Risk factors of major lower limb amputation in symptomatic peripheral artery disease: a retrospective cohort study

AIM

To find risk factors of major amputation in patients with peripheral artery disease (PAD) by a combination of both personal risk factors and treatment.

METHODS

This was a retrospective cohort study enrolled adult patients diagnosed as symptomatic PAD. Predictors for major amputation were analyzed.

RESULTS

There were 221 patients with PAD met the study criteria; 28 patients (12.67%) had major amputation events. There were three independent factors Rutherford classification, white blood cell, and serum albumin. The adjusted odds ratio (95% confidence interval) of these factors were 1.824 (1.118, 2.976), 1.073 (1.019, 1.131), and 0.421 (0.202, 0.879), respectively.

CONCLUSIONS

Serum albumin was modifiable to prevent future major amputation in patients with PAD.

Discrete truncation method for measuring the cardiac t2* values in patients with thalassemia

OBJECTIVE

In clinical work, it has been found that there are differences between the dark-blood (DB) and bright-blood (BB) cardiac magnetic resonance (CMR) T2* values (DB-T2* and BB-T2*) measured by the current automatic truncation method in patients with cardiac iron overload. The paper aims to develop a novel discrete truncation method to measure cardiac T2* value in patients with thalassemia.

METHODS

The cardiac T2* values of 349 thalassemia (TM) patients (mean age, 13.41 years ±8.761, 173 males) from three hospitals during January 2011 to June 2023 were measured by CMRtools software. Different truncation methods were used to remove signal values that deviated from the fitting curve and the corresponding T2* values were recorded. The difference, correlation and consistency of DB-T2* and BB-T2* measured by different methods were compared.

RESULTS

There was no significant difference between DB-T2* and BB-T2* measured by discrete truncation method (DB-T2* vs.BB-T2*, p = 0.249), respectively; and there was a high positive correlation (rs = 0.997, p < 0.0001). In the Bland-Altman analysis, the two methods had a very good agreement (p = 0.2489). There was a high positive correlation between DB-T2* and BB-T2* measured by the automatic truncation method (rs = 0.974, p < 0.0001), but there was a significant difference between them (DB-T2* vs.BB-T2*, p < 0.0001), respectively. In the Bland-Altman analysis, there was no good agreement between the two methods (p < 0.0001).

CONCLUSION

The discrete truncation method is more stable and reliable than the automatic truncation method in the measurement of cardiac T2* value in TM patients.

NADPH Oxidases in Cancer Therapy-Induced Cardiotoxicity: Mechanisms and Therapeutic Approaches

Cancer therapy-induced cardiotoxicity remains a significant clinical challenge, limiting the efficacy of cancer treatments and impacting long-term survival and quality of life. NADPH oxidases, a family of enzymes that are able to generate reactive oxygen species (ROS), have emerged as key players in the pathogenesis of cardiotoxicity associated with various cancer therapies. This review comprehensively examines the role of NADPH oxidases in cancer therapy-induced cardiotoxicity, elucidating the underlying mechanisms and exploring potential therapeutic approaches. We discuss the structure and function of NADPH oxidases in the cardiovascular system and their involvement in cardiotoxicity induced by anthracyclines and ionizing radiation. The molecular mechanisms by which NADPH oxidase-derived ROS contribute to cardiac injury are explored, including direct oxidative damage, activation of pro-apoptotic pathways, mitochondrial dysfunction, vascular damage, inflammation, fibrosis, and others. Furthermore, we evaluate therapeutic strategies targeting NADPH oxidases, such as specific inhibitors, antioxidant therapies, natural products, and other cardioprotectors. The review also addresses current challenges in the field, including the need for isoform-specific targeting and the identification of reliable biomarkers. Finally, we highlight future research directions aimed at mitigating NADPH oxidase-mediated cardiotoxicity and alleviating cardiovascular side effects in cancer survivors. By synthesizing current knowledge and identifying knowledge gaps, this review provides a rationale for future studies and the development of novel cardioprotective strategies in cancer therapy.

Effect of selenium on the dysfunction of rat salivary glands induced by 131I and expression of insulin-like growth factors and aquaporins

OBJECTIVES

To investigate the effects of selenium on functional and histopathological changes and mRNA expression levels of insulin-like growth factors 1 and 2 (IGF-1 and -2) and aquaporins 4 and 5 (AQP-4 and -5) in 131 I-induced damaged rat parotid glands.

METHODS

Rats were divided into three groups: iodotherapy-with-selenium, iodotherapy-only, and control. Rats in the iodotherapy-with-selenium group were intragastrically administered 131 I on the first day and selenomethionine through drinking water. Rats in the iodotherapy-only group were only administered 131 I. Changes in parotid gland function were evaluated using the functional parameters of salivary gland dynamics imaging pre-experiment and on days 7, 30, and 90 post-treatment. Immunofluorescence and quantitative real-time PCR analyses detected IGF-1, IGF-2, AQP-4, and AQP-5 expression levels in tissues.

RESULTS

The gland-to background ratio at a maximum count (G/BG max ), T max /T min , and S max values were significantly impacted over time in the iodotherapy-with-selenium group; on day 30, the G/BG max value was significantly higher than that in the iodotherapy-only group. Histopathological analysis revealed that on days 30 and 90, the iodotherapy-with-selenium group displayed greater parotid gland repair than the iodotherapy-only group. In the iodotherapy-with-selenium group, fluorescence intensity and mRNA levels of AQP-5 increased with the selenium supplementation period, reaching significantly higher levels on days 30 and 90 than in the iodotherapy-only group. Whereas the fluorescence intensity and mRNA levels of IGF-1 in the iodotherapy-with-selenium group were significantly higher on day 7 than on day 30 in the iodotherapy-only group.

CONCLUSION

Selenium may repair 131 I-induced tissue and functional damage in rat salivary glands by upregulating AQP-5 and IGF-1 expression.

Recent progress on the organoids: Techniques, advantages and applications

Organoids are a cutting-edge technology in the life sciences field, with applications in precision medicine, bionic organs, and toxicological evaluations of chemicals. Their 3D structure closely resembles that of real organs, allowing more accurate functional mimicry. The 3D organoid culture system can simulate the growth state of cells in vivo and establish a suspension culture system for organoid 3D culture by using scaffold-less or scaffold technology to avoid direct contact between cells and plastic culture vessels. Furthermore, organoids can simulate the pathophysiological state of tissues and organs in vitro. This paper primarily discusses the construction methodologies, as well as the advantages and disadvantages of 3D culture systems for both scaffold-free organoids and scaffolded organoids. This review also summarizes the application of organoid models in chemical toxicology evaluation, drug screening and functional evaluation, establishment of in vitro disease models, and research on disease occurrence and potential mechanisms. The aim is to provide a reference for the research and practical applications of organoid-related scientific fields.

Analysis of influencing factors for postoperative brain injury in patients with cardiac surgery

OBJECTIVE

To identify risk factors in people with heart disease prior to undergoing cardiac surgery and to provide a prediction model.

METHODS

106 patients who underwent cardiac surgery were selected by convenience sampling method. Case-control study design was used to divide them into control and observation groups according to whether there was postoperative brain injury. General demographic data, perioperative surgery, postoperative recovery, past medical history and preoperative conditions, laboratory test indicators were collected. Univariate and multivariate Logistic regression analyses were performed to select influencing factors. A nomogram model for predicting postoperative brain injury was established.

RESULTS

Univariate Logistic regression analysis showed that age, female, stroke, diabetes mellitus, perioperative administration of dexmedetomidine, intraoperative use of cardiopulmonary bypass were related factors for postoperative brain injury(p < 0.05). Multivariate Logistic regression analysis showed that females, history of stroke, and intraoperative use of cardiopulmonary bypass were risk factors, and perioperative administration of dexmedetomidine was protective factor(p < 0.05). Nomogram model was established with an AUC of 0.847 and accuracy of 84.7%.

CONCLUSION

Preoperative stroke history and females are risk factors for brain injury after coronary artery bypass grafting under cardiopulmonary bypass, and perioperative use of dexmedetomidine is protective factor.

Sex as a prognostic factor for mortality in adults with acute symptomatic pulmonary embolism

BACKGROUND

Pulmonary embolism (PE) is relatively common worldwide. It is a serious condition that can be life-threatening. Studies on the relationship between adverse outcomes of this condition and whether a patient is male or female have yielded inconsistent results. Determining whether there is an association between sex and short-term mortality in patients with acute PE is important as this information may help guide different approaches to PE monitoring and treatment.

OBJECTIVES

To determine whether sex (i.e. being a male or a female patient) is an independent prognostic factor for predicting mortality in adults with acute symptomatic pulmonary embolism.

SEARCH METHODS

The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials register up to 17 February 2023. We scanned conference abstracts and reference lists of included studies and systematic reviews. We also contacted experts to identify additional studies. There were no restrictions with respect to language or date of publication.

SELECTION CRITERIA

We included phase 2-confirmatory prognostic studies, that is, any longitudinal study (prospective or retrospective) evaluating the independent association between sex (male or female) and mortality in adults with acute PE.

DATA COLLECTION AND ANALYSIS

We followed the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of prognostic factor studies (CHARMS-PF) and the Cochrane Prognosis Methods Group template for prognosis reviews. Two review authors independently screened the studies, extracted data, assessed the risk of bias according to the Quality in Prognosis Studies (QUIPS) tool, and assessed the certainty of the evidence (GRADE). Meta-analyses were performed by pooling adjusted estimates. When meta-analysis was not possible, we reported the main results narratively.

