Apigenin improves chronic gastric ulcer in rats: The implication of COX-1/2 and 5-LOX signaling pathways

Peptic ulcer is a prevalent gastrointestinal illness. The aim is to investigate the possible implication of cyclooxygenase (COX)-1/2 and 5-lipoxygenase (5-LOX) signaling pathways in apigenin therapeutic effect on acetic acid-induced chronic gastric ulcer maintained with indomethacin. Rats were divided into 5 groups (n = 10): control, ulcer, omeprazole+ulcer, apigenin+ulcer, and apigenin only groups. Evaluations were for serum oxidative stress markers, gastric acidity, histopathology, immunohistochemistry, and scanning electron microscope (SEM). The ulcer group demonstrated body weight loss, increase in gastric acidity, decline in superoxide dismutase (SOD) and catalase (CAT) antioxidant activity, increase in malondialdehyde (MDA) level, decrease in COX-1 immuno-expression, and increase in COX-2 and 5-LOX immuno-expressions. Furthermore, histopathology revealed mucosal sloughing, and parietal cell degeneration, in addition to completely degenerated mucosa. These parameters were modulated in apigenin-treated group compared to ulcer one, via improved weight gain (37.11 vs. 21.23 g) (omeprazole = 30.95), increased gastric pH (5.82 vs. 3.98) (omeprazole = 4.63), elevated SOD and CAT levels (98.14 vs. 30.31, and 500.19 vs. 132.11 U/ml) (omeprazole = 70.44 and 362.42), decreased MDA levels (3.07 vs. 28.11 ng/ml) (omeprazole = 5.51), decreased ulcer index (0.31 vs. 7.19) (omeprazole = 2.63), increased parietal cell count (625.73 vs. 334.51 cell/mm) (omeprazole = 604.69), increased COX-1 immunostain percentage (25.28 vs. 10.92) (omeprazole = 17.46), lowered COX-2 and 5-LOX immunostain percentages (10.12 vs. 42.95, and 18.32 vs. 43.62) (omeprazole = 17.02 and 23.83). In conclusion, apigenin mitigates chronic gastric ulcer parameters via involvement of COX-1/2 and 5-LOX signaling pathways, having the upper hand over omeprazole.

An updated and comprehensive review of the health benefits and pharmacological activities of hesperidin

OBJECTIVES

This review aims to comprehensively assess the health benefits and pharmacological activities of hesperidin, a flavonoid commonly found in citrus fruits. It consolidates recent research findings to provide insights into hesperidin's diverse health-promoting effects.

KEY FINDINGS

Hesperidin has gained significant attention recently for its notable pharmacological activities and potential health benefits. Studies reveal its antioxidant properties, protecting cells from oxidative damage, and its anti-inflammatory effects, inhibiting pro-inflammatory cytokines and enzymes. Also, hesperidin shows promise in cardiovascular health by reducing blood pressure and cholesterol levels and enhancing endothelial function. It also exhibits anticancer potential by hindering cell proliferation, inducing apoptosis, and suppressing tumour growth. Moreover, hesperidin demonstrates neuroprotective effects, potentially mitigating neuroinflammation and oxidative stress associated with neurodegenerative diseases. Furthermore, it displays beneficial effects in metabolic disorders such as diabetes, obesity, and fatty liver disease by influencing glucose metabolism, lipid profile, and insulin sensitivity.

SUMMARY

Hesperidin exhibits a wide range of health benefits and pharmacological activities, making it a promising candidate for therapeutic interventions in various diseases. Its antioxidant, anti-inflammatory, cardiovascular, anticancer, neuroprotective, and metabolic effects underscore its potential as a valuable natural compound for promoting health and preventing chronic diseases.

Ameliorating monosodium glutamate-induced testicular dysfunction by modulating steroidogenesis, oxidative stress, inflammation, and apoptosis: therapeutic role of hesperidin

Monosodium glutamate (MSG), a commonly used food ingredient, has been reported to induce testicular dysfunction. This study aimed to evaluate the therapeutic potential of hesperidin (HESP), a citrus flavonoid, against MSG-induced testicular dysfunction, comparing it to sildenafil citrate (Sc). This investigation focused on oxidative stress, inflammation, apoptosis, histological alterations, spermatogenesis, steroidogenic enzyme expression, and reproductive hormone levels. Twenty-four adult male rats were divided into four groups: a negative control group (n = 6) and three MSG-treated groups (n = 18) that received MSG (1 g/kg/day) for four weeks, followed by either no treatment (positive control), HESP (200 mg/kg/day), or Sc (5 mg/kg/day) for another four weeks. Oral MSG exhibited significant reductions in gonadosomatic index, sperm parameters, and reproductive hormones, accompanied by downregulation of steroidogenic genes, severe histological damage to testicular tissues, and marked elevation in oxidative stress, inflammation, and apoptosis markers. HESP significantly improved sperm count (88 %) and motility (59 %), while reducing sperm abnormalities (34 %), outperforming Sc, which decreased sperm abnormalities by 15 %. Further, HESP significantly reduced inflammatory markers, including nuclear factor-kappa B, TNF-α, interleukin-1β, and interleukin-6 compared to MSG, outperforming Sc. HESP also demonstrated superior efficacy in reducing Bax by 41 % and increasing Bcl-2 by 68 %, while Sc reduced both by 27 % and 28 %, respectively. However, Sc also demonstrated superior efficacy in reducing malondialdehyde levels (67 %) and increasing catalase activity by 645 %, exceeding the effects of HESP (34 and 413 %, respectively). Overall, HESP outperformed Sc by reducing oxidative damage, inflammation, and apoptosis, while enhancing steroidogenesis, spermatogenesis, and reproductive hormones in MSG-treated rats.

Advanced nanoparticle engineering for precision therapeutics of brain diseases

Despite the increasing global prevalence of neurological disorders, the development of nanoparticle (NP) technologies for brain-targeted therapies confronts considerable challenges. One of the key obstacles in treating brain diseases is the blood-brain barrier (BBB), which restricts the penetration of NP-based therapies into the brain. To address this issue, NPs can be installed with specific ligands or bioengineered to boost their precision and efficacy in targeting brain-diseased cells by navigating across the BBB, ultimately improving patient treatment outcomes. At the outset of this review, we highlighted the critical role of ligand-functionalized or bioengineered NPs in treating brain diseases from a clinical perspective. We then identified the key obstacles and challenges NPs encounter during brain delivery, including immune clearance, capture by the reticuloendothelial system (RES), the BBB, and the complex post-BBB microenvironment. Following this, we overviewed the recent progress in NPs engineering, focusing on ligand-functionalization or bionic designs to enable active BBB transcytosis and targeted delivery to brain-diseased cells. Lastly, we summarized the critical challenges hindering clinical translation, including scalability issues and off-target effects, while outlining future opportunities for designing cutting-edge brain delivery technologies.

Molecular insights into diabetic wound healing: Focus on Wnt/β-catenin and MAPK/ERK signaling pathways

Diabetic wounds manifest significant clinical challenge with approximately 50-70 % reporting non-traumatic lower limb amputations annually. This review examines the intricate relationship between impaired wound healing in diabetes mellitus and two crucial signaling pathways: Wnt/β-catenin and MAPK/ERK. Chronic hyperglycemia in diabetes mellitus leads to peripheral neuropathy, vascular dysfunction, and compromised immune responses, resulting in delayed wound healing. The Wnt/β-catenin pathway, which is essential for cellular proliferation, differentiation, and tissue homeostasis, shows altered activity in diabetic wounds, particularly through decreased R-spondin 3 protein expression. Similarly, the MAPK/ERK pathway, which regulates cellular proliferation and differentiation through hierarchical kinase cascades, exhibits dysregulation under diabetic conditions. This review describes the current understanding of normal wound healing processes, diabetic wound pathophysiology, and the molecular mechanisms of both signaling pathways. Evidence suggests that targeting these pathways, either individually or synergistically offer promising therapeutic approaches for diabetic wound management. Future directions include, developing targeted delivery systems, exploring pathway cross-talk, and investigating dual-pathway modulators to enhance wound healing outcomes in diabetic patients. This comprehensive analysis provides insights into potential therapeutic strategies and emphasizes the necessity of research in this crucial area of diabetes treatment. (Graphical Abstract).

Cistanche deserticola polysaccharides protect against cyclophosphamide-induced premature ovarian failure in mice by regulating the JAK-STAT pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Classical Chinese medical texts, notably the Compendium of Materia Medica (Ben Cao Gang Mu) and Zhong Hua Ben Cao (Chinese Herbal Medicine), have historically documented Cistanche deserticola's application as a tonic herb for addressing reproductive disorders including male impotence, reduced fertility and female menstrual infertility, among other conditions. Polysaccharides from Cistanche deserticola are recognized as the plant's principal bioactive components. Nevertheless, the therapeutic potential and mechanistic actions of Cistanche deserticola polysaccharides (CDPs) in premature ovarian failure (POF) remain unexplored.

AIM OF THE STUDY

This study aimed to determine the protective role of CDPs in POF and to elucidate the underlying mechanisms.

MATERIAL AND METHODS

POF mouse models were developed through intraperitoneal administration of cyclophosphamide (CTX) at a high dose of 120 mg/kg/day and followed by 8 mg/kg/day (low maintenance dose) administered daily for 14 consecutive days. In a prophylactic therapeutic regimen, CDPs received pre-treatment initiation two weeks before model establishment, with phased administration maintained throughout three distinct temporal parameters (2-, 6-, and 8-week intervals) during pharmacological intervention. Upon anesthetization of the mice, ovarian tissues were collected for subsequent histopathological and molecular investigations. These analyses included immunohistochemistry to detect apoptotic proteins, Proliferative index mapping through Ki67 immunofluorescence, and electron microscopy to assess mitochondrial status and other pertinent indicators. RNA-seq elucidated the core regulatory pathway governing POF and potential protective targets for CDPs.

RESULTS

Experimental evidence established that intragastric administration of CDPs ameliorate histopathological ovarian lesions and rescue endocrine homeostasis, thereby enhancing the health of offspring in CTX-induced POF mice. This effect is facilitated by the promotion of follicular development, the proliferation of follicles, and the suppression of granulosa cell apoptosis. Furthermore, CDPs significantly attenuation of oxidative stress via ROS scavenging and restore mitochondrial morphology and function. In conclusion, the protective role of CDPs are closely linked to the JAK-STAT signaling pathway in POF models.

CONCLUSION

Our findings demonstrate that CDPs are capable of protecting protect the ovary tissue against CTX-induced damages through suppression of the activation of the JAK-STAT pathway and attenuation of granulosa cells (GCs) apoptosis.

