Perimenopausal depression: Targeting inflammation and oxidative stress (Review)

Depressive disorder is a highly disabling condition that affects more than 300 million individuals worldwide, with women affected at a higher rate than men. With the aging of the population, the incidence of perimenopausal depression has risen markedly, seriously jeopardizing women's physical and mental health. Symptoms of perimenopausal depression include feelings of depression, stress, anxiety and endocrine dysfunctions, particularly hypogonadism and senescence. During perimenopause, estrogen and progesterone levels fluctuate erratically, adding to the risk of developing depression associated with perimenopause. As a result of these hormonal changes, proinflammatory mediators are produced and oxidative stress is induced, which finally leads to progressive neuronal damage. The present study mainly reviewed roles of neuroinflammation in perimenopausal depression and explained potential anti‑inflammatory and anti‑oxidative stress mechanisms for clinically effective therapeutic treatment.

LuQi formula ameliorates pressure overload-induced heart failure by regulating macrophages and regulatory T cells

BACKGROUND

Inflammatory macrophages in failing myocardium secrete CCL17, which targets CCR4 in immunosuppressive Tregs and inhibits the intracellular second messenger ARRB2-mediated cardiac chemotaxis. Traditional Chinese medicine (TCM) LuQi formula (LQF) is safe and effective in treating heart failure (HF). This study aims to elucidate the cardioprotective mechanism of LQF through its modulation of cardiac macrophages and Tregs.

METHODS

In vivo, the HF mouse model was established via transverse aortic constriction (TAC), with the superagonistic anti-CD28 monoclonal antibody (CD28-SA)-induced Tregs expansion as a positive control. Proteomics analysis elucidated the core link of LQF in anti-HF. In vitro, bone marrow-derived macrophages (BMDMs) were isolated, and Naive CD4+T cells were sorted and stimulated to differentiate into Tregs. The pharmacological mechanism of LQF was confirmed through histological and molecular biology experiments.

RESULTS

Proteomics reveals that LQF modulates the immune microenvironment of failing myocardium. We revealed that LQF inhibited cardiac inflammatory macrophage infiltration and NF-κB (p50, p65)/CCL17 axis expression, and promoted cardiac Tregs recruitment against HF, with the comparable efficacy of CD-SA28-induced Tregs expansion. Mechanistically, LQF inhibited the NF-κB activator 1-induced NF-κB (p50, p65)/CCL17 axis overexpression, and JSH-23 (NF-κB Inhibitor) abolished NF-κB (p50, p65)/CCL17 axis expression in inflammatory macrophages. Furthermore, the inhibition of CCL17 expression in inflammatory macrophages by LQF was found to be mediated by NF-κB (p50, p65). LQF concentration-dependently promoted Tregs CD73/Foxp3 axis expression, enhancing Tregs immunosuppressive function. LQF activated CCR4-ARRB2 complex and CCR4/ARRB2 axis expression in Tregs. Although AZD2098 (CCR4 Inhibitor) blocked CCR4 expression and CCR4-ARRB2 complex, LQF promoted ARRB2-mediated Tregs cardiac chemotaxis independent of the CCR4. We revealed that NF-κB p50SEP337-CCL17, NF-κB p65SEP536-CCL17, and CCR4-ARRB2 highly bound subunit interface targets. Molecular docking analysis demonstrated that the LQF's active ingredients exhibit good binding affinity with the NF-κB (p50, p65) /CCL17 axis in macrophages and Foxp3 in Tregs.

CONCLUSION

LQF has the potential to enhance the cardiac immune microenvironment and effectively prevent and treat HF by modulating both innate and adaptive immune responses. It achieves this by inhibiting the infiltration of inflammatory macrophages, suppressing the NF-κB (p50, p65)/CCL17 axis, and promoting Tregs recruitment. The active ingredients of LQF provide valuable candidate compounds for developing new anti-HF drugs. Furthermore, CD-28SA-induced Tregs expansion showed cardioprotective effects in TAC-induced non-ischemic HF models.

Enhancing the Detection of Malignancy in Thyroid Nodules by Assessing Longitudinal Diameter-to-Anteroposterior Diameter Ratio

ABSTRACT

The aim of investigate the ability of 3-dimensional diameter measurements of the nodule to predict malignant nodules. Adult patients with thyroid nodules who underwent thyroid surgery or fine-needle aspiration biopsy between December 2017 and December 2022 were included in this retrospective study. Thyroid ultrasound images and final pathology results were collected. Nodule size was remeasured using recorded ultrasound images in 3 dimensions (longitudinal, anteroposterior, and transverse). The ratios of the longitudinal diameter to the transverse diameter (L/T), the longitudinal diameter to the anteroposterior diameter (L/AP), and the anteroposterior diameter to the transverse diameter (AP/T) were calculated. The recent American College of Radiology TI-RADS system was used for the ultrasonographic scoring of the nodules. Patients were grouped as benign or malignant based on their final pathology results. In total, 398 (70.69%) patients had benign nodules and 165 (29.31%) patients had malignant nodules. The malignant group was significantly older than the benign nodule group (P = 0.011), while sex distributions were similar (P = 0.101). Malignant nodules could be predicted with the following cutoff values: L/T ≤ 0.97 (P < 0.001), L/AP ≤1.6 (P < 0.001), and AP/T > 1.0 (P < 0.001) or >0.94 (P < 0.001). Multivariable logistic regression indicated that low (≤1.6) L/AP ratio and high scores for echogenicity, shape, margin, and echogenic foci were independently associated with malignancy. Combining the L/AP ratio with the AP/T ratio could improve the discrimination of malignant thyroid nodules from benign nodules. Incorporating the L/AP ratio into new risk classification systems warrants careful consideration.

Systematic review and meta-analysis of early visual processing, social cognition, and functional outcomes in schizophrenia spectrum disorders

Non-affective psychotic disorders are marked by cognitive and sensory processing abnormalities, including in early visual processing and social cognition. Understanding the relationships between these deficits and their impact on daily-life functional outcomes may help to improve outcomes in affected individuals. This systematic review and meta-analysis aimed to summarise the existing evidence on the relationships between early visual processing, social cognition, and functional outcomes, and to assess the evidence regarding the mediating role of social cognition in the association between early visual processing and functional outcomes in individuals with schizophrenia spectrum disorders. A comprehensive search across five databases identified 364 potentially eligible studies, with eight articles meeting all inclusion criteria. Meta-analytic techniques were employed to synthesise effect sizes and assess a meta-mediation model. Three random-effects meta-analyses revealed significant associations between all three domains of interest. Social cognition partially mediated the relationship between early visual processing and functional outcomes. The direct effect of early visual processing on functional outcomes remained significant, albeit with a reduced effect size. The findings suggest that interventions targeting both early visual processing and social cognition concurrently may improve functional outcomes more effectively than focusing on either domain alone.

From lipids to glucose: Investigating the role of dyslipidemia in the risk of insulin resistance

Dyslipidemia is recognized as one of the most prevalent metabolic disorders and is frequently associated with other prevalent conditions, particularly diabetes mellitus. There appears to be a bidirectional connection between these two metabolic disorders. While considerable research has focused on how insulin resistance can lead to lipid abnormalities, the reverse relationship specifically, how dyslipidemia could assist in developing insulin resistance and diabetes mellitus has received relatively less attention. This review aims to comprehensively evaluate the mechanisms through which dyslipidemia can induce insulin resistance. Dyslipidemia is primarily classified into three main categories: hypercholesterolemia, hypertriglyceridemia, and low levels of HDL. These conditions may promote insulin resistance across multiple pathways, including the accumulation of lipid metabolites, dysfunction of pancreatic β-cells, increased reactive oxygen species, endoplasmic reticulum stress and inflammation, endothelial dysfunction, alterations in adiponectin levels, changes in bile acid composition and concentration, and dysbiosis of gut microbiota. However, further investigation is required to fully elucidate the cellular and molecular mechanisms underlying the relationship between lipid disorders and insulin resistance. Emphasizing such research could facilitate the development of therapeutic strategies targeting both conditions simultaneously.

Hypoxia impairs autophagy of cardiomyocytes via p38/MAPK/MAP4 pathway

BACKGROUND

Myocardial hypoxia occurs in severe burns and may cause severe cardiac dysfunction, in which the blockage of the autophagy flux plays an important role. Previous studies indicates that the p38/MAPK pathway is involved in regulating the microtubule structure by regulating MAP4 phosphorylation, and the microtubule structure affects the autophagy. However, as a complex degradation process, how autophagy is specifically affected by microtubules remains unknown. An in-depth understanding of hypoxia-related autophagy disorders is critical for the treatment of myocardial injury.

METHODS

Cardiomyocytes (CMs) were isolated from the ventricles of neonatal Sprague-Dawley rats and cultured in an incubator filled with 1 % O2, 5 % CO2, and 94 % N2. SB203580 and MKK6 (Glu) recombinant adenovirus were used to specifically inhibit and activate the p38/MAPK pathway, respectively. The adeno-associated viruses (AAVs) encoding MAP4 gene and MAP4 siRNA were used to up-regulate and down-regulate the expression of MAP4, respectively. After infection of cells with AAV encoding GFP-LC3 fusion proteins, the number of green spots under fluorescence microscopy shows the quantity of autophagosomes. Western blots access the expression of LC3-II, LC3-I and p62. The ratio of LC3-II to LC3-I (LC3-II/I) tells the quantity of autophagosomes, and the expression of p62 indicates the extent of autophagosome degradation. Cell Counting Kit 8 was used to detect cell viability. Rapamycin was used to recover the autophagy.

RESULTS

Hypoxia reduced the viability of cardiomyocytes, in which the quantity of autophagosomes is increased, while the degradation is reduced, and the p38/MAPK pathway is activated. Activation of the p38/MAPK pathway could block the autophagy pathway. The phosphorylation of MAP4 did not affect the quantity of autophagosomes, but hindered its degradation. The p38/MAPK pathway could regulate the phosphorylation of MAP4. Finally, when the autophagy pathway was restored, cell viability has partially recovered.

CONCLUSIONS

Hypoxia regulates the phosphorylation of MAP4 through the p38/MAPK pathway, thereby hindering the degradation of autophagosomes, rather than the quantity, blocking autophagic flux and ultimately affecting cell viability.

