Methionine Metabolism Dictates PCSK9 Expression and Antitumor Potency of PD-1 Blockade in MSS Colorectal Cancer

Nutrient metabolisms are vitally interrelated to cancer progression and immunotherapy. However, the mechanisms by which nutrient metabolisms interact to remodel immune surveillance within the tumor microenvironment remain largely unexplored. Here it is demonstrated that methionine restriction inhibits the expression of proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of cholesterol homeostasis and a potential target for cancer immunotherapy, in colorectal cancer (CRC) but not in the liver. Mechanistically, methionine is catabolized to S-adenosylmethionine (SAM), promoting mRNA transcription of PCSK9 through increased DNA methyltransferase 1 (DNMT1)-mediated DNA methylation and suppression of sirtuin 6 (SIRT6) expression. Furthermore, both PCSK9 inhibition and dietary methionine restriction (DMR) potentiate PD-1 blockade therapy and foster the infiltration of CD8+ T cells in Colon 26 tumor-bearing mice-a proficient mismatch repair (pMMR)/microsatellite stable (MSS) CRC model that exhibits limited response to anti-PD-1 therapy. Moreover, combining 5-fluorouracil (5-FU) chemotherapy with PCSK9 inhibition and PD-1 blockade further augments therapeutic efficacy for MSS CRC. The findings establish a mechanistic link between amino acid metabolism and cholesterol metabolism within the tumor microenvironment where tumor cells sense methionine to regulate PCSK9 expression, highlighting promising combination therapeutic strategies that may greatly benefit MSS CRC patients.

Protective effect of curcumin against microplastic and nanoplastics toxicity

Microplastics and nanoplastics (MNPs) are present in urban dust and the aquatic environments of industrialized cities. MNPs in the human body accumulate in the lymphoid follicles, Peyer's patches of the gastrointestinal tract, and pulmonary vascular endothelial cells, which slowly result in toxicity. Since previous studies introduced curcumin as a natural protective agent against environmental toxins, we reviewed preclinical studies that had used curcumin to protect organs or cells from toxicity secondary to exposure to MNPs. It was found that exposure to MNPs resulted in osteolysis, immunotoxicity, thyroid disturbances, nephrotoxicity, neurotoxicity, hepatotoxicity, pulmonary toxicity, gastrointestinal toxicity, cardiovascular toxicity, and especially endocrine, and reproductive toxicity. Nevertheless, except for one study reviewed, curcumin restored all oxidative and histopathological damages induced by MNPs to normal due to curcumin's inherent antioxidant, antiapoptotic, anti-inflammatory, and anti-proliferative properties.

Residential Greenness Is Associated with Lower Thyroid Nodule Prevalence: A Nationwide Study in China

Background: The prevalence of thyroid nodules is increasing globally. This study explored the association between residential greenness and thyroid nodule prevalence. Methods: Data were collected from a national cross-sectional survey of 73,728 participants across 31 provinces in mainland China. Residential greenness was assessed with the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Thyroid nodules >10 mm in diameter were diagnosed via ultrasound. We used quartile comparisons of the NDVI and EVI to compare nodule prevalence and employed logistic regression and restricted cubic spline analyses to examine nodules' associations with greenness. Interaction and sensitivity analyses were performed to test robustness. Results: A total of 73,728 participants were included in this study. The prevalence of 10 mm thyroid nodules decreased across NDVI500 quartiles: Q1: 7.99% (7.59-8.39%), Q2: 10.04% (9.60-10.48%), Q3: 6.59% (6.23-6.95%), and Q4: 5.20% (4.88-5.52%) (p for trend <0.001). The prevalence was 5.25% (95% confidence interval [CI]: 5.02-5.49%) in males and 9.09% (CI: 8.80-9.39%) in females. Logistic regression analysis showed that greater residential greenness was associated with a lower prevalence of thyroid nodules after adjusting for all covariates. This association was observed for both continuous greenness measures (NDVI500: odds ratio [OR] = 0.20, CI: 0.16-0.25; EVI500: OR = 0.08, CI: 0.06-0.12) and across quartiles (NDVI500 Q4: OR = 0.53, CI: 0.48-0.58; EVI500 Q4: OR = 0.55, CI: 0.51-0.60; both compared to Q1). Multiple sensitivity analyses confirmed this negative association, including the use of an alternative thyroid nodule definition (5 mm threshold), exclusion of individuals with cysts on ultrasound, and subgroup analyses excluding individuals with autoimmune thyroid antibody positivity, goiter, or both. In all these sensitivity analyses, NDVI and EVI data were assessed using both 500 m and 1000 m buffers. Conclusion: Our study is the first to identify an association between higher levels of residential greenness and a lower prevalence of thyroid nodules.

Muscone Attenuates Uveitis Through the PI3K/AKT Signaling Pathway

Purpose

Uveitis is an immune-mediated ocular disorder that poses a significant threat to vision, particularly among young and middle-aged adults. The treatment of uveitis is complicated by the presence of the blood-retinal barrier (BRB), which restricts the passage of large molecular drugs into the eye, thus limiting effective therapeutic options. The primary objective of this study is to identify a novel therapeutic agent capable of treating uveitis and explore its underlying mechanism.

Methods

In this study, we used a mouse model of experimental autoimmune uveitis (EAU) induced by interphotoreceptor retinoid-binding protein (IRBP) and lipopolysaccharide (LPS) and interferon-gamma (IFN-γ)-induced inflammatory BV2 cells. Evans blue and fundus fluorescein angiography (FFA) experiments were performed to evaluate the destruction of BRB. Silt lamp and hematoxylin and eosin (H&E) staining were conducted to evaluate the inflammatory response. In vivo proteomics and Western blot were carried to investigate the underlying mechanisms.

Results

Our study reveals that Muscone significantly alleviates EAU and restores the integrity of BRB. Moreover, Muscone treatment markedly downregulated inflammatory factors within the retinas and BV2 cells. In vivo proteomic combined with liquid chromatography-mass spectrometry (LC-MS) has elucidated that Muscone exerts its anti-inflammatory effects by modulating the PI3K-AKT signaling pathway. Moreover, by using LY294002 to specifically inhibit PI3K, we observed a marked decrease in inflammatory phenotype and BRB destruction of EAU.

Conclusions

In summary, this study establishes the protective efficacy of Muscone against the progression of EAU and provides insights into the molecular mechanisms responsible for its therapeutic action.

Acute and chronic post-COVID-19 conditions: A study of genetic integrity and clinical markers

The long-term effects of COVID-19 infection on genomic integrity, along with hematological, biochemical, and inflammatory, remain poorly understood. Viral infections, including SARS-CoV-2, are known to induce genomic instability, potentially contributing to the persistence of post-COVID-19 symptoms. This study aimed to assess genomic instability in individuals with acute and chronic post-COVID-19 conditions, alongside hematological profiles, metabolic parameters, and inflammatory markers, compared to a SARS-CoV-2-negative control group. Participants (n = 231) from southern Brazil were stratified into acute post-COVID (n = 78), chronic post-COVID (n = 79), and control groups (n = 74). DNA damage was assessed using alkaline and enzyme-modified comet assays. Oxidative lesions were detected across all groups, but no significant differences were observed among them. Correlations with biochemical markers suggest inflammation and oxidative stress as central mechanisms in post-COVID-19 pathophysiology. Hematological and biochemical analyses revealed persistent inflammation, lipid metabolism disruptions, and gender-specific alterations, such as higher levels of inflammatory markers (C-reactive protein and ferritin) and lipid abnormalities in men, whereas women exhibited distinct hematological patterns. Age-related influences on metabolic and inflammatory markers further illustrate the systemic complexity of post-COVID-19 effects. The chronic group exhibited ongoing but attenuated markers of inflammation and oxidative stress compared to the acute group. These findings suggest that genetic instability alone may not fully explain the observed clinical manifestations, emphasizing the role of persistent inflammation and metabolic dysregulation. This study provides a comprehensive view of the interplay between genomic instability, inflammation, oxidative damage, and systemic alterations in post-COVID-19 condition. It underscores the importance of a multifaceted approach to understanding disease mechanisms and the need for longitudinal studies to explore the dynamic nature of these alterations and their long-term health implications.

Harnessing Noncanonical Proteins for Next-Generation Drug Discovery and Diagnosis

Noncanonical proteins, encoded by previously overlooked genomic regions (part of the "dark genome"), are emerging as crucial players in human health and disease, expanding our understanding of the "dark proteome." This review explores their landscape, including proteins derived from long non-coding RNAs, circular RNAs, and alternative open reading frames. Recent advances in ribosome profiling, mass spectrometry, and proteogenomics have unveiled their involvement in critical cellular processes. We examine their roles in cancer, neurological disorders, cardiovascular diseases, and infectious diseases, highlighting their potential as novel biomarkers and therapeutic targets. The review addresses challenges in identifying and characterizing these proteins, particularly recently evolved ones, and discusses implications for drug discovery, including cancer immunotherapy and neoantigen sources. By synthesizing recent findings, we underscore the significance of noncanonical proteins in expanding our understanding of the human genome and proteome, and their promise in developing innovative diagnostic tools and targeted therapies. This overview aims to stimulate further research into this unexplored biological space, potentially revolutionizing approaches to disease treatment and personalized medicine.

