Combination treatment of SGLT2i and GLP-1RA associated with improved cardiovascular outcomes in type 2 diabetes patients with acute coronary syndrome: A propensity score-matched cohort study

BACKGROUND

Few studies have investigated the effect of the combined use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) on the cardiovascular (CV) composite outcomes in type 2 diabetes (T2D) patients with acute coronary syndrome (ACS).

METHODS

We retrospectively collected the data of 1325 T2D patients treated with SGLT2i for more than 3 months before ACS admission at Civil Aviation General Hospital. According to the initiative GLP-1RA use after admission, patients were divided into a combination group (SGLT2i and GLP-1RA) or a SGLT2i group. The primary CV composite outcomes were defined as the first occurrence of major adverse cardiovascular events (MACE) with 1-year, encompassing all cause death, CV death, non-fatal myocardial infarction or stroke, coronary revascularization or heart failure readmission. Propensity score-matched (PSM) was used to control the confounding factors.

RESULTS

After matching, 208 pairs were finally included. Compared with the SGLT2i group, the combination group demonstrated a 31.0 % reduced risk of MACE (HR = 0.690, 95 %CI: 0.488-0.976), attributed primarily to a substantial 22.9 % (HR = 0.771, 95 %CI: 0.599-0.992) reduction in all-cause mortality and a 36.3 % reduction in non-fatal stroke (HR = 0.637, 95 %CI: 0.413-0.982). Subgroup analyses indicated consistent CV benefits across different subgroups (P interaction values >0.05).

CONCLUSIONS

The combined use of SGLT2i and GLP-1RA was associated with a significantly decreased risk of MACE primarily driven by the lowering risks of all-cause mortality and nonfatal stroke in T2D patients with ACS, compared with SGLT2i use alone.

Total adenosine deaminase cases as an inflammatory biomarker of pleural effusion syndrome

BACKGROUND

Although inflammatory diseases commonly affect the pleura and pleural space, their mechanisms of action remain unclear. The presence of several mediators emphasizes the concept of pleural inflammation. Adenosine deaminase (ADA) is an inflammatory mediator detected at increased levels in the pleural fluid.

AIM

To determine the role of total pleural ADA (P-ADA) levels in the diagnosis of pleural inflammatory diseases.

METHODS

157 patients with inflammatory pleural effusion (exudates, n = 124, 79%) and non-inflammatory pleural effusion (transudates, n = 33, 21%) were included in this observational retrospective cohort study. The P-ADA assay was tested using a kinetic technique. The performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The ideal cutoff value for P-ADA in pleural inflammation was determined using the Youden index in the ROC curve.

RESULTS

The transudates included congestive heart failure (n = 26), cirrhosis of the liver with ascites (n = 3), chronic renal failure (n = 3), and low total protein levels (n = 1). The exudate cases included tuberculosis (n = 44), adenocarcinoma (n = 37), simple parapneumonic effusions (n = 15), complicated parapneumonic effusions/empyema (n = 8), lymphoma (n = 7), and other diseases (n = 13). The optimal cutoff value of P-ADA was ≥ 9.00 U/L. The diagnostic parameters as sensitivity, specificity, positive and negative predictive values, positive and negative likelihood values, odds ratio, and accuracy were 77.69 (95%CI: 69.22-84.75); 68.75 (95%CI: 49.99-83.88); 90.38 and 44.90 (95%CI: 83.03-95.29; 30.67-59.77); 2.48 and 0.32 (95%CI: 2.21-11.2; 0.27-0.51); 7.65 (95%CI: 0.78-18.34), and 75.82 (95%CI: 68.24-82.37), respectively (χ² = 29.51, P = 0.00001). An AUC value of 0.8107 (95%CI: 0.7174-0.8754; P = 0.0000) was clinically useful. The Hosmer-Lemeshow test showed excellent discrimination.

CONCLUSION

P-ADA biomarker has high diagnostic performance for pleural inflammatory exudates.

Rutin protects the pancreas from inflammatory injury and oncogene-driven tumorigenesis by inhibiting acinar to ductal metaplasia

Rutin is a valuable traditional Chinese medicine known for its anti-inflammatory and anticancer effects. It has been shown to be effective in treating various inflammation-associated diseases. Here, we investigated the influence of rutin on acute pancreatitis and tumorigenesis. Using C57BL/6J mice and Kras mutant transgenic mice, we induced pancreatitis and acinar regeneration models. Pancreatic malondialdehyde (MDA), superoxide dismutase (SOD) activity and reduced glutathione (GSH) contents were measured for oxidative stress. Histological staining and a pancreatic acinar 3D culture model were used to clarify the influence of rutin on ADM in vivo and in vitro. Western blotting was adopted to detect ADM markers amylase and CK19. We found that rutin ameliorated inflammatory injury to the pancreas in both caerulein- and arginine-induced AP. Then, we revealed that the anti-damage effect of rutin may be due to its inhibition of oxidative stress. In addition, an acinar 3D culture model showed that rutin inhibited the formation of ADM by activating AMPK in acinar cells. Finally, the activation of AMPK is believed to be a potential mechanism by which rutin exerts inhibitory effects on Kras-driven tumorigenesis. Rutin inhibited AP-induced pancreatic injury and oncogenic Kras-driven tumorigenesis by inhibiting ADM.

The mitochondria-gut microbiota crosstalk - A novel frontier in cardiovascular diseases

Cardiovascular diseases (CVDs), including hypertension, atherosclerosis, and cardiomyopathy among others, remain the leading cause of global morbidity and mortality. Despite advances in treatment, the complex pathophysiology of CVDs necessitates innovative approaches to improve patient outcomes. Recent research has uncovered a dynamic interplay between mitochondria and gut microbiota, fundamentally altering our understanding of cardiovascular health. However, while existing studies have primarily focused on individual components of this axis, this review examines the bidirectional communication between these biological systems and their collective impact on cardiovascular health. Mitochondria, serving as cellular powerhouses, are crucial for maintaining cardiovascular homeostasis through oxidative phosphorylation (OXPHOS), calcium regulation, and redox balance. Simultaneously, the gut microbiota influences cardiovascular function through metabolite production, barrier integrity maintenance, and immune system modulation. The mitochondria-gut microbiota axis operates through various molecular mechanisms, including microbial metabolites such as trimethylamine N-oxide (TMAO), short-chain fatty acids (SCFA), and secondary bile acids, which directly influence mitochondrial function. Conversely, mitochondrial stress signals and damage-associated molecular patterns (DAMPs) affect gut microbial communities and barrier function. Key signalling pathways, including AMP-activated protein kinase (AMPK), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and the silent information regulator 1-peroxisome proliferator-activated receptor gamma coactivator 1-alpha (SIRT1-PGC-1α) axis, integrate these interactions, highlighting their role in CVD pathogenesis. Understanding these interactions has revealed promising therapeutic targets, suggesting new therapies aimed at both mitochondrial function and gut microbiota composition. Thus, this review provides a comprehensive framework for leveraging the mitochondria-gut microbiota axis in providing newer therapeutics for CVDs by targeting the AMPK/SIRT-1/PGC-1α/NF-κB signalling.

Exploring Alzheimer's disease treatment: Established therapies and novel strategies for future care

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by a gradual decline in cognitive function, memory impairment, and alterations in behavior. As the predominant etiology of dementia, AD affects millions of individuals worldwide, with its hallmark pathological feature being the accumulation of amyloid beta (Aβ) plaques, which disrupt neuronal function and progressively compromise brain structure. Early clinical manifestations often include forgetfulness, disorientation, and social withdrawal. Primarily impacting the elderly population, AD significantly impairs daily functioning and diminishes overall quality of life. Current therapeutic approaches for AD mainly focus on symptomatic relief and decelerating the disease's progression. Cholinesterase inhibitors, such as donepezil and rivastigmine, increase acetylcholine (ACh) levels to enhance cognitive function in individuals with mild to moderate AD. For individuals in more advanced stages of the disease, NMDA receptor antagonists modulate glutamate activity to mitigate excitotoxicity. In addition to pharmacological interventions, lifestyle modifications such as adherence to a balanced diet, regular physical activity, and cognitive engagement are advocated to support brain health. Novel therapeutic avenues are being explored to address underlying pathophysiological mechanisms, such as metal ion dysregulation within the brain. Furthermore, non-pharmacological approaches, including cognitive-behavioral therapy and patient support groups, provide essential behavioral and emotional support. Cutting-edge research continues to investigate innovative treatments, such as immunotherapies targeting amyloid plaques and tau tangles and neuroprotective compounds derived from natural sources. The goal of these multifaceted strategies is to alleviate symptoms, enhance quality of life, and offer hope for individuals and families affected by AD. This review provides a comprehensive summary of both established and emerging therapeutic interventions for the management of AD.

Glucose intake reduces alcohol craving and amplifies habituation to cue-induced brain activation in male patients with alcohol use disorder: A randomized, placebo-controlled crossover study examining male and female patients with AUD

INTRODUCTION

Evidence suggests a role of appetite-regulating hormones in alcohol use disorder. Reductions in acylated ghrelin levels are associated with reductions in craving and cue-induced brain activity. Ghrelin levels can be physiologically decreased by glucose intake, which therefore could be a treatment reducing craving and cue-induced brain activity in patients with alcohol use disorder, potentially mediated by acylated ghrelin.

MATERIAL AND METHODS

80 males and females with alcohol use disorder participated in the randomized placebo-controlled crossover study, examining glucose intake as acute treatment to reduce craving. Changes in craving and ghrelin levels were assessed at eight time points. Of these, 43 participants attended fMRI measurements examining habituation to cue-induced brain activation over time. Craving and hormone levels over time were analyzed using linear mixed modeling, brain activation habituation over time using flexible factorial models.