Tripterygium wilfordii polyglycoside tablets attenuated the progression of hepatocellular carcinoma by targeting IL-6 and downstream signaling pathways in a multi-target manner

Tripterygium wilfordii polyglycoside tablets (TWPT) have traditionally been used to treat certain inflammatory diseases. This study validated TWPT as a novel application in hepatocellular carcinoma treatment through multiple targets, thereby expanding its clinical medication scope. TWPT exhibited a low toxicity and a significantly antihepatoma effects in vitro and in vivo. Through network pharmacology analysis, we found TWPT attenuated the progression of hepatocellular carcinoma by multi-targeting, including IL-6, MMP9, TNF-α and VEGFA. Additionally, TWPT targeted IL-6 to regulate downstream pathways, including the PI3K/Akt, JAK2/STAT3, and MAPK signaling pathways. Thus, TWPT could be developed as a potential therapeutic drug for hepatocellular carcinoma.

Morphology and topography of chitosan-Zn complex/PEO fiber mats influence cell viability and attachment

Electrospun fiber mats with therapeutic potential show great promise as wound healing biomaterials. This study aims to compare the biophysical properties and biocompatibility of four different biodegradable fiber mats; namely chitosan and chitosan‑zinc complex (ChiZn)/(polyethylene oxide) PEO fibers, each with either nanometer-sized (~200 nm) or micron-sized (~1000 nm) diameters. Zn was incorporated to impact antibacterial properties of the fibers, ChiZn was synthesized using the in-situ precipitation method, and the influence of zinc chelation on the material structure and morphology was assessed using XRD, FTIR, XPS, and EDX, documenting the complexation and homogeneous distribution of zinc. ChiZn was then blended with PEO for electrospinning in a benign solvent system and crosslinked with glutaraldehyde vapor. SEM was used to examine fiber morphology while AFM documented a correlation between the roughness and fiber diameter. The effects of topography and composition on the viability, adhesion, and proliferation of stromal cells and mouse fibroblasts were investigated, showing higher cell viability on mats composed of nanosized fibers, whereas complex fiber mats composed of micron-sized fibers exhibited reduced cell viability. SEM evaluations showed that cells spread only on the surface of the nanosized fibers, independently of the presence of Zn, while cell infiltration into the mats was observed for micron-sized fibers.

Preoperative inflammatory pain exacerbates postoperative pain and neurocognitive impairment

Aims

Many studies have shown that postoperative pain aggravates perioperative neurocognitive disorder (PND). In this study we aimed to clarify the effect of preoperative inflammatory pain on postoperative pain and cognitive function.

Methods

We established the inflammatory pain model by injected complete freund adjuvant (CFA) and the PND model by tibial fracture surgery in 14- month-old C57BL/6 mice. The paw withdrawal threshold and body weight of the mice were measured 7 days before surgery and 3 days after surgery. On the third postoperative day, mice were subjected to behavioral testing or sacrificed to collect brain tissue.

Results

The result shows that CFA exacerbated postoperative pain and cognitive dysfunction in mice, enhanced surgery-induced activation of microglia and astrocytes in the hippocampus, and increased surgery-induced the overexpression of IL-1β, IL-6, and TNF-α, as well as aggravated the decreased expression of α7nAChR and the overexpression of HMGB1 in the hippocampus induced by surgery.

Conclusion

Our study shows that preoperative inflammatory pain further aggravates postoperative pain and neurocognitive dysfunction in aged rats, and the mechanism may be related to neuroinflammation caused by α7nAChR-mediated CAP dysfunction and high release of HMGB1.

Berberine hydrochloride-loaded liposomes-in-hydrogel microneedles achieve the efficient treatment for psoriasis

Psoriasis is a common immune-mediated squamous skin disease, primarily characterized by the over proliferation of keratinocytes and a significant thickening of the stratum corneum. Traditional systemic drug delivery therapies often fall short due to low drug bioavailability and significant toxic side effects. Topical medications, while capable of achieving local or systemic treatment via transdermal routes, face limitations in psoriasis patients due to the abnormal thickening of the epidermis, which reduces skin permeability and hampers drug penetration efficiency. Hydrogel microneedles, as an emerging transdermal drug delivery technology, offer significant advantages such as high permeability, ease of use, low toxicity and side effects, and controlled release. Therefore, this study developed a liposome-hydrogel microneedle delivery system for the administration of berberine hydrochloride. We successfully prepared berberine hydrochloride-loaded liposomes (Ber-LPs) with high encapsulation efficiency and good stability, and integrated them into hydrogel microneedles crosslinked with PVA and PEGDA (Ber-LPs-PEGDA&PVA MNs) through a photocuring method. These microneedles exhibit an intact structure, high mechanical strength, and effective skin penetration. In vivo studies on anti-psoriatic effects showed that, compared to the model group, Ber-LPs-PEGDA&PVA MNs significantly alleviated imiquimod-induced psoriasis-like symptoms in mice, reduced skin epidermal thickness, decreased the expression levels of inflammatory cytokines, and lowered the expression of CD31 and VEGF, demonstrating excellent therapeutic efficacy. Additionally, the microneedles exhibited good drug release properties, antioxidant capacity, and biocompatibility. The novel hydrogel microneedle drug delivery system developed in this study offers a safe and effective solution for the treatment of psoriasis, with significant potential for clinical application.

Outcome Predictors of Hardware Complications in Head and Neck Free Flap Reconstruction

OBJECTIVES

Osteocutaneous free flap reconstruction can be complicated by hardware failure. The present study investigates the frequency and predictors of hardware failure in head and neck osteocutaneous reconstruction.

METHODS

Patients who underwent osteocutaneous head and neck free flap reconstruction between the years of 2014 and 2022 were identified at our institution. Hardware failure was defined as hardware infection, screw plate loosening, exposed hardware, migration, deformation, or fracture.

RESULTS

We identified 47 patients who met the inclusion criteria for this study. Common indications for intervention included squamous cell carcinoma (35, 74%) and osteoradionecrosis (8, 17%). Most operations used fibular flaps (31, 66%) or osteocutaneous radial forearm flaps (12, 26%). The median age at the time of reconstruction was 66 years (IQR: 59 to 72). In total, 17 (36%) patients experienced hardware failure in the postoperative period. On univariable analysis, estimated blood loss ( P =0.01) and early postoperative infectious complication ( P =0.03) were the only significant predictors of hardware failure. On multivariable analysis, these factors retained significance. Estimated blood loss had an OR of 1.004 (95% CI: 1.001-1.008; P =0.01), and infectious complication had an OR of 5.22 (95% CI: 1.28-24.84; P =0.03).

CONCLUSION

The incidence of hardware failure among patients who undergo head and neck osteocutaenous free flap reconstruction is high (36%). Patients with infectious complications and high estimated blood loss may be more likely to develop hardware failure.

LEVEL OF EVIDENCE

Level III.

IL-12 family cytokines and autoimmune diseases: A potential therapeutic target?

In recent years, the discovery of IL-12 family cytokines, which includes IL-12, IL-23, IL-27, IL-35, and IL-39, whose biological functions directly or indirectly affect various autoimmune diseases. In autoimmune diseases, IL-12 family cytokines are aberrantly expressed to varying degrees. These cytokines utilize shared subunits to influence T-cell activation and differentiation, thereby regulating the balance of T-cell subsets, which profoundly impacts the onset and progression of autoimmune diseases. In such conditions, IL-12 family members are aberrantly expressed to varying degrees. By exploring their immunomodulatory functions, researchers have identified varying therapeutic potentials for each member. This review examines the physiological functions of the major IL-12 family members and their interactions, discusses their roles in several autoimmune diseases, and summarizes the progress of clinical studies involving monoclonal antibodies targeting IL-12 and IL-23 subunits currently available for treatment.

Hollow microneedles as a flexible dosing control solution for transdermal drug delivery

Microneedles, small needle-like structures typically less than 1000 μm in length, are effective tools for transporting substances across biological barriers via minimally invasive pathways. Various microelectromechanical system (MEMS) processes enable the production of different types of microneedles, including solid, coated, dissolving, hydrogel, and hollow microneedles, each tailored to specific drug and fluid delivery mechanisms. Among these, hollow microneedles stand out for their ability to offer flexible dosage control adaptable to varying drug formulations, making them particularly promising for transdermal drug delivery systems. This review examines the fabrication processes of hollow microneedles, highlights the advantages of their hollow structure for medical applications, and discusses the key factors influencing their performance. Finally, it proposes directions for advancing these technologies in both industrial and research settings.

The effect of highly bioavailable forms of curcumin on lipoprotein(a) plasma levels: A systematic review and meta-analysis of randomized clinical studies

Curcumin is a bioactive compound derived from the rhizome of Curcuma longa (turmeric) that has garnered increasing attention for its potential health benefits. However, its use in clinical practice is limited due to its generally poor bioavailability. This issue can be overcome using novel delivery systems that enhance curcumin's solubility, extend its residence time in plasma, improve its pharmacokinetic profile, and increase its cellular uptake. Novel curcumin formulations with improved bioavailability have been suggested to elevate plasma concentrations of lipoprotein(a) (Lp(a)), but there is no definitive evidence of a causal relationship. To address this, a systematic literature search was conducted in multiple electronic databases to identify relevant randomized placebo-controlled clinical studies published without a time limit. A meta-analysis of data suggested that dietary supplementation with highly bioavailable forms of curcumin significantly reduces Lp(a) levels [Standardized Mean Difference (SMD)= -0.96 (95 % Confidence Interval (CI): -1.82, -0.11)]. The effect size was robust in the leave-one-out sensitivity analysis and was not primarily driven by any single study. Of course, the clinical significance of this observation should be more thoroughly evaluated in longer-term trials, where the combined metabolic and anti-inflammatory effects of curcumin have vascular protective effects.

