MiRNA affects the advancement of breast cancer by modulating the immune system's response

Breast cancer (BC), which is the most common tumor in women, has greatly endangered women's lives and health. Currently, patients with BC receive comprehensive treatments, including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted therapy. According to the latest research, the development of BC is closely related to the inflammatory immune response, and the immunogenicity of BC has steadily been recognized. As such, immunotherapy is one of the promising and anticipated forms of treatment for BC. The potential values of miRNA in the diagnosis and prognosis of BC have been established, and aberrant expression of associated miRNA can either facilitate or inhibit progression of BC. In the tumor immune microenvironment (TME), miRNAs are considered to be an essential molecular mechanism by which tumor cells interact with immunocytes and immunologic factors. Aberrant expression of miRNAs results in reprogramming of tumor cells actively, which may suppress the generation and activation of immunocytes and immunologic factors, avoid tumor cells apoptosis, and ultimately result in uncontrolled proliferation and deterioration. Therefore, through activating and regulating the immunocytes related to tumors and associated immunologic factors, miRNA can contribute to the advancement of BC. In this review, we assessed the function of miRNA and associated immune system components in regulating the advancement of BC, as well as the potential and viability of using miRNA in immunotherapy for BC.

Combating Breast Cancer-associated Metastasis using Paclitaxel and Tranilast-loaded Human Serum Albumin Nanoparticles

OBJECTIVE

The objective of the current study is to combat breast cancer-associated metastasis using paclitaxel (PTX) and tranilast (TRA)-loaded human serum albumin (HAS) Nanoparticles.

SIGNIFICANCE

This combinatorial therapy using microtubule stabilizing agent PTX, along with TGFβ inhibitor TRA.TRA may offer an improved therapeutic effect in breast cancer by inhibiting cell proliferation and metastasis.

METHOD

Inspired by the remarkable anticancer properties of both drugs, they were encapsulated into HSA nanoparticles to enhance tumor site-specific drug accumulation and ensure sustained release over a prolonged period. The HSA nanoparticles were fabricated using the desolvation method and optimized using a Box-Behnken design (BBD) with a three-level, two-factor approach. Further, these nanoparticles were characterized using TEM, FTIR, XRD, and particle size. In vitro experiments were conducted using the MDA-MB-231 cell line, employing cell viability, cellular uptake, nuclear staining, scratch assay, and cell cycle analysis.

KEY FINDINGS

In vitro release kinetics reveal sustained PTX and TRA release from HSA nanoparticles. Wound healing assay depicted improved anti-migratory activity of PTX-TRA-NPs (30nM-75μM). Furthermore, the novel combination treatment caused G2/M phase cell cycle arrest, as indicated by cell cycle analysis.

CONCLUSION

HSA nanoparticles enhance the delivery and accumulation of hydrophobic drugs (PTX and TRA) in breast cancer cells, offering improved therapeutic outcomes. This combinatorial strategy permits further preclinical investigation for synergistic breast cancer management.

An overview of the relationship between melatonin and drug resistance in cancers

The most common methods of treating cancer are surgery, chemotherapy, and radiotherapy. However, given that some cancers are not operable, the best method is chemotherapy and radiotherapy. Over time, people become resistant to chemotherapy drugs, and increasing the dose of the drug leads to damage to normal cells. In this article, various sources such as Google Scholar, PubMed, and Semantic Scholar were used, and articles between 1997 and 2025 that were relevant to our topic were selected. Various factors are involved in drug resistance. Melatonin is a hormone that has various roles in the body. One of its most important functions is regulating the circadian rhythm of sleep and its anti-inflammatory and antioxidant properties. According to studies, melatonin plays a role in the treatment of some diseases and cancers. The roles of melatonin in cancer treatment include anti-apoptotic, anti-angiogenic, and anti-migratory effects, as well as drug resistance and cell cycle regulation. As mentioned, one of the main reasons for the failure of cancer treatment is drug resistance, and the role of melatonin in drug resistance in cancers has been proven. Therefore, in this study, our goal is to investigate the mechanisms through which melatonin plays a role in drug resistance in different types of cancer.

Translational strategies for oral delivery of faecal microbiota transplantation

Faecal microbiota transplantation (FMT) has emerged as a transformative therapy for Clostridioides difficile infections and shows promise for various GI and systemic diseases. However, the poor patient acceptability and accessibility of 'conventional' FMT, typically administered via colonoscopies or enemas, hinders its widespread clinical adoption, particularly for chronic conditions. Oral administration of FMT (OralFMT) overcomes these limitations, yet faces distinct challenges, including a significant capsule burden, palatability concerns and poor microbial viability during gastric transit. This review provides a comprehensive analysis of emerging strategies that aim to advance OralFMT by: (1) refining processing technologies (eg, lyophilisation) that enable manufacturing of low-volume FMT formulations for reducing capsule burden and (2) developing delivery technologies that improve organoleptic acceptability and safeguard the microbiota for targeted colonic release. These advancements present opportunities for OralFMT to expand its therapeutic scope, beyond C. difficile infections, towards chronic GI conditions requiring frequent dosing regimens. While this review primarily focuses on optimising OralFMT delivery, it is important to contextualise these advancements within the broader shift towards defined microbial consortia. Live biotherapeutic products (LBPs) offer an alternative approach, yet the interplay between OralFMT and LBPs in clinical practice remains unresolved. We postulate that continued innovation in OralFMT and LBPs via a multidisciplinary approach can further increase therapeutic efficacy and scalability by enabling disease site targeting, co-delivery of therapeutic compounds and overcoming colonisation resistance. Realising these goals positions OralFMT as a cornerstone of personalised care across a range of diseases rooted in microbiome health.

Incidence of benign prostatic hyperplasia in testicular cancer survivors in the Veteran's affairs health system

INTRODUCTION

Testosterone and prostatic inflammation have been postulated to influence the development of benign prostatic hyperplasia (BPH). Our study aims to evaluate the incidence of BPH in Testicular Cancer (TCa) survivors, focusing on its association with chemotherapy and post TCa diagnosed hypogonadism.

METHODS

We conducted a retrospective cohort analysis of US veterans diagnosed with TCa between 1990 and 2021, using the Veterans affairs database. BPH was defined using International Classification of Diseases (ICD) codes, Current Procedural Terminology (CPT) codes, or a 6-month prescription of medications. Associations with BPH were analysed, stratifying the cohort by receipt of chemotherapy and presence of hypogonadism. Multivariable cox regression models were used to determine statistical significance (p-value < 0.05).

RESULTS

Our cohort included 2038 TCa survivors with a median age at diagnosis of 41 years. On multivariable cox regression analysis, receipt of chemotherapy was not significantly associated with incidence of BPH (p-value = 0.13). When stratified by diagnosis of hypogonadism prior to BPH, no significant associations were found on univariable (p = 0.9) as well as multivariable (p = 0.63) analyses. In the multivariable model, age at diagnosis was significantly associated with an increased incidence of BPH (Hazard ratio: 1.06, p < 0.001).

CONCLUSION

Our findings demonstrate that age is a significant factor associated with development of BPH in this population, while suggesting that chemotherapy for TCa and hypogonadism might not substantially alter the development of BPH.

Prevalence and predictors of percutaneous injuries among health workers in Ghana: a cross-sectional study

Background

Percutaneous injuries (PI) persist as a prevalent healthcare issue, affecting over a third of healthcare workers worldwide on an annual basis. Globally, a few studies have documented the relationship between PI and factors like work pressure and shift systems. Additionally, limited evidence exists on how these factors contribute to this issue specifically in Ghana.

Objective

The study examined exposure to PI and its predictors among health workers in Ghana.

Methods

An analytic cross-sectional study involving multiple health facilities in the Greater Accra region was conducted between January 30 and May 31, 2023. A survey was carried out among 602 healthcare workers across 10 public and private hospitals. Study participants were selected using simple random sampling. Analysis was performed using Stata 15 software, and factors associated with PI were identified using log-binomial regression analysis, with a significance level set at p < 0.05.

Results

The prevalence of PI was 26.9% (95% CI: 23.4-30.6%). More work experience [APR = 0.97 (0.94, 0.99)], being on a mix of day, evening and night shifts [APR = 1.69 (1.26, 2.27)], frequent experience of work pressure [APR = 1.32 (1.00, 1.75)], frequent [APR = 0.59 (0.40, 0.88)], and constant [APR = 0.55 (0.40, 0.7)] adherence to standard precautions were factors significantly associated with PI.

Conclusion

Shift schedules and work pressure contributed to the substantial rate of PI among healthcare workers in Ghana. It is imperative for health authorities to establish and enforce safety policies prioritizing pressure reduction and fostering a safety-oriented culture across all shifts.