MAIN RESULTS

We included seven studies (726,293 participants), all of which were retrospective cohort studies with participants recruited and managed in hospitals between 2000 and 2018. Studies took place in the USA, Spain, and Japan. Most studies were multicentre. None were conducted in low- or middle-income countries. The participants' mean age ranged from 62 to 69 years, and the proportion of females was higher in six of the seven studies, ranging from 46% to 60%. Sex and gender terms were used inconsistently. Participants received different PE treatments: reperfusion, inferior vena cava filter, anticoagulation, and haemodynamic/respiratory support. The prognostication time (the point from which the outcome was predicted) was frequently omitted. The included studies provided data for three of our outcomes of interest. We did not consider any of the studies to be at an overall low risk of bias for any of the outcomes analysed. We judged the certainty of the evidence as moderate to low due to imprecision and risk of bias. We found moderate-certainty evidence (due to imprecision) that for female patients there is likely a small but clinically important reduction in all-cause mortality at 30 days (odds ratio (OR) 0.81, 95% confidence interval (CI) 0.72 to 0.92; I2 = 0%; absolute risk difference (ARD) 24 fewer deaths in women per 1000 participants, 95% CI 35 to 10 fewer; 2 studies, 17,627 participants). However, the remaining review outcomes do not indicate lower mortality in female patients. There is low-certainty evidence (due to serious risk of bias and imprecision) indicating that for females with PE, there may be a small but clinically important increase in all-cause hospital mortality (OR 1.11, 95% CI 1.00 to 1.22; I2 = 21.7%; 95% prediction interval (PI) 0.76 to 1.61; ARD 13 more deaths in women per 1000 participants, 95% CI 0 to 26 more; 3 studies, 611,210 participants). There is also low-certainty evidence (due to very serious imprecision) indicating that there may be little to no difference between males and females in PE-related mortality at 30 days (OR 1.08, 95% CI 0.55 to 2.12; I2 = 0%; ARD 4 more deaths in women per 1000 participants, 95% CI 22 fewer to 50 more; 2 studies, 3524 participants). No study data was found for the other outcomes, including sex-specific mortality data at one year. Moreover, due to insufficient studies, many of our planned methods were not implemented. In particular, we were unable to conduct assessments of heterogeneity or publication bias or subgroup and sensitivity analyses.

AUTHORS' CONCLUSIONS

The evidence is uncertain about sex (being male or female) as an independent prognostic factor for predicting mortality in adults with PE. We found that, for female patients with PE, there is likely a small but clinically important reduction in all-cause mortality at 30 days relative to male patients. However, this result should be interpreted cautiously, as the remaining review outcomes do not point to an association between being female and having a lower risk of death. In fact, the evidence in the review also suggested that, in female patients, there may be a small but clinically important increase in all-cause hospital mortality. It also showed that there may be little to no difference in PE-related mortality at 30 days between male and female patients. There is currently no study evidence from longitudinal studies for our other review outcomes. Although the available evidence is conflicting and therefore cannot support a recommendation for or against routinely considering sex to quantify prognosis or to guide personalised therapeutic approaches for patients with PE, this Cochrane review offers information to guide future primary research and systematic reviews.

The Preconditioning with Sevoflurane Alleviates Hypoxia-Reoxygenation-Induced Myocardial Cell Injury by Regulating the lncRNA LINC00265/miR-370-3p Axis

In recent years, the cardioprotective effects of the volatile anesthetic sevoflurane (SEV) have been confirmed, yet its underlying molecular mechanisms remain incompletely elucidated. Notably, lncRNA LINC00265 has been identified as dysregulated in damaged cardiomyocytes, potentially contributing to disease progression. However, limited research has focused on the interplay between SEV and lncRNA LINC00265. The main objective of this study was to explore the mechanism and role of lncRNA LINC00265 in mediating the cardioprotective effects of SEV against myocardial injury. An in vitro hypoxia/reoxygenation (H/R) model was created in AC16 cells following pretreatment with varying concentrations of SEV. RT-qPCR was used to evaluate the levels of lncRNA LINC00265, miR-370-3p, IL-6, and TNF-α. The concentrations of CK-MB and cTnI were determined using ELISA. Cell viability was evaluated using CCK-8, and apoptosis was quantified by flow cytometry. Additionally, the relationship between lncRNA LINC00265 and miR-370-3p was confirmed using a dual-luciferase reporter assay. Prolonged hypoxia gradually rose in lncRNA LINC00265 levels, which was reversed by SEV pretreatment. SEV pretreatment mitigated H/R-induced decreases in cell viability, increases in apoptosis, and excessive production of IL-6, TNF-α, CK-MB, and cTnI. However, the protective effects of SEV were counteracted by lncRNA LINC00265 overexpression. A negative regulatory relationship between lncRNA LINC00265 and miR-370-3p was discovered. miR-370-3p overexpression mitigated diminished protective effects of SEV by elevated lncRNA LINC00265 in myocardial injury. lncRNA LINC00265 could diminish the protective effects of SEV against myocardial injury by functioning as a sponge for miR-370-3p.

The Effect of Dietary Acid Load on Cardiometabolic Risk, Psychological Resilience and Sleep Quality in Adolescents with Obesity

Objective

Mild metabolic acidosis may adversely affect cardiovascular risk factors, and diet-dependent acid-base load may impair mental health and sleep quality. The aim of this study was to investigate the effects of dietary acid load (DAL) on cardiometabolic risk factors, psychological resilience, and sleep quality in adolescents with obesity.

Methods

Obese adolescents participated in the study. Biochemical parameters, anthropometric measurements and blood pressures were measured. Three-day retrospective food intake records were collected from the adolescents, and potential renal acid load (PRAL), net endogenous acid production (NEAP), and DAL were derived from food intake records. Psychological resilience was assessed by the Child and Youth Resilience Measure (CYRM-12) and sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI).

Results

A total of 205 adolescents with obesity (105 males, 100 females) aged 13-18 years participated. Body mass index, fat mass, fat percentage, fasting insulin, triglyceride, systolic blood pressure, homeostasis model assessment for insulin resistance (HOMA-IR) and PSQI scores were significantly higher and psychological resilience levels were significantly lower in high tertiles of DAL (p<0.05). Adolescents in the lowest tertile of DAL scores had higher consumption of whole grains, vegetables, dairy, legumes, and higher intakes of potassium and calcium than adolescents in the highest tertile of the DAL scores (p<0.05). Red meat, and white meat consumption and sodium intake were higher in adolescents in the high tertiles (p<0.05). Energy intakes were found to be significantly lower in the first tertile of PRAL and DAL scores compared to the other tertiles (p<0.05). A linear regression model ahowed an increase in NEAP, PRAL and DAL scores led to a decrease in psychological resilience score and an increase in PSQI and HOMA-IR scores (p<0.05).

Conclusion

High DAL was associated with high cardiometabolic risk, insulin resistance, and low psychological resilience and poor sleep quality.

Historical milestones and future horizons: exploring the diagnosis and treatment evolution of the pulmonary arterial hypertension in adults

INTRODUCTION

Pulmonary hypertension is a life-threatening condition characterized by elevated mean pulmonary arterial pressure and vascular resistance. Significant advances in diagnosis and treatment have been achieved over the 20th and 21st centuries, yet challenges remain in improving long-term outcomes.

AREAS COVERED

This review discusses the historical milestones in understanding and pharmacotherapy of the pulmonary arterial hypertension (PAH). A comprehensive literature search was conducted to explore the earliest reports of each approved medication for pulmonary hypertension, along with historical papers detailing the pathophysiological and diagnostic development. Additionally, the search aimed to identify novel therapeutic strategies, including repositioned drugs and emerging targets.

EXPERT OPINION

While current therapies, such as prostacyclin analogs and PDE5 inhibitors, improve functional capacity and hemodynamics, they face limitations, including costs, administration, and a predominantly vasodilatory approach. Additionally, the limitations of current clinical trial designs for rare diseases like pulmonary arterial hypertension hinder the evaluation of potentially effective drugs. These challenges underscore the urgent need for translational research to optimize trial methodologies, accelerating the development of new therapies. Innovative approaches, such as drug repositioning and the exploration of novel molecular targets, are critical to overcoming these barriers and ensuring timely, effective, and affordable treatment options for patients with PAH.

Effects of Curcumin on Postmenopausal Women's Health: A Systematic Review and Meta-Analysis

To evaluate curcumin's impact on postmenopausal women's health through a meta-analysis. The databases searched included PubMed, Embase, Cochrane Library, and Web of Science, from their inception to July 2024. The Cochrane risk of Bias assessment tool was used to assess the quality of the included studies. This meta-analysis reviewed 14 randomized controlled trials involving 982 participants (466 in the intervention group and 516 in the control group) and evaluated curcumin's effects across 30 indicators grouped into cardiovascular health, oxidative stress and antioxidant markers, bone health, metabolic health, and quality of life. We found that curcumin reduced systolic (SMD -0.51, 95% CI -0.83 to 0.19, p = 0.002) and diastolic blood pressure (SMD -0.63, 95% CI -0.96 to -0.30, p = 0.005), increased total antioxidant capacity (SMD 0.93, 95% CI 0.15 to 1.72, p = 0.020) and superoxide dismutase levels (SMD 0.30, 95% CI 0.04 to 0.56, p = 0.026), decreased aspartate aminotransferase (AST) (SMD -0.36, 95% CI -0.66 to -0.06, p = 0.020), and improved vasomotor (SMD -0.39, 95% CI -0.65 to -0.13, p = 0.003) symptoms. Curcumin positively impacts several indicators in postmenopausal women, highlighting its potential therapeutic role in managing cardiovascular risk factors, oxidative stress, hepatoprotective effects, and vasomotor symptoms. Due to variations in the purity and dosages across different studies and the lack of combinable data for certain indicators, the conclusions are still limited. These issues can be addressed through more comprehensive large-scale trials later. A more in-depth investigation into the mechanisms is also crucial.

Impact of age on cardiometabolic health in children at adiposity rebound: the role of genetic mechanisms

BACKGROUND

Identifying effective predictors early in life is crucial to enable timely prevention and intervention to improve cardiometabolic health outcomes. Adiposity rebound (AR) is an important period in early life, with earlier AR increasing the risk of cardiometabolic abnormalities. However, the role and mechanism of genetic factors in this association are unclear. Therefore, this study reviews the potential genetic mechanisms influencing the age at AR, as well as the genetic mechanisms linking earlier AR with cardiometabolic abnormalities.

DATA SOURCES

A comprehensive literature search was conducted in PubMed and China National Knowledge Infrastructure databases using a combination of medical subject headings terms and related keywords, including "adiposity rebound", "cardiometabolic", "obesity", "BMI trajectory", "diabetes mellitus", "dyslipidemias", "hypertension", "metabolic syndrome", "genetics", and "epigenetic". Citation tracking was performed as a supplementary search strategy. All potentially relevant articles were subsequently subjected to full-text evaluation for eligibility assessment.

