The efficacy of vortioxetine in the acute treatment of major depressive disorder: A systematic review and meta-analysis

BACKGROUND

Among the available pharmacological treatments for acute major depressive disorder (MDD), vortioxetine, a serotonin transporter inhibitor (SERT), has been widely used for its multimodal action on serotonin neurotransmission, which produces essential changes also on glutamate, gamma amino butyric acid (GABA), norepinephrine, acetylcholine, and dopamine.

AIM

This systematic review and meta-analysis aimed to evaluate the acute efficacy of vortioxetine across multiple dosing and to evaluate whether there is a dose-response effect and as well there is a dose-response issue with respect to side effects in acute depression.

METHODS

According to PRISMA guidelines, we systematically searched three major electronic databases (PubMed/MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials) for Randomized Controlled Trial (RCT) studies published between January 2013 and April 2024. Twenty-four studies were included in the review and two meta-analyses were conducted to determine whether the mean Montgomery-Asberg Depression Rating Scale (MADRS) scale values in the placebo groups differ significantly from the mean MADRS scale values in the group receiving vortioxetine 10 mg or vortioxetine 20 mg.

RESULTS

Vortioxetine significantly improved acute depression severity, anxiety symptoms, and cognitive function, with high response and remission rates in acute MDD. It was also well tolerated with a relatively low occurrence of severe or serious treatment-emergent adverse events (TEAEs). Observing the results of the meta-analysis, the effect was significant for both vortioxetine 10 and 20 mg, with a greater effect size for vortioxetine 20 mg.

CONCLUSION

Vortioxetine should be considered efficacious as a first- and second-line therapy.

Quantifying morphologic variations as an alternate to standard response criteria for unresectable primary liver tumors after checkpoint inhibition therapy

PURPOSE

The aim of this study was to assess the feasibility of quantifying morphologic changes in tumors during immunotherapy, as a reflection of response or survival.

METHODS AND MATERIALS

A retrospective single-center analysis was performed in patients with unresectable liver cancer previously enrolled in clinical trials combining immunotherapy (tremelimumab ± durvalumab) and locoregional treatment (either ablation or transarterial chemoembolization). Conventional response (RECIST 1.1) was assessed at 6-month follow-up. For morphologic assessment, the largest target lesion was manually segmented on axial slices in two dimensions using contrast-enhanced CT. Solidity and circularity of tumors were calculated at baseline, 3-month follow-up, and at 6-months follow-up. Survival analysis was performed.

RESULTS

From the 68 patients enrolled in clinical trials, 28 did not have target lesions separate from lesions treated by locoregional therapies, and 3 had no follow-up imaging. Thirty-seven patients (9 with biliary cancer and 28 with hepatocellular carcinoma) were included. Shape features and shape variation were not correlated with RECIST 1.1 status at 6-month follow-up. However, patients with low solidity tumors at 6-month follow-up showed poorer prognosis compared with patients with high solidity tumors at 6-month follow-up (p = 0.01). Solidity variation analysis confirmed that a decrease of tumor solidity at 6-month follow-up was associated with poorer prognosis (p = 0.01). No association was found between shape features at baseline or shape features at 3-month follow-up with overall survival.

CONCLUSION

Evolution and variation of tumor morphology during treatment may reflect or correlate with outcomes and contribute toward adapted response criteria.

Diagnostic and predictive values of m5C‑associated genes in idiopathic pulmonary fibrosis

In patients with idiopathic pulmonary fibrosis (IPF), the role of 5‑methylcytosine (m5C)‑associated genes in the pathogenesis and development of the disease remains unclear. The present study aimed to identify reliable diagnostic markers based on the expression of m5C‑associated genes for the early detection of IPF. Count data were obtained by screening the IPF genome‑wide assay in the Gene Expression Omnibus database, followed by a comparison of m5C gene expression in patients with IPF and controls. The GSE150910 and GSE173355 datasets yielded a total of 23 differentially expressed m5C‑associated genes, which were then investigated for their functions. A diagnostic model was built using eight m5C genes and validated with training sets and the GSE124685 dataset. IPF subtypes were identified based on expression of m5C‑related genes as well as clinical and immunological characteristics. Furthermore, a pulmonary fibrosis model was established in mice by administering bleomycin into the trachea. Lungs were harvested and analyzed using quantitative PCR to determine the expression of m5C‑related genes. The Kyoto Encyclopedia of Genes and Genomes enrichment analysis revealed that these genes were significantly enriched in 'base excision repair'. Immunoassay results revealed that 13 immune cell markers (naive, memory and B cell plasma, T cell CD4 naive, T cell CD4 memory resting, T cell follicular helper, T cell regulatory Tregs, NK cell resting, Monocyte, Macrophage M0, Mast cell activated, Eosinophil, and Neutrophil) were significantly associated with IPF. Patients with IPF had lower levels of resting memory CD4+ T cells, which were positively associated with Tet methylcytosine dioxygenase2 (TET2) and Thymine‑DNA glycosylase (TDG) but negatively correlated with NOP2/Sun RNA methyltransferase5 (NSUN5) expression. All samples were classified into based on the levels of the eight diagnostic m5C genes. Samples with high m5C scores are subtype 1, and those with low m5C scores are subtype 2. In subtype 2, male patients had lower levels of CD27 and CD70 but higher levels of CD274, CD86, Cytotoxic T‑lymphocyte‑associated protein4 and Hepatitis A virus cellular receptor2 (HAVCR2). When compared with normal mouse lung tissue samples, expression levels of NOP2/Sun RNA methyltransferase6 (NSUN6), Ubiquitin‑like with PHD and RING Finger Domains1, TDG and TET2 in lung fibrosis tissue samples were significantly higher, while expression levels of NSUN5, NTH‑like DNA glycosylase1, DNA (cytosine‑5‑)‑methyltransferase3 β and Methyl‑CpG binding domain protein 3) were lower. It is possible that m5C‑associated genes play an important role in the diagnosis and typing of IPF. These genes may facilitate investigation of the pathophysiology of IPF and identification of potential treatment targets.

The feasibility and short-term safety of single-site hysterectomy: a retrospective cohort study of a novel robotic platform

BACKGROUND

Robotic-assisted laparoscopic single-site hysterectomy is popular among patients and surgeons due to good cosmetic outcomes and fast recovery. However, questions remain such as loss of triangulation and instrument collision. Our aim is to test the feasibility and safety of a purpose-designed single-site robotic surgical platform mainly in hysterectomies.

METHODS

We retrospectively collected patients who had undergone hysterectomy by SHURUI (SR-ENS-600) robotic surgical system in the First Affiliated Hospital of Xi'an Jiaotong University. Initial cases as control were also collected including da Vinci single-site (IS4000) and multi-port (IS3000 and IS4000) hysterectomies performed by the same surgical team. The main outcome was surgical feasibility rate (valid surgeries/total cases × 100%). Short-term post-operative outcomes and complications were recorded and compared between three groups.

RESULTS

From Dec, 2nd, 2023 to Mar, 1st, 2024, 19 cases of hysterectomies were enrolled, including 6 myomas, 2 adenomyosis, 9 cervical high-grade squamous intraepithelial lesion/stage Ia1 cancers, and 2 stage Ia endometrial cancers. Seventeen cases of da Vinci single-site surgeries and 20 cases of multi-ports surgeries were also included for comparation. Intra-operative bleeding volume was significantly lower in SHURUI group compared with da Vinci single-site and multi-ports groups (40.5 mL vs 47.4 mL vs 58.5 mL, P = 0.046 and 0.028). Post-operative time to flatus was also shorter in SHURUI group compared with da Vinci single-site and multi-port surgeries (22.9 h vs. 33.5 h vs. 28.6 h, P = 0.054 and 0.001). Follow-up for SHURUI group lasted for 3 months with no complications.

CONCLUSIONS

SHURUI robotic surgery was feasible and safe in hysterectomies. It also had comparable outcomes with da Vinci robotic platform and approaches.

The Transorbital Approach to the Internal Carotid and Middle Cerebral Arteries. A Dissection Study Toward Targeted Access Aneurysm Clipping

BACKGROUND

The application of the transorbital (TO) approach for vascular lesions has been scarcely explored. In this anatomic study, we examine the carotid and middle cerebral arteries from the TO perspective and investigate the feasibility of vascular clipping in a pseudovascularized model.

METHODS

Three fixed human cadaveric specimens (6 sides) were used for dissection. The sequential TO approach comprised 1) conventional lateral orbital craniectomy; 2) lateral orbital rim removal; and 3) anterior clinoidectomy. The clinoidal, ophthalmic, and communicating carotid segments, branches, related cranial nerves, and dural attachments were examined. Comparison among the 3 variations of bone removal determined the minimal necessary steps for each vascular segment. An additional fresh pseudovascularized specimen (2 sides) was used to test the surgical feasibility of clipping.

RESULTS

The TO approach allowed exposure of the carotid C4 to bifurcation. Clinoidectomy and dural ring opening exposed lateral and dorsal aspects of C5/C6 and the ophthalmic, but not medial or ventral aspects, nor the superior hypophyseal artery or the carotid cave. The posterior communicating artery could be followed from origin to end. The anterior choroidal origin was seen but disappeared behind the uncus. The carotid bifurcation was visible, M1 could be followed to its bifurcation, but A1 lay deep within the field. The corridor permitted arachnoidal dissection, vessel manipulation, and clipping of exposed segments.

CONCLUSIONS

The TO approach provides anatomic access to the lateral and dorsal carotid siphon, complete posterior communicating artery, and proximal middle cerebral artery. This preliminary study suggests potential application in the elective treatment of paraclinoid and posterior communicating aneurysms.