Treatment of advanced‑stage non‑small cell lung cancer: Current progress and a glimpse into the future (Review)

Before the twentieth century, patients with advanced lung cancer had limited treatment options and chemotherapy was the primary form of treatment, with an overall survival often <0.5 years. However, with advances in society and medical technology, the treatment approaches for advanced non-small cell lung cancer (NSCLC) have markedly changed. Traditional chemotherapy has been gradually replaced by targeted therapy and immunotherapy, leading to the emergence of various new therapeutic options that offer patients more personalized and precise care. This raises the question of what the future holds for the treatment of NSCLC. This review provides a comprehensive analysis of the latest breakthroughs in targeted therapies, immunotherapies, and drugs for antibody-drug conjugates (ADCs), highlights advances in multimodal combination therapy strategies, and explores the causes of resistance and the challenges that exist in overcoming it. In particular, this review provides unique insights into key directions for future research in NSCLC, such as personalised treatment strategies and biomarker exploration based on multi-omics data, aiming to provide new inspiration for clinical decision-making and research.

Predictive utility of self-efficacy in early stroke rehabilitation

INTRODUCTION

A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual's belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs.

OBJECTIVE

To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation.

METHODS

Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level.

RESULTS

Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R2 = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R2 = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model.

DISCUSSION

Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual's care.

Significant association of functional variants in the promoter sequence of IL18 with disease susceptibility and systemic lupus erythematosus clinical parameters

ObjectiveSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with a complex etiology. Interleukin-18 (IL-18) possesses pro-inflammatory properties and plays a central role in the development of SLE. In this study, we assessed the association between two functional variants that affect the expression of IL-18, namely -607C > A (rs1946518) and -137G > C (rs187238), and the risk of SLE development.MethodsAs a case-control study, 251 peripheral blood samples were collected from 121 SLE patients and 130 healthy participants. Genotyping of these polymorphisms was performed using the high-resolution melting (HRM) method, which employs real-time polymerase chain reaction.ResultsOur findings revealed a significant association between the AA genotype and A allele in rs1946518, showing a decreased risk of SLE (AA vs CC; OR: 0.386; 95% CI [0.174-0.828], A vs C; OR: 0.548; 95% CI [0.369-0.809]). Analogously, the CC genotype and C allele in rs187238 exhibited a similar trend (CC vs GG; OR: 0.240; 95% CI [0.055-0.803], C vs G; OR: 0.604; 95% CI [0.390-0.928]), indicating a reduced risk of SLE Moreover, SLE subjects with the protective allele in rs1946518 (AA + AC) demonstrated significantly lower levels of CRP, and Anti-dsDNA, suggesting lower disease activity. These patients also had a later age of onset, and a lower incidence of renal involvement and creatinine levels, indicating milder disease severity (p < .05).ConclusionThe study indicates a significant relationship between the rs1946518 and rs187238 variants in IL-18 and a reduced risk of SLE. Furthermore, rs1946518 was found to be associated with certain clinical features related to disease activity and severity.

Re-evaluating vertebral height restoration assessment in osteoporotic compression fractures: a systematic review and meta-analysis

PURPOSE

Vertebral compression fractures (VCFs) are common among the elderly, causing significant morbidity, pain, and disability. This study quantitatively analyzes the vertebral height restoration via Kyphoplasty (KP) and Vertebroplasty (VP), along with the cement volume used and leakage percentage. Our meta-analysis of 14 randomized controlled trials (RCTs) compares these objective outcomes, considering cement volume and leakage in both procedures.

METHODS

Databases searched included Medline, PubMed, and Web of Science using MeSH keywords: 'Kyphoplasty,' 'Vertebroplasty,' 'Vertebral height restoration,' 'Bone cement volume,' and 'Vertebral compression fractures.' Fourteen RCTs were selected, focusing on outcomes such as anterior and central vertebral body height, kyphotic angle, cement volume, and leakage. Data analysis included mean values, standard deviations, ranges, Cohen's d-effect sizes, and standard errors, summarized in a forest plotQuery.

RESULTS

The review included 1456 patients (mean age 71.11 years). Follow-up ranged from 1 to 48 months (mean 15 months). KP showed a greater effect size in restoring anterior and central vertebral body height and kyphotic angle. Combined data from KP and VP showed increases of 3.48 mm (19.14%) in anterior vertebral heights, 4.38 mm in central vertebral heights, and a 2.85-degree correction in kyphotic angle.

CONCLUSIONS

Both KP and VP effectively restore vertebral height in VCF patients. KP is superior in restoring anterior and central vertebral body height and correcting kyphotic angle. VP, particularly unilateral, shows higher central vertebral height restoration but higher cement leakage. Standardized reporting and patient-specific volumetric assessments are crucial for optimizing vertebral augmentation procedures.

NSUN2/ALYREF-medicated m5C-modified circRNA505 regulates the proliferation, differentiation, and glycolysis of antler chondrocytes via the miRNA-127/p53 axis and LDHA

The deer antler is a fully regenerable and the fastest-growing osseous organ. Circular RNA (circRNA), a novel member of the non-coding RNA family, has significant research potential and crucial roles in biological processes. This study aims to explore the impact and mechanisms of circRNA505 on antler chondrocytes. Functional experiments demonstrated that m5C-modified circRNA505 inhibits antler chondrocyte proliferation, enhances osteogenic differentiation, and facilitates cellular glycolysis. Mechanistically, dual luciferase and AGO2-RIP assays revealed a direct binding relationship between circRNA505, miR-127, and p53. Rescue assays further showed that circRNA505 affects cell proliferation and differentiation through the miR-127/p53 axis. Meanwhile, RNA Antisense Purification (RAP) screening and analysis of related proteins binding to circRNA505 demonstrated that circRNA505 binds to LDHA and increases the level of LDHA phosphorylation through FGFR1 to promote cellular glycolysis by FISH-IF, RIP, and Western blot experiments. Additionally, Me-RIP assays confirmed the m5C methylation modification of circRNA505. NSUN2 mediates the m5C modification of circRNA505, affecting its stability, while the m5C reader ALYREF promotes the nuclear export of circRNA505 in an ALYREF-dependent manner. This study provides new insights into the regulatory mechanisms underlying rapid antler development.

How Successful Is AI in Developing Postsurgical Wound Care Education Material?

ChatGPT can be used as an aid in education, research and clinical management. This study was conducted using the ChatGPT 4.0 program to develop artificial intelligence-supported wound care education material that can be read and understood by patients discharged after surgery. In this methodological study, while creating wound care education material, the education needs of the patients were determined first. Then, the education content was created in the ChatGPT 4 program. Expert opinion was taken for the clarity, applicability, accuracy and quality of the education content. The Turkish readability index of the education material was found to be 68.9 and easily understandable. The Automated Readability Index was found to be 9.29, the Simple Measure of Gobbledygook 7.89, the Flesch-Kincaid 8.07, the Flesch Reading Ease 59.0 and the Average Reading Level Consensus 9.99, which are frequently used in health literature. The PEMAT understandability and applicability score averages were determined 93.90 ± 6.11 (84-100) and 90.20 ± 8.66, respectively. The Global Quality Scale score average was found to be 4.40 ± 0.69. This study reveals that ChatGPT provides understandable, applicable, accurate and high-quality postoperative wound care education material.

Stearoyl-coenzyme A desaturase enhances cell survival in human uterine leiomyoma

OBJECTIVE

Stearoyl-CoA desaturase (SCD1) is an enzyme that catalyzes the conversion of saturated delta-9 fatty acids to monounsaturated fatty acids. SCD1 is highly expressed in various cancers and facilitates cancer cell survival, tumor growth, and metastasis. This study aimed to assess SCD1 expression and function in uterine leiomyoma and matched myometrial tissue and evaluate the impact of SCD1 inhibition on leiomyoma cell viability and apoptosis.

DESIGN

Gene set enrichment analysis was performed to determine whether lipid metabolism pathways are dysregulated in leiomyoma. To assess the function of SCD1, primary leiomyoma and myometrial cells, as well as a CRISPR-engineered leiomyoma-relevant MED12 mutant human uterine smooth muscle (UtSM) cell line, were treated with SCD1 small interfering RNA or a small molecule inhibitor of SCD1, CAY10566. Cell viability and apoptosis assays, real-time quantitative polymerase chain reaction, and immunoblot analyses were performed to evaluate cell function in response to treatment.

SUBJECTS

Leiomyoma and myometrial tissues were obtained from premenopausal individuals designated female at birth (n = 30) undergoing myomectomy or hysterectomy.

EXPOSURE

SCD1 inhibition by small interfering RNA and CAY10566 treatment.

MAIN OUTCOME MEASURES

Messenger RNA (mRNA) and protein levels and cell viability and apoptosis.

RESULTS

Gene set enrichment analysis revealed that the cholesterol homeostasis pathway was significantly different in leiomyoma vs. adjacent myometrial tissues. Among the genes in this pathway, SCD1 mRNA levels were found to be significantly higher in leiomyoma than in matched myometrium. SCD1 inhibition by small interfering RNA or CAY10566 decreased antiapoptotic BCL2 mRNA and protein levels and cell viability in primary leiomyoma but not myometrial cells. SCD1 protein levels were significantly higher in the mutant MED12 UtSM cell line than in the wild-type MED12 UtSM cell line. CAY10566 treatment specifically decreased cell viability and increased apoptosis in mutant MED12 UtSM cells, with increased protein levels of cleaved caspase 3, cleaved PARP, and DDIT3 in mutant MED12 UtSM but not in wild-type MED12 UtSM cells.

CONCLUSION

SCD1, an enzyme involved in lipid homeostasis, may play an important role in promoting leiomyoma growth and represents a novel target for the treatment of leiomyoma.

