A shellfish-inspired bionic microstructure design for biological implants: Enhancing protection of antibacterial silver-loaded coatings and promoting osseointegration

Implants incorporating multi-level micro-nano structures and antibacterial coatings offer a promising approach to overcoming the shortcomings of titanium and its alloys in stimulating bone growth and preventing bacterial infections. Silver ions have been identified as promising antibacterial agents. However, silver-loaded surface coatings are susceptible to damage from direct friction, and excessive release of silver ions can lead to cytotoxicity, thereby limiting their practical application. Inspired by the wear-resistant surface structure of natural shellfish, this study developed a biomimetic micro/nano multi-level structure on the titanium alloy (TC4) surfaces. The structure incorporated a biomimetic microgroove structure (BMS) with alkaline heat treatment (AH) of sodium titanate and chitosan/silver (CS/Ag) micro-nanostructured coatings (BMS/AH/CS/Ag). The microstructural armor effectively reduced external mechanical friction, safeguarding the coatings from damage. Compared to the unstructured sample, the biomimetic micro-groove armor group with a large micro-groove angle (θ) exhibited significantly reduced wear volume and only a marginal decrease of 1.86% in inhibition against Staphylococcus aureus (S. aureus) post-wear, highlighting the protective effect of this microstructure on the coating. The outstanding improvement was primarily attributed to the increased micro-groove angle, which enhanced the stability of the microstructure and effectively mitigated the friction. Additionally, the biomimetic micro-nano multi-level structure and coating have shown a significant ability to improve the bioactivity for the implant, promoting the adhesion, proliferation, collagen secretion, and extracellular matrix mineralization of human mesenchymal stem cells (hMSCs), which suggests the potential for enhanced osteogenic differentiation and indicates that this method can effectively improve the clinical performance of the implant.

Using large language models as decision support tools in emergency ophthalmology

BACKGROUND

Large language models (LLMs) have shown promise in various medical applications, but their potential as decision support tools in emergency ophthalmology remains unevaluated using real-world cases.

OBJECTIVES

We assessed the performance of state-of-the-art LLMs (GPT-4, GPT-4o, and Llama-3-70b) as decision support tools in emergency ophthalmology compared to human experts.

METHODS

In this prospective comparative study, LLM-generated diagnoses and treatment plans were evaluated against those determined by certified ophthalmologists using 73 anonymized emergency cases from the University Hospital of Split. Two independent expert ophthalmologists graded both LLM and human-generated reports using a 4-point Likert scale.

RESULTS

Human experts achieved a mean score of 3.72 (SD = 0.50), while GPT-4 scored 3.52 (SD = 0.64) and Llama-3-70b scored 3.48 (SD = 0.48). GPT-4o had lower performance with 3.20 (SD = 0.81). Significant differences were found between human and LLM reports (P < 0.001), specifically between human scores and GPT-4o. GPT-4 and Llama-3-70b showed performance comparable to ophthalmologists, with no statistically significant differences.

CONCLUSION

Large language models demonstrated accuracy as decision support tools in emergency ophthalmology, with performance comparable to human experts, suggesting potential for integration into clinical practice.

High metastatic tumor-derived CXCL16 mediates liver colonization metastasis by inducing Kupffer cell polarization via the PI3K/AKT/FOXO3a pathway

Liver metastases represent a late-stage manifestation of numerous cancers, often associated with poor patient prognosis. Kupffer cells (KCs), resident liver macrophages, play a critical role in liver metastasis (LM). However, the mechanisms by which the polarization of KCs facilitate colorectal cancer (CRC) liver metastases remain elusive. Here, we established a CRC liver metastasis mouse model and employed a co-culture system, found that KCs were recruited and polarized to M2 phenotype. We isolated and purified highly metastatic cell lines to reveal potential changes in CRC cells during metastasis. Through bulk RNA sequencing, we identified and validated CXCL16 as a positive mediator in liver-metastatic CT26-LM cells that induced an M2-like KC phenotype. Knock down of CXCL16 reduced the M2 polarization of KCs and inhibited the formation of liver metastasis lesions. Next, this polarization process was shown to be achieved through the PI3K/AKT/FOXO3a pathway. Further investigation revealed FOXO3a transcriptionally activates CD206(MRC1) in this process. Pharmacological inhibition of the CXCL16-PI3K-FOXO3a axis to disrupt the polarization of KCs attenuated CRC liver metastasis in vivo. Our findings collectively indicate that targeting the CXCL16/PI3K/AKT/FOXO3a pathway in KCs may represent a promising therapeutic strategy for preventing CRC liver metastasis.

CXCL9 is a dual‑role biomarker in colorectal cancer linked to mitophagy and modulated by ALKBH5

Colorectal cancer (CRC), the third most prevalent cancer globally, shows a diminished 5‑year survival rate compared with patients at early stages of the disease, underscoring the urgency for early diagnostic biomarker identification. The C‑X‑C motif chemokine ligand (CXCL) family plays a significant role in immune modulation and cancer progression. the present study constructed a prognostic model for CXCL family in CRC and conducted an in‑depth investigation of the hub gene CXCL9 within the model. CXCL9 is highly expressed in CRC while high expression levels of CXCL9 in patients with CRC often indicates an improved prognosis. Through Gene Ontology, Kyoto Encyclopedia of Genes and Genomes and gene set enrichment analysis enrichment analysis, it was discovered that CXCL9 is not only associated with immune modulation but also closely related to pathways that affect the occurrence and development of cancer. CXCL9 is closely related to mitophagy and blocks autophagy flow by altering the expression of autophagy‑related genes. Additionally, it was found that CXCL9 is a downstream gene modified by ALKBH5 and can partially restore the tumor‑suppressive effects induced by the knockdown of ALKBH5. These studies indicated that CXCL9 is a prognostic marker in CRC and plays a dual role in cancer progression: It activates immune responses on one hand and promotes the malignant characteristics of cancer on the other hand.

Comparative transcriptomic analyses of macrophages infected with Toxoplasma gondii strains of different virulence provide molecular insights into the response of macrophage in phagocytosis and polarization to infection

Macrophages are essential for the proliferation and spread of Toxoplasma gondii. Modulating macrophage activation to improve the inflammatory environment is an effective approach for disease treatment. However, the molecular mechanism through which T. gondii alters macrophage function remain unknown. Based on transcriptomic data analysis of various macrophage types infected with T. gondii, current research revealed differences in the regulation of macrophage functions among strains with different virulence: RH was primarily involved in cell cycle regulation, ME49 was associated with cAMP signaling, and CEP mainly participated in ion channel activity. All three T. gondii strains were involved in regulating immune response activation, including leukocyte adhesion and the MAPK signaling pathway. Nineteen shared DEGs associated with macrophage phagocytosis or polarization were identified through the GeneCards database, and PPI analysis confirmed Il6 as the hub gene in the regulatory network. In vivo and in vitro experiments showed that the YZ-1 strain significantly regulated the expressions of eight DEGs (Il6, Rel, Cd83, Myc, Adora2b, Egr2, Gja1 and Nr4a2), and promoted macrophage phagocytic activity and induced M1 polarization, confirming a significant correlation with Il6. This study revealed the dissimilarities and commonalities in macrophage function regulated by T. gondii strains of different virulence, and identified key molecules involved in the regulation of macrophage phagocytosis and polarization during T. gondii infection. This is crucial for identifying potential drug targets against T. gondii and provides a new perspective on the etiopathogenesis and therapeutic approaches for toxoplasmosis.

Methylophiopogonanone A alleviates diabetic cardiomyopathy via inhibiting JNK1 signaling

OBJECTIVE

Diabetic cardiomyopathy (DCM) is a common complication of type 2 diabetes mellitus (T2DM). The effects of methylophiopogonanone A (MO-A), a natural homoisoflavonoid with anti-inflammatory effects, on DCM and its underlying mechanisms were investigated in this study.

METHODS

The T2DM mouse model was induced by intraperitoneal injection of 30 mg/kg streptozotocin for 7 consecutive days and fed with a high-fat diet for 12 weeks. T2DM mice received MO-A (2.5, 5, or 10 mg/kg) treatment for two weeks. Cardiac function, hypertrophy, fibrosis, and inflammation were evaluated. The binding energy between MO-A and JNK1 was analyzed using molecular docking. The underlying mechanism was further investigated in high glucose (HG)-induced H9C2 cells. The cytotoxic effects, cardiomyocyte hypertrophy, fibrosis, inflammation, and relevant signaling proteins were assessed.

RESULTS

MO-A treatment alleviated cardiac function and histopathological changes in DCM mice. Moreover, MO-A treatment significantly decreased COLI, TGF-β1, MYH7, and ANP expression levels in DCM mice. Furthermore, TNF-α, IL-6, and IL-1β expression levels were notably downregulated after treatment with MO-A in DCM mice. Similar results were also observed in vitro. Mechanistically, MO-A targets JNK1 and downregulates its phosphorylation levels in DCM mice. The protective properties of MO-A were reversed by JNK1 overexpression in HG-induced H9C2 cells.

CONCLUSION

Our results revealed that MO-A could alleviate cardiac function, hypertrophy, fibrosis, and inflammation in DCM via inhibiting JNK1 signaling.