Impact of Acute Short-Term Hypobaric Hypoxia on Anterior Chamber Geometry

PRCIS

Hypobaric hypoxia, the major environmental factor at high altitudes, has been observed to induce pupil miosis and widening of the anterior chamber angle. This environment may be safe for individuals with narrow angle and deserves further study.

PURPOSE

This study aimed to quantify anterior chamber biometric parameters before and after acute short-term, effortless exposure to hypobaric hypoxia (HH) in healthy lowlanders using swept-source anterior segment optical coherence tomography (SS AS-OCT).

METHODS

This prospective study included 25 healthy young lowlanders (50 eyes) who underwent SS AS-OCT measurements and intraocular pressure (IOP) assessments under baseline sea-level conditions (T1). They were then passively exposed to simulated 4000 m above sea level for 3 hours and underwent acute mountain sickness (AMS) symptoms evaluation and IOP measurement after 2 hours exposure to HH (T2). Repeat SS AS-OCT measurements and IOP assessments were taken within 15 minutes after leaving the hypobaric chamber (T3). Anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), angle opening distance (AOD500), trabecular-iris space area (TISA500), angle recess area (ARA500) at 500 μm from the scleral spur, iris curvature (IC), iris volume (IV), pupil diameter (PD), and central corneal thickness (CCT) were obtained through SS AS-OCT. These repeated measurements were compared using linear mixed model analysis.

RESULTS

In comparison to the sea level, both IOP (16.4±3.4 vs. 14.9±2.4 mm Hg, P =0.029) and PD (5.36±0.77 vs. 4.78±0.89 mm, P =0.001) significantly decreased after exposure to HH. Significant post-HH changes [mean difference (95% CI)] were observed in AOD500 [0.129 (0.006, 0.252), P =0.04], TISA500 [0.059 (0.008, 0.11), P =0.025], ARA500 [0.074 (0.008, 0.141), P =0.029], IV [1.623 (0.092, 3.154), P =0.038], and IC [-0.073 (-0.146, 0.001), P =0.047], whereas CCT, ACD, and LV remained stable. After adjusting for age, post-HH variations in AOD500 (Beta=0.553, 95% CI: 0.001, 1.105, P =0.048) and TISA500 (Beta=0.256, 95% CI: 0.02, 0.492, P =0.034) were associated with decreased IC but were not related to lowered arterial oxygen pressure or IV increase per millimeter of pupil miosis (IV/PD). These differences in anterior segment parameters were neither correlated with differences in IOP nor AMS.

CONCLUSIONS

After short-term, effortless exposure to hypobaric hypoxia, pupil miosis occurred with widening of the anterior chamber angle and decreased IC. These changes in anterior chamber angle parameters were associated with decreased IC but did not correlate with the post-hypobaric variations in IV/PD, IOP, or AMS.

Challenging diagnosis: unusual presentation of Unicentric Castleman disease-a case report

Castleman's Disease is an idiopathic rare lymphoproliferative disorder that is clinically Classified to multicentric to unicentric types. Only few cases were reported in children, with majority of them are unicentric and usually located in the mediastinum. We report a unique case of a 13-year-old boy who presented with a palpable enlarged mass in the left inguinal region without any constitutional symptoms. Surgical removal of this mass was essential to exclude worrying causes. Pathologic examination revealed proliferative changes consistent with Castleman's disease plasma cell type which is one of the rarest forms of the disease in children. To our knowledge, this case is the first reported case of Unicentric Castleman Disease (UCD) in the inguinal area. During a 12-month-period of follow-up, no additional lymph node enlargements or other symptoms were reported. In conclusion, any isolated lymph node enlargement wherever it is, especially in a child, should impose UCD as a possible differential diagnosis.

Endoscopic Papillary Large Balloon Dilatation With or Without Endoscopic Sphincterotomy in the Treatment of Common Bile Duct Stones

PURPOSE OF REVIEW

Endoscopic papillary large balloon dilation (EPLBD) has been proved to have better efficacy and safety in removing common bile duct stones. Conventional endoscopic sphincterotomy (EST) is usually performed before EPLBD. However, EPLBD without EST has recently reported short-term outcomes similar to those of EPLBD with EST. This article summarizes the latest research advances in EPLBD with or without EST for the treatment of large common bile duct stones (CBDS) as a way to provide further evidence to support the ERCP surgeon's choice of which technique to use for the treatment of large CBDS.

FINDINGS

EPLBD alone is recommended in cases of anatomical abnormalities or bleeding tendencies. EPLBD with EST is recommended in patients with stenosis of the duodenal papilla or distal common bile duct or with periportal diverticula. Most clinical studies have shown that the clinical efficacy and incidence of adverse events associated with ESLBD are comparable to those of standalone EPLBD. However, further large-scale prospective randomized controlled trials are needed to confirm these findings.

Cis-Regulation of an m6A Eraser by an Insertion Variant Associated with Survival of Patients With Non-Small Cell Lung Carcinoma

N6-methyladenosine (m6A) serves as one of the crucial RNA modifications for genes involved in cancer progression. Here, 7273 expression quantitative trait loci potentially regulating 30 m6A pathway genes are identified from the GTEx database, with 69 single nucleotide polymorphisms significantly associated with survival of non-small cell lung carcinoma (NSCLC) patients (n = 1523) from the ongoing genome-wide association study after false positive probability tests. Notably, the rs151198415 locus, situated in a potential enhancer region, demonstrated a prolonged survival effect with the C>CCACG insertion, which is validated in an independent prospective cohort (n = 237), yielding a pooled hazard ratio of 0.72 (p = 0.007). Mechanistically, the rs151198415 C>CCACG insertion engaged in long-range interaction with the promoter of m6A eraser ALKBH5, promoting ALKBH5 transcription by the creation of an EGR1 binding site. Then, ALKBH5 upregulated FBXL5 expression by m6A demethylation, which is dependent on the ALKBH5 H204 amino acid site and specific m6A sites on FBXL5 mRNA. Finally, the ALKBH5-FBXL5 axis reduces intracellular reactive oxygen species levels, leading to PI3K/AKT and NF-kB pathway inhibition and consequently suppresses NSCLC proliferation and metastasis in vitro and in vivo. Triggered by an insertion variant, this remote cis-regulation of m6A eraser and the downstream molecular events modulate the survival of NSCLC patients.

Dihydromyricetin Protects Against Hypoxia/Reoxygenation Injury in Cardiomyocytes by Activating miR-34a-Mediated Notch1 Pathway

Dihydromyricetin (Dih), a naturally occurring flavonoid, has been identified to exert a protective effect against ischemia/reperfusion injury. However, the detailed mechanisms remain unclear. Here we investigated the biological role of Dih in preventing hypoxia/reoxygenation (H/R) injury in cardiomyocytes. The results showed that Dih protected cardiomyocytes against H/R-induced apoptosis, as proved by improved cell viability and decreased lactate dehydrogenase (LDH) release, cell apoptosis percentage, and caspase-3/7 activity. H/R-induced oxidative stress in cardiomyocytes was also prevented by Dih with increased activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), and decreased levels of malondialdehyde (MDA) and reactive oxygen species (ROS). Treatment with Dih prevented H/R-induced increase in the activities of myocardial enzymes aspartate aminotransferase (AST), creatine kinase-MB (CK-MB), and creatine kinase (CK). miR-34a expression was upregulated after H/R stimulation, which could be attenuated by Dih pretreatment. Besides, miR-34a overexpression attenuated the protective effects of Dih against H/R-caused increase in apoptosis, oxidative stress, and myocardial enzyme activities. Next, we demonstrated that Notch1 was a target molecule of miR-34a. Notch1 overexpression reversed the role of miR-34a in regulating the cardioprotective effect of Dih on H/R injury. These observations indicated that the cardioprotective effect of Dih against H/R injury was mediated by the miR-34a/Notch1 signaling. Dih may be a candidate agent for improving the clinical efficacy of cardiac ischemia/reperfusion injury treatment.

Electronic Monitoring of Mom's Schedule (eMOMS™): A Feasibility Randomized Controlled Trial Targeting Postpartum Weight Retention and Breastfeeding Duration Among Populations With Overweight/Obesity

BACKGROUND

Globally, rising trends in gestational diabetes and body mass index contribute to maternal and neonatal morbidity and mortality. Lifestyle modifications and breastfeeding may reverse this effect, although few studies combine these into one intervention.

RESEARCH AIMS

To measure postpartum weight retention, breastfeeding duration, hemoglobin A1C, and mean arterial blood pressure at 6 months postpartum among women with elevated pre-pregnancy body mass index.

METHODS

The electronic Monitoring of Mom's Schedule study (eMOMS™) was a feasibility, three-arm, randomized controlled trial modeled after a Diabetes Prevention Program and breastfeeding support. A health coach delivered a 12-month virtual intervention. Study arm results were compared using Wilcoxon signed-ranks exact test reporting from a two-sided test and bootstrapped samples with 95% confidence intervals.

RESULTS

Between September 2019 and May 2021, 100 individuals were screened, and 35 were randomized: nine to Group 1, 14 to Group 2, and 12 to Group 3. At baseline, participants averaged 13.0 (SD = 2.5) weeks gestation, with a mean pre-pregnancy body mass index of 29.7 (SD = 3.0). With 5,000 bootstrapped samples, mean weight retention from baseline to 6 months postpartum was: 4.0 kg, 95% CI [1.6, 6.2] for Group 1; 3.7 kg, CI [-1.8, 9.8] for Group 2; and 7.5 kg, CI [4.1, 11.6] for Group 3. Mean (exclusive) breastfeeding duration was 9.3 weeks, 95% CI [0.43, 26.1]; 9.6 weeks, CI [4.4, 15.7]; and 15.1 weeks, CI [6.5, 23.3] for each group, respectively.

CONCLUSION

Our intervention was positively associated with postpartum weight retention and breastfeeding duration. Future research is needed to assess intervention components.

