The role of DUOXA2 in the clinical diagnosis of paediatric congenital hypothyroidism

Background: Congenital hypothyroidism (CH) is a common metabolic disorder in children that can impact growth and neurodevelopment, particularly during infancy and early childhood. DUOXA2, a DUOX maturation factor, plays a crucial role in the maturation and activation of dual oxidase DUOX2 (a member of the NADPH oxidase family). DUOX2 can correctly migrate to the plasma membrane from the endoplasmic reticulum (ER) with the help of DUOXA2, and the two proteins together form a stable complex that promotes hydrogen peroxide (H2O2) generation in the synthesis of thyroid hormones. Genetic alterations in DUOXA2 lead to defects function of DUOX2 protein causing inherited CH.

Objectives: This review discusses the relationship between DUOXA2 and CH, including the pathogenic mechanisms of CH in children caused by DUOXA2 mutations and the possibility or promise of DUOXA2 gene screening as a diagnostic marker for CH in the clinic.

Methods: The review synthesizes current research on the biological role of DUOXA2 and DUOX2 in thyroid hormone synthesis, the molecular impact of DUOXA2 mutations, and the clinical implications of genetic screening for CH.

Results: Mutations in DUOXA2 disrupt this process of H2O2 generation in the synthesis of thyroid hormones , leading to inherited CH. Early identification through DUOXA2 gene screening could improve diagnostic accuracy, which facilitates early intervention and personalized treatment.

Conclusions: DUOXA2 gene screening holds promise for enhancing diagnostic accuracy in CH. However, it cannot be used as a sole diagnostic indicator, and to optimize diagnostic sensitivity, it should be combined with the screening of other relevant genetic mutations and diagnostic tools. Further research is needed to refine screening protocols and explore therapeutic options.

Efficacy and safety of a novel short course rifapentine and isoniazid regimen for the preventive treatment of tuberculosis in Chinese silicosis patients: a pilot study (SCRIPT-TB)

BACKGROUND

Tuberculosis preventive treatment (TPT) is essential for the end TB Strategy, but shorter and better tolerated regimens are needed to boost its coverage and acceptance.

METHODS

Silicosis patients aged 18 to 65 years received a novel 1H3P3 regimen (400 mg isoniazid and 450 mg rifapentine, thrice-weekly for 4 weeks) under direct observation and were actively followed up for 3 years. The safety and efficacy were compared to the 3-month, once-weekly isoniazid/rifapentine (3HP) group and observation group from our previous trials.

RESULTS

A total of 279 eligible participants were enrolled, and 238 participants provided informed consent. All eligible participants had a median age of 56 years (IQR 52-60), 163 (68.5%) participants had a Bacillus Calmette-Guerin vaccine scar, and 74 (31.1%) participants were QuantiFERON-TB Gold In-Tube positive. There were 88 adverse events from 66 (27.7%) participants and only one (0.4%) participant had a Grade 3 adverse event. The completion rate was 92.0% (219/238). Six (2.5%) participants were diagnosed with active TB, five of which were bacterial confirmed cases. The cumulative active TB rate was 1.67 cases per 100 person-years. Compared to the previous study, the 1H3P3 regimen significantly reduced the 3-year cumulative active TB rate than the observation group (HR = 0.26, Log-rank P = 0.02) and was comparable with the 3HP group (HR = 0.74, Log-rank P = 0.69), while significantly reducing adverse events.

CONCLUSION

The 1H3P3 TPT regimen was both safe and effective among silicosis patients. Further work is necessary to test the regimen in other high-risk populations.Trial registration: ClinicalTrials.gov identifier: NCT06022146 and NCT03900858.

Sex-based estimation of biological variation in plasma-free amino acid concentrations among healthy adults

Introduction

Free amino acid (FAA) analysis plays a crucial role in diagnosing and monitoring inborn errors of metabolism, assessing nutritional status, and identifying metabolic imbalances associated with various diseases. This study aimed to provide updated biological variation (BV) data to support the reliable clinical application of FAA concentrations in plasma samples, utilizing LC-MS/MS.

Materials and methods

Venous blood was collected from 22 healthy Turkish adults (9 men and 13 women) over approximately nine weeks. Plasma FAAs were measured in duplicate. BV estimates with 95 % confidence intervals were determined using nested ANOVA for the entire study group and sex-stratified subgroups, following analysis of outliers, normality, steady-state conditions, and variance homogeneity.

Results

Within-subject variation (CVI) and between-subject variation (CVG) estimates ranged from 9.5 % to 32.5 % and 8.6 % to 50.0 %, respectively. The estimated CVI values for essential amino acids were significantly lower than those for non-essential amino acids (P = 0.03). For most plasma FAAs, no significant differences in CVI (except for alanine, arginine, glutamic acid, and threonine) or CVG were observed between sexes. However, differences in the indices of individuality were noted between men and women for some plasma FAAs.

Conclusions

This Biological Variation Data Critical Appraisal Checklist-compliant study provides the first updated BV data for plasma FAAs. The significant variation observed in CVI estimates is hypothesized to result from differences in the metabolic regulation of essential versus non-essential amino acids. The sex-stratified indices obtained in this study will aid in the appropriate application of population-based reference intervals for plasma FAA assessment.

Development of a direct dilution method for the simultaneous determination of 40 metal and non-metallic elements in urine and blood samples within 6 min using ICP-MS: Application of comprehensive biomonitoring of elementomic phenotypes of individuals in paired biological samples

The deficiency and overnutrition of both metal and non-metallic elements in human body can pose harmful effects to human health. Therefore, it is necessary to determination of elements in human body for assessing health risk of elementome. In this study, a simple and accurate biomonitoring approach was developed for quantifying 40 elements in biological samples within 6 min using a direct dilution method combined with inductively coupled plasma mass spectrometry (ICP-MS). It had good linearity (R2 ≥ 0.999) and high sensitivity (limit of detection (LOD) as low as 2 ng/L) with spiked recovery rates ranged between 82.53 % and 110.03 % for serum samples and between 81.92 % and 108.66 % for urine samples. The intra-day and inter-day precision are less than 15 %. In addition, uncertainty indicators and green analytical chemistry (GAC) approaches are used to evaluate the sources of uncertainty and greenness of developed analytical procedures. This method was finally used to detect the paired biofluids samples collected from 202 Chinese children. The distribution of element in this population through detection rate and level of body burden was analyzed. Furthermore, the function of paired serum and urine samples for detection of 40 elements is first explored by analyzing pairing samples. These results demonstrated that the proposed method for analysis of paired biological samples provides an alternative quantitative elementomics method to enable the comprehensive assessment of health risk associated with 40 elemental phenotypes of individuals.

Cyst fluid proteins stratify malignant risk of intraductal papillary mucinous neoplasm of the pancreas

Intraductal papillary mucinous neoplasm (IPMN) is the most common type of pancreatic cyst often incidentally detected in asymptomatic patients. The current consensus guidelines, largely based on imaging features, have high sensitivity but low specificity in differentiating benign from malignant IPMNs, leading to unnecessary surgeries. Discovering biomarkers is thus warranted to improve the preoperative risk stratification of IPMN. Pancreatic cyst fluid samples were obtained from patients with pathologically confirmed low-grade (n = 73) or high-grade/invasive (n = 18) IPMN. Global proteome quantitation was performed using liquid chromatography-tandem mass spectrometry. Differentially expressed proteins (DEPs) between the two groups were analyzed using Wilcoxon rank-sum test. 152 upregulated and 74 downregulated DEPs were discovered by comparing low-grade IPMN with high-grade/invasive IPMN (all p < 0.05). The enriched upstream regulators of these DEPs included let-7, miR-122, IL15, and FLT1 (p = 6.76 × 10-5 - 5.97 × 10-3). Five discriminatory biomarkers with the largest LASSO coefficients and each with AUCs of >0.75 (FAHD2A, TCEAL3, TWF1, MMUT, and NTPCR) were identified. The combined five-protein model achieved a bootstrap-corrected AUC of 0.94. A combined analysis of TCGA and GTEx databases showed TWF1 overexpression in pancreatic cancer (p = 2.22 × 10-16) that was associated with poor prognosis (p = 0.0063). The present study identified several cyst fluid proteins (particularly TWF1) that are predictive of malignant pancreatic cyst lesions. If validated in other patient populations, these biomarkers may enhance the accuracy of the preoperative detection of high-risk IPMN and thereby improve patient outcomes.

PRPS activity tunes redox homeostasis in Myc-driven lymphoma

Myc hyperactivation coordinately regulates numerous metabolic processes to drive lymphomagenesis. Here, we elucidate the temporal and functional relationships between the medley of pathways, factors, and mechanisms that cooperate to control redox homeostasis in Myc-overexpressing B cell lymphomas. We find that Myc overexpression rapidly stimulates the oxidative pentose phosphate pathway (oxPPP), nucleotide synthesis, and mitochondrial respiration, which collectively steers cellular equilibrium to a more oxidative state. We identify Myc-dependent hyperactivation of the phosphoribosyl pyrophosphate synthetase (PRPS) enzyme as a primary regulator of redox status in lymphoma cells. Mechanistically, we show that genetic inactivation of the PRPS2 isozyme, but not PRPS1, in Myc-driven lymphoma cells leads to elevated NADPH levels and reductive stress-mediated death. Employing a pharmacological screen, we demonstrate how targeting PRPS1 or PRPS2 elicits opposing sensitivity or resistance, respectively, to chemotherapeutic agents affecting the thioredoxin and glutathione network, thus providing a therapeutic blueprint for treating Myc-driven lymphomas.