Role of liposomes in chemoimmunotherapy of breast cancer

In the dynamic arena of cancer therapeutics, chemoimmunotherapy has shown tremendous promise, especially for aggressive forms of breast cancer like triple-negative breast cancer (TNBC). This review delves into the significant role of liposomes in enhancing the effectiveness of chemoimmunotherapy by leveraging breast cancer-specific mechanisms such as the induction of immunogenic cell death (ICD), reprogramming the tumour microenvironment (TME), and enabling sequential drug release. We examine innovative dual-targeting liposomes that capitalise on tumour heterogeneity, as well as pH-sensitive formulations that offer improved control over drug delivery. Unlike prior analyses, this review directly links advancements in preclinical research-such as PAMAM dendrimer-based nanoplatforms and RGD-decorated liposomes-to clinical trial results, highlighting their potential to revolutionise TNBC treatment strategies. Additionally, we address ongoing challenges related to scalability, toxicity, and regulatory compliance, and propose future directions for personalised, immune-focused nanomedicine. This work not only synthesises the latest research but also offers a framework for translating liposomal chemoimmunotherapy from laboratory research to clinical practice.

Effects of temporal lobe seizures on visual recognition memory in a non-human primate model

Patients with temporal lobe epilepsy frequently report memory impairment, which significantly impacts their quality of life. Several studies have demonstrated an association between temporal lobe epilepsy and memory dysfunction, though the underlying mechanisms remain unclear. This study investigates whether a penicillin-induced temporal lobe seizure model in non-human primates (NHPs) replicates the recognition deficits observed in epileptic patients. We recorded hippocampal activity in three NHPs during a visual paired comparison (VPC) task before and during seizures. The penicillin model induced multiple spontaneous, self-terminating temporal lobe seizures over 4-6 h. Seizures were induced after VPC training, and tasks were performed using an eye-tracking system while the animals were seated with head restraint. During the familiarization phase, novel objects were presented and later paired with a new object after a randomized delay (10 or 60 s). While task success rates did not differ between baseline and seizure conditions, we observed prolonged encoding durations. Further studies are needed to elucidate these findings, but this NHP model of temporal lobe epilepsy may provide critical insights into the relationship between epileptic activity and cognitive impairment.

The context-dependent effect of cellular senescence: From embryogenesis and wound healing to aging

Aging is characterized by a steady loss of physiological integrity, leading to impaired function and increased vulnerability to death. Cell senescence is a biological process that progresses with aging and is believed to be a key driver of age-related diseases. Senescence, a hallmark of aging, also demonstrates its beneficial physiological aspects as an anti-cancer, pro-regenerative, homeostatic, and developmental mechanism. A transitory response in which the senescent cells are quickly formed and cleared may promote tissue regeneration and organismal fitness. At the same time, senescence-related secretory phenotypes associated with extended senescence can have devastating effects. The fact that the interaction between senescent cells and their surroundings is very context-dependent may also help to explain this seemingly opposing pleiotropic function. Further, mitochondrial dysfunction is an often-unappreciated hallmark of cellular senescence and figures prominently in multiple feedback loops that induce and maintain the senescent phenotype. This review summarizes the mechanism of cellular senescence and the significance of acute senescence. We concisely introduced the context-dependent role of senescent cells and SASP, aspects of mitochondrial biology altered in the senescent cells, and their impact on the senescent phenotype. Finally, we conclude with recent therapeutic advancements targeting cellular senescence, focusing on acute injuries and age-associated diseases. Collectively, these insights provide a future roadmap for the role of senescence in organismal fitness and life span extension.

Regulation of macrophage efferocytosis by the CLCF1/NF-κB pathway improves neurological and cognitive impairment following CO poisoning

Severe carbon monoxide (CO) poisoning can induce structural and functional damage to the nervous system, resulting in persistent cognitive impairments. Properly terminating inflammation caused by neuronal damage is essential for tissue repair. Macrophages clear cell corpses and fragments through efferocytosis and produce cytokines to coordinate the immune response, thus promoting neuronal repair and regeneration. However, within the microenvironment of the CO-affected nervous system, macrophage efferocytosis is disrupted. Our study found that macrophages regulate efferocytosis by releasing Cardiotrophin-like cytokine factor 1 (CLCF1), which modulates the NF-κB pathway in both macrophages and microglia, thereby controlling inflammation and promoting nervous system repair. Furthermore, efferocytosis regulates the secretion of cytokines such as TNF-α, IL-1β, and IL-10, promoting M2 polarization of macrophages, which aids in neuronal repair and regeneration. Regulating macrophage CLCF1 expression also leads to improvements in the memory, learning, and motor abilities of rats poisoned with CO.

Application of liquid biopsy in differentiating lung cancer from benign pulmonary nodules (Review)

The diagnosis of malignant and benign pulmonary nodules has always been a prominent research topic. Accurately distinguishing between these types of lesions, particularly small or ground glass nodules, is crucial for the early detection and proactive treatment of lung cancer, ultimately leading to improved patient survival. Although various imaging methods and tissue biopsies have advanced the diagnostic efficacy of pulmonary nodules, each approach possesses inherent limitations. In recent years, there has been a growing interest in liquid biopsy as a non‑invasive and easily obtainable alternative. Furthermore, in‑depth investigations into the mechanisms underlying tumor initiation and progression have contributed to the development of circulating biomarkers for monitoring treatment response and efficacy in lung cancer. This review provides a comprehensive overview of the current landscape of pulmonary nodule diagnosis while highlighting the latest advancements in liquid biopsy techniques, such as extracellular vesicles, tumor‑educated platelets, non‑coding RNA, circulating tumor DNA and circulating antibodies.

VacA promotes pyroptosis via TNFAIP3/TRAF1 signaling to induce onset of atrophic gastritis

BACKGROUND

Atrophic gastritis (AG) is a chronic inflammation where gastric glandular cells are replaced by intestinal-type epithelium. Gastric epithelial cell loss is often linked to multiple cell death signaling pathways. While Helicobacter pylori (H. pylori) infection is the main cause of AG, its role in inducing cell death goes beyond apoptosis and autophagy. Pyroptosis could promote development of inflammation related cancers, but its involvement in H. pylori-induced malignant transformation remains unclear.

METHODS

The enrichment of pyroptosis signaling across pathological stages was assessed using immunohistochemistry and bioinformatic analysis. Gastric epithelial cells were co-cultured with VacA recombinant protein or VacA+H. pylori to investigate the role of VacA in pyroptosis, and its downstream targets. TNFAIP3 or TRAF1 was silenced/overexpressed in gastric epithelial cells to explore their impact on pyroptosis. Finally, the interaction between TNFAIP3 and TRAF1 was examined using Western Blot, immunofluorescence, co-immunoprecipitation and ubiquitin assays.

RESULTS

Expression of pyroptosis components and pyroptosis enrichment score were upregulated in AG and gastric cancer tissues compared to normal or non-atrophic gastritis tissues. Upon incubation with VacA recombinant protein or VacA+H. pylori, pyroptosis and TNFAIP3/TRAF1 were elevated in gastric epithelial cells. TRAF1 promoted expression of downstream pyroptosis components and release of IL-1β/IL18. TRAF1 ablation could reverse pyroptosis activation caused by VacA. Finally, we proved TNFAIP3 as deubiquitinating enzyme to increase TRAF1 stability, further inducing pyroptosis.

CONCLUSIONS

The VacA/TNFAIP3/TRAF1 signaling cascade facilitates pyroptosis in H. pylori- infected tissue. Overactivation of Pyroptosis caused the atrophy-like morphological changes of gastric epithelium, further inducing sustainable malignant transformation.

Understanding the risk factors of hemagglutinase-associated hypofibrinogenemia can improve the prognosis of patients

We editorialized on this study published by Zou et al . Gastrointestinal bleeding is a common clinical symptom, and hemocoagulase is frequently used to treat hemorrhagic conditions. However, studies have shown that hemocoagulase treatment may induce acquired hypofibrinogenemia, further aggravating the bleeding. Zou et al retrospectively analyzed 109 gastrointestinal bleeding cases to explore the hazards underlying hypofibrinogenemia induced by hemocoagulase, and identified higher total dose of hemocoagulase and female sex, as well as low baseline fibrinogen levels as significant hazards. Consequently, clinicians should be aware of both intrinsic and extrinsic risk factors when using hemocoagulase among this patient population, and remain vigilant for the potential development of hemocoagulase-induced hypofibrinogenemia.

Fecal microbiota transplantation in allergic diseases

Microorganisms such as bacteria, fungi, viruses, parasites living in the human intestine constitute the human intestinal microbiota. Dysbiosis refers to compositional and quantitative changes that negatively affect healthy gut microbiota. In recent years, with the demonstration that many diseases are associated with dysbiosis, treatment strategies targeting the correction of dysbiosis in the treatment of these diseases have begun to be investigated. Faecal microbiota transplantation (FMT) is the process of transferring faeces from a healthy donor to another recipient in order to restore the gut microbiota and provide a therapeutic benefit. FMT studies have gained popularity after probiotic, prebiotic, symbiotic studies in the treatment of dysbiosis and related diseases. FMT has emerged as a potential new therapy in the treatment of allergic diseases as it is associated with the maintenance of intestinal microbiota and immunological balance (T helper 1/T helper 2 cells) and thus suppression of allergic responses. In this article, the definition, application, safety and use of FMT in allergic diseases will be discussed with current data.