RESULTS

Polymorphisms in the DMRT1, FTO, LEPR, and TFAP2B genes, along with obesity susceptibility, can influence the age at AR. Single-nucleotide polymorphisms associated with the age at AR are enriched in the insulin-like growth factor 1 (IGF-1) signaling pathway, which can be modulated by the LEPR and TFAP2B genes. Shared genetic mechanisms between cardiometabolic abnormalities and the age at AR are influenced by obesity-related genetic variants. These variants regulate the growth hormone (GH)/IGF-1 axis, advancing AR and leading to cardiometabolic abnormalities. Earlier AR alters adiponectin and leptin levels, further activating the GH/IGF-1 axis and creating a vicious cycle. Long-term breastfeeding can counteract the adverse effects of obesity-related genetic susceptibility on AR timing, thereby reducing the genetic risk of cardiometabolic abnormalities.

CONCLUSIONS

Our results support earlier AR as a marker for identifying cardiometabolic risk and screening high-risk populations at the genetic level.

Evaluating Cardiovascular Risk Factors Among Healthcare Professionals in Iran

BACKGROUND Cardiovascular disease is a leading cause of morbidity and mortality worldwide, necessitating accurate risk prediction models for effective prevention strategies. This study compares the predictive capabilities of 3 widely used 10-year cardiovascular risk assessment tools - Atherosclerotic Cardiovascular Disease (ASCVD) risk score, Framingham Risk Score (FRS), and Systematic Coronary Risk Evaluation 2 (SCORE2) - in healthcare professionals in Iran. MATERIAL AND METHODS This cross-sectional study analyzed data from 222 healthcare professionals at Jamaran Hospital in Tehran, assessing cardiovascular risk profiles using the ASCVD, FRS, and SCORE2 tools. Risk factors included age, sex, dyslipidemia, hypertension, diabetes, obesity, and smoking status. Risk scores were compared to evaluate concordance and classification accuracy across different risk levels. RESULTS The prevalence of cardiovascular risk factors was notable: hypertension (30.1%), dyslipidemia (65.7%), diabetes (7.2%), and obesity (24.3%). SCORE2 showed varied distributions of fatal and nonfatal cardiovascular events. ASCVD categorized most participants as low risk (85.6%), with smaller percentages in borderline (6.8%), intermediate (7.2%), and high-risk (0.5%) groups. FRS classified 97.7% as low risk and 2.3% as intermediate risk. Moderate agreement was observed between SCORE2 and ASCVD in moderate-risk (P<0.001, kappa=0.43) and high-risk (P=0.007, kappa=0.45) regions, with fair agreement between FRS and ASCVD (P<0.001, kappa=0.435). CONCLUSIONS This study highlights the significant prevalence of cardiovascular risk factors among healthcare professionals in Iran. It emphasizes the need for recalibrating cardiovascular risk models to better reflect Iran's unique population characteristics, ultimately improving risk prediction accuracy and preventive strategies.

Transthoracic echocardiographic assessment of ventricular function in functional single ventricle: a comprehensive review

BACKGROUND

Functional single ventricle represents a complex congenital cardiac malformation where ventricular function directly impacts patients' quality of life and prognosis. Accurate assessment of ventricular function in FSV patients is crucial for treatment planning, surgical intervention, and monitoring therapeutic efficacy.

MAIN TEXT

Echocardiography, as a non-invasive, readily available, and real-time cardiac imaging modality, has emerged as the preferred method for evaluating functional single ventricle ventricular function. With continuous advancement and innovation in echocardiographic technology, methods for evaluating functional single ventricle ventricular function have become increasingly diverse and refined. This review synthesizes recent research developments in echocardiographic assessment of functional single ventricle ventricular function and analyzes the advantages, limitations, and future applications of various techniques.

CONCLUSION

Strain and strain rate derived from two-dimensional speckle tracking imaging have progressively entered clinical application, demonstrating substantial potential as crucial parameters for evaluating single ventricular function. Emerging technologies, including three-dimensional speckle tracking imaging and non-invasive pressure-strain loops, show promise for contributing to multi-dimensional, integrated assessment as research continues to advance.

Exploring preventive and treatment strategies for oral cancer: Modulation of signaling pathways and microbiota by probiotics

The evidence suggests that the microbiome plays a crucial role in cancer development. The oral cavity has many microorganisms that can influence oral cancer progression. Understanding the mechanisms and signaling pathways of the oral, gum, and teeth microbiome in tumor progression can lead to new treatment strategies. Probiotics, which are friendly microorganisms, have shown potential as anti-cancer agents. These positive characteristics of probiotic strains make them suitable for cancer prevention or treatment. The oral-gut microbiome axis supports health and homeostasis, and imbalances in the oral microbiome can disrupt immune signaling pathways, epithelial barriers, cell cycles, apoptosis, genomic stability, angiogenesis, and metabolic processes. Changes in the oral microbiome in oral cancer may suggest using probiotics-based treatments for their direct or indirect positive roles in cancer development, progression, and metastasis, specifically oral squamous cell carcinoma (OSCC). Here, reported relationships between probiotics, oral microbiota, and oral cancer are summarized.

Pharmacological countermeasures for long-duration space missions: addressing cardiovascular challenges and advancing space-adapted healthcare

Future long-duration crewed space missions beyond Low Earth Orbit (LEO) will bring new healthcare challenges for astronauts for which pharmacological countermeasures (pharmacological countermeasures) are crucial. This paper highlights current pharmacological countermeasures challenges described in the ESA SciSpacE Roadmap, with a focus on the cardiovascular system as a model to demonstrate the potential implication of the challenges and recommendations. New pharmacological approaches and procedures need to be adapted to spaceflight (spaceflight) conditions, including ethical and reglementary considerations. Potential strategies include combining pharmacological biomarkers such as pharmacogenomics with therapeutic drug monitoring, advancing microsampling techniques, and implementing a pharmacovigilance system to gain deep insights into pharmacokinetics/pharmacodynamics (PK/PD) spaceflight alteration on drug exposure. Emerging therapeutic approaches (such as long-term regimens) or manufacturing drugs in the space environment, can address specific issues related to drug storage and stability. The integration of biobanks and innovative technologies like organoids and organ-on-a-chip, artificial intelligence (AI), including machine learning will further enhance PK modelling leading to personalized treatments. These innovative pharmaceutical tools will also enable reciprocal game-changing healthcare developments to be made on Earth as well as in space and are essential to ensure space explorers receive safe effective pharmaceutical care.

Sedation management and processed EEG-based solutions during venovenous extracorporeal membrane oxygenation: a narrative review of key challenges and potential benefits

Extracorporeal membrane oxygenation (ECMO) is an established technique for managing severe cardiorespiratory failure. However, it is invasive and requires profound analgo-sedation during initiation and often throughout the therapy. Managing sedation in venovenous (VV) ECMO patients is particularly challenging due to the impact of ECMO circuits on pharmacokinetics and specific patient requirements. This can lead to unpredictable sedative effects and require multiple drugs at higher doses. Additionally, sedation is usually managed with traditional scoring methods, which are subjective and invalid during neuromuscular blockade. These uncertainties may impact outcomes. Recent clinical practice increasingly focuses on reducing sedation to enable earlier physiotherapy and mobilisation, particularly in patients awaiting transplants or receiving mechanical circulatory support. In this context, processed electroencephalogram-based (pEEG) sedation monitoring might be promising, having shown benefits in general anaesthesia and intensive care. However, the technology has limitations, and its benefits in ECMO practice have yet to be formally evaluated. This review provides insights into the challenges of ECMO sedation, including pharmacokinetics, unique ECMO requirements, and the implications of inadequate sedation scores. Finally, it includes a brief overview of the practicality and limitations of pEEG monitoring during VV-ECMO, highlighting a significant research gap.

Intraplaque haemorrhage quantification and molecular characterisation using attention based multiple instance learning

Intraplaque haemorrhage (IPH) represents a critical feature of plaque vulnerability as it is robustly associated with adverse cardiovascular events, including stroke and myocardial infarction. How IPH drives plaque instability is unknown. However, its identification and quantification in atherosclerotic plaques is currently performed manually, with high interobserver variability, limiting its accurate assessment in large cohorts. Leveraging the Athero-Express biobank, an ongoing study comprising a comprehensive dataset of histological, transcriptional, and clinical information from 2,595 carotid endarterectomy patients, we developed an attention-based additive multiple instance learning (MIL) framework to automate the detection and quantification of IPH across whole-slide images of nine distinct histological stains. We demonstrate that routinely available Haematoxylin and Eosin (H&E) staining outperformed all other plaque relevant Immunohistochemistry (IHC) stains tested (AUROC = 0.86), underscoring its utility in quantifying IPH. When combining stains through ensemble models, we see that H&E + CD68 (a macrophage marker) as well as H&E + Verhoeff-Van Gieson elastic fibers staining (EVG) leads to a substantial improvement (AUROC = 0.92). Using our model, we could derive IPH area from the MIL-derived patch-level attention scores, enabling not only classification but precise localisation and quantification of IPH area in each plaque, facilitating downstream analyses of its association and cellular composition with clinical outcomes. By doing so, we demonstrate that IPH presence and area are the most significant predictors of both preoperative symptom presentation and major adverse cardiovascular events (MACE), outperforming manual scoring methods. Automating IPH detection also allowed us to characterise IPH on a molecular level at scale. Pairing IPH measurements with single-cell transcriptomic analyses revealed key molecular pathways involved in IPH, including TNF-α signalling, extracellular matrix remodelling and the presence of foam cells. This study represents the largest effort in the cardiovascular field to integrate digital pathology, machine learning, and molecular data to predict and characterize IPH which leads to better understanding how it drives symptoms and MACE. Our model provides a scalable, interpretable, and reproducible method for plaque phenotyping, enabling the derivation of plaque phenotypes for predictive modelling of MACE outcomes.

