Correlation between the neutrophil-to-lymphocyte ratio and the 90-day all-cause mortality in patients with acute respiratory failure: a retrospective analysis based on the MIMIC-IV Database

INTRODUCTION

This study aims to examine the impact of the neutrophil-to-lymphocyte ratio (NLR) on 90-day all-cause mortality in individuals suffering from acute respiratory failure (ARF).

METHODS

Retrospectively including ARF patients from the MIMIC IV database, we classified them into the survivor and non-survivor cohorts according to their 90-day all-cause mortality rate. Demographic information, comorbidity, laboratory parameters, and other indices were collected.

RESULTS

A total of 3941 patients aged 65.0 years were enrolled in this. Multivariate COX regression analysis identified age(HR = 1.034, 95%CI:1.025-1.042,P < 0.001), history of chronic obstructive pulmonary disease(HR = 1.406, 95%CI:1.051-1.879,P = 0.022), history of hypertension(HR = 1.287, 95%CI:1.021-1.622,P = 0.032), history of type 2 diabetes mellitus(HR = 1.389, 95%CI:1.073-1.798,P = 0.013),history of coronary heart disease(HR = 2.138, 95%CI:1.639-2.788,P < 0.001), respiratory rate(HR = 1.043, 95%CI:1.026-1.01,P < 0.001), platelets (HR = 0.998, 95%CI: 0.997-0.999,P = 0.001), hemoglobin(HR = 0.859, 95%CI:0.820-0.901,P < 0.001), serum sodium (HR = 0.959, 95%CI:=0.041) and NLR(Q4, in comparison to Q1, HR = 1.627, 95%CI:1.167-2.268,P = 0.004) as independent predictors of the 90-day all-cause mortality rate. The relationship between NLR and mortality was observed to be non-linear(P-non-linear = 0.008) based on RCS curve analysis, with a threshold value of 12.8. A high NLR above this threshold was significantly associated with increased 90-day mortality rate after adjustment for covariates(HR = 1.535, 95%CI:1.196-1.968,P < 0.001).

CONCLUSION

The role of NLR as a risk factor in predicting 90-day all-cause mortality in ARF patients highlights its potential clinical usefulness in assessing patient prognosis.

A review on multiple sclerosis: Unravelling the complexities of pathogenesis, progression, mechanisms and therapeutic innovations

Multiple sclerosis (MS) is a chronic, inflammatory demyelinating disorder of the central nervous system (CNS) targeting myelinated axons. Pathogenesis of MS entails an intricate genetic, environmental, and immunological interaction. Dysregulation of immune response i.e. autoreactive T & B-Cells and macrophage infiltration into the CNS leads to inflammation, demyelination, and neurodegeneration. Disease progression of MS varies among individuals transitioning from one form of relapsing-remitting to secondary progressive MS (SPMS). Research advances have unfolded various molecular targets involved in MS from oxidative stress to blood-brain barrier (BBB) disruption. Different pathways are being targeted so far such as inflammatory and cytokine signaling pathways to overcome disease progression. Therapeutic innovations have significantly transformed the management of MS, especially the use of disease-modifying therapies (DMTs) to reduce relapse rates and control disease progression. Advancements in research, neuroprotective strategies, and remyelination strategies hold promising results in reversing CNS damage. Various mice models are being adopted for testing new entities in MS research.

Point Prevalence Survey of Antibiotic Use in Level 1 hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs

Introduction

The inappropriate prescribing and use of antibiotics have contributed to the emergence and spread of antimicrobial resistance (AMR). In Zambia, there is a paucity of information on the prescribing patterns and use of antibiotics among hospitalized patients in level 1 hospitals. This study investigated antibiotic use in five level 1 hospitals in Lusaka, Zambia.

Methods

This cross-sectional study utilized the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology among in-patients admitted in level 1 hospitals before 08:00 a.m. on the survey day in August 2024. Data were analysed using IBM SPSS version 23.0.

Results

The prevalence of antibiotic use among inpatients was 59.0%, with ceftriaxone being the most prescribed. Antibiotics were prescribed mainly for paediatrics and male inpatients. This study found that 53.0% of prescribed antibiotics were from the Access group while 38.2% were from the Watch group of the World Health Organization Access, Watch, and Reserve (AWaRe) classification. Adherence to national treatment guidelines was 36.0%, with most antibiotics prescribed empirically without evidence of culture and sensitivity tests.

Conclusion

This study found a high use of antibiotics and low adherence to treatment guidelines in level 1 hospitals in Lusaka, Zambia. The findings of this study demonstrate the need to establish and strengthen antimicrobial stewardship programs and strengthen laboratory capacity to aid clinicians in diagnosing, treating, and managing patients across level 1 hospitals in Zambia.

Fibromyalgia and Inflammation: Unrevealing the Connection

Fibromyalgia represents a chronic pain pathology characterized by severe musculoskeletal pain, fatigue, disturbances in sleep, and cognitive issues. Despite its presence, the underlying mechanisms of fibromyalgia remain inadequately understood; however, recent investigations have suggested that inflammation could play a fundamental role in the pathophysiology of this condition. Several studies highlight elevated concentrations of pro-inflammatory cytokines, dysregulation of immune responses, and neuroinflammation in fibromyalgia patients. Furthermore, chronic low-grade inflammation has been proposed as a potential catalyst for the sensitization of pain pathways, which exacerbates the symptoms of fibromyalgia. Understanding the role of inflammation in this disease might open new avenues for therapeutic interventions while providing a more profound insight into the complex nature of this debilitating disorder. Although progress has been made, further research is needed to uncover the complexities involved. This review investigates the intricate relationship between inflammation and fibromyalgia, analyzing the evidence that supports the involvement of both peripheral and central inflammatory processes in the onset and persistence of the disorder.

Tumour budding in invasive ductal breast carcinomas: correlation with clinicopathological prognostic parameters and hormone receptor status

Introduction

Breast cancer is a leading cause of morbidity and mortality among women. Advances in molecular biology have improved detection and treatment, but conventional histopathological factors remain crucial for prognosis. Tumour budding, defined as clusters of less than 5 tumour cells detached from the main tumour, has been linked to poor prognosis in several cancers. This study explores the association between intra-tumoral budding (ITB) and peripheral tumour budding (PTB) with known prognostic factors in Invasive Breast Carcinoma of no special type (IBC NST).

Materials and methods

This retrospective study analysed 70 cases of IBC NST diagnosed at Kasturba Medical College, Manipal, between January 2020 and December 2021. Tumour budding was classified as high-grade or low-grade based on density, which denotes the number of buds per x20 field. Clinicopathological data, including hormone receptor status, Ki-67 index, lymphovascular invasion (LVI), perineural invasion (PNI), and axillary lymph node involvement, were obtained. Statistical analyses were performed to identify a significant association between tumour budding and these factors. Univariate and multivariate logistic regression analyses were also done to demonstrate the significance of association.

Results

High-grade PTB showed significant associations with LVI (p = 0.046), PNI (p = 0.017), and axillary lymph node involvement (p = 0.021). In contrast, high-grade ITB was only significantly correlated with axillary lymph node involvement (p = 0.044). LVI (p-value = 0.240) and axillary lymph node involvement (p-value = 0.142) did not show any association with PTB on multivariate analysis and PNI (p-value = 0.074) near significant association with PTB). A significant inverse association was observed between PTB and Ki-67 (p = 0.012), which remained significant in univariate and multivariate analysis (p-value = 0.017). No significant associations were found between tumour budding and hormone receptor status or menopausal status.

Conclusion

Peripheral tumour budding (PTB) is significantly associated with several poor prognostic factors in IBC NST, while intra-tumoral budding (ITB) correlates primarily with axillary lymph node involvement. Tumor budding, particularly PTB, could serve as an important prognostic marker in breast cancer. Further research is needed to standardize tumour budding assessment in clinical practice.

Glioblastoma progression is hindered by melatonin-primed mesenchymal stromal cells through dynamic intracellular and extracellular reorganizations

Rationale: Glioblastoma (GBM) is the most fatal form of brain cancer and its treatment represents a persistent challenge. Mesenchymal stromal cells (MSCs) have been explored as therapeutic tools in cancer management owing to their tumor-homing abilities. However, their clinical application is limited due to the controversial role of MSCs in carcinogenesis. This study investigates how MSCs influence tumor behavior and explores the synergistic anticancer effects in combination with melatonin (Mel). Methods: Orthotopic and subcutaneous GBM xenograft mouse models were used to assess the antitumor effect of Mel pre-treated MSCs (MSCMel). Histological, immunohistochemical, and ultrastructural analyses were conducted to identify phenotypic changes in tumors. Through a set of in vitro assays, including direct and indirect co-cultures, dynamic single-cell tracking and tumorsphere assay, we explored the impact of MSCMel on primary and non-primary GBM cells. Transcriptomic profiling was used to identify genes and pathways modulated by this synergistic therapy. Results: MSCMel delayed tumor growth in mice and increased collagen deposition. Additionally, MSCMel showed enhanced capacity to prevent GBM cell migration compared to untreated MSCs. Molecular analysis identified genes and proteins related to cell migration, cytoskeletal dynamics and extracellular matrix remodeling in GBM cells exposed to MSCMel, including reduced vimentin expression. Finally, a genetic signature associated with the clinical outcomes of GBM patients was identified. Conclusions: Our study demonstrates that melatonin enhances the anticancer properties of MSCs, providing new insights into their interaction with GBM cells and tumor environment. These findings offer valuable guidance for advancing MSC-based therapies in clinical practice.