Verapamil inhibits TXNIP-dependent NLRP3 Inflammasome activation in an ulcerative colitis rat model: A new evolving role of the calcium channel blocker

Ulcerative colitis (UC) is a long-term inflammatory bowel disease (IBD) associated with significant morbidity. It is marked by inflammation and damage to the colon's mucosal lining. Studies have shown that NLRP3 inflammasome activation, apoptosis, and impaired autophagy are critical in its pathogenesis. Verapamil, a calcium channel blocker, has been found to inhibit NLRP3 inflammasome activation in various preclinical models. However, the potential influence of verapamil on the TXNIP in UC remains unexplored. This study investigates the effects of verapamil on an UC rat model induced chemically by acetic acid. Verapamil effectively inhibited the TXNIP-NLRP3-caspase-1 axis, reducing inflammasome activation and the release of IL-1β and IL-18. Additionally, verapamil suppressed NFκB, the priming step of NLRP3 activation. The drug enhanced autophagic activity, as indicated by increased expression of LC3-II and Beclin-1, along with reduced LC3-I and mTOR expression. Moreover, it demonstrated anti-apoptotic effects mediated by regulating Bax and cleaved caspase-3. These molecular changes contributed to mucosal healing and improved microscopic and macroscopic outcomes in the colitis model. Furthermore, verapamil improved the colon weight-to-length ratio and disease activity scores and mitigated oxidative stress. As verapamil has been safely used in clinics to treat hypertension, our findings suggest it may be a safe therapeutic option for ameliorating inflammation and apoptosis and activating autophagy in UC pathology. Since hypertension demonstrates a strong association with UC, the use of verapamil merits particular attention in hypertensive patients fighting against IBD.

Epithelioid angiosarcoma of the cervical spine: A case report

BACKGROUND

Epithelioid angiosarcoma (EA) is an aggressive, malignant endothelial-cell tumor of vascular or lymphatic origin. EA often arises from deep soft tissues such as pleura, breast, bone and gastrointestinal tract. It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice. Overall survivals are generally poor, ranging from 6 to 16 months. More than 50% of patients died of disease within 2 to 3 years of diagnosis.

CASE SUMMARY

We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis. The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation, followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation. Postoperative radiotherapy was administered without delay. However, the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.

CONCLUSION

EA with spinal involvement is extremely rare. Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.

Role and mechanism of sarcosine dehydrogenase in the progression of gallbladder cancer through chemokine pathways

BACKGROUND

Sarcosine dehydrogenase (SARDH) and C-X-C motif chemokine ligand 1 (CXCL1) have been identified as potential tumor regulators, with growing evidence linking them to cancer progression. However, their specific roles, regulatory mechanisms, and influence on key signaling pathways remain unclear.

AIM

To investigate the regulatory mechanisms of SARDH and CXCL1 in cancer cells and their impact on key signaling pathways.

METHODS

Real-time quantitative polymerase chain reaction and western blot analyses were used to assess the expression levels of SARDH and CXCL1 and their effects on protein kinase B (Akt) and extracellular signal-regulated kinase (ERK) signaling pathways. Gene overexpression was induced using an expression vector, while gene silencing was achieved using short hairpin RNA and small interfering RNA. CCK-8, migration, and invasion assays were used to evaluate the impact of gene suppression and overexpression on cancer cell proliferation, migration, and invasion.

RESULTS

SARDH silencing significantly enhanced cancer cell proliferation, whereas its overexpression suppressed proliferation in the early stages of the experiment. CXCL1 silencing reduced cancer cell migration and invasion. SARDH overexpression inhibited cell migration, invasion, and adhesion while increasing apoptosis. Conversely, SARDH silencing reversed these effects. Furthermore, simultaneous silencing of SARDH and CXCL1 strongly activated the Akt and ERK signaling pathways, indicating the potential role of these pathways in regulating cellular functions influenced by these genes.

CONCLUSION

This study revealed that SARDH and CXCL1 regulate cancer cell growth, migration, and invasion through Akt and ERK signaling pathways, highlighting their potential as therapeutic targets for cancer treatment.

Novel_circ_0004013 targeting miR-29a-3p affects age-related hearing loss in miR-29a mouse model by RNA-seq analysis

Age-related hearing loss (ARHL) is a gradual, symmetrical sensorineural disorder. Exploring the pathogenesis of ARHL from a biological perspective is important for its treatment. In this study, we analyzed the circRNA expression profiles of 2-month-old miR-29a+/+ mice and miR-29a-/- mice by transcriptome sequencing to investigate the role of circRNAs in ARHL. We identified 12 differentially expressed circRNAs in the two groups. Our focus was on circRNAs predicted to regulate miR-29a, with novel_circ_0004013 identified as having a targeted binding relationship with miR-29a-3p. Dual luciferase assays confirmed that miR-29a-3p is a direct target of novel_circ_0004013. Fluorescence in situ hybridization (FISH) was employed to localize the novel_circ_0004013 in HEI-OC1 cells and the cochlea. Novel_circ_0004013 was mainly expressed in the cytoplasm. In the hair cells (HCs) and stria vascularis (SV) regions of miR-29a-/- mice, novel_circ_0004013 expression was higher than the corresponding regions in miR-29a+/+ mice. Furthermore, Western blot assays revealed that levels of oxidative stress and apoptosis were significantly decreased in HEI-OC1 cells following the knockdown of novel_circ_0004013, whereas these levels were significantly increased in HEI-OC1 cells after the knockdown of miR-29a-3p. It was indicated in rescue assays that novel_circ_0004013 expedited oxidative stress and apoptosis of HEI-OC1 cells via modulation on miR-29a-3p. These findings may reveal the important role of novel_circ_0004013 in hearing loss and provide a new perspective and theoretical basis for the molecular mechanism of ARHL.

Diagnostic value of serum pepsinogen, gastrin, and carbohydrate antigens in gastric ulcer and gastric cancer

BACKGROUND

Emerging evidence suggests that serum levels of pepsinogen (PG), gastrin-17 (G17), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and CA72-4 may aid in distinguishing gastric cancer (GC) from gastric ulcer (GU).

AIM

To assess serum PG, G17, CEA, CA19-9, and CA72-4 in diagnosing GU and optimizing GC detection.

METHODS

A retrospective analysis was conducted from 263 patients treated at the Third People’s Hospital of Hefei, who were classified into three groups: Chronic non-atrophic gastritis (CG), GU, and GC. Fasting serum levels of PG, G17, CEA, CA19-9, and CA72-4 were measured and compared across the groups.

RESULTS

Serum levels of PGII and G17 were significantly elevated in both the GU and GC groups compared to the CG group (P < 0.01), whereas the PGI/PGII ratio was markedly decreased (P < 0.01). Levels of CEA, CA19-9, and CA72-4 were significantly higher in the GC group than in the CG and GU groups (P < 0.01). Receiver operating characteristic curve analysis identified the optimal diagnostic cut-off values for GU and GC as follows: PGI (169.855 pmol/L), PGII (30.555 μg/L), PGI/PGII ratio (16.529), G17 (6.435 pmol/L), CEA (2.005 ng/mL), CA19-9 (16.65 U/mL), and CA72-4 (2.075 U/mL). The area under the curve for combined detection was 0.826 (P < 0.001), indicating good diagnostic performance.

CONCLUSION

Serological biomarkers effectively distinguish GC from GU, with combined detection of PGII, PGI/PGII ratio, G17, and tumor markers enhancing diagnostic accuracy.

Kinesin family member 14 in digestive tract malignancies: Oncogenic mechanisms, clinical implications, and therapeutic prospects

In this editorial, we comment on the article by Qin et al, recently published in the World Journal of Gastrointestinal Oncology. Malignant tumors of the digestive tract represent a significant health threat. Kinesin family member 14 (KIF14), a critical kinesin, is pivotal in the proliferation, migration, and invasion of tumor cells. It has emerged as a focal point in recent studies of malignant tumors in the digestive tract. This article reviews the current research on KIF14 within these tumors and details its significant role in tumor cell behaviors, including proliferation, apoptosis, migration, invasion, and angiogenesis, alongside the regulatory mechanisms of the associated intracellular signaling pathways. Additionally, it explores the clinical value of KIF14 as a potential biomarker for early diagnosis, disease monitoring, and prognostic evaluation in malignant tumors of the digestive tract. The article concludes by introducing the potential regulatory role of traditional Chinese medicine, aiming to combine the strengths of both modern and traditional medical approaches to enhance treatment outcomes and prognosis for patients with these tumors.

FOXD3 promotes homologous recombination repair and genomic stability by facilitating MRE11-mediated DNA end resection

Homologous recombination (HR) is crucial for the high-fidelity repair of DNA double-strand breaks (DSBs), ensuring the maintenance of genome stability. In this study, we show that FOXD3 interacts with poly (ADP-ribose) polymerase 1 (PARP1) and is recruited to DSBs in a PARP1-dependent manner. FOXD3 directly binds to the DSB repair protein MRE11 and promotes its recruitment to DSB sites, ensuring proper end resection. Inhibition of FOXD3 expression compromises HR-mediated DSB repair and chromosome stability and sensitizes cancer cells to ionizing radiation. Collectively, our findings demonstrate that FOXD3 promotes HR-mediated DSB repair and genome stability.