Doxorubicin delivery of green-synthesized gold nanoparticles to MDA-MB-231 cells and collagen type II identification from yellow nose skate cartilage

Upcycling and green synthesis strategies have been applied for the synthesis of gold nanoparticles (AuNPs) using yellow nose skate (Dipturus chilensis) cartilage extract as a reducing and stabilizing agent (skAu). Doxorubin (DOX) was loaded onto the skAu, and the average size of the DOX-loaded AuNPs (c-skAuD) was measured to be 14.6 ± 0.5 nm by high-resolution transmission electron microscopy. Reaction parameters such as reaction time and DOX concentration were optimized for preparing c-skAuD. DOX was successfully loaded, as confirmed by the FT-IR results. In addition, FT-IR characterization revealed that chondroitin sulfate and collagen in the extract were involved in the synthesis of skAu. Although c-skAuD is cytotoxic to four different types of cancer cells (AGS, HeLa, A549 and MDA-MB-231), their cytotoxic effects were greatest on MDA-MB-231 cells. Analyzing cytotoxicity onto MDA-MB-231 cells revealed that c-skAuD had the greatest cytotoxicity, followed by a positive control (c-citAuD) and DOX. Furthermore, this cytotoxicity was dependent on the incubation time and DOX concentration. Cellular uptake of Au by inductively coupled plasma‒mass spectrometry demonstrated that compared with AGS cells (15.1%), MDA-MB-231 cells showed approximately two-fold greater Au uptake (29.9%) of c-skAuD. However, the Au uptake of the positive control (c-citAuD) did not significantly differ between the MDA-MB-231 and AGS cells. Moreover, collagen type II was identified in the extract by peptide analysis using LC‒ESI‒MS/MS. To the best of our knowledge, we are the first to report collagen type II in D. chilensis cartilage.

The role of CRISPR-Cas9 and CRISPR interference technologies in the treatment of autoimmune diseases

Autoimmune disorders can be described as inappropriate immune responses directed against self-antigens, which account for substantial healthcare concerns around the world. Immunosuppression or immune modulation are the main therapeutic modalities for autoimmune disorders. These modalities, however, impair the ability of the immune system to fight against infections, thereby predisposing to opportunistic diseases. This review explores existing therapies for autoimmune disorders, highlighting their limitations and challenges. Additionally, it describes the potential of CRISPR-Cas9 technology as a novel therapeutic approach to address these challenges.

Emerging Roles of Plant-Derived Extracellular Vesicles in Biotherapeutics: Advances, Applications, and Future Perspectives

Extracellular vesicles (EVs) are nanoscale luminal vesicles, which play an important role in intercellular communication through surface signaling and molecular cargo delivery (proteins, lipids, nucleic acids, etc.). Recently, plant-derived extracellular vesicles (PDVs) containing multiple biological activities have received increasing attention due to their better biocompatibility and lower cytotoxicity in healthy tissues. In the biomedical field, PDVs are employed as cargo delivery vehicles, enabling diverse functionalities through engineering modification techniques. Nonetheless, there are certain issues with the study of PDVs, such as the lack of standardization in the identification and isolation criteria. This review provides a quick overview of the biogenesis, physicochemical properties, isolation techniques, and biomedical applications of PDVs in current studies, while critically analyzing the current challenges and opportunities. This paper is expected to provide some theoretical guidance for the development of PDVs and further biomedical applications.

Mechanistic insights into chemotherapy-induced circadian disruption using rodent models

Chemotherapy treatment can significantly increase the survival of patients with cancer, but it also causes collateral damage in the body that can lead to treatment dose reductions and can reduce patient quality of life. One understudied side effect of chemotherapy is circadian disruption, which is associated with lasting biological and behavioral toxicities. Mechanisms of how chemotherapy alters circadian rhythms remain largely unknown, although leveraging rodent models may provide insights into causes and consequences of this disruption. Here, we review physiological, molecular, and behavioral evidence of central and peripheral circadian disruption in various rodent models of chemotherapy and discuss possible mechanisms driving these circadian disruptions. Overall, restoring circadian rhythms following treatment-induced disruptions may be a novel target by which to improve the health and quality of life of survivors.

Updated efficacy and safety of HLX02 versus reference trastuzumab in metastatic HER2-positive breast cancer: A randomized phase III equivalence trial

AIM

Equivalence between HLX02 and trastuzumab sourced from the European Union (EU-trastuzumab), in combination with docetaxel, was demonstrated in a phase III study. This study aimed to evaluate the long-term efficacy and safety data after 3 years of follow-up.

METHODS

Patients with previously untreated, HER2-positive metastatic breast cancer received intravenous HLX02 or EU-trastuzumab (initial dose of 8 mg/kg, followed by 6 mg/kg every 3 weeks for up to 12 months) in combination with docetaxel. Primary endpoint was the overall response rate up to week 24 (ORR24). Secondary endpoints including updated overall survival (OS), progression-free survival (PFS), safety and immunogenicity are reported in this long-term follow-up analysis.

RESULTS

After a median follow-up duration of 35.0 months, 270 out of the 649 enrolled patients had died; 128 (39.5 %) in the HLX02 and 142 (43.7 %) in the EU-trastuzumab group. Median OS was 37.3 (95 % CI 36.2, not evaluable [NE]) months and not reached (95 % CI 34.2, NE) (stratified HR 0.86 [95 % CI 0.68, 1.10]; p = 0.229), with a 3-year OS rate of 57.5 % and 54.0 %, respectively. Median PFS at this long-term follow-up assessment was 11.7 (95 % CI 11.5, 12.1) months for the HLX02 group and 10.6 (95 % CI 9.5, 11.7) months for the EU-trastuzumab group (stratified HR 0.86 [95 % CI 0.69, 1.06]; p = 0.158). No new safety concerns were reported until the end of the survival follow-up.

CONCLUSION

Long-term efficacy and safety were consistent with the previous findings. No clinically meaningful differences between HLX02 and reference trastuzumab were demonstrated.

CLINICAL TRIAL REGISTRATION

Chinadrugtrials.org CTR20160526 (September 12, 2016), ClinicalTrials.gov NCT03084237 (March 20, 2017), EudraCT 2016-000206-10 (April 27, 2017).

Advances and applications of gut organoids: modeling intestinal diseases and therapeutic development

Gut organoids are 3D cellular structures derived from adult or pluripotent stem cells, capable of closely replicating the physiological properties of the gut. These organoids serve as powerful tools for studying gut development and modeling the pathogenesis of intestinal diseases. This review provides an in-depth exploration of technological advancements and applications of gut organoids, with a focus on their construction methods. Additionally, the potential applications of gut organoids in disease modeling, microenvironmental simulation, and personalized medicine are summarized. This review aims to offer perspectives and directions for understanding the mechanisms of intestinal health and disease as well as for developing innovative therapeutic strategies.

Agarwood Chromone Alleviates Gastric Ulcers by Inhibiting the NF-κB and Caspase Pathways Based on Network Pharmacology and Molecular Docking

Background: Agarwood has been widely used for the treatment of gastrointestinal diseases. Our research group has suggested that agarwood alcohol extracts (AAEs) provide good gastric mucosal protection. However, the exact mechanisms underlying this effect remain unclear. Objectives: This study aimed to investigate the ameliorative effect of agarwood chromone on gastric ulcers and its mechanism. Methods: Network pharmacology was used to predict the disease spectrum and key therapeutic targets of 2-(2-phenylethyl)chromone (CHR1) and 2-(2-(4-methoxyphenyI)ethyl)chromone (CHR2). Mice were orally administered CHR1 (20 and 40 mg/kg) and CHR2 (20 and 40 mg/kg) and the positive drug omeprazole as an enteric-coated capsule (OEC, 40 mg/kg) orally. After 7 days of pretreatment with the CHRs, gastric ulcers were induced using absolute ethanol (0.15 mL/10 g). The ulcer index, gastric histopathology, biochemical parameters, and inflammatory and apoptotic proteins were evaluated. Finally, binding of the core compounds to the key targets was verified via molecular docking and visualized. Results: The pharmacological results show that the CHRs reduced the gastric occurrence and ulcer inhibition rates by up to more than 70% in a dose-dependent manner. The CHRs decreased the levels of interleukin 6 (IL-6), interleukin 12 (IL-12), interleukin 18 (IL-18), and tumor necrosis factor α (TNF-α), and improved the severity of the pathological lesions in the gastric tissue. The expression of ATP-binding box transporter B1 (ABCB1), arachidonic acid-5-lipoxygenase (ALOX5), nuclear factor kappa B (NF-κB), cysteinyl aspartate specific proteinase 3 3 (Caspase3), and cysteinyl aspartate specific proteinase 9 (Caspase9) was inhibited, but the expression of B-cell lymphoma-2 (Bcl-2) was enhanced. The CHRs bound stably to the key targets via hydrogen bonding, van der Waals forces, etc. These results demonstrate that agarwood chromone compounds exert alleviative effects against the occurrence and development of gastric ulcers by inhibiting the NF-κB and caspase pathways. The CHRs have a therapeutic effect on gastric ulcers through anti-inflammation and anti-apoptosis mechanisms. Conclusions: This study suggests that agarwood may have a potential role in drug development and the prevention and treatment of gastrointestinal inflammation, and tumors.

Efficacy of water infusion combined with defoamers in colonoscopy

BACKGROUND

Currently, colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during colonoscopy.

AIM

To analyze the efficacy of water infusion combined with defoamers in colonoscopy.