Advanced healing potential of simple natural hydrogel loaded with sildenafil in combating infectious wounds

Infected wounds are common clinical injuries that often complicated by inflammation and oxidative stress due to bacterial invasion. These wounds typically suffer from impaired vascularization, which delays healing and increases the risk of complications such as sepsis and chronic wounds. Therefore, developing an effective treatment for infected wounds is highly necessary. Egg white can promote cell regeneration and repair, while chitosan is effective in resisting bacterial invasion. Sildenafil is believed to have the potential to promote angiogenesis. Based on these properties, we have prepared a new type of hydrogel using egg white and chitosan as the framework, loaded with sildenafil (CEHS). The hydrogel combines the benefits of its components, exhibiting good biocompatibility and promoting the proliferation and migration of NIH 3T3 (3T3) cells and human umbilical vein endothelial cells (HUVEC), as well as the angiogenesis in HUVEC. It also exhibits significant antioxidant, anti-inflammatory, and antibacterial properties against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Additionally, in a mouse model of infected wounds, the CEHS effectively promoted wound healing through its excellent antioxidant and anti-inflammatory properties, antibacterial activity, and pro-angiogenic effects. In summary, this simple-to-prepare, multifunctional natural hydrogel shows great promise for the treatment of infected wounds.

The role of phosphatidylethanolamine-binding protein (PEBP) family in various diseases: Mechanisms and therapeutic potential

This article focuses on the phosphatidylethanolamine-binding protein (PEBP) family proteins, detailing PEBP1 and PEBP4 due to limited information on PEBP2 and PEBP3, in cellular signaling pathways and research in a spectrum of pathologies, including diverse cancers, metabolic disorders, immunological diseases and a subset of organ-specific diseases. It outlines the mechanisms through which PEBP1 and PEBP4 regulate essential signaling pathways that are critical for cellular processes such as proliferation, apoptosis, and metastasis. Recent advancements have shown further understanding of these proteins' roles in pathophysiology and their potential as future therapeutic targets. The findings suggest that the impact of PEBP1 and PEBP4 on the course of different diseases has underscored their potential for more in-depth medical research and novel clinically targeted therapies.

Titanium nanostructure mitigating doxorubicin-induced testicular toxicity in rats via regulating major autophagy signaling pathways

Doxorubicin (DOX) is a powerful antineoplastic FDA-approved anthracycline-derived antibiotic and is considered as the most suitable intervention for solid tumors and hematological cancers therapy. However, its therapeutic application is highly limited due to acute and chronic renal, hematological and testicular toxicity. Oxidative stress, lipid peroxidation and apoptosis in germ cells as well as low sperm count, motility and disturbing steroidogenesis are the principal machineries of DOX-induced testicular toxicity. Nevertheless, the comprehensive molecular pathways responsible for DOX-induced testicular damage are not yet fully understood. The current study aims to clarify the role of autophagy and apoptotic signaling pathways in testicular toxicity induced by DOX in the rat model. The study also investigates the potential role of both titanium dioxide nanoparticles (TiO2NP) loaded with DOX and Lactoferrin in combination with DOX in mitigating testicular toxicity induced by DOX the standard antitumor drug. In the present study, male Wister albino rats were intoxicated with a total cumulative dose of DOX (18 mg/kg) via intra-peritoneal injection and served as positive control group. The other two groups administered either TiO2NP-DOX or lactoferrin-DOX. Furthermore, biochemical and molecular analyses were then performed. DOX intoxication induced testicular toxicity, revealing mineral imbalance as indicated by an increase in both calcium and magnesium concentrations. Administration of either TiO2NP-DOX or lactoferrin-DOX resulted in a significant modulation of disrupted mineral concentrations, with TiO2NP-DOX showing superiority in modulating both magnesium and calcium concentrations. Acid Phosphatase level significantly increased upon DOX-induced testicular damage. Molecular analysis of EGFR and K-RAS gene expression showed significant overexpression, while p53 and JAK-2 gene expression was significantly reduced post-DOX intoxication. Protein expression of both AKT and PI3K significantly increased upon DOX administration. Results showed a remarkable modulation of all disrupted gene and protein expressions upon treatment with TiO2NP-DOX or Lactoferrin-DOX with the superiority of TiO2NP-DOX in modulating these parameters. In conclusion, TiO2NP-DOX could be a promising drug delivery system to improve bioavailability and drug release, as well as reducing DOX's adverse effects particularly on testicular function.

Association between liver fibrosis and osteoporosis in adults aged 50 and older: insights from the Bushehr Elderly Health Program

Objectives

Both liver fibrosis and osteoporosis share inflammatory pathways, with liver fibrosis potentially contributing to decreased bone mineral density (BMD). The rising prevalence of non-alcoholic fatty liver disease (NAFLD) and associated liver fibrosis, especially in older populations, may increase the risk of osteoporosis, but evidence remains inconclusive. This study aims to investigate the relationship between liver fibrosis and osteoporosis in individuals over 50 years old.

Methods

This cross-sectional study used data from the Bushehr Elderly Health Program (BEHP), a cohort of 2,000 participants aged 50 and older, selected through multistage stratified random sampling. BMD and trabecular bone score (TBS) measurements were assessed. The Fibrosis-4 (FIB-4) index, a surrogate marker for liver fibrosis, was also calculated to examine its association with these bone health indicators. Multiple linear regression was applied to assess the relationship between FIB-4 and lumbar, hip, femoral neck BMD, and TBS scores, while logistic regression was used to evaluate osteoporosis as the dependent variable.

Results

A total of 1,959 participants with adequate data were included in our analysis. 538 participants had osteoporosis, 936 participants had osteopenia, and 485 participants had normal bone density. FIB-4 index was higher in osteoporotic groups (1.45 ± 0.90) than in osteopenic (1.26 ± 0.58, p < 0.001) and normal groups (1.17 ± 0.48, p < 0.001). After controlling for confounders, FIB-4 index was negatively associated with hip BMD (βmen=-0.0162; 95% CI: -0.0313, -0.0012 and βwomen=-0.0221; 95% CI: -0.0340, -0.0102), femoral neck BMD (βmen=-0.0216; 95% CI: -0.0356, -0.0076 and βwomen=-0.0233; 95% CI: -0.0342, 0.0124), and TBS (βmen=-0.0154; 95% CI: -0.0264, -0.0043 and βwomen=-0.0244; 95% CI: -0.0338, -0.0149) in both genders and with lumbar BMD in women (β=-0.0176; 95% CI: -0.0307, -0.0045). An increase in the FIB-4 index was associated with more than a twofold rise in the risk of developing osteoporosis in women (OR = 2.123; 95% CI: 1.503, 3.000; p < 0.001) and a 36% higher risk in men (OR = 1.366; 95% CI: 1.012, 1.844; p = 0.042).

Conclusions

Liver fibrosis is associated with decreased bone density and attenuated bone architecture. Elevated FIB-4 index has been identified as a risk factor for osteoporosis, indicating a potential link between liver fibrosis and deteriorating bone health.

Associated effects of blood metal(loid) exposure and impaired glucose metabolism in patients with gastric precancerous lesions or gastric cancer

Exposure to metal(loid)s and glucose metabolism may influence the progression of gastric precancerous lesions (GPLs) or gastric cancer (GC), but their combined effects remain unclear. Our study aimed to elucidate the combined impact of metal (including metalloid and trace element) exposure and disturbances in glucose metabolism on the progression of GPLs and GC. From a prospective observational cohort of 1829 individuals, their metal(loid) levels and blood metabolism were analysed via inductively coupled plasma‒mass spectrometry and targeted metabolomics gas chromatography‒mass spectrometry, respectively. From healthy normal controls (NC) or GPLs to GC, we observed that the aluminum and arsenic levels decreased, whereas the vanadium, titanium and rubidium levels increased, but the iron, copper, zinc and barium levels initially decreased but then increased; these changes were not obvious from the NC to GPL group. With respect to glucose homeostasis, most metabolites decreased, except for phosphoenolpyruvate (PEP), which increased. Multiple logistic regression analysis revealed that titanium and phosphoenolpyruvate might be risk factors for GPLs, that barium is a protective factor for GC, and that D-glucaric acid might be a protective factor for GPLs and GC. Selenium, vanadium, titanium, succinate, maleate, isocitrate, PEP, and the tricarboxylic acid cycle (TCA) had good predictive potential for GPL and GC. Additionally, metal(loid)s such as arsenic, titanium, barium, aluminum, and vanadium were significantly correlated with multiple glucose metabolites involved in the TCA cycle in the GPL and GC groups. Our findings imply that metal(loid) exposure disrupts glucose metabolism, jointly influencing GPL and GC progression.

The development and validation of a risk stratification system for assessing axillary status after neoadjuvant therapy in node-positive breast cancer: a multicenter, prospective, observational study

OBJECTIVE

It is not clear which procedure is most optimal for axilla after neoadjuvant therapy (NAT) in node-positive breast cancer patients. Accurately identifying patients with axillary pathologic complete response (pCR) is crucial to minimize the overtreatment of axilla. This study was designed to develop a risk stratification model for axillary pCR.

METHODS

In this multicenter, prospective, observational study, node-positive breast cancer patients who received NAT followed by axillary lymph node dissection (ALND) were enrolled between June 2021 and April 2024. We assessed the performance of breast shear wave elastography (SWE) utilizing virtual touch imaging quantification in determining axillary status across ultrasound (US) nodal stages following NAT. A predictive model incorporating axilla US nodal stage and breast SWE was developed using multivariate logistic regression analysis. Last, a simplified risk score was developed based on the calculated prediction probability from this model and validated in the external test cohort.

RESULTS

The axillary pCR rates were 52.53% in the training cohort ( n = 257) and 51.79% in the external test cohorts ( n = 195). Approximately 21.67% of US N0 cases were false negatives; 42.35% of US N1 cases were false positives. With SWE, the false negative rate was 11.53% in US N0 patients and false positive rate was 22.22% in US N1 patients. The model based on dual-modality US demonstrated strong discriminatory ability (AUC, 0.93), precise calibration (slope of calibration curve, 0.99), and practical clinical utility (probability threshold, 4.5-94.5%); the percentages of accuracy, sensitivity, and specificity were 87.94%, 88.52%, and 87.41%, respectively. Patients scoring 1 demonstrated a low axillary non-pCR rate (5.21%-6.97%), potentially reducing unnecessary ALND rate (17.12%-24.10%).

CONCLUSIONS

The risk stratification model integrating axilla US and breast SWE demonstrated good performance for assessing axillary status after NAT in node-positive breast cancer and might provide guidance for less aggressive management for specific individuals.