Prevalence rates of depression, anxiety, and suicidal ideation in patients with ovarian cancer: A systematic review from 1977 to 2024

ObjectiveOvarian cancer patients are more likely to have mental disorders than other patients. However, to our knowledge, there has been no systematic analysis of its global epidemiology. Therefore, a systematic review was conducted to identify the prevalence of depression, anxiety, and suicidal ideation in ovarian cancer patients in different countries.MethodWe searched PubMed, Embase, Elsevier ScienceDirect, China National Knowledge Infrastructure, WanFang Data Knowledge Service Platform, and Duxiu Academic Search Platform to identify observational studies on depression, anxiety, and suicidal ideation in patients with ovarian cancer published up to 30 June 2024. We estimated the prevalence of depression, anxiety, and suicidal ideation in ovarian cancer patients worldwide and by region, country, research period, and assessment scales.ResultsA total of 31 studies were identified involving 8315 ovarian cancer patients. The prevalence rates of depression and anxiety were 35% and 37%, respectively. In China, the prevalence of suicidal ideation of ovarian cancer patients was 32%. Ovarian cancer patients in Asia had the highest prevalence of depression, while those in Oceania (Australia, New Zealand, etc.) had the lowest. Additionally, the prevalence rates of depression and anxiety increased considerably worldwide after 2000 and have gradually stabilized since then.ConclusionThis study found that the prevalence of depression and anxiety was high (more than one-third) among ovarian cancer patients. These findings underscore the need for a comprehensive study to address mental health problems in these patients, including the determination of incidence rates, investigation of regional differences, and assessment of comorbidities and treatment strategies.

Pathogenesis of recurrent respiratory papillomatosis and potential novel treatment strategies

OBJECTIVE

To describe the pathogenesis of human papillomavirus (HPV) and recurrent respiratory papillomatosis (RRP) caused by HPV6/11, immunologic and oncogenic properties, and currently available treatment strategies and to identify and discuss potential treatment targets that can become new foundations for development of future treatments.

METHODS

A comprehensive literature search was conducted using PubMed and Google Scholar utilizing search terms which includes "recurrent respiratory papillomatosis" "human papillomavirus" "HPV" "laryngeal papillomatosis" in combination with keywords "physiology" "treatment" "surgery" "adjunct therapy" "antiviral therapy" "gene therapy". No particular inclusion/exclusion criteria and no chronologic limitation were set during the search for studies to be used as references.

RESULTS/DISCUSSION

HPV infection begins with breaches in the epithelial barrier where it gains entry and access to the undifferentiated basal layer keratinocytes where the HPV genome interact with the host cell through the production of viral proteins encoded by the early and late gene regions facilitating viral entry, replication and proliferation. Oncoproteins interfere with host immune surveillance mechanism, promote growth factor signaling, and create a tumor microenvironment resulting in uncontrolled cell proliferation and progression of HPV infection. While high-risk HPV types integrate into the host genome and aggressively promote oncogenesis, low-risk HPV remain superficial with limited oncogenic activity and immune activation which allows avoidance of inflammation induction and cytolysis thereby preventing significant antigen production and facilitates immunosurveillance evasion. The current standard of treatment of RRP is surgical debulking using lasers or cold instruments with or without and adjuvant therapies like antivirals, interferons, VEGF/EGFR inhibitors, and immunomodulators. Novel immunotherapies such as gene therapies and immune checkpoint inhibitors show promising results in boosting immune responses and reducing the frequency of surgical interventions.

CONCLUSION

The treatment for recurrent respiratory papillomatosis still remains as a challenge due to its high recurrence rates needing repeated surgical and medical intervention attributed to its capability to evade the host immune responses. With the current standard of treatment, advances in the understanding of HPV pathogenesis paved a way for development of new treatment strategies. Understanding the complexities of the cellular and immune mechanisms involved between HPV and the host immune system will provide us with better foundation in identifying potential treatment targets in the future.

Oxaloacetate promotes the transition from glycolysis to gluconeogenesis through the Akt-FoxO1 and JNK/c-Jun-FoxO1 axes and inhibits the survival of liver cancer cells

BACKGROUND

Unlike other gluconeogenesis activators, oxaloacetate serves as both a metabolic intermediate and a signaling molecule, offering unique advantages in cancer therapy. This study explores the therapeutic potential of oxaloacetate in hepatocellular carcinoma, focusing on its impact on glucose metabolism, cell apoptosis, and intracellular signaling pathways.

METHODS

Utilizing bioinformatics analysis, we evaluated the metabolic flux of glucose in tumors and conducted differential and prognostic analyses of gluconeogenesis genes. Techniques such as transfection were employed to manipulate FoxO1 expression and Akt activity. GSH and NAC were used as antioxidants. Key enzyme activities, FoxO1 expression, cell viability, apoptosis-related proteins, ROS levels, and cell cycle progression were measured. Additionally, TUNEL apoptosis staining was performed.

RESULTS

Oxaloacetate promotes a glucose metabolic shift toward gluconeogenesis and induces apoptosis in cancer cells via FoxO1. In a mouse xenograft model, oxaloacetate treatment significantly reduced tumor size. Notably, tumors overexpressing Akt were larger, but their growth was also diminished following oxaloacetate treatment. FoxO1 expression and apoptosis-related proteins were elevated in oxaloacetate treated tumors. Oxaloacetate inhibits Akt phosphorylation and activates the JNK/c-Jun pathway, enhancing FoxO1 activity through dual mechanisms.

CONCLUSIONS

Oxaloacetate not only inhibits tumor proliferation through metabolic pathways but also acts as a signaling molecule influencing tumor growth via multiple signaling cascades. It disrupts liver cancer cell energy homeostasis and selectively targets glycolysis-addicted cancer cells. Furthermore, its endogenous presence and prior demonstration of safety in humans at relatively high doses highlight its potential for clinical translation in cancer therapy.

Case report: a critically ill patient with aggressive NK-cell leukemia receiving emergency chemotherapy in the ICU

Aggressive NK-cell leukemia (ANKL) is a scarce mature NK-cell neoplasm frequently associated with Epstein-Barr virus (EBV) infection. We report the case of a 47-year-old male patient who was admitted to the hospital due to recurrent fever, jaundice, and dyspnea, and was diagnosed with ANKL accompanied by multi-organ failure. Upon transfer to the intensive care unit (ICU), he received emergency chemotherapy consisting of etoposide, pegaspargase, and gemcitabine, in conjunction with organ support therapies including DPMAS, LPE, and CVVHD. Subsequently, the patient’s condition stabilized, and he was discharged. However, following the second cycle of chemotherapy, he was readmitted due to altered mental status. Due to financial constraints, the family decided not to pursue further treatment, leading to the patient’s eventual demise. Overall, this case highlights the critical importance of multidisciplinary collaboration for managing critically ill ANKL patients. Careful evaluation of the risks associated with chemotherapy, combined with timely administration of emergency chemotherapy in the ICU and comprehensive multi-organ support, can potentially offer a survival opportunity.

Podophyllum hexandrum Royle mitigates perimenopausal symptoms in an OVX rat model by activating the PI3K/AKT/mTOR pathway and enhancing estrogen receptor expression

ETHNOPHARMACOLOGICAL RELEVANCE

Podophyllum hexandrum Royle, recorded in the Pharmacopoeia of the People's Republic of China as Sinopodophyllum hexandrum (Royle) Ying (SH), is a nationally protected Tibetan medicinal plant in China, which has been traditionally used to regulate menstruation, enhance blood circulation, and treat blood stasis and dystocia. However, its potential role and mechanisms in managing perimenopausal syndrome (PMS) remain unclear.

AIM OF THE STUDY

This study evaluates the therapeutic potential of Sinopodophyllum hexandrum (Royle) Ying rhizomes (SHR) and fruits (SHF) in PMS and investigates their underlying molecular mechanisms.

MATERIALS AND METHODS

The anti-PMS effects of SHR and SHF were examined in an ovariectomized (OVX) rat model by assessing uterine histopathology and hormone levels. Serum lipid profiles, including triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), as well as malondialdehyde (MDA) levels and superoxide dismutase (SOD) levels, were analyzed using biochemical assays. Astral-DIA proteomics identified differentially expressed proteins (DEPs) and key signaling pathways affected by SHF. Protein expression was evaluated via western blotting, immunohistochemistry, and RT-qPCR. Estrogenic activity was further assessed in vitro through MCF-7 cell viability and estrogen receptor (ER) expression analysis.

RESULTS

SHR and SHF treatment significantly improved uterine morphology in OVX rats, restoring endometrial and epithelial thickness. High-dose SHF (SHF-H) increased serum estradiol (E2) by 100.02 %, anti-Müllerian hormone (AMH) by 34.68 %, and progesterone (PROG) by 39.96 % while decreasing luteinizing hormone (LH) by 31.53 %. High-dose SHR (SHR-H) treatment resulted in a 112.89 % increase in E2 levels and a 23.88 % decrease in LH levels. Additionally, SHR-H and SHF-H regulated the level of oxidative stress and serum lipid levels, showing a significant decline in MDA (48.32 %, 65.52 %), TG (34.71 %, 33.30 %), TC (22.34 %, 27.77 %), and LDL-C (57.09 %, 42.96 %). Proteomic analysis identified the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway and apoptotic regulation as key mechanisms underlying SHF's effects. SHF reversed the OVX-induced suppression of p-PI3K/PI3K, p-AKT/AKT, and p-mTOR in the uterus. SHR and SHF also modulated apoptosis-related proteins, downregulating Bax and Cleaved caspase-3/9 while upregulating Bcl-2. Moreover, SHF significantly increased uterine ERα and ERβ expression at both mRNA and protein levels. In vitro, SHR and SHF extracts promoted MCF-7 cell viability and upregulated ERα, ERβ, and proliferating cell nuclear antigen (PCNA), indicating estrogenic activity.