RESULTS

Models revealed a significant interaction effect (F(1,474.607)= 13.563, p < .001) between sex and treatment on craving, with lower craving values in males (difference in means=-.540, p = .016, 95 %CI: -.976, -.103) and higher craving in females (difference in means=.815, p = .005, 95 %CI:.243, 1.387) in the glucose compared to the placebo condition. In males, we found a significant effect of treatment (F(1,313.602)= 7.811, p = .006) and a trend, but no significant effect of acylated ghrelin (F(1,301.568)= 3.574, p = .060) on craving as well as greater habituation to cue-induced brain activation after glucose compared to placebo intake in right putamen (T(1,35)= 4.77, p = .019). Individual habituation slopes significantly predicted the difference in craving before and after the alcohol task (F(2,36)= 5.234, p = .010; B= -36.018, p = .027) in males.

CONCLUSIONS

Glucose intake could be a short-term treatment for males with alcohol use disorder to reduce alcohol craving and cue-induced brain activation. Sex-specific differences should be considered to gain a better understanding of the underlying mechanisms and develop treatment options for females.

Rosuvastatin inhibits carcinogenesis through Ca2+ triggered endoplasmic reticulum stress pathway in pancreatic cancer

BACKGROUND

Pancreatic cancer remains one of the most challenging malignancies to treat due to its late-stage diagnosis, aggressive progression, and high resistance to existing therapies. Rosuvastatin (ROV), known for its hypolipidemic effects, which significantly inhibited clonogenic capacity and epithelial-mesenchymal transition (EMT) in prostate cancer cells. However, the anti-cancer mechanisms of ROV in PC have not yet been fully explored.

PURPOSE

This study aimed to investigate the potential anti-cancer effects of ROV on PC cells and to elucidate the underlying mechanisms.

METHODS

Cytotoxicity was detected via MTT assay, while epithelial-mesenchymal transition (EMT) markers, Ca2+ levels, and endoplasmic reticulum (ER) stress were observed with fluorescence microscopy. RNA-seq analysis was used to identify significantly changed mRNA expression following ROV treatment. Additionally, western blotting and immunohistochemistry (IHC) were conducted to examine proteins involving in the cell cycle, EMT, Ca2+ signaling, and endoplasmic reticulum stress (ERS) in vitro and in vivo.

RESULTS

ROV inhibited PC cell proliferation by arresting the cell cycle at the G1/S phase and partially reducing cell mobility during the EMT process. A total of 1336 significantly different RNAs (P < 0.05 and |logFC|>1) were identified and analyzed through RNA-seq, revealing the Ca2+ and ER pathways in PC cells treated with ROV. ROV treatment significantly altered the level of intracellular Ca2+, triggering the ERS pathway and modulating the Ca2+/CaM/CaMKII/ERK pathway. Furthermore, ROV inhibited key proteins within the Ca2+ and ERS pathways, leading to reduced cell proliferation, mobility and G1/S phase arrest. In tumor tissues, the expression of Ki67, EMT markers, Calmodulin, and ATF6 corroborated the in vitro findings.

CONCLUSION

ROV inhibited proliferation and metastasis in PC cells by inhibiting the EMT process through the Ca2+/CaM/CaMKII/ERK and Ca2+-mediated ERS pathways, highlighting its potential as a prophylactic and therapeutic agent for PC.

Update in non-alcoholic fatty liver disease management: role of sodium-glucose cotransporter 2 inhibitors

Non-alcoholic fatty liver disease (NAFLD) is characterized by excessive lipid accumulation in hepatocytes without significant alcohol consumption. It is closely associated with sedentarism, hypercaloric diets, obesity, dyslipidemia, insulin resistance, type 2 diabetes mellitus, and genetic predisposition. NAFLD comprises a spectrum of liver disorders, from simple steatosis to non-alcoholic (NASH) and liver cirrhosis. The complex etiological mechanisms include oxidative stress, inflammation, apoptosis, and fibrosis; therefore, its management is challenging. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i), a class of antidiabetic drugs, have emerged as promising therapeutic agents due to their ability to improve key metabolic parameters, including obesity, dyslipidemia, insulin resistance, and hyperglycemia. This review explores the cellular mechanisms by which SGLT2i, either as monotherapy or combined with other treatments, modulate signaling pathways involved in lipid and carbohydrate metabolism. Additionally, we examine their effects on oxidative stress, inflammation, fibrosis, and apoptosis, which are critical drivers of NAFLD progression. This review is intended to summarize the multiple benefits of SGLT2 inhibitors and to educate healthcare providers on the therapeutic potential of these drugs in order to foster their incorporation into effective NAFLD management plans.

Novel artificial intelligence approach in neurointerventional practice: Preliminary findings on filter movement and ischemic lesions in carotid artery stenting

BACKGROUND AND OBJECTIVES

Embolic protection devices (EPDs) used during carotid artery stenting (CAS) are crucial in reducing ischemic complications. Although minimizing the filter-type EPD movement is considered important, limited research has demonstrated this practice. We used an artificial intelligence (AI)-based device recognition technology to investigate the correlation between filter movements and ischemic complications.

METHODS

We retrospectively studied 28 consecutive patients who underwent CAS using FilterWire EZ (Boston Scientific, Marlborough, MA, USA) from April 2022 to September 2023. Clinical data, procedural videos, and postoperative magnetic resonance imaging were collected. An AI-based device detection function in the Neuro-Vascular Assist (iMed Technologies, Tokyo, Japan) was used to quantify the filter movement. Multivariate proportional odds model analysis was performed to explore the correlations between postoperative diffusion-weighted imaging (DWI) hyperintense lesions and potential ischemic risk factors, including filter movement.

RESULTS

In total, 23 patients had sufficient information and were eligible for quantitative analysis. Fourteen patients (60.9 %) showed postoperative DWI hyperintense lesions. Multivariate analysis revealed significant associations between filter movement distance (odds ratio, 1.01; 95 % confidence interval, 1.00-1.02; p = 0.003) and high-intensity signals in time-of-flight magnetic resonance angiography with DWI hyperintense lesions. Age, symptomatic status, and operative time were not significantly correlated.

CONCLUSION

Increased filter movement during CAS was correlated with a higher incidence of postoperative DWI hyperintense lesions. AI-based quantitative evaluation of endovascular techniques may enable demonstration of previously unproven recommendations. To the best of our knowledge, this is the first study to use an AI system for quantitative evaluation to address real-world clinical issues.

Intestinal IL-17 family orchestrates microbiota-driven histone deacetylation and promotes Treg differentiation to mediate the alleviation of asthma by Ma-Xing-Shi-Gan decoction

BACKGROUND

Gut microbiota imbalance is well-known as one important trigger of allergic asthma. Ma-Xing-Shi-Gan decoction (MXSG) is a traditional Chinese medicine prescription with ideal clinical efficacy on asthma. However, whether and how MXSG exerts its efficacy on asthma through gut microbiota remains unclear.

PURPOSE

To investigate the underlying mechanism of MXSG against asthma using multi-omics technologies.

METHODS

An asthma model was established using 8-week-old C57BL/6 J mice, after which they were daily administrated with high-, medium- and low-dose MXSG for 7 days. Histopathological examinations and flow cytometry were performed to evaluate the effects of MXSG on lung immune injury. Key regulatory pathways were predicted via network pharmacology and verified using 16S rRNA sequencing, metagenomics, metabolomics, and in vivo experiments including the knockout of the targeting gene.

RESULTS

MXSG alleviated asthma symptoms, elevated intestinal microbial diversities, and enriched potential beneficial microbes such as Lactococcus, Lactobacillus, and Limosilactobacillus. Network pharmacology and experimental validation highlighted the IL-17/Treg signaling as crucial for asthma treatment. IL-17 knockout experiments revealed its necessity for Treg differentiation during asthma. Moreover, IL-17-deficient asthmatic mice exhibited lower levels of Lactobacillus and significant changes in microbial genes involving histone deacetylases (HDAC) and short-chain fatty acids (SCFAs). Finally, MXSG significantly boosted SCFA production and reduced HDAC9 expression, which were correlated with Treg cell ratios.

CONCLUSION

Our study delineates a novel mechanism where MXSG synergizes with the IL-17 family to enrich intestinal beneficial microbes (e.g. Lactobacillus) and SCFAs. This inhibits the expression of SCFA-downstream HDAC9 to promote Treg differentiation, and thus potentially alleviates asthma.

Phosphocreatine alleviates monocrotaline-induced liver injury dependent on PSRC1-regulated endoplasmic reticulum stress

Monocrotaline (MCT), a pyrrolizidine alkaloid (PA), is naturally found in certain plants and known for its hepatotoxic effects. In our prior research, we identified that phosphocreatine (PCr) mitigates PA-induced liver damage. However, the specific mechanism of PCr remains unknown. The objective of the present study was to elucidate the mechanism through which PCr shields against MCT-induced hepatic injury. In vitro assays demonstrated that PCr mitigated the MCT-induced ER stress and apoptosis. This alleviation was similarly observed with the use of the ER stress inhibitor 4-PBA, hinting at the role of ER stress in the protective mechanism of PCr against MCT-induced hepatic damage. In the MCT group, an upregulation of proline/serine-rich coiled-coil protein 1 (PSRC1) was evident, but this was notably downregulated following PCr treatment in vitro. The silencing of PSRC1 diminished the ER stress and apoptosis triggered by MCT, and the protective effect of PCr on liver injury remained evident. Overexpressing PSRC1 increased MCT-induced apoptosis and ER stress, and PCr still plays a protective role. In vivo experiments, we observed a notable attenuation of MCT-induced liver damage by PCr. Employing RNA sequencing and immunohistochemical staining techniques, we ascertained that endoplasmic reticulum (ER) stress, apoptosis and PSRC1 were significantly elevated in the liver samples treated with MCT. Notably, these alterations were counteracted by the presence of PCr. In conclusion, our findings suggest that PCr counteracts ER stress via modulation of PSRC1, which consequently confers protection against MCT-induced liver injury. Furthermore, this study offers potential therapeutic avenues for addressing hepatic damages attributable to MCT.