Ultrasound outcomes and surgical parameters of the double-layer purse-string uterine closure technique in cesarean delivery: a systematic review and meta-analysis of randomized trials

BACKGROUND

A cesarean scar defect is a structural abnormality in the myometrium at the site of a prior cesarean incision, primarily influenced by the closure technique. Purse-string uterine suturing (PSUS) may reduce the incidence of cesarean scar defects and improve uterine integrity. However, the literature presents inconsistent findings, necessitating a systematic evaluation. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of PSUS on ultrasound outcomes and surgical parameters related to cesarean scars.

METHODS

This systematic review and meta-analysis involved a search for relevant publications in English and Persian across multiple databases, including PubMed, the Cochrane Library, Google Scholar, Scopus, Web of Science, and SID. The search was unrestricted by date and included all available publications up to August 8, 2024. The risk of bias in the included studies was evaluated using the Risk of Bias 2 (ROB2) tool, while the certainty of the evidence was assessed through the GRADE approach. Meta-regression was employed to investigate potential risk factors for cesarean scar defects, and trial sequential analysis was conducted to mitigate Type I and Type II errors.

RESULTS

A total of 353 studies were identified through the search strategy, with 8 studies included in the analysis. The meta-analysis demonstrated a significant reduction in the rate of cesarean scar defects in the PSUS group compared to the control group (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.36 to 0.58; 8 trials, 751 participants, I² = 0%, indicating no heterogeneity). Additionally, a shorter uterine incision length was observed in the PSUS group compared to the control group (MD -3.84, 95% CI -4.97 to -2.71; 4 trials, 438 participants, I² = 80%, suggesting substantial heterogeneity). The PSUS group also exhibited greater residual myometrium thickness (RMT) than the control group (MD 1.33, 95% CI 0.72 to 1.94; 5 trials, 417 participants, I² = 92%, indicating considerable heterogeneity). However, no statistically significant differences were found between the PSUS and control groups regarding operation time (p = 0.10, I² = 67%, suggesting moderate heterogeneity), length (p = 0.14, I² = 98%, indicating considerable heterogeneity), height (p = 0.10, I² = 76%, suggesting substantial heterogeneity) of incision defects, or blood loss during the procedure (p = 0.94, I² = 0%, indicating no heterogeneity).

CONCLUSIONS

The use of PSUS during cesarean sections significantly reduces the occurrence of cesarean scar defects, indicating a clear clinical benefit with moderate certainty. However, the evidence for other ultrasound evaluation outcomes and surgical parameters remains of low to very low certainty. Therefore, further research is essential to validate these findings and assess the long-term clinical implications of integrating PSUS into cesarean procedures.

Hypothalamus-pituitary-adrenal and gut-brain axes in biological interaction pathway of the depression

The hypothalamus-pituitary-adrenal (HPA) and gut-brain axes are vital biological pathways in depression. The HPA axis regulates the body's stress response, and chronic stress can lead to overactivation of the HPA axis, resulting in elevated cortisol levels that contribute to neuronal damage, particularly in regions such as the hippocampus and prefrontal cortex, both of which are involved in mood regulation and mental disorders. In parallel, the gut-brain axis, a bidirectional communication network between the gut microbiota and the central nervous system, influences emotional and cognitive functions. Imbalances in gut microbiota can affect the HPA axis, promoting inflammation and increasing gut permeability. This allows endotoxins to enter the bloodstream, contributing to neuroinflammation and altering neurotransmitter production, including serotonin. Since the majority of serotonin is produced in the gut, disruptions in this pathway may be linked to depressive symptoms. This review explores the interplay between the HPA axis and the gut-brain axis in the context of depression.

Malícia honey (Mimosa quadrivalvis L.) produced by the jandaíra bee (Melipona subnitida D.) shows antioxidant activity via phenolic compound action in obese rats

Background and aims

Obesity is a disease associated with increased oxidative stress in humans and animals, and consumption of antioxidant compounds such as polyphenols can minimise it. These compounds are abundant in malícia (Mimosa quadrivalvis L.) honey produced by stingless bees. This study aimed to evaluate whether administration of Mimosa quadrivalvis L. honey to obese rats could reduce oxidative stress in vital organs through phenolic compound action.

Methods

Wistar rats (228 ± 14.69 g) were randomly divided into two groups: a healthy group (HG, n = 20) fed a control diet and an obese group (OG, n = 20) fed a cafeteria diet for the initial 8 weeks. After this period, these groups were again randomised into four subgroups: healthy (HG, n = 10), obese (OG, n = 10), healthy with malícia honey administration (1,000 mg/kg; HGH, n = 10), and obese with malícia honey administration (1,000 mg/kg; OGH, n = 10) for the final 8 weeks fed the previously mentioned diets. The rats were euthanised at the end of the experiment to collect brain, gut, kidney, and liver tissues to evaluate parameters related to oxidative stress and phenolic profile.

Results

The administration of malícia honey reduced energy intake and weight gain in the OGH in comparison to the OG. Total antioxidant capacity increased in the brain, liver, and gut in both groups treated with honey compared to respective controls. Lipid peroxidation decreased in the brain, gut, and kidney of the OGH. Both treated groups showed elevated phenolic compound deposition, including catechin, procyanidins, and flavonoids, across all organs. Specifically, the brain in the OGH showed greater procyanidin B2 and gallic acid deposition; the liver showed increased procyanidin B1 and B2, epicatechin, and myricetin concentrations; the gut showed higher procyanidin B2 and kaempferol 3-glucoside concentrations; and the kidneys had increased catechin, procyanidin B1 and B2, and gallic acid deposition compared to the OG.

Conclusion

Histologically, the OGH displayed reduced neuronal damage and prevention of hepatic steatosis induced by the cafeteria diet. Malícia honey effectively reduced oxidative stress via modulation of phenolic compounds in the brain, gut, kidney, and liver of cafeteria diet-induced obese rats.

Update on the Study of Angiogenesis in Surgical Wounds in Patients with Childhood Obesity

Background: Angiogenesis, the formation of new blood vessels from pre-existing ones, plays a pivotal role in wound healing, particularly in surgical contexts. Methods and results: However, this process can be significantly impaired in patients with childhood obesity, resulting in delayed healing and additional complications. The biological process of wound healing is complex, involving angiogenesis, cell proliferation, inflammation, and tissue remodeling. This review aims to explore recent advancements in research on angiogenesis in surgical wounds in patients with childhood obesity, with a focus on growth factors, inflammation, microcirculation, and innovative therapeutic strategies. Conclusions: It highlights therapeutic approaches such as the administration of growth factors and the application of biomaterials to enhance angiogenesis.

Antibiotic use at the Centre Hospitalier Universitaire de Zone d'Abomey Calavi/Sô-Ava (CHUZ/AS) in Benin: a point prevalence survey

Background

Antimicrobial stewardship promotes the appropriate use of antibiotics to prevent the emergence and spread of antimicrobial resistance. This study evaluated the use of antibiotics using a point prevalence survey at the Centre Hospitalier Universitaire de Zone d'Abomey Calavi/Sô-Ava (CHUZ/AS) in Benin.

Methods

This cross-sectional study utilized the WHO point prevalence survey methodology for monitoring antibiotic use among inpatients in hospitals. The survey was conducted from 11 January 2022 to 19 January 2022 among hospitalized patients before 8:00 a.m. on the day of the survey.

Results

Of the 111 inpatient medical files reviewed, the prevalence of antibiotic use was 82.9%. The number of antibiotics received per patient ranged from 1 to 5, with a mean of 2.45 ± 1.11 and a median of 2. The most commonly prescribed class of antibiotics was beta-lactams (46.7%), aminoglycosides (20.6%) and nitroimidazoles (19.7%). According to the WHO AWaRe classification, 30.4% of inpatients received the Access group of antibiotics and 44% received a combination of Access and Watch group antibiotics; treatment was empiric in 94.5% of encounters. Only 22.7% of patients were treated based on microbiological examination/culture and sensitivity testing.

Conclusions

This study found a high prevalence of antibiotic use among inpatients at the CHUZ/AS Tertiary Care Hospital in Benin. The most prescribed antibiotics were ampicillin, metronidazole and ceftriaxone. Consequently, the study found a low use of culture and sensitivity testing to guide treatment, particularly in the paediatric and surgical population, and the preference for broad-spectrum antibiotics suggests that antibiotic use at the CHUZ/AS Tertiary Care is not optimal. Therefore, antimicrobial stewardship programmes, policies and guidelines must be instigated and strengthened to address these gaps and promote rational use of antibiotics.

An Indirect Treatment Comparison of Lenvatinib for the First-Line Treatment of Patients with Unresectable Hepatocellular Carcinoma

INTRODUCTION

This study compared the relative efficacy of first-line lenvatinib, a standard-of-care treatment for unresectable hepatocellular carcinoma (uHCC), vs licensed/license in-progress comparators. Using inverse probability of treatment weighting (IPTW) and network meta-analysis (NMA), updated evidence for lenvatinib monotherapy from LEAP-002, in addition to evidence from REFLECT, was included in the analyses.