Decellularized extracellular matrix as a drug delivery carrier

Tissue engineering and regenerative medicine approaches seek to enhance biomaterial mimicry with the goal of driving cell recruitment, proliferation, and differentiation. Decellularized extracellular matrix (dECM) biomaterials have emerged as a promising platform for biomaterials development as they capture the complexity of native tissues and offer a rich environment of signals to guide cellular responses. However, the decellularization process can affect both the structure and composition of the ECM. Recent efforts have focused on leveraging dECM as drug delivery carriers for controlled release of bioactive molecules. This review highlights current strategies for incorporating therapeutic agents into dECM which include encapsulation within hydrogel formulations, direct bulk absorption of biomolecules, and affinity-based binding and conjugation. Each method offers unique advantages for modulating release profiles, which can range from rapid initial burst to prolonged, sustained release, depending on factors such as crosslinking density, degradation rate, and specific interactions of biomolecules with dECM components such as glycosaminoglycans.

Risk factors and therapeutic significance of HER2 overexpression in urothelial carcinoma

OBJECTIVE

We analyzed the expression of HER2 in urothelial carcinoma (UC) and the risk factors for overexpression, and then further explored the guiding significance of HER2 in the treatment of locally progressive and advanced UC.People's Republic of China METHODS: Immunohistochemistry (IHC) was used to detect HER2, luminal markers (CK20, GATA3), and basal markers (CK5/6, CD44). HER2 overexpression was defined as IHC 2 + or IHC 3 + . Binary logistic regression was used to analyze the risk factors for HER2 overexpression. The therapeutic significance of HER2 was preliminarily discussed through case analysis.

RESULTS

A total of 119 patients with UC were included in this study, including 99 males and 20 females, with an average age of 66.2 ± 9.6 years. UC were derived from the bladder [n = 97 (81.5 %)], renal pelvis [n = 15 (12.6 %)], ureter [n = 6 (5.0 %)] and prostate [n = 1 (0.8 %)], respectively. UC were classified according to molecular typing into luminal 76 (63.9 %) cases and basal 29 (24.4 %) cases. HER2 expression rates of IHC 0, 1 + , 2 + , and 3 + in UC were 39.5 %, 23.5 %, 31.9 %, and 5 %, respectively. HER2 overexpression was as high as 52.6 % in luminal patients, but only 3.4 % in basal patients (53.2 % vs 3.4 %, P < 0.001). HER2 overexpression was strongly correlated with lower urinary tract, invasive, high-grade, multiple tumors and luminal (P < 0.05), while no significant correlation was seen with patients' gender (P = 0.311), age (P = 0.722), lymph node metastasis (P = 0.282) and ki67 index (P = 0.964). Multiple tumors (OR=5.346, 95 %CI: 1.921-14.877, P = 0.001) and luminal (OR=28.827, 95 %CI: 2.768-300.225, P = 0.005) were independent risk factors for HER2 overexpression. cT2N0M0 patient with HER2 (2 +) showed significant tumor shrinkage after preoperative neoadjuvant therapy with RC48-ADC.

CONCLUSIONS

HER2 testing can be routinely done in patients with locally advanced or metastatic UC, multiple tumors and luminal. Neoadjuvant therapy (HER2-ADC) for locally advanced UC was found to significantly shrink tumors, providing a theoretical basis for organ preservation and functional protection in genitourinary tumor surgery. HER2-ADC may be effective and safe in the treatment of locally progressive or advanced UC.

Quercetin-loaded PEGylated liposomes alleviate testicular dysfunction in alloxan-induced diabetic rats: The role of Kisspeptin/Neurokinin B/Dynorphin pathway

Diabetes mellitus (DM) is a chronic metabolic disorder that can lead to serious complications, including testicular dysfunction. This dysfunction is considered a significant cause of male infertility. Quercetin (Que), a naturally existing flavonoid with versatile biological functions, has limited water solubility and low bioavailability. The current study was designed to develop a bioavailable formulation of Que. via encapsulating it in PEGylated liposomes (Que-PEG-Lip) and determine whether this formulation is effective in the treatment of alloxan-induced testicular injury via targeting Kisspeptin/Neurokinin B/Dynorphin/steroidogenesis signaling pathway. Thirty-two male Sprague Dawley rats were randomly divided into four groups: Control, alloxan-induced diabetes with testicular dysfunction (ALX), ALX + metformin (MET) and ALX + Que-PEG-Lip. The results showed that treatment of ALX group with Que-PEG-Lip significantly improved the alteration of glycemic index, serum reproductive hormones, testicular antioxidant status, testicular Kiss-1, androgen receptor (AR), and proliferation marker protein (ki67) immunoexpression in compared to ALX group. Moreover, the treatment of ALX group with Que-PEG-Lip regulated the Kisspeptin/Neurokinin B/Dynorphin/steroidogenesis pathway gene expression. Interestingly, the outcomes of the molecular docking analysis revealed a strong agonistic effect of Que. on the kisspeptin, neurokinin, and dynorphin receptors. In conclusion, Que-PEG-Lip mitigated the testicular dysfunction in alloxan-induced diabetic rats via regulation of hypothalamic-pituitary-gonadal axis signaling pathway and alleviation the testicular oxidative stress.

CCDC134 enhances ovarian reserve function and angiogenesis by directly interacting with INHA in a mouse model of premature ovarian insufficiency

Premature ovarian insufficiency (POI) is a multifactorial condition characterized by diminished ovarian function, granulosa cell (GC) apoptosis, and impaired ovarian angiogenesis, leading to infertility and long-term health complications. Despite its prevalence, effective therapeutic targets for POI remain limited. This study investigates the role of CCDC134 in maintaining ovarian reserve and promoting angiogenesis and its interaction with INHA in a mouse model of POI. Ovarian granulosa cells from POI patients and unaffected women were analyzed for apoptosis and CCDC134 expression. A cisplatin-induced mouse model of POI was used to evaluate the therapeutic potential of AAV-mediated ovary-specific overexpression of CCDC134. Ovarian morphology, hormonal levels, follicular development, granulosa cell viability, and angiogenesis were assessed. The interaction between CCDC134 and INHA was examined using co-immunoprecipitation, immunofluorescence, and molecular pathway analyses. CCDC134 expression was significantly downregulated in ovarian tissues and granulosa cells of POI patients and cisplatin-induced POI mice. CCDC134 overexpression improved ovarian morphology, restored follicular development across all stages, and enhanced reproductive outcomes in POI mice. Hormonal imbalances, including decreased AMH and E2 and elevated FSH and LH, were reversed following CCDC134 overexpression. Moreover, CCDC134 treatment significantly reduced GC apoptosis by downregulating pro-apoptotic markers (Caspase-3 and Bax) and upregulating anti-apoptotic Bcl-2. Angiogenesis was enhanced, as indicated by increased expression of CD34 and vWF, improved endothelial cell viability, and restored VEGF levels. Mechanistic studies revealed a direct interaction between CCDC134 and INHA, with CCDC134 promoting INHA expression and modulating apoptotic and angiogenic pathways. CCDC134 plays a critical role in maintaining ovarian reserve and promoting angiogenesis by directly interacting with INHA. Its overexpression restores ovarian function, mitigates granulosa cell apoptosis, and enhances angiogenesis in a mouse model of POI. These findings highlight the therapeutic potential of the CCDC134-INHA axis as a novel strategy for treating POI.

MicroRNA-541-3p/Rac2 signaling bridges radiation-induced lung injury and repair

Background

While radiation-induced lung injury decreases quality of life and suppresses efficacy of radiotherapy, to date, the relationship between radiation-induced lung injury and repair remains unclear. Our previous studies revealed that TNFRSF10B-RIPK1/RIPK3-MLKL signaling induces necroptosis of alveolar epithelial cells and potentiates radiation-induced lung injury. We also found that microRNA-541-3p is differentially expressed in radiation-damaged lungs. The connection between microRNA-541-3p, TNFRSF10B signaling, and TGFβ1 signaling is also unclear.

Objective

This study was performed to explore the regulatory effects of microRNA-541-3p on TNFRSF10B and TGFβ1 signaling.

Methods

Mouse alveolar epithelial cells were transfected with a vector expressing microRNA-541-3p to regulate expression of target genes. Flow cytometry, polymerase chain reaction, and western blotting were used to analyze cell necroptosis, target gene expression, and target protein expression, respectively.

Results

Overexpression of microRNA-541-3p positively regulated TNFRSF10B-RIPK1/RIPK3-MLKL signaling through Rac2 to induce cell necroptosis. MicroRNA-541-3p negatively regulates Rac2. MicroRNA-541-3p and Rac2 regulate the expression of Tgf-beta1 and its encoded proteins.

Conclusions

The Rac2 gene synchronously regulates TNFRSF10B-RIPK1/RIPK3-MLKL and TGFβ1 signaling. MicroRNA-541-3P/Rac2 act as mediators of radiation damage and repair signaling.

Non-coding RNA-mediated granulosa cell dysfunction during ovarian aging: From mechanisms to potential interventions

As the earliest aging organ in the reproductive system, the ovary has both reproductive and endocrine functions, which are closely related to overall female health. The exact pathogenesis of ovarian aging (OA) remains incompletely understood, with granulosa cells (GCs) dysfunction playing a significant role in this process. Recent advancements in research and biotechnology have highlighted the importance of non-coding RNAs (ncRNAs), including micro RNAs, long non-coding RNAs, and circular RNAs, in regulating the biological functions of GCs through gene expression modulation. This paper provides a comprehensive overview of the role of ncRNAs in various cellular functions such as apoptosis, autophagy, proliferation, and steroid synthesis in GCs, and explores the underlying regulatory mechanisms. Additionally, the therapeutic potential of ncRNAs, particularly those carried by exosomes derived from mesenchymal stem cells, in delaying OA is discussed. Understanding the regulatory mechanisms of ncRNAs in GC function and the current progress in this field is crucial for identifying effective biomarkers and therapeutic targets, ultimately aiding in the early diagnosis, prognostic assessment, and individualized treatment of OA.