Understanding the role of perfectionism in contributing to internalizing symptoms in youth with juvenile idiopathic arthritis

OBJECTIVE

Youth with juvenile idiopathic arthritis (JIA) experience elevated rates of internalizing symptoms, although more research is required to understand this phenomenon. Perfectionism, a multidimensional personality trait that involves dimensions such as striving for flawlessness (self-oriented perfectionism) and feeling that others demand perfection (socially-prescribed perfectionism), is a well-known risk factor for internalizing symptoms that has received minimal attention in pediatric populations. Preregistered hypotheses explored the relationships between youth and parent perfectionism and symptoms of depression and anxiety in youth with JIA, as mediated by (a) youth/parent negative self-evaluations and (b) youth self-concealment.

METHODS

One hundred fifty-six dyads comprised of youth (13-18 years) with JIA and a caregiver completed online questionnaires about trait perfectionism, negative self-evaluations (i.e., pain catastrophizing and fear of pain), self-concealment, and internalizing symptoms.

RESULTS

Positive relationships were observed between parent/youth self-oriented perfectionism and negative self-evaluations, youth self-oriented perfectionism and internalizing symptoms, and youth negative self-evaluations and internalizing symptoms. Parent self-oriented perfectionism was negatively related to youth depression symptoms. Indirect effects were observed for youth self-oriented perfectionism predicting anxiety and depression symptoms through pain catastrophizing (a1b1 = 0.13 and 0.12, 95% CI [.03, .24 and .03, .22], respectively). Exploratory mediations suggested youth socially-prescribed perfectionism might predict internalizing symptoms directly and indirectly through self-concealment.

CONCLUSION

Youth and parent perfectionism are implicated in the internalizing symptoms of youth with JIA and may manifest through youth negative self-evaluations (e.g., catastrophic thoughts) and self-concealment. While future research is needed, screening for perfectionistic tendencies in this population may help guide assessment, prevention, and treatment efforts.

Impact of Gut Microbiota on Lymphoma: New Frontiers in Cancer Research

The gut microbiome (GMB), which is made up of various microorganisms, plays a crucial role in maintaining the health of the host. Disruptions in this delicate ecosystem, known as microbial dysbiosis, have been linked to various diseases, including hematologic malignancies such as lymphoma. This review article explores the complex relationship between the GMB and the development of lymphoma and highlights its implications for diagnostic and therapeutic approaches. It discusses how GMB influences lymphoma development directly through the presence of certain microorganisms and indirectly through changes in the immune system. The clinical relevance of GMB is highlighted and its potential utility for diagnosis, predicting treatment outcomes and developing personalized therapeutic strategies for lymphoma patients is demonstrated. The review also looks at microbiome-targeted interventions such as fecal microbiome transplantation and dietary modification, which have shown promise for treating microbial dysbiosis and improving patient outcomes. In addition, it highlights the analytical challenges and the need for further research to fully elucidate the mechanistic functions of the GMB in the context of lymphoma. This review emphasizes the critical role of GMB in lymphomagenesis and its potential for the development of diagnostic and therapeutic strategies.

Severe Venous Calcifications in Phlebosclerotic Colitis and Significantly Decreased Expression in Betaine

Phlebosclerotic colitis (PC) is a rare type of chronic ischemic colitis. Its etiology is still unknown, and PC is also known as idiopathic mesenteric phlebosclerosis colitis. Currently, many studies have reported that long-term use of Chinese herbal medicine and drinking history are related to its pathogenesis. In the early stage of the lesion, due to insufficient understanding of PC, it is difficult to distinguish it from inflammatory bowel disease and other nonneoplastic intestinal diseases. We reported a case of severe diffuse total colon calcification with multiple misdiagnosis, summarizing and analyzing the clinical pathological characteristics to increase clinical and pathological physicians' understanding of the disease and reduce misdiagnosis. Moreover, for the first time, we conducted metabolomics sequencing on fresh intestinal specimens of PC, in order to explore the possible mechanism of severe calcification in the patient. We found that betaine was significantly decreased in the intestinal specimens of the patient, which is an amino acid that has been shown to improve vascular risk factors, and may be one of the mechanisms underlying severe calcification in the patient.

Multimodality Therapy and Survival Outcomes in Resectable Primary Small Cell Carcinoma of the Esophagus: A Multicenter Retrospective Study

BACKGROUND

Currently, optimal treatment strategy for resectable primary small cell carcinoma of the esophagus (PSmCCE) remains controversial. To address this, we conducted a multicenter study to evaluate treatment patterns and long-term survival of PSmCCE patients who underwent radical resection.

METHODS

This retrospective multicenter study included resected PSmCCE patients who received radical resection at seven high-volume cancer centers. Overall survival (OS) and median survival time (MST) were calculated by using a Kaplan-Meier method and the log-rank test was utilized to assess differences. Multivariable Cox analysis was performed to identify independent prognostic factors.

RESULTS

A total of 352 patients with resected PSmCCE were included. For PSmCCE with stage cT1-2N0M0, patients who received surgery plus adjuvant therapy showed better survival than those who received surgery alone (5-year OS rate: 32.8% vs. 19.2%, MST: 44.0 vs. 33.0 months, P = 0.035). Multivariable Cox survival analysis revealed an independent correlation between receiving surgery plus adjuvant therapy and improved OS (hazard ratio [HR] 0.529; 95% confidence interval [CI] 0.280-0.997; P = 0.049). For stage cT3N0M0/T1-3N1M0 PSmCCE, patients who received neoadjuvant therapy followed by surgery had superior long-term survival compared with those who received surgery combined with adjuvant therapy and those who received surgery alone (5-year OS rate: 27.2% vs. 9.5% vs. 0%, MST: 36.0 vs. 24.0 vs. 20.0 months, P = 0.014). Multivariable Cox survival analysis showed that neoadjuvant therapy was independently associated with improved OS (HR 0.384, 95% CI 0.203-0.728; HR 0.550, 95% CI 0.312-0.968; P = 0.013).

CONCLUSIONS

Adjuvant therapy was associated with improved survival in stage cT1-2N0M0 PSmCCE, but this should be confirmed in prospective studies. For stage cT3N0M0/T1-3N1M0 cases, neoadjuvant therapy followed by surgery should be considered.

Clinical Course and Outcome of COVID-19 in Children With Biliary Atresia: A Retrospective Study

Background and Aims

To investigate the infection status and outcomes of biliary atresia (BA) patients during the coronavirus disease 2019 (COVID-19) pandemic in Chinese population.

Methods

This retrospective study involved Kasai-postoperative BA patients who had achieved jaundice-free during the SARS-CoV-2 outbreak from December 1, 2022 to February 28, 2023. Children without hepatobiliary diseases hospitalized during the same period were as control group. Data collected included nutritional status, comorbidities, epidemiologic characteristics, fever symptoms (duration, max), respiratory symptoms (cough, runny nose and shortness of breath), and gastrointestinal symptoms (diarrhea and vomiting). All cases infected with SARS-CoV-2 were followed up for 3 months.

Results

A total of 128 BA patients were enrolled, ranged in age from 6 months to 12 years old (median age: 1.8 years). A total of 51 (39.8%) and 49 BA patients (38.3%) were classified as confirmed and suspected COVID-19 cases, respectively. Only two confirmed cases presented with moderate symptoms, while the rest developed asymptomatic or mild cases. Compared to the 115 control groups, the proportion of symptomatic cases in BA was slightly higher (78.1% vs. 67.8%) without significant difference (p = 0.07). Similarly, no differences were found in proportion of fever, respiratory tract symptoms and gastrointestinal symptoms between BA and control groups. However, it is worth noting that 7 BA patients developed symptoms of cholangitis during SARS-CoV-2 infection, who experienced pale stool and elevated bilirubin levels. After hospitalization, six patients achieved jaundice-free survival, but one child finally had to undergo liver transplantation due to hepatic failure.

Conclusions

The symptoms and course of COVID-19 in BA patients were similar to those in healthy population. The vast majority of BA patients made a good recovery from COVID-19.

Meta-Analysis of Endoscopic Full-Thickness Resection Versus Endoscopic Submucosal Dissection for Complex Colorectal Lesions

BACKGROUND

Studies evaluating endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for complex colorectal lesions have shown variable results. We conducted a meta-analysis of the available data.

METHODS

Online databases were searched for studies comparing EFTR versus ESD for complex colorectal lesions. The outcomes of interest were resection rates, procedure time (min), and complications. Pooled odds ratios (OR) and standardized mean difference (SMD) along with 95% CI were calculated.

RESULTS

A total of 4 studies with 530 patients (n=215 EFTR, n=315 ESD) were included. The mean follow-up duration was 5 months. The mean age of the patients was 68 years and 64% were men. The EFTR and ESD groups had similar rates of en bloc resection (OR: 1.73, 95% CI: 0.60-4.97, P =0.31) and R0 resection (OR: 1.52, 95% CI: 0.55-4.14, P =0.42). The EFTR group had significantly reduced procedure time (SMD -1.87, 95% CI: -3.13 to -0.61, P =0.004), total complications (OR: 0.24, 95% CI: 0.13-0.44, P <0.00001), perforation (OR: 0.12, 95% CI: 0.03-0.39, P =0.0005) and postresection electrocoagulation syndrome (OR: 0.06, 95% CI: 0.01-0.48, P =0.008). Delayed bleeding was similar in the 2 groups (OR: 0.80, 95% CI: 0.30-2.12, P =0.66). Residual/recurrent lesions were significantly higher in the EFTR group (OR: 4.67, 95% CI: 1.39-15.66, P =0.01).

DISCUSSION

This meta-analysis of small studies with high heterogeneity showed that EFTR and ESD have comparable resection rates for complex colorectal lesions. EFTR is faster and has fewer complications, but it increases residual or recurrent lesions.