METHODS

Randomized controlled trials (RCTs) were identified via systematic review. REFLECT and LEAP-002 investigated lenvatinib in uHCC, with patient-level data available for each; however, only REFLECT included a comparator arm of interest (sorafenib). The lenvatinib arm from LEAP-002 was adjusted to match aggregate data for confounding factors from REFLECT using IPTW. Weighted Cox regressions, including matching variables as covariates, were used to derive hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS). These HR estimates were included in Bayesian NMAs to compare lenvatinib with comparators; survival was significantly improved if the 95% credible interval for the HR did not include 1.0. Scenario analyses explored alternative choices for IPTW estimators.

RESULTS

Eight RCTs (including REFLECT) and the single-arm adjusted lenvatinib data from LEAP-002 were included in the NMA base case. Lenvatinib demonstrated significant improvement in OS compared with sorafenib 400 mg twice daily (BID) and significant improvement in PFS compared with sorafenib 400 mg BID, tremelimumab 300 mg plus durvalumab 1500 mg every 4 weeks (Q4W), and durvalumab 1500 mg Q4W.

CONCLUSIONS

These results suggest that patients with uHCC treated with lenvatinib have similar or significantly improved OS and PFS compared with licensed/license in-progress therapies.

Reducing Dietary Branched-Chain Amino Acids Intake Alleviates High-Fat Diet-Induced Pain Sensitization and Postoperative Pain in Male Mice

BACKGROUND

Poor dietary intake is associated with peripheral pain sensitization and postoperative pain. Given the limited research on diet and pain, it is essential to examine the possible analgesic effects of dietary interventions in preclinical studies.

OBJECTIVES

This study aimed to elucidate the role of high-fat diet (HFD) on pain sensitivity and postoperative pain, and determine the potential effects of modulating branched-chain amino acids (BCAA) intake on pain phenotypes.

METHODS

Four-week-old male mice were fed a purified control diet (CD) or HFD for 10 wk, followed by a hind paw incision. Four-week-old male mice were initially fed a CD or HFD for 8 wk, then switched to the high or low BCAA diet, and underwent a hind paw incision at 10 wk of these diets. Pain behaviors were assessed. Several proinflammatory genes in the lumbar dorsal root ganglion (DRG) were detected by quantitative polymerase chain reaction. Immunohistochemistry was used to estimate nerve fiber density at the incision site. Two-tailed unpaired Student's t-test, 2-way repeated-measures analysis of variance (ANOVA) with Bonferroni posttests, and 1-way ANOVA with Tukey's multiple comparisons test were used for data analysis.

RESULTS

HFD consumption induced pain sensitization and worsened postoperative pain in male mice (P < 0.0001). In CD group, mice switching to high or low BCAA diet displayed minor impacts on pain phenotypes. In HFD mice, switching to high BCAA diet exacerbated hyperalgesia and postsurgical pain (P < 0.05), leading to proinflammatory responses in the DRG and the reduction of nerve fiber density near the incision site on day 3 postsurgery (P < 0.05); whereas low BCAA diet intake alleviated these effects (P < 0.05).

CONCLUSIONS

High BCAA intake has negative impacts on pain sensitivity and postoperative pain in HFD-fed mice. Reducing dietary BCAA may be a novel nonpharmacological therapeutic to relieve pain in individuals on a conventional HFD.

Melatonin for gastric cancer treatment: where do we stand?

Gastric cancer (GC) is the third leading reason of death in men and the fourth in women. Studies have documented an inhibitory function of melatonin on the proliferation, progression and invasion of GC cells. MicroRNAs (miRNAs) are small, non-coding RNAs that play an important function in regulation of biological processes and gene expression of the cells. Some studies reported that melatonin can suppress the progression of GC by regulating the exosomal miRNAs. Thus, melatonin represents a promising potential therapeutic agent for subjects with GC. Herein, we evaluate the existing data of both in vivo and in vitro studies to clarify the molecular processes involved in the therapeutic effects of melatonin in GC. The data emphasize the critical function of melatonin in several signaling ways by which it may inhibit cancer cell proliferation, decrease chemo-resistance, induce apoptosis as well as limit invasion, angiogenesis, and metastasis. This review provides a resource that identifies some of the mechanisms by which melatonin controls GC enlargement. In light of the findings, melatonin should be considered a novel and testable therapeutic mediator for GC treatment.

A systematic review of cell therapy modalities and outcomes in cerebral palsy

Cerebral palsy is widely recognized as a condition that results in significant physical and cognitive disabilities. Interventions aim to improve the quality of life and reduce disability. Despite numerous treatments and significant advancements, cerebral palsy remains incurable due to its diverse origins. This review evaluated clinical trials, studies, and case reports on various cell therapy approaches for cerebral palsy. It assessed the clinical outcomes of applying different cell types, including mesenchymal stem cells, olfactory ensheathing cells, neural stem/progenitor cells, macrophages, and mononuclear cells derived from peripheral blood, cord blood, and bone marrow. In 60 studies involving 1474 CP patients, six major adverse events (0.41%) and 485 mild adverse events (32.9%) were reported. Favorable therapeutic effects were observed in 54 out of 60 cell therapy trials, indicating a promising potential for cell treatments in cerebral palsy. Intrathecal MSC and BM-MNC applications revealed therapeutic benefits, with MSC studies being generally safer than other cell therapies. However, MSC and BM-MNC trials have shown inconsistent results, with some demonstrating superior efficacy for certain outcomes. Cell dosage, transplantation route, and frequency of administration can affect the efficacy of these therapies. Our findings highlight the promise of cell therapies for improving cerebral palsy treatment and stress the need for ongoing research to refine treatment protocols and enhance safety. To establish conclusive evidence on the comparative effectiveness of various cell types in treating cerebral palsy, randomized, double-blind clinical trials are essential.

Evaluation of Drug Permeation Enhancement by Using In Vitro and Ex Vivo Models

Drugs administered by means of extravascular routes of drug administration must be absorbed into the systemic circulation, which involves the movement of the drug molecules across biological barriers such as epithelial cells that cover mucosal surfaces or the stratum corneum that covers the skin. Some drugs exhibit poor permeation across biological membranes or may experience excessive degradation during first-pass metabolism, which tends to limit their bioavailability. Various strategies have been used to improve drug bioavailability. Absorption enhancement strategies include the co-administration of chemical permeation enhancers, enzymes, and/or efflux transporter inhibitors, chemical changes, and specialized dosage form designs. Models with physiological relevance are needed to evaluate the efficacy of drug absorption enhancement techniques. Various in vitro cell culture models and ex vivo tissue models have been explored to evaluate and quantify the effectiveness of drug permeation enhancement strategies. This review deliberates on the use of in vitro and ex vivo models for the evaluation of drug permeation enhancement strategies for selected extravascular drug administration routes including the nasal, oromucosal, pulmonary, oral, rectal, and transdermal routes of drug administration.

Development and validation of a nomogram for predicting immune-mediated colitis in lung cancer patients treated with immune checkpoint inhibitors: a retrospective cohort study in China

Background

The increasing utilization of immune checkpoint inhibitors (ICIs) has led to a concomitant rise in the incidence of immune-related adverse events (irAEs), notably immune-mediated colitis (IMC). This study aimed to identify the clinical risk factors associated with IMC development in patients with lung cancer and to develop a risk prediction model to facilitate personalized treatment and care strategies.

Methods

The data collected included 21 variables, including sociodemographic characteristics, cancer-related factors, and routine blood markers. The dataset was randomly partitioned into a training set (70%) and a validation set (30%). Univariate and multivariate logistic regression analyses were conducted to identify independent predictors of IMC development. On the basis of the results of the multivariate analysis, a nomogram prediction model was developed. Model performance was assessed via the area under the receiver operating characteristic curve (AUC), calibration curve analysis, decision curve analysis (DCA), and clinical impact curve (CIC).

Results

Among the 2103 patients, 66 (3.14%) developed IMCs. Multivariate logistic regression analysis revealed female sex, small cell lung cancer (SCLC), elevated β2 microglobulin (β2-MG) and globulin (GLB) levels, and an increased neutrophil-lymphocyte ratio (NLR) as independent predictors of IMC development (all P < 0.05). Conversely, a higher white blood cell (WBC) count, CD4/CD8 ratio, and platelet-lymphocyte ratio (PLR) were identified as factors associated with a reduced risk of IMC development (all P < 0.05). The nomogram prediction model demonstrated good discrimination, achieving an AUC of 0.830 (95% CI: 0.774-0.887) in the training set and 0.827 (95% CI: 0.709-0.944) in the validation set. Analysis of the calibration curve, DCA, and CIC indicated good predictive accuracy and clinical utility of the developed model.

Conclusion

This study identified eight independent predictors of IMC development in patients with lung cancer and subsequently developed a nomogram-based prediction model to assess IMC risk. Utilization of this model has the potential to assist clinicians in implementing appropriate preventive and therapeutic strategies, ultimately contributing to a reduction in the incidence of IMC among this patient population.