The Protective Effects of Lactobacillus reuteri Combined With Clostridium butyricum Miyairi 588 on Intestinal Barrier Function, Water Transport, and Oxidative Stress in a Rat Model of 5FU-Induced Diarrhea

5-Fluorouracil (5FU) is a commonly employed and highly effective chemotherapeutic agent in clinical oncology. Nevertheless, one of the most frequent and debilitating adverse effects associated with 5FU treatment is diarrhea. These gastrointestinal complications can affect patients' quality of life and adherence to treatment regimens. Consequently, addressing and mitigating diarrhea during 5FU therapy presents a critical and urgent challenge in oncological care. This study investigated whether probiotic Lactobacillus reuteri combined with Clostridium butyricum Miyairi 588 (LCs) can alleviate 5FU-induced diarrhea and the potential mechanism. Wistar rats received 5FU (50 mg/kg, intraperitoneal injection) for 5 consecutive days to establish a 5FU-induced colitis diarrhea model. LCs were administered 15 days before the 5FU injection and continued until the day of sacrifice. Tissue morphology, inflammatory and oxidative stress markers, as well as the expression of mRNA related to intestinal barrier integrity, apoptosis, and aquaporins (AQPs) were evaluated in the colon tissue samples. These analyses used hematoxylin and eosin staining, enzyme-linked immunosorbent assay (ELISA), and quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) techniques. Additionally, the concentrations of short-chain fatty acids (SCFAs) were measured using gas chromatography-flame ionization detection (GC-FID) analysis. In this colitis model, LCs mitigated 5FU-induced weight loss, diarrhea, bloody stool, shortened colon length, and colonic histopathology. Treatment with LCs resulted in reduced levels of MDA, TNF-α, IL-1β, and MPO activity, as well as decreased mRNA expression of IFN-γ, AKT, NF-κB, TNF-α, and iNOS. Additionally, LCs significantly downregulated the expression of VCAM-1, CXCL4, MAPK, and caspase-3, while upregulating the tight junction protein occludin expression. LCs also notably diminished the mRNA expression levels of AQP7, VIP, and PKA. This study demonstrates that LCs have therapeutic effects on colitis, primarily through their antioxidant properties, anti-apoptotic effects, mucosal barrier integrity maintenance, neutrophil infiltration reduction, and inflammatory cytokines and aquaporin expression modulation.

Biogenic nanoparticles as a promising drug delivery system

Nanotechnology has significantly influenced the worldwide medical services sector during the past few decades. Biological collection approaches for nanoparticles are economical, non-toxic, and ecologically benign. This review provides up-to-date information on nanoparticle production processes and biological sources, including algae, plants, bacteria, fungus, actinomycetes, and yeast. The biological technique of generating nanoparticles has advantages over chemical, physical, and biological methods, including low-toxicity and friendly to the environment, thereby providing a viable option for therapeutic applications as s promising drug delivery system. In addition to aiding researchers, the bio-mediated, obtained nanoparticles also modify particles to promote both health and safety. We also looked at the important medicinal uses of nanoparticles, including their antifungal, antimicrobial, antiviral, antidiabetic, anti-inflammatory, and antioxidant properties. The current study highlights the findings of recent research in this field and discusses various methods proposed to describe the bio-mediated acquisition of novel nanoparticles.. The production of nanoparticles via biogenic sources possess various benefits, such as low cost, bioavailability, and environmental friendliness. In addition to the determination of the bioactive chemicals mediated by nanoparticle as well as the examination of the biochemical pathways and enzyme reactions. The major focus of this review is highlighting on the essential role of biogenic nanoparticles as promising drug delivery system.

APEX1 attenuates ERS-induced paraptosis by inhibiting the P53 pathway in LECs

Age-related cortical cataract (ARCC) is a prominent subtype of cataract, characterized by the presence of vacuoles and spoke-like opacity. Previous studies have suggested that paraptosis is involved in the onset of early ARCC vacuolar degeneration. In this experiment, hydrogen peroxide (H2O2)-induced SRA01/04 cells were used to establish a paraptosis-like cell model, and the function and underlying mechanism of APEX1 in this cell model were explored. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western Blot analyses were conducted to assess the expression of pertinent genes in SRA01/04. Confocal fluorescence microscopy, using ER-tracker kits, was applied to clarify the relationship between the endoplasmic reticulum and intracellular vacuoles. The co-IP assay was used to verify the interaction between APEX1 and P53. The GTRD database was employed to predict the putative target genes combined with P53, and CUT&RUN assay was employed to confirm the enrichment of the P53 and ATF6 promoters following APEX1 overexpression. Firstly, the pathological sections of the vacuolar degeneration zone in the lens cortex of ARCC patients exhibited fiber disarray and vacuole development. Meanwhile, the protein expression of Alix, a specific paraptosis inhibitor, was decreased in low-concentration H2O2-treated SRA01/04 cells. Secondly, we discovered that 4-PBA suppressed the expression of ATF6 and PERK. Moreover, overexpression of APEX1 in SRA01/04 cells improved endoplasmic reticulum morphology, inhibited the interaction between P53 and ATF6, and attenuated paraptosis in SRA01/04. APEX1 regulated P53 and then mediated ATF6 to affect the endoplasmic reticulum stress and paraptosis in H2O2-induced SRA01/04 cells.

Alternative therapies in chronic non-cancer pain management: A scoping review of randomized controlled trials

BACKGROUND

Chronic pain is one of the most challenging health problems in modern society, placing significant burdens on individuals and healthcare systems. While pharmacological treatments remain the primary approach to pain management, their limitations often restrict choices for both clinicians and patients. In contrast, complementary therapies are gaining recognition for their potential effectiveness and safety. However, the current literature lacks a comprehensive summary of the role of complementary therapies in chronic pain management.

OBJECTIVE

This review aims to summarize the complementary therapies used in chronic non-cancer pain management, assess their practical applications, identify research gaps and limitations, and provide a comprehensive perspective for the development of chronic non-cancer pain management and personalized pain management strategies.

METHODS

This scoping review followed the PRISMA-ScR guidelines. Randomized controlled trials (RCTs) published in the last decade were retrieved from PubMed and Web of Science using the keywords "chronic pain" and "complementary therapy." Non-English studies were excluded.

RESULTS

A total of 848 RCTs were identified, of which 128 met the inclusion criteria. The included studies addressed chronic musculoskeletal pain (102 studies), chronic visceral pain (5 studies), chronic neuropathic pain (7 studies), and 13 studies that did not specify the pain type. The complementary therapies investigated included acupuncture, manual therapy, exercise therapy, psychological interventions, mind-body therapies, and physical modalities.

CONCLUSION

This review provides preliminary evidence supporting the efficacy and safety of complementary therapies in the management of chronic non-cancer pain. However, methodological and quality-related limitations were identified in the included studies. Future high-quality RCTs are needed to validate the long-term efficacy of these therapies, explore their mechanisms of action, and provide stronger evidence for their clinical application.

REGISTRATION

This scoping review is registered on the Open Science Framework (OSF) under the following DOI: https://doi.org/10.17605/OSF.IO/67K32.

Role of the globus pallidus in motor and non-motor symptoms of Parkinson's disease

The globus pallidus plays a pivotal role in the basal ganglia circuit. Parkinson's disease is characterized by degeneration of dopamine-producing cells in the substantia nigra, which leads to dopamine deficiency in the brain that subsequently manifests as various motor and non-motor symptoms. This review aims to summarize the involvement of the globus pallidus in both motor and non-motor manifestations of Parkinson's disease. The firing activities of parvalbumin neurons in the medial globus pallidus, including both the firing rate and pattern, exhibit strong correlations with the bradykinesia and rigidity associated with Parkinson's disease. Increased beta oscillations, which are highly correlated with bradykinesia and rigidity, are regulated by the lateral globus pallidus. Furthermore, bradykinesia and rigidity are strongly linked to the loss of dopaminergic projections within the cortical-basal ganglia-thalamocortical loop. Resting tremors are attributed to the transmission of pathological signals from the basal ganglia through the motor cortex to the cerebellum-ventral intermediate nucleus circuit. The cortico-striato-pallidal loop is responsible for mediating pallidi-associated sleep disorders. Medication and deep brain stimulation are the primary therapeutic strategies addressing the globus pallidus in Parkinson's disease. Medication is the primary treatment for motor symptoms in the early stages of Parkinson's disease, while deep brain stimulation has been clinically proven to be effective in alleviating symptoms in patients with advanced Parkinson's disease, particularly for the movement disorders caused by levodopa. Deep brain stimulation targeting the globus pallidus internus can improve motor function in patients with tremor-dominant and non-tremor-dominant Parkinson's disease, while deep brain stimulation targeting the globus pallidus externus can alter the temporal pattern of neural activity throughout the basal ganglia-thalamus network. Therefore, the composition of the globus pallidus neurons, the neurotransmitters that act on them, their electrical activity, and the neural circuits they form can guide the search for new multi-target drugs to treat Parkinson's disease in clinical practice. Examining the potential intra-nuclear and neural circuit mechanisms of deep brain stimulation associated with the globus pallidus can facilitate the management of both motor and non-motor symptoms while minimizing the side effects caused by deep brain stimulation.

Iron overload exacerbates metabolic dysfunction-associated steatohepatitis via the microbiota-gut-liver axis through lipopolysaccharide-mediated Akr1b8 activation

Iron homeostatic is closely linked to the development of metabolic dysfunction-associated steatohepatitis (MASH). However, the underlying mechanisms remain poorly understood. HFE knockout (KO) mice were used to generate mild iron-overload models. MASH was induced by feeding mice a methionine- and choline-deficient (MCD) diet for 4 weeks. Iron overload significantly exacerbated the pathologies of MCD-induced MASH, including liver injury, hepatic lipid accumulation, inflammation, and fibrosis. Additionally, iron overload reshaped the composition of gut microbiota, and fecal microbiota transplantation assay proved that gut microbiota from iron-overload mice contributed to hepatic lipid accumulation in control mice. Furthermore, iron overload-induced dysbacteriosis altered the metabolite profiles, reducing short-chain fatty acid levels and increasing lipopolysaccharide (LPS) levels. Notably, elevated LPS levels upregulated the expression of aldo-keto reductase family 1 member B8 (Akr1b8), which accelerated lipid accumulation and inflammation in hepatocytes. Above results indicated that iron overload promoted MASH progression through the microbiota-gut-liver axis, mediated by LPS-induced activation of Akr1b8. These findings highlight the critical role of iron homeostasis and gut microbiota in MASH pathogenesis.