Blood-Based DNA Methylation Biomarkers to Identify Risk and Progression of Cardiovascular Disease

Non-communicable diseases (NCDs) are the leading cause of death worldwide, with cardiovascular disease (CVD) accounting for half of all NCD-related deaths. The biological onset of CVD may occur long before the development of clinical symptoms, hence the urgent need to understand the molecular alterations underpinning CVD, which would facilitate intervention strategies to prevent or delay the onset of the disease. There is evidence to suggest that CVD develops through a complex interplay between genetic, lifestyle, and environmental factors. Epigenetic modifications, including DNA methylation, serve as proxies linking genetics and the environment to phenotypes and diseases. In the past decade, a growing list of studies has implicated DNA methylation in the early events of CVD pathogenesis. In this regard, screening for these epigenetic marks in asymptomatic individuals may assist in the early detection of CVD and serve to predict the response to therapeutic interventions. This review discusses the current literature on the relationship between blood-based DNA methylation alterations and CVD in humans. We highlight a set of differentially methylated genes that show promise as candidates for diagnostic and prognostic CVD biomarkers, which should be prioritized and replicated in future studies across additional populations. Finally, we discuss key limitations in DNA methylation studies, including genetic diversity, interpatient variability, cellular heterogeneity, study confounders, different methodological approaches used to isolate and measure DNA methylation, sample sizes, and cross-sectional study design.

Risk Factors and Clinical Outcomes in Nonagenarians with Acute Coronary Syndrome: A Case-Control Study

Objective: With the growing number of individuals over the age of 90 (nonagenarians), understanding the risk factors and clinical outcomes associated with acute coronary syndrome (ACS) in this population has become increasingly important. This study aims to compare demographic, biochemical, and clinical parameters between nonagenarian ACS patients and a control group of healthy individuals within the same age bracket, as well as to analyze differences within the ACS group according to myocardial infarction type and evaluate the impact of percutaneous coronary intervention (PCI) on in-hospital mortality. Methods: 104 patients aged 90-100 years diagnosed with ACS for the first time between January 2022 and January 2024 were included in this retrospectively designed case-control study. The patients were categorized into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) groups based on their electrocardiographic findings. The control group included 113 healthy individuals within the same age range with no prior history of coronary artery disease. Data on traditional risk factors, including lipid profiles and family history, were analyzed using logistic regression models. Additionally, differences in clinical outcomes, including the length of hospital stay and mortality rates, were evaluated based on the application of PCI. Results: The ACS group exhibited significantly higher glucose, white blood cell count, and total cholesterol levels, along with lower hemoglobin and mean corpuscular volume, compared to the control group (p < 0.05). While no significant difference was found in low-density lipoprotein (LDL) levels, high-density lipoprotein (HDL) levels were significantly lower in ACS patients (p < 0.001). Family history played a more substantial role in the STEMI group compared to the NSTEMI group (p = 0.049). Additionally, STEMI patients were more likely to undergo invasive procedures, which were associated with reduced in-hospital mortality (p = 0.042). In contrast, no significant difference in mortality was observed in the NSTEMI group based on PCI status. Conclusions: This study highlights the distinct risk profiles of elderly ACS patients, emphasizing the critical role of low HDL levels and family history, particularly in STEMI cases. Furthermore, PCI was shown to reduce in-hospital mortality rates in STEMI patients, suggesting that invasive treatment approaches may be beneficial even in this vulnerable population. Personalized and multidisciplinary management strategies are essential for this vulnerable population. Further prospective research is needed to validate these findings and guide clinical decision-making for nonagenarians.

Advancements in synthetic methodologies and biological applications of lawsone derivatives

2-Hydroxy-1,4-naphthoquinone, widely recognized as lawsone, is a natural dye obtained from the henna plant (Lawsonia inermis), known for its biological activity and diverse applications in biochemistry and analytical chemistry. As a versatile precursor, it plays a crucial role in synthesizing a wide range of structurally diverse and bioactive molecular scaffolds. This review highlights recent progress in the development of lawsone derivatives, emphasizing their extensive biological activities, such as anticancer, antimicrobial, antioxidant, antimalarial, and metabolic enzyme-targeting activities, as well as their structure-activity relationships. Remarkably, this is the first detailed exploration covering both the biological activities and chemical synthesis of significant lawsone derivatives from 2016 to the present.

Metabolically Healthy Obesity Is Characterized by a Distinct Proteome Signature

Obesity is commonly associated with metabolic diseases including type 2 diabetes, hypertension, and dyslipidemia. Moreover, individuals with obesity are at increased risk of cardiovascular disease. However, a subgroup of individuals within the obese population presents without concurrent metabolic disorders. Even though this group has a stable metabolic status and does not exhibit overt metabolic disease, this status may be transient; these individuals may have subclinical metabolic derangements. To investigate the latter hypothesis, an analysis of the proteome signature was conducted. Plasma samples from 27 subjects with obesity but without an associated metabolic disorder (obesity only (OBO)) and 15 lean healthy control (LHC) subjects were examined. Fasting samples were subjected to Olink proteomics analysis targeting 184 proteins enriched in cardiometabolic and inflammation pathways. Our results distinctly delineated two groups with distinct plasma protein expression profiles. Specifically, a total of 24 proteins were differentially expressed in individuals with obesity compared to LHC. Among these, 13 proteins were downregulated, whereas 11 proteins were upregulated. The pathways that were upregulated in the OBO group were related to chemoattractant activity, growth factor activity, G protein-coupled receptor binding, chemokine activity, and cytokine activity, whereas the pathways that were downregulated include regulation of T cell differentiation, leukocyte differentiation, reproductive system development, inflammatory response, neutrophil, lymphocyte, monocyte and leukocyte chemotaxis, and neutrophil migration. The study identifies several pathways that are altered in individuals with obesity compared to healthy control subjects. These findings provide valuable insights into the underlying mechanisms, potentially paving the way for the identification of therapeutic targets aimed at improving metabolic health in individuals with obesity.

Apolipoprotein and sphingolipid measurements: Can be used in the clinical practice of atrial fibrillation diagnosing and evaluating the cryoablation effectiveness?

Atrial fibrillation (AF) has become the most common arrhythmia of clinical importance. A well-established and recommended therapeutic option for AF is the balloon-based cryoablation (CBA) method. There are still no sensitive biomarkers for AF prediction and cryoablation effectiveness assessment, therefore in our prospective study, we examined the plasma content of apolipoproteins (Apo) and sphingolipids, as well as the distribution of selected sphingolipids among lipoprotein fractions. The study included 33 patients with AF on admission and 24 h after cryoablation therapy, while 20 healthy volunteers were recruited to the control group. Plasma Apo concentrations were determined using a multiplex assay kit measuring fluorescence signal, whereas the high-performance liquid chromatography (HPLC) method was applied to assess the total plasma sphingolipid levels as well as their content in isolated lipoprotein fractions. Our results showed that cryoballoon ablation in AF patients markedly reduced the level of almost all Apo compared to the individuals from the control and Pre-CBA groups (Apo-A1: -25.9% and -20.0%, Apo-A2: -19.9% and -17.3%, Apo-B: -26.8% and -14.4%, Apo-C1: -20.3% and -13.4%, Apo-D: -15.9% and -22.2%, Apo-E: -18.3% and -14.3%, and Apo-J: -36.4% and -21.5%, p < 0.05, respectively). Importantly, the area under the curve of Apo-J (AUC 0.81; 95% CI, 0.71-0.92) indicates that it might be a useful biomarker of cryotherapy success in AF patients. Moreover, we also observed a pronounced increase in sphinganine (Sa; +33.5%), sphingosine (So; +24.6%), sphinganine-1-phosphate (Sa1P; +34.3%), and sphingosine-1-phosphate (So1P; +22.3%) concentrations in the Pre-CBA group in comparison with controls. This is the first study that evaluates such a broad panel of Apo and sphingolipids in patients with AF undergoing the CBA procedure, however, to confirm whether any of these parameters could be a clinically useful biomarker for predicting AF or assessing the effectiveness of treatment, further research will be necessary due to limitations of the study.

Evaluation of sociodemographic and nutrition-related factors for type 2 diabetes risk: a sample from Turkiye

BACKGROUND

Considering the increasing prevalence of diabetes, we aimed to evaluate the risk of diabetes in our sample and its relationship with sociodemographic and nutrition-related factors.

METHODS

We conducted the study in Afyonkarahisar province of Turkiye with participants aged 18-65 years. In this face-to-face study, we used a questionnaire on sociodemographic information and general dietary habits and the FINDRISC screening tool. We also recorded participants' 24-hour food recall and assessed anthropometric measurements. We analyzed epidemiological data using binary logistic regression models to assess possible risk factors associated with the presence of diabetes risk.

RESULTS

Overall, this study included 3,990 participants, 50.03% (n = 1996) and 49.97% (n = 1994) of whom were males and females, respectively. The FINDRISC score was higher in females (p = 0.001), married individuals (p < 0.001), those with lower education levels (p < 0.001), and participants diagnosed with the disease by a doctor (p < 0.001). Additionally, having a body mass index (BMI) of > 30 kg/m2 increased the risk by 7.33 folds compared with having a BMI of < 25 kg/m2. Significant but very low correlation coefficients were found between main meal consumption, energy, lipid and iron intake and diabetes risk (p < 0.001).

CONCLUSIONS

Our findings suggest that increasing age, increasing BMI, lower education level, and having a disease diagnosis can be significant risk factors for diabetes. However, more studies are needed to clarify risk factors, especially those related to nutrition.

Association of obesity or metabolic syndrome with various allergic diseases: An overview of reviews

The relationship between obesity, metabolic syndrome, related disorders, and various allergic diseases remains unclear. An overview of reviews investigating potential associations between obesity or metabolic syndrome and various allergic diseases was conducted. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. Systematic reviews and meta-analyses with summary effect size and corresponding 95% confidence intervals for at least one outcome (asthma, atopic dermatitis, and various allergic diseases) were included. This study encompassed 17 systematic review articles and 29 eligible meta-analyses. All included meta-analyses indicated a positive association between obesity/overweight and asthma. Three meta-analyses from one review demonstrated a positive association between obesity/overweight and the risk of atopic dermatitis. However, no meta-analyses focused on the associations between obesity/overweight or metabolic syndrome and allergic rhinitis, allergic conjunctivitis, or other allergic conditions. All included reviews employed poor methodology according to the AMSTAR-2 assessment tools. Our findings suggest that obesity likely increases the risk of asthma. However, evidence for associations with other allergic diseases is limited. Furthermore, no meta-analyses were conducted to assess the relationship between metabolic syndrome and allergic diseases. Further studies are necessary to elucidate the associations between obesity and the full spectrum of allergic diseases.