Electrochemical biosensors for hepatocellular carcinoma

The current review analyzes progress in electrochemical detection techniques for hepatocellular carcinoma biosignatures, highlighting their potential to enhance the timely detection and management of hepatocellular carcinoma. In this study, the authors explore the present state of hepatocellular carcinoma biosignatures, encompassing conventional proteins such as alpha-fetoprotein and promising biosignatures like non-coding RNAs and circulatory tumor DNA (ctDNA). This text analyzes the principles of electrochemical biosensing and explores sophisticated sensor designs employing surface modification techniques, innovative recognition elements, and nanomaterials. Particular focus is directed towards aptamer-based sensors, microfluidic technologies, and label-free methodologies. Herein, recent advancements in enhancing sensitivity and specificity are discussed, with some platforms reaching a threshold at the femtogram scale. The discussion also encompasses the progress achieved in point-of-care applications and the obstacles faced in transitioning experimental paradigms to medical applications. The prospective influence of these methodologies on medical results is under evaluation, emphasizing early detection and tailored treatment approaches. Future research should focus on creating advanced, integrated detection systems and conducting comprehensive clinical validation studies to assess the real-world effectiveness of electrochemical biosensors.

Drug metabolizing enzymes and transporters, and their roles for the development of drug-induced liver injury

INTRODUCTION

Drug-induced liver injury (DILI) poses a significant challenge to drug development and human healthcare. The complex mechanisms underlying DILI make it challenging to accurately predict its occurrence, often leading to substantial financial losses from failed drug development projects and drug withdrawals. Growing evidence suggests that drug-metabolizing enzymes and transporters (DMETs) play a critical role in the development of DILI.

AREAS COVERED

In this review, we explore findings about the contributions of DMETs to DILI, with a focus on the studies examining genetic polymorphisms and their interactions with drugs. Additionally, we highlight the roles of DMETs in the development of predictive models for assessing DILI potential and in uncovering the mechanisms involved in DILI.

EXPERT OPINION

As new approach methods (NAMs) for assessing and predicting drug toxicity gain more prominence, it is imperative to better understand the adverse outcome pathways (AOPs) that underpin these methods. DMETs largely play a pivotal role in the molecular initiating events of DILI-related AOPs. Further research is needed to characterize DILI-related AOP networks and enhance the predictive performance of NAMs for assessing DILI risk.

Impact of Fungal Co-Infection on Teicoplanin Plasma Trough Concentration in Critically Ill Adults: A Novel Consideration for Dose Adjustment

Objective

The pathophysiology and disease status of critically ill patients have a significant impact on the pharmacokinetics/pharmacodynamics (PK/PD) of antimicrobial agents. However, the effect of fungal co-infection on the plasma trough concentration (Cmin) of teicoplanin in critically ill patients remains unclear.

Materials and Methods

A retrospective cohort study was carried out. Clinical data of patients admitted to the intensive care unit and receiving teicoplanin therapeutic drug monitoring were collected. Multiple linear stepwise regression analysis and binary logistic regression analysis were used to identify the factors influencing teicoplanin Cmin and the achievement of the target Cmin (≥15.0 μg/mL).

Results

A total of 404 teicoplanin Cmin values from 231 patients were included. The mean teicoplanin Cmin was 20.63 ± 10.40 μg/mL, and the percentage of Cmin > 30.0 μg/mL was 15.8%. In the multivariate analysis, fungal co-infection was identified as an independent factor affecting teicoplanin Cmin (B=4.056, 95% CI 2.089-6.023; p<0.001) and the attainment of the target Cmin (OR=3.233, 95% CI 1.538-6.795; p=0.002). Sex, weight, teicoplanin dose, levels of direct bilirubin, blood urea nitrogen, estimated glomerular filtration rate, and uric acid were also found to be influencing factors. Patients with fungal co-infection had a higher teicoplanin Cmin (p<0.001) and a higher percentage of Cmin > 30.0 μg/mL (20.3% vs 12.0%; p=0.022) compared to those without, despite similar teicoplanin doses (p=0.302). The percentage of patients receiving continuous renal replacement therapy was higher in the fungal co-infection cohort (p=0.016), along with an older age and a lower body weight.

Conclusion

For critically ill patients with fungal co-infections, the teicoplanin dose should be decreased, or at least not increased. This is essential for reducing the potential risk of toxicity and customizing dosing strategies to meet individual patient needs. A large-scale, multi-center, prospective study is necessary to confirm the findings related to this dosing approach.

Pharmacokinetic Profile of Two Active Dipyrone Metabolites, 4-Methylaminoantipyrine (MAA) and 4-Aminoantipyrine (AA), Following Intravenous Administration in Dogs: A Preliminary Study

This study aimed to determine the pharmacokinetic profile of the active dipyrone metabolites, 4-methylaminoantipyrine and 4-aminoantipyrine, following intravenous administration in dogs. Eleven mixed-breed dogs received a 25 mg·kg-1 dipyrone dose and blood samples were collected at 0, 5, 15, 30 and 45 min, as well as at 1, 1.5, 2, 4, 6, 8, 10, 12, 24, 36 and 48 h. Plasma concentrations of both metabolites were analyzed by ultra-performance liquid chromatography coupled to mass spectrometry. The PKSolver 2.0 and GraphPad Prisma 10 software programs were used for pharmacokinetic and statistical analyses, applying a Principal Component Analysis for MAA and descriptive statistics for both metabolites. Two groups were noteworthy concerning MAA: slow metabolizers (SM) and normal/rapid metabolizers (NM). Significant differences were observed between half-life (T½) and MRT0_inf obs values between the MAA groups. The T½ and MRT0_info obs were 44.44 ± 11.74 and 32.62 ± 16.53 h for the SM group and 11.25 ± 5.37 and 7.44 ± 4.25 h for the NM group, respectively. The Cmax of AA was 2.80 ± 1.43 µg mL-1. Metabolites were detectable for 48 h in all animals for MAA and seven for AA. These findings suggest that metamizole reaches analgesia plasma concentrations associated with cyclooxygenase inhibition with few adverse effects in dogs. However, additional pharmacogenetic and pharmacotherapeutic monitoring studies are required.

A High Performing Biomarker Signature for Detecting Early-Stage Pancreatic Ductal Adenocarcinoma in High-Risk Individuals

Background/Objectives: Early detection of pancreatic cancer can improve patient survival, and blood-based biomarkers to aid in this are a significant need. The goal of this study was to develop and evaluate the performance of a 4- to 6-plex biomarker signature for detection of early-stage pancreatic ductal adenocarcinoma (PDAC) that performs well in high-risk controls. Methods: Enzyme-linked immunosorbent assays were used to measure 10 previously identified serum protein biomarker candidates in Stage I and II PDAC cases (n = 128), high-risk controls (n = 465), and normal-risk controls (n = 30). Various combinations of biomarker candidates (models) were trained using machine learning and tested for robustness in differentiating cases from controls on the full cohort and in clinically relevant sub-types including those with diabetes, those ≥65 years of age, and low producers of carbohydrate antigen 19-9 (CA 19-9). Results: At 98% specificity, the top performing model, which was comprised of tissue inhibitor of metalloproteinase 1 (TIMP1), intracellular adhesion molecule 1 (ICAM1), thrombospondin 1 (THBS1), cathepsin D (CTSD), and CA 19-9, achieved 85% sensitivity in the full cohort and sensitivities of 91% in diabetics, 90% in ≥65 years of age, and 60% in low CA 19-9 producers. This model demonstrated significantly higher sensitivity in detecting PDAC in the full cohort and all sub-populations compared to CA 19-9 alone (p < 0.001). Conclusions: Our findings demonstrate the feasibility of a blood-based assay for detecting early-stage PDAC in high-risk individuals and key sub-populations, representing an important step towards improving diagnostic success for early-stage disease.

Method Validation for the Determination of Nicotine and Nicotine Metabolite Levels in Urine, Serum, and Saliva Samples

Monitoring nicotine and its metabolites in bodily fluids is crucial for assessing tobacco exposure and related toxicity in clinical practice. Due to its high sensitivity for detecting low-level analytes, liquid chromatography-tandem mass spectrometry (LC-MS/MS) was employed to enhance a robust and accurate analytical procedure for quantifying nicotine and its derivatives in serum, urine, and saliva. Comparative analysis was conducted on samples collected from individuals with and without smoking habits. The LC-MS/MS method utilized an API 3200 triple quadrupole instrument paired with a Phenomenex Luna C18 column. Method sensitivity was demonstrated through evaluation of sensitivity parameters, including LOD and LLOQ for each analyte in all matrices. Inter-assay variability and bias values at the LLOQ level were kept below 20%. In serum, the LOD-LLOQ ranges were 0.02-0.05 μg/L for nicotine, 0.32-0.95 μg/L for cotinine, 0.07-0.25 μg/L for 3-OH cotinine, and 0.22-0.69 μg/L for norcotinine. In urine, the respective values were 0.03-0.10, 0.23-0.82, 0.06-0.14, and 0.20-0.55 μg/L, and in saliva, the values were 0.12-1.59, 0.22-2.34, 0.10-0.17, and 0.33-3.01 μg/L. The proposed method is efficient, specific, and adaptable to routine clinical workflows, providing a valuable tool for monitoring tobacco-related exposure.