METHODS

This study included 97 patients undergoing colonoscopy from January 2024 to June 2024. The participants were categorized into two groups, namely, the control group (n = 47), who underwent conventional colonoscopy, and the experimental group (n = 50), who received colonoscopy using water injection combined with defoamers. A comparative analysis was then conducted on the disease detection rate (colonic polyps, colonorrhagia, colonic ulcers, colonic mucosal lesions, and others), colonoscopy duration, abdominal pain [visual analog scale (VAS)], Boston bowel preparation scale (BBPS), self-rating anxiety scale (SAS), bowel preparation comfort, complications (intestinal perforation, bleeding, nausea and vomiting, abdominal pain, and abdominal distension), and patient satisfaction.

RESULTS

The experimental group demonstrated a significantly higher total disease detection rate, BBPS scores, and patient satisfaction compared with the control group. Further, the research group exhibited shorter colonoscopy duration, lower VAS and SAS scores and total complication rate, and better patient comfort and satisfaction.

CONCLUSION

These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy, mainly reflected in higher disease detection rate, faster examination efficiency, lower abdominal pain, anxiety, and complication incidences, and significantly better bowel preparation, comfort, and patient satisfaction.

The role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as venous thromboembolism predictors in breast cancer patients pre- and post-therapy

OBJECTIVES

Breast cancer (BC) accounts for 12.3% of all cancer-associated venous thromboembolism (VTE). Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are recognized inflammatory biomarkers but have not been incorporated into thrombosis risk stratification models. We evaluated NLR and PLR as predictive biomarkers for VTE in BC patients to determine their optimal predictive cutoffs and net predictive value before and after treatment.

METHODS

We conducted a prospective pilot study that involved 56 women with BC, recruited prior to treatment (chemotherapy and immunotherapy) initiation with at least 6-month monitoring for VTE. NLR and PLR were assessed pre and posttreatment.

RESULTS

Five patients (8.9%) developed VTE. NLR and PLR increased significantly posttreatment (P = 0.001). Post, not pretreatment, NLR (P = 0.029) and PLR (P = 0.033) were significantly associated with VTE occurrence. Receiver Operating curve analysis indicated enhanced predictive capacity for VTE postimmunotherapy. Optimal posttreatment cutoffs were 3.6 for NLR and 280 for PLR, aligning with existing literature, with slightly elevated NLR.

CONCLUSIONS

Posttreatment NLR and PLR have higher predictability for VTE in patients receiving immunotherapy compared to chemotherapy. NLR outperforms PLR, particularly postimmunotherapy. This data holds promise for thrombosis risk stratification in the context of immunotherapy but requires evaluation in larger studies.

Enhanced LRP8 expression induced by Helicobacter pylori drives gastric cancer progression by facilitating β-Catenin nuclear translocation

INTRODUCTION

Helicobacter pylori (H. pylori) infection has been associated with gastric carcinogenesis. However, the precise involvement of LRP8, the low-density lipoprotein receptor-related protein 8, in H. pylori pathogenesis and gastric cancer (GC) remains poorly understood.

OBJECTIVES

To investigate the potential role of LRP8 in H. pylori infection and gastric carcinogenesis.

METHODS

Three-dimensional human-derived gastric organoids (hGO) and gastric cancer organoids (hGCO) were synthesized from the tissues obtained from human donors. In this work, multi-omics combined with in vivo and in vitro studies were conducted to investigate the potential involvement of LRP8 in H. pylori-induced GC.

RESULTS

We found that H. pylori infection significantly upregulated the expression of LRP8 in human GC tissues, cells, organoids, and mouse gastric mucous. In particular, LRP8 exhibited a distinct enrichment in cancer stem cells (CSC). Functionally, silencing of LRP8 affected the formation and proliferation of tumor spheroids, while increased expression of LRP8 was associated with increased proliferation and stemness of GC cells and organoids. Mechanistically, LRP8 promotes the binding of E-cadherin to β-catenin, thereby promoting nuclear translocation and transcriptional activity of β-catenin. Furthermore, LRP8 interacts with the cytotoxin-associated gene A (CagA) to form the CagA/LRP8/β-catenin complex. This complex further amplifies H. pylori-induced β-catenin nuclear translocation, leading to increased transcription of inflammatory factors and CSC markers. Clinical analysis demonstrated that abnormal overexpression of LRP8 is correlated with a poor prognosis and resistance to 5-Fluorouracil in patients with GC.

CONCLUSION

Our findings provide valuable information on the molecular intricacies of H. pylori-induced gastric carcinogenesis, offering potential therapeutic targets and prognostic markers for GC.

AND-gated protease-activated nanosensors for programmable detection of anti-tumour immunity

The forward design of biosensors that implement Boolean logic to improve detection precision primarily relies on programming genetic components to control transcriptional responses. However, cell- and gene-free nanomaterials programmed with logical functions may present lower barriers for clinical translation. Here we report the design of activity-based nanosensors that implement AND-gate logic without genetic parts via bi-labile cyclic peptides. These actuate by releasing a reporter if and only if cleaved by a specific pair of proteases. AND-gated nanosensors that detect the concomitant activity of the granzyme B protease secreted by CD8 T cells and matrix metalloproteinases overexpressed by cancer cells identify the unique condition of cytotoxic T cell killing of tumour cells. In preclinical mouse models, AND-gated nanosensors discriminate tumours that are responsive to immune checkpoint blockade therapy from B2m-/- tumours that are resistant to it, minimize signals from tissues without co-localized protease expression including the lungs during acute influenza infection, and release a reporter locally in tissue or distally in the urine for facile detection.

Academic Detailing to Enhance Adoption of Clinical Decision Support for Patients at Risk of Opioid Overdose

BACKGROUND

 Not all patients at risk for opioid overdose are prescribed naloxone when discharged from the emergency department or hospital. Clinical decision support (CDS) can be used to promote clinical best practices, such as naloxone prescribing; however, it may be ignored due to knowledge deficiencies or alert fatigue.

OBJECTIVES

 Assess the effect of academic detailing on responses to a CDS alert recommending a naloxone prescription for patients at risk of opioid overdose.

METHODS

 A pre/postquality improvement study of 2,161 active providers at a 400-bed academic medical center. The first intervention was an educational email to all providers. The second intervention was individual emails to 150 providers who infrequently ordered naloxone in response to the alert. The main outcome measure was prescription-to-alert ratios, defined as the number of naloxone prescriptions signed in response to the alert divided by the number of times the alert fired.

RESULTS

 The first academic detailing intervention resulted in a prescription-to-alert ratio increase from 32.6 to 51.7%, a 19.1% absolute increase when comparing the approximately 8 months before and after the email was sent (95% confidence interval [CI]: 16.3-21.9%, p < 0.001). The second intervention resulted in an increased prescription-to-alert ratio from 9.3 to 50.6%, an absolute increase of 41.3% when comparing the nearly 8 months before and after the emails were sent (95% CI: 36.9-45.7%, p < 0.001). Improvements were seen across all services and all provider roles, particularly for advanced practice providers, and were sustained for 8 months.

CONCLUSION

 Academic detailing can be used to augment responses to CDS for patients with opioid dependence. Further study is needed to see if this effect can be replicated with CDS for other high priority conditions, and whether academic detailing with one alert might improve responses to other alerts as well, potentially decreasing alert fatigue.

Low-Power Blue LED Modulates NF-κB and Proinflammatory Cytokines in Doxorubicin-Treated MDA-MB-231 Cells

Doxorubicin is a crucial chemotherapy used in the treatment of triple-negative breast cancer (TNBC) patients, but elevated doxorubicin doses may induce therapeutic resistance. To overcome this limitation, we have previously established a photodynamic therapeutic (PDT)-like strategy that irradiates doxorubicin-treated cells with a low-power nonionizing blue LED device. This combined treatment increases the production of reactive oxygen species to promote cell death, consequently enabling reduced doxorubicin dosages. Yet, precisely determining the molecular mechanisms that drive this outcome is still required for advancing such PDT-like approach. Here, we aimed to correlate the expression of the inflammatory markers NF-κB, IL-8, IL-6, and IL-1β with the survival of TNBC cells submitted to our PDT-like protocol. Our results show that NF-κB/p65 nuclear levels were enhanced in MDA-MB-231 cells treated with doxorubicin and blue LED. Moreover, this PDT-like strategy increased IL-6 mRNA levels in MDA-MB-231 cells. IL-1β and IL-8 mRNA were upregulated in samples incubated with doxorubicin regardless of concomitant irradiation with blue LED. These results show that our PDT-like protocol is effective in elevating inflammatory signals, shedding light on the molecular mechanisms that underlie the efficacy of this innovative anticancer therapeutic approach.