Defining Clinical Remission in Severe Asthma: Expert Opinion From the Gulf Region Using the Modified Delphi Method

The introduction of biologics into the asthma management landscape and the adoption of patient-centricity and outcomes principles drive the need to revise clinical goals and targets while treating asthma patients. This necessitates a deeper understanding of asthma phenotypes, endotypes, pathophysiology, and clinical cutoff points depicting an operational definition of clinical remission in asthma. This publication represents a step in this direction, through systemically gathering and analyzing insights from experts in pulmonology and immunology from the Gulf Countries. A pre-workshop survey, scientific workshop, and two rounds of Delphi surveys constituted the analysis process and resulted in agreed-upon comprehensive criteria defining clinical remission in severe asthma. While constructing the Delphi expert opinion addressing the concept of on treatment remission, the following factors were agreed to be the main defining criteria: The sustained absence of asthma symptoms, the sustained absence of asthma exacerbations, stable lung function, and zero systemic corticosteroids for the treatment of asthma for at least 12 months.

Management of malignant inferior vena cava syndrome (IVCS) by endovascular bridging stent placement

A 73-year-old male patient was admitted to the emergency department with dyspnea and severe edema in the lower extremities. The patient had been diagnosed with extensive small-cell lung cancer 15 months previously. Contrast-enhanced CT revealed suprahepatic compression of the inferior vena cava (IVC) at the level of its entry into the right atrium, caused by a space-occupying, infiltrating right lung lesion. Inferior vena cava syndrome (IVCS) occurs after obstruction of venous flow through the IVC. Trunk and lower limb edema are the most common manifestations of this syndrome, whereas cardiac function may be compromised in more severe cases. Given the patient's performance status, disease stage, and symptom acuity, endovascular stenting of the IVC was preferred over surgery or radiotherapy. The superior vena cava (SVC)-to-IVC bridging stent approach was employed to address the severe mass effect and location of the IVC stenosis at its junction with the right atrium. Three uncovered self-expandable stents were deployed in tandem from the SVC to the IVC. Overlap between stents minimized the risk of collapse within the right atrium, possibly leading to cardiac conduction disorders or even perforation of the heart wall. The patient experienced alleviation of IVCS symptoms over the next 48 h but unfortunately passed away 8 days later from his primary disease. Although primarily palliative in oncologic cases, SVC-to-IVC stenting can offer rapid and safe relief of symptoms in patients with advanced oncologic disease by restoring venous return to the heart.

The Importance of Treatment Modality in Veterans with Opioid Use Disorder: Implications for Virtual Care

This study examined treatment utilization across in-person and virtual treatment modalities in veterans who were on medications for opioid use disorder (MOUD; N = 139). Treatment records for veterans in addiction treatment on MOUD were examined for 3-months prior to telehealth conversions ("Pre-Telehealth," 12/02/2019-03/14/2020), 3-months during the initial telehealth transition ("Telehealth," 03/15/2020-06/30/2020) and 3-months during post-telehealth transition ("Re-Entry," 07/01/2020-10/01/2020). Analyses examined the relationship between treatment modality and demographic features, psychiatric comorbidities, treatment engagement, and illness severity as measured by psychiatric emergency room (PER) utilization. Results demonstrated that modality was not associated with PER utilization. Past-year PER visits, alcohol use disorder (AUD), and psychotic disorders were associated with PER utilization during Telehealth, while AUD was associated with Re-Entry PER utilization. Given the likelihood of virtual treatment in the future, frequent in-person visits may not be necessary for MOUD; however, individuals with comorbid AUD and psychotic disorders may need additional support to prevent emergency care.

Mutation spectrum and clinical features of MYORG in Iranian patients with Primary Familial Brain Calcification (PFBC)

INTRODUCTION

Mutations in myogenesis regulating glycosidase (MYORG), result in autosomal recessive (AR) form of Primary Familial Brain Calcification (PFBC) which is a rare neurodegenerative disease. PFBC is characterized by symmetric brain calcifications, particularly in the thalami, cerebellum, basal ganglia, and subcortical white matter. To date, eight genes have been linked with PFBC, however, currently about half of people with PFBC remain without a genetic diagnosis. Among these genes, MYORG, JAM2, CMPK2, and NAA60 are associated with an AR-PFBC. Within AR-PFBCs, the frequency of mutations in MYORG and JAM2 is 13% and 2%, respectively. In this study, we present a comprehensive clinical and genetic analysis of a group of Iranian PFBC patients.

METHODS

Clinical and paraclinical assessments of all patients were done. Whole-exome sequencing was performed for all probands. Candidate variants were confirmed and checked in their family members.

RESULTS

Four homozygous variants in MYORG across four families were identified: two novel variants, c.1727G > A;p.Arg576His and c.1687del;p.The563Glnfs*191, in two families and two known mutations, c.176G > A;p.Gly59Asp and c.1092_1097del;p.Phe365_Asp366del in the remaining two families. A potential SNV/CNV in the PFBC-related genes that causes disease was not detected in one proband.

CONCLUSION

Our study expanded the clinical features and mutation spectrum of MYORG and emphasizes to genetic heterogeneity in different populations. While SLC20A2 mutations are the common cause of PFBC in other populations, MYORG and JAM2 mutations seem to be the main cause of this disease in Iran. This issue could prove to be advantageous in the process of gene prioritization for screening within this specific population.

Proniosomal encapsulation of olive leaf extract for improved delivery of oleuropein: Towards the valorization of an agro-industrial byproduct

Olive leaf, a by-product of the olive oil industry, is rich in bioactive compounds, including the antioxidant and anti-inflammatory oleuropein. Olive leaf extracts have been explored for nutraceutical applications, but oleuropein's low bioavailability and stability limit its use in food and supplements. This work aimed to mitigate these issues by nano-encapsulating the olive leaf extract in proniosomes-free-flowing powders that form niosomes upon hydration. These niosomes can then be further processed into dosage forms or incorporated into functional foods. Proniosomes based on lactose or mannitol were developed and characterized. Hydration of the proniosomes yielded niosomes with high oleuropein loading and antioxidant activity. These niosomes controlled oleuropein release in simulated gastric and intestinal fluids, protecting it from degradation. Furthermore, niosomal encapsulation enhanced protection against oxidative stress in intestinal cells compared to the unformulated extract, suggesting improved intracellular delivery and making this formulation a suitable candidate as a functional food ingredient.

miR-92a-1-5p targets MEF2A to induce insulin resistance in myocardial ischemia/reperfusion injury

PURPOSE

Improving myocardial energy metabolism is an important way to alleviate myocardial ischemia/reperfusion injury (MIRI). Myocardial insulin resistance (IR) can occur after MIRI and cause the inhibition of glucose absorption and metabolism. This study aimed to detect the mechanism of miR-92a-1-5p in MIRI-induced myocardial IR.

METHODS

First, MIRI rat models were established using the Langendorff technique. H9c2 cells were treated with oxygen-glucose deprivation/reperfusion (OGD/R) to establish in vitro cell models. The expression levels of miR-92a-1-5p and myocyte enhancer factor 2A (MEF2A) were detected using RT-qPCR, and the expression of glucose transporter 4 (GLUT4) in the cell membrane and MEF2A was detected using Western blot. Immunofluorescence was used to detect GLUT4 expression in the cell membrane of H9c2 cells. Glucose absorption was detected in H9c2 cells using flow cytometry. H&E staining was used to determine pathological changes in heart tissue. H9c2 cell viability was detected using CCK-8 assay, and the binding affinity between miR-92a-1-5p and MEF2A was verified using dual luciferase reporter assay.

RESULTS

miR-92a-1-5p expression increased, and MEF2A expression decreased after OGD/R in H9c2 cells or MIRI in rats. Overexpression of miR-92a-1-5p aggravated myocardial tissue and H9c2 cell damage, inhibited the translocation of GLUT4 to the cell membrane, and reduced glucose absorption. Inhibiting the miR-92a-1-5p yielded the opposite results. MEF2A overexpression reversed the injury, which was exacerbated by miR-92a-1-5p, and promoted the translocation of GLUT4 to the cell membrane and glucose absorption. The double luciferase reporter assay results showed that miR-92a-1-5p could negatively regulate the expression of MEF2A.

CONCLUSION

miR-92a-1-5p expression increased after IR in myocardial tissue and H9c2 cells. Inhibition of miR-92a-1-5p increased MEF2A expression, promoted GLUT4 translocation, and increased glucose absorption, thereby reducing MIRI.