Optimization of HPLC method for metanephrine and normetanephrine detection in urine: Enhancing diagnostic precision for pheochromocytoma

Catecholamines and their metabolites play critical physiological roles in the human body. Paragangliomas and pheochromocytomas are rare adrenal tumors that significantly alter catecholamine metabolism, particularly the concentrations of metanephrine (MN) and normetanephrine (NMN). This study presents the development and validation of a rapid and straightforward analytical method using reverse-phase high-performance liquid chromatography (RP-HPLC) coupled with a photodiode array (PDA) detector for quantifying MN and NMN in 24-h urine samples. Sample preparation involved adding 1 mL of urine to a tube containing the internal standard 3-methoxy-4-hydroxy benzylamine hydrochloride (MHBA) and a 2 g/L solution of 2-aminoethyl-diphenylborinate. After vortex mixing and centrifugation, ethyl acetate was used for extraction, and the organic layer was dried under nitrogen at 50-60 °C before reconstitution in the mobile phase. Chromatographic separation was achieved on an RP C-18 column with an isocratic flow of the mobile phase (sodium dihydrogen phosphate, citric acid monohydrate, acetonitrile, and sodium octyl sulfate). Detection was performed at 347 nm, with peak identification based on standard retention times. The method was validated for linearity (10-2000 ng/mL), recovery, sensitivity, precision, accuracy, selectivity, carryover, stability, and dilution effects. It showed a strong correlation coefficient (>0.99) and accuracy within ± 15 %. Inter- and intra-day precision confirmed the method reliability. This validated technique is suitable for clinical and research applications involving catecholamine metabolite screening.

Supportive care for systemic amyloidosis: International Society of Amyloidosis (ISA) expert panel guidelines

Systemic amyloidosis refers to a group of protein misfolding disorders resulting in organ deposition with amyloid, leading to organ dysfunction, ultimately resulting in organ failure and death if not successfully treated. Treatment is type-specific and aimed at the underlying source of the misfolded protein. In the past decades, treatments have become increasingly available across the various amyloidosis types with improved response rates and longer survival. Supportive care measures are an integral part of care for patients with systemic amyloidosis to improve symptom burden and quality of life, reduce healthcare costs, and potentially prolong survival while type-directed therapy takes effect. In these guidelines, we provide supportive care recommendations across eight areas of interest in systemic amyloidosis: cardiology, nephrology, peripheral neuropathy, central nervous system involvement, autonomic neuropathy, gastroenterology, coagulopathy and bleeding, nutrition and hematology. These guidelines were developed on behalf of the International Society of Amyloidosis (ISA) by experts in the above fields and provide the best available evidence and expertise for supportive care in these rare disorders.

Generating New Meniscus Therapies via Recent Breakthroughs in Development, Model Systems, and Clinical Diagnostics

Over 850,000 surgeries are performed to treat meniscal injuries each year in the United States. Even with repair, patients are likely to develop osteoarthritis (OA) within the next two decades. There is a pressing clinical need to improve meniscal repair procedures to restore tissue function and prevent joint degeneration later in life. Here we present a review of recently published articles (2020-2024) spanning basic science, translational, and clinical studies to highlight new advances in meniscus research across development, animal models, finite element models, and clinical interventions. Key progenitor cell populations and vascularity changes have been identified in human meniscus tissue development, aging, and degeneration with implications for novel tissue repair strategies. The use of animal and finite element models has expanded our understanding of meniscus tissue function and evaluated new therapies in preclinical studies. Further, advances in clinical diagnostics with machine learning models and surgical techniques have shed light on evidence-based practices for improving patient outcomes. We discuss across multiple length scales (micro-, meso-, macro-) the structure-function relationship of the meniscus in development and disease, recent advances in models and tools to study the meniscus, knowledge gaps in the field, persisting challenges in clinical treatments and assessments, and the translation of basic science therapies into the clinic.

Correlation between dexmedetomidine and postoperative sleep quality in older patients undergoing intestinal surgery

OBJECTIVE

This study examined the correlation between dexmedetomidine and postoperative sleep quality in older patients following intestinal surgery.

METHODS

A total of 112 older patients were randomly assigned to receive either saline (Group A) or dexmedetomidine (Group B). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) before surgery and on postoperative days 1, 3, 7 and 30. Urinary melatonin and cortisol levels were measured, and pain intensity was assessed using the Visual Analogue Scale (VAS) at various time points. Logistic regression analysis identified factors influencing postoperative sleep quality.

RESULTS

Both groups showed increased PSQI scores postoperatively, with Group A scoring higher than Group B. Group B exhibited a significantly lower incidence of sleep disorders on Days 1 and 3. Urinary melatonin levels decreased in both groups, with Group A showing lower levels, while cortisol concentrations increased, particularly in Group A. Higher VAS scores were also noted in Group A. Patients not receiving dexmedetomidine had a greater prevalence of sleep disorders. Logistic regression revealed dexmedetomidine dosage, gender and VAS scores at 24 h as significant factors affecting sleep quality.

CONCLUSIONS

Dexmedetomidine enhances postoperative sleep quality in older patients undergoing intestinal surgery by reducing cortisol levels, increasing melatonin production and effectively alleviating pain, thereby supporting better recovery outcomes.

Spatial gene regulatory networks driving cell state transitions during human liver disease

Liver fibrosis is a major cause of death worldwide. As a progressive step in chronic liver disease, fibrosis is almost always diagnosed too late with limited treatment options. Here, we uncover the spatial transcriptional landscape driving human liver fibrosis using single nuclei RNA and Assay for Transposase-Accessible Chromatin (ATAC) sequencing to deconvolute multi-cell spatial transcriptomic profiling in human liver cirrhosis. Through multi-modal data integration, we define molecular signatures driving cell state transitions in liver disease and define an impaired cellular response and directional trajectory between hepatocytes and cholangiocytes associated with disease remodelling. We identify pro-fibrogenic signatures in non-parenchymal cell subpopulations co-localised within the fibrotic niche and localise transitional cell states at the scar interface. This combined approach provides a spatial atlas of gene regulation and defines molecular signatures associated with liver disease for targeted therapeutics or as early diagnostic markers of progressive liver disease.

Prediction of lymph node metastasis in papillary thyroid carcinoma using non-contrast CT-based radiomics and deep learning with thyroid lobe segmentation: A dual-center study

Objectives

This study aimed to develop a predictive model for lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) patients by deep learning radiomic (DLRad) and clinical features.

Methods

This study included 271 thyroid lobes from 228 PTC patients who underwent preoperative neck non-contrast CT at Center 1 (May 2021-April 2024). LNM status was confirmed via postoperative pathology, with each thyroid lobe labeled accordingly. The cohort was divided into training (n = 189) and validation (n = 82) cohorts, with additional temporal (n = 59 lobes, Center 1, May-August 2024) and external (n = 66 lobes, Center 2) test cohorts. Thyroid lobes were manually segmented from the isthmus midline, ensuring interobserver consistency (ICC ≥ 0.8). Deep learning and radiomics features were selected using LASSO algorithms to compute DLRad scores. Logistic regression identified independent predictors, forming DLRad, clinical, and combined models. Model performance was evaluated using AUC, calibration, decision curves, and the DeLong test, compared against radiologists' assessments.

Results

Independent predictors of LNM included age, gender, multiple nodules, tumor size group, and DLRad. The combined model demonstrated superior diagnostic performance with AUCs of 0.830 (training), 0.799 (validation), 0.819 (temporal test), and 0.756 (external test), outperforming the DLRad model (AUCs: 0.786, 0.730, 0.753, 0.642), clinical model (AUCs: 0.723, 0.745, 0.671, 0.660), and radiologist evaluations (AUCs: 0.529, 0.606, 0.620, 0.503). It also achieved the lowest Brier scores (0.167, 0.184, 0.175, 0.201) and the highest net benefit in decision-curve analysis at threshold probabilities > 20 %.

Conclusions

The combined model integrating DLRad and clinical features exhibits good performance in predicting LNM in PTC patients.