Evaluation of Nanocurcumin Effects on Depressive-Like Behaviors in Rats and Determination of Serum BDNF and Serotonin Levels

INTRODUCTION

Major depressive disorder (MDD) is a highly prevalent psychiatric condition worldwide, and it is the leading cause of disability globally. Turmeric, an aromatic perennial herb widely used in traditional Asian medicine and cuisine, contains curcumin, which has several biological effects, including a pseudoantidepressant effect. However, curcumin's low bioavailability limits its effectiveness. This study evaluated nanocurcumin (NCUR) effects on depressive-like behaviors and examined serum BDNF and serotonin levels in a chronic stress model in rats. Behavioral assessments and biochemical indicators elucidated NCUR's antidepressant-like properties.

METHODS

In this experimental study, 30 adult male rats were randomly divided into six groups and exposed to unexpected chronic mild stress (UCMS). The groups included: control (CG), stress control (SCG), fluoxetine (FLU) treatment (20 mg/kg), and three NCUR doses (20, 40, and 80 mg/kg). Before UCMS exposure, rats underwent a sucrose preference test (SPT). Depressive behaviors were then assessed using the open field test (OFT), forced swimming test (FST), and tail suspension test (TST) on days 27 and 28. Blood samples were collected on day 28 to measure serum Brain derived neurotrophic factor (BDNF) and serotonin levels using enzyme-linked immunosorbent assay (ELISA).

RESULTS

NCUR treatment significantly alleviated depressive-like behaviors in stressed rats. The sucrose preference index of the SCG decreased after 26 days of stress, while NCUR (all doses) and FLU reversed this effect. In the FST and TST, immobility time was significantly reduced in the NCUR and FLU groups compared to the SCG (p < 0.05). The OFT also showed that the SCG had significantly fewer crossings compared to treated groups (p < 0.05). Additionally, NCUR treatment significantly increased serum BDNF and serotonin levels compared to the SCG.

CONCLUSIONS

This study demonstrates that NCUR exerts antidepressant-like effects, improving depressive behaviors and increasing BDNF and serotonin levels in rats exposed to chronic stress. NCUR may offer a promising alternative for the treatment of MDD.

The effects and mechanisms of chai shao jie yu granules on chronic unpredictable mild stress (CUMS)-induced depressive rats based on network pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Chai Shao Jie Yu Granules (CSJY) is a renowned and time-honored formula employed in clinical practice for the management of various conditions, notably depression. Depression, a prevalent psychiatric disorder, poses challenges with limited effective treatment options. Traditional herbal medicines have garnered increasing attention in the realm of combating depression, being perceived as safer alternatives to pharmacotherapy.

AIM OF THE STUDY

To explore the effects and mechanisms of CSJY in chronic unpredictable mild stress (CUMS)-induced depression.

MATERIALS AND METHODS

Rat models of CUMS-induced depression were established, and the rats were randomly allocated into six groups: Control, CUMS, CUMS + Paroxetine (PX), CUMS + CSJY-L, CUMS + CSJY-M, and CUMS + CSJY-H. Throughout the study, the rats' body weight was monitored. Depression-related behaviors were assessed using the sucrose preference test (SPT) and open field test (OFT). High-performance liquid chromatography-mass spectrometry (HPLC-MS) measured monoamine neurotransmitters in the rat cortex and hippocampus. We measured adrenocorticotropic hormone (ACTH), corticosterone (CORT), and corticotropin-release hormone (CRH) levels in rat serum. Additionally, network pharmacology was employed to predict relevant molecular targets and potential mechanisms, followed by in vivo validation. Western blot analysis was conducted to evaluate the protein levels of 5-hydroxytryptamine/serotonin receptor 1A (5-HT1A) and Glutamate (Glu)-related proteins, such as p-GluA1, GluA1, p-GluN1, GluN1, p-GluN2A and GluN2A in the hippocampus.

RESULTS

In behavioral assessments, CUMS rats exhibited depressive behaviors, which were ameliorated by CSJY or PX treatment. Moreover, CSJY or PX treatment increased serotonin (5-HT) levels. It reduced the kynurenine/tryptophan (KYN/TRP) and gamma-aminobutyric acid/glutamate (GABA/Glu) in the hippocampus and cortex, as well as reduced serum levels of ACTH, CORT and CRH. Furthermore, CSJY or PX administration enhanced the decreased expression of p-GluN1/GluN1 while upregulating 5-HT1A and p-GluA1/GluA1 levels in the CUMS group.

CONCLUSION

CSJY demonstrated the ability to alleviate depressive behaviors in CUMS-induced depression rats, potentially through the inhibition of the hypothalamic-pituitary-adrenal (HPA) axis, modulation of monoamine neurotransmitters, and glutamatergic neurons. These findings suggest that CSJY could serve as a promising treatment option for depression.

The role of circular RNAs in autoimmune diseases: Potential diagnostic biomarkers and therapeutic targets

With the emergence of high-quality sequencing technologies, further research on transcriptomes has become possible. Circular RNA (circRNA), a novel type of endogenous RNA molecule with a covalently closed circular structure through "back-splicing," is reported to be widely present in eukaryotic cells and participates mainly in regulating gene and protein expression in various ways. It is becoming a research hotspot in the non-coding RNA field. CircRNA shows close relation to several varieties of autoimmune diseases (AIDs) in both the physiological and pathological level and could potentially be used clinically in terms of diagnosis and treatment. Here, we focus on reviewing the importance of circRNA in various AIDs, with the aim of establishing new biomarkers and providing novel insights into understanding the role and functions of circRNA in AIDs. Specific signaling pathways of how circular RNAs are regulated in AIDs will also be illustrated in this review.

Based on the immune system: the role of the IL-2 family in pancreatic disease

The IL-2 family, consisting of IL-2, IL-4, IL-7, IL-9, IL-15 and IL-21, is a key regulator of the immune response. As an important endocrine and digestive organ, the function of the pancreas is regulated by the immune system. Studies have shown that each cytokine of the IL-2 family influences the occurrence and development of pancreatic diseases by participating in the regulation of the immune system. In this paper, we review the structural and functional characteristics of IL-2 family members, focus on their molecular mechanisms in pancreatic diseases including acute pancreatitis, chronic pancreatitis and pancreatic cancer, and highlight the importance of the related proteins in the regulation of immune response and disease progression, which will provide valuable insights for new biomarkers in pancreatic diseases, early diagnosis of the diseases, assessment of the disease severity, and development of new therapeutic regimens. The insights of the study are summarized in the following sections.

Targeted ErbB4 receptor activation prevents D-galactose-induced neuronal senescence via inhibiting ferroptosis pathway

Background

Neuronal senescence is a common pathological feature of various neurodegenerative diseases, with ferroptosis playing a significant role. This study aims to investigate the role of ErbB4 receptor activation in preventing D-Galactose (D-gal)-induced neuronal senescence.

Methods

Mice subjected to D-gal-induced aging were administered a small molecule ErbB4 receptor agonist (E4A), identified via virtual screening, melatonin, or a combination of both. Behavioral assessments were conducted to evaluate therapeutic efficacy in memory and cognitive functions. Immunofluorescence staining, western blot, and biochemical assays were primarily employed to assess changes in both senescence- and ferroptosis-related molecules in mouse hippocampal tissues in response to each treatment. Additionally, mouse hippocampal HT22 neuronal cell cultures were utilized to corroborate the in vivo findings.

Results

The targeted activation of ErbB4 receptor by E4A significantly ameliorated the behavioral deficits induced by D-gal in mice, demonstrating an effect comparable to that of melatonin, a natural inhibitor of in vivo senescence and ferroptosis. Both E4A and melatonin mitigated D-gal-induced aging in hippocampal neurons of mice. This was evidenced by the upregulation of Lamin B1 and the downregulation of P53, P21, P16, GFAP, and Iba-1 expression levels. Moreover, D-gal treatment markedly decreased the protein expression of the ferroptosis inhibitor Nrf2 while augmenting the expression of the ferroptosis promoter TFRC. These alterations were partially reversed by the individual administration of E4A and melatonin. In vitro studies further corroborated that D-gal treatment significantly and concurrently induced the expression of senescence markers and ferroptosis promoters. However, both E4A and melatonin were able to significantly reverse these changes. Additionally, E4A markedly ameliorated Erastin-induced ferroptosis in mouse hippocampal neuronal cells.

Conlusion

Our findings suggest that targeted activation of ErbB4 receptor may be a viable strategy for treating neuronal senescence by inhibiting ferroptosis, thereby offering a potential therapeutic avenue for senescence-associated neurodegenerative diseases.

Early management of acute caustic ingestion in pediatrics

This review is intended to provide an overview of currently available literature related to caustic ingestion in pediatric patients, including initial management considerations in symptomatic versus asymptomatic children, timing and necessity of endoscopic evaluations, and the use of various therapeutic interventions. Further, this review provides management considerations for children presenting for evaluation following caustic ingestion based on the best available evidence. Additional research is needed to develop conclusive pediatric guidelines that meet GRADE criteria for management of caustic ingestion in children.

Advances in clinical translation of stem cell-based therapy in neurological diseases

Stem cell-based therapies have raised considerable interest to develop regenerative treatment for neurological disorders with high disability. In this review, we focus on recent preclinical and clinical evidence of stem cell therapy in the treatment of degenerative neurological diseases and discuss different cell types, delivery routes and biodistribution of stem cell therapy. In addition, recent advances of mechanistic insights of stem cell therapy, including functional replacement by exogenous cells, immunomodulation and paracrine effects of stem cell therapies are also demonstrated. Finally, we also highlight the adjunction approaches that has been implemented to augment their reparative function, survival and migration to target specific tissue, including stem cell preconditioning, genetical engineering, co-transplantation and combined therapy.