The gut microbiome is associated with disease-free survival in stage I-III colorectal cancer patients

Colorectal cancer (CRC) is the second overall leading cause of cancer death in the United States, with recurrence being a frequent cause of mortality. Approaches to improve disease-free survival (DFS) are urgently needed. The gut microbiome, reflected in fecal samples, is likely mechanistically linked to CRC progression and may serve as a non-invasive biomarker. Accordingly, we leveraged baseline fecal samples from N = 166 stage I-III CRC patients in the ColoCare Study, a prospective cohort of newly diagnosed CRC patients. We sequenced the V3 and V4 regions of the 16S rRNA gene to characterize fecal bacteria. We calculated estimates of alpha diversity, beta diversity, and a priori- and exploratory-selected bacterial presence/absence and relative abundance. Associations of microbial metrics with DFS were estimated using multivariable Cox proportional hazards models. We found that alpha diversity was strongly associated with improved DFS, most strongly among rectal cancer patients (Shannon HRrectum = 0.40 95% CI = 0.19, 0.87; p = .02). Overall microbiome composition differences (beta diversity), as characterized by principal coordinate axes, were statistically significantly associated with DFS. Peptostreptococcus was statistically significantly associated with worse DFS (HR = 1.62, 95% CI = 1.13, 2.31; p = .01 per 1-SD) and Order Clostridiales was associated with improved DFS (HR = 0.62, 95% CI = 0.43-0.88; p = .01 per 1-SD). In exploratory analyses, Coprococcus and Roseburia were strongly associated with improved DFS. Overall, higher bacterial diversity and multiple bacteria were strongly associated with DFS. Metagenomic sequencing to elucidate species, gene, and functional level details among larger, diverse patient populations are critically needed to support the microbiome as a biomarker of CRC outcomes.

Re-imagining human cell culture media: Challenges, innovations, and future directions

The development of optimized culture media is pivotal to advancements in human cell culture, underpinning progress in regenerative medicine, cell therapies, and personalized medicine. While foundational formulations like Eagle's Minimum Essential Medium (MEM) and Dulbecco's Modified Eagle Medium (DMEM) have historically enabled significant biological research, these media were primarily designed for non-human cells and do not adequately address the unique metabolic and functional requirements of human cells. This review examines the evolution of cell culture media, identifying persistent challenges in reproducibility, scalability, and ethical concerns, particularly regarding the reliance on animal-derived components such as fetal bovine serum (FBS). We highlight innovations in serum-free and chemically defined media that offer promising alternatives by enhancing consistency, aligning with Good Manufacturing Practices, and addressing ethical concerns. Emerging approaches, including omics-based profiling, high-throughput screening, and artificial intelligence (AI)-driven media design, are reshaping media optimization by enabling precise tailoring to the needs of specific human cell types and patient-derived cells. Furthermore, we discuss economic and regulatory challenges, emphasizing the need for cost-effective and scalable solutions to facilitate clinical translation. Looking forward, integrating advanced biotechnological tools such as 3D bioprinting, organ-on-a-chip systems, and personalized media formulations presents a transformative opportunity for human cell culture. These innovations, aligned with ethical and clinical standards, can drive the development of human-specific media systems that ensure reproducibility, scalability, and enhanced therapeutic potential, thereby advancing both research and clinical applications.

Precision oncolytic viral therapy in colorectal cancer: Genetic targeting and immune modulation for personalized treatment (Review)

Colorectal cancer (CRC) is a leading health issue and treatments to eradicate it, such as conventional chemotherapy, are non‑selective and come with a number of complications. The present review focuses on the relatively new area of precision oncolytic viral therapy (OVT), with genetic targeting and immune modifications that offer a new future for CRC treatment. In the present review, an overview of the selection factors that are considered optimal for an oncolytic virus, mechanisms of oncolysis and immunomodulation applied to the OVT, as well as new strategies to improve the efficacy of this method are described. Additionally, cause‑and‑effect relationships are examined for OVT efficacy, mediated by the tumor microenvironment, and directions for genetic manipulation of viral specificity are explored. The possibility of synergy between OVT and immune checkpoint inhibitors and other treatment approaches are demonstrated. Incorporating the details of the present review, biomarker‑guided combination therapies in precision OVT for individualized CRC care, significant issues and future trends in this required area of medicine are highlighted. Increasingly, OVT is leaving the experimental stage and may become routine practice; it provides a new perspective on overcoming CRC and highlights the importance of further research and clinical work.

Advancements in Noncontrast Ultrasound Imaging for Low-Velocity Flow: A Technical Review and Clinical Applications in Vascular Medicine

Visualizing the arterial tree using ultrasound, from the aorta to the small vessels, has significantly improved over time due to advances in ultrasound imaging technology. Initially limited to exploring the major vessels, ultrasound analysis has made considerable progress with enhanced image quality. While injecting microbubbles as a contrast agent partially addresses this limitation, its use is constrained by the need for intravenous injection, making the examination more complex and time-consuming. To address these drawbacks, new commercial modes have emerged, distinct from conventional color- and power-Doppler modes, offering the ability to analyze slow flows and, consequently, microvascularization. These dedicated imaging modes include B-flowTM, E-flowTM, Superb Microvascular Imaging (SMITM), Micro Flow Imaging (MFITM), MV-FlowTM, Detective Flow Imaging (DFITM), Micro-VTM, and Angio PLUS imagingTM. Although these modes share similar objectives, they are based on different technologies, each with its own specific characteristics. The exact algorithms behind these modes vary and are proprietary but rely on a combination of approaches to reduce tissue clutter and electronic noise while improving sensitivity to slower-flow Doppler signals. This review aims to explain the technological basis of these "microvascular flow imaging modes" (MVFI) currently clinically available in vascular imaging to the physician and sonographer specialized in vascular ultrasound, discussing their current limitations and potential applications in vascular medicine.

Lower- versus higher-order suicide-related attentional processing measures as predictors of adolescent suicide ideation and attempt

Cognitive theories suggest that biased suicide-related attentional processing confers risk for suicide ideation (SI) and attempts (SAs), but studies to date, which have been mixed, have not compared lower- and higher-order measures of attentional processes. The present study examined attention fixation, attention disengagement, and semantic interference as predictors of future SI and SA among adolescents, a high-risk age group for onset of SI and SAs. Adolescents (N = 135) (75 % female), ages 12-19 (M = 15.4, SD = 1.9), who presented to emergency or outpatient departments with SI (n = 84) or a SA (n = 51) completed an attention disengagement task (ADT), Suicide Stroop task, and the Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ). A subsample of adolescents completed 3-month (n = 98) and 12-month follow-up assessments (n = 96) of SI severity and SA (n = 118) (based on adolescent or caregiver report). AFSEQ score predicted SI severity at 3- and 12-months, respectively, b = 0.47, p < .05; b = 0.44, p < .01, adjusting for ADT and relevant covariates, and also predicted SA at follow up, OR = 1.06, 95 % CI = 1.00-1.12, p < .05, adjusting for SA history, but not after adjusting for SI. Greater suicide-related attention disengagement difficulty predicted greater SI severity at 12 months, b = 0.03, p < .05, but not at 3 months. Self-reported, higher-order, attentional fixation may better predict future suicide-related risk among diverse adolescents than lower-order cognitive tasks assessing suicide-related attention disengagement or semantic interference.

Racial and ethnic differences in social determinants of health among patients with HCC

BACKGROUND

Racial and ethnic minority populations are disproportionately impacted by HCC due to more advanced tumor burden and underuse of treatments. We explored racial and ethnic differences in medical mistrust, barriers to treatment, and health literacy among patients with HCC.

METHODS

We conducted a multicenter survey among patients with newly diagnosed HCC between September 2018 and July 2023 at 4 large U.S. health systems. The survey assessed medical mistrust [Group-Based Medical Mistrust Scale (GBMMS)], health literacy (CHEW Assessment of Health Literacy), and barriers to HCC treatment. We performed multivariable logistic regression to evaluate associations between race and ethnicity and survey measures.

RESULTS

Of 1245 eligible patients, 833 (66.9%) completed the survey (45.9% Hispanic, 35.9% White, and 14.2% Black). A higher proportion of Black and Hispanic patients had high medical mistrust than White patients (14.2% and 3.3% vs. 0.7%, respectively; p<0.001). In multivariable analysis, Black race (OR: 19.2, 95% CI: 4.2-87.7) but not Hispanic ethnicity (OR: 3.72, 95% CI: 0.80-17.2) was significantly associated with high mistrust. Compared to White patients, Black and Hispanic patients both reported greater barriers to HCC treatment, with the most common barriers being concerns about pain (41.6%), financial burden (37.6%), and time commitment (31.1%). Limited health literacy was reported by 38.1% of patients (46.8% Hispanic, 41.0% Black, 26.2% White; p<0.001).

CONCLUSIONS

Medical mistrust, barriers to treatment, and limited health literacy are prevalent among Black and Hispanic patients with HCC. Understanding the interplay between race, ethnicity, and these factors is essential to address HCC disparities.

Radiological assessment of extremity bone involvement in Erdheim-Chester disease: a systematic review of case reports

OBJECTIVE

To describe the clinical presentations and radiological manifestations of Erdheim-Chester disease (ECD) in the extremities, with particular emphasis on radiologic findings, as radiographs are typically the initial imaging modality used in clinical practice.

METHODS

Following the PRISMA guidelines, a comprehensive systematic search was performed across Scopus, PubMed, Web of Science, and Embase databases, covering case reports from inception until August 1, 2024. Included were studies with pathologically confirmed ECD (CD68 positive and CD1a negative) that were evaluated with at least one imaging modality and provided detailed descriptions of radiological findings.

RESULTS

Out of 401 identified articles, 20 articles comprising 20 histologically confirmed cases of ECD met the inclusion criteria following screening and full-text review. Pathological reports were assessed for the presence of lipid-laden cells and Touton giant cells, which were identified in 84.2% and 75% of cases, respectively. Upper extremities were affected in 65% of cases and lower extremities in all cases. Symmetric involvement was observed in 84.6% of upper extremity cases and 84.2% of lower extremity cases. Radiological findings were categorized as pure sclerosis (53.3%) and cortical thickening (42.8%) identified as the most common findings. Clinical manifestations were assessed, with pain and swelling in the extremities being the most common symptoms, occurring in 70% of cases.