CONCLUSIONS

SH alleviates PMS by inhibiting uterine apoptosis via PI3K/AKT/mTOR pathway activation and enhancing estrogen receptor expression. It also regulates hormone levels, lipid metabolism, and oxidative stress, potentially slowing PMS progression. These findings highlight SH as a promising therapeutic agent for PMS and provide novel insights into the molecular mechanisms of Tibetan medicine.

Disturbed neurovascular coupling of limbic system in obstructive sleep apnea patients with mild cognitive impairment: A combined fMRI and ASL study

Obstructive sleep apnea (OSA) is a common sleep disorder that causes long-term intermittent hypoxia and sleep disturbances, negatively affecting cognitive function. The mechanisms underlying cognitive impairment in OSA may involve alterations in both brain structure and function. This study investigates the potential role of disturbed neurovascular coupling (NVC) in cognitive decline among OSA patients. A total of 27 OSA patients with mild cognitive impairment (OSA-MCI) and 26 with normal cognitive function (OSA-NC) were included. We calculated the correlation coefficients for z-transformed amplitude of low-frequency fluctuations (ALFF) and cerebral blood flow (CBF) at global and regional brain voxel levels using resting-state functional magnetic resonance imaging (rs-fMRI) and arterial spin labeling (ASL) to assess NVC. General linear modeling and partial correlation analysis revealed that OSA-MCI patients exhibited disturbed NVC primarily within the limbic system, which was associated with cognitive decline. The ROC curve demonstrated that left hippocampus exhibited the highest classification performance in distinguishing between two groups. In conclusion, this study highlights a strong association between disturbed NVC and cognitive decline in OSA, and underscore the potential of NVC as a biomarker for early detection and intervention in OSA-related cognitive impairment.

RNAa: Mechanisms, therapeutic potential, and clinical progress

RNA activation (RNAa), a gene regulatory mechanism mediated by small activating RNAs (saRNAs) and microRNAs (miRNAs), has significant implications for therapeutic applications. Unlike small interfering RNA (siRNA), which is known for gene silencing in RNA interference (RNAi), synthetic saRNAs can stably upregulate target gene expression at the transcriptional level through the assembly of the RNA-induced transcriptional activation (RITA) complex. Moreover, the dual functionality of endogenous miRNAs in RNAa (hereafter referred to as mi-RNAa) reveals their complex role in cellular processes and disease pathology. Emerging studies suggest saRNAs' potential as a novel therapeutic modality for diseases such as metabolic disorders, hearing loss, tumors, and Alzheimer's. Notably, MTL-CEBPA, the first saRNA drug candidate, shows promise in hepatocellular carcinoma treatment, while RAG-01 is being explored for non-muscle-invasive bladder cancer, highlighting clinical advancements in RNAa. This review synthesizes our current understanding of the mechanisms of RNAa and highlights recent advancements in the study of mi-RNAa and the therapeutic development of saRNAs.

Clinical and genetic analysis and literature review of children with myotonia congenita due to CLCN1 mutations

BACKGROUND

Myotonia congenita (MC) is mainly caused by variants in the CLCN1 Gene, which is characterized by having difficulty in relaxing the muscle after active contraction, known as myotonia. This study aims to investigate the clinical characteristics and gene mutations of myotonia congenita caused by CLCN1 mutation.

CASE PRESENTATION

Five children with myotonia congenita due to CLCN1 mutations admitted to Nanjing Children's Hospital were included. All five children had a juvenile onset of the disease (1 to 11 years of age). Two had onset before 2 years of age, and three had onset after 10 years of age. All patients experienced muscle stiffness (5/5, 100.0%), two reported delayed relaxation of the hand after forceful grasping (2/5, 40.0%), and three reported that the muscle stiffness worsened with changes in motor status (3/5, 60.0%). These symptoms improved with exercise (warm-up phenomenon) (5/5, 100.0%).Two children had elevated CK (2/5, 40.0%), and EMG showed muscle tonic potentials in all five children (5/5, 100.0%). Eight CLCN1 gene mutation sites were identified in five patients, including four unreported variants: c.688G > A (p.G230R), c.2653_c.2654insC (p.A885Afs*27), c.1938G > T (p.M646I) and c.1825 A > G (p.M609V). In this paper, we also summarized the Chinese CLCN1 mutation sites reported in the last 10 years, revealing that exons 8 and 15 may be the hotspot regions of mutation in Chinese children.

CONCLUSION

This study expands the clinical and genetic spectrum of Chinese children with myotonia congenita. The clinical manifestations observed in these children were similar with those previously reported in the literature. Additionally, exons 8 and 15 may be the hotspot regions for gene mutations in Chinese children with myotonia congentia.

Natural anti-cancer products: insights from herbal medicine

Herbal medicine exhibits a broad spectrum of potent anti-cancer properties, including the enhancement of tumor immune responses, reversal of multidrug resistance, regulation of autophagy and ferroptosis, as well as anti-proliferative, pro-apoptotic, and anti-metastatic effects. This review systematically explores recent advances (primarily documented since 2019) in research on key anti-cancer compounds derived from herbal medicine, such as apigenin, artemisinin, berberine, curcumin, emodin, epigallocatechin gallate (EGCG), ginsenosides, icariin, resveratrol, silibinin, triptolide, and ursolic acid (UA). These studies were sourced from scientific databases, including PubMed, Web of Science, Medline, Scopus, and Clinical Trials. The review focuses on the significant role that these natural products play in modern oncology, exploring their efficacy, mechanisms of action, and the challenges and prospects of integrating them into conventional cancer therapies. Furthermore, it highlights cutting-edge approaches in cancer research, such as the utilization of gut microbiota, omics technologies, synthetic derivatives, and advanced drug delivery systems (DDS). This review underscores the potential of these natural products to advance the development of novel anti-cancer treatments and support contemporary medicine. Additionally, recent multi-omics findings reveal how these compounds reshape transcriptional and metabolic networks, further broadening their therapeutic scope. Many natural products exhibit synergy with first-line chemotherapies or targeted therapies, thereby enhancing treatment efficacy and reducing side effects. Advanced nano-formulations and antibody-drug conjugates have also substantially improved their bioavailability, making them promising candidates for future translational research.

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

INTRODUCTION

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

AREAS COVERED

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

EXPERT OPINION

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

Sepsis in liver failure patients: Diagnostic challenges and recent advancements

Acute liver failure (ALF) and acute-on-chronic LF (ACLF) are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections (BI), despite significant systemic inflammation. Literature indicates that 30%-80% of ALF patients and 55%-81% of ACLF patients develop BI, attributed to immunological dysregulation. Bacterial sepsis in these patients is associated with adverse clinical outcomes, including prolonged hospitalization and increased mortality. Early detection of bacterial sepsis is critical; however, distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis. Conventional sepsis biomarkers, such as procalcitonin and C-reactive protein, have shown limited utility in LF patients due to inconsistent results. In contrast, novel biomarkers like presepsin and sTREM-1 have demonstrated promising discriminatory performance in this population, pending further validation. Moreover, emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization. Although preliminary findings are encouraging, further studies are necessary to validate these results across diverse patient cohorts, including those with LF. This article provides a comprehensive review of the magnitude, impact, and diagnostic challenges associated with BI in LF patients, focusing on novel advancements in early sepsis detection and characterization.

Using virtual patient cohorts to uncover immune response differences in cancer and immunosuppressed COVID-19 patients

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) resulted in millions of deaths globally. Adults with immunosuppression (e.g., solid organ transplant recipients) and those undergoing active cancer treatments experience worse infections and more severe COVID-19. It is difficult to conduct clinical studies in these populations, resulting in a restricted amount of data that can be used to relate mechanisms of immune dysfunction to COVID-19 outcomes in these vulnerable groups. To study immune dynamics after infection with SARS-CoV-2 and to investigate drivers of COVID-19 severity in individuals with cancer and immunosuppression, we adapted our mathematical model of the immune response during COVID-19 and generated virtual patient cohorts of cancer and immunosuppressed patients. The cohorts of plausible patients recapitulated available longitudinal clinical data collected from patients in Montréal, Canada area hospitals. Our model predicted that both cancer and immunosuppressed virtual patients with severe COVID-19 had decreased CD8 + T cells, elevated interleukin-6 concentrations, and delayed type I interferon peaks compared to those with mild COVID-19 outcomes. Additionally, our results suggest that cancer patients experience higher viral loads (however, with no direct relation with severity), likely because of decreased initial neutrophil counts (i.e., neutropenia), a frequent toxic side effect of anti-cancer therapy. Furthermore, severe cancer and immunosuppressed virtual patients suffered a high degree of tissue damage associated with elevated neutrophils. Lastly, parameter values associated with monocyte recruitment by infected cells were found to be elevated in severe cancer and immunosuppressed patients with respect to the COVID-19 reference group. Together, our study highlights that dysfunctions in type I interferon and CD8 + T cells are key drivers of immune dysregulation in COVID-19, particularly in cancer patients and immunosuppressed individuals.