Psychobiotics Ameliorate Depression and Anxiety Status in Surgical Oncology Patients: Results from the ProDeCa Study

Background: Psychological disorders are prevalent in patients having undergone gastrointestinal cancer surgery, and their emotional status may further deteriorate during subsequent chemotherapy. Psychobiotics are specific probiotics that have the unique characteristics of producing neuroactive substances that are thought to act on the brain-gut axis. The aim of the present study was to evaluate the benefits of a psychobiotic formula on depression and anxiety status, as well as on perceived stress, versus a placebo in patients on a chemotherapy course following gastrointestinal surgery for cancer. Patients: The enrolled patients, allocated to the psychobiotic and placebo groups, were assessed by means of these psychometric tests: Beck's Depression Inventory and the Hamilton Depression Rating 17-item Scale for depression; the General Anxiety Disorder-7 for anxiety; and the Perceived Stress Scale-14 Item for perceived stress at three time-points: upon allocation [T1], after one month of treatment [T2], and two months thereafter [T3]. Results: In total, 266 patients were included. One month of psychobiotic treatment improved [i] depression status by 60.4% [48 depressed patients at T1, reduced to 16 at T3]; [ii] anxiety by 57.0% [72 patients at T1, 26 at T3]; and [iii] stress by 60.4% [42 at T1, 14 at T3]. The placebo-treated patients experienced a deterioration in all parameters studied, i.e., depression increased by 62.9%, anxiety by 39.7%, and stress by 142.5%. Conclusions: Based on these findings, it can be recognized that psychobiotic treatment has great potential for every patient at risk of suffering from depression, anxiety, or stress during the course of surgery/chemotherapy for gastrointestinal cancer.

Oxidative Balance Score Calculated Using Different Methods and Its Associations with Colorectal Cancer Risk

BACKGROUND

The oxidative balance score (OBS) measures oxidative stress from diet and lifestyle, but research linking it to colorectal cancer (CRC) risk is scarce and varies in calculation methods.

METHODS

We conducted a case-control study in Guangzhou, China, involving 2799 CRC cases and an equal number of sex- and age-matched controls. We adopted and compared four different methods for calculating the OBSs. The odds ratio (OR) and 95% confidence interval (95%CI) for the relationship between OBS and CRC risk were determined using an unconditional logistic regression model. Restricted cubic splines were used to explore potential non-linear relationships. Additionally, stratified analyses were performed by sex, and subgroup analyses were performed based on the tumor site.

RESULTS

Among the four OBSs assessed, OBS-1 demonstrated superior performance. Higher adherence to four OBSs was associated with a lower risk of CRC. The adjusted ORs (95%CIs) for the highest quartile compared to the lowest quartile were as follows: 0.42 (0.35, 0.50) for OBS-1, 0.43 (0.36, 0.51) for OBS-2, 0.50 (0.42, 0.59) for OBS-3, and 0.43 (0.36, 0.51) for OBS-4. Linear relationships were observed between four OBSs and CRC risk (all p-Nonlinear > 0.05). Stratified analysis by sex revealed that all four OBSs were negatively associated with CRC risk in both male and female patients. Subgroup analysis by cancer site indicated that four OBSs were negatively associated with the risk of both colon and rectal cancer.

CONCLUSIONS

All four OBSs were negatively associated with CRC risk, with OBS-1 showing the strongest association in our analysis.

Genome-wide transcriptome analysis and drug target discovery reveal key genes and pathways in thyroid cancer metastasis

Introduction

Metastasis is the major cause of thyroid cancer morbidity and mortality. However, the mechanisms are still poorly understood.

Methods

We performed genome-wide transcriptome analysis comparing gene expression profile of metastatic thyroid cancer cells (Met) with primary tumor cells established from transgenic mouse models of papillary thyroid cancer (PTC), follicular thyroid cancer (FTC), poorly differentiated thyroid cancer (PDTC), and anaplastic thyroid cancer (ATC).

Results

Genes involved in tumor microenvironment (TME), inflammation, and immune escape were significantly overexpressed in Met cells. Notably, IL-6-mediated inflammatory and PD-L1 pathways were highly active in Met cells with increased secretion of pro-inflammatory and pro-metastatic cytokines such as CCL2, CCL11, IL5, IL6, and CXCL5. Furthermore, Met cells showed robust overexpression of Tbxas1, a thromboxane A synthase 1 gene that catalyzes the conversion of prostaglandin H2 to thromboxane A2 (TXA2), a potent inducer of platelet aggregation. Application of aspirin, a TXA2 inhibitor, significantly reduced lung metastases. Mertk, a member of the TAM (Tyro, Axl, Mertk) family of RTKs, was also overexpressed in Met cells, which led to increased MAPK activation, epithelial-mesenchymal transition (EMT), and enrichment of cancer stem cells. Braf-mutant Met cells developed resistance to BRAFV600E inhibitor PLX4720, but remained sensitive to β-catenin inhibitor PKF118-310.

Conclusion

We have identified several overexpressed genes/pathways in thyroid cancer metastasis, making them attractive therapeutic targets. Given the complexity of metastasis involving multiple pathways (PD-L1, Mertk, IL6, COX-1/Tbxas1-TXA2), simultaneously targeting more than one of these pathways may be warranted to achieve better therapeutic effect for metastatic thyroid cancer.

Day before late regimen vs standard split dose of low-volume PEG-CS for early morning colonoscopy: Multicenter randomized controlled trial

BACKGROUND AND STUDY AIMS

Despite lower patient adherence, the overnight split-dose (SD) intestinal preparation regimen is currently recommended for early morning colonoscopies. Using low-volume preparation, we compared performance of a "day before late" (DBL) regimen, with the whole preparation taken between 8.30 pm and midnight on the day before the endoscopic procedure vs the overnight SD regimen for colonoscopies scheduled between 8 am and 10 am.

PATIENTS AND METHODS

Patients were randomized to the DBL group (n = 162) or SD group (n = 158). The SD group took the second dose 5 hours before colonoscopy. Successful bowel cleansing, defined as an overall Boston Bowel Preparation Score ≥ 3, safety, compliance and tolerability were assessed in the two groups.

RESULTS

The DBL regimen failed to demonstrate non-inferiority compared with the SD regimen in terms of successful bowel cleansing (DBL, 88.2 % vs SD, 98.1%, P < 0.001). Subgroup analysis on colonoscopies before 9 am showed BBPS ≥ 3 rates of 94.6% and 100% in the DBL and SD groups, respectively P = 0.126). The two regimens showed similar compliance and tolerability. Compared with SD patients (25.5%), a lower proportion of DBL patients (13.9%) reported fear of incontinence during the journey to the hospital ( P = 0.01).

CONCLUSIONS

Albeit more tolerable, the DBL regimen was less effective than the SD regimen with regard to successful bowel cleansing for colonoscopies between 8 am and 10 am. Subgroup analysis on colonoscopies scheduled before 9 am showed that the two regimens have similar efficacy, suggesting that the DBL regimen may be a valuable alternative to the SD regimen for very early morning colonoscopies.

Exploring Resting Sinus Tachycardia in Cancer Care: A Comprehensive Review

Resting sinus tachycardia is frequently encountered in cancer patients. It affects a wide variety of cancer patients and is associated with distressing symptoms. Cancer-associated resting sinus tachycardia varies in its underlying mechanism. It can stem from the tumor burden or the side effects of chemotherapy/radiotherapy, or it can be secondary to paraneoplastic syndrome or the sequalae of cancer itself (infection, anemia, thrombosis, etc.). The clinical significance of resting sinus tachycardia extends beyond mere symptomatology, as it can potentially indicate severe complications which may facilitate or exacerbate a new or underlying cardiovascular dysfunction. Therefore, this necessitates thorough diagnostic tools to discern the underlying cause and tailor appropriate management strategies, whether pharmacological, non-pharmacological, or conservative. While resting sinus tachycardia has been extensively investigated in the context of cardiovascular disease, its underlying etiology, clinical implication, prognostic value, and treatment options remain vague in the context of cancer. This review aims to explore the topic of resting sinus tachycardia in cancer patients through delving deeper into its underlying mechanism, presenting the current evidence on its effect on cancer-independent cardiovascular and all-cause mortality, as well as providing some insight into the currently available treatment options. It will also propose therapeutic interventions and strategies aimed at optimizing cancer patient care. Lastly, it will highlight research gaps which need to be addressed further, as future research is needed to refine the diagnostic criteria, develop targeted therapies, find alternative cardioprotective/cardio-neutral chemotherapy options, and establish evidence-based guidelines to improve outcomes in this vulnerable patient population.

Opposing effects of mycotoxins alternariol and deoxynivalenol on the immunomodulatory effects of oxaliplatin and triapine

Mycotoxin occurrence in food worldwide is estimated to increase due to climate change. Moreover, studies on how these food contaminants interfere with medications and especially anticancer therapies are rare. With the rise of anticancer immunotherapies, particularly mycotoxins with immunomodulatory activity, such as alternariol (AOH) or deoxynivalenol (DON), are of great concern. Both mycotoxins interfere with the pro-inflammatory nuclear factor kappa B (NF-κB) pathway in myeloid cells. This pathway not only plays an important role in the anticancer immune response but also inflammatory side effects induced by chemotherapeutic drugs. Consequently, the aim of this study was to investigate possible beneficial or detrimental immunomodulatory interactions between these mycotoxins and anticancer drugs. To assess the combined influence of mycotoxins and anticancer therapies on immune cell stimulation, THP-1 NF-κB reporter cells were utilized as monocytes as well as differentiated and polarized macrophages. Parameters for activation (NF-κB activity and protein expression), differentiation (CD14 and CD71 surface marker expression) and polarization (interleukin 10 (IL10), interleukin 8 (CXCL8), tumor necrosis factor α (TNF), prostaglandin-endoperoxide synthase 2 expression and CXCL8 secretion) were assessed upon combinatory treatment. Both mycotoxins affected the immunostimulatory effects of the pre-selected anticancer drugs oxaliplatin and triapine, although in opposing directions. While AOH generally suppressed a drug-induced activation and increased anti-inflammatory IL10 levels, DON potentiated activation and pro-inflammatory markers, such as CXCL8 and TNF in immune cells. In conclusion, AOH and DON have the potential to alter the immunological effects of anticancer therapies, which should be considered during therapy as well as in their future risk assessment.