CONCLUSION

The hallmark of ECD is bilateral, symmetric diaphyseal and/or metaphyseal osteosclerosis in the long tubular bones of the lower extremities. Epiphyseal sparing is observed in more than half of the patients.

Nervous system in hepatocellular carcinoma: Correlation, mechanisms, therapeutic implications, and future perspectives

Hepatocellular carcinoma (HCC) is a highly heterogeneous and complex cancer influenced by both the tumor microenvironment and multi-level regulation of the nervous system. Increasing evidence highlights critical roles of the central nervous system (CNS) and peripheral nervous system (PNS) in modulating HCC progression. Psychological stress and emotional disturbances, representing CNS dysregulation, directly accelerate tumor growth, metastasis, and impair anti-tumor immunity in HCC. PNS involvement, particularly autonomic innervation, extensively reshapes the hepatic tumor microenvironment. Specifically, sympathetic activation promotes immune suppression, tumor cell proliferation, epithelial-mesenchymal transition (EMT), and cancer stemness via β-adrenergic signaling and hypoxia-inducible factor 1-alpha (HIF-1α) stabilization, whereas parasympathetic signals generally exert anti-inflammatory and tumor-suppressive effects mediated by acetylcholine. Neurotransmitters including epinephrine, norepinephrine, dopamine, serotonin, and acetylcholine precisely regulate critical pathways such as AKT/mTOR, ERK, and NF-κB, thereby driving malignant cell behaviors, immune evasion, and chemoresistance. Neuro-targeted pharmacological interventions (e.g., SSRIs, β-blockers, dopamine antagonists) and behavioral therapies have shown efficacy in preclinical studies, underscoring their therapeutic potential. Additionally, neural-associated biomarkers like NEDD9, CNTN1, and nerve growth factor (NGF) exhibit prognostic significance, supporting their future clinical application. By systematically integrating neuroscience with oncology, this review identifies innovative neural-based therapeutic strategies, highlights key mechanistic insights, and outlines promising directions for future research and personalized clinical management of HCC.

Microenvironment-Dependent MSC Immunoregulation in Type 1 Diabetes: Insights From IFNγ Preconditioning

Interferon-gamma (IFNγ) plays a crucial role in the pathogenesis of type 1 diabetes (T1D) and is widely utilized to license mesenchymal stem/stromal cells (MSCs) to enhance their immunosuppressive properties through a process known as preconditioning or priming. This study investigates the interaction of MSCs preconditioned with (IFNγ+) or without (IFNγ-) IFNγ, with peripheral blood mononuclear cells (PBMCs) from healthy controls (HC) and T1D patients. We assessed the effects of these interactions on anti-inflammatory gene expression, chemokine and receptor profiles, and the induction of regulatory T (Treg) cells. Our findings reveal contrasting responses in HC and T1D PBMCs when exposed to IFNγ+ and IFNγ- MSCs, particularly in the expression of key genes such as CXCR3 and its ligands (CXCL9, CXCL10), CXCR6, CCR5, and its ligands (CCL3 and CCL4). Pathway enrichment analysis further showed that IFNγ preconditioning tailors MSC responses to specific immune microenvironments. These differential gene expression patterns were also reflected in the proportions of Treg cells, which varied depending on whether paracrine signaling or direct cell contact was involved. Collectively, our results demonstrate that IFNγ+ and IFNγ- MSCs create distinct immunomodulatory microenvironments in T1D PBMCs compared to HC PBMCs, emphasizing the potential for tailored MSC-based therapies in T1D treatment.

Chemical components, health-promoting effects and industrial application of a Chinese bitter tea (Kuding tea): A comprehensive review

Kuding tea (KT), a traditional Chinese bitter tea, has long been recognized as Food & Medicine Homology product, known for its various active components and health benefits. However, research on KT is fragmented, lacking a comprehensive review of its key chemical constituents, health-promoting effects, and potential future applications. This review outlines the development history and nutritional components of KT while examining its functional benefits and industrial applications. KT is a promising and cost-effective product, containing numerous bioactive constituents, including polyphenols, triterpenoids, phenylethanoids, and polysaccharides, which exhibit strong antioxidant, anti-obesity, anti-diabetic, anti-inflammatory, neuroprotective, and anti-cancer activities. We summarized the researches on the health-promoting effects of KT and emphasized its practical applications in the food, agricultural, and pharmaceutical industries. Overall, this review presents a forward-looking viewpoint on creative KT applications and offers insights into KT's potential for future sustainable growth.

Selenium alleviates high-fat diet induced hepatocyte lipid accumulation via exosome miR-22/FGFR1 pathway in grass carp

The current study aims to investigate whether exosomal miRNAs are involved in lipid reduction by selenium (Se) in the liver of grass carp, through miRNA sequencing, transfection of miRNA mimic (miR-22m) or inhibitor (miR-22i), isolation of hepatocyte-derived exosomes and treatment, and detection of lipid metabolism-related genes and proteins. The miRNAs sequencing and bioinformatics revealed that miR-22 was most abundantly expressed in the differentially expressed miRNAs after selenium treatment, and was enriched in lipid metabolism-related pathways. Moreover, Se significantly up-regulated the miR-22 levels and reduced the lipid content in liver or hepatocytes of grass carp. Furthermore, the miR-22m significantly increased levels of miR-22 and reduced lipid content in grass carp hepatocytes, which were consistent with the Se-treatment. However, the miR-22i reversed these trends. Besides, the miR-22 suppressed the FGFR1-PI3K-AKT-mTOR signaling pathway and its downstream genes related to lipid synthesis. More importantly, the Se-treated hepatocyte-exosomes which were enriched in the miR-22 significantly reduced the triglycerides content in the oleic acid-treated hepatocytes. In summary, Se alleviated high fat-induced lipid accumulation in grass carp liver by up-regulating the expression of miR-22 which negatively regulates FGFR1 and its downstream regulatory genes. Moreover, exosomes participate in the lipid reduction by Se, which may be through carrying miR-22.

Extracellular vesicles and the lung: from disease pathogenesis to biomarkers and treatments

Nanosized extracellular vesicles (EVs) are released by all cells to convey cell-to-cell communication. EVs, including exosomes and microvesicles, carry an array of bioactive molecules, such as proteins and RNAs, encapsulated by a membrane lipid bilayer. Epithelial cells, endothelial cells, and various immune cells in the lung contribute to the pool of EVs in the lung microenvironment and carry molecules reflecting their cellular origin. EVs can maintain lung health by regulating immune responses, inducing tissue repair, and maintaining lung homeostasis. They can be detected in lung tissues and biofluids such as bronchoalveolar lavage fluid and blood, offering information about disease processes, and can function as disease biomarkers. Here, we discuss the role of EVs in lung homeostasis and pulmonary diseases such as asthma, chronic obstructive pulmonary disease, cystic fibrosis, pulmonary fibrosis, and lung injury. The mechanistic involvement of EVs in pathogenesis and their potential as disease biomarkers are discussed. Finally, the pulmonary field benefits from EVs as clinical therapeutics in severe pulmonary inflammatory disease, as EVs from mesenchymal stem cells attenuate severe respiratory inflammation in multiple clinical trials. Further, EVs can be engineered to carry therapeutic molecules for enhanced and broadened therapeutic opportunities, such as the anti-inflammatory molecule CD24. Finally, we discuss the emerging opportunity of using different types of EVs for treating severe respiratory conditions.

Contact X-ray Brachytherapy as a Boost Therapy After Neoadjuvant (Chemo)Radiation in High-Risk Locally Advanced Rectal Cancer

PURPOSE

Radical surgery following neoadjuvant therapy is the standard of care for locally advanced rectal cancer. A contact x-ray brachytherapy (CXB) boost can alternatively be used to treat residual disease postneoadjuvant (chemo)radiation, especially in patients who are not suitable for or do not wish to have surgery. Its role has mostly been studied to date in low- to intermediate-risk patients. We have now evaluated the utility of CXB boost in high-risk rectal cancers after their tumors have been significantly downstaged by neoadjuvant (chemo)radiation.

MATERIALS AND METHODS

Oncological outcomes and treatment tolerability were evaluated in 328 patients based on rectal cancer treatment risk stratification: low-/intermediate-risk (cT1-3ab, N0-1, M0, no extramural venous invasion, mesorectal fascia involvement >1 mm) and high-risk (cT3cd-4/N2, M0, mesorectal fascia ≤1 mm, and/or extramural venous invasion positive).

RESULTS

With a median follow-up of 33 (IQR, 15-54) months and a median age of 73 (IQR, 62-80) years, no significant differences were found between low/intermediate and high-risk groups in clinical complete response (78% vs. 73%, P = .32), local regrowth (16.6% vs. 22.4%, P = .41), nodal (1.8% vs. 5.8%, P = .051) or regional (1.3% vs. 2.9%, P = .33) relapse, or postradiation toxicities (P = .16). However, the high-risk group had a higher distant relapse rate (21.2% vs. 10.7%, P = .01), with no significant differences in 3-year organ preservation (80% vs. 87%, P = .25), 5-year disease-free survival (62% vs. 64%, P = .46), or overall survival (67% vs. 64%, P = .88). Longer treatment time, treatment gap >24 weeks between therapies, and administration of a higher than standard CXB dose were newly identified factors that negatively impacted outcomes.