Novel injectable self-healing bifunctionalized chitosan hydrogel with cell proliferation and antibacterial activity for promoting wound healing

Wound healing is a complex and continuous process and there is an urgent need to develop effective, functional wound dressings to accelerate wound healing. In this study, we developed an injectable self-healing dual-modified chitosan composite hydrogel, referred to as CSTA@Gel. This hydrogel exhibits good properties, including effective tissue adhesion, rapid hemostatic ability, and good cytocompatibility and hemocompatibility. Additionally, the incorporation of modified adenine and thymine enhances its cell proliferation-promoting and antimicrobial properties, demonstrating significant antibacterial activity against Staphylococcus aureus and Escherichia coli. Histological and immunohistochemical analyses reveal that treatment with CSTA@Gel significantly promotes wound healing, increases collagen deposition, and accelerates angiogenesis. These findings indicate that this hydrogel design presents a promising strategy for developing of novel wound dressings.

M2 macrophage-derived exosomes promote cell proliferation, migration and EMT of non-small cell lung cancer by secreting miR-155-5p

Tumor-associated macrophages (TAMs) are a type of highly plastic immune cells in the tumor microenvironment (TME), which can be classified into two main phenotypes: classical activated M1 macrophages and alternatively activated M2 macrophages. As previously reported, M2-polarized TAMs play critical role in promoting the progression of non-small cell lung cancer (NSCLC) via secreting exosomes, but the detailed mechanisms are still largely unknown. In the present study, the THP-1 monocytes were sequentially induced into M0 and M2-polarized macrophages, and the exosomes were obtained from M0 (M0-exos) and M2 (M2-exos) polarized macrophages, respectively, and co-cultured with NSCLC cells (H1299 and A549) to establish the exosomes-cell co-culture system in vitro. As it was determined by MTT assay, RT-qPCR and Transwell assay, in contrast with the M0-exos, M2-exos significantly promoted cell proliferation, migration and epithelial-mesenchymal transition (EMT) process in NSCLC cells. Next, through screening the contents in the exosomes, it was verified that miR-155-5p was especially enriched in the M2-exos, and M2-exos enhanced cancer aggressiveness and tumorigenesis in in vitro NSCLC cells and in vivo xenograft tumor-bearing mice models via delivering miR-155-5p. The detailed molecular mechanisms were subsequently elucidated, and it was found that miR-155-5p bound with HuR to increase the stability and expression levels of VEGFR2, which further activated the tumor-promoting PI3K/Akt/mTOR signal pathway, and M2-exos-enhanced cancer progression in NSCLC cells were apparently suppressed by downregulating VEGFR2 and PI3K inhibitor LY294002 co-treatment. Taken together, M2-polarized TAMs secreted miR-155-5p-containing exosomes to enhanced cancer aggressiveness of NSCLC by activating the VEGFR2/PI3K/Akt/mTOR pathway in a HuR-dependent manner.

Human and pathogen-encoded circular RNAs in viral infections: insights into functions and therapeutic opportunities

Circular RNAs (circRNAs) are emerging as important regulatory molecules in both host and viral systems, acting as microRNA sponges, protein decoys or scaffolds, and templates for protein translation. Host-derived circRNAs are increasingly recognized for their roles in immune responses, while virus-encoded circRNAs, especially those from DNA viruses, have been shown to modulate host cellular machinery to favor viral replication and immune evasion. Recently, RNA virus-encoded circRNAs were also discovered, but evidence suggests that they might be generated using a different mechanism compared to the circRNAs produced from the host and DNA viruses. This review highlights recent advances in our understanding of both host and virus-derived circRNAs, with a focus on their biological roles and contributions to pathogenesis. Furthermore, we discuss the potential of circRNAs as biomarkers and their application as therapeutic targets or scaffolds for RNA-based therapies. Understanding the roles of circRNAs in host-virus interactions offers novel insights into RNA biology and opens new avenues for therapeutic strategies against viral diseases and associated cancers.

Efficacy and mechanism of long-snake moxibustion for treating insomnia in breast cancer survivors: study protocol for a randomized controlled trial

Background

Insomnia (difficulty falling or staying asleep) is a common issue among breast cancer survivors, significantly impacting their quality of life. Current treatments, primarily pharmacological and psychological, have limitations: the former often causes side effects, while the latter faces accessibility barriers. Long-snake moxibustion (LSM), a traditional Chinese medicine (TCM) technique, involves applying moxibustion along the governor vessel, which is an important meridian in TCM that plays a key role in regulating brain function. LSM is characterized by its minimal side effects, ease of application, and cost-effectiveness, with preliminary studies supporting its potential for treating insomnia. This study aims to further investigate the therapeutic effectiveness of LSM in alleviating insomnia among breast cancer survivors and to explore its underlying mechanisms.

Methods

This single-center, rater-masked, randomized controlled trial will enroll 100 breast cancer survivors with chronic insomnia, who will be randomly assigned in a 1:1 ratio to either the LSM group or a waitlist control group. During the 4-week treatment period, all participants will receive standard care, with the LSM group additionally receiving LSM treatment twice a week. The primary efficacy outcome is the change in Insomnia Severity Index (ISI) score at the end of the intervention. Secondary outcomes include changes in hypnotic medication use, Pittsburgh Sleep Quality Index (PSQI) scores, Piper Fatigue Scale (PFS) scores, and Functional Assessment of Cancer Therapy-Breast (FACT-B) scores. Mechanistic evaluations will assess serum biochemical markers, gut microbiota composition, and metabolomic profiles.

Discussion

If proven effective, this trial will provide critical clinical evidence supporting LSM as a viable and accessible treatment for insomnia among breast cancer survivors. The findings could influence clinical practice by offering a non-pharmacological treatment option, improving patient outcomes, and reducing dependence on pharmacological interventions. Furthermore, exploring the underlying mechanisms may enhance our understanding of how LSM works, paving the way for future research.

Clinical trial registration

http://itmctr.ccebtcm.org.cn/, identifier ITMCTR2024000578.

Poria cocos Polysaccharide Reshapes Gut Microbiota to Regulate Short-Chain Fatty Acids and Alleviate Neuroinflammation-Related Cognitive Impairment in Alzheimer's Disease

Evidence indicates that Poria cocos polysaccharide (PCP) improves cognitive impairment in Alzheimer's disease (AD); however, its underlying mechanism, particularly its relationship with the gut microbiota, remains unclear. In the current study, we aimed to investigate the mechanism of PCP in improving cognitive impairment in AD. The results demonstrated that PCP markedly enhanced cognitive function and mitigated AD-related pathological alterations in 3 × Tg-AD mice. PCP treatment reversed the age-dependent gut microbiota dysbiosis in 3 × Tg-AD mice by 16S rDNA sequencing. The contents of propanoic acid, butanoic acid and isohexanoic acid were increased by short-chain fatty acid determination. In addition, PCP could restore both the intestinal barrier and the blood-brain barrier, as demonstrated by immunofluorescence staining of tight junction proteins. Furthermore, PCP alleviated systemic inflammation and neuroinflammation, as evidenced by reduced LPS levels in circulation and decreased IL-6 levels in the brain, likely by inhibiting the TLR4/NF-κB signaling pathway. In conclusion, PCP can reshape gut microbiota to regulate short-chain fatty acids and alleviate neuroinflammation-related cognitive impairment in AD mice.

Enhancing diagnostic accuracy: Role of stomach-specific serum biomarkers in real-world risk-based sequential screening for malignant gastric lesions

Objective

A risk-based sequential screening strategy, from questionnaire-based assessment to biomarker measurement and then to endoscopic examination, has the potential to enhance gastric cancer (GC) screening efficiency. We aimed to evaluate the ability of five common stomach-specific serum biomarkers to further enrich high-risk individuals for GC in the questionnaire-identified high-risk population.

Methods

This study was conducted based on a risk-based screening program in Ningxia Hui Autonomous Region, China. We first performed questionnaire assessment involving 23,381 individuals (7,042 outpatients and 16,339 individuals from the community), and those assessed as "high-risk" were then invited to participate in serological assays and endoscopic examinations. The serological biomarker model was derived based on logistic regression, with predictors selected via the Akaike information criterion. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC).

Results

A total of 2,011 participants were ultimately included for analysis. The final serological biomarker model had three predictors, comprising pepsinogen I (PGI), pepsinogen I/II ratio (PGR), and anti-Helicobacter pylori immunoglobulin G (anti-H. pylori IgG) antibodies. This model generated an AUC of 0.733 (95% confidence interval: 0.655-0.812) and demonstrated the best discriminative ability compared with previously developed serological biomarker models. As the risk cut-off value of our model rose, the detection rate increased and the number of endoscopies needed to detect one case decreased.

Conclusions

PGI, PGR, and anti-H. pylori IgG could be jointly used to further enrich high-risk individuals for GC among those selected by questionnaire assessment, providing insight for the development of a multi-stage risk-based sequential strategy for GC screening.

Global prevalence and risk factors of irritable bowel syndrome from 2006 to 2024 using the Rome III and IV criteria: a meta-analysis

Functional gastrointestinal disorders impact 40% of the global population, with irritable bowel syndrome (IBS) standing out due to its complexity, quality-of-life effects, and economic impact. Our meta-analysis explored the global prevalence of IBS, considering diagnostic criteria, subtypes, sampling methods, geographical variations, and risk factors. The literature search used databases like PubMed and Cochrane Library, focusing on IBS studies from 2006 to June 2024. Eligibility criteria included studies on individuals aged ≥18, based on Rome III/IV criteria, using random or convenience sampling. Data on IBS prevalence, subtypes, and sampling methods were extracted, and statistical analysis was performed using Open MetaAnalyst and the review manager. The study reviewed 96 articles on IBS prevalence using Rome III and IV criteria across 52 countries, revealing a global prevalence of 14.1%. Prevalence varied by subtype: IBS-C (26.1%), IBS-D (26.5%), IBS-M (31.4%), and IBS-U (8.3%). IBS-D was more prevalent under Rome III (26.2%), while IBS-C was more common under Rome IV (34.2%). First-world countries like the UK, China, and Japan had the highest prevalence. Females [odds ratios (OR): 1.49], stress (OR: 2.47), anxiety (OR: 2.93), and depression (OR: 2.24) were significantly more prevalent in IBS patients, while no significant differences were found in smoking, alcohol use, or education levels. This meta-analysis reveals regional and subtype variations in IBS prevalence, with psychological factors significantly impacting its development. The influence of sampling techniques and Rome III/IV criteria on prevalence estimates highlights the need for a multidisciplinary treatment approach, with important implications for IBS management.