Nutritional Deficiencies and Management in Tuberculosis: Pharmacotherapeutic and Clinical Implications

Tuberculosis is an infectious condition caused by Mycobacterium tuberculosis, primarily targeting the pulmonary system, with the potential to disseminate to various other organs via the haematogenous pathway, ranking among the top ten causes of global mortality. Tuberculosis remains a serious public health problem worldwide. This narrative review aims to emphasise the clinical importance of the inter-relationships between nutrition, pharmacotherapy, and the most common drug-nutrient interactions in the context of tuberculosis and multi-drug-resistant tuberculosis management. Nowadays, pharmacologic approaches utilise polytherapeutic regimens that, although showing increased efficacy, prominently affect the nutritional status of patients and modify multiple metabolic pathways, thus influencing both the effectiveness of therapy and the patient outcomes. There is much evidence that antituberculosis drugs are associated with deficiencies in essential vitamins and various micronutrients, leading to serious adverse consequences. Moreover, poor nutrition exacerbates TB outcomes, and TB further exacerbates nutritional status, a vicious cycle that is particularly prevalent in low-resource environments. Nutritional support is necessary, and clinicians ought to evaluate it on a patient-by-patient basis, as empirical evidence has shown that it can improve immune recovery, decrease tuberculosis-associated morbidity, and increase adherence to therapy. However, drug-food interactions are increasingly prevalent, and patients with tuberculosis require personalised dietary and pharmacological regimens. In this context, antituberculosis treatment requires a holistic approach, based on the collaboration of the prescribing physician, pharmacist, and nutritionist, to assess the patient's needs from a nutritional and pharmacological perspective, with the ultimate goal of decreasing mortality and improving the prognosis of patients through personalised therapies.

Endoscopic Ultrasound-Guided Pancreatic Cystic Fluid Biochemical and Genetic Analysis for the Differentiation Between Mucinous and Non-Mucinous Pancreatic Cystic Lesions

Pancreatic cystic lesions (PCLs) are increasingly identified via computerized tomography (CT) and magnetic resonance (MR), with a prevalence of 2-45%. Distinguishing mucinous PCLs (M-PCLs), which include intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) that can progress to pancreatic ductal adenocarcinoma, from non-mucinous PCLs (NM-PCLs) is essential. Carcinoembryonic antigen (CEA) remains widely used but often demonstrates limited sensitivity and specificity. In contrast, endoscopic ultrasound-guided measurement of intracystic glucose more accurately differentiates PCL subtypes, as tumor-related metabolic changes lower cyst fluid glucose in mucinous lesions. Numerous prospective and retrospective studies suggest a glucose cut-off between 30 and 50 mg/dL, yielding a sensitivity of 88-95% and specificity of 76-91%, frequently outperforming CEA. Additional benefits include immediate point-of-care assessment via standard glucometers and minimal interference from blood contamination. DNA-based biomarkers, including KRAS and GNAS mutations, enhance specificity (up to 99%) but exhibit moderate sensitivity (61-71%) and necessitate specialized, expensive platforms. Molecular analyses can be crucial in high-risk lesions, yet their uptake is constrained by technical challenges. In practice, combining glucose assessment with targeted molecular assays refines risk stratification and informs the choice between surgical resection or active surveillance. Future investigations should establish standardized glucose thresholds, improve the cost-effectiveness of genetic testing, and integrate advanced biomarkers into routine protocols. Ultimately, these strategies aim to optimize patient management, limit unnecessary interventions for benign lesions, and ensure timely therapy for lesions at risk of malignant transformation.

Proteomic profiling reveals common and region-specific protein signatures underlying tumor heterogeneity in cholangiocarcinoma

Cholangiocarcinoma (CCA), a neoplasm arising from biliary epithelial cells, is particularly widespread in Southeast Asia, with northeastern Thailand exhibiting the greatest prevalence attributed to Opisthorchis viverrini infection. This malignancy exhibits considerable molecular heterogeneity, leading to therapeutic resistance and recurrence. Comprehending its molecular mechanisms is essential for enhancing diagnostic and treatment approaches. Our research utilized multi-region LC-MS/MS proteomic analysis to investigate intratumor heterogeneity (ITH) in CCA. We examined 52 tumor areas and 13 neighboring tissues from 13 patients, concentrating on protein profiling, pathway analysis, differential protein expression, and the identification of shared and unique protein signatures. The findings indicated considerable inter-patient proteome variability, characterized by markedly distinct protein expressions among individuals, aligning with prior cancer research. Intra-tumor heterogeneity was apparent, with merely 18 proteins common to all tumor areas and patients, underscoring the intricacy of CCA. Significantly, the common proteins were associated with metabolic reprogramming and oxidative stress pathways, indicating possible indicators and therapeutic targets. This work highlights the significant proteome variability in CCA at both intra-tumor and inter-patient levels, underscoring the necessity for customized therapeutic approaches to tackle the disease's complexity and improve treatment outcomes.

Endocrine-disrupting chemicals as prostate carcinogens

Endocrine-disrupting chemicals (EDCs) are natural or synthetic compounds that are ubiquitous in the environment and in daily-usage products and interfere with the normal function of the endocrine system leading to adverse health effects in humans. Exposure to these chemicals might elevate the risk of metabolic disorders, developmental and reproductive defects, and endocrine-related cancers. Prostate cancer is the most common hormone-dependent cancer in men, and the fifth leading cause of cancer-related mortality, partly owing to a lack of knowledge about the mechanisms that lead to aggressive castration-resistant forms. In addition to the dependence of early-stage prostate cancer on androgen actions, the prostate is a target of oestrogenic regulation. This hormone dependence, along with the fact that exogenous influences are major risk factors for prostate cancer, make the prostate a likely target of harmful actions from EDCs. Various sources of EDCs and their different modes of action might explain their role in prostate carcinogenesis.

Understanding Glycogen Storage Disease Type IX: A Systematic Review with Clinical Focus-Why It Is Not Benign and Requires Vigilance

BACKGROUND/OBJECTIVES

Glycogen storage disease type IX (GSD IX) is a group of inherited metabolic disorders caused by phosphorylase kinase deficiency affecting the liver or muscle. Despite being relatively common among GSDs, GSD IX remains underexplored.

METHODS

A systematic review of GSD IX was conducted per PRISMA guidelines using SCOPUS and PubMed, registered with PROSPERO. Inclusion focused on human clinical studies published up to 31 December 2024.

RESULTS

A total of 400 patients with GSD IX were analyzed: 274 IXa (mean age at diagnosis 5.1 years), 72 IXc (mean age at diagnosis 4.9 years), 39 IXb (mean age at diagnosis 4.2 years), and 15 IXd (mean age at diagnosis 44.9 years). Hepatomegaly was commonly reported in types IXa, IXb, and especially IXc (91.7%), but was rare in IXd. Elevated transaminases were frequently observed in types IXa, IXb, and particularly IXc, while uncommon in IXd. Fasting hypoglycemia was occasionally observed in types IXa and IXb, more frequently in IXc (52.7%), and was not reported in IXd. Growth delay or short stature was observed in a substantial proportion of patients with types IXa (43.8%), IXb, and IXc, but was rare in IXd. Muscle involvement was prominent in IXd, with all patients showing elevated CPK (mean 1011 U/L). Neurological involvement was infrequently reported in types IXa and IXc.

CONCLUSIONS

This systematic review includes the most extensive clinical case history of GSD IX described in the literature. The clinical spectrum of GSD IX varies widely among subtypes, with IXc being the most aggressive. While liver forms are generally present in early childhood, muscle-type IXd shows delayed onset and milder symptoms, often leading to diagnostic delays. For diagnosis, it is essential not to underestimate key clinical features such as hepatic involvement and hypoglycemia in a child under 5 years of age. Other manifestations, including the as-yet unexplored systemic involvement of bone and kidney, remain insufficiently understood and require further investigation. Next-generation sequencing has improved diagnostic precision over traditional biopsy. Dietary management, including uncooked cornstarch, Glycosade®, and high-protein intake, remains the cornerstone of treatment. However, there is a paucity of well-designed, evidence-based studies to determine the most effective therapeutic approach. Despite its historically perceived benign course, the broad phenotypic variability of GSD IX, including progressive liver involvement and potential neurological complications, highlights its substantial clinical relevance and underscores the need for accurate diagnostic classification and long-term multidisciplinary follow-up.

Proactive Drug Monitoring Versus Clinically Based Dosing for Endoscopic Healing in Pediatric Crohn's Disease Receiving Infliximab

BACKGROUND & AIMS

Proactive dosing based on therapeutic drug monitoring (TDM) of adalimumab is associated with higher rates of sustained corticosteroid-free clinical remission (SCFCR) in children with Crohn's disease (CD) than that with reactive TDM. We aimed to investigate whether proactive dosing of infliximab (IFX) based on TDM is associated with higher rates of endoscopic healing (EH) in pediatric patients with CD than that with clinically based dosing.

METHODS

We conducted a non-blinded, randomized controlled trial of 112 biologic-naïve children with CD who had responded to IFX induction treatment at 4 centers in South Korea between July 2017 and November 2020. Patients were randomly assigned to receive dosing based on proactive TDM (proactive arm) or clinically based dosing (clinical arm). The primary endpoint was EH at week 54.

RESULTS

The primary endpoint was achieved in 80.0% (40/50) of the proactive arm and 57.1% (28/49) of the clinical arm (P = .025). SCFCR was achieved in 69.6% (39/56) of the clinical arm and 89.3% (50/56) of the proactive arm at week 54 of treatment (P = .019). According to the multivariate logistic regression analysis, the intervention group (proactive arm vs clinical arm) was an independent factor associated with EH (odds ratio, 3.48; 95% confidence interval, 1.26-10.43; P = .019) and SCFCR (odds ratio, 5.50; 95% confidence interval, 1.72-21.61; P = .007).