Wnt Pathway-Targeted Therapy in Gastrointestinal Cancers: Integrating Benchside Insights with Bedside Applications

The Wnt signaling pathway is critical in the onset and progression of gastrointestinal (GI) cancers. Anomalies in this pathway, often stemming from mutations in critical components such as adenomatous polyposis coli (APC) or β-catenin, lead to uncontrolled cell proliferation and survival. In the case of colorectal cancer, dysregulation of the Wnt pathway drives tumor initiation and growth. Similarly, aberrant Wnt signaling contributes to tumor development, metastasis, and resistance to therapy in other GI cancers, such as gastric, pancreatic, and hepatocellular carcinomas. Targeting the Wnt pathway or its downstream effectors has emerged as a promising therapeutic strategy for combating these highly aggressive GI malignancies. Here, we review the dysregulation of the Wnt signaling pathway in the pathogenesis of GI cancers and further explore the therapeutic potential of targeting the various components of the Wnt pathway. Furthermore, we summarize and integrate the preclinical evidence supporting the therapeutic efficacy of potent Wnt pathway inhibitors with completed and ongoing clinical trials in GI cancers. Additionally, we discuss the challenges of Wnt pathway-targeted therapies in GI cancers to overcome these concerns for effective clinical translation.

Assessment of Inflammatory and Oxidative Stress Biomarkers for Predicting of Patients with Asymptomatic Carotid Artery Stenosis

Background/Objectives: Asymptomatic carotid artery stenosis is usually detected by physicians in patients, coincidentally, during an ultrasound examination of the neck. Therefore, measurable biomarkers in blood are needed to define the presence and severity of atherosclerotic plaque in patients to identify and manage it. We hypothesized that biomarkers that indicate pathways related to the pathogenesis of atherosclerosis could be used to identify the presence and severity of atherosclerotic plaque. For this purpose, the levels of participants' inflammatory and oxidative stress biomarkers were determined. Kynurenine/tryptophan and neopterin levels were measured as relatively new biomarkers of inflammation in this study. Methods: Our study included 57 patients diagnosed with asymptomatic carotid artery stenosis and 28 healthy volunteers. Blood kynurenine and tryptophan levels were measured with LCMS/MS. Blood catalase, total superoxide dismutase (t-SOD), glutathione peroxidase (GPx), malondialdehyde, and neopterin levels were measured using the ELISA assay method. Result: The kynurenine/tryptophan ratio reflecting IDO activity was higher in patients than in healthy volunteers. Decreased tryptophan levels and increased kynurenine and neopterin levels were observed in patients who underwent carotid endarterectomy. In patients, catalase, t-SOD, and malondialdehyde levels were higher, while GPx activity was lower. These differences were found to be more significant in patients who underwent carotid endarterectomy. Conclusions: Increased kynurenine/tryptophan ratio and neopterin levels in patients with asymptomatic carotid artery stenosis were associated with the inflammatory status of the patients. Oxidative stress and inflammatory biomarkers can be considered effective diagnostic and severity indicators for asymptomatic carotid artery stenosis.

Preeclampsia as a Study Model for Aging: The Klotho Gene Paradigm

Aging and pregnancy are often considered opposites in a woman's biological timeline. Aging is defined by a gradual decline in the functional capabilities of an organism over its lifetime, while pregnancy is characterized by the presence of the transient placenta, which fosters the cellular fitness necessary to support fetal growth. However, in the context of preeclampsia, pregnancy and aging share common hallmarks, including clinical complications, altered cellular phenotypes, and heightened oxidative stress. Furthermore, women with pregnancies complicated by preeclampsia tend to experience age-related disorders earlier than those with healthy pregnancies. Klotho, a gene discovered fortuitously in 1997 by researchers studying aging mechanisms, is primarily expressed in the kidneys but also to a lesser extent in several other tissues, including the placenta. The Klotho protein is a membrane-bound protein that, upon cleavage by ADAM10/17, is released into the circulation as soluble Klotho (sKlotho) where it plays a role in modulating oxidative stress. This review focuses on the involvement of sKlotho in the development of preeclampsia and age-related disorders, as well as the expression of the recently discovered Mytho gene, which has been associated with skeletal muscle atrophy.

EFNet: estimation of left ventricular ejection fraction from cardiac ultrasound videos using deep learning

The ejection fraction (EF) is a vital metric for assessing cardiovascular function through cardiac ultrasound. Manual evaluation is time-consuming and exhibits high variability among observers. Deep-learning techniques offer precise and autonomous EF predictions, yet these methods often lack explainability. Accurate heart failure prediction using cardiac ultrasound is challenging due to operator dependency and inconsistent video quality, resulting in significant interobserver variability. To address this, we developed a method integrating convolutional neural networks (CNN) and transformer models for direct EF estimation from ultrasound video scans. This article introduces a Residual Transformer Module (RTM) that extends a 3D ResNet-based network to analyze (2D + t) spatiotemporal cardiac ultrasound video scans. The proposed method, EFNet, utilizes cardiac ultrasound video images for end-to-end EF value prediction. Performance evaluation on the EchoNet-Dynamic dataset yielded a mean absolute error (MAE) of 3.7 and an R2 score of 0.82. Experimental results demonstrate that EFNet outperforms state-of-the-art techniques, providing accurate EF predictions.

Nanoparticles for the Delivery of Pro-regenerative Cardiac Progenitor Secretory Proteins Targeting Cellular Senescence and Vasculogenesis

Contemporary therapies following heart failure center on regenerative approaches to account for the loss of cardiomyocytes and limited regenerative capacity of the adult heart. While the delivery of cardiac progenitor cells has been shown to improve cardiac function and repair following injury, recent evidence has suggested that their paracrine effects (or secretome) provides a significant contribution towards modulating regeneration, rather than the progenitor cells intrinsically. The direct delivery of secretory biomolecules, however, remains a challenge due to their lack of stability and tissue retention, limiting their prolonged therapeutic efficacy. We hypothesized that polyurethane-based nanoparticles with heteropolar-hydrophobic-ionic chemistry (DPHI-NPs) could enable the delivery of a subset of pro-regenerative cardiac progenitor cell proteins [bone morphogenetic protein-4 (BMP-4) and angiotensin 1-7 (Ang1-7)] to promote biological pathways conducive to repair processes such as antisenescence (through the quantification of β-galactosidase and interleukin-6) and vasculogenesis (through the formation of endothelial tubes), demonstrated in vitro with human cardiac fibroblasts (hCFs) and human microvascular endothelial cells (hMECs), respectively. DPHI-NPs with a diameter of 190 ± 2 nm (polydispersity index < 0.2) and a zeta potential of -40 ± 1 mV were generated using an emulsion inversion technique and loaded with both therapeutic proteins (BMP-4 and Ang1-7) by optimizing surface charge, loading solution concentration, coating duration, and coating efficiency. Senescence-induced hCFs treated with functionalized DPHI-NPs were found to exhibit a significant reduction in expressed β-galactosidase and IL-6 (p < 0.05). Additionally, hMECs treated with NPBMP-4 were found to display enhanced vasculogenesis compared to control culture conditions alone (p < 0.05). The development of a DPHI-NP vector for the delivery of pro-regenerative secretome biomolecules may present an effective translatable strategy to improve their therapeutic efficacy with respect to cell function.

Kindlin-1 promotes gastric cancer cell motility through the Wnt/β-catenin signaling pathway

Despite advances in gastric cancer diagnosis and treatment, its prognosis remains poor owing to aggressive tumor progression and metastasis. As understanding the relevant molecular mechanisms is essential to effectively improve patient outcomes, we elucidated the role of Kindlin-1 in gastric cancer progression and metastasis. Kindlin-1 expression was analyzed in 359 gastric cancer tissue samples provided by Kangnam Sacred Heart Hospital and publicly available GSE datasets. Kindlin-1 showed significantly higher expression in gastric cancer tissues than that in normal tissues, and high Kindlin-1 expression was associated with poor prognosis. Further, the mRNA and protein expression of Kindlin-1 were high in gastric cancer cell lines, where they were associated with increased proliferation, migration, and invasion. Our findings demonstrated that Kindlin-1 regulated epithelial-mesenchymal transition-related genes through interaction with activated Wnt/β-catenin signaling. Notably, Kindlin-1 enhanced β-catenin expression and promoted its nuclear translocation from the cytoplasm, increasing TCF4 transcriptional activity and inducing gastric cancer progression and metastasis. Overall, these findings demonstrate that Kindlin-1 is upregulated in gastric cancer and activates Wnt/β-catenin signaling to promote cell proliferation and motility.

A humanised thrombus-on-a-chip model utilising tissue-engineered arterial constructs: A method to reduce and replace mice used in thrombosis and haemostasis research

The study of in vivo thrombus formation has principally been performed using intravital microscopy in mice and other species. These have allowed us to visualise the molecular and cellular processes that regulate thrombus formation inside the body. However current in vivo arterial thrombosis models are difficult to standardise between labs and frequently produce results that do not reliably translate successfully in human clinical trials. Here we provide a step-by-step description with accompanying video tutorials to demonstrate how to produce a 3D humanised thrombus-on-a-chip model, which uses perfusion of fluorescently-labelled human blood over a mechanically-injured human tissue engineered arterial construct (TEAC) within a 3D printed microfluidic flow chamber to replicate thrombus formation within a healthy artery. We also provide a written methodology on how to use 3D printing to produce a mechanical injury press that can reproducibly damage the TEAC as a stimulus for thrombus formation as part of a mechanical injury model. Perfusion of the uninjured TEAC with whole human blood containing DiOC6-labelled platelets without initiating notable thrombus formation. The mechanical injury press was shown to induce a reproducible puncture wound in the TEAC. Fluorescence microscopy was used to demonstrate that thrombus formation could be observed reproducibly around sites of injury. This humanised thrombosis-on-a-chip model can replace the use of animals in in vivo thrombosis models for preclinical assessment of anti-thrombotic therapies. This method also offers multiple scientific advantages: allowing new drugs to be directly tested on human blood from a diverse array of donors, facilitating use of a realistic and reproducible injury modality as well as removing the potential confounding effects of general anaesthetics in animal studies. The use of human thrombus-on-a-chip models combining TEACs offers a new methodology to reduce animal use whilst improving the predictive capabilities of preclinical trials of anti-thrombotic therapies.