Advancing precision oncology with AI-powered genomic analysis

Multiomics data integration approaches offer a comprehensive functional understanding of biological systems, with significant applications in disease therapeutics. However, the quantitative integration of multiomics data presents a complex challenge, requiring highly specialized computational methods. By providing deep insights into disease-associated molecular mechanisms, multiomics facilitates precision medicine by accounting for individual omics profiles, enabling early disease detection and prevention, aiding biomarker discovery for diagnosis, prognosis, and treatment monitoring, and identifying molecular targets for innovative drug development or the repurposing of existing therapies. AI-driven bioinformatics plays a crucial role in multiomics by computing scores to prioritize available drugs, assisting clinicians in selecting optimal treatments. This review will explain the potential of AI and multiomics data integration for disease understanding and therapeutics. It highlight the challenges in quantitative integration of diverse omics data and clinical workflows involving AI in cancer genomics, addressing the ethical and privacy concerns related to AI-driven applications in oncology. The scope of this text is broad yet focused, providing readers with a comprehensive overview of how AI-powered bioinformatics and integrative multiomics approaches are transforming precision oncology. Understanding bioinformatics in Genomics, it explore the integrative multiomics strategies for drug selection, genome profiling and tumor clonality analysis with clinical application of drug prioritization tools, addressing the technical, ethical, and practical hurdles in deploying AI-driven genomics tools.

Association of cardiovascular health with morbidity and mortality among U.S. adults with osteoarthritis: a population-based study

BACKGROUND

Osteoarthritis (OA) is recognized as the most common joint disease with serious public health implications. Cardiovascular health (CVH) is also an issue that is frequently emphasized in public health and has an impact on a variety of diseases and mortality rates. This study aims to investigate the association of CVH with the morbidity of OA. And explore the association of CVH with both all-cause and cardiovascular disease (CVD) mortality among US adults with OA.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey 2005-2018, which included 21,289 adults aged ≥ 20, representing 137,912,968 Americans. CVH was assessed by Life's Essential 8 (LE8) includes 4 behavior and 4 factor metrics. Total LE8 scores were calculated from the unweighted average on a 0-100 scale and were categorized as high (80-100), moderate (50-79), and low (0-49) CVH. Multivariable logistic regression explored the association of OA with CVH. Cox proportional hazards regression examined LE8 associations with mortality.

RESULTS

Adjusting for confounding variables, per 10 points LE8 increase, the OR was 0.82 in association with OA, while OA morbidity were decreased by 30% (OR 0.70, 95%CI 0.57, 0.87) and 54% (OR 0.46, 95%CI 0.36, 0.60) in moderate and high CVH compared to low CVH. During a median follow-up of 7.58 years in OA participants, per 10 points LE8 increase were decreased 23% mortality of all-cause (HR 0.77, 95%CI 0.70, 0.85) and 29% mortality of CVD (HR 0.71, 95% 0.60, 0.84). Moderate and high CVH demonstrated a decreased mortality of both all-cause and CVD compared with low CVH.

CONCLUSIONS

Higher CVH is associated with a lower morbidity of OA and lower mortality in OA participants. Our results suggest that adherence to CVH could reduce the morbidity of OA and improve survival outcomes for those affected.

Expert consensus on cancer treatment-related lung injury

Background

Although advancements in cancer therapies have substantially improved the survival of cancer patients, these treatments may also result in acute or chronic lung injury. Cancer treatment-related lung injury (CTLI) presents with a diverse array of clinical manifestations and can involve multiple sites. Due to the lack of specific diagnostic protocols, CTLI can deteriorate rapidly and may be life-threatening if not promptly addressed. Unfortunately, there is no universally accepted consensus document on the diagnosis and management of CTLI.

Methods

A multidisciplinary panel comprising experts from respiratory and critical care medicine, oncology, radiation oncology, thoracic surgery, radiology, pathology, infectious diseases, pharmacy, and rehabilitation medicine participated in this consensus development. Through a systematic literature review and detailed panel discussions, the team formulated nine key recommendations.

Results

This consensus document addresses the concept, epidemiology, pathogenesis, risk factors, diagnostic approach, evaluation workflow, management strategies, differential diagnosis, type-specific management and clinical staging of CTLI. Emphasis is placed on raising awareness among clinicians and therapeutic practices through comprehensive guidelines.

Conclusions

The consensus provides a detailed diagnostic protocol for CTLI and introduces a structured management framework based on grading, typing, and staging. It highlights the critical role of multidisciplinary team (MDT) collaboration and emphasizes the need for individualized, whole-process patient care strategies to optimize clinical outcomes.

Tuning the optical, electrical, anti-microbial, and swelling activity of nanowires manganese dioxide-loaded chitosan matrix

Skin wound healing is undoubtedly a complex and challenging process. Creating innovative bio-nanocomposites for skin care and wound healing/dressing applications are currently an urgent need. In this context, a mixture of chitosan (CS) and MnO2 nanowires (NWs), as potential wound dressing nano-film, are systematically investigated for optical, electrical, and antibacterial applications. The crystallinity of the materials was investigated through XRD, while FTIR was used to examine the interactions between the CS films and the MnO2 nanofiller. The resulting nanocomposite membranes exhibit superior swelling capacity than that of the pure CS membrane. Additionally, the thermal stability of the films was evaluated, demonstrating the highest stability of composite samples. The optical properties, including bandgap energies and refractive indices, can be adjusted by tuning the content of MnO2. Remarkably, the refractive index dropped from 3.76 in pure CS film to 3.4 in the highest fraction of MnO2 (CS-4 wt% MnO2). The impedance analysis was further improved for the (CS-4 wt% MnO2) sample, posing lower interfacial resistance. A comprehensive investigation of the antibacterial performance of the prepared films was carried out against five bacteria types. The pure CS film exhibited mostly inhibitory effects against Gram-positive bacteria (i.e., B. subtilis, and S. aureus) between the 19 and 14 mm range, while the Gram-negative bacteria (i.e., E. coli, and P. aeruginosa) showed activity between the 19 and 20 mm range, with an effect on A. niger and C. albicans 17 and 22 mm. However, the addition of MnO2 has significantly increased its antimicrobial activity. Overall, the prepared CS films demonstrate great potential for multifunctional applications, including antibacterial, wound healing, and optoelectronics.

The Critical Role of Body Composition Assessment in Advancing Research and Clinical Health Risk Assessment across the Lifespan

Obesity and low muscle mass are major public health concerns, especially in older adults, due to their strong links to cardiovascular disease, cancer, and mortality. Beyond body mass index, body composition metrics including skeletal muscle, fat mass, and visceral adipose tissue offer deeper insights into nutrition and disease risk. These measures are essential for both cross-sectional assessments and longitudinal tracking, providing a clearer picture of health changes over time. Selecting body composition assessment tools requires balancing cost, practicality, accuracy, and data quality. The right tools enhance research, refine clinical assessments, and inform targeted interventions. Aligning methods with specific research or clinical goals improves disease risk stratification and advances personalized treatments. This review highlights the importance of integrating body composition assessment into research and clinical practice, addressing knowledge gaps across diverse populations and emphasizing its potential in advancing precision medicine. It also highlights recent advancements in body composition assessment techniques that warrant consideration when evaluating techniques for a specific application. Future efforts should focus on refining these tools, expanding their accessibility, and developing comprehensive risk models that incorporate body composition alongside behavioral, environmental, and genetic factors to improve disease prediction and prevention strategies.

Nanotechnology-driven strategies in postoperative cancer treatment: innovations in drug delivery systems

Cancer remains a global health challenge, and this challenge comes with a significant burden. Current treatment modalities, such as surgery, chemotherapy, and radiotherapy, have their limitations. The emergence of nanomedicines presents a new frontier in postoperative cancer treatment, offering potential to inhibit tumor recurrence and manage postoperative complications. This review deeply explores the application and potential of nanomedicines in the treatment of cancer after surgery. In particular, it focuses on local drug delivery systems (LDDS), which consist of in situ injection, implantation, and spraying. LDDS can provide targeted drug delivery and controlled release, which enhancing therapeutic efficacy. At the same time, it minimizes damage to healthy tissues and reduces systemic side effects. The nanostructures of these systems are unique. They facilitate the sustained release of drugs, prolong the effects of treatment, and decrease the frequency of dosing. This is especially beneficial in the postoperative period. Despite their potential, nanomedicines have limitations. These include high production costs, concerns regarding long-term toxicity, and complex regulatory approval processes. This paper aims to analyze several aspects. These include the advantages of nanomedicines, their drug delivery systems, how they combine with multiple treatment methods, and the associated challenges. Future research should focus on certain issues. These issues are stability, tumor specificity, and clinical translation. By addressing these, the delivery methods can be optimized and their therapeutic efficacy enhanced. With the advancements in materials science and biomedical engineering, the future design of LDDS is set to become more intelligent and personalized. It will cater to the diverse needs of clinical treatment and offer hope for better outcomes in cancer patients after surgery.

Comparative evaluation of chitligsan nanosuspension gel and spray for enhancing full-thickness wound healing in a rat model

Introduction: This study explores the wound healing potential of Chitligsan (CHG), a novel formulation derived from the enzymatic and fossil-based components of Sahara soil, in nanosuspension-based gel and spray forms. Using a full-thickness wound model in Wistar rats, CHG's efficacy was compared with saline (control) and terramycin treatments.