Nanodrug delivery systems targeting ferroptosis as an innovative therapeutic approach for Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic inflammatory disease characterized by joint inflammation, progressive cartilage degradation, and bone erosion. Recent research has implicated ferroptosis not only in autoimmune hepatitis but also in the pathogenesis and progression of autoimmune disorders like RA. Consequently, numerous therapeutic strategies have begun to target the ferroptosis pathway, particularly in the design and development of nanodrug delivery systems (NDDSs). While previous reviews have comprehensively discussed the mechanisms of ferroptosis, related signaling pathways, and NDDS materials, recent studies have further elucidated the interplay between ferroptosis and various metabolic pathways, providing a robust theoretical basis for the design of NDDS-based ferroptosis strategies. This review focuses on investigating the role of ferroptosis in the development of RA, aiming to elucidate how targeting ferroptosis can offer novel therapeutic concepts and potential treatments for RA patients. Specifically, it summarizes the design strategies of ferroptosis-based NDDSs via different pathways and highlights the feasibility of RA treatment regimens based on the ferroptosis mechanism. Furthermore, the review critically discusses the current limitations of NDDSs and offers perspectives on future research directions in this field.

Suv39h1 Regulates Phenotypic Modulation of Smooth Muscle Cells and Contributes to Vascular Injury by Repressing HIC1 Transcription

BACKGROUND

Vascular smooth muscle cells (VSMCs), in response to a myriad of injurious stimuli, switch from a contractile state to a proliferative/migratory state in a process known as phenotypic modulation. Phenotypic modulation of VSMCs contributes to neointima formation and underscores a host of vascular pathologies, including atherosclerosis. In the present study, we investigated the involvement of Suv39h1 (suppressor of variegation 3-9 homolog 1), a lysine methyltransferase, in this process.

METHODS

Suv39h1f/f mice were crossbred to the Myh11-CreERT2 mice to generate VSMC-restricted Suv39h1 knockout mice (conditional knockout). Vascular injury was created by carotid artery ligation. Cellular transcriptome was evaluated by RNA sequencing and cleavage under targets and tagmentation with deep sequencing.

RESULTS

Suv39h1 upregulation was observed in animal and cell models of phenotypic modulation. Consistently, Suv39h1 silencing restored expression of contractile genes and attenuated proliferation/migration in VSMCs exposed to PDGF (platelet-derived growth factor)-BB. Importantly, Suv39h1 deletion significantly ameliorated neointima formation in mice in both the carotid artery injury model and the femoral artery injury model. Importantly, a small-molecule Suv39h1 inhibitor F5446 suppressed phenotypic modulation in vitro and mitigated vascular injury in mice. RNA sequencing identified HIC1 (hypermethylated in cancer 1) as a novel target for Suv39h1. HIC1 expression was repressed by Suv39h1 during VSMC phenotypic modulation, whereas HIC1 overexpression antagonized neointima formation in mice. Integrated transcriptomic analysis indicated that HIC1 might regulate VSMC phenotypic modulation by activating Jag1 (Jagged 1) transcription.

CONCLUSIONS

Our data suggest that Suv39h1 is a novel regulator of vascular injury and can be targeted for intervention of restenosis.

Bispecific Antibodies in Hematologic and Solid Tumors: Current Landscape and Therapeutic Advances

Bispecific antibodies (bsAbs) have emerged as a novel class of therapeutics, offering a dual-targeting strategy to enhance the therapeutic efficacy of monoclonal antibodies, which is often limited by tumor heterogeneity and the occurrence of resistance mechanisms. By simultaneously engaging two distinct antigens or pathways, bsAbs disrupt multiple signaling cascades simultaneously, preventing escape mechanisms and offering a more durable response. Furthermore, they can optimize immune activation, improving immune cell recruitment strategies. In particular, T-cell engager bsAbs facilitate immune cell-mediated tumor destruction by linking T cells to tumor antigens. Instead, dual immune checkpoint inhibitors (CPIs) enhance immune activation by blocking inhibitory signals. Additionally, bsAbs targeting tumor growth factors or receptor tyrosine kinases offer solutions for overcoming drug resistance in solid tumors. Although bsAbs have shown remarkable success in hematologic malignancies, their expansion into solid tumors faces key challenges, including tumor heterogeneity, limited tumor penetration, and the risk of on-target, off-tumor toxicities. Addressing these challenges requires innovative engineering strategies, optimized delivery mechanisms, and careful patient selection to maximize therapeutic benefit while mitigating adverse effects. The efficacy of bsAbs in clinical trials has led to their approval for both hematologic and solid malignancies, with numerous agents in development. Combination strategies with chemotherapy, targeted agents, and immune CPIs could represent a promising strategy to further expand their potential. As research progresses, bsAbs are expected to play a role in reshaping the future of precision oncology, offering more effective and tailored treatment options.

Metabolomics integrated genomics approach: Understanding multidrug resistance phenotype in MCF-7 breast cancer cells exposed to doxorubicin and ABCA1/EGFR/PI3k/PTEN crosstalk

Resistance of cancer cells, especially breast cancer, to therapeutic medicines represents a major clinical obstacle that impedes the stages of treatment. Carcinoma cells that acquire resistance to therapeutic drugs can reprogram their own metabolic processes as a way to overcome the effectiveness of treatment and continue their reproduction processes. Despite the recent developments in medical research in the field of drug resistance, which showed some explanations for this phenomenon, the real explanation, along with the ability to precisely predict the possibility of its occurrence in breast cancer cells, still necessitates a deep consideration of the dynamics of the tumor's response to treatment. For this purpose the current study, combined both in vitro metabolomics and in vivo genomics analysis as the most advanced omics technologies that can provide a potential en route for inventing novel strategies to perform prospective, prognostic and diagnostic biomarkers for drug resistance phenomena in mammary cancer. Doxorubicin is the currently available breast cancer chemotherapeutic medication nevertheless; it was demonstrated to cause drug resistance, which impairs patient survival and prognosis by prompting proliferation, cell cycle progression, and preventing apoptosis, interactions between signaling pathways triggered drug resistance. In this research, in vitro metabolomics analysis based on GC-MS coupled with multivariable analysis was performed on MCF-7 and DOX resistant cell lines; MCF-7/adr cultured cells in addition to, further in vivo confirmation via inducing mammary cancer in rats via two doses of 7,12-dimethylbenz(a) anthracene (DMBA) (50 mg/kg and 25 mg/kg) proceeded by doxorubicin (5 mg/kg) treatment for one month. The metabolomics in vitro results pointed out that mannitol, myoinositol, glycine, α-linolenic acid, oleic acid and stearic acid have AUC values: 0.14, 0.5, 0.7, 0.1, 0.02, -0.02 (1, 1) respectively. Glycine and myoinositol metabolites provided the best discriminative power in the wild and resistance MCF-7 phenotypes. Meanwhile, in vivo results revealed a significant crosstalk between the alternation in oxidative stress biomarkers as well as Arginase II tumor biomarker and the molecular assessment of ABCA1 and P53 gene expression that displayed a marked reduction in addition to, the obvious elevation in resistance and apoptotic biomarkers EGFR/PI3k/AKT/PTEN signaling pathway upon DMBA administration. Data revealed a significant alternation in signaling pathways related to resistance upon doxorubicin administration that affect lipid metabolism in breast cancer. In conclusion, Metabolomics integrated genomics analysis may be promising in understanding multidrug resistance phenotype in MCF-7 breast cancer cells exposed to doxorubicin through modulating ABCA1/EGFR/P53/PI3k/PTEN signaling pathway thus metabolic biomarkers in addition to molecular biomarkers elucidate the challenges fronting profitable therapy of mammary cancer and an pioneering approaches that metabolomics compromises to improve recognizing drug resistance in breast carcinoma.

Advancements in targeting tumor suppressor genes (p53 and BRCA 1/2) in breast cancer therapy

Globally, among numerous cancer subtypes, breast cancer (BC) is one of the most prevalent forms of cancer affecting the female population. A female's family history significantly increases her risk of developing breast cancer. BC is caused by aberrant breast cells that proliferate and develop into tumors. It is estimated that 5-10% of breast carcinomas are inherited and involve genetic mutations that ensure the survival and prognosis of breast cancer cells. The most common genetic variations are responsible for hereditary breast cancer but are not limited to p53, BRCA1, and BRCA2. BRCA1 and BRCA2 are involved in genomic recombination, cell cycle monitoring, programmed cell death, and transcriptional regulation. When BRCA1 and 2 genetic variations are present in breast carcinoma, p53 irregularities become more prevalent. Both BRCA1/2 and p53 genes are involved in cell cycle monitoring. The present article discusses the current status of breast cancer research, spotlighting the tumor suppressor genes (BRCA1/2 and p53) along with structural activity relationship studies, FDA-approved drugs, and several therapy modalities for treating BC. Breast cancer drugs, accessible today in the market, have different side effects including anemia, pneumonitis, nausea, lethargy, and vomiting. Thus, the development of novel p53 and BRCA1/2 inhibitors with minimal possible side effects is crucial. We have covered compounds that have been examined subsequently (2020 onwards) in this overview which may be utilized as lead compounds. Further, we have covered mechanistic pathways to showcase the critical druggable targets and clinical and post-clinical drugs targeting them for their utility in BC.

Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) effectively reduces fibroid-related symptoms and improves quality of life-A prospective single-centre 12-month follow-up study

INTRODUCTION

Uterine fibroids are the most common benign tumors among women, and it is estimated that approximately 70% of women have one or multiple fibroids by the age of menopause. About 30% of these women suffer from symptoms related to the fibroids. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, non-invasive treatment method for symptomatic uterine fibroids.

MATERIAL AND METHODS

In this prospective, single-centre follow-up study, 175 women with symptomatic uterine fibroids were treated with MR-HIFU. The effect of MR-HIFU on fibroid symptoms and quality of life was evaluated using a uterine fibroid-specific quality of life questionnaire (UFS-QoL). The main outcome measure was the symptom severity score and quality of life (QoL) before the MR-HIFU and 3 and 12 months after the treatment. This study was registered at clinicaltrials.gov (NCT03937401).

