The role of serum inflammatory markers in determining the severity of cervical lesions

OBJECTIVE

To evaluate the role of serum inflammatory markers in determining colposcopy indications more accurately, reducing unnecessary colposcopy requests, and preventing overtreatment.

MATERIALS AND METHODS

In our study, the data of 218 patients who were followed up in our hospital's oncology outpatient clinic between April 2017 and November 2023 and who underwent colposcopy and biopsy for suspected cervical lesions due to Papanicolaou smear test abnormalities or the presence of human papillomavirus were evaluated retrospectively. The parameters of patients with and without cervical lesions were compared. Patients with cervical lesions were compared according to lesion type.

RESULTS

Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio levels were significantly higher in the cervical lesions (+) group compared with the cervical lesions (-) (p < 0.001 and p < 0.001, respectively). Systemic immuno-inflammation index and systemic inflammatory response index levels were significantly higher in the cervical lesions (+) group compared with the cervical lesions (-) group (p < 0.001 and p < 0.001, respectively). Mean platelet volume level was significantly lower in the cervical lesions (+) group compared with the cervical lesions (-) group (p < 0.001). In the group with cervical lesions, no significant relationship was found between the severity of the cervical lesions and serum inflammatory marker levels.

CONCLUSION

According to the results of our study, although there were significant differences between the serum inflammatory marker levels of patients with and without cervical lesions, their importance in predicting cervical lesions could not be clearly demonstrated. The importance of serum inflammatory markers should be evaluated in prospective studies with larger patient numbers and longer follow-up periods.

Evaluating Artificial Intelligence Chatbots in Oral and Maxillofacial Surgery Board Exams: Performance and Potential

BACKGROUND

While artificial intelligence has significantly impacted medicine, the application of large language models (LLMs) in oral and maxillofacial surgery (OMS) remains underexplored.

PURPOSE

This study aimed to measure and compare the accuracy of 4 leading LLMs on OMS board examination questions and to identify specific areas for improvement.

STUDY DESIGN, SETTING, AND SAMPLE

An in-silico cross-sectional study was conducted to evaluate 4 artificial intelligence chatbots on 714 OMS board examination questions.

PREDICTOR VARIABLE

The predictor variable was the LLM used - LLM 1 (Generative Pretrained Transformer 4o [GPT-4o], OpenAI, San Francisco, CA), LLM 2 (Generative Pretrained Transformer 3.5 [GPT-3.5], OpenAI, San Francisco, CA), LLM 3 (Gemini, Google, Mountain View, CA), and LLM 4 (Copilot, Microsoft, Redmond, WA).

MAIN OUTCOME VARIABLES

The primary outcome variable was accuracy, defined as the percentage of correct answers provided by each LLM. Secondary outcomes included the LLMs' ability to correct errors on subsequent attempts and their performance across 11 specific OMS subject domains: medicine and anesthesia, dentoalveolar and implant surgery, maxillofacial trauma, maxillofacial infections, maxillofacial pathology, salivary glands, oncology, maxillofacial reconstruction, temporomandibular joint anatomy and pathology, craniofacial and clefts, and orthognathic surgery.

COVARIATES

No additional covariates were considered.

ANALYSES

Statistical analysis included one-way ANOVA and post hoc Tukey honest significant difference (HSD) to compare performance across chatbots. χ2 tests were used to assess response consistency and error correction, with statistical significance set at P < .05.

RESULTS

LLM 1 achieved the highest accuracy with an average score of 83.69%, statistically significantly outperforming LLM 3 (66.85%, P = .002), LLM 2 (64.83%, P = .001), and LLM 4 (62.18%, P < .001). Across the 11 OMS subject domains, LLM 1 consistently had the highest accuracy rates. LLM 1 also corrected 98.2% of errors, while LLM 2 corrected 93.44%, both statistically significantly higher than LLM 4 (29.26%) and LLM 3 (70.71%) (P < .001).

CONCLUSION AND RELEVANCE

LLM 1 (GPT-4o) significantly outperformed other models in both accuracy and error correction, indicating its strong potential as a tool for enhancing OMS education. However, the variability in performance across different domains highlights the need for ongoing refinement and continued evaluation to integrate these LLMs more effectively into the OMS field.

Impact of Clinicopathological Features on Gastric Cancer Stage According to TNM Classification

BACKGROUND/AIM

TNM stage is crucial for patients with gastric cancer because curative resection and treatment are only possible in early TNM stages. Therefore, our objective was to assess the association of clinicopathological features with TNM stage in such patients.

PATIENTS AND METHODS

The association of age, sex, tumor location and Lauren type with TNM stage was analyzed in 910 patients with gastric cancer.

RESULTS

Age, sex, and tumor location did not have any association with TNM stage in univariate nor multivariate analyses (p>0.05). However, compared to the diffuse and mixed types, the intestinal type (as defined by the Lauren classification) presented lower T stage of gastric cancer in the chi-squared test (p<0.001) and this association was confirmed in the multinominal log normal model (p=0.001).

CONCLUSION

The histological Lauren type of gastric cancer is associated with lower TNM T stage.

Cost-effectiveness of an outreach program for HCC screening in patients with cirrhosis: a microsimulation modeling study

Background

Patients with cirrhosis are at high risk for hepatocellular carcinoma (HCC), but few undergo guideline-recommended semi-annual screening. Randomized clinical trials (RCTs) demonstrate that mailed outreach can increase screening versus visit-based screening. We estimated the costs and cost-effectiveness of an outreach strategy versus usual care.

Methods

We built a 10-year Markov chain Monte Carlo microsimulation model to conduct a cost-effectiveness analysis comparing a mailed outreach program versus usual care for HCC screening in a cohort of 10,000 patients with cirrhosis. Model inputs were based on literature review (2005-current), and costs were based on inflation-adjusted estimates from Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data. We conducted one-way sensitivity analyses for HCC incidence, outreach costs, efficacy of the outreach strategy to increase screening, and efficacy of curative (versus palliative) HCC treatments.

Findings

Mailed outreach was estimated to cost $32.45 per patient in the first year and $21.90 per patient in subsequent years. The outreach program increased the number of HCC patients detected at an early stage by 48.4% and increased quality-adjusted life years (QALYs) by 300. Cost savings from these increases offset the costs of mailed outreach. Mailed outreach remained cost-effective across a wide range of HCC incidence rates, outreach costs, efficacy of the outreach strategy to increase screening, and the efficacy of curative HCC treatments. Annual out-of-pocket patient costs in the outreach arm were low at $13 per year.

Interpretation

Mailed outreach to encourage HCC screening in patients with cirrhosis dominates usual care and should be considered for implementation in routine practice.

Funding

National Cancer Institute and Cancer Prevention Research Institute of Texas.

Disorders of gut-brain interaction through the lens of polyvagal theory

This paper introduces a metric capable of tracking a hypothetical brainstem "switching" mechanism involved in regulating the afferent influence of blood pressure on the vagal efferent control of heart rate. In theory, this metric could be applied to evaluate the "efficiency" of brainstem pathways involved in common mechanisms of autonomic function involving the vagal influences on the gut as well as the heart. Thus, by exploring the dynamic "efficiency" of the brainstem feedback circuit linking heart rate to posture, a clinically relevant index of vagal flexibility might be extracted that would provide a generalizable window into the vagal regulation of both the heart and gut. Recent research supports this contention and has documented that this metric, VE, appears to covary with disorders of the gut. Clinical application of this metric might identify individual vulnerabilities that frequently reflect symptoms assumed to have features of a dysregulated autonomic nervous system (i.e., dysautonomia). If this is confirmed by additional research, then this objective measure of neural regulation of autonomic function might provide insight into the pathogenesis of disorders of gut-brain interaction.

Effect of pet therapy on sleep and life quality of elderly individuals

AIM

The study aimed to determine the sleep and life quality of elderly individuals living in a nursing home using pet therapy, a complementary and supportive therapy.

METHODS

The study was conducted with elderly individuals in a nursing home in Tokat province in Turkey. The study sample consisted of 59 elderly individuals, with 30 in the intervention group and 29 in the control group, who met the inclusion criteria. Pet therapy was applied to elderly individuals twice a week for 6 weeks for a total of 12 sessions as a randomized controlled trial to determine the effect of pet therapy on sleep and life quality. While pet therapy was applied to the individuals in the intervention group, the control group was no pet theraphy.