Methods: A total of 48 rats were divided into four groups: Control (saline), Spray (CHG spray), Gel (CHG gel), and Terramycin pomad. Wound areas were measured at days 3, 7, 14, and 21.

Results: By day 21, CHG spray reduced wound size to 0.08 ± 0.01 cm2, while the gel achieved 0.09 ± 0.01 cm2, outperforming both control (0.34 ± 0.02 cm2) and terramycin (0.14 ± 0.05 cm2, p < 0.05). Histopathological analysis demonstrated superior epithelial regeneration, dense collagenization, and minimal inflammation in CHG-treated groups compared to others. The nanoscale size of CHG particles (89.6 ± 0.26 nm) and their stable zeta potential (-26.1 ± 1.5 mV) contributed to enhanced bioavailability and wound healing efficiency. Morphological and FTIR analyses confirmed the stability and compatibility of the nanosuspension.

Conclusions: This study highlights CHG's potential as a biocompatible and effective wound care solution, offering significant advantages in granulation tissue formation and keratinization compared to conventional treatments.

Infection, inflammation, and sexual function in male and female patients-recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)

INTRODUCTION

Sexual dysfunction in men and women is an important clinical issue; infection and inflammation can cause social, medical, and psychological problems that have a profound impact on sexual and reproductive health worldwide.

OBJECTIVES

We set out to identify sexual dysfunctions in men and women that arise from infection and inflammation and propose meaningful interventions, as evaluated by the Fifth International Consultation on Sexual Medicine (ICSM) held in June 2024 in Madrid (Spain).

METHODS

We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles and ClinicalTrials.gov and the World Health Organization's (WHO's) International Clinical Trials Registry Platform for prospective trials. This manuscript represents the opinions of 10 experts from 6 countries developed in a consensus process after completing the literature review, which produced a list of recommendations graded as weak or strong. This document was presented for peer review and debate in a public forum, and revisions were made based on the recommendations of chairpersons of the 5th ICSM.

RESULTS

Infections, and in particular sexually transmitted infections (STIs), dramatically affect the sexual and reproductive health of individuals and couples, irrespective of sexual orientation and gender. Similarly, non-communicable chronic diseases (NCDs), through the common pathogenetic mechanism of inflammation, can directly impair the ability to copulate, reproduce, and enjoy sexual life.

CONCLUSIONS

This expert consensus recommends prioritizing early detection, comprehensive treatment approaches, and preventive measures to mitigate the effects of infection and inflammation on sexual health, both for the patient and the couple. These insights provide a foundation for improving patient outcomes and fostering global awareness of the interconnections between infection, inflammation, and sexual dysfunction.

Correlation between EpCAM expression and cervical lymph node metastasis in papillary thyroid carcinoma: a study integrating ultrasonographic features

OBJECTIVES

The epithelial cell adhesion molecule (EpCAM) is a transmembrane glycoprotein that is overexpressed in various epithelial tumors and has been associated with tumor aggressiveness and unfavorable prognosis. This study aimed to explore the association between ultrasonic characteristics and EpCAM expression in papillary thyroid carcinoma (PTC), as well as the value in predicting the risk of cervical lymph node metastasis (CLNM).

METHODS

Participants with suspected thyroid cancer underwent conventional and contrast-enhanced ultrasonography (CEUS) before surgery. Age, sex, and nodule features in ultrasound were recorded. Participants were classified based on the presence of CLNM. EpCAM expression was detected using immunohistochemistry. The risk predictors of CLNM were evaluated by using univariate and multivariate Cox model.

RESULTS

The final dataset included 53 participants, of whom 27(50.94%) had CLNM, while 26(49.06%) did not. The EpCAM-positive area (p < 0.001), score (p < 0.001), and nuclear expression (p = 0.027) were significantly different between the CLNM and non-CLNM groups. Receiver operating characteristic curve analysis showed that EpCAM score with 4.5 had sensitivity and specificity of 85.2% and 76.9%, respectively, for diagnosing CLNM. Multivariate logistic regression results showed that overexpression EpCAM (score ≧ 4.5) [OR:46.54, p = 0.007], tumor size ≧ 1.05 cm [OR:14.21,p = 0.01] and extrathyroidal extension (ETE) on CEUS [OR:113.33, p = 0.01] were independent risk factors of CLNM. Overexpression of EpCAM (62.07%, 18/29) correlated with ETE of PTC confirmed by postoperative pathology (p = 0.01, 0.027). No significant difference in PTC histological variants was detected based on EpCAM expression (p = 0.05).

CONCLUSIONS

EpCAM overexpression demonstrated a significant association with ETE and CLNM in PTC. The integration of ultrasonography with EpCAM expression profiling offers A promising multiparameter diagnostic model to enhance predictive accuracy. Further studies evaluating EpCAM expression in fine-needle aspiration biopsy (FNAB) samples are required to determine its possible preoperative predictive value.

GADD45A suppression contributes to cardiac remodeling by promoting inflammation, fibrosis and hypertrophy

The growth arrest and DNA damage inducible 45A (GADD45A) is a multifaceted protein associated with stress signaling and cellular injury. Aside its well-established tumor suppressor activity, recent studies point to additional roles for GADD45A, including the regulation of catabolic and anabolic pathways, or the prevention of inflammation, fibrosis, and oxidative stress in some tissues and organs. However, little is known about its function in cardiac disease. In this study, we aimed to evaluate the role of GADD45A in the heart by using mice with constitutive and systemic deletion of Gadd45a, and cardiac cells of human origin. Gadd45a suppression in knockout mice triggered cardiac fibrosis, inflammation, and apoptosis, and these changes correlated with an hyperactivation of the pro-inflammatory and pro-fibrotic transcription factors activator protein-1 (AP-1), nuclear factor-κB (NF-κB), and signal transducer and activator of transcription 3 (STAT3). Deletion of Gadd45a also resulted in substantial cardiac hypertrophy, which negatively impacted cardiac morphology and function in knockout mice. Consistent with this, GADD45A overexpression in human AC16 cardiomyocytes partially prevented the inflammatory and fibrotic responses induced by tumor necrosis factor-α (TNF-α). Overall, data presented in this study highlight an important role for GADD45A in the heart, since it may prevent inflammation, fibrosis, and apoptosis, and, by this means, preserve cardiac function and performance. Since fibrosis and inflammation are crucial in the progression of cardiac hypertrophy and subsequent heart failure, these results suggest that promoting the activity of this protein might be a promising therapeutic strategy to slow down the progression of these deleterious diseases.

The Role of Ubiquitination on Macrophages in Cardiovascular Diseases and Targeted Treatment

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, with macrophage dysfunction playing a central role in its pathogenesis. Ubiquitination, a critical post-translational modification, regulates diverse macrophage functions, including lipoprotein metabolism, inflammation, oxidative stress, mitophagy, autophagy, efferocytosis, and programmed cell death (pyroptosis, necroptosis, ferroptosis, and apoptosis). This review highlights the regulatory roles of ubiquitination in macrophage-driven CVD progression, focusing on its effects on cholesterol metabolism, inflammation, activation, polarization, and the survival of macrophages. Targeting ubiquitination pathways has therapeutic potential by enhancing macrophage autophagy, reducing inflammation, and improving plaque stability. However, challenges, such as off-target effects, ubiquitination crosstalk, and macrophage heterogeneity, must be addressed. By integrating advances in ubiquitination biology, therapeutic strategies can be developed to mitigate CVD and other macrophage-driven inflammatory diseases. This review underscores the potential of ubiquitination-targeting therapies for mitigating CVD and highlights the key areas for further investigation.

Unraveling the Immune Puzzle: Role of Immunomodulation in Alzheimer's Disease

Alzheimer's disease (AD) is a complex neurodegenerative disorder with growing evidence highlighting the dual role of immunomodulation in its pathogenesis and potential therapeutic strategies. Disturbance in the immune system increases the inflammatory cytokines that cause tau hyperphosphorylation and neuroinflammation. Also, immune checkpoint inhibition further increases the amyloid-beta deposition. Therefore, this review examines the intricate interplay between the immune system and AD, focusing on how immunomodulatory mechanisms influence key pathological hallmarks, including amyloid-beta aggregation, tau hyperphosphorylation, neuroinflammation, and cholinergic dysfunction. We analyse critical signaling pathways involved in immune regulation, such as Toll-like receptor (TLR), Janus kinase/signal transducer and activator of transcription (JAK/STAT), phosphoinositide 3-kinase/Akt (PI3K/Akt), Wnt/β-catenin, tumor necrosis factor (TNF), and triggering receptor expressed on myeloid cells (TREM), along with immune checkpoints like programmed cell death protein 1 (PD-1). Preclinical studies of immunomodulatory agents, including salidroside, festidinol, astragalin, sulforaphane, BM-MSC, simvastatin, Ab-T1, hTREM2, and XENP345, demonstrate promising effects. Additionally, clinical investigations of drugs such as simufilam, AL002, TB006, VGL101, DNL919, XPro1595, astragalus, and IBC-Ab002 underscore the therapeutic potential of targeting immune pathways in AD. This review emphasizes how neuroinflammation, microglial activation, and peripheral immune responses contribute to disease progression. By exploring immunomodulatory mechanisms, the article sheds light on potential therapeutic targets that could help mitigate AD pathology which may pave the way for novel interventions preventing neurodegeneration in AD.