Piperazine ferulate impact on diabetes-induced testicular dysfunction: unveiling genetic insights, MAPK/ERK/JNK pathways, and TGF-β signaling

Diabetic testicular dysfunction (DTD) poses a significant threat to male reproductive health. This study delves into the potential of piperazine ferulate (PF), a natural phenolic compound, in alleviating DTD and sheds light on its underlying mechanisms in rats. Animals were divided into the control, PF, diabetic, and diabetic plus PF groups. Diabetes was induced in rats with a single intraperitoneal (i.p.) injection of streptozotocin (STZ) at 50 mg/kg. PF was administered at 50 mg/kg/day via i.p. injection for four weeks. Significant changes in sexual behavior were observed in diabetic rats, which additionally revealed lower serum levels of testosterone, FSH, and LH. The abnormalities in sperm count, viability, motility, and morphology occurred along with the demonstrated suppression of genes and protein expression related to spermatogenesis. Atrophy of the seminiferous tubules and extensive degeneration and necrosis of the germ and Leydig cells were highlighted by histopathological examination. The testicular function of diabetic rats was significantly improved after PF administration, evidenced by normalized testicular histology, increased testosterone levels, and enhanced sperm quality. In addition to reducing inflammatory cytokines, COX2, and NF-κB expression, pf administration elevated the antioxidant levels and Nrf2/HO-1 expression. Furthermore, key signaling pathways involved in testicular degeneration are regulated by PF. It promoted cell survival and tissue repair by activating the protective TGF-β signaling pathway and attenuating the MAPK/ERK/JNK signaling cascade, which in turn reduced inflammation and apoptosis. PF suppressed the expression of INSL3, SPHK1, CD62E, ANGPTL2, and miR-148a-5p, while increasing the expression of testicular genes like HSD17B1, DAZL, and S1P, addressing DTD. This study highlights the potential of PF to restore testicular function and fertility in diabetic males by modulating genetic and signaling pathways.

Clinical features and management of thoracic endometriosis: a 20-year monocentric retrospective study

PURPOSE

Although thoracic endometriosis (TE) represents the most common manifestation of extra-pelvic endometriosis, it is a rare condition and currently there is no established clinical guideline for the management of this condition. The study's primary objective was to assess patient satisfaction with the treatment provided. A secondary objective was to investigate the efficacy of different treatment modalities in terms of symptom and lesion recurrence.

METHODS

A retrospective review of the clinical records of all women with TE who had been referred to our institution, a tertiary referral center, was conducted between January 2000 and September 2021. A frequency analysis was performed for all the variables examined in the study. The Kaplan-Meier method was adopted to analyse the time from thoracic surgery to PNX recurrence. Lastly, an intention-to-treat analysis was performed.

RESULTS

Regarding clinical presentation, 50% of women (30/60; 95% CI 36.8-63.2) experienced at least one episode of pneumothorax (PNX). A total of 61.7% of the women in the study underwent surgical intervention, while 36.6% received pharmacological treatment. The cumulative recurrence rate of the first PNX following surgery was 0.26 (0.13-0.41) and 0.82 (0.44-0.95) at six months and 240 months, respectively. At the follow-up assessment, regardless of the administered treatment modality, over half of the women included in the study reported being satisfied with their treatment (PGIC). Additionally, most of them described their overall condition as having improved since the onset of the treatment (PGIS).

CONCLUSION

Both surgical and pharmacological treatments are valuable options for TE. Rather than being considered mutually exclusive, these approaches should be viewed as complementary.

Computer-simulated mirror osteotomy in the treatment of post-traumatic cubitus varus deformity in children

PURPOSE

To explore the feasibility and early clinical efficacy of computer-based mirroring technology in simulating osteotomy for the treatment of post-traumatic cubitus varus deformity in children.

METHODS

A retrospective analysis was conducted on the data of 26 patients with cubitus varus deformity who were admitted between June 2019 and June 2024. Among them, there were 19 males and 7 females, with an average age of 8.12 ± 2.83 years (ranging from 5 to 15 years). The time from injury to surgery ranged from 13 to 84 months, averaging at 27.85 ± 21.91 months. The carrying angle and anteversion measured on full-length anteroposterior radiographs of both upper extremities and lateral radiographs of the elbow joint were used as osteotomy parameters. Low-dose CT scans of both upper extremities of the pediatric patients were performed to reconstruct three-dimensional (3D) models of the affected limb for computer-simulated osteotomy. The 3D mirror-imaging technique of the unaffected side was applied for overlay comparison, and the osteotomy parameters were adjusted accordingly. Surgeries were performed based on the final parameters obtained. Intraoperative data such as surgical duration and blood loss were recorded, and regular postoperative follow-ups were conducted with X-ray examinations to observe bone callus formation in the osteotomy area. At the final follow-up, the carrying angle, anteversion, and range of motion (flexion and extension) of the elbow joints on both the affected and unaffected sides were measured, and elbow function was assessed using the Mayo score.

RESULTS

The surgical duration for the 26 patients ranged from 35 to 55 min, averaging at 44.23 ± 7.83 min, with an average blood loss of 32.12 ± 6.35 ml (ranging from 20 to 40 ml). The mean follow-up duration was 31.12 ± 15.81 months (ranging from 6 to 60 months). Kirschner wires (K-wires) were removed 8-12 weeks postoperatively, and plates were taken out 4-6 months later. During the follow-up period, two patients experienced pin tract irritation symptoms after K-wire fixation, which improved after dressing changes; one patient had poor plate adherence causing skin irritation and recovered after early removal of the internal fixation. No complications such as fracture or loosening of the internal fixation devices occurred. At the final follow-up, the carrying angle of the affected elbow joint was (13.48 ± 4.19) °, the anteversion was (44.08 ± 3.80) °, the flexion was (143.27 ± 1.51) °, and the extension was (-7.23 ± 1.63) °. These values were significantly improved compared to those before surgery and showed no significant difference compared to the unaffected side. According to the Mayo Elbow Performance Score, 24 patients were rated as excellent and 2 as good.

CONCLUSION

Using computer-based mirroring technology for osteotomy simulation enables precise bone resection, which not only shortens the surgical duration but also makes the surgical procedure easier to operate, with satisfactory clinical treatment outcomes in the short-term.

Drug treatments for mild or moderate covid-19: systematic review and network meta-analysis

OBJECTIVE

To compare the effects of treatments for mild or moderate (that is, non-severe) coronavirus disease 2019 (covid-19).

DESIGN

Systematic review and network meta-analysis.

DATA SOURCES

Covid-19 Living Overview of Evidence Repository (covid-19 L-OVE) by the Epistemonikos Foundation, a public, living repository of covid-19 articles, from 1 January 2023 to 19 May 2024. The search also included the WHO covid-19 database (up to 17 February 2023) and six Chinese databases (up to 20 February 2021). The analysis included studies identified between 1 December 2019 and 28 June 2023.

STUDY SELECTION

Randomised clinical trials in which people with suspected, probable, or confirmed mild or moderate covid-19 were allocated to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.

METHODS

After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias was assessed by use of a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, following GRADE guidance, drug treatments were classified in groups from the most to the least beneficial or harmful.

RESULTS

Of 259 trials enrolling 166 230 patients, 187 (72%) were included in the analysis. Compared with standard care, two drugs probably reduce hospital admission: nirmatrelvir-ritonavir (25 fewer per 1000 (95% confidence interval 28 fewer to 20 fewer), moderate certainty) and remdesivir (21 fewer per 1000 (28 fewer to 7 fewer), moderate certainty). Molnupiravir and systemic corticosteroids may reduce hospital admission (low certainty). Compared with standard care, azithromycin probably reduces time to symptom resolution (mean difference 4 days fewer (5 fewer to 3 fewer), moderate certainty) and systemic corticosteroids, favipiravir, molnupiravir, and umifenovir probably also reduce duration of symptoms (moderate to high certainty). Compared with standard care, only lopinavir-ritonavir increased adverse effects leading to discontinuation.

CONCLUSION

Nirmatrelvir-ritonavir and remdesivir probably reduce admission to hospital, and systemic corticosteroids and molnupiravir may reduce admission to hospital. Several medications including systemic corticosteroids and molnupiravir probably reduce time to symptom resolution.

SYSTEMATIC REVIEW REGISTRATION

This review was not registered. The protocol is publicly available in the supplementary material.

Synthesis and characterization of sodium alginate/poly(N-vinylpyrrolidone) nano-carrier loaded with rebaudioside A and/or stevioside for anticancer drug delivery

Stevioside and rebaudioside A revealed anticancer effects against diversity of cancers, such as colon, breast and liver cancers. Rebaudioside A can trigger apoptosis in cancer cells via activation of caspase-dependent pathway. In this study sodium alginate/poly(N-vinylpyrrolidone) as nano-carriers loaded with natural products rebaudioside A (R) and/or stevioside (S) were assessed for anticancer activities. The nanogel of structure R improved cytotoxicity against MCF-7, HepG2, HCT116 and A549 cancers by 60.29 %, 53.45 %, 72.86 % and 62.13 %, correspondingly. Additionally, the nanogel of structure S improved cytotoxicity against MCF-7, HepG2, HCT116 and A549 cancers by 63.96 %, 53.41 %, 70.59 % and 52.88 %, respectively. Furthermore, the nanogel for mixture of R/S improved cytotoxicity against MCF-7, HepG2, HCT116 and A549 cancers by 78.86 %, 54.75 %, 74.10 % and 56.53 % correspondingly. Also, cytotoxic activities of structures R, S and R/S and their nanogels exhibited low toxicity on VERO cells with IC50 = 30.90-46.50 μM and high selectivity against cancer cells. Moreover, R/S (nanogel), R (nanogel) and S (nanogel) demonstrated the uppermost binding affinities with DNA at reduced IC50 values of 31.50, 32.60, and 33.90 μM, respectively. In addition, they inhibited Topo-II activity with remarkably low IC50 value of 0.95, 1.00, and 1.10 μM, respectively.

Imaging of the umbilicus

The umbilicus is a scar of the umbilical cord containing various embryonic remnants that can lead to postnatal diseases. It is the collection point for blood and lymphatic flow and other structures. Hence, various diseases and conditions can occur. In this review, we aimed to categorize umbilical diseases based on the embryonic remnants, including urachal remnants, omphalomesenteric duct anomalies, and complications of the umbilical arteries and veins. The urachus, formed from the allantois, can result in anomalies such as patent urachus and urachal cysts, with infections being the most common complication. Radiologists must note that urachal carcinoma is a rare complication presenting with characteristic imaging findings. The omphalomesenteric duct can lead to Meckel's diverticulum, the most prevalent gastrointestinal anomaly. In addition, obliterated umbilical arteries and veins can cause various conditions, including hernias and abscesses. This review also summarizes the umbilical ring lesions, such as gastroschisis and omphalocele, and iatrogenic lesions associated with laparoscopic procedures and catheter placement. Imaging techniques such as ultrasound, computed tomography, and magnetic resonance imaging are crucial for diagnosing and managing these conditions. Understanding the embryological basis and imaging features of umbilical diseases is vital for timely diagnosis and treatment.