RESULTS

It was determined that the sleep and life quality of the individuals in the intervention group increased statistically and significantly. There was no statistically significant difference in the change in sleep and life quality of individuals in the control group. A statistically significant difference was determined between the intervention and control groups regarding sleep and life quality.

CONCLUSION

Pet therapy was determined to significantly improve the sleep and life quality of elderly individuals living in a nursing home. Geriatr Gerontol Int 2025; 25: 356-365.

Molecular detection and phylogenetic analysis of microsporidia in stool specimens isolated from multiple sclerosis patients in the west of Iran

BACKGROUND

Intestinal microsporidiosis is an emerging opportunistic infection that primarily affects individuals with compromised immune systems. This study investigated intestinal microsporidia infections in individuals diagnosed with multiple sclerosis (MS) and elucidated the genetic diversity and evolutionary relationships of microsporidia.

METHODS

A total of 116 stool samples were collected from individuals diagnosed with MS, including 54 men and 63 women, during 2022-2023 in Kurdistan Province, western Iran. The mean age of the participants was 38.28 ± 7.8 years. RNA extraction was performed, followed by amplification of the small subunit ribosomal RNA (SSU rRNA) to identify and characterize microsporidia and their associated genetic markers. A phylogenetic tree was constructed using MEGA X software to explore the evolutionary relationships among the isolates.

RESULTS

PCR revealed Enterocytozoon bieneusi in 5 of 116 samples (4.3 %), whereas no positive cases of Encephalitozoon species were detected. Additionally, no statistically significant associations were observed between the presence of microsporidia and variables such as age, sex, or geographic region.

CONCLUSION

This study highlights the clinical significance of Enterocytozoon bieneusi in immunocompromised populations, particularly in patients with multiple sclerosis (MS). The findings underscore the potential role of zoonotic transmission and highlight the urgent need for enhanced diagnostic capabilities and preventive strategies to combat intestinal microsporidiosis in vulnerable groups, particularly in regions such as western Iran.

Biosocial Determinants of Health Among Patients with Chronic Liver Disease and Liver Cancer

BACKGROUND

Metabolic disorders and chronic liver disease (CLD) play crucial roles in the development and progression of liver cancer (LC). Since the ethnic minority population increasingly suffers from CLD and LC, it is vital to understand the biosocial factors contributing to CLD and LC. The 'All of Us' database, with significant participation from minority populations, provides a valuable tool for studies in different racial/ethnic groups. Using different databases, including the 'All of Us' and 'The Cancer Genome Atlas', this study aimed to understand the biosocial factors contributing to CLD and LC.

METHODS

Using 'All of Us' data, confounding factors like the lack of immunization, comorbidities, and socioeconomic status (SES) barriers were analyzed in a cohort of 33767 CLD [non-alcoholic fatty liver disease, alcoholic liver disease, and Hepatitis B and C] patients. Among the 556 LC patients in the 'All of Us' database, 92% had CLD. Since hypoxanthine is known to be increased in the urine of LC patients, purine metabolic pathway genes were analyzed using different databases and validated using publicly available RNASeq data.

RESULTS

We identified several confounding factors associated with CLD in Hispanic (HA) and African American (AA) populations compared to the non-Hispanic White (NHW) populations. HA and AA CLD patients suffer from high SES barriers. While most of the genes related to the purine metabolic pathway were upregulated in LC, xanthine dehydrogenase (XDH), which converts hypoxanthine to uric acid, showed a downregulation in the tumor compared to the normal tissues. The TCGA data among different racial/ethnic groups showed that only in Asian (AN) LC tumors the XDH expression was significantly lower compared to the NHW. The decreased XDH mRNA expression in AN LC compared to benign tissues was further validated using publicly available RNAseq datasets. Survival analysis confirmed poor overall survival among the AN LC patients with lower XDH expression in their tumors.

CONCLUSIONS

Our study identified several confounding factors contributing to the minority CLD population. This study also identified decreased XDH expression as a critical metabolic alteration that has clinical significance in AN LC patients.

The crucial role of hypertension in determining latent classes of metabolic syndrome in northern Iran and predictive power of these classes in non-alcoholic fatty liver: a gender-based insight

Introduction

This study investigates the subclasses of metabolic syndrome (Mets) and their relationship with non-alcoholic fatty liver (NAFLD) and the probable predictive role of serum vitamin D and CRP levels.

Methods

This community-based, cross-sectional study was performed on adults in the framework of the Amol cohort prospective study (AmolCPS). Mets was defined as Adult Treatment Panel III criteria (ATP III) and ultrasound was used to diagnose NAFLD. Anthropometric and blood pressure measurements were conducted, and biochemical measurements were assessed after fasting. Data analysis included Latent class analysis, two-tailed χ2 statistics, one-way analysis of variance, and logistic regression using Mplus (version 7.4) and spss (version 26) softwares.

Results

The study involved 2308 participants, with a mean age of 43.17 ± 12.30 years. Mets prevalence was 25.64%, with three identified classes: Mets with Hypertension (HTN), Mets without HTN (Non-HTN), and Low Risk. Mets with HTN had a high probability of at least four components, particularly high SBP. Non-HTN had at least three high probable components, especially high TG and low HDL but not high SBP and DBP. The low-risk class had a low probability of all components except low HDL in women. Serum vitamin D and CRP levels did not significantly predict Mets classes in men, while CRP level significantly predicted the HTN class in women (OR:1.03, CI:1.004-1.067). Both HTN, and Non-HTN Mets classes significantly increased the odds of NAFLD compared to the low risk class, especially in women (HTN class OR: 4.20 vs 2.94; non-HTN class OR: 5.60 vs 3.12 in women and men respectively).

Conclusion

The latent class analysis in northern Iran identified three Mets classes: HTN, Non-HTN, and low-risk, with hypertension playing a crucial role in determining these classes. These classes were stronger predictors of NAFLD in women. Serum CRP and vitamin D levels did not emerge as significant predictors of the classes, except for serum CRP in the HTN class among women.

Metabolic syndrome including both elevated blood pressure and elevated fasting plasma glucose is associated with higher mortality risk: a prospective study

BACKGROUND

Metabolic syndrome (MetS) encompasses a collection of metabolic abnormalities. This study aims to determine which combination of MetS components has the highest mortality risk, and to investigate the causal relationships between MetS components and longevity.

METHODS

Prospective analyses were conducted on 340,196 participants from the MJ cohort at baseline, and 121,936 participants had follow-up MetS information. We defined MetS according to the NCEP ATP III criteria. The study's outcomes included mortality from cardiovascular disease (CVD), cancer, and all causes combined. We employed Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals. Multivariable Mendelian randomization (MVMR) was employed to infer causality using the genetic data of MetS components and longevity.

RESULTS

Elevated blood pressure (BP) was the initial split for all-cause mortality, cancer mortality, and CVD mortality. Participants with MetS, especially those with elevated BP and elevated fasting plasma glucose (FPG), had higher mortality risks than those with other types of MetS. In the MJ cohort, participants with elevated BP and FPG (BG-type MetS) had a 44% (HR = 1.44, 95% CI = 1.37-1.51), 73% (HR = 1.73, 95% CI = 1.62-1.84), and 34% (HR = 1.34, 95% CI = 1.27-1.42) increased risk of all-cause mortality, cancer mortality, and CVD mortality, respectively, compared with non-BG-type MetS (12%, 24%, 5%). The highest mortality rate and mortality risk were observed in participants with BG-type MetS at baseline and follow-up (mortality rate/1000 person years = 9.73, 95% CI = 8.81-10.74; HR = 1.52, 95% CI = 1.35-1.72). SBP and FPG increases that were genetically proxied to a 1-standard deviation higher level decreased the probabilities of living to the 90th percentile age by 41% (OR = 0.59, 95% CI = 0.40-0.86) and 32% (OR = 0.68, 95% CI = 0.48-0.98) in MVMR, respectively.

CONCLUSIONS

Individuals with BG-type MetS are at a higher risk of death than those with other types of MetS. Therefore, these individuals should be targeted to improve MetS outcomes.

A comparison of the burden of cancers between 1990 and 2019 in Iran: A national and subnational study

BACKGROUND

Cancer is a rapidly increasing global problem, and one of the leading causes of burden and mortality. This study aims to compare the burden of cancer in Iran between the year 1990 and 2019.

METHODS

We used Global Burden of Disease data on cancer from 1990 to 2019 by province, year, age group, and sex. We then estimated the trend of age standardized mortality and Disability-Adjusted Life Years (DALYs) of the cancers by sex. Age pattern and geographical variation in the ranking of cancers were assessed at national and sub-national levels from 1990 to 2019.