Mechanism of lncRNA gadd7 regulating mitofusin 1 expression by recruiting LSD1 to down-regulate H3K9me3 level, and mediating mitophagy in alveolar type II epithelial cell apoptosis in hyperoxia-induced acute lung injury

OBJECTIVE

Hyperoxic exposure induces acute lung injury (ALI). We analyzed the mechanism of long non-coding RNA (lncRNA) growth-arrested DNA damage-inducible gene 7 (gadd7) regulating mitofusin 1 (MFN1) in Hyperoxia-induced ALI (HALI) type II alveolar epithelial cell (AEC II) apoptosis.

METHODS

The HALI rat model was generated using hyperoxic induction and treated with shRNA-gadd7 and rapamycin (Rapa), with ALI, apoptotic level, total protein concentration and total cell, neutrophil and macrophage counts assessed. The HALI cell model was developed on hyperoxia-induced RLE-6TN cells and processed with oe-MFN1, si-gadd7 and Rapa. Cell viability, apoptosis, TOM20/LC3BII co-localization, mitochondrial membrane potential (MMP), superoxide dismutase activity, malonaldehyde, reactive oxygen species (ROS), tumor necrosis factor-α, interleukin (IL)-10, IL-6, IL-1β, gadd7, MFN1, Cleaved caspase-3, Cleaved poly (ADP-ribose) polymerase, B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X, LC3BI/II, lysine-specific demethylase 1 (LSD1), p62, and H3K9me3 protein levels were measured. gadd7-LSD1 interaction was predicted and verified by RPISeq database, RIP, and RNA pull-down assay.

RESULTS

In HALI rats, gadd7 was up-regulated in lung tissues, and gadd7 silencing alleviated oxidative stress, ALI and apoptosis. gadd7 knockdown inhibited oxidative stress and apoptosis though MFN1, and mediated mitophagy (evidenced by diminished LC3BII/LC3BI ratio, TOM20/LC3BII co-localization and ROS level, and elevated p62 level and MMP), which were reversed by mitophagy activation. By recruiting LSD1 to down-regulate H3K9me3 level and promote MFN1 expression, gadd7-mediated mitophagy affected ALI and apoptosis in HALI rats.

CONCLUSION

LncRNA gadd7 regulated MFN1 expression by recruiting LSD1 to down-regulate H3K9me3 level and mediate mitophagy, thereby promoting AEC II apoptosis in HALI.

Crosstalk Between Bile Acids and Intestinal Epithelium: Multidimensional Roles of Farnesoid X Receptor and Takeda G Protein Receptor 5

Bile acids and their corresponding intestinal epithelial receptors, the farnesoid X receptor (FXR), the G protein-coupled bile acid receptor (TGR5), play crucial roles in the physiological and pathological processes of intestinal epithelial cells. These acids and receptors are involved in the regulation of intestinal absorption, signal transduction, cellular proliferation and repair, cellular senescence, energy metabolism, and the modulation of gut microbiota. A comprehensive literature search was conducted using PubMed, employing keywords such as bile acid, bile acid receptor, FXR (nr1h4), TGR5 (gpbar1), intestinal epithelial cells, proliferation, differentiation, senescence, energy metabolism, gut microbiota, inflammatory bowel disease (IBD), colorectal cancer (CRC), and irritable bowel syndrome (IBS), with a focus on publications available in English. This review examines the diverse effects of bile acid signaling and bile receptor pathways on the proliferation, differentiation, senescence, and energy metabolism of intestinal epithelial cells. Additionally, it explores the interactions between bile acids, their receptors, and the microbiota, as well as the implications of these interactions for host health, particularly in relation to prevalent intestinal diseases. Finally, the review highlights the importance of developing highly specific ligands for FXR and TGR5 receptors in the context of metabolic and intestinal disorders.

FIGO guideline on liver disease and pregnancy

The number of women entering pregnancy with chronic liver disease is rising. Gestational liver disorders affect 3% of the pregnant population. Both can be associated with significant maternal and fetal morbidity and mortality. European guidance has recently been published to inform management. This FIGO (the International Federation of Gynecology & Obstetrics) guideline aims to use the latest evidence to inform practice relevant to a global population. The immediate past and present chairs of FIGO's Committee on the Impact of Long-term Health invited the Chair of the European guideline, alongside two trainees with an interest in liver disorders in pregnancy, to develop a guideline relevant to a global audience, thus serving the real-world population and fulfilling FIGO's ambition to enhance their global voice for women's health. Experts in the field with experience in managing liver disorders in pregnancy from a diverse selection of continents helped to develop a guideline. A guideline has been developed including the most common pre-existing and gestational liver disorders. Evidence-based best practice recommendations are summarized in addition to pragmatic recommendations. Printable tables/figures are included in the guideline for ease of use. These include a table of normal ranges of commonly used blood tests, a table outlining safety of investigations, and a table of delivery considerations relevant to a global audience. Figures designed to summarize each section of the guideline and the multidisciplinary approach to managing liver disorders in pregnancy are also included. This guideline incorporates guidance for a global audience aimed at improving the management of women with pre-existing and new liver disease in pregnancy.

Beyond surgery: Repurposing anesthetics for treatment of central nervous system disorders

The development of new drugs is a complex, expensive, and time-consuming process, often fraught with a high likelihood of failure. Amid these obstacles, drug repurposing, which identifies new therapeutic applications for already existing medications, offers a more economical and time-saving approach, particularly in the challenging field of neurological and psychiatric disorders. This narrative review explores both preclinical and clinical studies to examine the potential of anesthetics such as ketamine, nitrous oxide, isoflurane, sevoflurane, propofol, dexmedetomidine, and sodium oxybate in treating central nervous system disorders. Various research highlights the potential of anesthetics to provide rapid antidepressant effects, enhance learning and memory, improve synaptic plasticity, and offer neuroprotective benefits, demonstrating promise for treating depression, post-traumatic stress disorder, cognitive decline, traumatic brain injury, and neurodegenerative disorders. Anesthetics appear to alleviate symptoms in neurological conditions, likely by modulating GABAergic and glutamatergic pathways. However, challenges such as dose-dependent neurotoxicity, variability in preclinical and clinical outcomes, as well as environmental concerns remain significant issues. Future research is essential to optimize dosing strategies, ensure long-term safety, and gain a deeper understanding of the precise mechanisms of action. The concept of anesthetics' repurposing presents a unique solution to tackle the challenges in neurological and psychiatric therapy by providing a platform for the development of new and improved therapies.

Risk Factors and Prevention of Cancer and CVDs: A Chicken and Egg Situation

Cardiovascular diseases and cancer are the two primary causes of mortality worldwide. Although traditionally regarded as distinct pathologies, they share numerous pathophysiological mechanisms and risk factors, including chronic inflammation, insulin resistance, obesity, and metabolic dysregulation. Notably, several cancers have been identified as closely linked to cardiovascular diseases, including lung, breast, prostate, and colorectal cancers, as well as hematological malignancies, such as leukemia and lymphoma. Additionally, renal and pancreatic cancers exhibit a significant association with cardiovascular complications, partly due to shared risk factors and the cardiotoxic effects of cancer therapies. Addressing the overlapping risk factors through lifestyle modifications-such as regular physical activity, a balanced diet, and cessation of smoking and alcohol-has proven effective in reducing both CV and oncological morbidity and mortality. Furthermore, even in patients with established cancer, structured interventions targeting physical activity, nutritional optimization, and smoking cessation have been associated with improved outcomes. Beyond lifestyle modifications, pharmacological strategies play a crucial role in the prevention of both diseases. Several cardiovascular medications, including statins, aspirin, beta-blockers, and metformin, exhibit pleiotropic effects that extend beyond their primary indications, demonstrating potential anti-neoplastic properties in preclinical and observational studies. Recently, novel therapeutic agents have garnered attention for their possible cardioprotective and metabolic benefits. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is), initially developed for managing type 2 diabetes, have shown CV and renal protective effects, alongside emerging evidence of their role in modulating cancer-related metabolic pathways. Inclisiran, a small interfering RNA targeting PCSK9, effectively lowers LDL cholesterol and may contribute to reducing CV risk, with potential implications for tumor biology. Additionally, sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has revolutionized heart failure management by improving hemodynamic parameters and exerting anti-inflammatory effects that may have broader implications for chronic disease prevention. Given the intricate interplay between CVD and cancer, further research is essential to clarify the exact mechanisms linking these conditions and assessing the potential of CV therapies in cancer prevention. This review aims to examine shared risk factors, consider the role of pharmacological and lifestyle interventions, and emphasize crucial epidemiological and mechanistic insights into the intersection of CV and oncological health.

Brain Targeting Bacterial Extracellular Vesicles Enhance Ischemic Stroke Therapy via Efficient ROS Elimination and Suppression of Immune Infiltration

Ischemic stroke (IS) as a detrimental neurological disease is accompanied by oxidative-stress-induced injury, concurrent inflammatory response, overactivated brain immune microenvironment, and disruption of the blood-brain barrier (BBB). This cascade of events ultimately leads to neuronal death and significantly impairs the recovery of neurological function. In this study, we presented extracellular vesicles derived from the gut probiotic Lactobacillus reuteri (LrEVs) integrated with brain targeting, reactive oxygen species (ROS) scavenging, and reduced infiltration of immune cells for effective multiple therapeutic interventions of IS. LrEVs inherited peptidoglycan (PGN) specifically targeted upregulated toll-like receptor 2 (TLR2) in the injured region of the ischemic brain, achieving the effective penetration of the BBB and accumulation in the ischemic brain. In the meantime, LrEVs prevented neuronal apoptosis after stroke by scavenging ROS overproduction and modulating microglial polarization through inhibition of the MAPK and NF-κB pathways. Furthermore, LrEVs inhibited the aggregation of C-C motif chemokine ligand 2 (CCL2), reduced the infiltration of peripheral immune cells such as macrophages and neutrophils into ischemic brain tissue, and suppressed the impairment of BBB, thereby improving the overactivated brain immune microenvironment. The findings provide a vesicle that combines ROS scavenging and modulation of the immune microenvironment, showcasing the potential of gut-probiotic-derived vesicles to treat neurological damage.