Mechanistic study of the effect of a high-salt diet on the intestinal barrier

Despite the established link between chronic high salt diet (HSD) and an increase in gut inflammation, the effect of HSD on the integrity of the intestinal barrier remains understudied. The present study aims to investigate the impact of HSD on the intestinal barrier in rats, encompassing its mechanical, mucous, and immune components. Expression levels of intestinal tight junction proteins and mucin-2 (MUC2) in SD rats were analyzed using immunofluorescence. The expression area of goblet cell mucopolysaccharides was assessed through PAS staining. Additionally, serum D-lactic acid, SIgA, β-defensin, and colonic tissue cytokines were measured using ELISA. Rats fed with HSD exhibited decreased expression of tight junction proteins, particularly Occludin, resulting in impairment of the intestinal epithelial barrier and an elevated serum D-lactic acid level. Furthermore, a notable reduction in the expression of goblet cell mucopolysaccharides, along with lower β-defensin and MUC2 levels, was observed. Notably, the SIgA and immune-related cytokines were significantly reduced in the HSD group. HSD disrupts the intestinal barrier in rats, leading to increased permeability and the entry of inflammatory factors into the bloodstream. This finding suggests that HSD may contribute to the pathogenesis of various diseases.

Nephrotoxic effect of cypermethrin ameliorated by nanocurcumin through antioxidative mechanism

Cypermethrin is a pyrethroid showing nephrotoxicity by generating ROS-impaired oxidative stress and changes in inflammatory and apoptotic markers. The harmful consequences are intended to be mitigated by the imbalance between oxidants and antioxidants. The anti-inflammatory and antioxidant possessions of nanocurcumin (NC) with improved bioavailability ameliorate Cyp toxicity in rat kidneys. In our study, Group I was the control while Group II was treated alone with NC (5 mg). Group III was given 50 mg/kg of Cyp for two weeks. Groups IV, V, and VI received Cyp as in group III and co-treatment with varying NC doses after 5 days of Cyp dosing, respectively. All treatments were given orally for two weeks. After the termination of the study, LPO, 4-HNE, GSH, antioxidant catalase, and SOD were evaluated as markers of inflammation and apoptosis along with ELISA, qRT-PCR, and histopathology were used to assess morphological changes. Our work has shown that Cyp causes nephrotoxicity by altering all parameters. The Cyp-treated group was shown to have higher expression of the oxidative stress marker LPO and inflammatory interleukins as well as Bax, NF-kB, caspase-3, and caspase-9. Although LPO, inflammation, and apoptosis are reduced, antioxidant status is improved by NC.

Impact of Lupus Anticoagulant on INR Using Recombinant Prothrombin Time Reagent

BACKGROUND Lupus anticoagulants (LA) can interfere with routine coagulation tests such as the activated partial thromboplastin time (aPTT) and prothrombin time (PT). The international normalized ratio (INR) is derived from PT and is used to monitor warfarin therapy. A positive LA result is one of the laboratory criteria of the 2023 ACR/EULAR antiphospholipid syndrome (APS) classification criteria. We report a case in which LA interfered with INR measurement in an APS patient. CASE REPORT Our patient was a 45-year-old man who had experienced multiple episodes of thromboembolism. His INR was consistently high, despite not being on any anticoagulant. Our laboratory used a recombinant PT reagent, Siemens Healthineers Dade® Innovin® on a fully automated coagulometer, the Sysmex CS-2500. PT measurements were repeated using 2 different analyzers, the Sysmex CA-104 and Werfen ACL Top 550 CTS. The PT results were 40.5 s (reference range (RR): 9.3-10.8 s) and 56 s, using Sysmex CS2500 and CS104, respectively. However, the PT was 13.4 s (RI: 10.3-12.7 s) using Werfen ACL Top 550 CTS. We retested the sample using Thromborel® S, a tissue-derived PT reagent, and PT was found to be within the reference range. The patient tested positive for LA, anti-cardiolipin, and anti-beta2 glycoprotein I antibodies. CONCLUSIONS LA can falsely prolong the PT when a recombinant PT reagent is used. When we retested the plasma using a tissue-derived PT reagent - Thromborel® S - PT was within normal limits. Thus, it is important to acknowledge that LA can react differently with different PT reagents.

Perilipin2-dependent lipid droplets accumulation promotes metastasis of oral squamous cell carcinoma via epithelial-mesenchymal transition

Emerging evidence shows that lipid metabolic reprogramming plays a vital role in tumor metastasis. The effect and mechanism of fatty acids and lipid droplets (LDs), the core products of lipid metabolism, on the metastasis of oral squamous cell carcinoma (OSCC), need further exploration. In this study, the influence of palmitic acid (PA) and oleic acid (OA) on the migration and invasion ability of OSCC cells was determined by in vitro experiments. Genetic manipulation of PLIN2 was performed to explore its effect on the accumulation of LDs and OSCC metastasis. Possible mechanisms of these biological effects were clarified by detecting the levels of epithelial-mesenchymal transition (EMT) markers and phosphatidylinositol 3-kinase (PI3K) pathway proteins as well as conducting various bioinformatics analyses. The results indicated that PA/OA promoted the migration and invasion of OSCC cells and induced PLIN2-dependent LDs accumulation in vitro. Knockdown of PLIN2 inhibited the LDs accumulation and the migration and invasion of OSCC cells in vitro, while overexpression of PLIN2 enhanced those of OSCC cells in vitro and also promoted the metastasis of OSCC in vivo. Besides, PLIN2 up-regulation activated the PI3K pathway and subsequently enhanced EMT in OSCC cells in vitro. OSCC patients with higher PLIN2 expression possessed poorer prognosis and higher sensitivity to chemotherapy drugs (1S,3 R)-RSL3 and ML-210. In conclusion, PLIN2-dependent LDs accumulation could promote the metastasis of OSCC cells by regulating EMT. PLIN2 might be a potential therapeutic target for OSCC patients, especially those with obesity.

Clinical characteristics, diagnosis, treatment, and prognosis of Atezolizumab-induced encephalitis, aseptic meningitis or meningoencephalitis

Objective

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and expanded the range of tumor indications. However, as the usage of this medication has increased, related adverse events are increasingly being identified. Among these, Atezolizumab-induced encephalitis, aseptic meningitis, and meningoencephalitis remain poorly understood regarding clinical features. This study provides a comprehensive reference for classifying, identifying, and managing Atezolizumab-associated neurological adverse events, specifically encephalitis, aseptic meningitis, and meningoencephalitis.

Methods

This study systematically collected published case reports from public databases such as PubMed, Web of Science, Wanfang Database, and CNKI Database. Two independent reviewers screened titles and abstracts and then extracted data in the included article according to the designed table and analyzed the clinical characteristics of Atezolizumab-induced encephalitis, aseptic meningitis, or meningoencephalitis.

Results

A total of 17 articles were included, with 19 patients diagnosed with encephalitis, aseptic meningitis, or meningoencephalitis after Atezolizumab treatment. The most common presenting symptoms included fever, altered consciousness, fatigue, somnolence, and seizures. Diagnosis was primarily based on cerebrospinal fluid analysis, blood tests, and imaging studies, such as computed tomography (CT) scans. Treatment strategies typically involved systemic steroids, antiviral agents, antibiotics, and anti-epileptic medications, as appropriate.

Conclusion

Neurological immune-related adverse events may rapidly progress and impact prognosis. Therefore, clinical practitioners should have a deep understanding of these neurological immune-related adverse events, promptly diagnose them, and provide accurate and timely treatment.

Ginsenoside Rd protects against acute liver injury by regulating the autophagy NLRP3 inflammasome pathway

Ginsenoside Rd (Rd) is a bioactive compound predominantly found in Panax ginseng C.A. Meyer and Panax notoginseng (Burkill) F.H. Chen ex C.H. Chow, both species belonging to genus Panax in the Araliaceae family. However, its hepatic protective effect against acute liver injury and related mechanistic action remain unexplored. To investigate the protective effect of Rd against thioacetamide (TAA)-induced acute liver injury and assess its underlying regulatory mechanisms related to autophagy and inflammation. Forty-eight 8 weeks old C57BL/6 mice were treated with saline (control or model group), Rd (12.5 mg/kg, 25 mg/kg or 50 mg/kg), and diammonium glycyrrhizinate (DG, 30 mg/kg) for three days. Then the mice were stimulated with TAA to establish acute liver injury model, excluding the control group. HSC-T6 cells were treated with Rd at concentrations of 2.5, 5, or 10 µM, for 12 h with or without Lipopolysaccharide (LPS) stimulation at 100 ng/mL. Immunofluorescence staining, qPCR and Western blot were employed to analyze the expressions of genes and proteins associated with inflammation and autophagy. To validate the role of Rd in regulating autophagy and inflammation, the autophagy inducers, rapamycin and GSK621, were utilised in reverse validation experiments in cells. Rd exhibited significant hepatic protective effects in mice by reducing the serum levels of Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Glutathione S-transferase (GST) and Lactate dehydrogenase (LDH) with acute liver injury. It exhibited strong anti-inflammatory effect by reducing inflammation associated protein, such as cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), nod-like receptor protein 3 (NLRP3), associated speck-like protein containing a CARD (ASC), interleukin-18 (IL-18) and interleukin-1β(IL-1β) proteins and the mRNA expression levels of COX-2, Tumor Necrosis Factor α (TNF α), interleukin-6 (IL-6) and iNOS were decreased in liver tissue. And Rd inhibited LPS-induced inflammation by reducing the expression of COX-2 and NLRP3 in HSC-T6 cells. Moreover, not only in vivo but also in vitro, Rd downregulated the expression of LC3II, Beclin1, phosphorylation-AMP-activated protein kinase (p-AMPK), phosphorylation-ULK1 (p-ULK1) and upregulated the expression of p62 and phosphorylation-mechanistic target of rapamycin (p-mTOR) to suppress autophagy via the AMPK/mTOR/ULK1 pathway. Finally, the inhibitory effects of Rd on autophagy and inflammation in HSC-T6 cells were partially blocked by rapamycin and GSK621. Rd is a promising therapeutic agent to protect liver against TAA-induced acute liver injury by regulating the autophagy-NLRP3 inflammasome pathway.