Associations of Serum Per- and Polyfluoroalkyl Substances with Genotoxic Biomarkers: New Insights from Cross-Sectional and In Vivo Evidence

The effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) on genomic stability remain unclear. Here, a cross-sectional study was conducted to establish the associations of PFAS with genotoxic biomarkers. We recruited a cohort of 453 residents in 2021 in Zhejiang, China. Thirty PFAS in serum were quantified, alongside seven indicators of genomic stability [five rDNA copy numbers (rDNA-CN), mitochondrial DNA copy numbers (mtDNA-CN), and relative telomere length (RTL)] in whole blood. Results showed that PFUnDA, perfluorohexanesulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), 6:2 Cl-PFESA, and PFO5DoDA were positively correlated with rDNA-CN, while PFHpA, PFOA, and PFMOAA showed inverse associations. PFO4DA and PFO5DoDA were positively correlated with mtDNA-CN. PFOA, HFPO-TA, and PFMOAA were negatively associated with the RTL, while perfluorononanoic acid, PFHxS, PFOS, and 6:2 Cl-PFESA showed positive associations. Nonlinear exposure-response relationships were also observed between PFAS and genotoxic biomarkers using restricted cubic spline models. Furthermore, PFAS mixtures were positively associated with mtDNA-CN, with PFO5DoDA showing the highest contribution by the quantile-based g-computation model. In vivo studies further confirmed that PFO5DoDA increased mtDNA-CN in male mice in a dose-dependent manner. This study provides novel evidence that PFAS disrupt genomic stability, with effects varying by functional groups and fluoroalkyl(ether) chain lengths.

Associations among blood heavy metals, neurofilament light chains and cognition function in US adults: NHANES 2013-2014

BACKGROUND

Heavy metals could induce neurotoxicity, leading to cognitive function and motor deficiencies. Serum neurofilament light chain (sNfL) is a promising biomarker for neurological injury, and it may indicate nerve damage from heavy metals exposure. However, there's limited research exploring the associations among heavy metals, sNfL, and cognitive function in adults, and the existing findings are inconsistent.

OBJECTIVE

959 participants were enrolled from the National Health and Nutrition Examination Surveys (NHANES) 2013-2014. This study was aimed to investigate the possible associations among heavy metals, sNfL, and cognitive function in adults.

METHODS

We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014, comprising 959 participants. Heavy metals were detected in blood samples including lead (Pb), cadmium (Cd), mercury (Hg), manganese (Mn), and selenium (Se), with measurements taken using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) technology. The level of sNfL was quantified via an innovative high-throughput immunoassay technology developed by Siemens Healthineers. Cognitive function were assessed using the Animal Fluency Test (AFT), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), and the Digit Number Symbol Substitution Test (DSST). Additionally, generalized linear models (GLMs), weighted quantile sum regression (WQS), Bayesian kernel machine regression (BKMR), quantile-based g computation (qgcomp), and restricted cubic splines (RCS) analyses were employed to examine the associations between heavy metals exposure and sNfL level. Finally, a mediation analysis to explore the interaction among heavy metals, sNfL, and cognitive function in adults aged 60 and above.

RESULTS

The generalized linear models exhibited a positive correlation between blood Pb or Cd levels and sNfL (β = 0.14, 95 % CI: 0.08-0.20; β = 0.14, 95 % CI: 0.07-0.20), in total population. Both WQS and BKMR analysis consistently showed a strong correlation between higher levels of the blood heavy metals mixture and increased sNfL (OR=0.051, 95 %CI: 0.025-0.090). The qgcomp model indicated that Cd had a significant positive correlation with sNfL, while Mn and Se showed a significant negative correlation with sNfL. Moreover, we have identified a significant relationship between sNfL or Cd and cognitive function scores (AFT, DSST) in adults aged 60 and above. The mediation analysis further revealed that sNfL partially mediated the relationship between Cd and AFT or DSST scores, with interpretive efficiencies of 23.35 % and 32.7 %, respectively.

CONCLUSION

This study is the first to utilize sNfL data to establish a link between heavy metals exposure and cognitive function. The finding highlight the the positive correlation between Pb or Cd and sNfL, the negative correlation between Se and sNfL. The impact of Cd exposure on cognitive function in individuals older than 60 was partially explained by sNfL. Further investigations are required to validate these findings, considering the constraints of the NHANES study.

From current landscape to future horizon in stem cell therapy for tissue regeneration and wound healing: bridging the gap

Stem cell therapy has emerged as a groundbreaking approach in regenerative medicine, offering immense potential for tissue regeneration and wound healing. Stem cells, with their ability to self-renew and differentiate into specialized cell types, provide innovative therapeutic strategies for variety of medical conditions. Key stem cell types, including embryonic, induced pluripotent, and adult stem cells such as mesenchymal and hematopoietic stem cells, play pivotal roles in regenerative processes and wound repair. In tissue regeneration, stem cells replenish damaged or necrotic cells by differentiating into specialized cell types like bone, muscle, or nerve cells, thus restoring the structural and functional integrity of tissues. In wound healing, stem cells stimulate angiogenesis, generate new skin cells, and modulate immune responses to enhance repair. This multifaceted therapeutic potential has paved the way for clinical applications in cardiovascular, neurological, musculoskeletal, and autoimmune disorders, as well as skin and burn injuries. This review highlights recent advancements in stem cell therapy, exploring its clinical applications and addressing challenges such as immune rejection, ethical concerns, scalability, and the need for long-term clinical trials. The article underscores the importance of continued research to fully realize the transformative potential of stem cell therapy in modern medicine.

Precision exosome engineering for enhanced wound healing and scar revision

The dysfunction of wound-healing processes can result in chronic non-healing wounds and pathological scar formation. Current treatment options often fall short, necessitating innovative approaches. Exosomes, extracellular vesicles secreted by various cells, have emerged as promising therapeutic agents serving as an intercellular communication system. By engineering exosomes, their cargo and surface properties can be tailored to enhance therapeutic efficacy and specificity. Engineered exosomes (eExo) are emerging as a favorable tool for treating non-healing wounds and pathological scars. In this review, we delve into the underlying mechanisms of non-healing wounds and pathological scars, outline the current state of engineering strategies, and explore the clinical potential of eExo based on preclinical and clinical studies. In addition, we address the current challenges and future research directions, including standardization, safety and efficacy assessments, and potential immune responses. In conclusion, eExo hold great promise as a novel therapeutic approach for non-healing wounds and non-healing wounds and pathological scars. Further research and clinical trials are warranted to translate preclinical findings into effective clinical treatments.

Death-ision: the link between cellular resilience and cancer resistance to treatments

One of the key challenges in defeating advanced tumors is the ability of cancer cells to evade the selective pressure imposed by chemotherapy, targeted therapies, immunotherapy and cellular therapies. Both genetic and epigenetic alterations contribute to the development of resistance, allowing cancer cells to survive initially effective treatments. In this narration, we explore how genetic and epigenetic regulatory mechanisms influence the state of tumor cells and their responsiveness to different therapeutic strategies. We further propose that an altered balance between cell growth and cell death is a fundamental driver of drug resistance. Cell death programs exist in various forms, shaped by cell type, triggering factors, and microenvironmental conditions. These processes are governed by temporal and spatial constraints and appear to be more heterogeneous than previously understood. To capture the intricate interplay between death-inducing signals and survival mechanisms, we introduce the concept of Death-ision. This framework highlights the dynamic nature of cell death regulation, determining whether specific cancer cell clones evade or succumb to therapy. Building on this understanding offers promising strategies to counteract resistant clones and enhance therapeutic efficacy. For instance, combining DNMT inhibitors with immune checkpoint blockade may counteract YAP1-driven resistance or the use of transcriptional CDK inhibitors could prevent or overcome chemotherapy resistance. Death-ision aims to provide a deeper understanding of the diversity and evolution of cell death programs, not only at diagnosis but also throughout disease progression and treatment adaptation.

Mesenchymal stem cells derived from hPSC via neural crest attenuate chemotherapy-induced premature ovarian insufficiency by ameliorating apoptosis and oxidative stress in granulosa cells

BACKGROUND

Premature ovarian insufficiency (POI) poses a significant threat to female reproductive health and currently lacks effective interventions. Recent studies highlight the promising potential of human pluripotent stem cell-derived mesenchymal stem cells (hPSC-MSC) in regenerative medicine. However, research on hPSC-MSC-based treatments for POI remains limited, particularly in the characterization of the intermediate differentiation stages from hPSC to MSC. This study presents an accelerated differentiation protocol for generating hPSC-MSC via neural crest cells (NCC) and evaluates their therapeutic potential in chemotherapy-induced POI.

METHODS

We modified a canonical small molecule-mediated protocol for hPSC-NCC-MSC differentiation. Systematic characterization of differentiated-cells was performed using qPCR, immunofluorescence, cell viability assays, flow cytometry and trilineage differentiation. In vivo, hPSC-NCC-MSC were transplanted into chemotherapy-induced POI SD rat models, and parameters such as body weight, ovarian weight, estrous cycle, hormone levels, follicle count, and mating were assessed. Granulosa cells (GC) apoptosis was analyzed using TUNEL assay and immunohistochemistry. In vitro, their effects on apoptosis inhibition and oxidative stress alleviation were investigated in a cultured GC cell line. Additionally, comparisons between umbilical cord MSC (UC-MSC) and hPSC-NCC-MSC in chemotherapy-induced POI was conducted.

RESULTS

Our optimized protocol, combining CHIR99021 and SB431542, efficiently induced NCC from both human embryonic stem cells (hESC) and human induced pluripotent stem cells (hiPSC). The programmed hPSC-NCC-MSC, characterized by specific NCC markers (P75, HNK1, SOX10, and AP2α), exhibited typical MSC morphology, trilineage differentiation potential, favorable cell viability, and prominent anti-senescence properties. Among these, NCC differentiated from H1-hESCs (H1-NCC) demonstrated the highest induction efficiency (72.45%), and H1-NCC-derived MSC (H1-NCC-MSC) displayed superior proliferation and anti-senescence properties compared to UC-MSC. Besides, H1-NCC-MSC exhibited therapeutic efficacy comparable to UC-MSC in both in vivo and in vitro models of chemotherapy-induced POI, potentially through mechanisms involving reduced GC apoptosis, alleviated oxidative stress, and improved mitochondrial function.

CONCLUSIONS

Our findings propose a modified hPSC-NCC-MSC differentiation protocol, offering an inexhaustible and stable source for regenerative therapies. Furthermore, we provide the first experimental evidence that hPSC-NCC-MSC have therapeutic potential comparable to UC-MSC in restoring chemotherapy-induced POI. The underlying mechanisms are likely associated with paracrine-mediated effects on GC apoptosis, oxidative stress, and mitochondrial dysfunction.