Correlation study of PBK/TOPK expression, prognosis, and immune infiltration in breast cancer

PDZ-binding kinase/T-lymphokine-activated killer-cell-originated protein kinase (PBK/TOPK) is a serine-threonine protein kinase. This study aimed to investigate the expression pattern, prognostic significance, and relationship with tumor immune infiltration of PBK/TOPK in breast cancer through bioinformatics analyses and immunohistochemistry (IHC), providing insights for individualized treatment and immunotherapy strategies. PBK/TOPK expression and its correlation with clinicopathological features were analyzed using TIMER, UALCAN, and TCGA databases. Prognostic value was assessed via Kaplan-Meier plotter and bc-GenExMiner. Variants of the PBK/TOPK gene and their prognostic implications were explored using cBioPortal. Enrichment analysis in R identified signaling pathways linked to PBK/TOPK. The relationships between PBK/TOPK, tumor-infiltrating lymphocytes (TILs), and immune cell markers were evaluated using TIMER and TISIDB. IHC experiments validated PBK/TOPK expression in tumor samples and its association with prognosis. Meanwhile, IHC also further confirmed the correlation between PBK/TOPK and CD4+ and CD8+ T cells infiltration, as well as the relationship between T cells and breast cancer prognosis. PBK/TOPK was significantly overexpressed in breast cancer tissues compared to normal tissues and correlated with clinicopathological features, including tumor size and lymph node stage. High expression of PBK/TOPK was associated with poor prognosis. While breast cancer subtypes exhibited different PBK/TOPK gene variants, these variants did not influence prognosis. PBK/TOPK is involved in cell meiosis, cytoskeletal motility, and pathways such as FoxO and p53. It is associated with immune infiltration and is differentially expressed in breast cancer subtypes and correlates with TILs and immune cell markers. IHC confirms that PBK/TOPK expression positively correlates with CD4+ T and CD8+ T cells infiltration. CD4+ T cells were positively associated with the prognosis of triple-negative breast cancer. PBK/TOPK is overexpressed in breast cancer tissues, and high expression levels are associated with poor patient prognosis. Additionally, PBK/TOPK is linked to immune infiltration in breast cancer, positively correlating with CD4+ and CD8+ T cells infiltration, suggesting a new avenue for immunotherapy research in breast cancer.

Gut microbiome dysbiosis as a potential biomarker for liver metabolic disorders in in neonatal hemolytic jaundice

BACKGROUND

This study aims to reveal the composition and features of the gut microbiota in neonatal hemolytic jaundice, potentially identifying biomarkers for the diagnosis of this condition.

METHODS

A total of 62 neonates with hemolytic jaundice and 20 healthy neonates were ultimately enrolled in the study. Clinical data and fecal samples from these infants were collected separately. The composition and features of the gut microbiota were analyzed using 16S rRNA high-throughput sequencing technology. Alpha and Beta diversity analyses were conducted to elucidate the differences in gut microbiota composition. Additionally, LEfSe analysis was employed to identify differential microorganisms. Finally, PICRUSt2, metagenomeSeq, and BugBase software were utilized to investigate the phenotypic and functional differences in the gut microbiota.

RESULTS

Beta diversity analysis revealed significant differences in the composition of gut microbiota. LEfSe analysis demonstrated a significant increase in the relative abundance of Enterobacter in neonatal hemolytic jaundice. Furthermore, METACYC metabolic pathway analysis based on PICRUSt2 indicated a notable elevation in liver-related metabolic pathways in neonatal hemolytic jaundice. The metabolic analysis of differential bacterial genera revealed that Enterobacter secretes a wide array of enzymes, including oxidases, oxidoreductases, transferases, hydrolases, isomerases, and lyases. Notably, these enzymes are responsible for altering the liver metabolic pathways in neonates with hemolytic jaundice.

CONCLUSIONS

Enterobacter is linked to multiple metabolic pathways in the liver via the secretion of numerous enzymes along the gut-liver axis metabolic pathway. This interaction indirectly reflects the metabolic status and disease progression in neonatal hemolytic jaundice. Consequently, Enterobacter may serve as a potential diagnostic marker of the gut microbiota for assessing liver metabolic disorders associated with hemolytic jaundice.

Virtual reality and sports performance: a systematic review of randomized controlled trials exploring balance

Introduction

Our systematic literature review aimed to select randomized controlled trials (RCTs) in which virtual reality (VR) has been used in athletes or players to evaluate the effectiveness of this technology in gaining performance.

Methods

In accordance with PRISMA guidelines, a systematic literature search was conducted in the MEDLINE, Scopus and Web of Science databases using the keyword set [(Virtual reality) OR (VR)] AND [(Athletes) OR (Players)] AND [(Performance) OR (Balance)]. Peer-reviewed articles published within the last ten years in English and open access were included. The methodological quality of the articles was assessed using the Jadad scale, while the eligibility criteria were evaluated using the PICOS approach.

Results

Specifically, six RCTs were selected, one of which scored 5/5 on the Jadad scale, four scored 3/5 and one scored 2/5. Importantly, five RCTs found a positive influence of VR on performance in terms of balance, stability, sprinting, jumping, neurocognitive function, reaction time and technical skills, while only one RCT found no difference in these parameters.

Discussion

In conclusion, the results included in our systematic review showed that VR seems to have a positive effect in improving sports performance. However, the heterogeneity of the studies did not allow for a comparison of the data to clarify the relevance of VR technology in performance, suggesting the need for in-depth investigations to confirm its efficacy in sports.

Attenuated PINK1 autophosphorylation play neuroprotective and anti-seizure roles in neonatal hypoxia

This study investigated the roles and mechanisms of PINK1 activity in neonatal hypoxia-induced seizures with shRNA intervention targeting translocase outer mitochondrial membrane 7 (TOM7), the positive regulator of PINK1 autophosphorylation, or overlapping with the m-AAA protease 1 homolog (OMA1), the negative regulator of PINK1 autophosphorylation. Studies have suggested that in hypoxia-induced neonatal seizures, the phosphorylation level of PINK1 is significantly increased and the mitophagic pathway is activated, accompanied by neuronal damage and learning-memory deficits. Inhibiting PINK1 phosphorylation by reducing TOM7 expression alleviated mitophagy, mitochondrial oxidative stress, neuronal damage and seizures. In contrast, the inhibition of OMA1 expression resulted in a further increase in PINK1 phosphorylation and aggravated hypoxia-induced seizures and neuronal injury. This study implicated PINK1 activity in neonatal hypoxia and suggest that attenuated PINK1 autophosphorylation may have neuroprotective and anti-seizure effects in neonatal hypoxia.

Comparative Analysis of Salivary Tumor Marker CA-125 Among Oral Squamous Cell Carcinoma Patients and Healthy Individuals

Background/Objectives: In Sudan, oral cancer is one of the top ten most common cancers, with OSCC representing the majority of the cases. To date, despite the fact that saliva can be collected simply and non-invasively, there is no approved salivary tumor marker for OSCC. This study aimed to investigate the reliability of salivary CA-125 as a tumor marker for OSCC by measuring and comparing its level among OSCC and healthy individuals as well as its level across different histopathological grades. Methods: A total of 100 subjects were enrolled; 50 were patients with OSCC, while the other 50 were matched healthy individuals. Non-stimulated whole saliva was collected before the administration of definitive treatment, and the concentration of salivary CA-125 was quantified using an automated immunoassay analyzer that employs a one-step sandwich fluorescent enzyme immunoassay (FEIA). Results: The level of salivary CA-125 was 342.65 U/mL in the cases group, which was significantly increased compared with 203.65 U/mL in the healthy controls (p = 0.017). Statistically significant differences in the level of salivary CA-125 among different histopathological grades were observed (p = 0.014). The sensitivity, specificity, accuracy, and positive and negative predictive values were 48%, 78%, 63%, 68.6%, and 60%, respectively. Conclusions: This study suggests that salivary CA-125 could serve as a potential tumor marker for OSCC. However, its clinical application requires further validation.

Phospholipids and peroxisomes in ferroptosis: the therapeutic target of acupuncture regulating vascular cognitive impairment and dementia

Ferroptosis, since its conceptualization in 2012, has witnessed an exponential growth in research interest over recent years. It is regulated by various cellular metabolic pathways during chronic cerebral ischemia and hypoxia, including reactive oxygen species (ROS) generation, iron accumulation, abnormalities in glutathione metabolism, and disruptions in lipid and glucose metabolism. With the deepening and widespread research, ferroptosis has emerged as a critical pathway in the pathogenesis of vascular cognitive impairment and dementia (VCID). This unique cell death pathway caused by iron-dependent phospholipid peroxidation is strongly related to VICD. We examine the impact of phospholipid composition on neuronal susceptibility to ferroptosis, with a particular focus on the critical role of polyunsaturated fatty acids (PUFAs) in this process. Intriguingly, peroxisomes, as key regulators of lipid metabolism and oxidative stress, influence the susceptibility of neuronal cells to ferroptosis through the synthesis of plasmalogens and other lipid species. In this Review, we provide a critical analysis of the current molecular mechanisms and regulatory networks of acupuncture for ferroptosis, the potential functions of acupuncture in peroxisomal functions and phospholipid metabolism, and its neuroprotective effects in VCID, together with a potential for therapeutic targeting. As such, this highlights the theoretical basis for the application of acupuncture in VCID through multi-target regulation of ferroptosis. This review underscores the potential of acupuncture as a non-pharmacological therapeutic approach in VCID, offering new insights into its role in modulating ferroptosis and associated metabolic pathways for neuroprotection.