RESULTS

The mortality rate decreased from 102 (95% UI: 91, 111) to 96 (95% UI: 88, 103) per 100000 population. Additionally, the DALYs rates decreased from 2619 (95% UI: 2357, 2852) to 2321 (95% UI: 2116, 2497) per 100000 between 1990 and 2019. Both of the mortality and DALYs rate from cancers increased with age. These indicators were significantly higher in men than in women across all age groups. Consequently, the mortality rate and DALYs per 100,000 of cancers were higher in the northwest and northeast of Iran. Notably, stomach cancer was identified as the leading cause of cancer mortality in 23 provinces of Iran in 2019. The highest percentage change of DALYs per 100,000 rate between 1990 and 2019 was observed for malignant skin melanoma, stomach cancer, and cervical cancers with rate of -41.1, -40.1, and -38.4, respectively.

CONCLUSION

Overall, the mortality and DALYs per 100,000 rates of all cancers for both sexes in Iran have decreased between 1990 and 2019. However, there is an increasing trend in types of cancers, such as pancreatic, ovarian, and breast cancers.

Exploring a decade of deep learning in dentistry: A comprehensive mapping review

OBJECTIVES

Artificial Intelligence (AI), particularly deep learning, has significantly impacted healthcare, including dentistry, by improving diagnostics, treatment planning, and prognosis prediction. This systematic mapping review explores the current applications of deep learning in dentistry, offering a comprehensive overview of trends, models, and their clinical significance.

MATERIALS AND METHODS

Following a structured methodology, relevant studies published from January 2012 to September 2023 were identified through database searches in PubMed, Scopus, and Embase. Key data, including clinical purpose, deep learning tasks, model architectures, and data modalities, were extracted for qualitative synthesis.

RESULTS

From 21,242 screened studies, 1,007 were included. Of these, 63.5% targeted diagnostic tasks, primarily with convolutional neural networks (CNNs). Classification (43.7%) and segmentation (22.9%) were the main methods, and imaging data-such as cone-beam computed tomography and orthopantomograms-were used in 84.4% of cases. Most studies (95.2%) applied fully supervised learning, emphasizing the need for annotated data. Pathology (21.5%), radiology (17.5%), and orthodontics (10.2%) were prominent fields, with 24.9% of studies relating to more than one specialty.

CONCLUSION

This review explores the advancements in deep learning in dentistry, particulary for diagnostics, and identifies areas for further improvement. While CNNs have been used successfully, it is essential to explore emerging model architectures, learning approaches, and ways to obtain diverse and reliable data. Furthermore, fostering trust among all stakeholders by advancing explainable AI and addressing ethical considerations is crucial for transitioning AI from research to clinical practice.

CLINICAL RELEVANCE

This review offers a comprehensive overview of a decade of deep learning in dentistry, showcasing its significant growth in recent years. By mapping its key applications and identifying research trends, it provides a valuable guide for future studies and highlights emerging opportunities for advancing AI-driven dental care.

Dissecting the rising tide of inflammatory bowel disease among youth in a changing world: insights from GBD 2021

OBJECTIVES

This study investigates the alarming epidemiological trends of inflammatory bowel disease (IBD) among children and young adults, highlighting the associated disease burden on global health.

MATERIALS AND METHODS

Utilizing data from the Global Burden of Disease (GBD) study 2021, we conducted a comprehensive analysis of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPC). Future trends were forecasted using the Bayesian age-period-cohort model.

RESULTS

From 1990 to 2021, IBD incidence and DALY rates remained persistently high, with a concerning upward trend noted among children and young adults. While men experienced a decline in DALY rates, women faced increasing burdens. In 2021, high-income regions, particularly North America, reported the highest incidence and DALY rates, contrasting sharply with Central Latin America, which exhibited the lowest ASIR. Southeast Asia presented the most favorable DALY rates. A notable negative correlation was identified between DALY rates and socio-demographic index (SDI) at the national level, with high and high-middle SDI countries continuing to bear a substantial burden, while low and middle SDI nations faced rising challenges.

CONCLUSIONS

The persistent high burden of IBD in children and young adults signifies a critical public health concern. The marked geographical and gender disparities underscore the urgent need for tailored regional and population-based strategies aimed at primary prevention and effective management. This study illuminates the pressing necessity for policy interventions to address the growing epidemic of IBD among vulnerable populations.

Association of portfolio diet score with breast cancer risk: insights from a case-control analysis

BACKGROUND

The Portfolio Diet (PD) is a plant-based dietary approach that has been associated with a reduced risk of cancer-related mortality. The aim of this study was to investigate the relationship between PD score (PDS) and breast cancer (BC) risk in Iranian women, providing insights into the impact of diet on BC risk across different menopausal stages.

METHODS

The current case-control study included 133 women with newly diagnosed BC and 265 controls without any neoplastic disorders, all of whom were referred to the oncology department of two referral hospitals in Tehran, Iran. A validated semi-quantitative food frequency questionnaire, consisting of 168 food items, was used to gather dietary information. Additionally, odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated to assess the associations of BC with the PDS and its components, using univariate and multivariate logistic regression analysis.

RESULTS

After adjusting for variables in multivariate analysis, a significantly lower association was observed between each unit increase in plant protein intake and the odds of BC in the total population (OR = 0.399, 95% CI: 0.170-0.936). Based on menopausal status, a significant association was found between PDS and the odds of BC in premenopausal women (OR = 0.914, 95% CI: 0.845-0.989). Additionally, in the postmenopausal women, significantly lower odds of BC were observed with each unit increase in plant protein intake in the adjusted model (OR = 0.078, 95% CI: 0.015-0.399).

CONCLUSIONS

This study provides novel insights into the protective role of PD against BC, demonstrating that a higher PDS is associated with a significant reduction in BC odds among premenopausal women. Plant protein intake also demonstrated a protective effect against BC in both the overall population and postmenopausal women. These findings highlight the potential benefit of the PD as a preventative dietary strategy against BC, particularly emphasizing the role of plant protein.

Depression, stress and anxiety among Khartoum University students who stay in war-afflicted regions in Sudan 2024

BACKGROUND

The ongoing conflict in Sudan leads to widespread displacement and increased mortality, significantly impacting the mental health of populations in conflict zones. This study aims to fill the gap and assess the level of stress, depression, and anxiety among Khartoum University undergraduate students in war-afflicted regions.

METHODS

A cross-sectional study among 443 undergraduate students Was conducted using cluster and stratified sampling techniques. Data was collected using a valid questionnaire in a period of one month and analyzed using SPSS and a regression model to assess factors affecting distress.

RESULTS

The study shows high levels of psychological distress, particularly among female students. Median anxiety and stress levels were 12.50 and 14.00, respectively, for women, significantly higher than those for men (p < 0.001). Faculty, physical health, time management, and support systems were also significantly correlated with distress levels. Students in the Faculty of Forests and Animal Breeding exhibited the highest levels of depression and anxiety. Poor physical health and seeking professional help were strongly associated with increased psychological distress. Regression analysis identified gender (p = 0.001) and time management (p = 0.022) as significant predictors of overall distress.

CONCLUSION

Undergraduate university students in war regions experience high levels of stress, anxiety, and depression due to conflict situations. These findings reflect the urgent need for interventions such as community-based programs and counselling. We recommended future studies to explore long-term impacts on students' mental health.

Effect of reduced flaxseed cyclic peptide [1-9-NαC]-linusorb B2 (CLB) and its oxidized form on the oxidative stability of flaxseed oil

This study aimed to explore the antioxidant capacity and mechanism of cyclic peptide [1-9-NαC]-linusorb B2 (CLB) and its oxidized form ([1-9-NαC],[1-MetO]-linusorb B2 (CLC),[1-9-NαC],[1-MetO2]-linusorb B2 (CLK)) in flaxseed oil (FSO). The results showed that CLB delayed the oxidation of FSO (containing Cu2+) in the initial stage of accelerated oxidation, whereas CLK accelerated the oxidation, leading to an increase of 25 % in AV and 33 % in POV (P < 0.05). In molecular docking, the binding ability of cyclic peptides to metal ions and intermediate oxidative products such as aldehydes tends to decrease when CLB oxidized to CLC, then CLK. CLK had the poorest binding capacity with the most serious oxidation on FSO. In conclusion, the antioxidant capacities of CLB and its oxidized form were contributed by their reducing ability as well as their binding ability to metal ions and intermediate oxidative products of fatty acids.