A multi-modal training environment for colonoscopy with pressure feedback

BACKGROUND

Colonoscopy is a complex procedure with a 3-5% failure rate even for experts. Mastering endoscopy skills and reducing complication rates extend well beyond the initial training phase for most endoscopists, and continues into their clinical experience. Thus, continuing efforts should focus on optimizing training methods to make them individualized with clear objective learning goals for trainees.

METHODS

A hybrid (physical and computer) colonoscopy training simulator was developed using a novel pressure-sensing sleeve covering the full length of a colonoscope, and a physical colon simulator (Kyoto Kagaku) along with custom-designed training software to visualize the color-mapped 3D pressure profile of the colonoscope during the simulated procedure and provide a visual and quantitative evaluation of the endoscopist's skills post-procedure. A system usability questionnaire and objective evaluation metrics were used to determine the model's effectiveness as a training tool.

RESULTS

Thirty-three participants were enrolled in the study, among which 8 were experts and 25 trainees. The interactive maximum and average pressures applied by the trainees were generally higher than those applied by experts, however, this difference was only statistically significant in the recto-sigmoid region. The mean average pressure applied in the rectum and the rectosigmoid region was 6.5 kPa for the experts compared to 13.7 kPa for the trainees, with a p-value of 0.011. Both groups agreed that the system is easy to understand and use, and would be helpful as a learning aid in training programs for colonoscopy skills.

CONCLUSIONS

The proposed system is expected to enhance the quality of colonoscopy procedures by enabling endoscopists to adopt safer and more efficient navigational skills. The evaluation metrics discussed in this research offer useful insights into the performance of endoscopists, and the ability of trainees to compare their performance against expert benchmarks will enable them to establish personalized objective training goals.

Outcome of treatment modalities for spontaneous esophageal rupture: a meta-analysis and case series

BACKGROUND

Current treatment modalities for spontaneous esophageal perforation remain controversial because of their rarity.

OBJECTIVE

To describe our institution's experience in managing patients with spontaneous esophageal rupture and conduct a meta-analysis of existing studies to determine the best evidence-based treatment options.

METHODS

The authors enrolled patients with spontaneous esophageal rupture who underwent their first treatment at our institution. The authors also identified studies through a systematic search of the MEDLINE, EMBASE, and Cochrane Library databases before 1 April 2024, for inclusion in the meta-analysis.

RESULTS

This case series included data from 17 patients with delayed diagnosis who were treated with esophageal stents, with an immediate mortality rate of 5.9%. In addition to the cases from our institution, the authors obtained 944 patients from 46 studies in the final analysis. The combined immediate mortality rate was 11% (95% CI: 0.08-0.15). The combined reintervention rate was 11% (95% CI: 0.05-0.19). The combined immediate mortality was 6% (95% CI: 0.04-0.09) after primary closure, 14% (95% CI: 0.02-0.32) after T-tube drain repair, 2% (95% CI: 0.00-0.15) after esophagectomy, 8% (95% CI: 0.03-0.15) after stent placement, and 22% (95% CI: 0.03-0.47) after conservative treatment. The subgroup analysis based on the timing of the intervention showed that the immediate mortality rate in patients initiating treatment within 24 h of rupture was 3% (95% CI: 0.01-0.08), whereas that in patients initiating treatment >24 h later was 12% (95% CI: 0.08-0.18).

CONCLUSION

Outcomes are best after esophagectomy, and primary closure or esophageal stenting is a good option compared with other treatment modalities. Prognosis is related to the timing of intervention, and accurate diagnosis and treatment within 24 h significantly reduces the risk of death in patients. Patients with delayed diagnosis may have a better prognosis with stent placement.

Intestinal Epithelial Cell-specific Knockout of METTL3 Aggravates Intestinal Inflammation in CLP Mice by Weakening the Intestinal Barrier

BACKGROUND

Many studies have demonstrated that the expression of methyltransferase- like 3 (METTL3) is altered in various inflammatory diseases. Its specific mechanistic role in the intestinal inflammatory response during sepsis remains limited and requires further investigation.

OBJECTIVES

Explore the potential mechanism of METTL3 in the intestinal inflammatory response during sepsis.

MATERIALS AND METHODS

Immunohistochemical analysis was utilized to detect the expression of METTL3 in the necrotic intestine of patients with intestinal necrosis and the small intestine of cecal ligation and puncture (CLP) mice. Mice were subjected to the CLP and Sham surgeries, intestine tissue was harvested and performed HE staining, and ELISA to examine intestinal inflammatory responses, while TUNEL staining was applied to detect intestinal cell apoptosis. Additionally, ELISA was used to detect diamine oxidase (DAO) and intestinal fatty acid binding protein (I-FABP) levels in intestinal tissue. Immunohistochemistry and RT-qPCR were also employed to examine the mRNA and protein expression levels of Zona Occludens 1 (ZO-1) and Claudin-1. Finally, transcriptomic sequencing was performed on the small intestine tissues of METTL3 Knock-out (KO) and Wild-type (WT) mice in response to sepsis.

RESULTS

METTL3 exhibited lower expression level in the necrotic intestine of patients and the small intestine of CLP mice. Loss of METTL3 in CLP mice triggered significantly higher expression of TNF-α and IL-18, down-regulated expression of ZO-1 and claudin-1, and decreased expression of DAO and I-FABP in the intestinal tissue. KEGG enrichment analysis showed that the differential genes were significantly enriched in immune-related pathways.

CONCLUSION

This study reveals a novel mechanism responsible for exacerbated intestinal inflammation orchestrated by METTL3. Particularly, METTL3 null mice displayed decreased ZO- 1 and Claudin-1 expression, which largely hampered intestinal epithelial barrier function, resulting in bacterial and toxin translocation and intestinal immune activation and inflammation against sepsis.

A case report of a rare etiology of an abdominal cystic lesion in adults: Peritoneal inclusion cysts

INTRODUCTION AND IMPORTANCE

Peritoneal inclusion cysts (PICs), also known as peritoneal mesothelial cysts, are rare, benign cystic lesions primarily occurring in the abdominopelvic cavity of premenopausal women with histories of pelvic surgery or inflammation. These cysts can present with nonspecific symptoms and may mimic other abdominal pathologies, making diagnosis challenging.

CASE PRESENTATION

A 41-year-old male with no significant medical history, who experienced progressive nonspecific abdominal pain over several months. Clinical examination revealed a poorly defined mass in the right hemi-abdomen. Imaging studies, including CT and MRI, identified an elongated subhepatic cystic lesion, suggesting a peritoneal inclusion cyst or mesenteric cyst. Surgical intervention was decided following multidisciplinary team consultation. Intraoperative findings revealed a 13 cm intraperitoneal cyst with clear fluid content in the right hemi-abdomen, adherent to adjacent structures. Monobloc cystectomy was performed, and a histopathological examination confirmed the diagnosis of a peritoneal inclusion cyst.

CLINICAL DISCUSSION

PICs are rare and typically affect females, with only limited cases reported in males. These cysts can be asymptomatic or present with non-specific symptoms such as abdominal pain or distension, often requiring imaging and, occasionally, surgical exploration for diagnosis. The differential diagnosis includes other cystic abdominal lesions, emphasizing the need for thorough clinical and imaging assessment. The preferred management of PICs is surgical excision, as it provides histological confirmation and minimizes recurrence risk.

CONCLUSION

This case highlights a rare presentation of a PIC in a male patient, underscoring the importance of considering PICs within the differential diagnosis of abdominal cystic lesions regardless of patient gender. Surgical resection remains the primary management approach, but further research is needed to establish standardized guidelines for diagnosis and treatment.

Aloe vera gel relieves cadmium triggered hepatic injury via antioxidative, anti-inflammatory, and anti-apoptotic routes

Aloe vera (AV) gel extracted from fresh AV leaves was chosen in this study to evaluate its antioxidant, anti-inflammatory, and antiapoptotic activities against cadmium (Cd) -induced liver injury. Forty Wistar male adult rats were equally divided into four groups. Group I (standard control) ingested with 2.5 ml/kg b.w. of physiological saline. Group II (Cd-intoxicated) received 3 mg/kg b.w./day of CdCl2 dissolved in saline. Group III (AV) received 200 mg/kg b.w./day of AV gel dissolved in saline. Group IV (Cd+AV) ingested with 200 mg/kg b.w./day of AV gel solution along with 3 mg/kg b.w. CdCl2. All groups were ingested orally by gavage for 3 consecutive weeks. Paraoxonase-1 (PON-1) and HSP70 were measured in serum. The deposited Cd level, nitric oxide content, lipid peroxidation, collagen-1 (COL-1), and metalloproteinase-9 (MMP-9) levels were all determined in liver tissue homogenates. Gene expression of NF-κB and IL-6, Bax, and Bcl2, as well as immunohistochemistry analysis of activated caspase-3, was performed. Results showed that ingestion of AV gel greatly relieved all oxidative stress due to Cd exposure, modulated the NF-κB, IL-6, Bax, and Bcl2 expression levels, and improved the apoptotic state. In conclusion, AV gel confirmed its potential ameliorating effect against liver injury induced due to Cd exposure.