Muscle parameters in men and oxidative stress markers

BACKGROUND

The oxidative handicap hypothesis posits that testosterone-dependent traits, such as muscle mass and strength, may be costly to develop due to testosterone's pro-oxidative properties, leading to increased oxidative stress. This hypothesis suggests that only individuals with superior biological conditions can afford these costs. This study examines the oxidative handicap hypothesis, exploring the relationship between muscle mass or handgrip strength and oxidative stress markers in men.

METHODS

Handgrip strength and muscle mass were measured in 179 men, with muscle mass assessed using bioelectrical impedance analysis (BIA) and handgrip strength measured using a hydraulic dynamometer. Serum testosterone levels and antioxidant capacity were measured. 8-OH-dG, 8-epi-PGF2α, and protein carbonyls were measured to evaluate oxidative stress level. Pearson's correlation and multivariate regression analyses were performed to examine the relationships between handgrip strength, muscle mass, and oxidative stress markers, controlling for age, serum testosterone levels, and antioxidant capacity.

RESULTS

No significant correlations were found between handgrip strength and oxidative stress markers, even when controlling for muscle mass, antioxidant capacity, testosterone levels, and age.

CONCLUSIONS

The study's findings do not support the oxidative handicap hypothesis in the context of muscle parameters in men. The results suggest that testosterone-driven traits like handgrip strength or muscle mass may not necessarily incur oxidative stress costs in healthy young men, possibly due to effective compensatory antioxidant mechanisms. Factors like lifestyle, diet, and genetic predisposition, which were not controlled in this study, could also influence the observed outcomes and should be included in future research.

Nonlinear association between red cell distribution width/albumin ratio and peripheral arterial disease in the NHANES: a cross-section study with propensity score matching analysis

Background

Peripheral arterial disease (PAD) is a prevalent cardiovascular condition that affects up to 200 million people globally, and has significant implications for morbidity and mortality. Recent studies have identified the red cell distribution width-to-albumin ratio (RDW/ALB) as a potential systemic inflammatory marker that is correlated with several cardiovascular and inflammatory diseases including PAD. However, the comprehensive role of RDW/ALB in PAD remains underexplored. The objective of this study was to elucidate the relationship between RDW/ALB and PAD and to provide novel insights into the prevention and treatment of PAD.

Methods

This retrospective cross-sectional study leveraged data from the NHANES data (1999-2004) identifying PAD using ankle-brachial index measurements (<0.90). The association with PAD was assessed using multivariable logistic regression, complemented by a restricted cubic spline for nonlinearity, and propensity score methods for robustness checks, including propensity score matching and subgroup analyses.

Results

This study included 6,421 participants, 452 of whom had PAD. The mean age was 70.1 years; the patients were predominantly male. After adjustment, the RDW/ALB ratio showed a significant association with PAD (OR 1.71, 95% CI 1.29-2.26, p < 0.001). After quartiles of RDW/ALB, the risk of PAD was determined to be 2.03 (95% CI 1.31-3.14) in the Q4 group compared with the Q1 group in the adjusted complete model. The restricted sample cubic spline of RDW/ALB and risk of developing PAD demonstrated a nonlinear relationship. The risk of PAD increased considerably with higher RDW/ALB ratios less than 4.08. Subgroup and PSM analyses underscored the consistency of these findings.

Conclusions

The study demonstrated a significant association between RDW/ALB and PAD, with a nonlinear relationship and a threshold effect. Further prospective clinical research is required to validate the relationship between the RDW/ALB ratio and PAD.

Artificial Intelligence and Neuroscience: Transformative Synergies in Brain Research and Clinical Applications

The convergence of Artificial Intelligence (AI) and neuroscience is redefining our understanding of the brain, unlocking new possibilities in research, diagnosis, and therapy. This review explores how AI's cutting-edge algorithms-ranging from deep learning to neuromorphic computing-are revolutionizing neuroscience by enabling the analysis of complex neural datasets, from neuroimaging and electrophysiology to genomic profiling. These advancements are transforming the early detection of neurological disorders, enhancing brain-computer interfaces, and driving personalized medicine, paving the way for more precise and adaptive treatments. Beyond applications, neuroscience itself has inspired AI innovations, with neural architectures and brain-like processes shaping advances in learning algorithms and explainable models. This bidirectional exchange has fueled breakthroughs such as dynamic connectivity mapping, real-time neural decoding, and closed-loop brain-computer systems that adaptively respond to neural states. However, challenges persist, including issues of data integration, ethical considerations, and the "black-box" nature of many AI systems, underscoring the need for transparent, equitable, and interdisciplinary approaches. By synthesizing the latest breakthroughs and identifying future opportunities, this review charts a path forward for the integration of AI and neuroscience. From harnessing multimodal data to enabling cognitive augmentation, the fusion of these fields is not just transforming brain science, it is reimagining human potential. This partnership promises a future where the mysteries of the brain are unlocked, offering unprecedented advancements in healthcare, technology, and beyond.

Treatment of gingival recession with vestibular incision subperiosteal tunnel access and advanced platelet-rich fibrin

OBJECTIVES

The current literature about the effect of advanced platelet rich fibrin(A-PRF) with vestibular incision subperiosteal tunnel access (VISTA) technique in treating gingival recession is scarce. Therefore, the aim of the current randomized clinical trial is to evaluate the effect of A-PRF with VISTA technique in the treatment of Cairo class 1 gingival recession (RT1).

METHODS

Twenty-four patients who met the eligibility criteria were randomly allocated into two groups. VISTA + A-PRF was the treatment of the study group, while VISTA + collagen matrix was performed for the control group. The clinical outcomes were assessed by a single-blind assessor at baseline, three months, and six months. They were divided into primary and secondary outcomes. The primary outcomes included recession depth (RD), recession width (RW), gingival thickness (GT), mean of root coverage % (MRC%), and width of attached gingiva (WAG) while the secondary outcome included clinical attachment level (CAL).

RESULTS

The primary outcomes analysis demonstrated statistically significant improvements in RD, RW, MRC%, GT, and WAG after 3 and 6 months in both groups (p < 0.001). However, the study group demonstrated a significantly greater improvement than the control group in RD, RW, and MRC%. No significant differences were observed between the two groups regarding GT and WAG.

CONCLUSIONS

Both treatment approaches were effective in the treating of RT1 adjacent gingival recessions. A-PRF showed promising results compared to collagen matrix.

TRIAL REGISTRATION

The current randomized clinical trial was registered at ClinicalTrials.gov (Registration number: NCT06357351) and it was released on 10/04/2024.

Photopsias are associated with greater levels of depression and anxiety

CLINICAL RELEVANCE

Vitreous floaters have been associated with depressive and anxiety symptoms. However, there is a scarcity in the literature regarding the possible impact of vitreous flashes on the psychological status of the patients.

BACKGROUND

Photopsias and vitreous floaters frequently co-exist. Floaters have been accompanied by exacerbated levels of depression and anxiety. The aim of this study was to examine whether the presence of photopsias in patients suffering from vitreous floaters is accompanied by exacerbated levels of anxiety and depression.

METHODS

One hundred and four patients complaining of floaters were included in the study; 51 experienced also photopsias and 53 did not. A comprehensive ocular examination, including funduscopy and optical coherence tomography scans was performed to every patient, while their clinical and demographic data were also assessed. Every participant completed the PHQ-9, the Zung SDS, and the HADS anxiety and depression questionnaires.

RESULTS

The clinical and demographic data did not differ significantly between the study groups (p > 0.05).The scores of every questionnaire were significantly higher among the patients with vitreous flashes (p < 0.05 for all). After adjustment for several confounders, the values remained significantly impaired.

CONCLUSION

Photopsias negatively affect the psychological and mental well-being of the patients, by the terms of amplified levels of depression and anxiety. These findings underscore the necessity for a more holistic approach to managing patients presenting with vitreous flashes.

Anal Cancer Screening: 10-Year Experience of a Specialized Outpatient Clinic

In 2012, the Department of Visceral Surgery of the Lausanne University Hospital CHUV implemented a dedicated high-resolution anoscopy (HRA) outpatient clinic for surveillance and follow-up purposes. This 10-year longitudinal study analyzed 537 patients (2214 visits) using a structured screening protocol. Dysplastic lesions were detected in 49% of patients, predominantly low-grade squamous intraepithelial lesions (LSILs, 74%). Among LSIL cases, 6% progressed to high-grade squamous intraepithelial lesions (HSILs) within 24 months, reaching 25% cumulative progression at 36 months. Of HSIL patients, 3% developed carcinoma in situ after 48 months. Notably, no invasive carcinoma was observed during the follow-up. Four patients diagnosed with squamous cell carcinoma at initial screening were treated with chemoradiotherapy, and one required salvage surgery. Independent risk factors for the presence of higher-stage precancerous lesions (≥HSILs) were the presence of high-risk HPV genotypes (OR 14.5, 95% CI 5-42.2, p < 0.001), detectable HIV viral load (OR 5.4, 95% CI 1.8-16.7, p = 0.003), and symptoms at the first screening visit (OR 3.2, 95% CI 1.1-9.9, p = 0.04). HIV-positive status was associated with a trend towards an increased risk of progression (OR 2.79, p = 0.073). These findings highlight the importance of systematic follow-up and early intervention in high-risk populations to prevent anal cancer progression.