Assessing the impact of 25-hydroxyvitamin concentrations on mortality in chronic diarrhea: a cross-sectional analysis

Background

The aim of this study was to assess the relationship between serum 25-hydroxyvitamin levels and all-cause mortality in patients with chronic diarrhea.

Methods

We carried out a cross-sectional study using information drawn from the National Health and Nutrition Examination Survey (NHANES). To assess mortality outcomes, we compared our data with records from the National Death Index as of December 31, 2011. The NHANES data were used to determine mortality outcome. We used a Cox regression model-based approach to analyze the relationship between serum 25-hydroxyvitamin concentrations and mortality in chronic diarrhea patients.

Results

A total of 2,972 participants with chronic diarrhea were included in our study, 488 cases of all-cause mortality were recorded. The study showed an L-shaped relationship between 25-hydroxyvitamin concentrations and all-cause mortality with a threshold of 73.40 nmol/L. On the left side of the threshold, each 1-unit increase in 25-hydroxyvitamin concentrations was associated with a 2.2% reduction in the risk of all-cause mortality (HR 0.978; 95% CI: 0.969, 0.987); however, on the right side of the threshold, there was no significant correlation between 25(OH)D concentrations and all-cause mortality.

Conclusion

Serum 25-hydroxyvitamin D levels showed an L-shaped association with all-cause mortality in patients with chronic diarrhea, with 73.40 nmol/L as the potential threshold. However, because this was a cross-sectional study, only an association, not a causal relationship, can be inferred. Further prospective studies are needed to confirm these findings and explore the potential impact of vitamin D supplementation on mortality outcomes.

Global prevalence of Fusobacterium nucleatum and Bacteroides fragilis in patients with colorectal cancer: an overview of case reports/case series and meta-analysis of prevalence studies

BACKGROUND

Colorectal cancer (CRC) is the second deadliest carcinoma across the globe and has been known as a multi-factor induced-disease. Emerging research have demonstrated that bacterial colonization may contribute to the initiation and promotion of the CRC. The presence of Fusobacterium nucleatum (F. nucleatum) and Bacteroides fragilis (B. fragilis) in the gut is associated with the development of CRC. In this study, the prevalence of F. nucleatum and B. fragilis among CRC patients has been assessed worldwide through a systematic review and meta-analysis.

METHODS

The extensive search was performed using "Fusobacterium nucleatum", "Bacteroides fragilis", "Colorectal cancer" and all relevant keywords. Then, a systematic paper screening was done following a comprehensive search in Embase, Web of Science, and PubMed databases while the time range was limited between the years 2000 and 2024. Afterwards, statistical analysis was performed utilizing the comprehensive meta-analysis (CMA) software (version 2.0, Biostat, USA).

RESULTS

According to the meta-analysis of prevalence studies, the prevalence of F. nucleatum among 19 countries and B. fragilis among 10 countries were indicated to be 38.9% (95% CI 33.7-44.3%) and 42.5% (95% CI 34.4-51.1%), respectively, among the CRC patients. It was then revealed that Asia had the highest prevalence of F. nucleatum while most of the B. fragilis isolates in CRC cases were reported in European countries. Moreover, the data suggested that the most common comorbidity observed among the CRC cases was diabetes.

CONCLUSION

Our results emphasized the high prevalence of F. nucleatum and B. fragilis in CRC patients. Based on this meta-analysis review, regulating the gut microbiota in CRC patients seemed to be a promising approach to improving the efficacy of CRC therapy.

HepatoPredict Accurately Selects Hepatocellular Carcinoma Patients for Liver Transplantation Regardless of Tumor Heterogeneity

BACKGROUND/OBJECTIVES

Hepatocellular carcinoma (HCC) is a major cause of cancer-related deaths rising worldwide. This is leading to an increased demand for liver transplantation (LT), the most effective treatment for HCC in its initial stages. However, current patient selection criteria are limited in predicting recurrence and raise ethical concerns about equitable access to care. This study aims to enhance patient selection by refining the HepatoPredict (HP) tool, a machine learning-based model that combines molecular and clinical data to forecast LT outcomes.

METHODS

The updated HP algorithm was trained on a two-center dataset and assessed against standard clinical criteria. Its prognostic performance was evaluated through accuracy metrics, with additional analyses considering tumor heterogeneity and potential sampling bias.

RESULTS

HP outperformed all clinical criteria, particularly regarding negative predictive value, addressing critical limitations in existing selection strategies. It also demonstrated improved differentiation of recurrence-free and overall survival outcomes. Importantly, the prognostic accuracy of HP remained largely unaffected by intra-nodule and intra-patient heterogeneity, indicating its robustness even when biopsies were taken from smaller or non-dominant nodules.

CONCLUSIONS

These findings support the usage of HP as a valuable tool for optimizing LT candidate selection, promoting fair organ allocation and enhancing patient outcomes through integrated analysis of molecular and clinical data.

QuantiFERON® Monitor Test as a Potential Tool for Stratifying Patients by Infection Risk and Tailoring Follow-Up Care in Lung Transplant Recipients: A Single-Center Retrospective Experience

BACKGROUND

Lung transplantation is a life-saving option for patients with end-stage respiratory diseases, but risk of infections remains critical for ensuring long-term organ function. This study aimed to assess immune recovery in lung transplant recipients by measuring IFN-γ levels using the QuantiFERON Monitor Test (QFM). Results were correlated with episodes of infection and organ rejection to explore the assay's predictive potential.

METHODS

A retrospective study was conducted on 15 lung transplant recipients at the Lung Transplant Centre of Turin (Città della Salute e della Scienza di Torino, Italy) between December 2019 and January 2023. Patients were divided into a High Infection (HI) group (with >3 infections) and Low Infection (LI) group (with ≤3 infections). QFM assays were performed after 18 months post-transplant.

RESULTS

HI patients had lower QFM levels compared to LI (68.84 ± 21.98 vs. 380.54 ± 104.64 UI/mL, p = 0.033). A QFM value <89.5 UI/mL was associated with increased infection risk (p < 0.05). Patients with lower QFM levels also exhibited higher rates of MRSA bacteremia during hospitalization (50% HI vs. 0% LI, p = 0.04). No differences were observed in acute or chronic rejection rates, but LI patients showed more frequent alveolar neutrophilia at the fourth month post-transplant (0% HI vs. 55.5% LI, p = 0.04).

CONCLUSION

lower QFM values were associated with higher infection risk, highlighting the assay's potential for immune monitoring. In this study, a QFM value of 89.5 UI/mL showed good predictive accuracy for infections beyond 18 months. Further studies are needed to refine QFM's role in post-transplant care.

Comparative Efficacy and Safety of Lubiprostone and Osmotic Laxatives in Chronic Idiopathic Constipation: A Systematic Review and Network Meta-Analysis

OBJECTIVE

The objective of this study is to compare the efficacy and safety of lubiprostone (Lub) with osmotic laxatives in the treatment of chronic idiopathic constipation (CIC).

METHODS

A comprehensive literature search was conducted using PubMed, EMBASE, and the Cochrane Library in May 2024. Studies that met the inclusion criteria were manually searched by two independent reviewers. The efficacy was assessed by the proportion of patients with spontaneous bowel movements (SBMs) within 24 h after the first administration of the medication and SBMs in Weeks 1 and 4. Safety was evaluated based on adverse events including nausea, diarrhea, and abdominal distension. Optimal probability values and the surface under the cumulative ranking area (SUCRA) were also calculated for all interventions. Higher SUCRA values indicate better efficacy and safety of the intervention.

RESULTS

Following a thorough search and screening process, 25 articles were included. Among the selected trials, 8 compared Lub to placebo, 10 compared polyethylene glycol (PEG) to placebo, 4 compared lactulose (Lac) to placebo, and 3 compared PEG to Lac. The meta-analysis results indicated that Lub and osmotic laxatives were significantly more effective than placebo. According to the SUCRA results, the highest rank probabilities were for Lub in increasing the SBMs and reducing abdominal distension.

CONCLUSION

Lubiprostone is more effective than PEG and Lactulose for treating CIC, with comparable safety profiles. However, this conclusion requires further validation through large-scale, high-quality studies.