Endoscopy in Special Situations in Inflammatory Bowel Disease: Acute Colitis, Pregnancy, and Pediatrics

Endoscopy for a hospitalized patient with acute severe ulcerative colitis should be limited to flexible sigmoidoscopy. If, during pregnancy, inflammatory bowel disease (IBD) is active or if a new diagnosis of IBD is suspected, endoscopy may be needed to guide medical decision-making. The determination to proceed with endoscopy during pregnancy is nuanced and requires the ability to discern appropriate indications, knowledge regarding safety of bowel preparation and anesthesia. Pediatric patients with IBD represent a unique subset of IBD with distinctive diagnostic, therapeutic, and monitoring considerations.

Ulva pertusa Modulated Colonic Oxidative Stress Markers and Clinical Parameters: A Potential Adjuvant Therapy to Manage Side Effects During 5-FU Regimen

One of the most used chemotherapy agents in clinical practice is 5-Fluorouracil (5-FU), a fluorinated pyrimidine in the category of antimetabolite agents. 5-FU is used to treat a variety of cancers, including colon, breast, pancreatic, and stomach cancers, and its efficacy lies in its direct impact on the patient's DNA and RNA. Specifically, its mechanism blocks the enzymes thymidylate synthetase and uracil phosphatase, inhibiting the synthesis of uracil, which cannot be incorporated into nuclear and cytoplasmic RNA. Despite being one of the most used drugs in oncology, it is associated with several significant side effects, including inflammation of the mouth, loss of appetite, and reduction in blood cells. In our study, we examined the reduction of side effects in a 5-FU regimen administered at doses of 15 mg/kg and 6 mg/kg for 14 days in 6-week-old male Sprague-Dawley rats. On the 14th day, the rats were treated orally for 2 weeks with 100 mg/kg of Ulva pertusa, a well-known seaweed from the Ulvaceae family, which has demonstrated powerful biological properties. The administration of this green alga alleviated the side effects of 5-FU, improving several parameters including body weight, food intake, and diarrhea index. It also helped reduce side effects in the blood, kidneys, and liver. Histological and molecular analyses were conducted on serum and colon tissues from the rats, examining changes in colon structure and the release of oxidative stress markers such as iNOS, COX-2, and nitrotyrosine. Several biochemical indicators, including SOD, CAT, GSH, MDA, and ascorbic acid, were also evaluated. Overall, our data indicated Ulva pertusa to be a promising therapeutic against 5-FU's adverse effects, therefore, it could be worthwhile to investigate the possibility of using this alga in safer cancer treatment formulations. Certainly, future preclinical and clinical studies could assess the alga's efficacy in diverse cancer treatment regimens, exploring its role as an adjuvant therapy that may reduce chemotherapy-related toxicity without compromising therapeutic outcomes.

Surgical Insight-guided Deep Learning for Colorectal Lesion Management

BACKGROUND

Colonoscopy stands as a pivotal diagnostic tool in identifying gastrointestinal diseases, including potentially malignant tumors. The procedure, however, faces challenges in the precise identification of lesions during visual inspections. The recent strides in AI and machine learning technologies have opened avenues for enhanced medical imaging analysis, including in the field of colonoscopy.

METHODS

In this study, we developed and evaluated a deep learning (DL) model, ColoNet, for detecting lesions in colonoscopic images. We analyzed 1760 images from 306 patients who underwent colorectal surgery between 2009 and 2022, meeting specific inclusion criteria. These images were used to train and validate ColoNet, employing the YOLOv8 architecture and various data augmentation techniques. Deep learning metrics are assessed via YOLO architecture and trained model diagnostic accuracy was assessed via sensitivity, specifity, positive predictive value, and negative predictive value.

RESULTS

Our results from the validation dataset revealed a precision of 0.79604, a recall of 0.78086, an mAP50 of 0.83243, and an mAP50-95 of 0.4439. In addition, on a separate real-time dataset of 91 images consisting both healthy and suspect lesions, ColoNet achieved a sensitivity of 70.73%, specificity of 92.00%, positive predictive value (PPV) of 87.88%, and negative predictive value (NPV) of 79.31%. The positive and negative likelihood ratios were 8.84 and 0.32, respectively, with an overall accuracy of 82.42%.

CONCLUSIONS

In conclusion, our model has demonstrated promising results, indicating its potential as a valuable tool to assist surgeons during colonoscopy procedures. Its ability to detect suspicious lesions with potential malignancy offers a noteworthy advancement in the early diagnosis and management of colorectal cancers. Further multicentric, prospective research and validation are warranted to fully realize its clinical applicability and impact.

An adapted taxonomy and framework for monitoring road safety strategies: a case study of Morocco

Traditional approaches to monitoring road safety have primarily focused on measuring outcomes such as the number of fatalities and injuries. While effective in capturing overall trends, this macroscopic approach often overlooks the underlying causes of unsafe conditions. Recognizing these limitations, many countries now embrace a safe system-based approach, which emphasizes a holistic view of road safety, considering various elements and their interactions. In response to this shift, this study introduces a five-step framework designed to provide comprehensive coverage and tailored assistance in selecting and utilizing appropriate Road Safety Indicators (RSIs) for more effective performance monitoring. The framework integrates a novel RSIs taxonomy aligned with critical elements of the safe system. It also incorporates an MCDA-based approach to account for decision-makers' preferences when selecting suitable RSIs. A case study demonstrates the practical application of the proposed steps, including the identification, classification, selection, and development of descriptive sheets for each selected RSI, as well as the continuous updating of the RSIs set. The findings offered valuable insights into the commonly used indicators in international road safety reports, while also revealing the limitations of currents metrics and data in fully capturing critical elements and hierarchical level within the road safety management system.

Predictive action of oncomiR in suppressing TP53 signaling pathway in hypoxia-conditioned colon cancer cell line HCT-116

Hypoxia-induced heterogeneity in colorectal cancer (CRC) significantly impacts patient survival by promoting chemoresistance. These conditions alter the regulation of miRNAs, key regulators of crucial processes like proliferation, apoptosis, and invasion, leading to tumor progression. Despite their promising potential as diagnostic and therapeutic targets, the underlying mechanisms by which miRNAs influence hypoxia-mediated tumorigenesis remain largely unexplored. This study aims to elucidate the action of miRNAs in HCT-116 colorectal cancer stem cells (CSCs) under hypoxia, providing valuable insights into their role in tumor adaptation and progression. MiRNA expression was determined using Nanostring nCounter, and bioinformatic analysis was performed to explain the molecular pathway. A total of 50 miRNAs were obtained with an average count of ≥ 20 reads for comparative expression analysis. The results showed that hypoxia-affected 36 oncomiRs were increased in HCT-116, and 14 suppressor-miRs were increased in MSCs. The increase in miRNA expression occurred consistently from normoxia to hypoxia and significantly differed between mesenchymal stem cells (MSCs) and HCT-116. Furthermore, miR-16-5p and miR-29a-3p were dominant in regulating the p53 signaling pathway, which is thought to be related to the escape mechanism against hypoxia and maintaining cell proliferation. More research with a genome-transcriptome axis approach is needed to fully understand miRNAs' role in adapting CRC cells and MSCs to hypoxia. Further research could focus on developing specific biomarkers for diagnosis. In addition, anti-miR can be developed as a therapy to prevent cancer proliferation or inhibit the adaptation of cancer cells to hypoxia.

Synergistic anti-tumorigenic effect of diosmetin in combination with 5-fluorouracil on human colon cancer xenografts in nude mice

5-Fluorouracil (5-FU) is frequently used to treat colorectal cancer (CRC), but its clinical application is limited by its toxicity. Natural compounds have been combined with chemotherapeutic drugs to reduce chemotherapy-related toxicity. Diosmetin, a natural flavonoid, has demonstrated anticancer effects against CRC. This study investigated diosmetin's potential in combination with 5-FU using a murine model of HCT-116 colon cancer xenografts in nu/nu nude mice. HCT-116 cells were injected into the right flanks of mice, and once tumors reached a size of 50 mm3, the mice were treated with diosmetin (100 mg/kg), 5-FU (30 mg/kg), or a combination of both at two dose levels (100 + 30 mg/kg and 50 + 15 mg/kg) for 4 weeks. Blood and tumors were collected on the final day for further analysis. Mice treated with the higher combination dose exhibited the smallest tumor volume (330.91 ± 88.49 mm3). Biochemistry and histology analysis showed no toxicity or abnormalities in the liver, kidney, and heart with the combination therapy. Immunohistochemistry results revealed a notable reduction in the proliferation marker (Ki67) and inflammation marker (TLR4) in tumors from high-dose combination-treated mice. Moreover, immunofluorescence data indicated increased levels of apoptotic markers (Bax, Caspase-3, p53, p21) and downregulation of anti-apoptotic protein (Bcl-2) in the high-dose combination group. The findings suggest that 100 mg/kg of diosmetin combined with 30 mg/kg 5-FU significantly reduced tumor volume and had a less toxic effect on the heart compared to 5-FU monotherapy.