Outcomes Comparison of Endovascular and Open Surgical Approaches for Subclavian Arterial Injury: A Nationwide Analysis

BACKGROUND

The management of patients with subclavian artery injury is rapidly evolving from an open to an endovascular approach. We aim to present an analysis of management and a comparison of outcomes according to the type of approach used to treat these challenging injuries.

METHODS

Adult patients with subclavian arterial injuries were abstracted from the National Inpatient Sample database from 2012-2014 and 2016-2021. Patients were divided according to the type of management, which was endovascular management (EM; stent placement) or open surgery (OS), and clinical outcomes were compared. A multivariable logistic regression model was used to determine risk factors associated with in-hospital mortality.

RESULTS

A total of 1200 cases were analyzed. The EM and OS groups had similar baseline characteristics, including age, sex, All Patient Refined Diagnosis-Related Groups severity of illness and risk of mortality scores, and Charlson Comorbidity Scores. The presence of shock on admission was similar between groups (EM: 23.1% vs. OS: 34.2%; P = 0.115). Median injury severity score was higher in the EM group but with a lower mortality rate (5.5% vs. 14.8%, P = 0.045) than OS. Additionally, EM was associated with a lower fasciotomy rate (P = 0.018). Hemorrhagic shock on presentation (odds ratio: 3.72) was associated with a marked increase in the odds of in-hospital mortality, while EM was associated with a 67% decrease (odds ratio: 0.33).

CONCLUSIONS

EM is associated with significantly better outcomes, including lower odds of in-hospital mortality and a decreased need for fasciotomy. Currently, EM is a feasible option in the management of subclavian arterial injuries.

Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Traumatic Rib Fracture: A Randomized, Active-controlled, Participant- and Observer-masked Study

BACKGROUND

Traumatic rib fractures are associated with pain lasting weeks to months and a decreased ability to inspire deeply or cough to clear secretions. Ultrasound-guided percutaneous cryoneurolysis involves reversibly ablating peripheral nerve(s) using exceptionally low temperature with a transdermal probe, resulting in a prolonged nerve block with a duration measured in months. The authors hypothesized that cryoneurolysis would improve analgesia and inspired volume after rib fracture.

METHODS

Adults with one to six traumatic rib fractures were randomized to either active cryoneurolysis and sham peripheral nerve block or sham cryoneurolysis and active peripheral nerve block in a participant/observer-masked fashion. The primary endpoint was the maximum inspired volume the day after the procedure as measured with an incentive spirometer.

RESULTS

The day after the procedure, the unadjusted median [interquartile range] maximum inspired volume for participants who received cryoneurolysis (n = 11) was 2,250 ml [1,500, 2,500 ml] versus 1,300 ml [750, 2,500 ml] for peripheral nerve block (n = 9, mean difference, 496; 95% CI, -428 to 1,420; t test P = 0.269). When adjusted for covariates ( e.g. , baseline lung volume), the cryoneurolysis group had an estimated 793 ml greater mean volume than peripheral nerve block (95% CI, 273 to 1,312 ml; analysis of covariance P = 0.005). Improvement from baseline in maximum inspired volume for cryoneurolysis was 1,000 ml [1,000, 1,375 ml] versus 300 ml [0, 1,000 ml] for peripheral nerve block ( t test P = 0.002). This was equivalent to an improvement over baseline of 100% [90%, 188%] for cryoneurolysis versus 30% [0%, 50%] for peripheral nerve block ( t test P = 0.003). Average daily pain scores were generally lower for the cryoneurolysis group throughout the first month. Total cumulative oxycodone equivalents were 5 mg [0, 13 mg] for cryoneurolysis versus 45 mg [43, 135 mg] for peripheral nerve block ( t test P = 0.013).

CONCLUSIONS

Ultrasound-guided percutaneous cryoneurolysis improves maximum inspired lung volume while concurrently decreasing pain and opioid consumption after traumatic rib fracture. These results should be considered preliminary, requiring confirmation with a trial including a larger sample size.

Assessment of Heart Rate Variability in Children with Mitral Valve Prolapse

BACKGROUND

Mitral valve prolapse (MVP) is a heart valve anomaly with specific electrocardiographic findings and arrhythmia. A predominant sympathetic tone and diminished vagal activity have been reported especially in symptomatic MVP patients.

OBJECTIVES

In the current study, we aim to review heart rate variability (HRV) parameters of MVP children in order to determine if there is an impaired autonomic regulation.

METHODS

The data of children with MVP were retrospectively analyzed. Demographic characteristics, body mass index, symptomatology, MVP type and mitral regurgitation, MVP-related electrocardiographic changes, arrhythmia, and HRV parameters in 24-h Holter monitoring were recorded. HRV parameters of the control group were obtained from children applying for sport participation. Statistical significance limit was accepted as p < 0.05.

RESULTS

154 of the patients (74.8%) were girls, the median age was 13.58 ± 2.99 years. While MVP patients had shorter PR intervals, those who had syncope had longer PR intervals. Short PR distance may be a feature of MVP, long PR distance may be a condition associated with syncope with the underlying paroxysmal atrioventricular block. Moreover, the minimum heart rate was significantly lower in the MVP group compared to the control and there were no significant differences in terms of remaining parameters. The number of low LF values was higher in MVP patients than the control. Comparing HRV values of groups by gender, we found that overall HRV parameters were lower in girls with MVP while minimum, maximum, and average heart rate were lower in boys with MVP.

CONCLUSION

Impaired HRV associated with MVP could be age, gender, and symptom related. In addition, low LF may indicate impaired baroreflex sensitivity in MVP patients.

Left atrial strain and risk of atrial fibrillation after coronary artery bypass-grafting

AIM

Postoperative Atrial Fibrillation (POAF) is a common complication following Coronary Artery Bypass Grafting (CABG), associated with increased morbidity and mortality. Aim of the study is to analyze whether the measurement of preoperative Left Atrial (LA) strain can offer advantages over conventional clinical and echocardiographic parameters to identify patients at risk of developing POAF.

METHODS AND RESULTS

We conducted a prospective study involving 100 patients undergoing isolated CABG from April 2023 to April 2024. Key parameters measured included LA strain measurements, Left Atrial Emptying Fraction (LA-EF), Left Ventricular Ejection Fraction, Left Atrial Volume index (LAVi). POAF occurred in 27 patients (27 %) with a mean latency of 3.2 ± 2.1 days. Higher preoperative serum creatinine levels were significantly associated with POAF. LA strain parameters (LA Reservoir Strain, LA Contraction Strain) and LA-EF were all significantly lower in the POAF group. Multivariate logistic regression identified LA Contraction Strain (OR: 0.73, p = 0.04), LA Reservoir Strain (OR: 0.27, p = 0.02) and preoperative serum creatinine (OR: 0.55, p = 0.01) as significant predictors of POAF. ROC curve analysis indicated that LA Reservoir Strain ≤24.5 %, LA Contraction Strain ≤9.5 %, LA-EF ≤ 43.4 % have a good accuracy in detection of POAF. Significant correlations were found between LAVi and LA Reservoir Strain, LAVi and LA-EF, and LA Reservoir Strain and LA-EF.

CONCLUSIONS

Preoperative LA analysis are significant predictors of POAF. These findings suggest that echocardiographic strain measurements offer an added value in preoperative risk assessment for POAF in CABG patients.

Effects of nanocurcumin supplementation on metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Metabolic syndrome (MetS) encompasses metabolic risk factors like elevated blood glucose, abnormal lipid levels, and hypertension. Nanocurcumin, a nanoscale formulation of curcumin, may offer therapeutic benefits for MetS management. This systematic review and meta-analysis evaluates the impact of nanocurcumin supplementation on key MetS parameters.

METHODS

A systematic literature search identified 20 randomized controlled trials (RCTs) with 1394 participants. Data were pooled using a random-effects model, and standardized mean differences (SMDs) were calculated for key outcomes.

RESULTS

Nanocurcumin supplementation significantly improved waist circumference (WC) (standardized mean difference (SMD): -0.30 cm), fasting blood sugar (FBS) (SMD: -0.34 mg/dL), HbA1c (SMD: -0.33 %), and quantitative insulin sensitivity check index (QUICKI) score (SMD: 0.73). Lipid profile parameters, including total cholesterol (SMD: -0.18 mg/dL), LDL-C (SMD: -0.16 mg/dL), and HDL-C (SMD: 0.32 mg/dL), also reduced significantly. Improvement in diastolic blood pressure (DBP) (SMD: -0.32 mmHg), total antioxidant capacity (TAC) (SMD: 0.44 mmol/L), malondialdehyde (MDA) (SMD: -0.37 mmol/L), tumor necrosis factor-α (TNF-α) (SMD: -2.30 ng/L), interleukin-6 (IL-6) (SMD: -1.07 ng/L), and high-sensitivity C-reactive protein (hs-CRP) (SMD: -0.34 mg/L) were observed.

CONCLUSION

Nanocurcumin supplementation significantly improves multiple MetS-related parameters, including anthropometric measures, glycemic control, lipid profile, blood pressure, oxidative stress markers, and inflammatory biomarkers. These findings highlight nanocurcumin's potential as an effective adjunctive therapy for managing MetS. However, the variability in study participant ages, treatment durations, and sample sizes suggests the need for further well-designed RCTs to establish optimal usage guidelines.

The correlation between subcutaneous fat thickness and the incidence of chemoport-related infection

Background

This study aimed to examine the correlation between subcutaneous fat thickness and chemoport-related infection and to determine the risk factors that lead to complications associated with chemoport.

Methods

This study retrospectively reviewed 363 patients with chemoport insertion between May 2018 and May 2022. The patients were classified into three groups, with 121 patients in each group, based on the tertiles of subcutaneous fat thickness measured in the computed tomography (CT) scan. The incidence of short-term and long-term complications, including dislocation, infection, and malfunction, were obtained and compared between the three groups. The risk factors of chemoport-related complications were analysed in multivariate analysis.