Interferon therapy in alpha and Delta variants of SARS-CoV-2: The dichotomy between laboratory success and clinical realities

The COVID-19 pandemic has caused significant morbidity and mortality worldwide. The emergence of the Alpha and Delta variants of SARS-CoV-2 has led to a renewed interest in using interferon therapy as a potential treatment option. Interferons are a group of signaling proteins produced by host cells in response to viral infections. They play a critical role in the innate immune response to viral infections by inducing an antiviral state in infected and neighboring cells. Interferon therapy has shown promise as a potential treatment option for COVID-19. In this review paper, we review the current knowledge regarding interferon therapy in the context of the Alpha and Delta variants of SARS-CoV-2 and discuss the challenges that must be overcome to translate laboratory findings into effective clinical treatments.

Short-term effect of gluten-free diet on disease severity, quality of life, and inflammatory markers among patients with mild to moderate ulcerative colitis: A triple-blind randomized placebo-controlled trial

BACKGROUND AND STUDY AIMS

Diet is an important underlying factor in ulcerative colitis (UC) disease. The present study aimed to investigate the effect of a gluten-free diet (GFD) on disease severity, quality of life, and inflammatory markers in patients with UC.

PATIENTS AND METHODS

In this triple-blind randomized placebo-controlled clinical trial, we evaluated the effect of a GFD on the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fecal calprotectin, disease severity, and quality of life in patients with mild to moderate UC. Patients' quality of life and severity of symptoms were evaluated using the Inflammatory Bowel Disease Questionnaire (IBDQ) and Simple Clinical Colitis Activity Index (SCCAI), respectively. Patients received this regimen for six weeks and were evaluated before and after the intervention.

RESULTS

The mean age of patients (n = 26) was 39.31 years (standard deviation = 9.34). In both study groups, the mean ESR, CRP, IBDQ, and SCCAI showed no statistically significant improvement with the dietary intervention. Fecal calprotectin was increased in both groups without statistical significance.

CONCLUSIONS

We could not find any significant effect of GFD on inflammatory markers, quality of life, and disease severity among patients with mild to moderate UC. It is too early to suggest the gluten-free diet as a safe and beneficial regimen for UC patients. There is a need for further investigations with larger sample sizes and longer follow-ups as clinical trials and cohort studies to obtain more reliable results.

[Lessons from the COVID-19-Pandemic : Experiences of critical care nurses during the COVID-19 pandemic: a qualitative explorative study]

BACKGROUND

When the workload for critical care nurses becomes too high, this can have consequences for both personal health as well as patient care. During the COVID-19 pandemic, critical care nurses were confronted with new and dynamic changes.

OBJECTIVE

The aim of this study was to describe the experiences of critical care nurses regarding the ad hoc measures taken and the perceived physical and psychological burden experienced during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This was a cross-sectional study conducted at two hospitals using an online survey. The open questions addressing the challenges faced during the COVID-19 pandemic were subjected to content analysis according to Mayring.

RESULTS

A total of 179 critical care nurses participated in the online survey. From the results, the following four categories were developed: "not meeting one's own quality of care requirements," "uncertainties in everyday professional and private life," "increased responsibility with lack of relief," and "insufficient coping strategies for physical and psychological burden."

CONCLUSION

Critical care nurses require structures and processes which support them in situations of high workload. The focus should be on the self-imposed requirements of quality of care as well as potentially relieving measures.

SARS-CoV-2 S protein disrupts the formation of ISGF3 complex through conserved S2 subunit to antagonize type I interferon response

Viral immunosuppression substantially affects the host immune response of infected patients and the protective efficacy of vaccines. Here, we found that the spike (S) protein, the major vaccine antigen of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), strongly suppresses host innate immunity by inhibiting interferon-stimulated gene (ISG) expression through both S1 and S2 subunits. Mechanistically, the S protein inhibited the formation of the classic interferon-stimulated gene factor 3 (ISGF3) complex composed of STAT1, STAT2, and IRF9 by competing with STAT2 for binding to IRF9, thereby impeding the transcription of ISGs. A strong interaction between S and the STAT1/STAT2 proteins further traps the ISGF3 complex in the endoplasmic reticulum and hinders the nuclear translocation of ISGF3. Notably, the interferon-inhibitory mechanism of the S protein was universal among SARS-CoV-2 variants and other human coronaviruses, including SARS-CoV, Middle East respiratory syndrome coronavirus (MERS-CoV), human coronavirus 229E (HCoV-229E), human coronavirus NL63 (HCoV-NL63), and human coronavirus HKU1 (HCoV-HKU1), through the most evolutionarily conserved region of S2 subunit. Taken together, the findings of this study reveal a new mechanism by which the coronavirus S protein attenuates the host antiviral immune response and provides new insights into the proper design of coronavirus S-based vaccines to prevent immunosuppressive effects.

IMPORTANCE

This study unveils a new mechanism by which the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) protein attenuates the host's antiviral immune response. The interferon-inhibitory mechanism of the S protein was universal among SARS-CoV-2 variants and other human coronaviruses, including SARS-CoV, MERS-CoV, HCoV-229E, HCoV-NL63, and HCoV-HKU1, through conserved S2 domains. Our study expands the understanding of SARS-CoV-2 and other human coronaviruses in evading antiviral immune strategies, which is very important for the design and optimization of vaccine antigens, thus providing a theoretical basis for human anti-coronavirus immunity and understanding the interaction between the host and coronavirus.

Prevalence of common diarrheagenic enterobacteriaceae in Iran (2000-2023): a systematic review and meta-analysis

OBJECTIVE

Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023.

METHODS

A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant.

RESULTS

Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11-0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13-0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09-0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05-0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03-0.08) in 2000-2004 to 36% (95% CI: 0.20-0.55) in 2021-2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01-0.24) to 17% (95% CI: 0.07-0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000-2004 and 2005-2008 periods to 20% (95% CI: 0.03-0.66) in 2009-2012 and 30% (95% CI: 0.11-0.60) in 2017-2020. Yersinia spp. was only determined in 2000-2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33-0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran.

CONCLUSION

This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns.

Lactobacillus fermentum 016 Alleviates Mice Colitis by Modulating Oxidative Stress, Gut Microbiota, and Microbial Metabolism

Ulcerative colitis (UC) is a chronic and progressive inflammatory gastrointestinal disease closely associated with gut microbiota dysbiosis and metabolic homeostasis disruption. Although targeted microbial therapies are an emerging intervention strategy for inflammatory bowel disease (IBD), the mechanisms by which specific probiotics, such as Lactobacillus fermentum 016 (LF), alleviate UC remain unclear. The current study evaluated the effects of LF supplementation on gut health in a basal model using C57BL/6 mice. Subsequently, the preventive effects and mechanisms of LF supplementation on DSS-induced UC were systematically investigated. According to our findings, LF supplementation revealed immunoregulatory capabilities with significantly altered gut the composition of microbiota and metabolic activities, particularly enhancing tryptophan metabolism. In the UC model, LF supplementation effectively mitigated weight loss, increased the disease activity index (DAI), and alleviated diarrhea, rectal bleeding, and colon shortening. Moreover, it reduced colonic pathological damage and histological injury scores. LF intervention improved antioxidant markers and intestinal mucosal barrier function with the activation of the Nrf2-Keap1 signaling pathway and regulation of systemic inflammatory markers, i.e., IL-1β, IL-6, TNF-α, IFN-γ, IL-4, and IL-10. Importantly, LF supplementation reversed metabolic disturbances by significantly increasing the abundance of beneficial genera (e.g., g_Dubosiella, g_Faecalibaculum, g_Odoribacter, g_Candidatus_saccharimonas, g_Roseburia, and g_Eubacterium_xylanophilum_group) and elevating tryptophan metabolites (e.g., melatonin, kynurenic acid, 3-indoleacetic acid, 5-methoxytryptophan, and 5-hydroxyindoleacetic acid). In conclusion, Lactobacillus fermentum 016 exhibits potential for regulating gut microbiota homeostasis, enhancing tryptophan metabolism, and alleviating UC, providing critical insights for developing probiotic-based precision therapeutic strategies for IBD.

Evaluation of Chatbots in the Emergency Management of Avulsion Injuries

BACKGROUND

This study assessed the accuracy and consistency of responses provided by six Artificial Intelligence (AI) applications, ChatGPT version 3.5 (OpenAI), ChatGPT version 4 (OpenAI), ChatGPT version 4.0 (OpenAI), Perplexity (Perplexity.AI), Gemini (Google), and Copilot (Bing), to questions related to emergency management of avulsed teeth.

MATERIALS AND METHODS

Two pediatric dentists developed 18 true or false questions regarding dental avulsion and asked public chatbots for 3 days. The responses were recorded and compared with the correct answers. The SPSS program was used to calculate the obtained accuracies and their consistency.

