided transluminal drainage for PFC.

Immunoglobulin G4 biomarkers and pathogenesis in immunoglobulin G4-related spinal pachymeningitis

This letter to the editor highlights adding the diagnostic utility of immunoglobulin G4 (IgG4) measurements and its potential role in IgG4-related spinal pachymeningitis (IgG4-RSP) pathogenesis to the case reported by Chae TS et al, which focused on IgG4-RSP diagnosis based on magnetic resonance imaging findings and increased plasma IgG4 concentrations. A comprehensive understanding of both IgG4 serological and cerebrospinal fluid biomarkers is essential for managing this complex condition.

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.

Effects of mesenchymal stem cells on repair of injured endometrium in mice

Endometrial damage severely affects women's reproductive health and function. Although various treatments are available, their efficacy remains generally unsatisfactory. Mesenchymal stem cells (MSCs) possess multidirectional differentiation abilities and immunoregulation. To evaluate whether direct MSC transplantation into the uterine cavity enhances endometrial thickness, an animal model with thin endometrium was developed by administering ethanol into the uterine cavity. Our study aimed to observe and compare repair effects about three types of MSCs on endometrial injury, including menstrual blood-derived MSCs (MenSCs), bone marrow MSCs (BMSCs), and umbilical cord-derived mesenchymal stem cells (UC-MSCs). HE and Masson staining were used to assess endometrial morphology and fibrosis in the third estrous period post-operation. Immunohistochemistry and western blot were utilized to detect the expression of marker proteins in endometrial tissue. Endometrial thickness and protein expression in the MSC transplantation groups showed a notable improvement compared to the control group, though still below normal levels. Among MSC transplantation groups, no statistical difference was observed between MenSC and BMSC groups in endometrial thickness or ItgαVβ3 expression, but MenSCs showed higher levels than UC-MSCs, with statistical significance. CK18 and Vimentin expression in the MenSC and BMSC groups were similarly higher than UC-MSCs, with no significant difference. VEGF expression indicated that MenSCs outperformed both BMSCs and UC-MSCs. In conclusion, all three types of MSCs improved endometrial thickness and regeneration when transplanted into the injured endometrium. MenSCs demonstrated the greatest potential in promoting endometrial regeneration and improving receptivity, suggesting a promising new approach for treating endometrial injury.

The effect of toluene exposure on the fine structure of motor cortex pyramidal neurons in different aged rats: An electron microscopy study

Toluene is known to affect the central nervous system. When inhaled, it can rapidly enter the bloodstream and reach the brain. Exposure to toluene may have a specific effect on pyramidal neurons in the motor cortex, as these neurons play a critical role in the control of voluntary motor movements. The effects of toluene on neurons may vary depending on several factors, including the level and duration of exposure, the age of the exposed individual, and individual susceptibility. The effects of toluene on the morphology of neurons in the motor cortex were studied in adolescent (P28-30) and adult (P110-120) male rats of different ages. Experimental rats were exposed to toluene vapor at a concentration of 2000 ppm for 3-4 min per day for 40 days. The number of pyramidal neurons in the motor cortex and their fine structure were studied. The results showed that in adults there are fewer changes in the fine structure of neurons, mainly affecting the mitochondria, where individual cristae are damaged. The changes were much more pronounced in rats that inhaled toluene at the age of one month. Here there were changes in the structure of synapses, severe damages of mitochondria, which leads to degenerative changes in neurons and ultimately to neuronal death.

Tired of the confusion around pleural effusions: Adenosine deaminase detection sets the record straight!

Pleural effusion, characterized by the accumulation of fluid in the pleural space, poses significant challenges in clinical practice, especially in determining whether it belongs to the inflammatory exudates or non-inflammatory transudates. Adenosine deaminase (ADA), an enzyme primarily produced by immune cells, particularly lymphocytes, increase in response to inflammatory conditions, including tuberculosis and malignancies. Elevated ADA levels in pleural have been shown to correlate with inflammatory exudates, making it a valuable biomarker for differentiating between inflammatory and non-inflammatory effusions. Moreover, numerous studies have demonstrated the treatment function of ADA in inflammation- related pleural effusion syndrome. Recently, research has established the values for the implication of ADA in diagnosing and managing pleural disease. Based on these findings, ADA becomes a reliable, non-invasive marker for early diagnosis and the appropriate treatment for pleural inflammation, ultimately improving patient outcomes.