Classification of urinary stones using near-infrared spectroscopy and chemometrics: A promising method for intraoperative application

In low-invasive surgical treatment of urolithiasis, there is a need for an analytical method to determine the chemical composition of urinary stones in real-time mode, i.e., intraoperatively. While a thorough phase analysis can be done after the surgery, preliminary information about a target stone would be helpful for the specialists for choosing an optimal strategy of treatment and giving some immediate dietary or drug prescriptions to a patient. Near-infrared spectroscopy (NIRS) is a good candidate for such a method that can provide immediate results without obligatory sample preparation. Fiber optic probes, often used for acquiring near-infrared spectra, are compatible with surgical instrumentation. Chemometric algorithms can successfully resolve the complexity of NIR spectra, which consist of overlapped signals. For the first time, we applied NIRS in diffuse reflectance mode to classify three major types of urinary stones: oxalates, urates, and phosphates. To imitate the real conditions of a surgery, the NIR spectra were acquired not only under ambient conditions but also in saline medium. A trained and optimized multinomial classifier (Error Correcting Output Codes) showed an acceptable precision and recall for an independent validation dataset. Even considering the strong absorbance of saline, the calculated geometric mean was 94 %, 87 %, and 71 % for oxalates, urates, and phosphates, respectively. A first real-time approbation during a real surgery (percutaneous nephrolithotomy) demonstrated a compatibility of the suggested approach with the surgical protocols and a good agreement of the acquired NIR spectra and the results of reference X-ray phase analysis.

Urine flow cytometry in older adults urinary tract infection diagnosis: is it time to reevaluate thresholds for men and women?

BACKGROUND

To evaluate the utility of automated urine flow cytometry in the diagnosis of urinary tract infection (UTI) in older patients without waiting for urine culture results.

METHODS

This prospective study included patients aged ≥ 65 years admitted to the emergency department of Besançon University Hospital over a six-month period. Clinical and biological data were collected and UTI diagnosis was based on strict clinical and biological criteria. Urine analysis was performed using the UF-4000 (Sysmex). Parameters or thresholds were defined based on an AUC > 0.8 and a clinically relevant negative likelihood ratio (LR-) < 0.1.

RESULTS

Of 456 patients, 69 (15.1%) had a UTI. Bacteriuria (AUC = 0.874) and leukocyturia (AUC = 0.925) were strongly associated with UTI, with thresholds of 150 bacteria/µL and 50 leukocytes/µL (both LR- < 0.1). These cut-offs varied by sex. Urine dipsticks effectively excluded UTI in men (LR- < 0.1), but were less reliable in women (LR- = 0.129). Gender-specific diagnostic algorithms were suggested.

CONCLUSIONS

Urine flow cytometry provides valuable diagnostic thresholds for bacteriuria and leukocyturia and helps to exclude UTI before culture results. Recommendations for the diagnosis of UTI in older patients should take into account gender differences.

Validation of the PEACE score for predicting abnormal echocardiographic findings in pulmonary embolism patients

BACKGROUND

Pulmonary embolism (PE) is a life-threatening condition requiring rapid risk stratification for optimal management. The Pulmonary Embolism Advanced Cardiac Evaluation (PEACE) Score is a novel tool integrating clinical, laboratory, and echocardiographic parameters to assess disease severity. This study aimed to evaluate the correlation between PEACE Score and echocardiographic abnormalities in PE patients, and to determine its effectiveness as a rapid risk assessment tool in emergency settings.

METHODS

Between June 2020 and June 2024, 120 patients were prospectively screened and enrolled in the study after being diagnosed with pulmonary embolism via CT angiography in the emergency department. Patients were categorized into three groups according to PEACE score as low risk (< 3 points, n = 42), intermediate risk (3-5 points, n = 52) and high risk (> 5 points, n = 26). Echocardiographic findings were not used for stratification but rather analyzed as outcome variables to assess the discriminative validity of the PEACE Score. Demographic data, laboratory findings and echocardiographic parameters were recorded. Patients were followed up for at least 1 year. Follow-up from 3 months to 6 months was evaluated and mortality rates at the end of 1 year were determined.

RESULTS

PEACE Score was strongly correlated with echocardiographic abnormalities (r = 0.685, p < 0.001) and inflammatory markers, including CRP (r = 0.524, p < 0.001). The PEACE Score had the highest diagnostic value for predicting echocardiographic abnormalities, with an AUC of 0.82 (95% CI: 0.74-0.90, p < 0.001). Specifically, in predicting right ventricular dysfunction, the PEACE Score achieved an AUC of 0.85 (95% CI: 0.77-0.93, p < 0.001). A cutoff of > 5 points showed a sensitivity of 84.6% and specificity of 79.2% for detecting severe echocardiographic abnormalities. One-year survival rates were 45% in the high-risk group, 65% in the intermediate-risk group, and 85% in the low-risk group. Kaplan-Meier analysis confirmed significant differences in survival among risk groups (p < 0.001).

CONCLUSION

The PEACE Score demonstrated a strong association with echocardiographic abnormalities and patient survival in emergency department PE cases. These findings suggest that PEACE may serve as a valuable tool for rapid risk stratification, aiding emergency physicians in early clinical decision-making. Specifically, high PEACE Scores were associated with a greater need for thrombolytic therapy and ICU admission, suggesting its potential utility in guiding treatment escalation and resource allocation in critically ill PE patients.

CLINICAL TRIAL NUMBER

Not applicable.

Histopathological examination of lung from infant with lethal COVID-19 with special attention on pneumocytes type II and the immune infiltrate: a case study

BACKGROUND

COVID-19 is a complex disease caused by SARS-CoV-2. The molecular and cellular mechanisms of the disease are unclear and their study is one of the greatest challenges for the modern science. Since the lung is the biggest target for SARS-CoV-2, the studies on cellular and molecular changes in this organ are essential to establish the pathogenesis of the disease. To date there is increasing number of reports on the lung pathology of fatal COVID-19 and the results are mainly obtained by autopsies of elderly patients, since this age group shows highest mortality. Little is known about the progression of the disease in children and especially newborn and infants and, to our knowledge, there are no reports on the lung features of fatal COVID-19 in this age group.

METHODS

In the present case study, we have investigated the lung morphological features in 11-months old infant who has died as a result of complications from COVID-19. Immunohistochemistry for immune cell markers and transmission electron microscopy for alveolocytes type II (ATII) are made.

RESULTS

Immediate cause of the death was acute respiratory failure resulting from bilateral interstitial pneumonia and subsequent acute cardiovascular failure. The histopathology shows lung edema, hyaline membranes, airway mucus plugging and interstitial inflammation. On cellular level we have observed a substantial increase in the number of ATII cells. ATII cells were marked with cytokeratin 19, TTF1 and napsin A. Transmission elec-tron microscopy reveals ongoing apoptosis in these cells with a typical chromatin clustering and condensation towards the inner nuclear membrane. Immunohisto-chemistry shows significant increase of CD68+ macro-phages in the alveoli, increase of IL-6 in immune and stromal cells, moderate elevation of FOXP3+ and IL-17+ cells and expression of CD4+ and CD8+ cells in alveolar walls. Immune cell interactions are discussed in the sense of ongoing cytokine storm.

CONCLUSIONS

Our findings highlight the complexity of COVID-19 lung affection, involving ATII cell hyperplasia, interstitial mononuclear cell infiltration and macrophages increase. The findings provide an additional knowledge on the pathophysiology of COVID-19 in the lung and can serve as a basis for investigation of molecular mechanisms of this disease.

Comparison of a minimally invasive osteosynthesis technique with open surgical technique for transverse patellar fractures

This retrospective study aimed to compare the safety and efficacy of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures. Between January 2016 and December 2022, a total of 138 patients with transverse patellar fractures who underwent osteosynthesis with either minimally invasive osteosynthesis technique (MIOT) or open reduction and internal fixation (ORIF) were enrolled and retrospectively analyzed. The outcomes were assessed for 67 patients in the MIOT group (mean age: 46.2 ± 15.8 years old, mean follow-up: 26.4 ± 5.1 months) and 51 patients in the ORIF group (mean age: 43.7 ± 13.4 years old, mean follow-up: 25.1 ± 4.8 months). Clinical outcomes, including surgical time, blood loss, bony union time, final range of motion involving knee extension and flexion, Bostman score, visual analogue scale (VAS), and complications, were measured over a minimum follow-up period of 24 months. The surgical time in the MIOT group was shorter than that in the ORIF group (P = .001). The blood loss in the MIOT group was significantly less than that in the ORIF group (P < .0001). At the 2-year follow-up, all fractures had healed. The mean union time in the MIOT group was shorter than that in the ORIF group (P = .002). The MIOT group also exhibited significantly better flexion (P = .001) and a higher Bostman score (P = .0065), compared with the ORIF group. The mean VAS was significantly lower in the MIOT group than that in the ORIF group (P < .0001). The MIOT group had a lower complication rate, including delayed wound healing and implant irritation, as well as an overall lower complication rate. The MIOT method proved to be a reproducibly reliable approach, offering lower surgical trauma, improved functional outcomes, and a lower incidence of complications compared with the conventional open surgical technique for transverse patellar fractures. It may be a prudent choice for treating transverse patellar fractures.

Early radiotherapy improved survival of patients with extensive-stage small cell lung cancer treated with first-line chemo-immunotherapy

BACKGROUND AND PURPOSE

This real-world study aimed to investigate the efficacy of early radiotherapy (RT) in ES-SCLC patients treated with first-line chemo-immunotherapy.

MATERIALS AND METHODS

ES-SCLC patients were enrolled from August 2018 to October 2023. Patients who received early radiotherapy before disease progression were defined as Early RT group, while the others, named Salvage and Non-RT (S&N RT) group. Propensity score matching (PSM) with a 1:1 ratio was performed to balance the baseline characteristics.