Hydrogen sulfide and ferroptosis inhibition underlies the dietary restriction-induced protection against cyclophosphamide cystitis

Dietary restriction (DR) has emerged as a potential therapeutic intervention for various pathological conditions. This study investigated the effects of DR on cyclophosphamide-induced cystitis in mice. Animals were subjected to controlled food restriction for 1 week prior to cyclophosphamide administration. We evaluated changes in body weight, bladder pathology, redox status, and ferroptotic parameters. DR significantly attenuated cyclophosphamide-induced cystitis severity, as evidenced by reduced bladder weight, decreased lipid peroxidation, and diminished ferroptotic markers in bladder tissue. Mechanistic investigations revealed that DR upregulated hepatic hydrogen sulfide (H2S)-synthesizing enzymes and enhanced H2S production. Inhibition of H2S-synthesizing enzymes with DL-propargylglycine (PAG) and aminooxyacetic acid (AOAA) exacerbated cyclophosphamide-induced cystitis, whereas administration of diallyl trisulfide (DATS), an H2S donor, markedly ameliorated bladder pathology. In vitro studies demonstrated that H2S donors, NaHS and DATS, protected against cyclophosphamide metabolite acrolein (ACR)-induced urothelial cell death by suppressing oxidative stress, as indicated by reduced p38 MAPK activation and protein carbonylation. These findings suggest that DR confers protection against cyclophosphamide-induced cystitis through the induction of endogenous H2S production and inhibition of ferroptosis. Our study provides additional evidence supporting the health-promoting effects of DR as well as novel mechanistic insights into the beneficial effects of DR. Given H2S has anti-inflammatory and anti-oxidative properties and that oxidative stress and ferroptosis underlie various diseases, our finding could have broader implications.

Impacts of Prior Anti-Osteoporosis Treatments on Sequential Denosumab Responses in BMD Changes Among Postmenopausal Osteoporosis Women in East China: Real-World Data Analysis

Purpose

This study aimed to investigate the impacts of prior anti-osteoporosis treatments on bone mineral density (BMD) changes in Chinese postmenopausal women with osteoporosis following 1-year Denosumab (Dmab) therapy.

Patients and Methods

This retrospective cohort study enrolled 381 postmenopausal women, all receiving a 1-year Dmab treatment. Participants were stratified into five groups based on prior anti-osteoporosis treatments: no treatment (NT), alendronate (ALN), zoledronic acid (ZOL), teriparatide (TPT), and raloxifene (RAL). Potential factors influencing BMD changes were screened using least absolute shrinkage and selection operator (LASSO). The selected variables were then incorporated into a multivariate regression model to identify independent risk factors. Finally, after adjusting for confounders, the impacts of prior anti-osteoporosis treatment on sequential Dmab responses were evaluated.

Results

1) Further BMD increases were observed after sequential 1-year Dmab with prior use of other anti-osteoporosis drugs; 2) Compared to the NT group, ZOL significantly reduced BMD changes at the lumbar spine (LS), femoral neck (FN), and total hip (TH) (LS: β = -0.01, P = 0.016; FN: β = -0.01, P = 0.010; TH: β = -0.01, P = 0.011); Significant negative associations with FN BMD changes were observed for the ALN group (β = -0.01, P< 0.001), and the RAL group (β = -0.01, P = 0.010) compared to the NT group; TPT showed no significant differences with the NT group at all sites; 3) Multiple analysis revealed baseline BMD were independently associated with changes in BMD (LS: β = -0.04, P = 0.009; FN: β = -0.19, P <0.001; TH: β = -0.14, P <0.001).

Conclusion

These findings indicated that prior anti-osteoporosis treatments differentially influenced BMD responses to 1-year Dmab therapy. While patients who had previously been treated with ZOL had limited subsequent BMD improvement, patients who had previously used TPT and had lower baseline BMD benefited more.

Promising odor-based therapeutics targeting ectopic olfactory receptor proteins in cancer: A review

Cancer remains a formidable adversary in global health, necessitating the development of innovative strategies to curb the proliferation, invasion, and metastasis of cancer cells for effective treatment outcomes. Traditional cancer therapies often fall short in addressing the diverse therapeutic requirements of patients. Consequently, the exploration of novel therapeutic targets has become increasingly vital. Olfactory receptors (ORs) belonging to the G protein-coupled receptor (GPCR) subfamily, are present in non-nasal tissues and contribute to a wide range of physiological functions. ORs are specifically expressed in malignant tumors and have emerged as potential biomarkers for cancer detection. They can regulate diverse tumor biological behaviors and are involved in the development of malignant tumors, indicating that they might serve as potential targets for cancer treatment. This paper provides a comprehensive review of the ectopic expression of ORs, their functions in malignancies and odor-based therapeutics targeting ectopic olfactory receptors (EORs) in cancer, and aims to clarify their connection with cancer, providing new clues for probing the tumor biology and developing therapeutic strategies against cancer.

Primary umbilical endometriosis in a nulliparous woman: A rare case report

INTRODUCTION AND IMPORTANCE

Endometriosis describes the presence of endometrial tissue outside the uterine cavity. These patients often experience cyclic pain, dysmenorrhea, dyspareunia and infertility. Extra-pelvic endometriosis, particularly at the umbilicus, is rare. The exact incidence of endometriosis is unknown; definitive diagnosis requires surgical exploration and histopathological confirmation. Conservative, medical and surgical approaches are used in treatment. A combined approach is most useful in cases where pain is a prominent symptom. There is limited discussion of umbilical endometriosis in the literature, most information is derived from case reports.

CASE PRESENTATION

Herein we present the case of a 35-year-old nulliparous woman in Northern Tanzania with a 10-year history of infertility. On presentation this patient reported a three-year history of a cyclical aching pain associated with an umbilical mass. An abdominal MRI revealed an ill-defined, enhancing mass measuring 3 × 4 × 6 cm located along the right anterior abdominal wall. The mass was connected to a sinus tract extending inferiorly to the suprapubic region but showed no communication with the peritoneal cavity, suggestive of endometriosis. Furthermore, bilateral adnexal lesions demonstrated hyperintense signals with focal hypointense areas and variable restrictions, consistent with bilateral ovarian endometriomas. The patient underwent excision of the umbilical mass, and histopathological examination confirmed the diagnosis of primary umbilical endometriosis. Despite her stable condition following management, she did not conceive over the course of the following year.

CLINICAL DISCUSSION

This case describes a case of primary umbilical endometriosis and bilateral ovarian endometriomas in a 35-year-old nulliparous woman. Surgical excision and histopathological analysis confirmed endometriosis. However, following intervention the patient was still unable to conceive. Whilst this is perhaps not unsurprising given the patient's age it is important for us to consider all possible explanations for her infertility. Critically, this case emphasizes the need for early intervention and comprehensive management of endometriosis-related fertility challenges.

CONCLUSION

We aim to provide a detailed description of this case in order to support clinicians who may encounter similar cases in the future especially in resource poor settings. We are providing data to support the theory that primary umbilical endometriosis can occur spontaneously in patients without a surgical history. Enhancing clinician awareness of this condition and fostering interdisciplinary collaboration is fundamental in providing timely support in relation to fertility challenges and symptom relief.

Cyclophosphamide-induced testicular injury: the role of chrysin in mitigating iron overload and ferroptosis

This study evaluated the beneficial effects of chrysin against cyclophosphamide (CP)-induced testicular toxicity in rats across several parameters, including hormones, oxidative stress, inflammation, apoptosis, and protein expression. Rats were pretreated with oral doses of chrysin at 25, 50, or 100 mg/kg daily for 7 days. On the 8th day, all groups except controls received CP (200 mg/kg) injection. Chrysin doses continued for 7 more days. Hormones, oxidative stress markers, inflammatory cytokines, apoptosis regulators, and iron regulatory proteins were assessed. CP decreased testosterone, inhibin B, GSH, and GPx4 and increased FSH, cholesterol, MDA, IL-6, and BAX. It also drastically reduced TfR1, liprin, and IREB2. Chrysin dose-dependently counteracted these effects. The highest 100 mg/kg chrysin dose increased testosterone, inhibin B, GSH, GPx4, BCL2, TfR1, liprin, and IREB2 while decreasing FSH, cholesterol, MDA, IL-6, and BAX close to control levels. There were also significant incremental benefits for testosterone, inhibin B, and other parameters with higher chrysin doses. Chrysin dose-dependently attenuated CP-induced hormonal dysfunction, oxidative stress, inflammation, apoptosis, and iron-regulatory protein suppression. The maximum dose showed the most optimal protective effects in restoring the testicular toxicity markers. These results validate the promising spermatoprotective properties of chrysin against chemotherapeutic germ cell damage.

Comparing Efficacy of Chiglitazar, Pioglitazone, and Semaglutide in Type 2 Diabetes: A Retrospective Study

INTRODUCTION

Type 2 diabetes (T2D) is a complex chronic metabolic disease characterized by insulin resistance, dyslipidemia, inflammation, and visceral fat accumulation, leading to complications, such as cardiovascular disease and kidney damage. Emerging metabolic regulators, including chiglitazar, semaglutide, and pioglitazone, have gained prominence in managing T2D and associated metabolic disorders. However, their relative efficacy and optimal clinical applications remain unclear. This study's objective was to compare the effects of chiglitazar, semaglutide, and pioglitazone on glycemic control, lipid metabolism, insulin resistance, inflammatory response, liver function, kidney function, and dawn phenomenon intensity in T2D participants, and to explore their relative efficacy and clinical value.

METHODS

This retrospective study was conducted from October 2024 to November 2024 to compare the effects of chiglitazar, semaglutide, and pioglitazone in managing type 2 diabetes (T2D) and associated metabolic disorders.This retrospective cohort study included 175 participants with T2D divided into three groups: chiglitazar (n = 55), semaglutide (n = 57), and pioglitazone (n = 63). participants underwent a 4-week treatment period. Core metrics, including blood glucose, lipid metabolism indicators, urinary albumin-to-creatinine ratio (UACR), and metabolic insulin resistance score (METS-IR), were assessed before and after treatment to evaluate drug efficacy.

RESULTS

Dawn phenomenon: chiglitazar significantly improved dawn phenomenon intensity (Δ0.004 ± 0.80 to -0.77 ± 0.67, p < 0.01), outperforming other drugs. Lipid metabolism: semaglutide demonstrated superior efficacy in reducing total cholesterol (TC) and free fatty acids (FFA) (p < 0.05). Kidney function: both semaglutide and chiglitazar significantly lowered UACR (p < 0.01), with semaglutide showing greater efficacy (-0.13 ± 0.02 versus -0.08 ± 0.01, p < 0.05). Insulin resistance and cardiovascular protection: all three drugs significantly improved METS-IR, with no statistical differences between groups (p > 0.05).

SAFETY

all drugs exhibited good tolerability with no severe adverse events.

CONCLUSIONS

Chiglitazar is particularly effective for participants with pronounced dawn phenomenon, semaglutide excels in lipid metabolism improvement and kidney protection, while pioglitazone remains effective for insulin resistance and glycemic control. These findings provide evidence-based guidance for individualized T2D management.

Association and mechanism of montelukast on sleep disorders: insights from NHANES 2005-2018 data analysis and a network pharmacology study

BACKGROUND

Studies have suggested associations between montelukast and increased risks of sleep disorders, including overall sleeping problems and insomnia. However, the results of observational studies are not consistent. Understanding these associations is crucial, particularly in patients solely diagnosed with allergic rhinitis, where montelukast use remains prevalent.