Results

The incidence of infection in the low, middle, and high subcutaneous fat thickness groups were 1.7%, 3.3%, and 0%, respectively (P = 0.131). No short-term complications occurred in this study group. After one year of follow-up, 11 patients (3.0%) had long-term complications; 6 patients (1.7%) developed chemoport infection, while five patients (1.4%) had chemoport dislocation. In multivariate analysis, the risk of dislocation was significantly higher when insertion was performed via the left internal jugular vein (OR = 9.87, P=0.033).

Conclusions

The thickness of subcutaneous fat does not significantly correlate with the incidence of chemoport infection, and placement of the port on the left side of the chest wall via the left internal jugular vein is the risk factor for chemoport dislocation.

Minimally invasive autologous pericardial patch reconstruction of the pulmonary artery for locally advanced lung cancer following neoadjuvant treatment

Pulmonary arterioplasty with an autologous pericardial patch helps avoid having to perform pneumonectomy in patients with locally advanced non-small cell lung cancer. However, a minimally invasive procedure for this technique has rarely been reported because the patch usually shrinks and recoils after retrieval, complicating the suturing procedure. We describe our experience with performing autologous pericardial patch arterioplasty without glutaraldehyde fixation using video-assisted thoracoscopic surgery in a patient who received neoadjuvant immunotherapy. The pulmonary bloodstream was temporarily controlled by an endoscopic tourniquet placed at the pulmonary artery proximal to the ligamentum arteriosum as well as at the inferior pulmonary vein. A pericardial patch harvested anterior to the phrenic nerve was used to repair the hemi-circumferential pulmonary artery defect. Patch angioplasty was performed using a running suture with a 5-0 nonabsorbable monofilament thread, with the epicardial layer facing inside. No graft-related complications including stenosis occurred during the follow-up period.

Percutaneous Closure of Sub-Annular Rupture Following Transcatheter Aortic Valve Replacement Complicated by Severe Tricuspid Regurgitation

Aortic annular rupture is a rare and usually fatal complication of TAVR. We report the case of a sub-annular aortic rupture contained in the right ventricle and percutaneously repaired. The procedure was complicated by new-onset severe tricuspid regurgitation related to tricuspid injury during wire externalization and immediately treated by transcatheter edge-to-edge repair.

Venous aneurysm leading to fatal pulmonary thromboembolism with a history of a remote stab wound of the extremity

Venous aneurysms are rare, and their incidence is unknown. External iliac vein aneurysms are even more rare with only 50 case reports published from 1950 to 2018. We present a case of an individual who died suddenly from a pulmonary thromboembolic event due to an external iliac vein aneurysm formed by a remote penetrating injury. A 32-year-old male was in Immigration and Customs Enforcement (ICE) custody when he died suddenly. It was discovered during his autopsy that he had an occlusive pulmonary thromboembolism (PE) within the left main pulmonary artery and distal branches of the right pulmonary artery. On additional investigation and postmortem computed tomography, a large saccular aneurysm arising from the external iliac vein was discovered. This aneurysm contained clotted blood, and was determined to be the cause of his PE and subsequent death. Although rarely a source for a fatal PE, venous aneurysms should be considered as a possible source for thromboembolism; their presence may alter the manner of death, given their underlying etiology. This is especially true for young adults with a remote history of trauma near a major venous tributary, as traumatic arteriovenous fistula is a common cause of secondary venous aneurysm. For this case, the manner of death was classified as homicide.

Curcumin ameliorates pyroptosis in diabetic seminal vesicles by upregulating TRPV6

BACKGROUND

Diabetes damages the seminal vesicle tissues leading to a decrease in seminal fluid secretion, so investigations are ongoing to identify specific therapeutic approaches to address diabetes-induced damage to seminal vesicles.

OBJECTIVE

This study investigated the secretory dysfunction of seminal vesicles and how curcumin can ameliorate this dysfunction.

MATERIALS AND METHODS

First, 40 diabetic males (DM group) and 40 nondiabetic males (control group) underwent seminal vesicle ultrasound evaluation and ejaculate volume measurements. Then, the effects of curcumin on seminal vesicle function were investigated in a diabetic rat model. Fifty 8-week-old SPF-grade SD rats were categorized into five groups: control, DM (diabetes mellitus), low-dose CUR (curcumin 50 mg/kg/d), medium-dose CUR (curcumin 100 mg/kg/d), and high-dose CUR (curcumin 150 mg/kg/d). After a month-long diet with varying curcumin doses, key parameters such as body weight, blood glucose levels, seminal vesicle volume, and seminal fluid secretion were measured. Transcriptome sequencing was performed to assess differences in gene expression and structural changes in rat seminal vesicle tissues were examined by HE staining. Finally, human seminal vesicle cell lines were cultured and divided into five groups (HG-CON, HG-CUR-5 µM, HG-CUR-10 µM, HG-CUR-20 µM, and HG-CUR-50 µM) to measure the fructose levels in the seminal vesicle cell culture fluids and evaluate the expression of CASP1, GSDMD, and TRPV6. Post TRPV6 interference, variations in the gene expression of CASP1, GSDMD, and TRPV6 were monitored.

RESULTS

Diabetic patients exhibited a notable reduction in seminal vesicle volume and ejaculate volume compared with the control group, with a direct correlation between the decrease in ejaculate and seminal vesicle volume. Animal studies demonstrated that curcumin supplementation significantly augmented seminal vesicle volume in diabetic rats and notably improved their seminal vesicle secretory dysfunction, particularly in the high-dose curcumin group. Transcriptome sequencing and experimental verification pinpointed the differential expression of TPRV6 and pyroptosis-associated genes (CASP1, GSDMD), with reduced TRPV6 expression but increased markers of pyroptosis (CASP1 and GSDMD) in diabetic rats. Curcumin treatment reversed these effects with an increase in TRPV6 and a decrease in GSDMD and CASP1. Cell transfection experiments indicated that TRPV6 downregulation increased GSDMD and CASP1 gene expression.

CONCLUSION

Curcumin effectively activates TRPV6, thereby diminishing pyroptosis in the seminal vesicle tissues of diabetic rats. This activation not only leads to an increase in the seminal vesicle volume but also significantly ameliorates the seminal vesicle secretory dysfunction in diabetic rats.

Effects of Herbal Tea (Non-Camellia sinensis) on Glucose Homeostasis and Serum Lipids in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

CONTEXT

Hyperglycemia and hyperlipidemia increase the risk for diabetes and its complications, atherosclerosis, heart failure, and stroke. Identification of safe and cost-effective means to reduce risk factors is needed. Herbal teas may be a vehicle to deliver antioxidants and polyphenols for prevention of complications.

OBJECTIVE

This systematic review and meta-analysis were conducted to evaluate and summarize the impact of herbal tea (non-Camellia sinensis) on glucose homeostasis and serum lipids in individuals with type 2 diabetes (T2D).

DATA SOURCES

PubMed, FSTA, Web of Science, CINAHL, MEDLINE, and Cochrane Library databases were searched from inception through February 2023 using relevant keyword proxy terms for diabetes, serum lipids, and "non-Camellia sinensis" or "tea."

DATA EXTRACTION

Data from 14 randomized controlled trials, totaling 551 participants, were included in the meta-analysis of glycemic and serum lipid profile end points.

RESULTS

Meta-analysis suggested a significant association between drinking herbal tea (prepared with 2-20 g d-1 plant ingredients) and reduction in fasting blood glucose (FBG) (P = .0034) and glycated hemoglobin (HbA1c; P = .045). In subgroup analysis based on studies using water or placebo as the control, significant reductions were found in serum total cholesterol (TC; P = .024), low-density lipoprotein cholesterol (LDL-C; P = .037), and triglyceride (TG; P = .043) levels with a medium effect size. Meta-regression analysis suggested that study characteristics, including the ratio of male participants, trial duration, and region, were significant sources of FBG and HbA1c effect size heterogeneity; type of control intervention was a significant source of TC and LDL-C effect size heterogeneity.

CONCLUSIONS

Herbal tea consumption significantly affected glycemic profiles in individuals with T2D, lowering FBG levels and HbA1c. Significance was seen in improved lipid profiles (TC, TG, and LDL-C levels) through herbal tea treatments when water or placebo was the control. This suggests water or placebo may be a more suitable control when examining antidiabetic properties of beverages. Additional research is needed to corroborate these findings, given the limited number of studies.

Characterization of epicardial adipose tissue thickness and structure by ultrasound radiomics in acute and chronic coronary patients

We hypothesize that epicardial adipose tissue (EAT) structure differs between patients with coronary disease and healthy individuals and that EAT may undergo changes during an acute coronary syndrome (ACS). This study aimed to investigate EAT thickness (EATt) and structure using ultrasound radiomics in patients with ACS, patients with chronic coronary syndrome (CCS), and controls and compare the findings between the three groups. This prospective monocentric comparative cohort study included three patient groups: ACS, CCS, and asymptomatic controls. EATt was assessed using transthoracic echocardiography. Geometrical features (as mean gray value and raw integrated density) and texture features (as angular second moment, contrast and correlation) were computed from grayscale Tagged Image File Format biplane images using ImageJ software. EATt did not significantly differ between the ACS group (8.14 ± 3.17 mm) and the control group (6.92 ± 2.50 mm), whereas CCS patients (9.96 ± 3.19 mm) had significantly thicker EAT compared to both the ACS group (p = 0.025) and the control group (p < 0.001). Radiomics analysis revealed differences in geometrical parameters with discriminatory capabilities between both ACS group and controls and CCS group and controls. A multivariate analysis comparing ACS and CCS patients revealed that differences in EAT characteristics were significant only in patients with a body mass index below 26.25 kg/m². In this subgroup, patients older than 68 exhibited a higher modal gray value (p = 0.016), whereas those younger than 68 had a lower minimum gray value (p = 0.05). Radiomic analysis highlights its potential in developing imaging biomarkers for early diagnosis and coronary artery disease progression monitoring.