CONCLUSIONS

Dosing based on proactive TDM was superior to clinically based dosing in terms of EH in a randomized controlled trial of pediatric CD. Trial identifier: cris.nih.go.kr: KCT0005190.

Challenges in Adapting Fibre Optic Sensors for Biomedical Applications

Fibre optic sensors (FOSs) have developed as a transformative technology in healthcare, often offering unparalleled accuracy and sensitivity in monitoring various physiological and biochemical parameters. Their applications range from tracking vital signs to guiding minimally invasive surgeries, enabling advancements in medical diagnostics and treatment. However, the integration of FOSs into biomedical applications faces numerous challenges. This article describes some challenges for adopting FOSs for biomedical purposes, exploring technical and practical obstacles, and examining innovative solutions. Significant challenges include biocompatibility, miniaturization, addressing signal processing complexities, and meeting regulatory standards. By outlining solutions to the stated challenges, it is intended that this article provides a better understanding of FOS technologies in biomedical settings and their implementation. A broader appreciation of the technology, offered in this article, enhances patient care and improved medical outcomes.

Genetic Etiology of Permanent Congenital Hypothyroidism in Korean Patients: A Whole-Exome Sequencing Study

Congenital hypothyroidism (CH) is among the most common endocrine disorders in neonates. Genetic testing is essential for elucidating the underlying etiology, especially in cases of permanent CH. We enrolled 32 patients diagnosed with permanent CH from the Pediatric Endocrinology Clinics at Jeju National University Hospital and Soonchunhyang University Cheonan Hospital. Whole-exome sequencing (WES) was performed on genomic DNA extracted from buccal swabs. Variants were classified according to guidelines established by the American College of Medical Genetics and Genomics (ACMG) and the Association for Molecular Pathology (AMP). WES identified 21 distinct genetic variants in 20 of the 32 patients (62.5%), spanning 6 CH-related genes: DUOX2, DUOXA2, TPO, PAX8, TG, and TSHR. Of these, 12 variants classified as pathogenic or likely pathogenic were detected in 15 patients (50%). When classified by inheritance patterns, nine patients had either homozygous (n = 1) or compound heterozygous (n = 8) variants, four patients exhibited oligogenic variants, and two patients carried a single heterozygous variant with pathogenicity. The most frequently affected gene was DUOX2, with pathogenic or likely pathogenic variants found in six patients. Notably, none of the six patients with thyroid agenesis or ectopic thyroid glands harbored detectable pathogenic variants. Our findings underscore the critical role of genetic analysis in determining the etiology of permanent CH. Whole-exome sequencing demonstrated a high prevalence of pathogenic variants, particularly in DUOX2, in Korean patients with CH. These data enhance our understanding of the genetic architecture of CH and have important implications for personalized treatment and genetic counseling.

Bedaquiline does not enhance a clofazimine-azithromycin-ethambutol regimen against Mycobacterium avium in the hollow-fiber system

Bedaquiline has been proposed as a second-line drug to treat pulmonary disease caused by Mycobacterium avium complex. Based on in vitro synergy and interactions, a logical regimen would combine bedaquiline and clofazimine as additions to an ethambutol-azithromycin backbone. Here, we evaluate the added benefit of bedaquiline in a regimen of azithromycin, ethambutol, and clofazimine. THP-1 cells infected with M. avium ATCC 700898 were seeded in a hollow-fiber model and exposed to a regimen of azithromycin, ethambutol, and clofazimine with or without bedaquiline for 3 weeks. Epithelial lining fluid pharmacokinetic profiles of azithromycin and ethambutol were simulated, while an average steady-state concentration was sought for clofazimine and bedaquiline. Pharmacokinetics and pharmacodynamics were monitored throughout the experiment. Both regimens led to sustained bacterial killing (both intracellular and extracellular) throughout the experiment. No difference in kill rate was observed between the two therapies. The extracellular kill rate for the 3-drug regimen was 0.65 (95% CI 0.63-0.67) and for the 4-drug regimen 0.65 (95% CI 0.64-0.67). The intracellular kill rate was 0.48 (95% CI 0.46-0.50) for the 3-drug regimen and 0.48 (95% CI 0.46-0.50) for the 4-drug regimen. Macrolide-tolerant subpopulations were observed with both treatment regimens at day 21. Bedaquiline does not add killing activity to a clofazimine-ethambutol-azithromycin regimen and did not improve suppression of the emergence of macrolide resistance, which makes its role as a second-line agent doubtful.

Cubebin alleviates chronic stress-induced depression-like behavior in mice by regulating the gut microbiome

The gut-brain axis is dysregulated as a consequence of alterations in the gut microbiota. These alterations increase toxic microbial metabolites, endotoxemia, and the release of immune mediators and contribute to the development of depression. Cubebin is a dibenzyl butyrolactone lignan, and its stem is also known as Agaru in Tibetan areas, it is commonly used as a sedative and tranquilizing medicine. This study aimed to investigate the effects of cubebin on chronic stress-induced depression-like behavior in mice. Cubebin was observed to mitigate depressive-like behavior in chronic unpredictable mild stress (CUMS) mice, influence the restoration of their cerebral cortex and hippocampal tissue morphology, and enhance the abundance of relevant intestinal flora in depression model mice, particularly by decreasing the abundance of Clostridium, Dorea, and Ruminococcus. The final protein function expression was normalized by regulating depression-related metabolic pathways. Concomitantly, the concentrations of neurotransmitters serotonin (5-HT), norepinephrine (NE), and dopamine (DA) in the brains of mice in the model group were enhanced, and their depressive symptoms were mitigated. Our study findings suggest that cubebin may ameliorate CUMS-induced depression in mice by modulating the microbe-gut-brain axis, elucidating the key effect of gut metabolites on depressive symptoms.

Clinical Efficacy of Serum Antiglycopeptidolipid Core IgA Antibody Test for Screening Nontuberculous Mycobacterial Pulmonary Disease in Bronchiectasis: A European Multicenter Cohort Study

BACKGROUND

The serum antiglycopeptidolipid core IgA antibody test has been proposed as a diagnostic tool for Mycobacterium avium complex pulmonary diseases. Cross-reactivity with other nontuberculous mycobacteria (NTM), including Mycobacterium abscessus, indicates that it may have a role as a broader screening test for nontuberculous mycobacterial pulmonary disease (NTM-PD). NTM-PD is believed to be underdiagnosed in patients with bronchiectasis.

RESEARCH QUESTION

Can the serum antiglycopeptidolipid core IgA antibody test be used to screen for NTM-PD in bronchiectasis?

STUDY DESIGN AND METHODS

Patients from the prospective European Bronchiectasis Registry (European Multicentre Bronchiectasis Audit and Research Collaboration-Bronchiectasis Research Involving Databases, Genomics and Endotyping; ClinicalTrails.gov Identifier: NCT03791086) were enrolled. Patients from the United Kingdom, Italy, Spain, Belgium, The Netherlands, and Germany were included. A control cohort of patients without any underlying lung disease also was recruited. The levels of serum IgA antibodies against the glycopeptidolipid core were measured using an enzyme immunoassay kit, and receiver operating characteristics curve analysis was conducted to evaluate the accuracy of the antibody level in screening for NTM-PD.

RESULTS

Two hundred eighty-two patients were enrolled (151 female patients [53.6%]; median age, 68 years). Median antiglycopeptidolipid core IgA antibody levels were 0.2 U/mL (interquartile range [IQR], 0.1-0.3 U/mL) in patients without NTM isolation and NTM-PD (n = 238), 0.3 U/mL (IQR, 0.2-0.4 U/mL) in patients with NTM isolation that was incompatible with the diagnosis of NTM-PD (n = 18), and 1.5 U/mL (IQR, 0.4-6.2 U/mL) in patients with NTM-PD (n = 26; P = .0001). Antibody levels showed excellent accuracy in identifying patients with NTM-PD (area under the receiver operating characteristic curve, 0.886; 95% CI, 0.800-0.973) in the bronchiectasis cohort and also showed excellent discrimination of patients with NTM-PD from those with NTM isolation who did not meet the diagnostic criteria for NTM-PD (0.816; 95% CI, 0.687-0.945).

INTERPRETATION

The antiglycopeptidolipid core IgA antibody demonstrated excellent efficacy in screening for NTM-PD in a large cohort of patients with bronchiectasis.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT03791086; URL: www.

CLINICALTRIALS

gov.