RESULTS

The median symptom severity score decreased from 56 (IQR 44-69) at baseline to 28 (IQR 16-44) at 3 months (p < 0.01) and 25 (IQR 16-38) at 12 months (p < 0.01) after treatment. The QoL score increased from a median of 48 (IQR 33-66) at baseline to 73 (IQR 59-93) at 3 months (p < 0.01) and 78 (IQR 66-90) at 12 months after treatment (p < 0.01). The reintervention rate during the 12-month follow-up was 2%.

CONCLUSIONS

MR-HIFU significantly reduces the severity of fibroid-related symptoms in selected patients as early as 3 months after MR-HIFU. The effect persists at 12 months. There is also a significant improvement in the quality of life 3 months after treatment, which further increases at 12 months.

Decoding SPP1 regulation: Genetic and nongenetic insights into its role in disease progression

Secreted phosphoprotein 1 (SPP1), also known as osteopontin, is a multifunctional glycoprotein that plays a critical role in various physiological processes, including cell adhesion, chemotaxis, immune regulation, and tissue remodeling. Originally identified as a key component of the bone matrix, SPP1 is now recognized for its broad involvement in numerous tissues and significant impact on both normal physiology and disease progression. Dysregulation of SPP1 has been strongly implicated in the pathogenesis and progression of several diseases, including cancer, cardiovascular diseases, autoimmune disorders, and chronic inflammatory conditions. The expression of SPP1 is tightly regulated by genetic and nongenetic mechanisms. Genetic alterations, such as single-nucleotide polymorphisms, insertions and deletions, and structural variations within the SPP1 gene, have been associated with increased susceptibility to various diseases, influencing disease severity and outcomes. Additionally, nongenetic regulations, including DNA methylation, histone modifications, and long noncoding RNAs, play crucial roles in modulating SPP1 expression in response to environmental and cellular signals. This review provides a comprehensive overview of the genetic and nongenetic regulatory mechanisms governing SPP1 and examines their implications in disease pathogenesis. By integrating recent findings, this review highlights the complex interplay between genetic predispositions and nongenetic regulations in determining SPP1 activity and offers new insights into its role as a potential biomarker and therapeutic target. Understanding these regulatory pathways is essential for the development of targeted interventions for diseases in which SPP1 plays a pivotal role.

HEALEY ALS Platform Trial, HEALEY ALS Platform Trial Study Group. Safety and efficacy of trehalose in amyotrophic lateral sclerosis (HEALEY ALS Platform Trial): an adaptive, phase 2/3, double-blind, randomised, placebo-controlled trial

BACKGROUND

Trehalose is a disaccharide that activates autophagy pathways in animal models of neurodegenerative diseases, with the potential to catalyse clearance of toxic, misfolded proteins in motor neurons and slow disease progression in amyotrophic lateral sclerosis (ALS). We aimed to evaluate the safety and efficacy of trehalose in individuals with ALS.

METHODS

The HEALEY ALS Platform Trial is a perpetual, adaptive, phase 2/3, randomised, double-blind, multi-regimen trial conducted at 60 geographically diverse sites in the USA. In the current regimen, adults with clinically possible, probable, laboratory-supported probable, or definite ALS, defined by the revised El Escorial criteria, were randomly allocated (3:1), stratified by use of edaravone and riluzole, to receive trehalose 0·75 g per kg intravenously weekly over 24 weeks, or matching placebo. The primary outcome was a composite of the relative rate of disease progression, as measured by the Revised ALS Functional Rating Scale (ALSFRS-R), and survival over 24 weeks, estimated in a Bayesian shared-parameter model. The study included prespecified stopping rules for futility; interim analyses occurred every 12 weeks. The primary outcome was analysed according to the intention-to-treat principle in all participants in the trehalose group, the placebo group within the regimen, and placebo groups from other contributing regimens; the safety analysis population was comprised of all participants who initiated treatment. This study is registered with ClinicalTrials.gov, NCT05136885.

FINDINGS

Between Feb 21, 2022, and Feb 17, 2023, 1021 participants were screened for the platform trial and 171 were assigned to the trehalose regimen. Of these, 161 participants met eligibility criteria, with 120 randomly allocated to trehalose and 41 to regimen-specific placebo. 164 participants randomly allocated to placebo in other regimens were added for analysis (totalling 205 placebo recipients). The disease rate ratio for change in ALSFRS-R and survival was 0·87 (95% credible interval 0·665-1·102, posterior probability of superiority 0·877). Serious adverse events occurred in 19 (16%) participants in the trehalose group and three (7%) participants in the regimen-only placebo group, leading to premature discontinuations in 14 (12%) versus one (2%), respectively. Fatal treatment-emergent adverse events occurred in seven participants in the trehalose group and none in the regimen-only placebo group. No death was considered related to the trial drug. The most common cause of death was respiratory failure, consistent with the natural history of ALS.

INTERPRETATION

Trehalose was well tolerated but there was no evidence to suggest a difference in ALS disease progression compared with placebo in this study. No statistical benefit was seen in secondary clinical or biomarker measures, suggesting that trehalose at this dosage is unlikely to be efficacious for treatment of ALS.

FUNDING

AMG Charitable Foundation, Tackle ALS, the ALS Association, ALS Finding a Cure, the Muscular Dystrophy Association, ALS ONE, the Arthur M Blank Family Foundation, I AM ALS, Tambourine ALS Collaborative, and other community fundraising initiatives and donors. Study drug and partial regimen-related funding was provided by Seelos.

Regulatory T cells in the blood of patients with chronic obstructive pulmonary disease (COPD): A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) ranks among the leading causes of mortality and morbidity worldwide. Due to the lack of effective treatments for COPD, targeting regulatory T-cells (Treg) has recently attracted considerable attention. Therefore, we conducted a systematic review and meta-analysis to review all of the existing data about the percentage of Treg cells in peripheral blood samples of COPD patients to discover the potential role of these cells in finding new treatments for these patients.

METHODS

We explored SCOPUS, PubMed, and Web of Science databases using search terms like "Chronic obstructive pulmonary disease", "Emphysema", "suppressive lymphocyte", and "Regulatory T Cell". Data regarding the number of COPD patients and healthy subjects, Treg cell identification, definition of Treg cell markers, and the percentage of Tregs in COPD patients and controls, in addition to smoking, and clinical status of COPD patients were extracted.

RESULTS

The overall assessment showed no significant difference in the frequency of Treg cells between COPD patients and healthy subjects. No remarkable difference in Treg frequencies was observed in subgroup analysis based on the markers used to define Tregs, the clinical state of COPD patients, and the patient's smoking history. Based on our results, smoking reduces the level of Treg cells in the body. The frequency of CD4+CD25+FoxP3+ Tregs was considerably lower in the blood of smokers than in non-smoking healthy individuals.

CONCLUSION

The overall result of this meta-analysis points out the importance of smoking in the prevalence of peripheral blood Treg cells.

Silencing of FZD7 Inhibits Endometriotic Cell Viability, Migration, and Angiogenesis by Promoting Ferroptosis

BACKGROUND

Endometriosis (EMS) is a difficult gynecological disease to cure. Frizzled-7 (FZD7) has been shown to be associated with the development of EMS, but its specific mechanism remains unclarified. This study aims to explore the role of FZD7 in EMS.

METHODS

RT-qPCR and western blot were used to detect the expression level of FZD7 in human endometrial stromal cells (hESCs) and human ectopic endometrial stromal cell line hEM15A. The interfering plasmid of FZD7 was established. CCK-8, EdU, wound healing, transwell invasion, and cytoskeletal staining assays were applied to evaluate the role of FZD7 silencing in hEM15A cell proliferation, invasion, and migration. Tube forming ability of cells was evaluated by tube formation assay. Cellular VEGF, GSH, and MDA levels were measure by kits. Intracellular lipid ROS and Fe2+ levels were tested using C11-BODIPY (581/591) and FeRhoNox-1 probes, respectively. The ferroptosis-related protein SLC7A11, GPX4, and ACSL4 expressions were analyzed using western blot. The effects of ferroptosis on endometriotic cell viability, migration, and angiogenesis were further analyzed with the addition of an ferroptosis inhibitor (Fer-1).

RESULTS

FZD7 was upregulated in hEM15A cells, and silencing of FZD7 inhibited cell proliferation, migration, invasion, and angiogenesis abilities. Downregulation of FZD7 decreased cellular GSH level and elevated MDA level. Knockdown of FZD7 also caused an increase in intracellular ROS and Fe2+ levels, as well as the downregulation of SLC7A11 and GPX4 levels and the upregulation of ACSL4 level, which are hallmarks of ferroptosis. However, the inhibitory effects of FZD7 knockdown on hEM15A cell progression were reversed when ferroptosis inhibitor Fer-1 added.

CONCLUSION

The above indices suggest that FZD7 knockdown regulates endometriotic cell proliferation, invasion, migration, and angiogenesis via ferroptosis.

Combined Ribociclib and NU7026 administration enhances radio-sensitivity by inhibiting DNA repair in prostate cancer

Radiosensitivity is critical for clinical outcomes and overall survival of prostate cancer patients treated with irradiation. Ribociclib and NU7026 have been reported as radiosensitizers in cancer cells, but which are inadequately understood in prostate cancer cells. The present study was performed to investigate the effects of ribociclib, NU7026, and their combination on the radiosensitivity of prostate cancer cells. Optimal combined concentrations of ribociclib and NU7026 with X-irradiation were selected. Flow cytometry, CCK-8 assays, soft agar colony formation, and γH2AX foci formation assays were performed to assess the cell cycle distribution, cell viability, cell proliferation, and DNA damage, respectively. Finally, the expression of proteins related to the cell cycle, DNA repair, and cell death was evaluated by western blot analysis. Ribociclib arrested prostate cell cycle in the G0/G1 phase. Compared with the control, X-irradiation combined with ribociclib or NU7026 significantly decreased cell proliferation, reduced colony formation, and enhanced γH2AX foci formation in PC3 and DU145 cells. Moreover, the protein expression levels of CDK4, p-Rb, cyclin D1, rad51, and DNA-PKcs were significantly decreased, whereas that of Bax was significantly increased.The combination of ribociclib and NU7026 may be a potential strategy for prostate cancer therapy by promoting radiosensitivity.