OBJECTIVE

This study aimed to assess whether montelukast exposure is associated with sleep disorders and elucidate the possible molecular mechanism.

METHOD

We conducted a cross-sectional study of 16,520 adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Multivariable regression was used to evaluate the association between montelukast exposure and sleep disorder. Network pharmacology was conducted to identify the mechanisms of montelukast on sleep disorders.

RESULTS

Montelukast exposure had a higher prevalence of sleep disorders (25.28%). In a multivariable logistic regression model adjusted for sociodemographic, behavioral, and health characteristics, montelukast exposure was associated with sleep disorders (odds ratio [OR]: 1.72; confidence interval [CI]: 1.32-2.26). Network pharmacology was identified 39 intersection targets and 17 core targets of montelukast on sleep disorders. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis suggested montelukast mainly works through multiple pathways in chemical carcinogenesis-receptor activation, cancer, estrogen signaling pathway, etc.

CONCLUSIONS

The study implies a potential positive association between long-term montelukast exposure and sleep disorders through multi-faceted mechanisms. It is suggested that attention be given to the possibility of sleep disorders in patients undergoing prolonged montelukast therapy.

Antioxidants improve the viability of diabetic bone marrow MSCs without rescuing their pro-regenerative secretome function

Bone marrow mesenchymal stem cell (BM-MSC) dysfunction and poor viability are prominent in diabetes and limit their therapeutic efficacy. A proteomic investigation was performed to assess disease associated alterations and the efficacy of antioxidants to rescue cellular function. BM-MSCs were isolated from obese diabetic mice (B6.Cg-Lepob/J) cultured in the presence or absence of N-acetylcysteine (NAC) and ascorbic acid-2phosphate (AAP). Label free Liquid Chromatography and Mass Spectrometry (LC-MS) analysis detected 5079 proteins with 251 being differentially expressed between treatment groups. NAC/AAP improved cellular growth/viability post isolation by up-regulating proteins involved in redox status, ATP synthesis, Rho-GTPase signaling and modulated the immunophenotype of BM-MSCs. Despite a single application of the secretome not providing any advantage for wound bed regeneration in full thickness excisional diabetic wounds, the intracellular proteome illustrated the potential mechanisms of action by which NAC/AAP targeted the respiratory chain and modulated the immune phenotype of BM-MSCs. Given these observations, antioxidant supplementation might be more effective as prophylactic strategy to protect MSCs against functional decline instead of using it as a restorative agent and warrants further investigation.

Advanced nanomicelles for targeted glioblastoma multiforme therapy

Glioblastoma multiforme (GBM) is the most aggressive and malignant primary brain tumor, classified as grade IV by the WHO. Despite standard treatments like surgical resection, radiotherapy and chemotherapy (i.e. temozolomide), GBM's prognosis remains poor due to its heterogeneity, recurrence and the impermeability of the blood-brain barrier (BBB). The exact cause of GBM is unclear with potential factors including genetic predisposition and ionizing radiation. Innovative approaches such as nanomicelles-nanoscale, self-assembled structures made from lipids and amphiphilic polymers show promise for GBM therapy. These nanocarriers enhance drug solubility and stability, enabling targeted delivery of therapeutic agents across the BBB. This review explores the synthesis strategies, characterization and applications of nanomicelles in GBM treatment. Nanomicelles improve the delivery of both hydrophobic and hydrophilic drugs and provide non-invasive delivery options. By offering site-specific targeting, biocompatibility, and stability, nanomicelles can potentially overcome the limitations of current GBM therapies. This review highlights recent advancements in the use of nanomicelles for delivering therapeutic agents and nucleic acids addressing the critical need for advanced treatments to improve GBM patient outcomes.

Umbilical venous catheter misplacement due to unexpected supernumerary patent umbilical artery

BACKGROUND

Umbilical vein catheterization is relatively straightforward procedure because the vein is easily recognized as a single, large, thin-walled vessel. However, anomalies of the umbilical vessels, such as the multivessel cord, which embeds more than two arteries or more than one vein, can result in catheter misplacement.

CASE PRESENTATION

We present a unique case of a supernumerary patent umbilical artery in an asphyxiated term neonate, which resulted in the misplacement of the umbilical venous catheter in one of the three arteries. The diagnosis of artery cannulation was made through a comprehensive analysis of the patient's blood gases, the use of a pressure transducer to confirm the presence of a pulsatile arterial signal, and the interpretation of a chest X-ray. Subsequently, the catheter was removed without complication. A more detailed examination of the umbilical cord revealed the presence of three arteries and a vein, which was then successfully cannulated.

CONCLUSIONS

This case reinforces the notion that the umbilical cord may include more than three vessels, and that umbilical vein cannulation requires prior meticulous observation of the number of vessels to prevent misplacement of the catheter.

Synthetic and Pharmacological Activities of Alantolactone and Its Derivatives

Alantolactone, a sesquiterpene lactone, is isolated from the traditional Chinese medicinal herb Inula helenium L. (Asteraceae). Alantolactone is known as its wide spectrum of biological effects, including antimicrobial, antifungal, antiviral, and anthelmintic activities; anti-inflammatory activities; and antiproliferative effects on several cancer cell lines. Thus, it has received extensive attention, causing in-depth research in medicinal chemistry, and numerous undescribed alantolactone derivatives have been synthesized through different strategies. Herein, recent advances in diverse bioactivities and mechanism of alantolactone, including its derivatives, were summarized.

Meckel's diverticulum discovered by capsule endoscopy: a systematic review of case reports

OBJECTIVES

Capsule endoscopy has achieved its place as a diagnostic tool in a clinical setting, especially in the small bowel. The most frequent malformation of the gastrointestinal tract (Meckel's Diverticulum) has therefore been discovered incidentally by capsule endoscopies multiple times. However, it is still not a regular diagnostic modality when the pathology is suspected. In this review of case reports, we aim to evaluate the knowledge and rationales of using capsule endoscopy as a diagnostic tool for Meckel's diverticulum.

METHODS

We performed a search through Pubmed and Embase to find all publications describing cases of Meckel's diverticulum diagnosed by capsule endoscopy. All data was collected, and a stratification based on age group (adult versus pediatric patients) was performed.

RESULTS

The search resulted in 43 cases of Meckel's diverticulum diagnosed with capsule endoscopy, reported in 33 publications. The majority of the patients were male, with a median age of 20 years, and had an average of three negative investigations performed prior to capsule endoscopy. The three most commonly used investigations were upper and lower endoscopy and Meckel's scan. The most frequent finding on capsule endoscopy was the double lumen sign.

CONCLUSION

The case reports indicate that capsule endoscopy can and has been used as a diagnostic tool for Meckel Diverticulum going back as far as 2002, with the most common finding being the double lumen sign. But it also highlights that patients too often go through multiple negative investigations before having a capsule endoscopy performed.

Skin Wound Healing Following Injecting Hyaluronic Acid Rejuvenating Complex, Polycaprolactone, or Combination Therapy: An Experimental Study

PURPOSE

This study aimed to investigate the effects of hyaluronic acid rejuvenating complex, polycaprolactone, and their combination on skin wound healing, assessing their potential to accelerate tissue regeneration and optimize healing outcomes.

MATERIALS AND METHODS

Forty eight Wistar Albino rats were randomly divided into four groups. Group 1 received hyaluronic acid rejuvenating complex injection, Group 2 received polycaprolactone injection, and Group 3 received a combination of both. Group 4 served as the control, undergoing incision without intervention. Skin biopsies were collected at baseline, day 7, and day 14 postincision. Wound healing was evaluated histologically using hematoxylin and eosin (H&E) and Masson's trichrome staining, focusing on epithelial thickness, collagen synthesis, and inflammatory cell infiltration.

RESULTS

The combination therapy group (Group 3) exhibited the most pronounced wound healing response, demonstrating significantly accelerated re-epithelialization, enhanced collagen deposition, and well-structured granulation tissue by days 7 and 14. Additionally, inflammatory cell infiltration was markedly reduced, indicating a faster transition from the inflammatory to the proliferative phase. Compared to single-agent treatments, the combined approach resulted in superior tissue remodeling and a more efficient healing process.

CONCLUSION

The dual administration of hyaluronic acid rejuvenating complex and polycaprolactone offers a synergistic effect, significantly enhancing skin wound healing compared to monotherapies. These findings highlight the potential of combination therapy as a promising strategy for improving wound repair and tissue regeneration in aesthetic and regenerative dermatology.

PLAP expression is linked to invasive tumor growth in urothelial carcinoma of the bladder

PURPOSE

Placental alkaline phosphatase (PLAP) is a protein with a poorly understood function that is normally only expressed in the placenta. In cancer, PLAP expression is a hallmark of germ cell neoplasms, but it can also occur in urothelial carcinoma. To evaluate the potential clinical significance of PLAP expression in bladder cancer, METHODS: PLAP protein was analyzed by immunohistochemistry in more than 2500 urothelial bladder carcinomas in a tissue microarray format.

RESULTS

PLAP staining was absent in normal urothelial cells but was observed in 15.9% of urothelial carcinomas, including 282 (11.5%) with weak, 57 (2.3%) with moderate, and 51 (2.1%) with strong staining. PLAP positivity occurred in 4.1% of 413 pTa G2 low-grade, 10.2% of 176 pTa G2 high-grade, and 7.2% of 97 pTa G3 tumors (p = 0.0636). As compared to pTa tumors, the PLAP positivity rate was markedly higher in 1341 pT2-4 carcinomas (19.8%, p < 0.0001). Within pT2-4 carcinomas, PLAP staining was unrelated to pT, pN, grade, L-status, V-status, overall survival, recurrence-free survival, and cancer-specific survival (p > 0.25). However, PLAP positivity was linked to p16 positivity (p = 0.0185), GATA3 positivity (p < 0.0001), and p63 expression loss (p = 0.0456).

CONCLUSION

In summary, these data show that PLAP is expressed in a significant fraction of pT2-4 urothelial carcinomas, unrelated to cancer aggressiveness but associated with specific molecular features. Once anti-PLAP cancer drugs become effective, urothelial carcinoma is a candidate tumor entity for clinical evaluation.

Effects of radiofrequency electromagnetic field exposure on cancer in laboratory animal studies, a systematic review

BACKGROUND

More than ten years ago, the World Health Organization's (WHO) International Agency for Research on Cancer (IARC) published a monograph concluding there was limited evidence in experimental animals for carcinogenicity of Radio Frequency Electromagnetic Field (RF EMF).

OBJECTIVE

The objective of this review was to systematically evaluate the effects of RF EMF exposure on cancer in experimental animals.