Newborn screening follow-up for very long-chain acyl-CoA dehydrogenase deficiency in Colorado: Working towards a standardized protocol

Very long chain acyl-CoA dehydrogenase deficiency (VLCADD) is an autosomal recessive fatty acid β-oxidation disorder that has been identified by newborn screening (NBS) in most states since the early 2000s. Despite over 20 years of experience, there are aspects of VLCADD NBS that remain challenging. We conducted a retrospective chart review of abnormal NBS for VLCADD in Colorado between 2017 and 2023. We analyzed confirmatory plasma acylcarnitine profiles (P-ACP), genetic sequencing of ACADVL, Collaborative Laboratory Integrated Reports (CLIR) scores, patient enzyme analysis of VLCAD, and cell-based variant expression analysis. A real-world "Clinical Designation" was then compared to a variety of algorithms trialed on the data. Of the 67 infants with abnormal screens during this timeframe, 5 (7 %) had a Clinical Designation of affected, 4 (6 %) remained unclassified, and 58 (87 %) were discharged based on a designation of unaffected. A Kruskal-Wallis rank sum test showed the biomarker with the best discrimination between affected and unaffected individuals was C14:1/C12:1 [chi-squared 10.4 (p = 0.001)]. The highest performing algorithm was (Molecular testing + cell-based expression) + (P-ACP C14:1 OR P-ACP C14:1/C12:1). Excluding the missing data, this algorithm showed 96 % (46 of 48) agreement with the Clinical Designation. We conclude that there is not a single biomarker that can specifically discern affected from unaffected individuals who screen positive on NBS for VLCADD. Thus, we developed a standardized diagnostic approach to more accurately classify patients that starts with the molecular findings and requires at least one of the P-ACP C14:1 or P-ACP C14:1/C12:1 to agree with molecular findings. The algorithm needs to be trialed with a different data set, and will advance the conversation around maximizing benefits and minimizing harms for infants who screen positive for VLCADD.

Study of toxic and essential elemental imbalances at more advance stage of breast carcinoma patients

Delayed diagnosis and limited access to healthcare resources are leading to advanced stage breast carcinoma posing a formidable health challenge to modern medical science. Avoiding the occurrence of breast carcinoma is only possible by ascertaining the risk factors contributing to the progression of this fatal malignancy. Among other factors, exposure to trace elements plays a decisive role in progression of breast carcinoma development. The purpose of this investigation was to evaluate the harmful traces and vital components (Pb, Ca, Mn, Cd, Na, Cr, Cu, Mg, Sr, K, Fe, Zn, Co, Li, Se, Ag, Hg, As, Al and Ni) contents in the blood (n = 161), scalp hair (n = 149) and nails (n = 135) of stage IV breast carcinoma patients and female controls by atomic absorption spectrometry. The results revealed that mean Cr, Cu, Pb and Cd levels were elevated significantly (p < 0.05) in the nails and blood, while Ni, Co, Cr, Pb and Cd levels (p < 0.05) were elevated in the scalp hair of stage IV breast carcinoma patients than the female controls. Based on pathological breast cancer types, Pb and Cd were elevated in invasive ductal carcinoma, while Cu and Co were higher in invasive lobular carcinoma patients. Multivariate analysis was applied for the source of identification and apportionment of toxic trace elements in both donor groups. Most of the factors showed significant differences between the malignant and control groups' dietary, housing, and tobacco use/nonuse behaviors. The correlation analysis revealed significantly different association patterns for toxic trace elements in patients and controls and has an influential effect on cancer risk. Overall, the current study indicates a potential role of toxic trace elements in the development of breast carcinoma and these findings could be significant in the predicting diagnosis/prognosis of breast malignancy.

Multifunctional Conductive Nanofibers for Self-Powered Glucose Biosensors

Electrochemical glucose biosensors are essential for diabetes management, and self-powered systems present an eco-friendly and innovative alternative. Traditional biosensors face several limitations including limited sensitivity, enzyme instability, and dependency on external power sources. Addressing these issues, the study develops a novel multifunctional nanofiber integrating biosensor for glucose detection and a self-powered motion sensor, utilizing an innovative triboelectric nanogenerator (TENG) system. Electrospun nanofibers, composed of graphene oxide (GO), porous graphene (PG), graphene foam (GF), polypyrrole (PPy), and polycaprolactone (PCL), demonstrate enhanced electrical conductivity, triboelectric efficiency, and mechanical strength. Among these, dip-coated nanofibers exhibited the highest conductivity of 4.9 × 10⁻⁵ S/cm, attributed to superior surface electrical properties of GO. PCL/PPy/GO nanofibers achieved the highest glucose detection performance in cyclic voltammetry and differential pulse voltammetry due to efficient electron transfer mechanisms of GO and PPy. Additionally, triboelectric tests revealed peak voltages of 63V with PCL/PPy/GO and polyvinylidene fluoride nanofibers containing glucose oxidase enzyme. Core-sheath and dip-coated nanofibers also demonstrated significant mechanical resilience (∼0.9 N force, ∼350 s durability). These findings highlight PCL/PPy/GO nanofibers as a multifunctional, efficient, and scalable solution, offering highly sensitive glucose detection and non-invasive sweat analysis along with robust energy harvesting for environmentally friendly and advanced diabetes management systems.

Semi-empirical Anticoagulation Model (SAM): Dose prediction during warfarin therapy

Management of oral anticoagulant therapy is essential to ensure a good quality of life for patients. To assist clinicians, several computerized dosing algorithms were developed to determine optimal anticoagulant doses. However, these algorithms have several limitations that can lead to inaccuracies in dosing recommendations. To overcome some of these challenges, this paper proposes a warfarin dose prediction algorithm using individual patient sensitivity analysis. The proposed algorithm is designed to account for factors that influence an individual's response to warfarin, allowing it to more accurately adjust and optimize dosing. It is based on the Semi-empirical Anticoagulation Model (SAM), but has been extended to incorporate stochastic process analysis. This allows the algorithm to assess the probability of events that could change the relationship between the International Normalized Ratio (INR) and the therapy administered. To evaluate the effectiveness of the algorithm, a retrospective observational study of 1796 patients was conducted over one year. The study compared the doses of warfarin administered in clinical practice with those suggested by the algorithm. Percentage Bland-Altman Analysis was used to assess accuracy, which showed that the algorithm had an average accuracy of (3.24±25.80)%. When compared to other algorithms in the literature, which showed an accuracy of (5.73±60.9)%, the proposed algorithm showed significantly better accuracy. The improved accuracy of the proposed algorithm allows for more flexible and precise adjustments to therapy, resulting in an INR closer to the target range with less variability. This ultimately improves patient safety and the overall quality of life for those suffering from venous thromboembolism.

Voriconazole in the treatment of pediatric patients with hematologic malignancies and invasive fungal infections: a real-world study

PURPOSE

To evaluate the factors influencing voriconazole (VRC) administration, clinical efficacy, and safety in children with hematological malignancies (HM) and invasive fungal infection (IFD).

METHODS

This is a single-center, retrospective real-world study conducted between July 2018 and December 2023. Univariate and multivariate logistic regression analysis were used to analyze the affecting factors.

RESULTS

A total of 167 patients were included in this study. Among them, 13.77% (23/167) of children under 2 years old received off-label use of VRC, with an initial maintenance dose higher than that of other groups (P < 0.001). There were 8 cases (4.79%) of cured, 148 cases (88.62%) of improved, and 11 cases (6.59%) of ineffective. Thirty-eight cases experienced adverse drug reactions (ADR), with a highest incidence (10.2%) of hepatotoxicity. The concomitant proton pump inhibitors (PPIs), days of central venous catheterization and coagulopathy were independent influencing factors of ADR. Sixty-six patients underwent therapeutic drug monitoring (TDM), which increased the probability of achieving the target plasma trough concentration (Cmin). Among children < 2 years old underwent TDM, 88.89% (8/9) achieved therapeutic concentration, and the probability was higher than that of the older groups. Days of VRC treatment had a positive but not statistically significant effect on achievement of target Cmin. Hypoalbuminemia and days of antimicrobials treatment were independent influencing factors of Cmin distribution.

CONCLUSION

Attention to the off-label use of VRC in children < 2 years old, hypoalbuminemia and coagulopathy correction, potential drug interactions with VRC, and ADR monitoring is crucial for clinical efficacy and safety.

Jasmine tea extract prevents CUMS-induced depression-like behaviors through the modulation of microbiota-gut-brain axis

Depression is strongly linked to dysfunctions in the microbiota-gut-brain axis. Jasmine tea, a traditional Chinese beverage made by combining green tea with Jasminum sambac, has potential antidepressant effects. However, its potential to alleviate depression via modulation of the microbiota-gut-brain axis remains largely unstudied. In this study, we used a rat model of depression induced by chronic unpredictable mild stress (CUMS) to investigate the effects of jasmine tea extract (JT) on depression-related symptoms. Behavioral assessments, inflammatory marker analysis, hippocampal histology, and brain-derived neurotrophic factor (BDNF) expression assays demonstrated that JT alleviated depressive behaviors, reduced brain tissue damage, and restored cognitive function in CUMS-exposed rats. JT also significantly reduced intestinal levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) and modulated oxidative stress markers (MDA, SOD, and CAT), suggesting a role in preserving intestinal integrity. Further, 16S rRNA sequencing revealed that JT shifted the gut microbiota composition in favor of beneficial bacteria such as Romboutsia, Blautia, and Monoglobus, while decreasing the abundance of potentially harmful bacteria, including Bifidobacterium, Clostridium_sensu_stricto_1, and Escherichia-Shigella. Meanwhile, non-targeted and targeted metabolomics analyses showed that JT influenced key metabolic pathways involving tryptophan, short-chain fatty acids, and bile acids, helping to restore metabolic balance across various tissues (feces, colon, serum, and cerebral cortex) in the depressed rats. These findings indicate that JT may alleviate depression by modulating the microbiota-gut-brain axis, highlighting its potential as a dietary intervention for depression management.