Cost-effectiveness analysis of PD-L1 testing associated with pembrolizumab for first-line treatment of advanced non-small cell lung cancer in China

BACKGROUND

Lung cancer is the leading cause of cancer-related deaths in China, and pembrolizumab shows differential efficacy in advanced non-small cell lung cancer (NSCLC) with different PD-L1 expression levels.

AIM

To assess the cost-effectiveness of PD-L1 testing associated with pembrolizumab for first-line treatment of NSCLC from the perspective of Chinese healthcare system.

METHOD

Over a lifetime horizon, a three-state partitioned survival model was developed to assess the cost-effectiveness of PD-L1 testing and no PD-L1 testing. In the PD-L1 testing group, patients were stratified by PD-L1 tumor proportion score ≥ 50%, 1-49%, or < 1% and received pembrolizumab monotherapy, pembrolizumab plus chemotherapy, or chemotherapy alone, respectively. In the non-PD-L1 testing group, all patients received pembrolizumab plus chemotherapy. Model inputs were obtained from published literature and a healthcare price database, and clinical outcomes from two randomized clinical trials were used. The net monetary benefit (NMB) was estimated for the PD-L1 testing group versus the non-PD-L1 testing group. Deterministic and probabilistic sensitivity analyses, and scenario analyses were conducted to assess robustness of results.

RESULTS

Using PD-L1 testing to guide treatment led to cost savings of $49,392.7 and a reduction in quality-adjusted life years (QALYs) of 0.234, resulting in a positive NMB of $46,421.7 at a willingness-to-pay (WTP) threshold of $12,680.8/QALY (GDP per capita in China, 2023). Findings were robust across sensitivity and scenario analyses.

CONCLUSION

Using PD-L1 testing to guide first-line pembrolizumab treatment in patients with advanced NSCLC is a cost-effective strategy at a WTP threshold of $12,680.8/QALY for China.

Aseptic meningitis: a foundation review

PURPOSE OF REVIEW

This review addresses the multifaceted nature of aseptic meningitis, a condition with diverse infectious and noninfectious etiologies. Despite its common presentation in clinical settings, over half of the cases remain without an identified cause, necessitating a comprehensive examination of diagnostic and management strategies. The increasing availability of advanced molecular diagnostics and the challenge of distinguishing bacterial from nonbacterial cases make this an opportune time to explore its implications for clinical practice.

RECENT FINDINGS

The literature highlights the pivotal role of advanced molecular diagnostics, such as multiplex PCR and metagenomic sequencing, in improving the identification of pathogens in aseptic meningitis. Enteroviruses remain the leading cause, but pathogens like Herpesviridae, arboviruses, and nonviral agents such as fungi and spirochetes also contribute significantly. New diagnostic algorithms and clinical models are emerging to distinguish bacterial from viral meningitis, reducing unnecessary treatments.

SUMMARY

Aseptic meningitis management is evolving with advancements in diagnostic technologies that allow for earlier pathogen identification, improving patient outcomes and minimizing healthcare costs. These findings underscore the importance of timely and accurate diagnostics and tailored therapeutic strategies in both clinical and research settings. Enhanced awareness of noninfectious causes is also crucial for comprehensive care.

Nanomaterials in the diagnosis and treatment of gastrointestinal tumors: New clinical choices and treatment strategies

Nanomaterials have emerged as a promising modality in the diagnosis and treatment of gastrointestinal (GI) tumors, offering significant advancements over conventional methods. In diagnostic applications, nanomaterials facilitate enhanced imaging techniques, including magnetic resonance imaging (MRI), computed tomography (CT), and fluorescence imaging, which provide improved resolution and more accurate detection of early-stage cancers. Nanoparticles (NPs), such as liposomes, dendrimers, and quantum dots, are increasingly employed for the targeted imaging of specific biomarkers associated with GI malignancies, thereby enhancing diagnostic sensitivity and specificity. Liposomes are primarily used for drug delivery due to their ability to encapsulate hydrophobic drugs, dendrimers are useful for both drug delivery and gene therapy due to their highly branched structure, and quantum dots are primarily used in imaging and diagnostics because of their fluorescent properties. We also discuss their respective advantages and limitations. In therapeutic contexts, nanomaterials play a pivotal role in the development of targeted drug delivery systems. These systems address the limitations of traditional chemotherapy by improving drug bioavailability, reducing systemic toxicity, and promoting selective accumulation at tumor sites via both passive and active targeting mechanisms. Nanomedicines, including NPs and nanocarriers, enable the precise delivery of chemotherapeutic agents, nucleic acid -based therapies, and immunomodulators directly to cancer cells, thereby optimizing therapeutic efficacy. Furthermore, nanotechnology offers the potential to modulate the tumor microenvironment (TME), a critical factor in overcoming challenges related to tumor resistance and metastasis. Despite these promising advancements, several challenges persist, including concerns regarding long-term toxicity, stability, and regulatory approval. Nonetheless, the integration of nanomaterials into clinical practice holds substantial potential for revolutionizing the management of GI cancers, paving the way for more precise, personalized, and effective therapeutic strategies.

"The captain wanted to stay with the sinking … (can't say boat)": How hypomanic personality traits interfere with inhibitory control?

Inhibitory control, the ability to suppress or countermand an action or thought, is notably impaired in patients with bipolar disorder. However, the specific characteristics of this impairment and whether deficits can manifest prior to a formal bipolar disorder diagnosis or among individuals with subsyndromal symptoms are relatively unknown. Here we test whether healthy individuals exhibiting a higher level of hypomanic personality traits respond more rapidly, albeit with weaker inhibitory control. We evaluated 83 native French speakers using the Hypomanic Personality Scale (HPS) and administered the Hayling Sentence Completion Test for response inhibition and the Stroop Test for interference control. We found negative correlations between the HPS score and both the response initiation and response inhibition times on the Hayling Sentence Completion Test, but the scores did not affect accuracy. Regarding the Stroop Test, we observed a significant positive correlation between the scores for hypomanic personality traits and the number of errors on the color-word condition. Our findings demonstrate that a high level of hypomanic personality traits correlates with faster reaction times on response inhibition tasks and higher error rates on interference tasks. This underlines the importance of distinguishing between inhibitory control concepts when examining the risks of bipolar disorder.

Fusobacterium nucleatum-derived 3-indolepropionic acid promotes colorectal cancer progression via aryl hydrocarbon receptor activation in macrophages

An increasing body of research indicates that Fusobacterium nucleatum (F. nucleatum) significantly influences the onset and progression of colorectal cancer (CRC). Our previous study has shown that F. nucleatum exerts pro-tumorigenic effects through aryl hydrocarbon receptor (AhR) activation. However, the role of its microbial metabolites in regulating immune responses remains unclear. Here, we report for the first time that F. nucleatum-derived 3-Indolepropionic acid (IPA) activates AhR in macrophages, driving M2 polarization and tumor-promoting immunosuppression. We discovered that culture supernatant of F. nucleatum (CSF) robustly activates AhR in macrophages. In co-culture systems, CSF upregulated the expression of the M2 marker CD206 and elevated mRNA levels of CD163, TGF-β, IL-10, and VEGF. In a subcutaneous allograft model, CSF induced an elevated number of CD206+ macrophages and decreased presence of CD8+ T cells within the tumor microenvironment, thereby promoting tumor growth. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed IPA as a novel major AhR-activating metabolite in CSF. Strikingly, IPA recapitulated CSF's effects in promoting tumor cell migration and immunosuppression, both in vitro and in vivo. Critically, the AhR inhibitor CH223191 abolished both IPA-mediated M2 polarization and tumor growth. Our study revealed a novel mechanism by which F. nucleatum-derived IPA reprograms macrophages through AhR activation to fuel CRC progression, providing potential therapeutic targets for CRC treatment and prognosis improvement.

Skeletal muscle and MASLD: Mechanistic and clinical insights

Metabolic dysfunction-associated steatotic liver disease (MASLD) is intrinsically linked with widespread metabolic perturbations, including within skeletal muscle. Indeed, MASLD is associated with a range of skeletal muscle abnormalities, including insulin resistance, myosteatosis, and sarcopenia, which all converge on the liver to drive disease progression and adverse patient outcomes. This review explores the mechanistic links between skeletal muscle and MASLD, including the role of abnormal glycemic control, systemic inflammation, and disordered myokine signaling. In turn, we discuss how intrinsic liver pathology can feed back to further exacerbate poor skeletal muscle health. Given the central importance of skeletal muscle in MASLD pathogenesis, it offers clinicians an opportunity to intervene for therapeutic benefit. We, therefore, summarize the role of nutrition and physical activity on skeletal muscle mass, quality, and metabolic function and discuss the knock-on effect this has on the liver. An awareness of these treatment strategies is particularly important in the era of effective pharmacological and surgical weight loss interventions, which can be associated with the development of sarcopenia. Finally, we highlight a number of promising drug agents in the clinical trial pipeline that specifically target skeletal muscle in an attempt to improve metabolic and physical functioning.

A State of the Science Review of Human Health Effects of the Michigan Polybrominated Biphenyl Contamination after Five Decades

BACKGROUND

The Michigan Polybrominated Biphenyl (PBB) Registry, followed since 1976, was created after a 1973 chemical manufacturing mistake. The flame retardant PBB was accidentally mixed into animal feed and distributed to Michigan farms for nearly a year, exposing farm residents and animal product consumers.

OBJECTIVE

We synthesized knowledge to date on health effects of PBB exposure within the Michigan PBB Registry and describe research findings in the context of literature on other persistent organic pollutants (POPs) and endocrine-disrupting chemicals (EDCs).

METHODS

We reviewed literature published from 1973 to 2025 on human health effects of PBB following the Michigan contamination, using PubMed and Thompson Reuters (ISI) Web of Science databases. We excluded studies not in English; studies on exposures besides PBB; animal studies; reviews, abstracts, or letters to the editor; studies without a health outcome; and studies outside of Michigan or unrelated to the 1973 contamination. For each article, two researchers performed title and abstract screening, full article review, and data extraction.