Epidemiological status of family-based Helicobacter pylori infection in Yunnan Province, China

BACKGROUND

The status of family-based H. pylori infection in Yunnan Province is unknown. This study is the first family-based epidemiological survey of H. pylori in the province, aiming to provide new insights into the status of family-based H. pylori infections in Yunnan Province as well as in the country as a whole.

METHODS

Between 2021 and 2023, 1,176 families with 2,947 family members were tested for H. pylori in six cities in Yunnan Province with different geographic locations and economic status, to assess the status of H. pylori infection, and to clarify the related factors and modes of transmission by means of a questionnaire survey.

RESULTS

In Yunnan Province, the H. pylori infection rate was 31.46% (927/2947) in people and 54.59% (642/1176) in families.On the individual side, living outside of southern Yunnan (e.g., Central OR 1.41, 95% CI 1.10-1.81), having a family member living together for ≥ 1 year (OR 2.43, 95% CI 1.49-3.95), being ≥ 18 years old (e.g., 18-44 years old: OR 3.51, 95% CI 1.98-6.23), and gastrointestinal discomfort within the last 1 year (OR 1.25, 95% CI 1.04-1.50) were independent risk factors for H. pylori infection in the study population in Yunnan Province, whereas an education level of college/university and above (OR 0.62, 95% CI 0.48-0.79), and a gastroscopy within 5 years (OR 0.58, 95% CI 0.46-0.73) were independent protective factors for their H. pylori infection. In terms of family, living outside of southern Yunnan (e.g., Central OR 1.52, 95% CI 1.07-2.18), and having ≥ 3 people living together in the family (e.g., 3-4 people: OR 2.04, 95% CI 1.52-2.72) were independent risk factors for H. pylori infection in study families in Yunnan Province, whereas an annual household income of ≥ 100,000 ( OR 0.68, 95% CI 0.51-0.90), total household living area ≥ 60 m2 (OR 0.62, 95% CI 0.39-0.97), the use of separate meals for intra-household gatherings (OR 0.56, 95% CI 0.38-0.85), and the use of communal spoons and chopsticks (OR 0.38, 95% CI 0.28-0.52) were the independent protective factorse.

CONCLUSION

The risk factors of Family-Based H. pylori infection in Yunnan province were closely related to demographic characteristics, personal and family living habits. Close contact with infected family members may be the main cause of transmission. Family-based control of H. pylori infection should be regarded in clinical practice.

Development and validation of a logistic regression model for the diagnosis of colorectal cancer

Colorectal cancer (CRC) diagnosis is challenging due to generalized symptoms. Various biomarker models exist, but their clinical application is limited by low sensitivity and heterogeneous cutoff values. This study aimed to develop and validate a diagnostic model for CRC. Data from 489 patients-337 with CRC and 152 with benign disease-were included. Patients were randomly assigned to training (n = 342) and validation (n = 147) cohorts. Logistic regression identified age (OR 1.06), CA153 (OR 0.26), CEA (OR 4.49), CYFRA 21-1 (OR 5.88), ferritin (OR 0.15), and hs-CRP (OR 0.05) as independent risk factors. Sensitivity and specificity were 88.61% and 82.86% in the training cohort and 90.00% and 76.60% in the validation cohort. Cutoff values for the biomarkers were: CA199, 9.809 U/mL; CA125, 7.743 U/mL; CA153, 6.295 U/mL; CEA, 3.982 ng/mL; CYFRA 21-1, 1.769 ng/mL; ferritin, 163.361 mg/L; hs-CRP, 0.196 mg/L; and serum albumin, 55.966 g/L. The model showed higher sensitivity for early-stage CRC (95.45%, 95% CI 87.2-98.6%) than late-stage CRC (87.27%, 95% CI 76.4-93.5%; P = 0.08). AUCs were 0.907 (training) and 0.872 (validation). The model demonstrated higher sensitivity for early-stage CRC (95.45%) than late-stage CRC (87.27%), underscoring its utility in early detection.

[Use of Virtual Reality Based on Daily Activities for Cognitive Rehabilitation After Stroke: A Systematic Review]

BACKGROUND

Virtual reality (VR) generates a virtual environment with which one can interact as if it were real. In Stroke, which represents one of the highest causes of cognitive impairment in Europe, the use of VR in cognitive rehabilitation has been studied through the performance of different types of tasks, which could have different impacts. For this reason, the objective of this study was to review the use of VR tasks based exclusively on daily activities for the cognitive rehabilitation of people with stroke over 18 years of age.

METHODS

A search was carried out of the databases PubMed, Web of Science, and Scopus, obtaining 531 articles that, after applying inclusion/exclusion criteria, were reduced to eight (six randomized clinical trials and two quasi-experimental studies).

RESULTS

The number of positive results was higher than the number of negative results only in global cognitive function. In specific cognitive functions the number of positive results was lower than the negatives.

CONCLUSIONS

These results highlight the need to carry out more studies with larger samples to obtain robust results and conclusions. Furthermore, this study highlights the value of research in this topic due to the interesting lines of future research.

Efficacy and safety of hydromorphone for postoperative patient-controlled intravenous analgesia for patients undergoing orthopedic surgery: a randomized, double-blinded controlled trial

Background

The study aimed to evaluate the efficacy and safety of hydromorphone in postoperative patient-controlled intravenous analgesia (PCIA) for orthopedic surgery patients, offering a reference for postoperative pain management in this patient population.

Methods

This was a prospective, randomized, double-blinded, controlled trial involving 80 patients aged 23 to 64 years undergoing elective orthopedic surgery. All participants were randomly assigned to the test group (Group H) and the control group (Group C) by the random number table method. In Group H, hydromorphone (0.2 mg/kg) and palonosetron (4 μg/kg) diluted to 150 mL with saline were used for PCIA, while in Group C, sufentanil (2 μg/kg) and palonosetron (4 μg/kg) were diluted to the same volume. Postoperative pain was assessed using the resting Visual Analog Scale (VAS) at 2, 6, 12, 24, and 48 h postoperatively. The total and effective PCIA button presses within 48 h, along with the number of remedial analgesia cases, were recorded. Ramsay, Awakening time, extubation time, hospital stay duration, and adverse events within 48 h postoperatively were also recorded.

Results

Compared to Group C, Group H had significantly lower VAS scores at 2 and 6 h, as well as Ramsay, SDS, and PSQI scores at 24 and 48 h postoperatively (all p < 0.01). Furthermore, the incidence of dizziness and drowsiness within 48 h postoperatively was significantly reduced in Group H (p = 0.007 and p = 0.003, respectively).

Conclusion

Hydromorphone-based PCIA enhances early postoperative pain relief in orthopedic surgery patients, alleviates postoperative depression and sleep disturbances, and reduces the incidence of dizziness and drowsiness.

Clinical trial registration

This study was registered in the Chinese Clinical Trial. Registry (www.chictr.org.cn) on 01/04/2024 (ChiCTR2400082567).

A Scoping Review of Precision Medicine in Breast Reconstruction (2011-2025)

Background: Personalization of medical care is a significant topic of interest. Precision medicine denotes customized medical treatments based on individual genetic, molecular, and/or biomarker data. We conducted a scoping review to identify studies exploring precision medicine in breast reconstruction. Objectives: (1) To map the existing literature, (2) to identify key concepts, and (3) to discuss current and future clinical implications of precision medicine in breast reconstruction. Eligibility criteria: Indexed journal articles (primary research studies) relating to precision medicine in breast reconstruction written in the English language. Sources of evidence: Medline (via Pubmed), Web of Science, and the Cochrane Library. Charting methods: Data charting of selected studies was performed independently by two reviewers using Microsoft Excel. Any discrepancies in data charting were addressed through inter-reviewer discussion and/or expert review. Results: Of 321 initial records, 9 studies that were published between 2011 and 2025 were included in the final review. Eight studies focused predominantly on genomics, and one study focused predominantly on targeted therapies. Genomic-based studies were frequently implemented to evaluate patient risk and inform clinical decision-making, while targeted therapies were used to optimize reconstructive outcomes through cell-based therapies. Conclusions: There is a limited but emerging body of literature on precision medicine in breast reconstruction. Genomic data are the driving force of precision medicine in breast reconstruction, and multiple potential avenues exist to achieve translational applications in the short-term period. Future efforts should focus on translating known genomic data into real-time clinical applications and investing in precision-based research for targeted therapies and regenerative medicine in breast reconstruction.

Runt-related transcription factors: from pathogenesis to therapeutic targets in multiple-organ fibrosis

Fibrosis is a partially manageable process that leads to scarring and tissue hardening by prompting myofibroblasts to deposit significant amounts of extracellular matrix (ECM) following injury. It results in detrimental consequences and pathological characteristics, which hinder the functioning of associated organs and increase mortality rates. Runt-related transcription factors (RUNX) are part of a highly conserved family of heterodimer transcription factors, comprising RUNX1, RUNX2, and RUNX3. They are involved in several biological processes and undergo various forms of post-translational modification. RUNX regulates multiple targets and pathways to impact fibrosis, indicating promise for clinical application. Therefore, its significance in the fibrosis process should not be disregarded. The review begins with an objective description of the structure, transcriptional mechanism, and biological function of RUNX1, RUNX2, and RUNX3. A subsequent analysis is made of their physiological relationship with heart, lung, kidney, and liver, followed by a focus on the signaling mechanism of RUNX in regulating fibrosis of these organs. Furthermore, potential agents or drugs targeting RUNX for treating organ fibrosis are summarized, along with an evaluation of the therapeutic prospects and potential value of RUNX in fibrosis. Further research into RUNX could contribute to the development of novel therapeutic approaches for fibrosis.