Determination of Glomerular Filtration Rate After Contrast-Enhanced CT Among Critically Ill Patients: Support for a New Procedure

OBJECTIVES

To measure glomerular filtration rate using iohexol plasma clearance (mGFRiohexol) in critically ill patients using the high doses of iohexol administered at CT and to evaluate its agreements with urinary creatinine clearance (uClcr) and estimated glomerular filtration rates (eGFRs), calculated from plasma concentrations of creatinine (eGFRcr) and cystatin C (eGFRcys).

DESIGN

Prospective observational cohort study.

SETTING

ICUs across Southeast Sweden.

PATIENTS

Critically ill adult patients.

INTERVENTIONS AND MEASUREMENTS

Twenty-six ICU patients were given high doses of iohexol (range, 27-140 mL) for contrast-enhanced CT, whereafter blood samples were taken in the elimination phase for determination of mGFRiohexol. Plasma iohexol concentrations were determined by high-performance liquid chromatography and mGFRiohexol was calculated. Standard dose (5 mL) of iohexol was administered the following days to compare low-dose clearance results with the high-dose clearance results. Six-hour uClcr was performed four times a day and averaged.

MAIN RESULTS

Mean ± sd mGFRiohexol after CT was 77.4 ± 38.1 mL/min (n = 26), and uClcr was 97.3 ± 58.2 mL/min (n = 25) in the critically ill patients. There was a strong positive correlation between mGFRiohexol determined with high and low doses of iohexol in patients with normal or high mGFRiohexol (coefficient of determination [R2] = 0.88; p < 0.001) and between mGFRiohexol and uClcr (R2 = 0.87; p < 0.001). eGFRcr overestimated mGFRiohexol and eGFRcys underestimated mGFRiohexol.

CONCLUSIONS

mGFRiohexol after contrast-enhanced CT compares well with mGFRiohexol after standard low-dose iohexol respectively uClcr. Over- and underestimation of mGFRiohexol by eGFRcr and eGFRcys is probably explained by increased tubular secretion of creatinine and increased production of cystatin C in intensive care patients.

A Bottom-Up Liquid Chromatography-Tandem Mass Spectrometry Method for Therapeutic Drug Monitoring of Infliximab: Method Development, Comparison With 2 Enzyme-Linked Immunosorbent Assay Methods, and Evaluation of Anti-Drug Antibody Interference

CONTEXT.—

Therapeutic drug monitoring is recommended to optimize infliximab use and improve outcome in chronic inflammatory disorders.

OBJECTIVE.—

To describe a simple and affordable liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to measure infliximab in serum.

DESIGN.—

Infliximab was measured using winged stable isotope-labeled peptides as internal standards. Linearity, lower limit of measuring interval, limit of detection, precision, accuracy, carryover, and ion suppression were evaluated. Method comparison against 2 enzyme-linked immunosorbent assay (ELISA) methods (Remsima Monitor and IDKmonitor Infliximab) and anti-drug antibody (ADA) interference were evaluated using clinical specimens from inflammatory bowel disease patients (N = 237).

RESULTS.—

Analytical run time and sample preparation time were 5 minutes per sample and 3 hours per batch, respectively. Analytical measurement interval and limit of detection were 0.50 to 50.0 μg/mL (R2 = 0.998) and 0.25 μg/mL, respectively. The intraday and interday imprecision percentage coefficients of variation were less than 6.1%. Accuracy was 94.2% to 98.7%. No significant ion suppression or carryover was observed. Infliximab concentrations measured by LC-MS/MS showed good agreement with those measured by Remsima Monitor (mean percentage difference, 5.7%; 95% CI, -1.2% to 12.6%) but were markedly lower than those measured by IDKmonitor (-32.6%; -35.8% to -29.4%), demonstrating significant bias between ELISAs. Although a good agreement between LC-MS/MS and ELISA was observed for ADA-negative samples (-3.5%; -12.8% to 5.9%), a significant bias was observed for ADA-positive samples (13.6%; 1.7% to 25.6%).

CONCLUSIONS.—

This simple, fast, and affordable LC-MS/MS method for infliximab quantitation could improve standardization of infliximab quantitation and optimization of infliximab use in patients with high-titer ADA.

A comprehensive update of genotype-phenotype correlations in PMM2-CDG: insights from molecular and structural analyses

PMM2-CDG (phosphomannomutase 2-deficiency) is the most prevalent N-glycosylation disorder and results from impairments of PMM2 activity. This disease presents a large variety of pathogenic variants, which cause a wide phenotypical spectrum. This diversity, together with the low number of affected patients, raises the challenge of determining genotype-phenotype correlations in PMM2-CDG. This type of correlation could be highly significant in determining disease progression, prognosis, severity and in developing genome-personalized therapies. Structural analyses offer a valuable approach for assessing the pathogenic mechanisms within the PMM2 protein structure at a molecular level. Such an approach can reveal novel insights into the consequences of missense variants and their relationship with patients'phenotype. In this comprehensive review, we evaluate at a structural level 41 missense mutations in PMM2-CDG, examining their phenotypical characteristics and clinical severity, protein properties and interference at the enzymatic level. This work broadens the understanding of the intricate relationships between genotype and clinical manifestations of PMM2-CDG.

Effect of pH on stability and solid phase extraction of urinary free metadrenaline measurement by liquid chromatography tandem mass spectrometry

BackgroundMeasurement of urine free metadrenalines offers potential diagnostic and practical advantages over urinary fractionated metadrenalines in detection of phaeochromocytoma and paraganglioma, including sample collection without acid preservative. Here, we evaluate stability with and without sample acidification as well as pH implications for analysis by solid-phase extraction (SPE) and liquid chromatography tandem mass spectrometry.MethodsSpot urine samples were adjusted to pH 3 or unacidified on day of collection and stored at room temperature, 4°C or -20°C, for up to 28 days to assess changes in free metadrenaline concentrations over time. Extraction of unacidified versus acidified urine was examined by comparing peak areas and measuring concentrations present in sample eluents according to two SPE methodologies.ResultsFree metadrenalines remained stable in urine with or without acidification for up to 28 days, with mean reduction in concentrations of <10% for all storage conditions. Measured concentrations progressively increased without acidification at room temperature at low concentrations but remained constant when spiked with pathological concentrations. Peak areas were up to 97-fold lower in acidified than unacidified samples when extracted using weak cation exchange (WCX). On average 64% of analyte eluted in the flowthrough in acidified samples relative to 1.5% without acidification. By contrast, over 99% was retained in the extract using polar extraction at either pH.ConclusionUrine free metadrenalines remain stable at room temperature for up to 28 days and are more efficiently extracted without use of acid preservative if using WCX methodology.

Characteristic Findings of Infants with Transient Elevation of Acylcarnitines in Neonatal Screening and Neonatal Weight Loss

The detection of elevated long-chain acylcarnitine levels, particularly C14:1 and the C14:1/C2 ratio, during neonatal screening may indicate very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD), although similar findings can result from postnatal starvation. We investigated the relationship between false-positive results, postnatal weight loss, and subsequent growth. Additionally, we explored potential diagnostic markers of postnatal starvation. The following neonates from Oita Prefecture (April 2014-March 2024) were included in this study: patients identified as false-positive for VLCADD (n = 19), patients with VLCADD (n = 3), and children negative in mass screening who completed their 3-year-old health check-up (n = 30). The false-positive group exhibited significant weight loss at blood sampling for neonatal screening. An acylcarnitine analysis showed significant increases in various short- to long-chain fatty acids in the false-positive group, likely owing to enhanced fatty acid catabolism via β-oxidation. Elevation of a broad range of fatty acids and reduced amino acid levels seemed to be associated with significant weight loss at blood sampling.

An immunosensor for the detection of N-(carboxymethyl)lysine - a diabetic biomarker

Carboxymethyl-lysine (CML) is a well-known lysine product that strongly correlates with type 2 diabetes mellitus (T2DM), and its elevated levels are significantly associated with renal impairment and T2DM-related complications. Thus, it is imperative to quantify CML levels and recognize the onset of hyperglycemia and its consequences. In this context, the development of an electrochemical immunosensor for the rapid and ultralow-level detection of CML was attempted. The fabrication of the working electrode involves the covalent immobilization of anti-CML/EDC-NHS on the surface of a carbon quantum dot (CQD)-modified glassy carbon electrode (GCE). The immunosensor exhibited two discrete linear concentration ranges of 0.5-5.0 ng mL-1 and 5.5-10.0 ng mL-1, with limits of detection and quantification of 0.027 and 0.087 ng mL-1 and 0.16 and 0.51 ng mL-1, respectively. The observed specificity and other merits of the sensor make it suitable for testing human plasma samples.