METHODS

Eligibility criteria: Based on pre-established Populations, Exposures, Comparators, Outcomes, and Study Type (PECOS) criteria, studies in experimental animals of the following study types were included: chronic cancer bioassays, initiation-(co-)promotion studies, and studies with tumor-prone animals.

INFORMATION SOURCES

MEDLINE (PubMed), Science Citation Index Expanded and Emerging Sources Citation Index (Web of Science), and the EMF Portal. Data abstraction and synthesis: Data are publicly available online as interactive visuals with downloadable metadata. We adapted the risk-of-bias (RoB) tool developed by Office of Health Assessment and Translation (OHAT) to include considerations pertinent to the evaluation of RF EMF exposure and cancer bioassays. Study sensitivity was assessed with a tool adopted from the Report on Carcinogens (RoC). We synthesized studies using a narrative approach. Effect size was calculated as the 1% Bayesian Average benchmark dose (BMD) of a respective study when dose-response or a trend was identified (see BMDAnalysisSupplementaryMaterial) (Supplement 1). Evidence Assessment: Certainty of the evidence (CoE) was assessed using the Grading of Recommendations, Assessment, Developing and Evaluations (GRADE) approach, as refined by OHAT. Evidence from chronic cancer bioassays was considered the most directly applicable to evaluation of carcinogenicity.

RESULTS

We included 52 studies with 20 chronic bioassays No studies were excluded based on risk of bias concerns. Studies were not considered suitable for meta-analysis due to heterogeneity in study design, species, strain, sex, exposure characteristics, and cancer outcome. No or minimal evidence of RF EMF exposure-related cancer outcomes was found in most systems or organs in any study (these included gastrointestinal/digestive, kidney, mammary gland, urinary, endocrine, musculoskeletal, reproductive, and auditory). For lymphoma (18 studies), with 6 chronic bioassays (1,120 mice, 1,780 rats) inconsistency between two chronic bioassays was not plausibly explainable, and the CoE for lymphoma was rated 'moderate'. For brain tumors (20 studies), including 5 chronic bioassays (1,902 mice, 6,011 rats), an increase in glial cell-derived neoplasms was reported in two chronic bioassays in male rats. The CoE for an increased risk in glioma was judged as high. The BMD analysis was statistically significant for only one study and the BMD was 4.25 (95% CI 2.70, 10.24). For neoplasms of the heart (4 chronic bioassays with 6 experiments), 3 studies were performed in rats (∼2,165 animals), and 1 in mice (∼720 animals). Based on 2 bioassays, statistically significant increases in malignant schwannomas was judged as high CoE for an increase in heart schwannomas in male rats. The BMDs from the two positive studies were 1.92 (95 %CI 0.71, 4.15) and 0.177 (95 %CI 0.125, 0.241), respectively. Twelve studies reported neoplasms in the adrenal gland (5 chronic bioassays). The CoE for an increased risk in pheochromocytoma was judged as moderate. None of these findings were dose-dependent when compared to the sham controls. Sixteen studies investigated tumors of the liver with 5 of these being chronic bioassays. The CoE was evaluated as moderate for hepatoblastomas. For neoplasms of the lung (3 chronic bioassays), 8 studies were conducted in rats (∼1,296 animals) and 23 studies in mice (∼2,800 animals). In one chronic bioassay, a statistically significant positive trend was reported for bronchoalveolar adenoma or carcinoma (combined), which was rated as moderate CoE for an increase in lung neoplasms with some evidence from 2 initiation-(co-)promotion studies.

DISCUSSION

Meta-analysis was considered inappropriate due to the heterogeneity in study methods. The GRADE/OHAT CoE framework has not been frequently applied to animal studies and experience to date suggests refinements are needed. We referred to standard methods in environmental health where CoE is framed in the context of strength of the evidence providing positive support for carcinogenicity. High CoE can be interpreted as the true effect is highly likely to be reflected in the apparent relationship. Moderate CoE indicates the true effect may be reflected in the apparent relationship. Cancer bioassays conducted in experimental animals are commonly used to identify potential human carcinogens. We note that the two tumor types with high CoE in animals in this systematic review are the same as those identified with limited evidence in humans by the IARC Working Group. However, even in cases where the animal evidence demonstrates high CoE, the extrapolation of risk from cancer bioassays to humans is particularly complex for RF EMF. Without a better understanding of the mechanism of the carcinogenicity of RF-EMF, the choice of exposure metric for risk extrapolation (whole body versus localized), intensity or cumulative exposure, whether or not a monotonic dose-response holds for carcinogenic effects, and whether SAR is the appropriate dose metric for adverse effects induced by RF-EMF, may be critical.

OTHER

This review was partially funded by the WHO radioprotection programme. The protocol for this review was registered in Prospero reg. no. CRD42021265563 and published in Environment International 2022 (Mevissen et al. 2022).

Incisional hernia incidence following laparoscopic versus open abdominal surgery: an updated systematic review and meta-analysis of randomized controlled trials

PURPOSE

Incisional hernias (IH) are a frequent complication following open surgery (OP). While laparoscopic (LAP) surgery is designed to enhance patient recovery through smaller incisions, contemporary quantitative evidence supporting its efficacy in reducing IH rates (IHR) is sparse. This study aims to provide an overview of IHR following OP and LAP abdominal operations.

METHODS

We searched for randomized controlled trials (RCTs) studies in PubMed, Cochrane, and Embase from inception until May 2024 comparing OP approach to LAP and reported IH incidence as a postoperative complication. Exclusion criteria included studies involving patients aged ≤ 18 years, those lacking a control group, or those with a follow-up period of less than 12 months. Studies were stratified by procedure type and by fully laparoscopic (T-LAP) versus laparoscopic-assisted (LAP-A) approaches. Statistical analyses were performed using RStudio software. To address potential clinical and methodological heterogeneity across studies, we applied the restricted maximum-likelihood estimator and random-effects models for outcome analysis.

RESULTS

8.754 studies were screened, and 72 studies were reviewed. From the initial screening, 28 studies involving 6,113 patients were included, of which 3,337 (54.6%) underwent LAP. Analysis revealed a significantly lower incidence of IH among patients who received LAP (RR 0.51; 95% CI 0.33-0.79). Subgroup analysis by surgery type indicated that bariatric (RR 0.20; 95% CI 0.068-0.578) and fundoplication procedures (RR 0.1; 95%CI 0.018-0.545) were associated with a substantial reduction in IHR. Moreover, totally-laparoscopic (T-LAP) procedures showed a significant reduction in IHR (RR 0.26;95%CI 0.14-0.5), while LAP-A procedures failed to show the same benefit.

CONCLUSION

LAP surgery is associated with reduced IHR in abdominal operations, with the benefit being particularly notable amongst LAP-A, bariatric, and fundoplication procedures. These findings underscore the advantages of LAP in specific surgical contexts, emphasizing its potential to minimize postoperative complications such as IH. Further research focusing on comparing IHR on open versus LAP approaches is warranted.

STUDY REGISTRATION

A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42024551280).

A cross-sectional study on peroneal muscle echogenicity changes and their effects on balance functions in individuals with chronic ankle instability

This study investigated the relationship between peroneal muscle echogenicity and balance function in individuals with chronic ankle instability (CAI). While prior research has examined peroneal muscle activity, reaction time, and balance, the impact of echogenicity-an indicator of myosteatosis/fibrosis-remained underexplored. Cross-sectional study. Sixty-two adults with CAI were included. Peroneal muscle size, echogenicity, and stiffness were assessed using ultrasound. Dynamic balance was evaluated via the Y balance test (YBT), and static postural control was evaluated during lateral step-down (LSDT) and single-leg stance test (SLST). Eversion strength was assessed with a dynamometer. The relationship between muscle characteristics and balance was assessed using canonical correlation and stepwise linear regression. Individuals with increased peroneal muscle echogenicity had reduced muscle size, poorer eversion strength, and poorer balance. Eversion strength is positively associated with YBT scores across all echogenicity levels and negatively associated with posture parameters during the LSDT in moderate echogenicity. Peroneal longus stiffness was positively associated with YBT in severe echogenicity and posture parameters during the SLST. Increased peroneal muscle echogenicity is associated with poorer eversion strength and stiffness, resulting in poorer balance performance. Improving the peroneal muscle quality may enhance functions in the CAI condition.

Fertility-Enhancing Potential of P. amygdalas and J. regia Oil Mixture in Wistar Rats: Male/Female Infertility Models Assessment

Polyunsaturated fatty acids-rich nuts are a group of natural sources that have served as a tonic in the treatment of many ailments for centuries. In this regard, P. amygdalas and J. regia nuts are traditionally used in infertility treatments. However, so far, the main mechanisms for the fertility-enhancing effects of these nuts in males/females are unknown. The present study was intended to evaluate the fertility-boosting effect of a mixture constituting P. amygdalas and J. regia oil on male/female infertility models and in two successive generations of rats; F 0 (parents) and F 1 (offspring). For the fertility assessment, male and female rats, 18 pairs (n = 36, 1:1, F 0 generation), were separated into three groups and dosed with 2 and 4 mL/kg daily of oil mixture and saline, respectively, from precohabitation up to lactation. To determine the further protective role of the oil mixture in infertility, we designed ethanol-induced male and estradiol-induced female infertility models. Various parameters like hormonal, hematological, lipid profile, and antioxidant markers [superoxide dismutase (SOD), glutathione peroxidase (GPx)] were measured along with histopathology of sex organs. The continual exposure of F 0 and F 1 generations to the oil mixture did not affect the fertility index and survival index in females. However, in males, all sperm parameters were significantly improved in both generations. We have found pronounced fertility outcomes with oil mixture supplementation in both genders of F 0 and F 1 generations. Results showed that the oil mixture significantly restored (p < 0.05) luteinizing hormone (LH), follicular stimulating hormone, GPx, plasma testosterone, and SOD activities in both models. Histological findings endorsed enhanced folliculogenesis and spermatogenesis with enhanced architecture. Our results strongly suggest that P. amygdalas and J. regia oil mixture might be a promising option in future for male/female sterility treatment. This finding could pave the way in infertile men and women for clinical trials. This is the first study that has provided an experimental rationale for a walnut and almond oil mixture combination as an effective candidate for fertility recovery by improving sex hormones and managing oxidative stress.