Understanding Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): a comprehensive meta-analysis of clinical characteristics, management, and prognosis compared to MI with the Obstructive Coronary Artery (MIOCA)

BACKGROUND

MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) represents a unique subset of acute coronary syndrome, distinct from MIOCA (Myocardial Infarction with Obstructive Coronary Arteries) and a control group. This study systematically compares their prevalence, clinical characteristics, management strategies, and outcomes to improve understanding and treatment approaches.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines across multiple databases up to 2024. STATA 17 was used for statistical analyses, and the Newcastle-Ottawa Scale was employed to assess study quality.

RESULTS

One-hundred and twelve studies, including 5,908,768 patients, were analyzed. The pooled prevalence of MINOCA among patients undergoing coronary angiography was 8.92% (95% CI: 8.90-8.94). MINOCA patients were generally younger, predominantly female, and more likely to present with atypical chest pain and dyspnea compared to MIOCA patients. Laboratory findings showed higher levels of CRP, BNP, and fibrinogen in MINOCA patients, suggesting inflammation and microvascular dysfunction as key mechanisms. In contrast, MIOCA patients had higher rates of diabetes and dyslipidemia, highlighting differences in pathophysiological processes. Medication use differed between the groups, with MINOCA patients more likely to be prescribed anticoagulants and β-blockers. Prognostically, MINOCA patients experienced significantly lower rates of adverse short- and long-term outcomes, including major adverse cardiac events (MACE) and cardiovascular death, compared to MIOCA patients.

CONCLUSIONS

This study demonstrated that patients with MINOCA have a better prognosis compared to those with MIOCA and are at a lower risk of serious cardiac events. Based on the findings of this study, we emphasize that microcirculation and vascular spasm are the main mechanisms involved in MINOCA. Considering these findings, it is suggested that a better management strategy for MINOCA patients can be established by precisely defining diagnostic criteria and focusing on anti-inflammatory treatments and risk factor control.

Effects of carotenoid supplementation on glycemic control: a systematic review and meta-analysis of randomized clinical trials

OBJECTIVES

We conducted a systematic review and meta-analysis to assess the effects of carotenoid supplementation on glycemic indices, and the certainty of evidence.

METHODS

A systematic literature search in PubMed, SCOPUS, ISI-Web of Science, and Cochrane Library was conducted from inception up to Jun 17, 2024. Randomized controlled trials (RCTs) investigating the effect of carotenoid supplementation on circulating glycemic parameters were included. Records were excluded when studies reported the effect of co-interventions with other nutrients, did not provide mean differences (MDs) and standard deviations (SD) for outcomes, or administered whole food rather than supplements of carotenoids. Summary mean differences (MDs) and 95% CI between intervention and control groups were estimated using a random-effects model. The risk of bias of the included studies was assessed using the Risk of Bias 2.0 (RoB 2.0) tool.

RESULTS

Overall, 36 publications with 45 estimated effect sizes were included in the meta-analyses. The overall findings showed an improvement in fasting blood glucose (FBG) (MD = -4.54 mg/dl; 95% CI: -5.9, -3.2; n = 45), and hemoglobin A1C (HbA1C) (MD = -0.25% (95% CI: -0.4, -0.11; n = 22) in the intervention group in comparison with the control group. Moreover, in individuals with type 2 diabetes (T2D), interventions with astaxanthin and fucoxanthin led to a reduction in FBG by 4.36 mg/dl (95% CI: -6.13, -2.6; n = 10). The findings also showed that the intervention with crocin reduced FBG levels by 13.5 mg/dl (95% CI: -15.5, -7.8; n = 5), and HbA1C by 0.55% (95% CI: -0.77, -0.34; n = 5) in individuals with T2D. However, the certainty of evidence was very low.

CONCLUSION

Carotenoid's supplementation improved glycemic parameters especially in people with T2D. However. the certainty of evidence was very low, mainly due to small sample size, and indirectness. Therefore, no specific recommendations can be provided at present and well-designed RCTs are required. REGISTRY URL: https://www.crd.york.ac.uk/PROSPERO/ REGISTRY NUMBER: CRD42021285084 REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: PROSPERO ID: CRD42021285084.

Surgical and multimodal approaches to right-sided cardiac tumours

PURPOSE OF REVIEW

Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case of malignancies. This review synthesizes recent findings surrounding the diagnosis and management of specifically right-sided cardiac tumours, with a particular focus on surgical resection and reconstructive techniques.

RECENT FINDINGS

Management of cardiac tumours can be categorized into three key phases. First: early and accurate diagnosis is critical for improving outcomes, especially in malignancies. Advances in imaging modalities like MRI, CT, PET-CT, and biopsy techniques enhance diagnostic accuracy. Second: surgical resection is a cornerstone treatment for both benign and malignant right-sided cardiac tumours. Surgery is often curative for benign tumours, while for malignant tumours, R0 resection (complete microscopic removal) in appropriate candidates correlates with better survival. Third: managing cardiac malignancies necessitates a multidisciplinary approach, integrating additional therapies such as chemotherapy, radiation, and emerging immunotherapies tailored to patient and tumour characteristics.

SUMMARY

Managing right-sided cardiac tumours demands interdisciplinary expertise. Standardized protocols are limited by the rarity of cases and insufficient high-quality data. International collaboration and sharing of experiences through prospective registries and clinical studies are essential to advancing knowledge and improving patient outcomes.

The non-dipping blood pattern in type 1 diabetes mellitus: pathophysiology, complications, and management strategies

The non-dipping blood pressure (BP) pattern, characterized by a less than 10% decline in sleep-time BP compared to awake-time values, is prevalent in individuals with type 1 diabetes mellitus (T1DM) and is associated with increased cardiovascular (CV) risk. This review discusses the prevalence, pathophysiological mechanisms, complications, and management strategies of the non-dipping pattern in T1DM. The non-dipping pattern is linked to poor cardiac autonomic function, higher rates of albuminuria, early markers of diabetic kidney disease, and increased arterial stiffness. It is also associated with a two-fold increase in all-cause mortality. Despite its clinical significance, there is no consensus on specific treatment recommendations for non-dippers with T1DM. While some studies suggest that bedtime administration of antihypertensive medications, such as ACE inhibitors and angiotensin II receptor blockers, can improve the dipping pattern and reduce CV events, these findings are primarily based on studies in the general hypertensive population. Emerging evidence also indicates a potential role for vitamin D supplementation and lifestyle interventions in improving BP variability. Further research is needed to develop evidence-based management strategies tailored to non-dippers with T1DM, aiming to reduce CV risk and improve long-term outcomes.

Alginate hydrogel-encapsulated bone marrow-derived mesenchymal stem cells and crocin improve cardiac function in a rat model of myocardial infarction

Cardiovascular diseases (CVDs), particularly myocardial infarction (MI), are the leading cause of mortality worldwide and significantly contribute to morbidity. This study incorporated varying concentrations of crocin (CRO) into alginate hydrogel (ALG) to enhance cardiac function. Following synthesizing the hydrogel, it was characterized through a series of experiments, including morphological assessment, rheological analysis, cytocompatibility testing, and cellular viability evaluation. The therapeutic efficacy of the synthesized hydrogel in combination with bone-derived mesenchymal stem cells (BMSCs), was then investigated in a rat model of MI using echocardiography, histology, and immunohistochemistry. The results indicated that the prepared hydrogels exhibited adequate porosity and favorable rheological properties. Notably, CRO at lower concentrations significantly improved the viability of BMSCs. To evaluate the therapeutic potential in vivo, the ALG/CRO hydrogel loaded with BMSCs was implanted into the MI region of the rat model. The findings demonstrate that the ALG/CRO hydrogel can significantly reduce scar thickness and promote angiogenesis, thereby improving the recovery of cardiac function. Consequently, the ALG/CRO hydrogel has the potential to serve as an injectable carrier for the delivery of cells aimed at cardiac regeneration.

Doxorubicin-Induced Cardiac Remodeling: Mechanisms and Mitigation Strategies

BACKGROUND

The therapeutic prowess of doxorubicin in oncology is marred by its cardiotoxic consequences, manifesting as cardiac remodeling. Pathophysiological alterations triggered by doxorubicin include inflammatory cascades, fibrotic tissue deposition, vascular and valvular changes, and finally cardiomyopathy. These multifarious consequences collectively orchestrate the deterioration of cardiac architecture and function.

METHOD

By charting the molecular underpinnings and remedial prospects, this review aspires to contribute a novel perspective using latest publications to the ongoing quest for cardioprotection in cancer therapy.

RESULTS AND DISCUSSION

Experimental analyses demonstrate the pivotal roles of oxidative stress and subsequent necrosis and apoptosis of cardiomyocytes, muscle cells, endothelial cells, and small muscle cells in different parts of the heart. In addition, severe and unusual infiltration of macrophages, mast cells, and neutrophils can amplify oxidative damage and subsequent impacts such as chronic inflammatory responses, vascular and valvular remodeling, and fibrosis. These modifications can render cardiomyopathy, ischemia, heart attack, and other disorders. In an endeavor to counteract these ramifications, a spectrum of emerging adjuvants and strategies are poised to fortify the heart against doxorubicin's deleterious effects.

CONCLUSION

The compendium of mitigation tactics such as innovative pharmacological agents hold the potential to attenuate the cardiotoxic burden.

Rare Pathogenic NR2F2 (COUP-TFII) Variants as Potential Etiological Causes in Pediatric Patients with Congenital Heart Diseases (CHDs)

BACKGROUND

Congenital heart diseases (CHDs) are complex genetic disorders, and their genetic basis is not yet fully understood. Nuclear receptor subfamily 2 group F member 2 (NR2F2 or COUP-TFII) encodes a transcription factor which is expressed at high levels during mammalian development. Few studies have identified heterozygous and rare variants in the NR2F2 gene in individuals with congenital heart disease (CHD).

OBJECTIVES

This study aimed to evaluate the association between pathogenic genetic alterations in NR2F2 with CHD risk.

METHODS

A case-control study was conducted on a group of 135 patients (83 boys and 52 girls) with non-hereditary various types of isolated congenital heart disease who were undergoing open-heart surgery. Additionally, 95 matched healthy children without syndromic or isolated heart abnormalities were selected.