Preoperative serum total bilirubin-albumin ratio as a prognostic indicator in patients with hepatitis-related cirrhosis after splenectomy

BACKGROUND

Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis. However, the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.

AIM

To assess the potential of preoperative total bilirubin-albumin (B/A) ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.

METHODS

A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study. Normality test, t-test, Wilcoxon test, χ 2 test, or Fisher's exact test was employed to analyze the intraoperative and postoperative conditions of the patients. Receiver operating characteristic (ROC) curve analysis was utilized to depict the 10-year overall survival rate.

RESULTS

During the follow-up period, 85.99% of the patients survived, with a median survival time of 64.6 months. Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival (P = 0.037). ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value. Consequently, the patients were categorized into two groups: High B/A group (n = 64) and low B/A group (n = 193). The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months, respectively (P = 0.045). Notably, the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group (P < 0.001). Patients with hepatocellular carcinoma (HCC) had lower overall survival rates. Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not, early Child-Pugh grade, low albumin-bilirubin grade, and model for end-stage liver disease score ≥ 10 (log-rank test, P < 0.001 for all).

CONCLUSION

The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virus-related cirrhosis following splenectomy, and a higher B/A ratio may suggest a poorer prognosis.

Dissecting Tumor Size Underestimation in Pancreatic Cancer: A Comparative Analysis of Preoperative Treatments

BACKGROUND

Tumor size (TS) in pancreatic ductal adenocarcinoma (PDAC) is one of the most important prognostic factors. However, discrepancies between TS on preoperative images (TSi) and pathological specimens (TSp) have been reported. This study aims to evaluate the factors associated with the differences between TSi and TSp.

PATIENTS AND METHODS

We retrospectively analyzed patients with PDAC who underwent surgery at our institution between January 2010 and November 2023. TS discrepancy (TSD[%]) was defined as ([TSp - TSi]/TSp) × 100. Using logistic regression, we generated a receiver operating characteristic (ROC) curve to define the cutoff for TSi underestimation predicting clinical tumor (T) stage migration. Univariate and multivariate analyses were performed to evaluate predictors of TSi underestimation.

RESULTS

Of the 231 patients, 99 (42%) patients received preoperative chemotherapy. The ROC curve determined a TSD underestimation cutoff of 25.9%. The number of TSp > TSi cases was 185 (80%), and TSi underestimation was present in 117 (51%) patients. T stage migration rates were 76%, 26%, and 50% in clinical stage (c) T1, cT2, cT3, respectively, among the patients with chemotherapy, and 93%, 33%, and 14%, respectively, in those without chemotherapy. Multivariate analyses revealed that independent predictors of TSi underestimation were posterior surface invasion in the patients with preoperative chemotherapy and anterior surface invasion in those without chemotherapy.

CONCLUSIONS

TS was more commonly underestimated than overestimated, and cT1 rarely corresponded to pathological (p)T1. The factors contributing to TSi underestimation differed between patients with and without preoperative chemotherapy. Therefore, these two groups should be considered separately for accurate TSi evaluation.

Screening Depression in Ischemic Heart Disease: Gender Differences and Psychosocial Implications Using a Self-Developed Questionnaire

Background/Objectives: Ischemic heart disease (IHD) is a major cause of morbidity and mortality worldwide, and it is frequently associated with depression, which can negatively impact both clinical outcomes and quality of life. The relationship between IHD and depression is complex, with gender differences influencing the severity of depression and willingness to seek psychological support. This study aims to evaluate the prevalence and severity of depression in IHD patients using the Depression Assessment in Ischemic Heart Disease Questionnaire (DA-IHDQ) and to explore gender differences in depression severity and help-seeking behavior. Methods: This cross-sectional study involved 103 patients diagnosed with IHD (62 males, 41 females), with data collected from two general practice clinics in Arad, Romania, between November 2023 and November 2024. Participants completed the DA-IHDQ, a self-developed questionnaire designed to screen for depression in IHD patients. The questionnaire categorizes depression severity into four grades: minimal to no depression, mild depression, moderate depression, and severe depression. The study also assessed participants' interest in receiving psychological support. Descriptive and inferential statistical analyses were performed, and the psychometric properties of DA-IHDQ, including its reliability (Cronbach's α = 0.957) and diagnostic accuracy (sensitivity = 90.0%, specificity = 98.8%), were evaluated. Results: Mild depression was the most common grade in both male and female IHD patients, while severe depression was the least prevalent. Males had a higher overall frequency of depression, with more cases of mild depression, whereas females had a higher proportion of moderate and severe depression. Additionally, males demonstrated significantly lower interest in psychological or psychiatric help, while females showed greater willingness to seek mental health support. The DA-IHDQ exhibited strong internal consistency and high diagnostic accuracy in identifying depressive symptoms in IHD patients. The DA-IHDQ exhibited strong internal consistency and high diagnostic accuracy in identifying depressive symptoms in IHD patients. Conclusions: The findings highlight the high prevalence of depression in IHD patients and the gender disparities in mental health engagement, emphasizing the need for targeted psychological interventions. The DA-IHDQ demonstrated strong psychometric properties and could serve as an effective screening tool for depression in IHD care. The DA-IHDQ demonstrated strong psychometric properties and could serve as an effective screening tool for depression in IHD care. Future research should explore the barriers to help-seeking among male IHD patients and develop gender-sensitive strategies to improve access to mental health services.

Clinical observation on prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation

BACKGROUND

A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.

AIM

To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation (RPH).

METHODS

A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group (n = 50) and the treatment group (n = 50) by rolling the dice. The procedure for prolapse and hemorrhoids (PPH) was adopted in the control group, while polidocanol foam injection + RPH was adopted in the treatment group. The therapeutic effects, operation time, wound healing time, hospital stay, pain situation (24 hours post-operative pain score, first defecation pain score), quality of life (QOL), incidence of complications (post-operative hemorrhage, edema, infection), incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.

RESULTS

Compared with the control group, the total effective rate of treatment group was higher, and the difference was significant (P < 0.05). The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group (P < 0.05). The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group (P < 0.05). After surgery, the QOL scores of the two groups decreased, with the treatment group having higher scores than that of the control group (P < 0.05). Compared with the control group, the incidence of postoperative complications in the treatment group was lower, and the difference was significant (P < 0.05); However, there was no significant difference in the incidence of postoperative bleeding between the two groups (P > 0.05); There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups (P > 0.05).

CONCLUSION

For patients with mixed hemorrhoids, the therapeutic effect achieved by using polidocanol injection combined with RPH was better. The wounds of the patients healed faster, the postoperative pain was milder, QOL improved, and the incidence of complications was lower, and the short-term and long-term prognosis was good.

Efficacy of dietary modifications and mucosal protectors in the treatment of laryngopharyngeal reflux: a multicenter study

Background

Laryngopharyngeal reflux (LPR) is defined as an extraesophageal reflux of gastroduodenal contents to the laryngopharynx, affecting the upper aerodigestive tract. There is currently no standardized treatment protocol for LPR. The use of proton pump inhibitors (PPIs) is widely established in common practice and derives from the standard approach of using PPIs to treat patients with gastroesophageal reflux disease (GERD). However, as PPIs may not be effective on all types of reflux, the aim of our study was to evaluate the effectiveness of dietary changes and mucosal protectants, alone or in combination, in LPR treatment.

Methods

This multicenter randomized controlled trial included 48 patients divided into three groups: dietary modifications only, mucosal protectors only, and a combination of both. The patients' responses were assessed over 1 month using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS), along with measurements of salivary and nasal pepsin concentration and rhinomanometry.

Results

Significant improvements were observed in RSI and RFS scores across all groups. The group receiving combined dietary modifications and mucosal protectors showed the most substantial benefits. Additionally, a notable reduction in salivary and nasal pepsin concentrations and nasal resistances was observed, particularly in patients combining dietary modifications and mucosal protectors.

Conclusion

The study showed that combined dietary modifications and mucosal protects strategies effectively manage LPR symptoms, offering a potential therapeutic approach.

Serum KNG and FVIII may serve as potential biomarkers for depression

BACKGROUND

The global burden of major depressive disorder (MDD) is rising, with current diagnostic methods hindered by significant subjectivity and low inter-rater reliability. Several studies have implied underlying link between coagulation-related proteins, such as kininogen (KNG) and coagulation factor VIII (FVIII), and depressive symptoms, offering new insights into the exploration of depression biomarkers. This study aims to elucidate the roles of KNG and FVIII in depression, potentially providing a foundational basis for biomarker research in this field.

METHODS

A three-part experiment was conducted: (1) we measured serum levels of KNG and FVIII in the chronic unpredictable mild stress (CUMS) model; (2) KNG adeno-associated-virus overexpression (KNG-AAV-OE) model was constructed to further investigate the roles of KNG and FVIII. Meanwhile, quantity PCR, western blotting and immunofluorescence staining detected the KNG-FVIII pathway. (3) Peripheral blood samples were gathered from healthy control (HC, N = 21), as well as first-episode drug-naive patients with MDD (FEDN-MDD, N = 21), to further confirm the association between KNG, FVIII and depression.