RESULTS

ChatGPT 4.0 achieved the highest accuracy rate of 95.6% over the entire time frame, while Perplexity (Perplexity.AI) had the lowest accuracy rate of 67.2%. ChatGPT version 4.0 (OpenAI) was the only AI that achieved perfect agreement with real answers, except at noon on day 1. ChatGPT version 3.5 (OpenAI) was the AI that showed the weakest agreement (6 times).

CONCLUSIONS

With the exception of ChatGPT's paid version, 4.0, AI chatbots do not seem ready for use as the main resource in managing avulsed teeth during emergencies. It might prove beneficial to incorporate the International Association of Dental Traumatology (IADT) guidelines in chatbot databases, enhancing their accuracy and consistency.

Current applications and challenges in large language models for patient care: a systematic review

BACKGROUND

The introduction of large language models (LLMs) into clinical practice promises to improve patient education and empowerment, thereby personalizing medical care and broadening access to medical knowledge. Despite the popularity of LLMs, there is a significant gap in systematized information on their use in patient care. Therefore, this systematic review aims to synthesize current applications and limitations of LLMs in patient care.

METHODS

We systematically searched 5 databases for qualitative, quantitative, and mixed methods articles on LLMs in patient care published between 2022 and 2023. From 4349 initial records, 89 studies across 29 medical specialties were included. Quality assessment was performed using the Mixed Methods Appraisal Tool 2018. A data-driven convergent synthesis approach was applied for thematic syntheses of LLM applications and limitations using free line-by-line coding in Dedoose.

RESULTS

We show that most studies investigate Generative Pre-trained Transformers (GPT)-3.5 (53.2%, n = 66 of 124 different LLMs examined) and GPT-4 (26.6%, n = 33/124) in answering medical questions, followed by patient information generation, including medical text summarization or translation, and clinical documentation. Our analysis delineates two primary domains of LLM limitations: design and output. Design limitations include 6 second-order and 12 third-order codes, such as lack of medical domain optimization, data transparency, and accessibility issues, while output limitations include 9 second-order and 32 third-order codes, for example, non-reproducibility, non-comprehensiveness, incorrectness, unsafety, and bias.

CONCLUSIONS

This review systematically maps LLM applications and limitations in patient care, providing a foundational framework and taxonomy for their implementation and evaluation in healthcare settings.

Predictive Value of the Triglyceride-Glucose Index for Metabolic-Associated Fatty Liver Disease in Individuals with Different Metabolic Obese Phenotypes

Objective

To investigate the relationship between triglyceride-glucose (TyG) index and metabolic-associated fatty liver disease (MAFLD), and to evaluate the predictive value of the TyG index for MAFLD in individuals with different metabolic obese phenotypes. The aim is to provide a novel approach for the screening and early diagnosis of MAFLD in the general population.

Methods

A total of 2614 subjects were recruited and classified into four categories of metabolic obese phenotypes based on their body mass index (BMI) and metabolic status. Basic data and general blood indices were collected and analyzed. The TyG index was calculated, and an abdominal ultrasound was performed to detect the presence of fatty liver disease. The aforementioned data were then subjected to statistical analysis.

Results

The TyG index was significantly higher in the MAFLD group than in the non-MAFLD group (P < 0.001). Furthermore, the TyG index in the metabolically unhealthy and obese (MUO) group and the metabolically unhealthy normal weight (MUNW) group was significantly higher than that in the metabolically healthy and obese (MHO) group and the metabolically healthy normal weight (MHNW) group (P < 0.001). The area under the curve (AUC) of the TyG index for predicting MAFLD in the MHNW, MUNW, MHO, and MUO groups was 0.765, 0.766, 0.659, and 0.650, respectively. The critical values were 8.575, 9.075, 8.795, and 9.165, respectively.

Conclusion

The TyG index is a reliable predictor of MAFLD risk, exhibiting a higher predictive ability for the risk of developing MAFLD in individuals with normal BMI compared to those with abnormal BMI. The findings of this study lend support for the use of the TyG index as a screening tool and for guiding subsequent management of patients with MAFLD.

Cost-effectiveness of plasmapheresis and hemoperfusion in COVID-19 survivors: A six-month follow-up analysis after hospital discharge

INTRODUCTION

To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge.

METHODS

Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves.

RESULTS

A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO2, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO2, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls.

CONCLUSION

While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.

Upregulated PCAT-1 predicts poor prognosis and reduced immune cell infiltration in head and neck squamous cell carcinoma through the miR-145-5p / FSCN-1 axis

BACKGROUND

LncRNA PCAT-1 is known to promote cancer proliferation, invasion, and metastasis. However, its significance in HNSCC is not fully understood. This research investigates how the PCAT-1 / miR-145-5p / FSCN-1 axis promote HNSCC.

METHODS AND RESULTS

We analyzed the gene expression patterns on 238 fresh-frozen samples, comparing tumors with their normal adjacent tissues (NATs). HNSCC samples showed higher PCAT-1 and FSCN-1 expression compared to NATs (p < 0.001 and p < 0.001, respectively). In contrast, miR-145-5p expression was markedly downregulated compared to NATs (p < 0.001). Notably, ROC curve analysis revealed exceptional diagnostic power, with an AUC of 0.83 for PCAT-1, 0.95 for miR-145-5p, and 0.91 for FSCN-1. Pearson correlation analysis unveiled a significant positive correlation between PCAT-1 and FSCN-1 expression levels (r = 0.084, p < 0.001) and negative correlations between FSCN-1 and miR-145-5p (r = -0.710, p < 0.001) as well as between PCAT-1 and miR-145-5p (r = -0.759, p < 0.001). Distinct molecular profiles were observed in the levels of PCAT-1, miR-145-5p, and FSCN-1 between HPV (-) and HPV ( +) 16 and 18 genotypes (p = 0.007, p = 0.027, and p = 0.002). MiR-145-5p expression showed significant differences between HPV (-) and HPV ( +) other genotypes (p = 0.035). FSCN-1 expression showed notable distinctions between HPV ( +) 18 & 16 and HPV ( +) other genotypes (p = 0.031).

CONCLUSIONS

Elevated levels of lncRNA PCAT-1 promote HNSCC through the miR-145-5p/FSCN-1 axis and are associated with poor prognosis and reduced immune cell infiltration levels.

Novel Development and Sensory Evaluation of Extruded Snacks from Unripe Banana (Musa ABB cv. Kluai 'Namwa') and Rice Flour Enriched with Antioxidant-Rich Curcuma longa Microcapsules

With the growing consumer demand for natural functional ingredients that promote health and well-being while preventing age-related diseases, this study aimed to develop extruded snacks enriched with Curcuma longa (turmeric) microcapsules, recognized for their significant antioxidant properties. Unripe banana flour (Musa ABB cv. Kluai 'Namwa') and rice (Oryza sativa) flour were employed as a gluten-free base to create this novel extruded snack. Curcuma longa extract microcapsules were prepared using a spray-drying technique with varying core-to-wall ratios. Antioxidant capacities were assessed through DPPH, ABTS, superoxide radical scavenging, metal chelating, and ferric-reducing assays. The CM6 microcapsules, prepared at 140 °C with a 1:10 core-to-wall ratio, exhibited potent antioxidant activity, with 58.93 ± 3.31% inhibition for DPPH radicals, 87.58 ± 1.33% for ABTS, and 78.41 ± 1.40% for superoxide radicals. Snacks enriched with 0.25% CM6 microcapsules received high consumer acceptance, with an average liking score of 7.5 out of 9. These findings suggest that snacks made with these gluten-free flours and Curcuma longa microcapsules could be novel, convenient, and appealing functional food products that offer an attractive way to deliver antioxidant benefits with high consumer acceptance. Further research on evaluating the active constituents in the snack, its long-term health benefits, and shelf-life stability is recommended for commercialization.