CONCLUSIONS

High-risk patients with rectal cancer treated with CXB boost had more distant relapses, but comparable locoregional tumor control, organ preservation, disease-free survival, and overall survival to lower risk patients, with acceptable toxicities. CXB boost is, therefore, a viable option for selected high-risk patients with rectal cancer. Timely reassessment, prompt referral, and CXB dose optimization are crucial for improving outcomes.

Cathepsins: Emerging targets in the tumor ecosystem to overcome cancers

Cathepsins, a group of lysosomal peptidases, have traditionally been recognized as tumor facilitators. Recent research, however, highlights their critical role in orchestrating cancer and the tumor microenvironment (TME). Primality, cathepsins degrade extracellular matrix, enabling cancer cells to invade and metastasize, while also promoting vascular endothelial infiltration and subsequent angiogenesis. Additionally, cathepsins boost fibroblast growth, thereby supporting tumor progression. More importantly, cathepsins are pivotal in modulating immune cells within the TME by regulating their recruitment, antigen processing and presentation, differentiation, and cell death, primarily contributing to immune suppression. Given their overexpression in tumors and elevated levels in the circulation of cancer patients, it is crucial to consider the systemic effects of cathepsins. Although the comprehensive role of cathepsins in cancer patients' bodies remains underexplored, they likely influence systemic immunity and inflammation, cellular metabolism, muscle wasting, and distant metastasis through their unique proteolytic functions. Notably, cathepsins also confer resistance to chemoradiotherapy by rewriting the cellular profile within the TME. In this context, promising results are emerging from studies combining cathepsin inhibitors with conventional therapies to suppress tumor development effectively. This review aims to decipher the cathepsin-driven networks within cancer cells and the TME, detailing their contribution to chemoradioresistance by reshaping both micro- and macroenvironments. Furthermore, we explore current and future perspectives on therapies targeting cathepsins' interactions, offering insights into innovative treatment strategies.

Studies on the functional role of UFMylation in cells (Review)

Protein post‑translational modifications (PTMs) play crucial roles in various life activities and aberrant protein modifications are closely associated with numerous major human diseases. Ubiquitination, the first identified protein modification system, involves the covalent attachment of ubiquitin molecules to lysine residues of target proteins. UFMylation, a recently discovered ubiquitin‑like modification, shares similarities with ubiquitination. The precursor form of ubiquitin fold modifier 1 (UFM1) undergoes synthesis and cleavage by UFM1‑specific protease 1 or UFM1‑specific protease 2 to generate activated UFM1‑G83. Subsequently, UFM1‑G83 is activated by a specific E1‑like activase, UFM1‑activating enzyme 5. UFM1‑conjugating enzyme 1 and an E3‑like ligase, UFM1‑specific ligase 1, recognize the target protein and facilitate UFMylation, leading to the degradation of the target protein. Current knowledge regarding UFMylation remains limited. Previous studies have demonstrated that defects in the UFMylation pathway can result in embryonic lethality in mice and various human diseases, highlighting the critical biological functions of UFMylation. However, the precise mechanisms underlying UFMylation remain elusive. This present review aimed to summarize recent research advances in UFMylation, with the aim of providing novel insights and perspectives for future investigations into this essential protein modification system.

Effect of Low-Intensity Pulsed Ultrasound on Post-Traumatic Intra-Articular Knee Adhesions in Rats

OBJECTIVE

Intra-articular adhesions (IAA) caused by trauma or surgical invasion commonly elicit pain and motor dysfunction. However, effective treatments for preventing IAA remain elusive. This study investigated the effects of low-intensity pulsed ultrasound (LIPUS) therapy on IAA after immobilization following trauma.

METHODS

A knee adhesion model was established in male Wistar rats, which were divided into LIPUS and sham groups. LIPUS was applied for 20 min/d (30 mW/cm2 [spatial average temporal average], 1 MHz, duty cycle 20%, 5 times/wk, for 1, 2 and 3 wk). Another group of rats was treated with the same parameters for 3 or 7 d. After the treatment period, we evaluated the range of motion (ROM) of the knee joint, the length of the adhesion and the posterior knee joint capsule. RNA-seq and RT-quantitative polymerase chain reaction were performed to investigate the molecular mechanisms underlying the effects of LIPUS.

RESULTS

The knee ROM was significantly improved, and the adhesion length was reduced in the LIPUS group. RNA-seq identified 113 and 776 differentially expressed genes on days 3 and 7, respectively, highlighting pathways related to inflammatory, immune and fibrotic responses. IL-6 mRNA in the LIPUS group was significantly upregulated on day 3 and significantly downregulated at 1 wk. The TNFα, TGFβ and HIF1α levels did not differ between all groups. COL1A1 expression in the sham group significantly increased on day 7.

CONCLUSION

These results indicate that LIPUS therapy may affect inflammatory and fibrotic pathways and may serve as a rehabilitation approach to prevent the development of IAA.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Comprehensive insights of etiological drivers of hepatocellular carcinoma: Fostering targeted nano delivery to anti-cancer regimes

Hepatocellular carcinoma (HCC) stands as one of the most prevalent and deadliest malignancies on a global scale. Its complex pathogenesis arises from multifactorial etiologies, including viral infections, metabolic syndromes, and environmental carcinogens, all of which drive genetic and molecular aberrations in hepatocytes. This intricate condition is associated with multiple causative factors, resulting in the abnormal activation of various cellular and molecular pathways. Given that HCC frequently manifests within the context of a compromised or cirrhotic liver, coupled with the tendency of late-stage diagnoses, the overall prognosis tends to be unfavorable. Systemic therapy, especially conventional cytotoxic drugs, generally proves ineffective. Despite advancements in therapeutic interventions, conventional treatments such as chemotherapy often exhibit limited efficacy and substantial systemic toxicity. In this context, nanomedicine, particularly lipid-based nanoparticles (LNPs), has emerged as a promising strategy for enhancing drug delivery specificity and reducing adverse effects. This review provides a comprehensive overview of the molecular and metabolic underpinnings of HCC. Furthermore, we explored the role of lipid-based nano-formulations including liposomes, solid lipid nanoparticles, and nanostructured lipid carriers in targeted drug delivery for HCC. We have highlighted recent advances in LNP-based delivery approaches, FDA-approved drugs, and surface modification strategies to improve liver-specific delivery and therapeutic efficacy. It will provide a comprehensive summary of various treatment strategies, recent clinical advances, receptor-targeting strategies and the role of lipid composition in cellular uptake. The review concludes with a critical assessment of existing challenges and future prospects in nanomedicines-driven HCC therapy.

Anaplastic thyroid cancer: Genetic roles, targeted therapy, and immunotherapy

Anaplastic thyroid cancer (ATC) stands as the most formidable form of thyroid malignancy, presenting a persistent challenge in clinical management. Recent years have witnessed a gradual unveiling of the intricate genetic underpinnings governing ATC through next-generation sequencing. The emergence of this genetic landscape has paved the way for the exploration of targeted therapies and immunotherapies in clinical trials. Despite these strides, the precise mechanisms governing ATC pathogenesis and the identification of efficacious treatments demand further investigation. Our comprehensive review stems from an extensive literature search focusing on the genetic implications, notably the pivotal MAPK and PI3K-AKT-mTOR signaling pathways, along with targeted therapies and immunotherapies in ATC. Moreover, we screen and summarize the advances and challenges in the current diagnostic approaches for ATC, including the invasive tissue sampling represented by fine needle aspiration and core needle biopsy, immunohistochemistry, and 18F-fluorodeoxyglucose positron emission tomography/computed tomography. We also investigate enormous studies on the prognosis of ATC and outline independent prognostic factors for future clinical assessment and therapy for ATC. By synthesizing this literature, we aim to encapsulate the evolving landscape of ATC oncology, potentially shedding light on novel pathogenic mechanisms and avenues for therapeutic exploration.

Mature and Juvenile Neuromuscular Plasticity in Response to Unloading

The neuromuscular junction (NMJ) is the synapse that enables the requisite electrical communication between the motor nervous system and the myofibers that respond to such electrical stimulation with movement and force development. Changes in an NMJ's normal activity pattern have been demonstrated to remodel both the synapse and the myofibers that comprise the NMJ. Significant amounts of research have been devoted to the study of aging on the neuromuscular system. Far less, however, has been focused on revealing the effects of reduced activity on the NMJ and myofibers comprising juvenile neuromuscular systems. In the present investigation, the consequences of decreased activity imposed by muscle unloading (UL) via hindlimb suspension for 2 weeks (a period known to induce muscle remodeling) were examined in both young adult, that is, mature (8 mo), and juvenile (3 mo) neuromuscular systems. In total, 4 treatment groups comprised of 10 animals (Juvenile-Control, Juvenile-Unloaded, Mature-Control, and Mature-Unloaded) were studied. Immunofluorescent procedures, coupled with confocal microscopy, were used to quantify remodeling of both the pre- and postsynaptic features of NMJs, as well as assessing the myofiber profiles of the soleus muscles housing the NMJs of interest. Results of ANOVA procedures revealed that there were significant (p < 0.05) main effects for both treatment, whereby UL consistently led to expanded size of the NMJ, and Age where expanded NMJ dimensions were consistently linked with mature compared to juvenile neuromuscular systems. Moreover, only sporadically was interaction between the main effects of Age and Treatment noted. Importantly, one variable that remained impressively resistant to the effects of both Age and Treatment was the critical parameter of pre- to postsynaptic coupling suggesting stability in effective communication at the NMJ throughout the lifespan and despite changes in activity patterns. The data presented here suggest that further inquiry must be performed regarding disuse-related plasticity of the neuromuscular system in adolescent individuals as those individuals regularly suffer injuries resulting in periods of muscle UL.