Drug-Free Mesoporous Silica Nanoparticles Enable Suppression of Cancer Metastasis and Confer Survival Advantages to Mice with Tumor Xenografts

Despite advancements in nanomedicine for drug delivery, many drug-loaded nanoparticles reduce tumor sizes but often fail to prevent metastasis. Mesoporous silica nanoparticles (MSNs) have attracted attention as promising nanocarriers. Here, we demonstrated that MSN-PEG/TA 25, with proper surface modifications, exhibited unique antimetastatic properties. In vivo studies showed that overall tumor metastasis decreased in 4T1 xenografts mice treated with MSN-PEG/TA 25 with a notable reduction in lung tumor metastasis. In vitro assays, including wound-healing, Boyden chamber, tube-formation, and real-time cell analyses, showed that MSN-PEG/TA 25 could modulate cell migration of 4T1 breast cancer cells and interrupt tube formation by human umbilical vein endothelial cells (HUVECs), key factors in suppressing cancer metastasis. The synergistic effect of MSN-PEG/TA 25 combined with liposomal-encapsulated doxorubicin (Lipo-Dox) significantly boosted mouse survival rates, outperforming Lipo-Dox monotherapy. We attributed the improved survival to the antimetastatic capabilities of MSN-PEG/TA 25. Moreover, Dox-loaded MSN-PEG/TA 25 suppressed primary tumors while retaining the antimetastatic effect, thereby enhancing therapeutic outcomes and overall survival. Western blot and qPCR analyses revealed that MSN-PEG/TA 25 interfered with the phosphorylation of ERK, FAK, and paxillin, thus impacting focal adhesion turnover and inhibiting cell motility. Our findings suggest that drug-free MSN-PEG/TA 25 is highly efficient for cancer treatment via suppressing metastatic activity and angiogenesis.

Integrin-Specific Stimuli-Responsive Nanomaterials for Cancer Theranostics

Background: Cancer is one of the leading causes of death worldwide. The tumor microenvironment makes the tumor difficult to treat, favoring drug resistance and the formation of metastases, resulting in death. Methods: Stimuli-responsive nanoparticles have shown great capacity to be used as a powerful strategy for cancer treatment, diagnostic, as well as theranostic. Nanocarriers are not only able to respond to internal stimuli such as oxidative stress, weakly acidic pH, high temperature, and the high expression of particular enzymes, but also to external stimuli such as light and paramagnetic characteristics to be exploited. Results: In this work, stimulus-responsive nanocarriers functionalized with arginine-glycine-aspartic acid (Arg-Gly-Asp) sequence as well as mimetic sequences with the capability to recognize integrin receptors are analyzed. Conclusions: This review highlights the progress that has been made in the development of new nanocarriers, capable of responding to endogenous and exogenous stimuli essential to combat cancer.

Ferroptosis: opening up potential targets for gastric cancer treatment

The fifth most frequent cancer in the world is gastric cancer. It ranks as the fourth most common reason for cancer-related deaths. Even though surgery is the only curative treatment for stomach cancer, adding adjuvant radiotherapy and chemotherapy is preferable than only surgery. The majority of patients, however, are discovered to be extremely tardy the first time and have a terrible prognosis. Therefore, it is necessary to create more viable therapy modalities. A growing number of studies in recent years have shown that ferroptosis and many cancer types are related. This gives our treatment a fresh viewpoint. We investigated the relationship between different signal pathways and non-coding RNA on ferroptosis in gastric cancer cells. Also discussed the targets cause ferroptosis resistance increased or reduced to the influence of the chemoresistance,proliferation and metastasis.

Intragastric Balloons: Practical Considerations

Obesity is escalating, projected to affect 17.5% of adults globally and afflict 400 million children by 2035. Managing this intricate and chronic condition demands personalized, multidisciplinary approaches. While dietary changes, lifestyle modifications, and medications yield short-term results, long-term outcomes are often poor, with bariatric surgery standing out as the most effective option. However, only a small fraction undergoes surgery due to various barriers. Intragastric balloon (IGB) emerges as a minimally invasive alternative, approved by major regulatory bodies. This review adresses the pivotal role of IGB in obesity management, delving into its history and technological evolution.

A case of benign multicystic peritoneal mesothelioma

Benign Multicystic Peritoneal Mesothelioma (BMPM) is an exceedingly rare benign abdominal neoplasm with fewer than 200 cases reported worldwide. Owing to its rarity, vague clinical picture, and elusive causes, diagnosis is often delayed or missed. Histopathological examination and immunohistochemical staining are crucial for definitive diagnosis. However, due to lack of substantial literature, the standard of care and future prognosis remain subjects of inquiry. We present a case report of one female patient diagnosed with BMPM and treated with surgical resection.

Fecal microbiota spores, live-brpk (VOWST™/VOS) for prevention of recurrent Clostridioides difficile infection

Clostridioides difficile infection (CDI) is a health crisis comprising a majority of healthcare-associated infections and is now being seen in the community. Persistent dysbiosis despite treatment with standard-of-care antibiotics increases risk of recurrent infections. Fecal microbiota transplantation has been an effective way of addressing dysbiosis, but the studies have lacked standardization, which makes outcome and safety data difficult to interpret. Standardized microbiome therapies have demonstrated efficacy and safety for recurrent CDI and have been approved to prevent recurrent infection. In this review, we discuss the data behind and the practice use of fecal microbiota spores, live-brpk (VOWST™ / VOS), a US FDA approved live biotherapeutic for the prevention of recurrent CDI.

Bioengineered Anthocyanin-Enriched Tomatoes: A Novel Approach to Colorectal Cancer Prevention

Colorectal cancer (CRC) remains a significant global health challenge, with barriers to effective prevention and treatment including tumor recurrence, chemoresistance, and limited overall survival rates. Anthocyanins, known for their strong anti-cancer properties, have shown promise in preventing and suppressing various cancers, including CRC. However, natural sources of anthocyanins often fail to provide sufficient quantities needed for therapeutic effects. Bioengineered crops, particularly anthocyanin-enriched tomatoes, offer a viable solution to enhance anthocyanin content. Given its large-scale production and consumption, tomatoes present an ideal target for bioengineering efforts aimed at increasing dietary anthocyanin intake. This review provides an overview of anthocyanins and their health benefits, elucidating the mechanisms by which anthocyanins modulate the transcription factors involved in CRC development. It also examines case studies demonstrating the successful bioengineering of tomatoes to boost anthocyanin levels. Furthermore, the review discusses the effects of anthocyanin extracts from bioengineered tomatoes on CRC prevention, highlighting their role in altering metabolic pathways and reducing tumor-related inflammation. Finally, this review addresses the challenges associated with bioengineering tomatoes and proposes future research directions to optimize anthocyanin enrichment in tomatoes.

Gut microbiome and inflammation in response to increasing intermittent hypoxia in the neonatal rat

BACKGROUND

Intermittent hypoxia (IH) and oxidative stress play key roles in gut dysbiosis and inflammation. We tested the hypothesis that increasing numbers of daily IH episodes cause microbiome dysbiosis and severe gut injury.

METHODS

Neonatal rats were exposed to hyperoxia (Hx), growth restriction, and IH. For IH, pups were exposed to 2-12 daily episodes from birth (P0) to postnatal day 7 (7D) or P0-P14 (14D), with or without recovery in room air (RA) until P21. Animals raised in RA from P0 to P21 served as normoxia controls. Stool was expressed from the large intestines for microbiome analysis, and tissue samples were assessed for histopathology and biomarkers of inflammation.

RESULTS

Hx and IH caused a significant reduction in the number and diversity of organisms. The severity of gut injury and levels of inflammatory cytokines and TLR4 increased, while total glutathione (tGSH) declined, with increasing daily IH episodes. The number of organisms correlated with the villi number (p < 0.05) and tGSH depletion (p < 0.001).

CONCLUSIONS

The critical number of daily IH episodes that the newborn gut may sustain is 6, beyond which irreversible damage occurs. The immature gut is highly susceptible to IH-induced injury, and IH may contribute to pathological outcomes in the immature gut.

IMPACT STATEMENT

1. The neonatal gut at birth is highly susceptible to intermittent hypoxia (IH) injury. 2. IH causes gut dysbiosis, inflammation, and glutathione depletion. 3. The severity of gut injury worsens as a function of increasing daily IH episodes. 4. The critical number of daily IH episodes that the newborn gut may sustain is 6, beyond which irreversible damage occurs.

Modified Banxiaxiexin decoction benefitted chemotherapy in treating gastric cancer by regulating multiple targets and pathways

ETHNOPHARMACOLOGICAL RELEVANCE

Chemotherapy tolerance weakened efficacy of chemotherapy drugs in the treating gastric cancer (GC). Banxiaxiexin decoction (BXXXD) was widely used in digestive diseases for thousands of years in Traditional Chinese medicine (TCM). In order to better treat GC, three other herbs were added to BXXXD to create a new prescription named Modified Banxiaxiexin decoction (MBXXXD). Although MBXXXD potentially treated GC by improving chemotherapy tolerance, the possible mechanisms were still unknown.