RESULTS

Using the Sanger sequencing method, we identified five heterozygous single nucleotide variations in exons two and three of the NR2F2 gene. These variations were novel and not present in any genomic variation databases. Four of the variations were missense mutations (p.Pro159Arg, p.Ser329Phe, p.Qln338Pro, and p.Tyr348Ser) and one was a synonymous variant (p.G361=) in the coding region. Importantly, in-silico results indicated that the missense variants had pathogenic effects on protein function. Additionally, the missense variants substantially altered the predicted structure of COUP-TFII.

CONCLUSION

The results we obtained not only validate the correlation between NR2F2 mutations and CHDs but also have significant potential for guiding new preventive and therapeutic strategies. This could contribute to the advancement of medical interventions in the fields of cardiology and genetics.

Fetal adnexa-derived allogeneic mesenchymal stem cells for cardiac regeneration: the future trend of cell-based therapy for age-related adverse conditions

Heart failure is known as the leading cause of mortality and morbidity in adults, not only in USA but worldwide. Since the world's population is aging, the burden of cardiovascular disorders is increasing. Mesenchymal stem/stromal cells (MSCs) from a patient's bone marrow or other tissues have been widely used as the primary source of stem cells for cellular cardiomyoplasty. The incongruencies that exist between various cell-therapy approaches for cardiac diseases could be attributed to variations in cell processing methods, quality of the process, and cell donors. Off-the-shelf preparations of MSCs, enabled by batch processing of the cells and controlled cell processing factories in regulated facilities, may offer opportunities to overcome these problems. In this study, for the first time, we focused on the fetal membranes and childbirth byproducts as a promising source of cells for regenerative medicine. While many studies have described the advantages of cells derived from these organs, their advantage as a source of younger cells has not been sufficiently covered by the literature. Thus, herein, we highlight challenges that may arise from the impairment of the regenerative capacity of MSCs due to donor age and how allograft cells from fetal adnexa can be a promising substitute for the aged patients' stem cells for myocardial regeneration. Moreover, obstacles to the use of off-the-shelf cell-therapy preparations in regenerative medicine are briefly summarized here.

Effects of Sacha Inchi (Plukenetia volubilis L.) Oil Supplementation on Hyperglycaemia, Hypertension and Hyperlipidaemia (3Hs) Patients: A Preliminary Human Trial

Sacha Inchi oil (SIO), derived from seeds of Plukenetia volubilis L., is a novel plant source of unsaturated fatty acids, highly regarded for its health benefits. The rich fractions of polyunsaturated fatty acids have shown potential in improving or reducing the impact of hyperglycaemia, hypertension and hyperlipidaemia (3Hs) for both in vivo and preliminary human studies. This study aimed to investigate the effects of SIO supplementation on glycaemic, lipid and blood pressures outcomes of patients with 3Hs. A randomised, double-blind, placebo-controlled human clinical trial was conducted to investigate the effects of SIO supplementation in fifty-four (n = 54) 3Hs patients. Assessments of glycaemic control, blood pressure and lipid profiles were conducted and compared at baseline and week-12 after 3Hs patients were randomised into SIO group (n = 27) (received 1000 mg of SIO soft gel per day) or the placebo group (n = 27) (received 1000 mg of corn oil), with prescribed medications. The compliancy and tolerability of supplementation were assessed concurrently. The SIO group demonstrated lower systolic (-8.6 mmHg, p = 0.004) and diastolic blood pressure (BP) (-7.0 mmHg, p = 0.004), total cholesterol (TC) (-0.6 mmol/L, p = 0.024), low density lipoprotein-cholesterol (LDL-C) (-0.3 mmol/L, p = 0.036) and high density lipoprotein-cholesterol (HDL-C) (p = 0.048) but no effect on glycaemic markers. No clinical adverse events were reported, and the side effects of SIO supplementation were self-limiting and minimal. SIO supplementation showed the potential to alleviate BPs, reduced both TC and LDL-C, and improved HDL-C levels. SIO may offer a simple, novel complementary medicine for the management of 3Hs.

Traumatic chylothorax management post-coronary artery bypass grafting - A systematic review

INTRODUCTION

Coronary artery bypass graft (CABG) surgery is performed globally around 400,000 times annually. Despite its benefits, CABG can lead to complications, including chylothorax, a rare condition where chyle accumulates in the pleural cavity due to thoracic duct trauma. Currently, there are no international guidelines for traumatic chylothorax management post-CABG. This is the first systematic review to provide a comprehensive overview of the current state of management for chylothorax post-CABG.

METHODS

This systematic review was conducted by searching EMBASE, Cochrane, Ovid and PubMed databases on 16 June 2024. The inclusion criteria focused on studies addressing post-CABG chylothorax management and reporting clinical outcomes. Data was extracted from 11 studies focusing on graft type, complications and management strategies.

RESULTS

This review included 11 case report studies with 14 cases of post-CABG chylothorax. Conservative management was attempted in all cases, with varying components such as total parenteral nutrition, nil by mouth, octreotide and low-fat diets. High-output chylothorax (>1000 mL/day) often necessitated surgical intervention after an average of 12.5 days of conservative management. Surgical approaches included thoracic duct ligation, embolisation and pleurodesis. Surgical ligation was effective in three cases, while thoracic duct embolisation was successful in one case.

CONCLUSIONS

Chylothorax post-CABG is managed initially with conservative strategies, but high-output cases often necessitate surgical intervention. This review highlights the need for standardised guidelines, regarding the timing of surgical escalation and the use of octreotide and somatostatin. Further research should focus on higher-powered studies to validate these findings and establish clinical guidelines for managing chylothorax post-CABG.

Effect of perioperative remote ischemic conditioning on myocardial injury in patients with unstable angina undergoing percutaneous coronary intervention: protocol of a multicenter, randomized, double-blind clinical trial

BACKGROUND

Cardiovascular disease is a leading cause of death, with ischemic heart disease being a significant contributor. While percutaneous coronary intervention (PCI) effectively reduces mortality in myocardial infarction patients, its efficacy for unstable angina (UA) patients is controversial. Complications associated with PCI further limit application in UA. RIC is hypothesized to be an effective co-intervention that reduces PCI-related complications and may potentially enhance the efficacy of the PCI procedure itself.

METHODS

This is a pragmatic, prospective, dual-center, double-blind, randomized controlled clinical trial assessing the effect of remote ischemic conditioning (RIC) during percutaneous coronary intervention (PCI) on injury in unstable angina patients aged ≥ 18 years undergoing coronary angiography. Participants will be randomized to receive either RIC or Sham RIC, in addition to standard pharmacotherapy. Primary outcome includes periprocedural myocardial injury measured by hs-cTnT levels, while secondary outcomes encompass major adverse cardiovascular events, coronary artery lesions Gensini Score, arrhythmia, angina incidence, SAQ scores, ECG changes, and cardiac function assessed by two-dimensional echocardiography. The trial aims to recruit 574 participants and is scheduled to be initiated on 15 January 2024. We will conduct the primary statistical analysis using the intention-to-treat principle. Results from the trial will be presented as comparative summary statistics following the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

TRIAL REGISTRATION

ChiCTR2400079855, 15 January 2024.

Natural Bioactive Compounds in the Management of Type 2 Diabetes and Metabolic (Dysfunction)-Associated Steatotic Liver Disease

Type 2 diabetes (T2D) and metabolic (dysfunction)-associated steatotic liver disease (MASLD) affect a growing number of individuals worldwide. T2D and MASLD often coexist and substantially elevate the risk of adverse hepatic and cardiovascular clinical outcomes. Several common pathogenetic mechanisms are responsible for T2D and MASLD onset and progression, including insulin resistance, oxidative stress, and low-grade inflammation, among others. The latter can also be induced by gut microbiota and its derived metabolites. Natural bioactive compounds (NBCs) have been reported for their therapeutic potential in both T2D and MASLD. A large amount of evidence obtained from clinical trials suggests that compounds like berberine, curcumin, soluble fibers, and omega-3 fatty acids exhibit significant hypoglycemic, hypolipidemic, and hepatoprotective activity in humans and may be employed as adjunct therapy in T2D and MASLD management. In this review, the role of the most studied NBCs in the management of T2D and MASLD is discussed, emphasizing recent clinical evidence supporting these compounds' efficacy and safety. Also, prebiotics that act against metabolic dysfunction by modulating gut microbiota are evaluated.

Exploring the Effects of Incorporating Different Bioactive Phospholipids into Messenger Ribonucleic Acid Lipid Nanoparticle (mRNA LNP) Formulations

The current rapid advancement in ribonucleic acid (RNA) therapeutics research depends on innovations in drug delivery, especially the development of a lipid-nanoparticle (LNP)-based system. The conventional LNP formulation typically contains four components, including an ionizable cationic lipid, a phospholipid, cholesterol or a cholesterol derivative, and poly(ethylene glycol) (PEG)-lipid, with each contributing to the formulation's overall stability and effectiveness. Among these four types of lipids, the phospholipid component is often known to provide structural support for the nanoparticles but is also a class of bioactive molecules with strong cell signaling potential. This study explores the possibility of incorporating some known structurally related bioactive phospholipids as the fifth component of a conventional four-component LNP formulation and assesses the impacts of such an approach on the physicochemical properties and biological functions of the mRNA LNP formulation. We screened a library of mRNA LNP formulations containing 7 different structurally related bioactive phospholipids at molar concentrations of 5%, 15% and 30% in addition to a conventional four-component LNP formulation (base). We observed differences in physicochemical properties between the mRNA LNP formulations that could be attributed to both the types of phospholipids examined and the molar concentrations used. Cryo-EM analysis revealed structural similarity between the Base formulation and the other formulations. We also characterized the protein expression level in HeLa cells and picked up a distinct cytokine panel signature for each formulation in human peripheral blood mononuclear cells (hPBMCs). Further immunophenotyping analysis showed that most cells that were transfected were CD4+ T cells, and the addition of the different bioactive phospholipids slightly altered cellular tropism. This exploratory study illustrates how adding the bioactive phospholipid can be used to modulate the LNP function, further expanding the design space for RNA LNP formulations and potentiating LNPs for use as RNA therapeutics.