Unraveling the potential of bioengineered microbiome-based strategies to enhance cancer immunotherapy

The human microbiome plays a pivotal role in the field of cancer immunotherapy. The microbial communities that inhabit the gastrointestinal tract, as well as the bacterial populations within tumors, have been identified as key modulators of therapeutic outcomes, affecting immune responses and reprogramming the tumor microenvironment. Advances in synthetic biology have made it possible to reprogram and engineer these microorganisms to improve antitumor activity, enhance T-cell function, and enable targeted delivery of therapies to neoplasms. This review discusses the role of the microbiome in modulating both innate and adaptive immune mechanisms-ranging from the initiation of cytokine production and antigen presentation to the regulation of immune checkpoints-and discusses how these mechanisms improve the efficacy of immune checkpoint inhibitors. We highlight significant advances with bioengineered strains like Escherichia coli Nissle 1917, Lactococcus lactis, Bifidobacterium, and Bacteroides, which have shown promising antitumor efficacy in preclinical models. These engineered microorganisms not only efficiently colonize tumor tissues but also help overcome resistance to standard therapies by reprogramming the local immune environment. Nevertheless, several challenges remain, such as the requirement for genetic stability, effective tumor colonization, and the control of potential safety issues. In the future, the ongoing development of genetic engineering tools and the optimization of bacterial delivery systems are crucial for the translation of microbiome-based therapies into the clinic. This review highlights the potential of bioengineered microbiota as an innovative, personalized approach in cancer immunotherapy, bringing hope for more effective and personalized treatment options for patients with advanced malignancies.

Giant lipoma in the anterior region of the neck: A case report of a rare condition and review of literature

Lipomas are benign and very common subcutaneous tumors of adipose tissue, which may occur anywhere in the body. Lipomas in head and neck regions are extremely rare. A giant neck lipoma is classified as a lesion greater than 10 cm in one dimension or weighing more than 1000 g. In this case report and review of the literature, a 66-year-old male with likely diagnosis of neck lipoma was under 5-year surveillance prior to development of giant neck lipoma. Computed tomography provided critical insight in the extent of neck mass in relation to surrounding structures in assessing possibility of malignancy and in guiding appropriate management.

VISTA as a context-dependent immune checkpoint: Implications for tumor immunity and autoimmune pathogenesis

V-domain Ig suppressor of T cell activation (VISTA) is a recently characterized as immune checkpoint regulator with critical roles in modulating immune responses across pathological contexts. In cancer, VISTA contributes to immune evasion by sustaining an immunosuppressive tumor microenvironment, emerging as a promising target for immunotherapeutic intervention. In contrast, in autoimmune diseases, VISTA preserves peripheral immune tolerance and suppresses aberrant immune activation, thereby preventing tissue destruction. This functional dichotomy reflects the complexity of VISTA-mediated signaling, which is modulated by cellular context, microenvironmental cues, and disease stage. Recent studies have elucidated key aspects of VISTA biology, including its structural features, ligand interactions, and context-dependent expression patterns. VISTA operates as a co-inhibitory molecule in cancer, while exerting co-stimulatory or regulatory effects in autoimmunity. This review provides a comprehensive overview of VISTA's discovery, molecular mechanisms, and dual roles in cancer and autoimmune pathogenesis. Furthermore, the current status of VISTA-targeted therapeutic strategies is critically examined, highlighting the translational challenges posed by discrepancies between preclinical models and clinical trial outcomes. Finally, the potential of targeting VISTA within the broader paradigm of immune checkpoint plasticity is discussed, with emphasis on overcoming compensatory immune resistance to enhance therapeutic efficacy. A deeper mechanistic understanding of VISTA is essential for the rational design of future immunomodulatory therapies tailored to specific disease contexts.

Novel evidence in vivo: Berberine ameliorated glucocorticoid-induced post-natal growth retardation by regulating the GH/IGF-1 axis through KMT1A downregulation

BACKGROUND

Glucocorticoids (GCs) are widely used anti-inflammatory agents that inhibit growth in children. However, their mechanisms and effect on the growth hormone (GH)/insulin-like growth factor (IGF)-1 axis remain unclear.

PURPOSE

This study, we aimed to establish a mouse model of GC-induced growth retardation during the critical growth period and explore the underlying mechanisms. Additionally, we aimed to identify novel biomarkers and potential therapeutic agents for GC-induced growth impairment.

METHODS

Four-week-old mice were treated with GCs for two weeks and subsequently assessed for body length, weight, and body composition. Immunohistochemical analysis of the growth plate in the proximal tibia and biochemical assays of blood were performed to evaluate changes in growth plate length and GH/IGF-1 axis. KMT1A expression and its effects on Ghr expression were examined, and the impact of berberine on GC-induced growth retardation was assessed.

RESULTS

GCs significantly reduced growth by impairing growth plate expansion, disrupting the GH/IGF-1 axis, and downregulation of the GH receptor (Ghr) and Igf-1 levels in the liver. These changes were attributed to the upregulation of the H3K9 trimethyltransferase KMT1A, which decreased Ghr transcription in the liver. In vitro screening of natural compounds revealed that berberine chloride hydrate decreased the KMT1A levels and increased GHR levels. Berberine chloride hydrate also effectively ameliorated GC-induced growth retardation by restoring Ghr expression via KMT1A inhibition, thereby enhancing the circulating IGF-1 levels.

CONCLUSION

Overall, our findings highlight the potential of targeting KMT1A using berberine chloride hydrate as an epigenetic modifier to treat GC-induced growth impairment.

NME2 modulates HCC progression through 4EBP1 phosphorylation and autophagy regulation independent of mTOR

BACKGROUND

To investigate the role of nucleoside diphosphate kinase 2 (NME2) in HCC progression, assessing its therapeutic potential.

METHODS

Utilizing transcriptome sequencing data from The Cancer Genome Atlas (TCGA) and immunohistochemical staining of tissue microarrays, we analyzed NME2 expression in HCC tumor tissues. The effects of NME2 on HCC cell proliferation and autophagy flux were assessed through knockdown and overexpression experiments. Additionally, the relationship between NME2 and 4EBP1 phosphorylation was explored through specific site mutation analysis.

RESULTS

NME2 overexpression in HCC correlated with poor prognosis. NME2 knockdown significantly hindered HCC cell proliferation and induced autophagy flux. Notably, NME2 modulates 4EBP1 phosphorylation (Thr37/46) independently of mTOR, unveiling a novel axis in HCC pathogenesis. Additionally, NME2 modulates eukaryotic translation initiation factor 4F (eIF4F) complex formation and autophagy flux.

CONCLUSIONS

NME2 plays a crucial role in HCC development by modulating 4EBP1 phosphorylation and autophagy through an mTOR-independent pathway. Our research underscores NME2's significance as a potential therapeutic target in HCC, meriting further exploration of its underlying mechanisms and clinical applicability.

SNX10 regulates the proliferation, apoptosis and cell cycle of acute B lymphoblastic leukemia cells via the PI3K/Akt signaling pathway

B‑cell acute lymphoblastic leukemia (B‑ALL) is a type of acute lymphoblastic leukemia that originates from B cells. It typically occurs in children and adolescents, but it can also appear in adults. Sorting nexin 10 (SNX10) has recently been identified as a significant regulatory factor in various tumors, although its specific roles remain contested. However, its function in B‑ALL has not been previously explored. The present study investigated the role of SNX10 in B‑ALL pathogenesis. Bioinformatics analysis identified SNX10 as a Core Hub gene in the B‑ALL signaling network, with significantly reduced expression in patients with B‑ALL. These findings were corroborated through analysis of clinical bone marrow samples and B‑ALL cell lines. Functional in vitro studies revealed that SNX10 knockdown markedly inhibited B‑ALL cell proliferation, increased apoptosis, and arrested cells in the G0/G1 phase. By contrast, SNX10 overexpression enhanced cell proliferation, suppressed apoptosis and promoted G2/M phase progression. Proteomic analysis further implicated the PI3K/Akt signaling pathway in mediating the effects of SNX10. Specifically, SNX10 overexpression increased the phosphorylation levels of PI3K and Akt, while SNX10 knockdown had the opposite effect. In vivo experiments demonstrated that elevated SNX10 expression accelerated leukemia progression in a mouse model. Collectively, these findings highlighted the pivotal role of SNX10 in promoting B‑ALL cell proliferation via the PI3K pathway, highlighting its potential as a therapeutic target for B‑ALL and providing a foundation for future investigations.

Eating Disorders and Later Incidence of Cancer: A Nationwide Longitudinal Study in Denmark

Background

We examined the incidence of cancer types among individuals with eating disorders (EDs).

Methods

A nationwide longitudinal study of 6,807,731 individuals born between 1940 and 2015 was conducted using the Danish National Registries. Cox models with ED diagnosis as exposure and cancer diagnoses as outcomes were used to estimate hazard ratios (HRs) and 95% CIs while adjusting for sex, birth year, and comorbidities. The primary analysis comprised ICD-8 and ICD-10 codes for anorexia nervosa (AN) and other ED (OED). The secondary analysis comprised ICD-10 codes and included AN, bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS).

Results

AN was associated with a reduced incidence of breast cancer while adjusting for sex and birth year (HR, 0.80; 95% CI, 0.66-0.97) and elevated incidence of respiratory (HR, 1.59; 95% CI, 1.24-2.04), cervical (HR, 1.45; 95% CI, 1.05-1.98), and esophageal (HR, 4.77; 95% CI, 2.82-8.06) cancers. OED was associated with an elevated incidence of respiratory (HR, 1.57; 95% CI, 1.20-2.06) and cervical (HR, 1.60; 95% CI, 1.20-2.14) cancers. ICD-10-only analyses confirmed the association of AN with reduced incidence of breast cancer and elevated incidence of respiratory and cervical cancers. BN was associated with reduced incidence of breast cancer in sensitivity analysis. EDNOS was associated with reduced incidence of breast cancer and elevated incidence of respiratory and cervical cancers.