RESULTS

In this study, 375 patients with ES-SCLC treated with first-line chemo-immunotherapy were enrolled. The median PFS was 11.4 months of the Early RT group compared to 6.1 months of the S&N RT group (HR = 0.59, 95%CI 0.45-0.77; p < 0.001). The median OS was 23.8 months of the Early RT group versus 18.0 months of the S&N RT group (HR = 0.50, 95%CI 0.34-0.73; p = 0.004). The survival benefit persisted in the PSM cohort. Furthermore, survival was significantly improved in Early RT group compared to Salvage RT group (p = 0.028), while Salvage RT group had a similar survival with Non-RT group (p = 0.868). The risk of adverse events was tolerable. The multivariate analysis also demonstrated that early radiotherapy was an independently positive predictor for PFS and OS.

CONCLUSIONS

Administering early radiotherapy significantly improved both PFS and OS in patients with ES-SCLC treated with first-line chemo-immunotherapy with tolerable adverse events, while salvage radiotherapy did not improve survival. This finding warrants further validation through prospective randomized studies.

Endoplasmic reticulum stress sensor protein PERK in hepatic stellate cells promotes the progression of hepatocellular carcinoma via p38δ MAPK/IL-1β axis

Palmitic acid (PA) absorption from the intestine is increased in metabolic dysfunction-associated steatohepatitis (MASH). It induces endoplasmic reticulum (ER) stress and interleukin-1 beta (IL-1β) production in hepatic stellate cells (HSCs). Protein kinase R-like endoplasmic reticulum kinase (PERK) is an ER stress sensor protein involved in HSC activation and liver fibrosis. However, its role in HSCs during hepatocellular carcinoma (HCC) progression remains unclear. This study clarified the process of IL-1β production via PERK in HSCs and explored the mechanism underlying MASH-related HCC progression. HSCs were treated with PA or transfected with PERK small-interfering RNA (siRNA) or PERK plasmid. Proliferation, scratch, and Transwell assays were performed on HCC cells cultured in the conditioned medium (CM) from HSCs. PA treatment increased PERK and IL-1β expression in HSCs. PERK knockdown decreased IL-1β expression, while its overexpression increased it in HSCs. The CM from PA-treated HSCs showed elevated IL-1β levels and enhanced HCC cells' proliferation, migration, and invasion; however, these effects were suppressed by PERK knockdown in HSCs. RNA-sequencing analysis revealed that p38δ mitogen-activated protein kinase (MAPK) is the intermediate molecule between PERK and IL-1β in HSCs. In the tumor microenvironment of MASH-related HCC, PERK in HSCs promotes HCC progression via the p38δ MAPK/IL-1β axis.

Novel compound heterozygous DOCK6 variants expand the mutational spectrum in prenatal diagnosis of Adams-Oliver syndrome 2

BACKGROUND

Adams-Oliver syndrome (AOS) is a rare developmental disorder, and the DOCK6 gene is an identified AOS gene. This report highlights the prenatal diagnosis of AOS-2 by ultrasonography and genetic testing.

METHODS

A growth-restricted fetus with bilateral ventriculomegaly, paraventricular calcifications, and ventricular septal defect underwent trio-whole-exome sequencing (trio-WES). Functional validation of the splice-altering variant was performed via minigene assays and protein structural modeling.

RESULTS

Trio-WES revealed compound heterozygous DOCK6 variants: a paternal frameshift (c.3190_3191del; p. Leu1064Valfs60) and a maternal splice-site variant (c.3241-1G > T). Minigene assays demonstrated that c.3241-1G > T caused intron 26 retention (486 bp), introducing a premature termination codon (p. Val1081Glufs37). Structural modeling confirmed the loss of critical DHR2 domains in both truncated proteins.

CONCLUSIONS

This study expands the mutational spectrum of DOCK6 and underscores the importance of combining prenatal imaging with functional genomics for early diagnosis of AOS2.

L-Theanine Mitigates Chronic Alcoholic Intestinal Injury by Regulating Intestinal Alcohol and Linoleic-Arachidonic Acid Metabolism in Rats

Background: Chronic alcohol intake impairs intestinal function, while L-theanine (LTA) may support intestinal health. However, the protective effects of LTA to chronic alcoholic intestinal injuries remain unclear. Methods: SD rats were administered LTA for 8 weeks and then co-administered Lieber-DeCarli liquid alcohol feed and LTA for 4 weeks to establish a chronic alcoholic intestinal injury model and investigate the mitigating influence of LTA on chronic alcoholic intestinal injury. Results: LTA alleviated duodenal pathology and intestinal permeability injury and reduced intestinal oxidative stress and inflammatory response, thereby mitigating chronic alcoholic intestinal injury. Additionally, LTA ameliorated disturbances in the gut microbiota induced by chronic alcohol intake by increasing the beneficial bacteria abundance (Ruminococcus and Odoribacter) and decreasing the harmful bacteria abundance (Enterococcus). Moreover, LTA altered the metabolic profiles associated with ethanol and linoleic (LA) and arachidonic acid (AA) metabolism. ADH6, ALDH2, and ACSS1 mRNA and protein levels were upregulated by LTA, whereas those for CYP2E1, FADS2, ALOX-5, and COX-1 were downregulated. Concurrently, LTA increased the levels of metabolites, such as acetyl-CoA, and decreased the levels of ethanol, acetaldehyde, acetic acid, LA, AA, PGE2, 13-HPODE, and LTB4. Conclusions: L-theanine mitigates chronic alcoholic intestinal injury by regulating intestinal alcohol and LA-AA metabolism. Our findings support the functional potential of the dietary supplement LTA and highlight its potential for addressing chronic intestinal injury caused by chronic alcohol intake.

ECM-responsive PEGylated liposomal biomaterial for enhanced tumor penetration through Dual-Mechanism microenvironment remodeling in lung cancer

This study aimed to develop a self-facilitating PEGylated liposomal system co-delivering ceritinib (anticancer) and telmisartan (antifibrotic) to overcome the extracellular matrix (ECM) barrier limiting therapeutic efficacy in solid tumors. Dual drug-loaded liposomes were prepared by thin film hydration using an optimized 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC):cholesterol:1,2-distearoyl-sn-glycero-3-phosphoethanolamine-polyethylene glycol 2000 (DSPE-PEG(2000)) ratio (6:1:0.1). Formulations were characterized for particle size, zeta potential, drug encapsulation, and release kinetics. Physicochemical characteristics were evaluated using differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), and Fourier transform infrared spectroscopy (FTIR). Therapeutic efficacy was assessed in A549 lung cancer cells and A549 xenograft mouse models. The optimized formulation exhibited nanoscale dimensions (77.7 ± 3.54 nm) with a zeta potential of -23.9 ± 8.73 mV and high encapsulation efficiencies for ceritinib (69.61 ± 2.30 %) and telmisartan (63.43 ± 1.12 %). Drug release followed Korsmeyer-Peppas kinetics (R2 > 0.98) with diffusional exponents of 0.45-0.48. The liposomal system demonstrated remarkable stability for 12 months under refrigeration with < 18 % size increase and > 89 % drug retention. In vivo studies revealed 4.85-fold greater tumor reduction compared to ceritinib-only liposomes, with 67.3 ± 5.2 % reduction in collagen density creating enhanced penetration pathways. Caspase-3/7 assays confirmed 5.3-fold increased apoptotic activity. The dual drug-loaded PEGylated liposomal system offers a promising pharmaceutical platform for overcoming ECM barriers in cancer therapy, with excellent stability characteristics and significant advantages over conventional approaches.

Microbiome Engineering for Biotherapeutic in Alzheimer's Disease Through the Gut-Brain Axis: Potentials and Limitations

Alzheimer's disease (AD) is a neurodegenerative condition characterized by considerable cognitive decline and functional impairment, primarily due to the progressive alteration of neurons, microglia, and astrocytes. Pathological manifestations of AD include the loss of synaptic plasticity, reduction in synaptic strength by amyloid-beta, aggregation, and neurotoxicity from tau protein post-translational modifications, all contributing to the disruption of neural networks. Despite its current pharmacological treatment for AD, different approaches to treat such disease are being developed, from a microbiome perspective. The microbiome encompasses a diverse microorganism, including beneficial bacteria that create a positive impact to diminish AD pathogenesis. Growing evidence suggests that probiotic, prebiotic, synbiotic, and postbiotics can positively modulate the gut-brain axis, reducing systemic inflammation, restoring neurotransmitter balance, and improving gut health, thereby possibly mitigating AD pathogenesis. Moreover, there is paraprobiotics as the most recently developed biotherapeutic with beneficial effects. This review explores the correlation between AD and gut-brain axis as a novel biotherapeutic target. The underlying mechanism of the microbiota-gut-brain axis in AD is examined. Novel insights into the current applications as potential treatment and its limitations are highlighted.