RESULTS

We included 79 publications out of 601 identified and screened. Early studies did not find many health outcomes associated with PBB, possibly because of methodological limitations. More recent studies on long-term and multigenerational impacts found an increased breast cancer risk, accelerated pubertal development and earlier menarche for girls exposed in utero, urogenital problems and slower pubertal development in boys exposed in utero, lower estrone 3-glucuronide and follicle-stimulating hormone among women exposed in childhood, and increased miscarriage risk among daughters of exposed women. Epigenetic and metabolomic research reported altered pathways related to estrogenic effects and immune function as well as the epigenetic alterations of spermatogenic cells.

DISCUSSION

This unique community-academic partnership has produced insights into multigenerational consequences of EDC/POP exposures across the life course. The findings from this cohort underscore the broader relevance of critical windows of vulnerability, particularly during fetal development and childhood. https://doi.org/10.1289/EHP15012.

Regulation and Function of Tumor-Associated Macrophages (TAMs) in Colorectal Cancer (CRC): The Role of the SRIF System in Macrophage Regulation

Colorectal cancer (CRC) remains the leading cause of morbidity and mortality for both men and women worldwide. Tumor-associated macrophages (TAMs) are the most abundant immune cells in the tumor microenvironment (TME) of solid tumors, including CRC. These macrophages are found in the pro-inflammatory M1 and anti-inflammatory M2 forms, with the latter increasingly recognized for its tumor-promoting phenotypes. Many signaling molecules and pathways, including AMPK, EGFR, STAT3/6, mTOR, NF-κB, MAPK/ERK, and HIFs, are involved in regulating TAM polarization. Consequently, researchers are investigating several potential predictive and prognostic markers, and novel TAM-based therapeutic targets, especially in combination therapies for CRC. Macrophages of the gastrointestinal tract, including the normal colon and rectum, produce growth hormone-releasing inhibitory peptide/somatostatin (SRIF/SST) and five SST receptors (SSTRs, SST1-5). While the immunosuppressive function of the SRIF system is primarily known for various tissues, its role within CRC-associated TAMs remains underexplored. This review focuses on the following three aspects of TAMs: first, the role of macrophages in the normal colon and rectum within the broader context of macrophage biology; second, the various bioactive factors and signaling pathways associated with TAM function, along with potential strategies targeting TAMs in CRC; and third, the interaction between the SRIF system and macrophages in both normal tissues and the CRC microenvironment.

Effect of dapagliflozin on blood and breath ketones during supervised insulin withdrawal in adults with type 1 diabetes: A randomized crossover trial

AIMS

Sodium-glucose cotransporter 2 (SGLT2) inhibitors increase ketoacidosis risk, limiting their use in type 1 diabetes. To better understand the pathophysiology of SGLT2 inhibitor-mediated ketoacidosis, we measured blood glucose, capillary blood and plasma β-hydroxybutyrate (BOHB) and breath acetone (BrACE) during supervised insulin withdrawal in adults with type 1 diabetes with and without dapagliflozin treatment.

MATERIALS AND METHODS

Twenty adults with type 1 diabetes underwent supervised insulin withdrawal twice in a randomized crossover design: during usual care and after treatment with dapagliflozin (10 mg daily for 2 weeks plus the test day). After insulin withdrawal, capillary blood glucose, BOHB and BrACE measurements were obtained at least hourly until stopping rules were met (>8 h elapsed, symptoms of ketosis, glucose >400 mg/dL, BOHB >4 mmol/L or participant request).

RESULTS

The peak BOHB and BrACE values achieved during supervised insulin withdrawal were both greater with dapagliflozin than with usual care. Throughout the insulin withdrawal study, dapagliflozin treatment was associated with significantly greater BOHB and BrACE concentrations. The proportions of participants reaching BOHB >1.5 mmol/L and >2.5 mmol/L during supervised insulin withdrawal were greater in the dapagliflozin arm. Blood glucose reached a lower peak in the dapagliflozin arm.

CONCLUSIONS

In adults with type 1 diabetes undergoing supervised insulin withdrawal, dapagliflozin treatment compared to usual care was associated with greater blood and breath ketone concentrations in the absence of significant hyperglycaemia.

Novel dihydrochalcone from Fissistigma latifolium targets STAT3 and survivin to overcome multidrug resistance cancers in vitro and in vivo

BACKGROUND

Multidrug resistance (MDR) remains a significant challenge in cancer chemotherapy, with no FDA-approved drugs currently available for its treatment. Natural chalcones, known for their diverse bioactivities, have emerged as potential therapeutic candidates.

PURPOSE

This study aimed to investigate the potential of 4,6-dimethoxy-2,5-quinodihydrochalcone (DODHC), a compound derived from Fissistigma latifolium, in overcoming MDR in cancer and to elucidate its underlying molecular mechanisms.

METHODS

The reversal effects of DODHC on MDR were evaluated using cytotoxicity assays. The molecular mechanisms were explored through apoptosis- and cell cycle-related assays, STAT3 ELISA, western blotting, docking simulations, and a zebrafish model. The impact of DODHC on P-glycoprotein (P-gp) activity was assessed using the Calcein-AM uptake assay.

RESULTS

DODHC promoted apoptosis in MDR cancer cells by suppressing survivin expression and activating the extrinsic apoptotic pathway. It also induced G2/M phase cell cycle arrest by downregulating cell division control protein 2 (CDC2) and cyclin B1 (CCNB1), thereby inhibiting cell proliferation. Additionally, DODHC reduced both total and phosphorylated STAT3 levels in MDR cancer cells without affecting P-gp activity. In vivo, DODHC significantly inhibited tumor growth in MDR cancer models, both as a monotherapy and in combination with paclitaxel.

CONCLUSION

This study highlights DODHC as a dual inhibitor of STAT3 and survivin, demonstrating its potential as a promising candidate for the treatment of MDR cancers.

Combination Immunotherapy for Mucosal Melanoma: Molecular Mechanism, Research Status, and Future Directions

OPINION STATEMENT

Mucosal melanoma is a rare and aggressive subtype of melanoma, accounting for 1%-2% of new cases in the United States in 2023, and 20%-30% in China and other Asian countries. Its origin is often occult, with the lack of early clinical features, the absence of actionable driver mutations, and poor response to immunotherapy, all contributing to its poor prognosis. The rarity of this subtype leads to limited awareness and interventions. Furthermore, due to its immune evasion mechanisms, mucosal melanoma shows resistance to traditional immune checkpoint inhibitors. Consequently, new therapeutic strategies are urgently needed to improve patient outcomes. Recent clinical trials have suggested that combination immunotherapy can overcome immune evasion, reduce resistance to treatment, produce synergistic anti-tumor effects, and improve survival. Epidemiological factors and clinical characteristics play significant roles in diagnosis and prognosis, while the mutational landscape influences responses to immunotherapy. This review provides an overview of these aspects and systematically discusses current research on combination therapies and emerging immunotherapy approaches for mucosal melanoma. It also explores potential future directions for treatment, aiming to enhance therapeutic strategies for this rare cancer and improve patient outcomes.

Medication-induced causes of delirium in patients with and without dementia: a systematic review of published neurology guidelines

BACKGROUND

While medication is a recognized risk factor of delirium, there is currently a lack of detailed information on managing and preventing medication-induced cases.

AIM

This review summarizes the information provided in neurology guidelines on medication-induced delirium in patients with and without dementia to inform guidance on prevention and management strategies.

METHOD

A systematic literature review was conducted across 114 neurological and medical organisations, Guideline Central and PubMed. Guidelines, consensus guidelines, white papers, frameworks, protocols, standard procedures, action plans and strategic documents detailing the prevention and management of medication-induced delirium in adults with or without dementia were included. Title and full-text screening was completed independently by two reviewers using PICOS. AGREE II was used to assess reporting quality. A data extraction tool was designed based on the Cochrane Effective Practice and Organization of Care Review Group (EPOC) checklist and a mixed methods approach to synthesis adopted. The systematic review protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO) [ID: CRD42022366025].

RESULTS

Out of 143 guidelines identified, 30 were included. Information for 140 individual medications was extracted. Medications most frequently cited included sedatives (n = 24/80%), opioids (n = 22/73,3%), psychoactive drugs (n = 21/70%) + anti-convulsants (n = 14/46,7%), anti-cholinergic agents (n = 20/66,7%), antihistamines (n = 18/60%), and steroids (n = 16/53,3%). Despite a consistently high-quality rating (n = 19, 63,3%), the detail provided often lacks specificity about pharmacological mechanisms, individual risk, dosing instructions, associated symptoms, therapeutic alternatives and avoidable drug-drug combinations. In relation to dementia, detailed information on the use of antipsychotics, cholinesterase inhibitors and benzodiazepines was extracted. No papers were excluded based on their quality.

CONCLUSION

No single guideline contains enough information on the risk, prevention, and management of medication-induced delirium to sufficiently support clinical decision making.

Novel insights into neuroinflammatory mechanisms in traumatic brain injury: Focus on pattern recognition receptors as therapeutic targets

Traumatic brain injury (TBI) is a major global health concern and a leading cause of morbidity and mortality. Neuroinflammation is a pivotal driver of both the acute and chronic phases of TBI, with pattern recognition receptors (PRRs) playing a central role in detecting damage-associated molecular patterns (DAMPs) and initiating immune responses. Key PRR subclasses, including Toll-like receptors (TLRs), NOD-like receptors (NLRs), and cGAS-like receptors (cGLRs), are abundantly expressed in central nervous system (CNS) cells and infiltrating immune cells, where they mediate immune activation, amplify neuroinflammatory cascades, and exacerbate secondary injury mechanisms. This review provides a comprehensive analysis of these PRR subclasses, detailing their distinct structural characteristics, expression patterns, and roles in post-TBI immune responses. We critically examine the molecular mechanisms underlying PRR-mediated signaling and explore their contributions to neuroinflammatory pathways and secondary injury processes. Additionally, preclinical and clinical evidence supporting the therapeutic potential of targeting PRRs to mitigate neuroinflammation and improve neurological outcomes is discussed. By integrating recent advancements, this review offers an in-depth understanding of the role of PRRs in TBI pathobiology and underscores the potential of PRR-targeted therapies in mitigating TBI-associated neurological deficits.