Sarcopenia and myosteatosis are associated with low survival in patients receiving lenvatinib for unresectable hepatocellular carcinoma

PURPOSE

To investigate the association of skeletal muscle mass and quality with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib (LEN).

METHODS

In this retrospective study, LEN-treated patients with HCC were enrolled. Sarcopenia and myosteatosis were evaluated on the basis of baseline skeletal muscle index and mean muscle attenuation, respectively, on computed tomography at the L3 level. Low skeletal muscle mass (LSMM) was determined on the basis of index value, and bioinformatics tools were used to determine reliable cutoff values. Myosteatosis was defined on the basis of mean Hounsfield unit values and predefined cutoff values. A logrank test and Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS).

RESULTS

A total of 81 patients were included. Patients with LSMM exhibited significantly lower PFS (p = 0.003) and OS (p = 0.010) than did patients without LSMM. Patients with myosteatosis exhibited significantly lower PFS (p = 0.012) and OS (p < 0.001) than did patients without myosteatosis. In multivariate analysis adjusted for tumor extent and liver function reserve, LSMM and myosteatosis remained independent predictors of low PFS (p = 0.028, p = 0.031) and OS (p = 0.027, p = 0.001), respectively.

CONCLUSION

LSMM and myosteatosis are independent prognostic factors for PFS and OS in advanced patients with HCC who received LEN and may exert synergistic effects on these survival outcomes.

Comprehensive analysis of the prognostic, immunological, and diagnostic roles of SIRT1 in pan-cancer and its validation in KIRC

Background

Disturbances in DNA damage repair may lead to cancer. SIRT1, an NAD+-dependent deacetylase, plays a crucial role in maintaining cellular homeostasis through the regulation of processes such as histone posttranslational modifications, DNA repair, and cellular metabolism. However, a comprehensive exploration of SIRT1's involvement in pan-cancer remains lacking. Our study aimed to analyze the role of SIRT1 in pan-cancer to gain a more comprehensive understanding of its role in multiple malignancies.

Methods

We systematically examined the role of SIRT1 in pan-cancer by analyzing data from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases. Various tools, including R, Cytoscape, HPA, Archs4, TISIDB, cBioPortal, STRING, GSCALite, and CancerSEA, were used to integrate and analyze SIRT1 gene expression, prognosis, protein interactions, signaling pathways, immune infiltration, and other relevant information. Furthermore, we validated the differential expression of SIRT1 in normal human kidney cells and kidney cancer cell lines via experimental verification.

Results

SIRT1 expression was significantly reduced in various cancers and was different across molecular and immune subtypes. SIRT1 is intricately linked to numerous cancer pathways. In most cancer types, increased SIRT1 expression is positively associated with eosinophils, helper T cells, central memory T cells, effector memory T cells, γδ T cells, and Th2 cells. SIRT1 expression is significantly correlated with immune regulatory factors across various cancer types. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blot (WB) analyses confirmed that SIRT1 is differentially expressed in kidney renal clear cell carcinoma (KIRC).

Conclusions

Using an integrative approach involving bioinformatics analysis and experimental validation, we clarified the potential roles and mechanisms of SIRT1 in pan-cancer, providing a theoretical basis for the development of SIRT1-targeted therapies in clinical applications.

Impact of COVID-19 on Ocular Surface Health: Infection Mechanisms, Immune Modulation, and Inflammatory Responses

COVID-19, caused by SARS-CoV-2, has presented formidable challenges to global health since its emergence in late 2019. While primarily known for respiratory symptoms, it can also affect the ocular surface. This review summarizes the effects of SARS-CoV-2 on ocular surface immunity and inflammation, focusing on infection mechanisms, immune responses, and clinical manifestations. Ocular symptoms, though uncommon, include conjunctivitis, dry eye, and blurred vision. SARS-CoV-2 binds to ACE2 receptors in ocular surface epithelial cells, facilitating viral entry, replication, and local dissemination. The innate immune responses involving corneal epithelial cells and immune cells are discussed, alongside mechanisms of antigen presentation and adaptive immunity. The review also examines the roles of cytokines and chemokines in mediating ocular surface inflammation and explores the impact of cytokine storms and chronic inflammation on ocular health. Additionally, the interplay between systemic and ocular immune responses is highlighted, analyzing how systemic COVID-19 inflammation influences ocular surface health. These insights underscore the broader implications of COVID-19 beyond localized ocular infection. By consolidating current findings, this review aims to guide preventive and therapeutic strategies while identifying directions for future research to mitigate the ocular consequences of COVID-19.

Biomitigation of ammonical stress in aquaculture using luffa sponge coupled with medicinal and aromatic plants for potential application in aquaponics

Ammonia, a major stress-inducing factor in aquaculture, contributes a significant challenge in maintaining sustainable fish production. Addressing this issue requires environmentally and economically sustainable solutions. This study explores the use of readily available and environmentally friendly porous lignocellulosic luffa sponge as a biostimulator, with a combination of three medicinal and aromatic plants(MAPs) viz. Asparagus racemosses(satavari) roots, Cammiphora wightii(guggal) stems, and Vitex negundo(nirgundi) stem for alleviating ammoniacal stress by biotransforming ammonia in aquaponics water/ aquaculture. A 45-day experiment was conducted using Pangasianodon hypophthalmus in tanks containing aquaponics water. The study consists of a control (C) and four treatments: L(Luffa), LS(Luffa + shatavari roots), LG(Luffa + guggal stem) and LN(Luffa + nirgundi stem). Ammonia was spiked weekly at different concentrations(2, 2.5, 3, 5, and 10 mgL-1). The L group showed significantly(p < 0.05) higher ammonia removal of 86.06% ± 9.62(spiked 3 mgL-1) in 24 hrs, and 73.98%±2.6 and 86.35%±4.47(spiked 5 mgL-1) in 24 and 48 hrs, respectively, which may be attributed to a higher surface area of the substrate for microbial attachment. The MAPs upregulated fish's hematological and serum biochemical parameters under elevated ammonia, indicating ammonical stress mitigation. Treatment groups showed significantly (p < 0.05) higher fish yield than the control (165.66 ± 0.50 g), with L, LS, LG, and LN giving a yield of 174.76 ± 2.07, 175.41 ± 0.59, 179.07 ± 4.29, and 181.57 ± 0.45 g respectively, with no significant difference detected among them. Promising outcomes in ammonia removal and stress mitigation were demonstrated by incorporating the lignocellulosic biomass and MAPs in this study, which is beneficial in commercial aquaculture with prospects in aquaponics systems.

A cutting-edge investigation of the multifaceted role of SOX family genes in cancer pathogenesis through the modulation of various signaling pathways

This detailed study examines the complex role of the SOX family in various tumorigenic contexts, offering insights into how these transcription factors function in cancer. As the study progresses, it explores the specific contributions of each SOX family member. The significant roles of the SOX family in the oncogenic environment are well-recognized, highlighting a range of regulatory mechanisms that influence tumor progression. In brain, lung, and colorectal cancers, SOX types like SOX2, SOX3, and SOX4 promote the migration, proliferation, and angiogenesis of cancer cells. Conversely, in pancreatic, gastric, and breast cancers, SOX types, including SOX1, SOX9, and SOX17 inhibit various cancer cell activities such as proliferation and invasion. This thorough investigation enhances our understanding of the SOX family's complex role in cancer, establishing a foundation for future research and potential therapeutic strategies targeting these versatile transcription factors.

Titanium dioxide nanoparticles: a promising candidate for wound healing applications

Effective wound management and treatment are crucial in clinical practice, yet existing strategies often fall short in fully addressing the complexities of skin wound healing. Recent advancements in tissue engineering have introduced innovative approaches, particularly through the use of nanobiomaterials, to enhance the healing process. In this context, titanium dioxide nanoparticles (TiO2 NPs) have garnered attention due to their excellent biological properties, including antioxidant, anti-inflammatory, and antimicrobial properties. Furthermore, these nanoparticles can be modified to enhance their therapeutic benefits. Scaffolds and dressings containing TiO2 NPs have demonstrated promising outcomes in accelerating wound healing and enhancing tissue regeneration. This review paper covers the wound healing process, the biological properties of TiO2 NPs that make them suitable for promoting wound healing, methods for synthesizing TiO2 NPs, the use of scaffolds and dressings containing TiO2 NPs in wound healing, the application of modified TiO2 NPs in wound healing, and the potential toxicity of TiO2 NPs.

Prediction of the need for surgery in patients with unruptured abdominal aortic aneurysm based on SOFA score

OBJECTIVE

This retrospective study aimed to explore the association and clinical value of sequential organ failure assessment (SOFA) score on the predictors of adverse events in patients with unruptured abdominal aortic aneurysms (AAA).