RESULTS

Firstly, serum KNG and FVIII levels were significantly elevated in the CUMS model. Then, the rats exhibited pronounced depressive-like behaviors in the KNG-AAV-OE model, with corresponding increases in serum KNG and FVIII. Lastly, clinical data showed increased KNG and FVIII levels in FEDN-MDD compared to HC. Furthermore, KNG and FVIII levels exhibited a strong positive correlation with the scores of the 24-item Hamilton Depression Scale and the 14-item Hamilton Anxiety Scale.

CONCLUSION

To sum up, this study highlights critical roles of serum KNG and FVIII in depression and the KNG-AAV-OE may lead the augment of FVIII in serum. Consequently, our research may offer new evidence and foundation for depression biomarkers research in the future.

UHRF1 promotes epithelial-mesenchymal transition mediating renal fibrosis by activating the TGF-β/SMAD signaling pathway

Renal fibrosis is widely recognized as the ultimate outcome of many chronic kidney diseases. The process of epithelial-mesenchymal transition (EMT) plays a critical role in the progression of fibrosis following renal injury. UHRF1, as a critical epigenetic regulator, may play an essential role in the pathogenesis and progression of renal fibrosis and EMT. However, the potential mechanisms remain to be elucidated. We aim to investigate the role of UHRF1 in EMT and renal fibrosis and to evaluate the potential benefits of Hinokitiol in preventing renal fibrosis. Based on data from the GEO and Nephroseq databases, UHRF1 exhibited high expression levels in the unilateral ureteral obstruction (UUO) model and in patients with nephropathy. Gene set enrichment analysis predicted that UHRF1 may function through the TGF-β signaling pathway in fibrosis. By establishing a TGF-β1-stimulated HK2 cell model and animal models of renal fibrosis induced by UUO and folic acid, we confirmed that UHRF1 was highly expressed in both in vitro and in vivo models of renal fibrosis. After knockdown of UHRF1 in vitro, we found that the TGF-β/SMAD signaling pathway was inhibited, renal tubular epithelial cell EMT was reduced and renal fibrosis was attenuated. Hinokitiol has been reported to reduce the expression of UHRF1 mRNA and protein. We observed that inhibition of UHRF1 with Hinokitiol ameliorated induced EMT and renal fibrosis by reducing SMAD2/3 phosphorylation in vivo and in vitro. Taken together, our data demonstrated that the upregulation of UHRF1 accelerated the EMT of renal tubular cells and renal fibrosis through the TGF-β/SMAD signaling pathway. Hinokitiol may ameliorate renal fibrosis by suppressing the expression of UHRF1 in the kidney.

Airway Colonization in Children with Medical Complexity: Challenges and Management Strategies

Over recent years, advances in medical care have significantly improved the survival of children with severe chronic conditions. These children, referred to as children with medical complexity (CMC), present unique and demanding healthcare challenges. Although definitions of CMC remain inconsistent, these patients are typically characterized by chronic, often severe conditions requiring daily specialized treatments and the use of various medical devices. CMC represent a substantial burden for healthcare systems due to their high medical costs, and place considerable strain on caregivers, who must provide continuous assistance. Airway colonization by pathogens such as Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), and Haemophilus influenzae is common in CMC and contributes to recurrent respiratory infections, increased hospitalizations, and progressive lung damage. The management of airway colonization in this population is a topic of ongoing debate, often involving a combination of airway clearance techniques (ACT) and antibiotic therapies. Antibiotics may be administered systemically, nebulized, or in combination, depending on the clinical context and severity of the condition. This review highlights the complexities of managing airway colonization in CMC, emphasizing the need for tailored therapeutic approaches to mitigate respiratory complications and improve outcomes.

Pharmaco-Multiomics: A New Frontier in Precision Psychiatry

The landscape of psychiatric care is poised for transformation through the integration of pharmaco-multiomics, encompassing genomics, proteomics, metabolomics, transcriptomics, epigenomics, and microbiomics. This review discusses how these approaches can revolutionize personalized treatment strategies in psychiatry by providing a nuanced understanding of the molecular bases of psychiatric disorders and individual pharmacotherapy responses. With nearly one billion affected individuals globally, the shortcomings of traditional treatments, characterized by inconsistent efficacy and frequent adverse effects, are increasingly evident. Advanced computational technologies such as artificial intelligence (AI) and machine learning (ML) play crucial roles in processing and integrating complex omics data, enhancing predictive accuracy, and creating tailored therapeutic strategies. To effectively harness the potential of pharmaco-multiomics approaches in psychiatry, it is crucial to address challenges such as high costs, technological demands, and disparate healthcare systems. Additionally, navigating stringent ethical considerations, including data security, potential discrimination, and ensuring equitable access, is essential for the full realization of this approach. This process requires ongoing validation and comprehensive integration efforts. By analyzing recent advances and elucidating how different omic dimensions contribute to therapeutic customization, this review aims to highlight the promising role of pharmaco-multiomics in enhancing patient outcomes and shifting psychiatric treatments from a one-size-fits-all approach towards a more precise and patient-centered model of care.

Patient-reported outcomes in mothers with chronic hepatitis B infection: A cross-sectional analysis

BACKGROUND & AIMS

The health-related quality of life (HRQoL) during pregnancy has not been well-lidated in mothers with chronic hepatitis B (CHB). We aim to compare patient-reported outcomes (PROs) in CHB mothers with those of healthy mothers during pregnancy.

METHODS

Between 4/16/2023 and 7/31/2023, we invited consecutive CHB and healthy mothers to complete the self-administered 36-item Short Form Survey (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) for PRO assessment. Pairwise comparisons of PRO scores between groups were performed using chi-square tests. Covariates for worse PROs were further analyzed by the multiple linear regression model to identify the independent predictors RESULTS: Among 257 participants (CHB: healthy control was 100:157), the mean (SD) age was 29.6 (3.4), and the majority completed the PRO assessment at the gestational weeks of 16-24. When compared to healthy mothers, CHB mothers had a significant impairment of PROs in the CLDQ domain of worry (6.97±0.16 vs 5.83±0.99, p<0.05) and the SF-36 domain of social functioning (95.33±10.00 vs 91.67±16.37, p<0.05). The subgroup analyses in CHB mothers showed HBV DNA >200,000 IU/mL associated with significantly worse PROs. The multivariate analyses identified CHB infection, severe nausea or vomiting, poor living conditions, and spousal negative attitude as independent predictors of HRQoL impairment.

CONCLUSION

This study suggests that CHB infection during pregnancy negatively impacted HRQoL, particularly in worry and social functioning domains. CHB infection was an independent predictor for PRO impairments. Further integration of monitoring and intervention on HRQoL impairment should be considered when managing CHB mothers during pregnancy.

The oxygen level in air directs airway epithelial cell differentiation by controlling mitochondrial citrate export

Oxygen controls most metazoan metabolism, yet in mammals, tissue O2 levels vary widely. While extensive research has explored cellular responses to hypoxia, understanding how cells respond to physiologically high O2 levels remains uncertain. To address this problem, we investigated respiratory epithelia as their contact with air exposes them to some of the highest O2 levels in the body. We asked how the O2 level in air controls differentiation of airway basal stem cells into the ciliated epithelial cells essential for clearing airborne pathogens from the lung. Through a metabolomics screen and 13C tracing on primary cultures of human airway basal cells, we found that the O2 level in air directs ciliated cell differentiation by increasing mitochondrial citrate export. Unexpectedly, disrupting mitochondrial citrate export elicited hypoxia transcriptional responses independently of HIF1α stabilization and at O2 levels that would be hyperoxic for most tissues. These findings identify mitochondrial citrate export as a cellular mechanism for responding to physiologically high O2 levels.

Prevalence of accessory navicular in Japanese children: A cross-sectional study using ultrasound-Katsuragi Integrated Defense for Locomotive Syndrome in children study

The accessory navicular (AN) is an accessory bone located on the posteromedial aspect of the navicular tuberosity that can cause pain following overuse or trauma, particularly during childhood. However, the detailed epidemiological characteristics of AN in children have not been well studied. This study aimed to clarify the prevalence of AN and painful AN among Japanese children by examining the characteristics according to sex and age. This cross-sectional study used data from the Katsuragi Integrated Defense for Locomotive Syndrome in Children Study, focusing on musculoskeletal disorders in 875 children aged 6-15 years, with 1750 feet being assessed. Children were divided into five age groups: 6-7, 8-9, 10-11, 12-13, and 14-15. AN was detected using ultrasound to avoid radiation exposure. The sex- and age-group-dependent prevalence of AN and painful AN were calculated, and statistical analyses examined sex differences in prevalence by age group. The overall prevalence of AN was 15.1%, higher in females (17.9%) than in males (12.3%). The prevalence of AN increased with age in both sexes. Among cases diagnosed with AN, 20.8% were symptomatic, with a unimodal peak observed at ages 12-13 in males and 10-11 in females. No statistically significant differences were observed in the proportion of painful AN between sexes. This is the first large-scale epidemiological study on AN in children. The overall prevalence of AN was 15.1%, higher in females than in males. Additionally, 20.8% of patients with AN experienced pain. The results of this study provide important epidemiological data to support clinical management strategies for pediatric patients with AN.