Large Yellow Croaker (Pseudosciaena crocea, Richardson) E2F4, a Cyclin-Dependent Transcription Factor, Forms a Heterodimer with DP1

E2F transcription factors regulate cell cycle progression by influencing the expression of proteins required for the G1-S phase transition and DNA synthesis with its heterodimeric partners (DP1 or DP2). The dimerization domain is the E2Fs and DP1 protein interaction interface and is believed to function in protein dimerization. In this study, eight E2F transcription factors (PcE2F1-8) of large yellow croaker Pseudosciaena crocea and one dimerization partner (PcDP1) are identified in the genome of large yellow croakers. The prediction of E2Fs conserved domains revealed that PcE2F1-6 has one DNA-binding domain (DBD) and one dimerization-binding domain (DD), while PcE2F7-8 only possess two duplicate DBDs but not DD, indicating that E2F7-8 cannot form the E2F/DP1 heterodimer. To explore whether PcDP1 is a partner of PcE2F1-6, the ORF of PcE2F1-6 was cloned. Subsequently, its sequence characteristics, the expression pattern in healthy fish, and subcellular co-localization were analyzed, and an interaction between PcDP1 and PcE2F1-6 were detected directly by yeast two-hybrid and BiFC. The PcE2F1, PcE2F2, PcE2F3, PcE2F4, PcE2F5, and PcE2F6 genes encode a protein of 454, 448, 444, 392, 362, and 396 amino acids, respectively, with accession numbers QFZ93593.1, QFZ93594.1, QFZ93595.1, QFZ93596.1, QFZ93597.1, and QFZ93598.1, respectively. Sequence characteristics analysis found that PcE2F1-5 but not PcE2F6 proteins share the pocket protein-binding domain sequestering in dimerization domains and transactivation domains. The PcE2F1,2,4 proteins possess one nuclear localization signal (NLS), and PcE2F3 protein possess two NLSs, but there is no NLS in PcE2F5 and 6 protein. Moreover, PcE2F4 also contains one NES. However, PcE2F1-6 proteins were all located in nucleus by using Euk-mPloc 2.0 programs and were confirmed by performing the Cherry and EGFP reporter assay. Regarding co-expression of DP1, only E2F4 can transfer DP1's subcellular location from cytoplasm to the nucleus. RT-qPCR analysis indicated that PcE2F1-6 are constitutively and tissue specifically expressed in all of the tissues tested of a healthy large yellow croaker. The PcE2F1-6, except for PcE2F3, mRNA levels were all detected higher in the liver. PcE2F1-4 were also highly specifically expressed in the kidney, PcE2F4,6 in the brain, and PcE2F5 in the spleen of a healthy large yellow croaker, respectively. Using a yeast two-hybrid system, PcE2F4 interacting with PcDP1 was identified. The interaction between PcE2F4 and PcDP1 was further confirmed by a bimolecular fluorescence complementation (BiFC) assay. Collectively, these results indicate that an interaction between PcE2F4 and PcDP1 was detected, which may form heterodimer E2F4/DP1 to regulate cell cycles and immune-related pathways in large yellow croakers.

Lactylation: From Homeostasis to Pathological Implications and Therapeutic Strategies

Lactylation, a recently identified post-translational modification, represents a groundbreaking addition to the epigenetic landscape, revealing its pivotal role in gene regulation and metabolic adaptation. Unlike traditional modifications, lactylation directly links metabolic intermediates, such as lactate, to protein function and cellular behavior. Emerging evidence highlights the critical involvement of lactylation in diverse biological processes, including immune response modulation, cellular differentiation, and tumor progression. However, its regulatory mechanisms, biological implications, and disease associations remain poorly understood. This review systematically explores the enzymatic and nonenzymatic mechanisms underlying protein lactylation, shedding light on the interplay between cellular metabolism and epigenetic control. We comprehensively analyze its biological functions in normal physiology, such as immune homeostasis and tissue repair, and its dysregulation in pathological contexts, including cancer, inflammation, and metabolic disorders. Moreover, we discuss advanced detection technologies and potential therapeutic interventions targeting lactylation pathways. By integrating these insights, this review aims to bridge critical knowledge gaps and propose future directions for research. Highlighting lactylation's multifaceted roles in health and disease, this review provides a timely resource for understanding its clinical implications, particularly as a novel target for precision medicine in metabolic and oncological therapies.

Saccharomyces cerevisiae SC-2201 Attenuates AOM/DSS-Induced Colorectal Cancer by Modulating the Gut Microbiome and Blocking Proinflammatory Mediators

Colorectal cancer is the third most common cancer in the world today, and studies have shown that the ratio of Candida to Saccharomyces cerevisiae increased, and the abundance of S. cerevisiae in the intestines of patients with colorectal cancer decreased, which suggests that there is an imbalance in the proportion of fungi in the intestines of patients with colorectal cancer. The objective of this study was to screen S. cerevisiae isolate from traditional Chinese fermentation starters and assess its ability to ameliorate dysbiosis and to alleviate the carcinogenic process of azoxymethane/dextran sodium sulfate-induced colorectal cancer in mice model. S. cerevisiae strain SC-2201 was isolated and exhibited probiotic properties, including the ability to survive in an acidic pH environment and in the presence of bile salts in the gastrointestinal tract, as well as antioxidant activities. Oral administration of S. cerevisiae SC-2201 not only alleviated weight loss but also reduced colonic shortening and histological damage in azoxymethane/dextran sodium sulfate-induced colorectal cancer in mice. Furthermore, the administration of S. cerevisiae SC-2201 suppressed the expression of proinflammatory mediators, such as interleukin-1β, interleukin-6, cyclooxygenase-2, vascular endothelial growth factor, nucleotide-binding domain, leucine-rich repeat, and pyrin domain-containing protein 3. Specifically, the analysis of gut bacteriome showed a significant decrease in Bacteroidota and Campylobacterota levels, as well as an increase in Proteobacteria level in the colorectal cancer group, which was alleviated by supplementation with S. cerevisiae SC-2201. The analysis of the mycobiome revealed a significant increase in the levels of Basidiomycota, Apiosordaria, Naganishia, and Taphrina genera in the colorectal cancer group, which were alleviated after supplementation with S. cerevisiae SC-2201. However, the levels of Xenoramularia, Entoloma, and Keissleriella were significantly increased after administration with S. cerevisiae SC-2201. Overall, the findings of this study demonstrate that S. cerevisiae SC-2201 possesses potential probiotic properties and can effectively attenuate the development of colorectal cancer, highlighting its cancer-preventive potential. This is the first report of a S. cerevisiae strain isolated from traditional Chinese fermentation starters which showed good probiotic properties, and mitigated azoxymethane/dextran sodium sulfate-induced colorectal cancer by modulating the gut microbiome and blocking proinflammatory mediators in mice.

Traumatic spinal cord injury: a review of the current state of art and future directions - what do we know and where are we going?

Background

Traumatic spinal cord injury (SCI) remains a devastating condition, with limited functional recovery despite advancements in clinical management and understanding of its mechanisms. SCI pathophysiology involves primary mechanical trauma and secondary neuroimmune and structural changes, leading to neuronal death and chronic functional deficits.

Methods

Through a comprehensive literature review of articles published in the PubMed, MEDLINE, Embase, and Cochrane Reviews Library databases, this article provides an update on the current management of traumatic SCI with a focus on these emerging therapeutic strategies that hold potential for future advancements in the field.

Results

Current management strategies include pre-hospital care, acute clinical interventions, surgical decompression and spine destabilization, and neurorehabilitation. Despite these interventions, SCI patients often fail to fully restore lost functions. Emerging therapies focus on neuroprotection, neuroregeneration, and neuromodulation, leveraging advances in molecular biomarkers, imaging techniques, and cell-based treatments. Neuroprotective agents, including the sodium-glutamate antagonist riluzole, aim to keep cells alive through the secondary injury phase, while regenerative strategies utilize neurotrophic factors and stem cell transplantation or approaches to target inhibitor molecules such as NOGO or RGMa to regenerate new cells, axons, and neural circuits. Neuromodulation techniques, such as electrical and magnetic field stimulation, offer promising avenues for functional recovery. Combining these novel therapies with traditional neurorehabilitation holds potential for improved outcomes.

Conclusions

While significant strides have been made in understanding the mechanisms underlying SCI and in developing novel therapeutic approaches, the challenge and opportunity will be to tailor treatments to fit the heterogenous clinical presentation of patients with SCI and to better understand the heterogeneity in clinical trajectories.

Pharmacokinetic/Pharmacodynamic Analysis of Extended/Two-Step Infusion Ceftazidime/Avibactam in Children With Gram-Negative Bacterial Infections

PURPOSE

To simulate the pharmacokinetic/pharmacodynamic (PK/PD) exposure of ceftazidime/avibactam (CZA) in children with gram-negative bacterial infections, and explore the appropriateness of the CZA standard dosing regimen (STD), further optimize the dosing regimen by extended/two-step infusion.

METHODS

Monte Carlo simulations were performed to calculate the probability of target attainment (PTA) and cumulative fraction of response (CFR) of CZA with varying weight in two age groups (≥6-12 and ≥12-18 years old, respectively), utilizing PK parameters and PD data (from the EUCAST as well as the published data on US children). The simulated dosing regimens included STD and extended/two-step infusion.

FINDINGS

When the PK/PD target for ceftazidime was set at 50% of time that free drug concentrations remain above the minimum inhibitory concentration of the pathogen during the dosing interval (50% fT > MIC), the CZA STD achieved PTAs of ≥90% at susceptibility breakpoint (MIC = 8 mg/L) for children in weighed 15-30 kg (≥6-12years old) and 35-45 kg (≥12-18 years old). However, when the PK/PD target for ceftazidime was set at 100% fT > MIC, none could achieve PTAs of ≥90%. The CFR results showed that the STD couldn't provide CFRs ≥90% in all children, but extended infusion or two-step infusion could achieve the target CFRs in all children based on the MIC distribution of US children, and improve the CFRs based on EUCAST's MIC distribution. Compared with extended infusion, two-step infusion could reduce total infusion time in partial patients.

IMPLICATIONS

The current STD of CZA may not adequately meet the therapeutic requirements in children, thus it is recommended to optimize the dosing regimen by extended/two-step infusion or increasing the daily dose, guided by therapeutic drug monitoring.