Association between allergic diseases and mucosal healing in ulcerative colitis

Allergic diseases and ulcerative colitis (UC) share pathophysiological similarities. This study aimed to investigate the unclear association between allergic diseases and mucosal healing (MH), an important factor in the prognosis of UC. We studied 289 Japanese patients with UC. Information on allergic diseases (bronchial asthma, atopic dermatitis, pollen allergy, food allergy, and drug allergy), as diagnosed by physicians, was collected through self-reported questionnaires. The definition of MH was Mayo Endoscopic Score 0. The association between each allergic disease and its multimorbidity with MH was evaluated using multivariate logistic regression analyses. Pollen allergy was the most common allergic condition (36.3%). Pollen allergy and food allergy were independently associated with MH (pollen allergy adjusted OR: 1.82 [95% CI: 1.01-3.26]; food allergy adjusted OR: 3.47 [95% CI: 1.26-9.68]). The rates of MH for 0 and 3 or more allergic diseases were 24.6% and 4.2%, respectively. After adjustment for confounders, 3 or more allergic diseases were independently associated with MH (adjusted OR: 8.13 [95% CI: 2.17-34.04], p for trend = 0.020). This study demonstrates a significant positive association between specific allergic diseases (pollen and food allergies) and MH in UC patients, with a stronger association in cases of allergic multimorbidity.

Correlation analysis of the triglyceride-glucose index and related parameters in metabolic dysfunction-associated fatty liver disease

This study aimed to investigate the correlation and predictive value of TyG and related parameters with metabolic dysfunction-associated fatty liver disease (MAFLD) MAFLD. This study retrospectively included individuals who underwent health examinations and abdominal ultrasound from July 2021 to June 2024 at the Affiliated Hospital of Southwest Medical University, Sichuan Province, China. A total of 71,299 subjects' clinical and laboratory data were extracted, the correlation between TyG and related parameters and MAFLD was analyzed via univariate and multivariate logistic regression methods, and the nonlinear relationship between the TyG index and the risk of MAFLD was explored via restricted cubic spline (RCS) analysis. The predictive value of TyG and related parameters for MAFLD was assessed using the receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). TyG and related parameters were positively correlated with MAFLD, and the results remained unchanged after adjustment for the corresponding parameters. RCS analysis revealed a significant dose‒response relationship between TyG and related parameters and MAFLD. ROC curve analysis revealed AUC values of 0.83 (0.82-0.83), 0.92 (0.91-0.92), 0.90 (0.90-0.91), and 0.87 (0.87-0.88) for TyG, TyG-BMI, TyG-WC, and TyG-WHR, respectively. Subgroup analyses revealed that the TyG index and related parameters had greater predictive value in the female, younger, and BMI < 23.7 populations.

A Narrative Review of the Role of Immunotherapy in Metastatic Carcinoma of the Colon Harboring a BRAF Mutation

Patients affected by metastatic carcinoma of the colon/rectum (mCRC) harboring mutations in the BRAF gene (MBRAF) respond poorly to conventional therapy and have a prognosis worse than that of patients without mutations. Despite the promising outcomes of targeted therapy utilizing multi-targeted inhibition of the mitogen-activated protein kinase (MAPK) signaling system, the therapeutic efficacy, especially for the microsatellite stable/DNA proficient mismatch repair (MSS/PMMR) subtype, remains inadequate. Patients with MBRAF/mCRC and high microsatellite instability or DNA deficient mismatch repair (MSI-H/DMMR) exhibit a substantial tumor mutation burden, suggesting a high probability of response to immunotherapy. It is widely acknowledged that MSS/pMMR/mCRC is an immunologically "cold" malignancy that exhibits resistance to immunotherapy. The integration of targeted therapy and immunotherapy may enhance clinical outcomes in patients with MBRAF/mCRC. Efforts to enhance outcomes are exclusively focused on MSS/DMMR-BRAF mutant cancers, which constitute the largest proportion. This review evaluates the clinical efficacy and advancement of novel immune checkpoint blockade therapies for MSI-H/DMMR and MSS/PMMR BRAF mutant mCRC. We examine potential indicators in the tumor immune milieu for forecasting immunotherapeutic response in BRAF mutant mCRC.

The Effect of Emotional Intelligence Training on Work-Family Conflict in Intensive Care Nurses: A Randomized Controlled Trial

Introduction

Work-family conflict (WFC) is a prevalent stressor for nurses, particularly in intensive care units (ICUs) due to demanding workloads. Emotional intelligence (EI) training has been demonstrated to enhance conflict resolution abilities.

Objective

This study aimed to evaluate the impact of EI training on WFC among ICU nurses.

Methods

A randomized controlled trial with a pretest and posttest design was conducted with 74 nurses from two Iranian hospitals. Participants completed a demographic questionnaire, the Mayer-Salovey-Caruso Emotional Intelligence Test, and the Carlson WFC Scales. They were then randomly assigned to a training group (n = 36) and a control group (n = 38). The training group received eight 60-min face-to-face EI training sessions twice a week, while the control group received no intervention. Posttest assessments were conducted four weeks later. Data analysis was performed using paired t-tests, independent t-tests, and one-way analysis of covariance in SPSS version 27.

Results

Emotional intelligence training significantly reduced overall WFC and its subscales (strain-based and behavior-based), indicating improved EI outcomes due to training in ICU nurses (p < .016). While time-based conflict did not show a significant reduction, improvements were observed within the training group.

Conclusions

The findings suggest that EI training is effective in mitigating WFC and enhancing EI among ICU nurses. Specifically, this training demonstrated significant reductions in behavior-based and strain-based WFC. This approach has the potential to improve both the professional and personal lives of nurses, ultimately contributing to a more fulfilling and sustainable nursing workforce.

Lessons Learned From Clinical Trials of Immunotherapeutics for COVID-19

The COVID-19 pandemic caused by the SARS-CoV-2 virus was arguably one of the worst public health disasters of the last 100 years. As many infectious disease experts were focused on influenza, MERS, ZIKA, or Ebola as potential pandemic-causing agents, SARS-CoV-2 appeared to come from nowhere and spread rapidly. As with any zoonotic agent, the initial pathogen was able to transmit to a new host (humans), but it was poorly adapted to the immune environment of the new host and resulted in a maladapted immune response. As the host-pathogen interaction evolved, subsequent variants of SARS-CoV-2 became less pathogenic and acquired immunity in the host provided protection, at least partial protection, to new variants. As the host-pathogen interaction has changed since the beginning of the pandemic, it is possible the clinical results discussed here may not be applicable today as they were at the start of the pandemic. With this caveat in mind, we present an overview of the immune response of severe COVID-19 from a clinical research perspective and examine clinical trials utilizing immunomodulating agents to further elucidate the importance of hyperinflammation as a factor contributing to severe COVID-19 disease.

Advances in genotypic antimicrobialresistance testing: a comprehensive review

Antimicrobial resistance (AMR) represents a substantial threat to global public health, complicating the treatment of common infections and leading to prolonged illness and escalated healthcare expenses. To effectively combat AMR, timely and accurate detection is crucial for AMR surveillance and individual-based therapy. Phenotypic antibiotic resistance testing (AST) has long been considered the gold standard in clinical applications, serving as the foundation for clinical AMR diagnosis and optimized therapy. It has significantly contributed to ensuring patients' health and the development of novel antimicrobials. Despite advancements in automated culture-based AST technologies, inherent limitations impede the widespread use of phenotypic AST in AMR surveillance. Genotypic AST technologies offer a promising alternative option, exhibiting advantages of rapidity, high sensitivity, and specificity. With the continuous advancement and expanding applications of genotypic AST technologies, such as microfluidics, mass spectrometry, and high-resolution melting curve analysis, new vigor has been injected into the development and clinical implementation of genotypic AST technologies. In this narrative review, we discuss the principles, applications, and advancements of emerging genotypic AST methods in clinical settings. The comprehensive review aims to highlight the significant scientific potential of emerging genotypic AST technologies in clinical AMR diagnosis, providing insights to enhance existing methods and explore novel approaches.

Role of Gut-Liver Axis in Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) has emerged as a significant global health problem, mainly due to the increasing prevalence of obesity and metabolic syndrome. The gut microbiota plays an essential role in the development of NAFLD through the gut-liver axis. Dysbiosis of. the gut microbiota (GM) is associated with the pathogenesis of NAFLD. Dietary choices and other lifestyle factors influence the composition of the GM and contribute to the development of NAFLD. At the phylum level, individuals with NAFLD show an increased level in Actinobacteria and Firmicutes, while Verrucomicrobia, Thermus, Proteobacteria, Lentiphaerae, and Fusobacteria are found to be decreased. Several genera, including Faecalibacterium and Akkermansia, exhibit alterations in NAFLD and are linked to disease progression. Modulating the GM through prebiotics, probiotics, or fecal microbiota transplantation represents a promising therapeutic strategy for NAFLD. This review summarizes the current understanding of GM changes in NAFLD, focusing on findings from both human and animal studies.