Single-cell differential detergent fractionation for detection of cytokeratin 8 proteoforms

Simultaneous profiling of proteoforms and nucleic acids at the single-cell level, i.e., multi omics, directly links the central dogma. However, current single-cell approaches are limited in their ability to identify proteoforms while preserving the nucleus for further analysis. This limitation is especially pronounced in proteins where their proteoforms present diverse biological functions such as cytokeratin 8 (CK8), which, while commonly known for its structural role, is also involved in several diseases. Here, we present a single-cell western blot (scWB) integrated with differential detergent fractionation (DDF) to selectively solubilize and separate CK8 proteoforms while preserving nuclear integrity for subsequent nucleus-based assays. We report on assay development, including screening a panel of lysis buffers based on nonionic detergents and electrophoresis conditions to achieve a separation resolution between two proteoforms of up to 0.94 with an electric field of 30 V/cm, while preserving an intact nucleus. The cytoplasm-specific lysis approach (DDF buffer) demonstrated comparable solubilization efficiency to whole-cell solubilization (RIPA buffer), achieving proteoform solubilization in 14.3% and 10.3% of solubilized cells using DDF and RIPA buffers, respectively, while keeping the nucleus intact. To understand the broad applicability of the assay conditions, we scrutinized electrophoresis performance for resolving CK8 proteoforms across a panel of widely used breast cancer cell lines (MCF7, SKBR3, and MDA-MB-231), showing presence of proteoforms only in MCF7. Our approach allows for tailored solubilization, achieving reliable proteoform detection and nuclear retention across different cell types. Proteoform profiling at the single-cell level forms a basis for the exploration of the role of specific CK8 molecular forms in cellular processes.

Curcumin: A Potential Detoxifier Against Chemical and Natural Toxicants

The human body gets exposed to a variety of toxins intentionally or unintentionally on a regular basis from sources such as air, water, food, and soil. Certain toxins can be synthetic, while some are biological. The toxins affect the various parts of the body by activating numerous pro-inflammatory markers, like oxidative stresses, that tend to disturb the normal function of the organs ultimately. Nowadays, people use different types of herbal treatments, viz., herbal drinks that contain different spices for detoxification of their bodies. One such example is turmeric, the most commonly available spice in the kitchen and used across all kinds of households. Turmeric contains curcumin, which is a natural polyphenol. Curcumin is a medicinal compound with different biological activities, such as antioxidant, antineoplastic, anti-inflammatory, and antibacterial. Hence, this review gives a comprehensive insight into the promising potential of curcumin in the detoxification of heavy metals, carbon tetrachloride, drugs, alcohol, acrylamide, mycotoxins, nicotine, and plastics. The review encompasses diverse animal-based studies portraying curcumin's role in nullifying the different toxic effects in various organs of the body (especially the liver, kidney, testicles, and brain) by enhancing defensive signaling pathways, improving antioxidant enzyme levels, inhibiting pro-inflammatory markers activities and so on. Furthermore, this review also argues over curcumin's safety assessment for its utilization as a detoxifying agent.

Characterization and Proteomic Profiling of Hepatocyte-like Cells Derived from Human Wharton's Jelly Mesenchymal Stromal Cells: De Novo Expression of Liver-Specific Enzymes

End-stage liver disease (ESLD), affecting millions worldwide, represents a challenging issue for clinical research and global public health. Liver transplantation is the gold standard therapeutic approach but shows some drawbacks. Hepatocyte transplantation could be a reliable alternative for patient treatment. Mesenchymal stromal cells derived from Wharton's jelly of the umbilical cord (WJ-MSCs) can differentiate into hepatocyte-like cells (HLCs) and show immunomodulatory functions. Due to the increasing demand for fully characterized cell therapy vehicles warranting both the safety and efficacy of treatments, in this work, we extensively characterized WJ-MSCs before and after the application of a hepatocyte-directed differentiation protocol. HLCs exhibited a morphology resembling that of hepatocytes, expressed early and late hepatic markers (α-fetoprotein, albumin, CK18, HNF4-α), and acquired hepatic functions (glycogen synthesis, xenobiotics detoxification), as also revealed by the shotgun proteomics approach. HLCs maintained the same pattern of immunomodulatory molecule expression and mesenchymal markers, other than displaying specific enzymes, suggesting these cells as promising candidates for cellular therapy of ESLD. Our work shed new light on the basic biology of HLCs, suggesting new therapeutic approaches to treat ESLD.

Primary and Specialty Palliative Care Utilization at a Regional Burn Center

There is little research informing appropriate specialty palliative care consultation over primary palliative care practice, or the ability of the burn surgeon to perform skills such as effective goals of care discussions. We sought to characterize patterns of palliative care utilization and hypothesized that greater modified Baux (mBaux) and systemic organ failure assessment (SOFA) scores would correlate with increased specialty palliative involvement but have no relationship with primary palliative involvement. A retrospective chart review was conducted at a regional burn center between 2020 and 2021 including patients admitted with burns or inhalation injury and a mBaux score over 60, detailing circumstances of palliative consultation and goals of care discussions. A total of 163 patients met the criteria. The odds of specialty palliative consultation increased by 3.9% for each additional mBaux score point and 23.3% for every SOFA score point. The odds of goals of care discussion by a burn surgeon increased by 3.5% for each mBaux score point and 23.9% for each SOFA score point. Those receiving palliative consultation tended to have greater burn surface area, graft complications, code status changes, and more goals of care discussions by any provider at admission; there was no difference in symptom control or hospital length of stay. Higher mBaux and SOFA scores correlate with increased odds of both specialty and primary palliative involvement in our cohort. There is bias in diverting both primary and specialty palliative care resources toward acutely ill patients and those with less immediate projected mortality may need additional attention.

Integrated analysis of miRNA and mRNA expression profiles in the bursa of Fabricius of specific pathogen-free chickens infected with avian reticuloendotheliosis virus strain SNV

Reticuloendotheliosis virus (REV) is a gamma retrovirus that can cause immunosuppression, dwarf syndrome and acute reticulocytoma in poultry. The molecular mechanism by which REV infection leads to immunosuppression and tumorigenesis is poorly understood. In this study, we elucidated the regulatory network of miRNA-mRNA and the major signaling pathways involved in REV-SNV infection. Therefore, we used the spleen necrosis virus (SNV) model of REV to inoculate one-day-old specific pathogen-free (SPF) chickens and then performed global miRNA and mRNA expression profiling by conducting high-throughput sequencing of 18 bursa of Fabricius samples collected at 7, 14, and 21 dpi. In total, 213 differentially expressed miRNAs (DEMs) and 3311 differentially expressed genes (DEGs) were identified. In the miRNA-mRNA network constructed based on the association analysis of these DEMs and DEGs, 1376 negatively correlated miRNA-mRNA pairs were identified; among them, 82 pairs were identified at 7 dpi, 203 pairs were identified at 14 dpi, and 873 pairs were identified at 21 dpi. Moreover, the results of the Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the mRNAs in the network revealed greater enrichment of immune-related pathways, such as the immune system, signal transduction, cell growth and death, and signaling molecules and interactions. We confirmed the selected immune-related DEMs and their DEGs by conducting quantitative RT-PCR (qRT-PCR) analysis. These findings increased our understanding of the interactions of miRNAs and their target genes during infection with REV-SNV, and contributed to the understanding of host-virus interactions.

Membrane drug transporters in cancer: From chemoresistance mechanism to therapeutic strategies

Chemoresistance is a multifactorial phenomenon and the primary cause to the ineffectiveness of oncotherapy and cancer recurrence. Membrane drug transporters are crucial for drug delivery and disposition in cancer cells. Changes in the expression and functionality of these transporters lead to decreased intracellular accumulation and reduced toxicity of antineoplastic drugs. As the mechanism has been better understood and genetic engineering technology progressed quickly in recent years, some novel targeting strategies have come to light. This article summarizes the regulatory mechanisms of membrane drug transporters and provides an extensive review of current approaches to address transporters-mediated chemoresistance. These strategies include the use of chemical inhibitors to block efflux transporters, the development of copper chelators to enhance platinum drug uptake, the delivery of genetic drugs to alter transporter expression, the regulation of transcription and post-translational modifications. Additionally, we provide information of the clinical trial performance of the related targeting strategies, along with the ongoing challenges. Even though some clinical trials failed due to unexpected side effects and limited therapeutic efficacy, the advent of targeting membrane drug transporters still presents a hopeful path for overcoming chemoresistance.

Radiomics for prediction of perineural invasion in colorectal cancer: a systematic review and meta-analysis

BACKGROUND

Perineural invasion (PNI) in colorectal cancer (CRC) is a significant prognostic factor associated with poor outcomes. Radiomics, which involves extracting quantitative features from medical imaging, has emerged as a potential tool for predicting PNI. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of radiomics models in predicting PNI in CRC.

METHODS

A comprehensive literature search was conducted across PubMed, Embase, and Web of Science for studies published up to July 28, 2024. Inclusion criteria focused on studies using radiomics models to predict PNI in CRC with sufficient data to construct diagnostic accuracy metrics. The quality of the included studies was assessed using QUADAS-2 and METRICS tools. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated. Subgroup analyses were performed based on imaging modalities, segmentation methods, and other variables.

RESULTS

Twelve studies comprising 2853 patients were included in the systematic review, with ten studies contributing to the meta-analysis. The pooled sensitivity and specificity for radiomics models in predicting PNI were 0.74 (95% CI: 0.63-0.82) and 0.85 (95% CI: 0.79-0.90), respectively, in the training cohorts. In the validation cohorts, the sensitivity was 0.65 (95% CI: 0.57-0.72), and specificity was 0.85 (95% CI: 0.81-0.89). The AUC was 0.87 (95% CI: 0.63-0.82) for the training cohorts and 0.84 (95% CI: 0.81-0.87) for the validation cohorts, indicating good diagnostic accuracy. The METRICS scores for the included studies ranged from 65.8 to 85.1%, with an overall average score of 67.25%, reflecting good methodological quality. However, significant heterogeneity was observed across studies, particularly in sensitivity and specificity estimates.

CONCLUSION

Radiomics models show promise as a non-invasive tool for predicting PNI in CRC, with moderate to good diagnostic accuracy. However, the current study's limitations, including reliance on retrospective data, geographic concentration in China, and methodological variability, suggest that further research is needed. Future studies should focus on prospective designs, standardization of methodologies, and the integration of advanced machine-learning techniques to improve the clinical applicability and reliability of radiomics models in CRC management.