AIM OF THE STUDY

To explore the therapeutic effect of MBXXXD on GC patients and explore the possible anti-cancer mechanism.

MATERIALS AND METHODS

A randomized controlled trial (n = 146) was conducted to evaluate the clinical efficacy between MBXXXD + chemotherapy (n = 73) and placebo + chemotherapy (n = 73) in GC patients by testing overall survival, progression free survival, clinical symptoms, quality of life score, tumor markers, T cell subpopulation, and adverse reactions. Network pharmacology was conducted to discover the potential mechanism of MBXXXD in treating GC. Metabolic activity assay, cell clone colony formation and mitochondrial apoptosis were detected in human GC cell lines including AGS cell, KNM-45 cell and SGC7901 cell treated by MBXXXD. Multiple pathways including P53, AKT, IκB, P65, P38, ERK, JNK p-AKT, p-P65, p-P38, p-ERK and p-JNK in AGS cell, KNM-45 cell and SGC7901 cell treated by MBXXXD and GC patients treated by MBXXXD + chemotherapy were also detected.

RESULTS

MBXXXD + chemotherapy promoted overall survival and progression free survival, improved clinical symptoms and quality of life score, increased T4 lymphocyte ratio and T8 lymphocyte ratio as well as T4/T8 lymphocyte ratio, and alleviated adverse reactions in GC patients. Network pharmacology predicted multiple targets and pathways of MBXXXD in treating GC including apoptosis, P53 pathway, AKT pathway, MAPK pathway. MBXXXD inhibited cell viability, decreased cell clone colony formation, and promoted mitochondrial apoptosis by producing reactive oxygen species (ROS), promoting mitochondrial permeability transition pore (MPTP) and the cleavage of pro-caspase-3 and pro-caspase-9, and decreasing mito-tracker red Chloromethyl-X-rosamine (CMXRos) in AGS cell, KNM-45 cell and SGC7901 cell. MBXXXD up-regulated the expression of P53 and IκB, and down-regulated the expression of p-AKT, p-P65, p-P38, p-ERK, p-JNK, AKT, P65, P38, ERK and JNK AGS cell, KNM-45 cell and SGC7901 cell treated by MBXXXD and GC patients treated by MBXXXD + chemotherapy.

CONCLUSION

MBXXXD benefitted chemotherapy for GC by regulating multiple targets and pathways.

Exploring single-cell RNA sequencing as a decision-making tool in the clinical management of Fuchs' endothelial corneal dystrophy

Single-cell RNA sequencing (scRNA-seq) has enabled the identification of novel gene signatures and cell heterogeneity in numerous tissues and diseases. Here we review the use of this technology for Fuchs' Endothelial Corneal Dystrophy (FECD). FECD is the most common indication for corneal endothelial transplantation worldwide. FECD is challenging to manage because it is genetically heterogenous, can be autosomal dominant or sporadic, and progress at different rates. Single-cell RNA sequencing has enabled the discovery of several FECD subtypes, each with associated gene signatures, and cell heterogeneity. Current FECD treatments are mainly surgical, with various Rho kinase (ROCK) inhibitors used to promote endothelial cell metabolism and proliferation following surgery. A range of emerging therapies for FECD including cell therapies, gene therapies, tissue engineered scaffolds, and pharmaceuticals are in preclinical and clinical trials. Unlike conventional disease management methods based on clinical presentations and family history, targeting FECD using scRNA-seq based precision-medicine has the potential to pinpoint the disease subtypes, mechanisms, stages, severities, and help clinicians in making the best decision for surgeries and the applications of therapeutics. In this review, we first discuss the feasibility and potential of using scRNA-seq in clinical diagnostics for FECD, highlight advances from the latest clinical treatments and emerging therapies for FECD, integrate scRNA-seq results and clinical notes from our FECD patients and discuss the potential of applying alternative therapies to manage these cases clinically.

GENETIC ABLATION OF THE C-TYPE LECTIN RECEPTOR CLEC2D INCREASES PERITONITIS MORTALITY, INFLAMMATION, AND PHYSIOLOGY WITHOUT DIMINISHING ORGAN INJURY

ABSTRACT

Background: Sepsis accounts for substantial morbidity and mortality motivating investigators to continue the search for pathways and molecules driving the pathogenesis of the disease. The current study examined if the novel C-type lectin receptor (CLR), Clec2d, plays a significant role in the pathogenesis of sepsis. Methods: Clec2d knockout (KO) mice were fully backcrossed onto the C57/BL6 background. Acute endotoxemia was induced with an intraperitoneal injection of lipopolysaccharide (LPS). Sepsis was induced in two different models, cecal ligation and puncture (CLP) and Pseudomonas aeruginosa pneumonia. Both models were treated with antibiotics and fluid resuscitation. In the sepsis models, physiologic and hematologic measurements were measured at 24 h by collecting a small sample of peripheral blood. Mortality was followed for 14 days. Results : A total of 197 mice were studied, 58 wild type (WT) and 54 knock-out (KO) in the LPS model; 27 wild type and 21 KO mice in the CLP model; and 22 WT and 15 KO mice in the pneumonia model. Clec2d KO mice had greater mortality in the LPS and CLP studies but not the pneumonia model. There were significant differences in multiple parameters determined 24 h post sepsis between mice who subsequently died and those lived. Consistent with previous reports in the CLP model, higher concentrations of IL-6, increased numbers of peripheral blood lymphocytes and greater renal injury were found in the dying mice. In contrast, in the pneumonia model, IL-6 was higher in the surviving mice; however, the IL-6 levels in the pneumonia model (0.6 ± 0.3 ng/mL mean ± SEM) were less than 2% of the IL-6 levels of mice that died in the CLP model (41 ± 9 ng/mL, mean ± SEM). There were no differences in the lymphocyte count or renal injury between living and dying mice in the pneumonia model. In both sepsis models, dying mice had lower heart rates, respiratory rates, and body temperatures. These values were also lower in the KO mice compared to the WT in CLP, but the breath rate and body temperature were increased in the KO pneumonia mice. Conclusion: The C-type lectin receptor Clec2d plays a complicated role in the pathogenesis of sepsis, which varies with source of infection as demonstrated in the models used to study the disease. These data highlight the heterogeneity of the responses to sepsis and provide further evidence that a single common pathway driving sepsis organ injury and death likely does not exist.

Situation and associated factors of needle stick and sharps injuries among health-care workers in a tertiary hospital: a cross-sectional survey

PURPOSE

This study aimed to assess the prevalence of and factors associated with needle stick and sharps injuries (NSSIs) among health-care workers (HCWs) in a tertiary hospital in China.

MATERIALS AND METHODS

This retrospective survey was conducted with 562 HCWs at a tertiary hospital in China in July 2023. Information was collected using a self-designed questionnaire, and all enrolled members were required to fill in the demographic characteristics, occurrence of NSSIs and other associated factors in the past year. Logistic analysis was used to identify variables associated with NSSIs.

RESULTS

The proportion of participants with at least one injury within the year preceding the investigation was 21.2%. Male (AOR = 2.116 [1.265, 3.538]), working hours per week > 40 (AOR = 1.718 [1.056,2.796]), rarely checking blood-borne infections before invasive operations (AOR = 2.219 [1.303,3.782]) were significantly associated with NSSIs.

CONCLUSION

The prevalence of NSSIs was not low in the survey area, especially in male, individuals with longer working hours, and rarely checking blood-borne infections before invasive operations. Therefore, it is necessary to promote educational programs to enhance awareness of standard prevention measures, especially for key populations, and reduce heavy workloads to decrease the occurrence of such injuries.

The Prevalence of HIV Seroconversion in Healthcare Workers Following Sharp Injuries and Exposure to Biofluids

Background and objective Workplace accidents (WPAs) are a common problem worldwide. They are often considered a public health concern due to the potential transmission of infections such as HIV, hepatitis B, and hepatitis C through sharp devices or direct exposure to biofluids. Post-exposure prophylaxis (PEP) has demonstrated effectiveness in such instances, especially immediately after exposure. The present study aimed to report the prevalence rate of HIV seroconversion following such exposure among healthcare workers (HCWs). Methods We conducted a cross-sectional study involving a database analysis of cases from 2015 to 2024. Central tendency measures were used to describe population characteristics, and rates were calculated using standard methods. Results A total of 514 HCWs were included in the study. The prevalence of WPAs was 13 per 100 HCWs. Regarding WPAs related to HIV exposure, the prevalence was 0.9 per 100 HCWs, with 0% seroconversion thanks to timely PEP. Conclusions WPAs related to HIV exposure are a serious issue for public health systems worldwide. Although protocols are available and no seroconversion cases were reported in the present study, PEP is not always accessible in several settings, increasing the risk of seroconversion. International public policy measures should be uniformly implemented to provide faster access to prophylaxis, educate the personnel, raise awareness about bloodborne diseases, and reduce excessive red tape.