Meta-Analysis: Global Prevalence of Coeliac Disease in Type 1 Diabetes

BACKGROUND

Coeliac disease (CD) is common in patients with type 1 diabetes (T1D), but prevalence varies globally due to differing screening protocols. There have been substantial changes in screening guidelines over the past two decades.

AIM

To evaluate CD prevalence in patients with T1D, focusing on screening studies using antitissue transglutaminase (anti-tTG) antibody.

METHODS

We searched PubMed, Web of Science, Embase and Scopus for studies published up to 11 December 2023 using keywords related to CD and diabetes. We used random-effects models for overall prevalence and all subgroups, with heterogeneity assessed using Cochran's Q test and the I2 statistic performed in STATA 18.

RESULTS

We included 106 articles involving 65,102 T1D patients across 40 countries. The pooled CD seroprevalence and confirmed CD prevalence were 9% (95% confidence interval, CI, 8%-10%) and 6% (95% CI 5%-7%), respectively. The prevalence was higher in females and children. Denmark, Saudi Arabia and Libya exhibited the highest prevalence (11%), followed by India and Egypt (10%). Belgium, France, Germany, South Africa and the United States had the lowest prevalence (2%). High-income countries showed significantly a lower CD prevalence than middle-income countries (p = 0.03). Meta-regression based on the Human Development Index (HDI) indicated that countries with higher HDI have lower seroprevalence and confirmed CD prevalence.

CONCLUSION

Approximately 1 in 16 patients globally and 1 in 12 patients in Asia and the Middle East with T1D has CD. We suggest that all patients with T1D should be screened for CD.

Role of artificial intelligence in early diagnosis and treatment of infectious diseases

Infectious diseases remain a global health challenge, necessitating innovative approaches for their early diagnosis and effective treatment. Artificial Intelligence (AI) has emerged as a transformative force in healthcare, offering promising solutions to address this challenge. This review article provides a comprehensive overview of the pivotal role AI can play in the early diagnosis and treatment of infectious diseases. It explores how AI-driven diagnostic tools, including machine learning algorithms, deep learning, and image recognition systems, enhance the accuracy and efficiency of disease detection and surveillance. Furthermore, it delves into the potential of AI to predict disease outbreaks, optimise treatment strategies, and personalise interventions based on individual patient data and how AI can be used to gear up the drug discovery and development (D3) process.The ethical considerations, challenges, and limitations associated with the integration of AI in infectious disease management are also examined. By harnessing the capabilities of AI, healthcare systems can significantly improve their preparedness, responsiveness, and outcomes in the battle against infectious diseases.

Bioactive Secondary Metabolites from Bauhinia variegata Linn. Roots: Isolation, Characterization, and Cytotoxic Evaluation

INTRODUCTION

This study aims to isolate and characterize potential cytotoxic compounds from the roots of Bauhinia variegata Linn. (Caesalpiniaceae) and evaluate their activity against human cancer cell lines. Five compounds, namely β-sitosterol (1), piperine (2), piperolein B (3), retrofractamide A (4), and dehydropipernonaline (5), were isolated from B. variegata roots using various chromatographic procedures.

METHODS

The root extracts were prepared using aqueous and organic solvents, including n-hexane, ethyl acetate, and methanol. The isolated compounds were subjected to a sulforhodamine B cytotoxicity assay against DU-145 and PC-3 (prostate), HT-29 (colon), and MCF-7 (breast) human cancer cell lines. Among the isolates, compound 5 exhibited significant bioactivity against all tested cell lines. Compound 4 demonstrated in vitro activity, specifically against MCF-7 cancer cell lines.

RESULTS

Importantly, these compounds were identified for the first time from B. variegata roots. In conclusion, this study highlights the enhanced spectrum of cytotoxic activity exhibited by the isolated compounds. These findings encourage further investigation to elucidate the mechanism of action of these compounds against the respective cell lines.

CONCLUSION

The identification and characterization of these bioactive compounds contribute to the understanding of the potential therapeutic applications of B. variegata in cancer treatment.

Assessing adult sinusitis guidelines: A comparative analysis of AAO-HNS and AI Chatbots

OBJECTIVE

To compare the guidelines offered by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS) on adult sinusitis to chatbots.

METHODS

ChatGPT-3.5, ChatGPT-4.0, Bard, and Llama 2 represent openly accessible large language model-based chatbots. Accuracy, over-conclusiveness, supplemental, and incompleteness of chatbot responses were compared to the AAO-HNS Adult sinusitis clinical guidelines.

RESULTS

12 guidelines consisting of 30 questions from the AAO-HNS were compared to 4 different chatbots. Adherence to AAO-HNS guidelines varied, with Llama 2 providing 80 % accurate responses, BARD 83.3 %, ChatGPT-4.0 80 %, and ChatGPT-3.5 73.3 %. Over-conclusive responses were minimal, with only one instance each from Llama 2 and ChatGPT-4.0. However, rates of incomplete responses varied, with Llama 2 exhibiting the highest at 40 %, followed by ChatGPT-4.0 at 33.3 %, BARD at 23.3 %, and ChatGPT-3.5 at 36.7 %. Fisher's Exact Test analysis revealed significant deviations from the guideline standard, with less accuracy (p = 0.012 for Llama 2, p = 0.026 for BARD, p = 0.012 for ChatGPT-4.0, p = 0.002 for ChatGPT-3.5), inclusion of supplemental data (p < 0.001 for all), and less completeness (p < 0.01 for all) across all chatbots, indicating potential areas for enhancement in their performance.

CONCLUSION

Although AI chatbots like Llama 2, Bard, and ChatGPT exhibit potential in sharing health-related information, their present performance in responding to clinical concerns concerning adult rhinosinusitis is not up to par with recognized clinical criteria. Future revisions should focus on addressing these shortcomings and placing an emphasis on accuracy, completeness, and conformity with evidence-based practices.

Efficacy of 2-Mercaptoethane Sulfonate Sodium (MESNA) in the Prevention of Pancreatitis After Endoscopic Retrograde Cholangiopancreatography: A Randomized Open Label Trial

Background and Aim

Oxidative stress has been considered a factor in the development of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The present clinical trial evaluated whether adding intravenous mesna to rectal indomethacin could prevent or alleviate PEP.

Methods

An open-labeled clinical trial was done on 698 participants undergoing endoscopic retrograde cholangiopancreatography (ERCP). Eligible patients received 100 mg indomethacin suppository 30 min before undergoing ERCP. Randomly, the participants received 400 mg intravenous mesna or nothing 30 min before doing the procedure. The PEP incidence and degree were measured in the patients as the main outcome.

Results

The total rate of PEP was equal to 13.7%. No significant difference was seen in the rate and severity of PEP between the mesna plus indomethacin and indomethacin alone arms (14% vs. 13.4%, respectively, p = 0.671). In high-risk patients, PEP rate and severity were lower in the mesna plus indomethacin group compared with indomethacin alone group and the statistical analysis showed that the difference was significant (41.7% vs. 51.8%, respectively, p = 0.033).

Conclusion

In high-risk patients undergoing ERCP, a combination of intravenous mesna plus rectal indomethacin may decrease the PEP rate and severity.

Celiac disease care differs significantly between high- and low-middle-income countries: a global survey of celiac experts from 63 countries

BACKGROUND AND AIM

Celiac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally.

METHODS

A 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten-free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high-income (HIC) and lower-income countries (LIC) (including upper-middle-, lower-middle-, and low-income countries). Survey responses were summarized as a single score using principal component analysis.

RESULTS

Valid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P < 0.001), quality (52% vs 20%; P < 0.001), and legislation for labeling of GF foods (82% vs 37%; P < 0.001), with unfavorable reimbursement policies (27% vs 12%; P = 0.002), subsidies (32% vs 13%; P < 0.001), and insurance (76% vs 43%; P < 0.001) for CeD patients. LIC also lacked awareness about CeD among general physicians (69% vs 32%; P < 0.001), trained celiac dieticians (39% vs 12%; P = 0.002), and active CeD patient support groups (93% vs 50%; P < 0.001). All experts believed that GF foods were costly (94% vs 87%), frequently contaminated (27% vs 32%), and unfavorably taxed (97% and 93%). The experts agreed on key unmet needs and better research funding. Overall CeD preparedness score (median 58.3 vs 33.0; P < 0.001) was also associated with income.

CONCLUSIONS

The present survey highlights the opinion of global experts on the challenges, opportunities, and preparedness related to CeD and differences worldwide by income.