METHODS

A total of 322 patients from Medical Information Mart for Intensive Care IV database were enrolled. Logistic regression was conducted to explore the association between SOFA and primary outcome (need for surgery, NFS). Receiver operating characteristic (ROC) and nomogram analyses were used to assess its performance for predicting NFS. We also explored the association and clinical value of SOFA on secondary outcomes including hospital length of stay (LOS), ICU-LOS, and in-hospital mortality by linear and logistic regression analyses, generalized additive model, ROC, and decision curve analysis.

RESULTS

Totally 291 patients underwent the surgery. High SOFA score significantly correlated with NFS both in crude and adjusted models (all P<0.05). SOFA had a relatively favorable prediction performance on NFS (AUC = 0.701, 95%CI: 0.596-0.802). After adjusting for related diseases, its prediction performance was increased. When SOFA was combined with lactate and gender, the model showed an AUC of 0.888 (95%CI: 0.759-1.000) and 0.3-0.9 prediction possibility. Further, the SOFA also showed significant relationship with hospital-LOS, ICU-LOS, and in-hospital mortality (all P<0.05), and exerted some value in the prediction of 7-day hospital-LOS (AUC = 0.637, 95%CI: 0.575-0.686) and in-hospital mortality (AUC = 0.637, 95%CI: 0.680-0.845).

CONCLUSIONS

SOFA score was related to the NFS and can be regarded as a useful indicator for predicting the NFS in patients with AAA.

Assessment for Diabetic Neuropathy: Treatment and Neurobiological Perspective

Diabetic neuropathy, also known as diabetic peripheral sensorimotor neuropathy (DPN), is a consequential complexity of diabetes, alongside diabetic nephropathy, diabetic cardiomyopathy, and diabetic retinopathy. It is characterized by signs and symptoms of peripheral nerve damage in diabetes patients after ruling out other causes. Approximately 20% of people with diabetes are affected by this painful and severe condition. The development of diabetic neuropathy is influenced by factors such as impaired blood flow to the peripheral nerves and metabolic issues, including increased polyol pathway activation, myo-inositol loss, and nonenzymatic glycation. The present review article provides a brief overview of the pathological changes in diabetic neuropathy and the mechanisms and types of DPN. Various diagnostic tests and biomarkers are available to assess nerve damage and its severity. Pharmacotherapy for neuropathic pain in diabetic neuropathy is complex. This review will explore current treatment options and potential future developments to improve the quality of life for patients suffering from diabetic neuropathy.

Ameliorative Potential of Sudachitin Against Paraquat Induced Renal Toxicity in Rats Via Regulating Nrf2/Keap1 Pathway: An Inflammatory, Apoptotic and Histopathological Assessment

Paraquat (PQ) is a noxious herbicide which is well known for its adverse effects on vital organs including kidneys. Sudachitin (SCN) is a plant derived flavone that is obtained from Citrus sudachi and demonstrates a range of pharmacological potentials. This investigation was executed to assess the protective effects of SCN to counteract PQ instigated renal damage in albino rats (Rattus norvegicus). Twenty-four rats were apportioned in 4 different groups i. e., control group, PQ (5 mg/kg) intoxicated group, PQ (5 mg/kg)+SCN (20 mg/kg) cotreated group and SCN (20 mg/kg) only administrated group. Our findings revealed that exposure to PQ reduced the expressions of Nrf2 (nuclear factor erythroid 2-related factor 2) and its cytoprotective genes while escalating the expression of keap1. Furthermore, PQ intoxication reduced the activities of superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GSR), heme-oxygenase-1 (HO-1) and glutathione (GSH) contents while increasing the levels of malondialdehyde (MDA) and reactive oxygen species (ROS). Moreover, PQ exposure significantly increased the levels of neutrophil gelatinous-associated lipocalin (NGAL), urea, kidney injury molecule-1(KIM-1) as well as creatine while reducing creatine clearance. Additionally, PQ upregulated the levels of inflammatory markers including interleukin-6 (IL-6), tumor necrosis- α (TNF- α), nuclear factor- κB (NF-κB), interleukin 1beta (IL-1β), and cyclo-oxygenase-2 (COX-2). Moreover, PQ administration upregulated the expression of Bax (Bcl-2-associated X protein) and (cysteine-aspartic acid protease) Caspase-3 while downregulating the expressions of (B-cell lymphoma 2 protein) Bcl-2. Besides, PQ exposure prompted various histopathological damages in renal tissues. Nonetheless, SCN substantially restored aforementioned alterations in the renal tissues owing to its anti-oxidative, anti-inflammatory and anti-apoptotic potential.

Signal Mining and Analysis of Drug-Induced Myelosuppression: A Real-World Study From FAERS

IntroductionDrug-induced myelosuppression (DIM) is a serious side effect of several medications, particularly chemotherapy, immunosuppressants, and targeted therapies, which can lead to infections, anemia, and bleeding. While these drugs are effective, their adverse effects can disrupt treatment plans and reduce quality of life. However, early identification of DIM remains challenging, as many associated drugs do not explicitly list this risk, complicating clinical monitoring.MethodsThis study utilized the FDA Adverse Event Reporting System (FAERS) database to perform signal mining and assess the risks of DIM. Reports from the first quarter of 2004 to the third quarter of 2024 were analyzed using signal detection algorithms such as Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM). These methods helped identify drug signals related to DIM and explore risk factors and occurrence patterns.ResultsThe study analyzed 21 380 adverse event reports related to DIM, showing a significant increase in the number of reports since 2019, peaking at 3501 in 2021. Among patients, 50.2% were female, 35.5% were male, and the majority (44.42%) were aged between 18 and 65. Breast cancer patients had the highest DIM incidence (10.6%). Geographically, China reported the most cases (57.4%), followed by Japan (12.4%), and the United States (6.76%). The drugs most frequently linked to DIM included trastuzumab, bevacizumab, venetoclax, methotrexate, and pertuzumab. Additionally, 12 new drug signals were identified that were not labeled for DIM risk, including PERTUZUMAB, SODIUM CHLORIDE, and MESNA, which showed particularly strong or unexpected associations.ConclusionThis study identifies new DIM-related drug signals and emphasizes the need for early detection to improve clinical management and optimize treatment regimens. The findings provide valuable evidence for drug safety monitoring and can help reduce DIM-related risks in cancer treatment.

Tumor Budding: A Novel Prognostic Marker in Breast Carcinoma with Correlation of Histopathological and Immunohistochemical Parameters

Introduction

Breast cancer is a highly heterogenous tumor with different subtypes showing varying prognosis. Tumor budding is an unfavorable histological feature of many epithelial cancers. The purpose of this study is to analyze the association between tumor bud density with various histological and immunohistochemical characteristics and to explore its prognostic role in breast carcinoma.

Materials and Methods

A retrospective analysis was performed on 100 patients of breast cancer diagnosed in our institute from January to December 2017. Hematoxylin and eosin (H&E) stained slides from tumors and immunohistochemical slides were reviewed independently by two pathologists, and clinical data were acquired from computerized records. Patients on neoadjuvant chemotherapy were excluded from the study.

Results

The study comprised 100 patients of invasive breast carcinoma. The median age was 52 years, and 96% were invasive ductal carcinoma. The median follow-up was 34 months. High tumor bud density was substantially correlated with primary tumor staging (T3, T4; 73% [11/15] cases) and lymph node staging (N2, N3; 68% [13/19] cases) with p -values of 0.017 and 0.023, respectively. Systemic metastasis (85% [6/7] cases) was significantly associated with high tumor bud density ( p =0.025) but lymphovascular invasion (LVI) and perineural invasion (PNI) were not significantly associated with tumor bud density ( p  = 0.762 and 0.862, respectively). Patients with N2 nodal stage had low event-free survival rate than N0/N1 nodal stage irrespective of tumor bud status. Grade 3 tumors with high tumor bud density had worse event-free survival than any other grades. There was no association of tumor bud density with tumor staging, necrosis, PNI, LVI, estrogen receptor (ER), progesterone receptor (PR) and Her2/neu , and event-free survival.

Conclusion

Strong relationships have been found between tumor bud density and poor prognostic variables such as primary tumor staging and lymph node staging. These results provide credence to the idea that tumor bud density can be an assessable prognostic feature that should be taken into account while reporting breast cancer cases. Tumor bud density evaluation has to be standardized nevertheless if it is to be widely adopted.

The role of pharmacy in promoting public health: Pharmacy and public health in 2050

From 2000 to 2025, the profession of pharmacy expanded into vaccinations, point-of-care testing, and chronic disease prevention and management. In the next 25 years, pharmacy will continue to advance in new ways. This paper focuses on expanded roles of community and ambulatory care pharmacy to more directly improve public health. Built around the ten essential services of public health, this paper calls upon the profession of pharmacy to stretch beyond traditional roles to assume roles that would strengthen the public health workforce and make seminal contributions to improved population health. Barriers to be overcome in pursuit of that future are also addressed. The paper will conclude with a public health-focused call to pharmacy.