Conclusions

All EDs were associated with a reduced incidence of breast cancer. All EDs except BN were associated with a higher incidence of respiratory and cervical cancers. AN was associated with a higher incidence of esophageal cancer.

UBC9 ameliorates diabetic cardiomyopathy by modulating cardiomyocyte mitophagy through NEDD4/RUNX2/PSEN2 axis

AIM

Diabetic cardiomyopathy (DCM) is one of the most significant cardiovascular complications in patients with diabetes. Ubiquitin conjugating enzyme 9 (UBC9) is the only SUMO-E2 enzyme that plays a key role in cardiomyocytes homeostasis. This study aimed to elucidate the roles and mechanisms of UBC9 in DCM development.

METHODS

We established cardiomyocyte-specific UBC9 knockout mice and UBC9-overexpressing mice in vivo. A DCM model was established by feeding a high-fat diet and administering a low-dose streptozotocin injection. Proteomics, H&E staining, Sirius Red staining, WGA staining, real-time PCR, and western blotting were performed to examine fibrosis, hypertrophy, and mitophagy in the myocardium. Neonatal mouse cardiomyocytes (NMCMs) were cultured in vitro and stimulated with palmitic acid, UBC9 overexpression adenovirus, and small interfering RNA to establish UBC9 overexpression or knockdown NMCMs. Real-time PCR, western blotting, and immunoprecipitation were employed to examine the roles and mechanisms of UBC9 in cardiomyocyte mitophagy.

RESULTS

The transcription and protein levels of UBC9 were significantly decreased in the myocardium of DCM mice. Cardiomyocyte-specific UBC9 knockout aggravated cardiac dysfunction, myocardial fibrosis, hypertrophy, and impaired mitophagy. Conversely, UBC9 overexpression produced opposite effects. UBC9 protected cardiomyocyte mitophagy independently of SUMOylation. UBC9 exerted protective effects against defective cardiomyocyte mitophagy by directly binding to NEDD4, enhancing RUNX2 ubiquitination and degradation, which in turn increased PSEN2 expression. Moreover, the impact of UBC9 on cardiomyocyte mitophagy was reversed upon PSEN2 knockdown.

CONCLUSIONS

UBC9 alleviated DCM development through the NEDD4/RUNX2/PSEN2 pathway. These findings offer novel insights into the potential of UBC9 as a therapeutic target for DCM.

Combined quercetin with phosphodiesterase inhibitors; sildenafil and pentoxifylline alleviated CCl4-induced chronic hepatic fibrosis: Role of redox-sensitive pathways

Liver fibrosis is a common pathological condition that is caused by complicated molecular and cellular processes. This study evaluated the therapeutic potential of combined quercetin (QU) with either sildenafil (Sild) or pentoxifylline (PTX) in chronic carbon tetrachloride (CCl4)-induced liver fibrosis in Wistar albino rats. Fibrosis was induced by CCl4 injections (1.5 mg/kg, i.p.) three times weekly for 10 weeks. After six weeks, rats received oral QU (50 mg/kg/day), Sild (50 mg/kg/day), or PTX (10 mg/kg twice/day) individually or in combination for the remaining four weeks. Results showed significant alterations in liver biochemical markers, histopathology, oxidative stress, inflammation, apoptosis, and hypoxic responses due to CCl4 exposure. These changes included reduced expression of Nrf-2, HO-1, and cytoglobin, alongside increased levels of NF-κB, cleaved caspase-3, TNF-α, IL-1β, and HIF-1. Notably, QU, Sild, and PTX, individually or in combination, improved these parameters. The combination of QU with Sild or PTX proved more effective than single treatments, modulating anti-oxidant (Nrf2/HO-1/cytoglobin), anti-inflammatory (NF-κB/TNF-α), and hypoxic signaling pathways (HIF-1α). In conclusion, QU combined with phosphodiesterase inhibitors shows promise as a therapy for liver fibrosis, offering enhanced protection through anti-oxidants and anti-inflammatory mechanisms.

Identification of metabolites associated with capecitabine‑induced hand‑foot syndrome using untargeted metabolomics in patients with cancer

Hand‑foot syndrome (HFS) is defined as a major adverse reaction to capecitabine; however, the underlying mechanisms remain unclear. In total, 85 patients who were taking oral capecitabine were included in the present study and these patients were divided into HFS‑positive and HFS‑negative groups. Serum samples were collected from patients and an untargeted metabolomics analysis was conducted using ultra‑high performance liquid chromatography‑mass spectrometry/mass spectrometry. The present study aimed to investigate the presence of metabolites in the serum of patients that developed HFS in response to capecitabine treatment. A total of 193 differential metabolites were identified, with 134 upregulated and 59 downregulated. Bioinformatics analysis revealed four novel metabolites that may be associated with HFS. Subsequent in vitro experiments were conducted to explore the damaging effects of capecitabine and its associated metabolites on human adult keratinocyte cell line, TPA‑treated (HaCaT) cells. Results of the present study revealed that aciclovir and lamivudine affected cellular damage at the highest level. In conclusion, the present study aimed to systematically and comprehensively describe the metabolites present in patients with capecitabine‑induced HFS and may further the current understanding of the capecitabine pathways that play a key role in HFS.

Advances and applications of multiomics technologies in precision diagnosis and treatment for gastric cancer

Gastric cancer (GC), one of the most prevalent malignancies worldwide, is distinguished by extensive genetic and phenotypic heterogeneity, posing persistent challenges to conventional diagnostic and therapeutic strategies. The significant global burden of GC highlights an urgent need to unravel its complex underlying mechanisms, discover novel diagnostic and prognostic biomarkers, and develop more effective therapeutic interventions. In this context, this review comprehensively examines the transformative roles of cutting-edge technologies, including radiomics, pathomics, genomics, transcriptomics, epigenomics, proteomics, and metabolomics, in advancing precision diagnosis and treatment for GC. Multiomics data analysis not only deepens our understanding of GC pathogenesis and molecular subtypes but also identifies promising biomarkers, facilitating the creation of tailored therapeutic approaches. Additionally, integrating multiomics approaches holds immense potential for elucidating drug resistance mechanisms, predicting patient outcomes, and uncovering novel therapeutic targets, thereby laying a robust foundation for precision medicine in the comprehensive management of GC.

Establishing a Research Agenda for Physiotherapy in Portugal: A Delphi Study

BACKGROUND

As physiotherapy research advances, identifying knowledge gaps and setting priorities is crucial for enhancing its efficiency in national and international collaborations. This study aimed to establish a physiotherapy research agenda in Portugal by integrating perspectives from physiotherapists and users of physiotherapy services.

METHODS

An online two-round Delphi study was conducted from April to August 2024 with two panels: physiotherapists and users of physiotherapy services. Participants rated 66 research priorities in the two rounds using a four-point Likert scale (1 = not important, 4 = very important), with 13 new priorities introduced in the second round. These priorities were organized into nine research categories identified from a prior scoping review: (1) (cost)effectiveness; (2) service delivery; (3) education, professional development and quality; (4) measurement instruments; (5) mechanisms behind disability, physiotherapy treatments and patient classification; (6) patients' needs, expectations, experience and context; (7) prognostic outcomes and responses to therapy; (8) decision-making strategies; and (9) technology and big data. Consensus was defined as a cut-off median score of ≥ 3.25.

RESULTS

A total of 479 physiotherapists and 70 users of physiotherapy services participated in Round 1 with final retention rates of 64% and 43%, respectively. The final 'Top 10' priorities focused on three research categories: researching optimal service delivery models, structures, and processes (n = 5); establishing the (cost)effectiveness of different physiotherapy interventions (n = 3); and exploring the best models of physiotherapy education, professional development, and quality (n = 2).

CONCLUSIONS

This study established a physiotherapy research agenda for Portugal, focusing on (cost)effectiveness, service delivery, education, professional development, and quality, integrating the perspectives of physiotherapists and users of physiotherapy services. The final priorities provide a foundation for future research and policy development.

Conditions at risk of pancreatic cancer: The radiology perspective

Pancreatic cancer remains one for the most aggressive cancer worldwide, with pancreatic ductal adenocarcinoma being the most common malignant pancreatic lesion, associated with poor prognosis. While surgical resection is the only curative treatment, only a minority of patients is eligible for surgery due to its diagnosis at advanced stages. Therefore, strategies for early detection of pancreatic cancer are needed. This article aims to provide a state-of-the-art review of the most common conditions associated to an increased risk of pancreatic cancer. Conditions linked to risk of pancreatic cancer development include certain pancreato-biliary anatomical variants, intraductal papillary mucinous neoplasms, mucinous cystic neoplasm, and familial pancreatic cancer with specific genetic mutations. Early imaging signs of pancreatic cancer can also be incidentally encountered on CT or MRI performed for other indications and they should be promptly recognized by the radiologists in order to avoid delays in the diagnosis. The features include focal pancreatic atrophy, contour deformity, dilation of the main pancreatic duct (MPD), changes in the caliber of the MPD, abrupt interruption of the MPD, and biliary tree dilation. MRI with the adoption of abbreviated protocols has been increasingly evaluated for the follow-up of cystic lesions. Although screening of the general population is not recommended due to the low incidence and high costs, surveillance with MRI can be considered in selected high-risk individuals.