Evaluation of the Toxicity Profile and Central Nervous System Activities of Glue (Adhesive) Inhalation in Wistar Rats

Background: Glue inhalation is a common unconventional substance of abuse, and it contains neurotoxic and volatile solvents. We examined the toxicity profile and central nervous system (CNS) activities of glue inhalation in Wistar rats. Methods: Acute toxicity was investigated, and the subacute toxicity was studied using 24 male Wistar rats at graded concentrations of air, 2, 4 and 8 mL glue (n = 6/group) for 28 days. Blood samples were collected for biochemical and haematological evaluations, and vital organs (lung, liver, kidney, heart, brain and eye) were used for histological analysis. Behavioural studies were carried out using an elevated plus maze, hole board test, open-field test, tail suspension test and forced swim test. Dependence and abstinence effects were also evaluated. Results: The lethal dose (LD50) of the inhalational glue was 14.14 mL. Glue significantly increased liver function parameters such as TB, DB, ALP, ALT, TP and electrolyte levels (K+ and HCO3) but reduced cholesterol levels in exposed rats. Glue inhalation had significant anxiolytic and depressant effects on the rats at concentrations of 4 and 8 mL. Histological analysis revealed liver and lung tissue abnormalities and subconjunctival inflammation in eye tissue at 8 mL. Conclusion: The study therefore suggests that glue inhalation has anxiolytic and depressant effects in Wistar rats.

Thioredoxin-loaded nanocomposite wound dressing for the delivery of adipose derived stem cells for wound healing applications

In the current research, Thioredoxin was loaded into chitosan nanoparticles and then loaded into the matrix of collagen hydrogel containing adipose-derived stem cells (ASCs). In vitro studies including Scanning electron microscopy imaging, cell viability assay, cell migration assay, swelling assay, release assay, radical scavenging assay were performed in order to characterize the dressings. Then, the wound healing activity of these scaffolds were studied in a rat model of wound healing. Our findings indicate that the scaffolds markedly accelerated wound closure, enhanced epithelial regeneration, and increased collagen deposition. The wound closure values for the developed dressings were 60.507 ± 2.287% on Day 7 and 95.270 ± 2.600% on Day 14. ELISA results demonstrated an upregulation of VEGF, b-FGF, and TGF-β expression, while TNF-α and IL-6 levels were significantly reduced. For our developed dressings, VEGF levels were 661.307 ± 80.195 pg/mL, while bFGF was detected at 524.410 ± 81.040 pg/mL. The concentration of TGF-β was 315.357 ± 54.783 pg/mL, and TNF-α was measured at 176.093 ± 43.934 pg/mL. Additionally, IL-6 levels were found to be 187.577 ± 40.860 pg/mL. Our results suggest that our developed hydrogel system has improved wound healing via improving angiogenesis and modulating inflammation. These mechanisms can be attributed to the proangiogenic and immunomodulatory activities of ASCs and the antioxidative properties of Thioredoxin.

Post-marketing surveillance study on the effectiveness and safety of molnupiravir in high-risk COVID-19 outpatients: a prospective case series study

BACKGROUND

Molnupiravir, approved for treating mild to moderate COVID-19 in adults, aims to reduce hospitalisation and mortality rates. Although it was withdrawn from the market after the present study was conducted, understanding its long-term effects remains pertinent. We aimed to assess the real-world effectiveness and safety of molnupiravir in high-risk COVID-19 outpatients.

METHODS

This prospective, multicenter, noninterventional, postmarketing cohort study enrolled high-risk COVID-19 outpatients with mild to moderate COVID-19, eligible under national prescribing criteria, who initiated molnupiravir within five days of symptom onset and were ineligible for first-line antiviral therapy. Patients were consecutively enrolled from eight Portuguese study sites and monitored for three months. Effectiveness was assessed by all-cause mortality and hospitalisation through day 29. Safety was evaluated by the incidence, severity, and causality of adverse events (AE), coded using MedDRA terminology and assessed via the WHO-UMC system. Data were collected through structured patient questionnaires and electronic health records. Statistical analysis was descriptive; proportions were reported with 95% confidence intervals (CI), and comparisons between groups were performed using appropriate statistical tests.

RESULTS

By day 29 post-treatment initiation, no deaths were reported (n = 0; 0%; 95%CI = [0,26]), and all patients were either at home or institutionalised, with favourable outcomes. Out of the 12 patients enrolled, eight (67%; 95%CI = [35,90]) reported at least one AE, with the median time to the first AE being five days (range 5-7 days). Half of the patients (n = 6; 95%CI = [21,79]) reported AE deemed possibly or probably related to molnupiravir, involving nausea (25%), dizziness (17%), bitter taste (17%), and headache (17%). These AE were more commonly observed in older individuals and those overweight, indicating a potential influence of these factors on AE occurrence.

CONCLUSIONS

Molnupiravir appears to show good safety and effectiveness, offering an alternative for high-risk COVID-19 outpatients ineligible for first-line therapy. Despite its market withdrawal, ongoing research into its long-term effects is crucial to potentially repurpose it for other viral infections.

Assessing Heavy Metal Contamination in Food: Implications for Human Health and Environmental Safety

Ensuring food security is essential for achieving sustainable global development, requiring a balance between sufficient food production and maintaining its safety and nutritional value. However, this objective faces considerable challenges due to the infiltration of toxic metal species into the food supply. Heavy metals and metalloids, depending on their molecular form and daily dose, exhibit varying degrees of toxicity, making the precise identification of their species essential for assessing their impact on human health and the environment. This study focuses on identifying the primary anthropogenic sources and dissemination pathways of heavy metal pollutants, with an emphasis on their speciation and bioavailability. It examines how toxic metal species, such as Pb2+, Cd2+, Hg2+, and various arsenic species (AsIII and AsV), infiltrate ecosystems, bioaccumulate within the food chain, and ultimately compromise food safety and nutritional value. Furthermore, the research explores the physiological and biochemical disruptions caused by these toxic metal species, including the displacement of essential ions from enzymatic active sites and transport proteins due to competitive binding by pollutants, oxidative stress induced by reactive oxygen species generation, and cellular dysfunction affecting metabolic pathways and signaling cascades, all of which contribute to both chronic and acute health conditions. By providing a detailed analysis of exposure routes and toxicological processes, this paper highlights the far-reaching consequences of heavy metal contamination on public health and agricultural sustainability. Special attention is given to the need for precise terminology, as the toxicity of metals is inherently linked to their daily dose and chemical species rather than their elemental form. Finally, this study advocates for integrated, multidisciplinary strategies aimed at mitigating these risks, enhancing ecosystem stability, and ensuring long-term food security in the face of environmental challenges.

Safety of an Unconventional Vertical Transumbilical Incision for Pediatric Umbilical Hernia Repair

INTRODUCTION

Umbilical hernias are a common pediatric surgical problem, typically repaired at 4-5 y of age. Vertical transumbilical incision (VTUI) is a less common surgical approach associated with improved cosmetic outcomes. Our goal was to demonstrate the safety of this approach compared to the periumbilical incision (PUI).

METHODS

We retrospectively reviewed 402 pediatric patients who underwent an index open umbilical hernia repair for any indication at a single institution from 2013 to 2023. Patient demographics, operative outcomes, narcotic use, and complications were compared by incision type. Data were stratified by age and weight. Analysis was performed using student's t-test.

RESULTS

We analyzed 402 patients. Three hundred thirty-seven (83.8%) had PUI and 65 (16.2%) had VTUI. Mean (standard deviation) age was 5 (3.18) y, ranging 0-18 y. Females represented 55%. There was no difference in age based on incision type. PUI and VTUI room time (79.2 v 83.3 min, P = 0.10) and anesthetic time (37.8 v 33.2, P = 0.31) were not significantly different. Mean intraoperative morphine milliequivalents per kilogram (MME/kg) were not different between incision types (P = 0.99). Average postanesthesia care unit MME/kg showed no difference between PUI and VTUI (3.7 v. 7.6, P = 0.06). There were 6 (1.5%) complications with no difference based on incision: 4 recurrences (3 PUI, 1 VTUI), 1 hospital readmission (PUI), and 1 patient with uncontrolled pain requiring admission (PUI). Stratified by weight, there were no significant differences in complication rates based on incision type.

CONCLUSIONS

Our findings support VTUI as a safe alternative in the pediatric population without an increase in postoperative complications, anesthetic time, or MME/kg utilization.

Immunoexpressions of PD-L1 and EZH2 in Endometrial Carcinoma: Associations with Clinicopathological Parameters

Background: This study investigated PD-L1 and EZH2 immunoexpressions in endometrial carcinomas (ECs) and correlated their associations with clinicopathological parameters and five-year survival outcomes. Methods: A cross-sectional, retrospective study was conducted on all ECs diagnosed between January 2014 and December 2018. Immunohistochemical staining for PD-L1 (clone 22C3) and EZH2 was performed on tumour samples, and their expression levels were assessed. Results: Among the 104 EC cases included, 19.2% (n = 20) overexpressed PD-L1, while 8.7% (n = 9) overexpressed EZH2. Most (n = 19/20, 95.0%) PD-L1-expressing tumour cells showed EZH2 immunonegativity. Likewise, most (n = 8/9, 88.9%) EZH2-expressing ECs were PD-L1-negative. Increased PD-L1 and EZH2 expressions in ECs were seen more frequently in women more than 60 years of age (p = 0.013 and p = 0.039). EZH2 overexpression was associated with higher tumour grade (p = 0.009) and more aggressive histological subtypes (p = 0.013), while PD-L1 expression was not significantly associated with tumour grade, tumour stage, histological subtypes, and lymph node status (p > 0.05). Kaplan-Meier survival analysis revealed that PD-L1-positive ECs had a significantly better five-year overall survival (OS) rate compared to PD-L1-negative ECs (p = 0.034). Conversely, EZH2 overexpression did not correlate with survival outcomes (p > 0.05). Notably, the combination of PD-L1 and EZH2 expression patterns on ECs (PD-L1-/EZH2+) portends the worst OS compared to other combined PD-L1/EZH2 expression patterns (p = 0.05). Conclusions: PD-L1 immunoexpression was associated with better survival outcomes in ECs, while overexpression of EZH2 was associated with higher tumour grade and aggressive histological subtypes, suggesting their potential utility as prognostic biomarkers in ECs.

The Importance of Cancer Stem Cells and Their Pathways in Endometrial Cancer: A Narrative Review

Endometrial cancer is one of the most common malignancies seen in women in developed countries. While patients in the early stages of this cancer show better responses to surgery, adjuvant hormonal therapy, and chemotherapy, patients with recurrence show treatment resistance. Researchers have recently focused on cancer stem cells (CSCs) in the treatment of gynecologic cancer in general but also specifically in endometrial cancer. CSCs have been investigated because of their resistance to conventional therapies, such as chemo- and radiotherapy, and their ability to induce the progression and recurrence of malignancy. The activation of alternative pathways, such as WNT, PI3K, NF-kB, or NOTCH, could be the basis of the acquisition of these abilities of CSCs. Their specific markers and signaling pathways could be treatment targets for CSCs. In this article, we discuss the importance of obtaining a better understanding of the molecular basis and pathways of CSCs in endometrial cancer and the role of CSCs, aiming to discover more specific therapeutic approaches.