Ischemic Stroke in Patients Under Oral Anticoagulation: The Achilles Heel of Atrial Fibrillation Management

Oral anticoagulation (OAC) is essential for preventing ischemic stroke events in patients with atrial fibrillation (AF), and leads to a significant ischemic prophylaxis, when appropriately used. However, there is still a risk of experiencing stroke events, despite being under anticoagulation. Stroke despite OAC is an increasingly common diagnosis, and pathophysiologically, it can be associated with several etiologies, ranging from AF competing mechanisms to true anticoagulation failure. While the cardioembolic origin of stroke is the most frequently identified etiology, other factors also have to be considered, as there is a significance risk of coexistence. This highlights the need for thorough diagnostic testing, evaluating each stroke etiology independently, with the use of imaging, biomarker and blood tests. Treating such patients, however, is more complex, as there is still uncertainty regarding the selection of OAC post-stroke, with data showing a superiority of direct OAC (DOAC), compared to vitamin K antagonists, in recurrent ischemic stroke prevention and conflicting results regarding OAC switch. Finally, the additive value of cardiac interventions, such as left atrial appendage occlusion (LAAO), in secondary prevention of stroke, is being explored, as it could potentially lead to significant stroke risk reduction. This review, therefore, provides an updated summary of the pathophysiology, diagnostics and therapeutics of stroke under OAC, while also discussing the future direction on the Achilles heel of AF management.

Novel ACAD8 variants identified in Isobutyryl-CoA dehydrogenase deficiency: challenges in phenotypic variability and management

Isobutyryl-CoA dehydrogenase deficiency (IBDD) is a rare autosomal recessive disorder caused by biallelic variants in the ACAD8 gene, which disrupts valine metabolism. In this study, we report seven individuals identified through newborn screening (NBS) with elevated C4-acylcarnitine levels, including five confirmed patients and two heterozygous carriers. Genetic analysis identified 12 distinct ACAD8 variants, seven of which were novel (c.221C>T, c.518T>C, c.727A>G, c.868G>A, c.947A>T, c.966G>A, c.1058T>C). According to ACMG classification criteria, c.221C>T was classified as likely pathogenic, while the remaining variants were categorized as variants of uncertain significance (VUS). During a mean follow-up of 4.81 years, all patients maintained normal growth patterns but two patients developed neurological symptoms that included recurrent febrile seizures and sensory integration dysfunction. These findings expand the ACAD8 variant spectrum, highlight the phenotypic variability of IBDD, and underscore the importance of long-term follow-up and individualized management strategies.

Cutoff levels for newborn screening of 21-OH deficiency in a Brazilian metropolitan area

OBJECTIVE

To evaluate the accuracy of neonatal 17-hydroxyprogesterone (N17OHP) levels adjusted for birth weight (BW) and time of the sample collection (TC) and propose optimized cutoff values to improve the effectiveness of newborn screening tests for congenital adrenal hyperplasia (CAHNBS) programs, utilizing a comprehensive dataset encompassing all newborn screening tests for 21-hydroxylase deficiency (21OHD) conducted over a decade in a Brazilian metropolitan region.

METHODS

A cross-sectional study analyzed all CAHNBS tests from newborns aged 2 to 7 days in the Federal District, Brazil, from January 2012 to September 2022. The accuracy of cutoff values based on the 99.5th percentile (99.5P) for BW and TC was compared to the CAHNBS program of São Paulo and a threshold of ≥20 mg/dL. New cutoff values were proposed to enhance screening effectiveness.

RESULTS

Among the 340,291 newborns screened, CAH-21OHD was confirmed in 11 cases. The N17OHP cutoff in this sample reduced false positives for neonates ≤ 2500 g but increased them for those > 2500 g The proposed cutoff values based on 99.5P from the sample for neonates ≤ 2500 g, combined with a fixed cutoff ≥ 20 mg/dL for those > 2500 g, showed superior specificity (99.83 %, 95 % CI: 99.81-99.84 %), LR+ (579.16, 95 % CI: 524.23-627.87), PPV (1.84, 95 %CI: 1.70-1.99), and accuracy (99.83 %, 95 %CI: 99.81-99.84 %) than prior criteria.

CONCLUSION

The proposed 17OHP cutoff strategy effectively reduced false positives, improving specificity, LR+, PPV, and accuracy Thus, it optimized CAHNBS programs while minimizing unnecessary costs and parental distress.

Biosensors, Artificial Intelligence Biosensors, False Results and Novel Future Perspectives

Medical biosensors have set the basis of medical diagnostics, and Artificial Intelligence (AI) has boosted diagnostics to a great extent. However, false results are evident in every method, so it is crucial to identify the reasons behind a possible false result in order to control its occurrence. This is the first critical state-of-the-art review article to discuss all the commonly used biosensor types and the reasons that can give rise to potential false results. Furthermore, AI is discussed in parallel with biosensors and their misdiagnoses, and again some reasons for possible false results are discussed. Finally, an expert opinion with further future perspectives is presented based on general expert insights, in order for some false diagnostic results of biosensors and AI biosensors to be surpassed.

Posaconazole versus fluconazole as primary antifungal prophylaxis for patients at high risk of invasive fungal infections receiving allogeneic hematopoietic stem cell transplantation

With the aim to reduce the incidence of invasive fungal infections (IFI) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), the ECIL group recommends the use of drugs active against molds such as posaconazole instead of fluconazole in high-risk (HR) IFI patients. But data to support this recommendation are poor. The aim of this monocentric study was to compare retrospectively the use of fluconazole (n = 96) vs. posaconazole (n = 63), as primary antifungal prophylaxis within the first 90 days (D) post-transplant in a cohort of patients at HR-IFI (n = 159). HR-IFI was defined by the use of an alternative donor, post-transplant cyclophosphamide and/or sequential conditioning regimen, and/or an active disease at transplant or a previous allo-HSCT. Incidences of D90, 6-month, 1-year and 2-year CI of IFI as well as D90 primary prophylaxis failure (IFI resulting in the initiation of a curative antifungal therapy or a permanent discontinuation of the prophylaxis for toxicity) were similar between both groups. However, the number of probable/proven IFI that occurred between D0 and D90 was the double in the fluco group (9 vs. 4). Also, no proven IFI (vs. 4) or mucormycoses (vs. 1) or IFI related death (vs. 4) occurred in the posa group in the first 90 days. Posaconazole thus appears to be a good option to prevent IFI after allo-HSCT in patients at HR-IFI.

Metal Nanocomposites as Biosensors for Biological Fluids Analysis

Metal nanocomposites are rapidly emerging as a powerful platform for biosensing applications, particularly in the analysis of biological fluids. This review paper examines the recent advancements in the development and application of metal nanocomposites as biosensors for detecting various analytes in complex biological matrices such as blood, serum, urine, and saliva. We discuss the unique physicochemical properties of metal nanocomposites, including their high surface area, enhanced conductivity, and tunable optical and electrochemical characteristics, which contribute to their superior sensing capabilities. The review will cover various fabrication techniques, focusing on their impact on the sensitivity, selectivity, and stability of the resulting biosensors. Furthermore, we will analyze the diverse applications of these biosensors in the detection of disease biomarkers, environmental toxins, and therapeutic drugs within biological fluids. Finally, we will address the current challenges and future perspectives of this field, highlighting the potential for improved diagnostic tools and personalized medicine through the continued development of advanced metal nanocomposite-based biosensors.

Genetic variants in NUDT15 gene their clinical implications in cancer therapy

Individual variations in the response to thiopurine-based anticancer drugs are influenced by genetic and environmental factors, making it challenging to optimize dosing and minimize toxicity. Among the key genes involved, genetic variations in the nudix hydrolase 15 (NUDT15) gene affect on thiopurine metabolism, thus influencing drug efficacy and the risk of severe adverse effects, such as myelosuppression, These variations also contribute to inter-individual differences in drug tolerance and clinical outcomes. Despite the recognized impact of NUDT15 variations, there has been limited comprehensive exploration of these variants and their clinical significance in thiopurine therapy. This review provides a thorough analysis of NUDT15 genetic variants by synthesizing findings from prior clinical studies and employing in silico analyses to predict the functional effects of variants with uncertain significance. Comprehensive analysis of NUDT15 variants and their interactions with other metabolic pathways could offer valuable insights for advancing personalized medicine in cancer treatment. This review aims to establish a foundation for integrating NUDT15 genetic information into the clinical practice, reducing toxicity, and improved therapeutic outcomes in patients undergoing thiopurine-based chemotherapy.

Co-Deposited Proteins in Alzheimer's Disease as a Potential Treasure Trove for Drug Repurposing

Alzheimer's disease (AD) affects an increasing number of people as the human population ages. The main pathological feature of AD, amyloid plaques, consists of the key protein amyloid-β and other co-deposited proteins. These co-deposited proteins and their protein interactors could hold some additional functional insights into AD pathophysiology. For this work, proteins found on amyloid plaques were collected from the AmyCo database. A protein-protein and protein-drug interaction network was constructed with data from the IntAct and DrugBank databases, respectively. In total, there were 12 proteins co-deposited on amyloid plaques that reportedly interact with 513 other proteins and are targets of 72 drugs. These drugs were shown to be almost entirely distinct from the panel of drugs currently approved by the FDA for AD and their corresponding protein targets. In conclusion, this work demonstrates the potential for drug repurposing of drugs that target proteins found in amyloid plaques.