Decreased expression of hsa-miR-142-3p and hsa-miR-155-5p in common variable immunodeficiency and involvement of their target genes and biological pathways

Common variable immunodeficiency (CVID) is the most common symptomatic and heterogeneous type of inborn errors of immunity (IEI). However, the pathogenesis process of this disease is often unknown. Epigenetic modifications may be involved in unresolved patients. MiR-142 and miR-155 were identified as immune system modulators and dysregulated in autoimmune and inflammatory diseases. We assessed hsa-miR-142-3p and hsa-miR-155-5p expression in a selected cohort of unresolved CVID cases and identified experimentally validated targets of these miRNAs. We constructed a protein-protein interaction (PPI) network from the common targets of two miRNAs and determined the hub genes. The hub genes' expression was investigated in GEO datasets. Gene ontology (GO) and pathway enrichment analysis were done for target genes. Hsa-miR-142-3p and hsa-miR-155-5p expression were significantly reduced in CVID patients. Evaluation of the PPI network demonstrated some hub genes in which pathogenic mutations have been reported in IEI, and other hub genes directly contribute to immune responses and the pathophysiology of IEI. Expression analysis of hub genes showed that they were significantly dysregulated in validating the CVID cohort. The pathway enrichment analysis indicated the involvement of the FOXO-mediated signaling pathway, TGFβ receptor complex, and VEGFR2-mediated vascular permeability. Considering the dysregulation of hsa-miR-142-3p and hsa-miR-155-5p in CVID and the known role of their target genes in the immune system, their involvement in the pathogenesis of CVID can be suggested.

Metabolomics in Depression: What We Learn from Preclinical and Clinical Evidences

Depression is one of the predominant common mental illnesses that affects millions of people of all ages worldwide. Random mood changes, loss of interest in routine activities, and prevalent unpleasant senses often characterize this common depreciated mental illness. Subjects with depressive disorders have a likelihood of developing cardiovascular complications, diabesity, and stroke. The exact genesis and pathogenesis of this disease are still questionable. A significant proportion of subjects with clinical depression display inadequate response to antidepressant therapies. Hence, clinicians often face challenges in predicting the treatment response. Emerging reports have indicated the association of depression with metabolic alterations. Metabolomics is one of the promising approaches that can offer fresh perspectives into the diagnosis, treatment, and prognosis of depression at the metabolic level. Despite numerous studies exploring metabolite profiles post-pharmacological interventions, a quantitative understanding of consistently altered metabolites is not yet established. The article gives a brief discussion on different biomarkers in depression and the degree to which biomarkers can improve treatment outcomes. In this review article, we have systemically reviewed the role of metabolomics in depression along with current challenges and future perspectives.

Adeno-associated virus vectors and neurotoxicity-lessons from preclinical and human studies

Over 15 years after hepatotoxicity was first observed following administration of an adeno-associated virus (AAV) vector during a hemophilia B clinical trial, recent reports of treatment-associated neurotoxicity in animals and humans have brought the potential impact of AAV-associated toxicity back to prominence. In both pre-clinical studies and clinical trials, systemic AAV administration has been associated with neurotoxicity in peripheral nerve ganglia and spinal cord. Neurological signs have also been seen following direct AAV injection into the brain, both in non-human primates and in a clinical trial for late infantile Batten disease. Neurotoxic events appear variable across species, and preclinical animal studies do not fully predict clinical observations. Accumulating data suggest that AAV-associated neurotoxicity may be underdiagnosed and may differ between species in terms of frequency and/or severity. In this review, we discuss the different animal models that have been used to demonstrate AAV-associated neurotoxicity, its potential causes and consequences, and potential approaches to blunt AAV-associated neurotoxicity.

Characterization of the chemical profiles and biological activities of Thesium bertramii Azn. Extracts using a combination of in vitro, in silico, and network pharmacology methods

The genus Thesium, family Santalaceae, comprises about 350 species, and, although many of them are used as functional food and in traditional medicine, there are limited studies evaluating their pharmacological potential. The present study was designed to evaluate the chemical profile, antioxidant, and enzyme inhibition potential of aerial parts and roots of T. bertramii Azn. Extracts were rich in phenolics: MeOH and aqueous extracts of the aerial parts showed the highest total phenolic and flavonoid contents and the best antioxidant activity in most assays. Ethyl acetate extracts of both organs exerted comparable anti-butyrylcholinesterase activity, while their methanol extracts displayed comparable anti-tyrosinase activity. The highest acetylcholinesterase inhibitory activity was recorded from the root's ethyl acetate extract, while that of the aerial parts revealed the best α-amylase and α-glucosidase inhibitory activity. Chemically, the aerial parts were dominated by quercetin derivatives, feruloylquinic acids, caffeoylquinic acids, and elenolic acid glucoside. Roots showed a lower diversity of compounds with elenolic acid, quercetin glycoside, and kaempferol glycoside as major compounds. Additionally, network pharmacology analyses (KEGG and STRING) identified critical molecular pathways and hub genes, including IL6, TNF, BCL-2, and JUN, indicating the multi-target potential of T. bertramii in cancer and cardiovascular diseases. In conclusion, this study assessed the chemical and biological properties of T. bertramii for the first time, and the obtained results indicated the potential of this species as a valuable source of bioactive molecules for the pharmaceutical, food, and cosmetic industries.

Immune-related adverse events-pembrolizumab-induced colitis-the importance of early diagnosis and treatment: A case report and review of the literature

Immune Checkpoint Inhibitors (ICIs) are monoclonal antibodies that block inhibitory immune targets, such as cytotoxic T lymphocyte antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed death ligand 1 (PD-L). Pembrolizumab targets the PD-1 receptor of lymphocytes in lung cancer treatment. ICI checkpoint blockade enhances immunity against cancer cells. However, loss of immunoregulatory control can cause autoimmune reactions in various organs, leading to immune-related adverse events (irAEs). The most common irAE is ICIs-induced colitis, which usually develops 6-8 weeks after ICI initiation and can involve any part of the gastrointestinal system. Herein, we report a presentation of pembrolizumab-induced colitis in a female patient with metastatic lung cancer and review the most recent findings in the model of checkpoint-induced colitis. It was interesting to learn that the colon mucosa may show normal macroscopic findings, but microscopically, immunotherapy-induced autoimmune colitis could be present. Additionally, patients with grade 2 or higher symptoms should have a colonoscopy, receive systemic corticosteroids as treatment, and, based on their response, receive biologic therapy. Here, we present a case report of in a 45-year-old female who has been a smoker for 25 years, without comorbidities, and with metastatic lung cancer who developed colitis after the seventh cycle of pembrolizumab. This case presentation highlights the importance of early recognition and appropriate intervention in order to prevent permanent interruption of treatment with checkpoint inhibitors, as well as prevention of colitis complications.

Harnessing the ubiquitin proteasome system as a key player in stem cell biology

Intracellular proteins take part in almost every body function; thus, protein homeostasis is of utmost importance. The ubiquitin proteasome system (UPS) has a fundamental role in protein homeostasis. Its main role is to selectively eradicate impaired or misfolded proteins, thus halting any damage that could arise from the accumulation of these malfunctioning proteins. Proteasomes have a critical role in controlling protein homeostasis in all cell types, including stem cells. We will discuss the role of UPS enzymes as well as the 26S proteasome complex in stem cell biology from several angles. First, we shall overview common trends of proteasomal activity and gene expression of different proteasomal subunits and UPS enzymes upon passaging and differentiation of stem cells toward various cell lineages. Second, we shall explore the effect of modulating proteasomal activity in stem cells and navigate through the interrelation between proteasomes' activity and various proteasome-related transcription factors. Third, we will shed light on curated microRNAs and long non-coding RNAs using various bioinformatics tools that might have a possible role in regulating UPS in stem cells and possibly, upon manipulation, can enhance the differentiation process into different lineages and/or delay senescence upon cell passaging. This will help to decipher the role played by individual UPS enzymes and subunits as well as various interrelated molecular mediators in stem cells' maintenance and/or differentiation and open new avenues in stem cell research. This can ultimately provide a leap toward developing novel therapeutic interventions related to proteasome dysregulation.

Effect of galangin on oxidative stress, antioxidant defenses and mitochondrial dynamics in a rat model of focal cerebral ischemia

Focal ischemia occurs when a cerebral artery becomes obstructed by an embolus or thrombus, leading to a rapid reduction in cerebral blood flow and significantly increasing the risk of mortality and disability. This condition is of particular concern in developing countries, where its prevalence is on the rise. Galangin, a flavonoid found in Alpinia officinarum, shows strong antioxidant, anti-inflammatory and anti-apoptotic properties. Its wide-ranging bioactivity in both in vitro and animal studies points to promising therapeutic applications. Given the role of oxidative stress in the pathophysiology of focal ischemia, the present study explored the effects of galangin on oxidative stress markers and antioxidant defenses in an animal model of the disease. A total of 60 healthy male Wistar rats were randomly assigned to six groups: Control, right middle cerebral artery occlusion (Rt.MCAO) + vehicle, Rt.MCAO + piracetam, and Rt.MCAO + galangin at doses of 25, 50 and 100 mg/kg body weight. The results indicated that 7 days of galangin treatment reduces infarct volume, malondialdehyde levels, and the density ratio of mitogen-activated protein kinase, while enhancing catalase, glutathione peroxidase and superoxide dismutase activities, and improving the density ratio of mitofusin 2 protein in the cortex and hippocampus. In conclusion, galangin showed significant in vivo potential in mitigating the pathological changes caused by cerebral ischemia, likely due to its antioxidant properties and modulation of mitochondrial dynamics. Additional research is now needed to explore the biochemical and neurological impacts of galangin in focal cerebral ischemia and to fully elucidate its mechanism of action.