Microbiota geography in the colorectal carcinoma microenvironment: A spatiotemporal atlas of colonic mucosal microbial niche reconstruction

A case-control study on the differences in colonic mucosa-associated microbiotas between patients with and without colorectal cancer (CRC) in the Indonesian population was recently published. The geographical distribution characteristics of the gut microbiota in the carcinogenic microenvironment are closely related to disease progression. Therefore, the results of that study are of great significance for determining the pathogenesis of CRC in the Indonesian region and for clinically diagnosing and treating CRC. While acknowledging the strengths of the study, its limitations should also be addressed. Future case-control studies of the gut microbiota based on specific populations should be further refined to provide more optimized guidance for clinical precision treatment.

Prescribing lithium for the management of persons suffering from bipolar disorders: expert consensus based on a Delphi study

BACKGROUND

According to international guidelines, lithium treatment represents the gold standard for the appropriate management of persons with bipolar disorder. However, prescription rates in ordinary practice are not in line with clinical guidelines' suggestions. Clinicians prefer to use drugs other than lithium, considering its low therapeutic window, the need for regular lab tests and its side effects profile. Based on these premises, a Delphi-method study focused on highly-debated aspects of lithium treatment in bipolar disorder has been promoted with the aim to reach a consensus among an expert panel of Italian psychiatrists.

METHODS

The Delphi method is a structured technique aimed to obtain a consensus from repeated rounds of questionnaires where opinion/agreement among experts are important. A Steering Committee of experts has developed a 24-items questionnaire exploring: (1) the use of lithium as first choice for treating different phases of bipolar disorder; (2) the side effect and tolerability profile of lithium treatment as hampering factors for its use in clinical practice; (3) the lithium prescribing in special target population, such as adolescents, elderly patients, and pregnant women.

RESULTS

The questionnaire was delivered to a panel of 100 Italian psychiatrists, experts in the field of managing people with bipolar disorders. An almost complete positive consensus was reached for statements dealing with the use of lithium treatment as first choice in the management of patients with bipolar disorder, and as the first choice for preventing manic/hypomanic and depressive episodes.

CONCLUSIONS

Current clinical guidelines and scientific evidence support the use of lithium as first choice treatment in patients with bipolar disorder. However, over the last decades a downward tendency in lithium's prescription has been registered worldwide. The present Delphi study confirmed the "good clinical reasons" for supporting lithium prescription in clinical practice. Our findings should be used to develop clinical practice guidelines and reduce the discrepancy between international guidelines and ordinary care.

Pan-carcinoma data driven analysis reveals Platelet-Activating Factor Receptor (PTAFR) involvement in immunosuppressive tumor microenvironment signaling and clinical prognosis

Solid tumor carcinogenesis is driven by complex interactions within the tumor microenvironment (TME), which influence tumor initiation, progression, and response to treatment. The phospholipid platelet-activating factor (PAF) has been described to affect TME and growth; however, evidence so far has been limited to experimental in vitro and in vivo models. This study investigates the role of PAF receptor (PTAFR) across various carcinomas through patient data-driven analysis. We analyzed RNA sequencing and clinical data from publicly available tumor tissue samples of 8,977 carcinoma patients in the Genomic Data Commons. Our findings revealed that PTAFR overexpression correlates with reduced patient survival, increased tumor size, and enhanced lymph node metastasis. Further analysis identified 151 differentially expressed genes associated with PTAFR, many of which regulate immune responses and proto-oncogenic signaling. Histological and single-cell analyses demonstrated an immunosuppressive TME in carcinoma tissues with elevated PTAFR expression. In vivo validation indicated reduced tumor growth and increased infiltration of pro-inflammatory cells in PTAFR knockout mice. Protein modeling suggests that PTAFR forms physical complexes with immunosuppressive mediators STAT3 and PDL2, and that pathogenic variants may disrupt the PAF-binding domain, potentially altering signaling. Together, our findings establish PTAFR as a critical regulator of tumor progression, directly linking its expression to an immunosuppressive signaling in TME, enhanced tumor growth, and reduced patient survival, underscoring its potential as a therapeutic target.

Short- and long-term outcomes of robot-assisted versus laparoscopic lateral lymph node dissection for rectal cancer

PURPOSE

The lateral pelvic cavity is an anatomically tricky site to access using a linear approach; therefore, robot-assisted lateral lymph node dissection (LLND) may be superior over existing laparoscopic procedures. In this study, we aimed to compare the short- and long-term outcomes of robot-assisted LLND (R-LLND) versus laparoscopic LLND (L-LLND) for locally advanced low rectal cancer and explore the potential advantages of robot-assisted surgery.

METHODS

This single-center, retrospective cohort study included patients aged ≥ 18 years who underwent minimally invasive total mesorectal excision (TME) plus LLND for low rectal adenocarcinoma. Patients were divided into L-LLND and R-LLND groups. The short- and long-term outcomes of the procedures were compared.

RESULTS

There were 41 patients in the L-LLND group and 21 in the R-LLND group. The incidence of postoperative complications was significantly lower in the R-LLND group (49% vs. 19%, p = 0.029), especially urinary retention (29% vs. 5%, p = 0.046). The median postoperative hospital stay was significantly shorter in the R-LLND group (22 vs. 15 days, p < 0.001). The 3-year relapse-free survival rates in the L-LLND and R-LLND groups were 75.3% (95% confidence interval [CI]: 58.9-85.9) and 65.7% (95% CI: 30.7-86.1), respectively. No significant differences were observed in long-term survival outcomes.

CONCLUSION

Patients with locally advanced rectal cancer who underwent TME plus R-LLND had a significantly lower incidence of postoperative complications and a significantly shorter postoperative hospital stay compared to those who underwent TME plus L-LLND. The long-term outcomes were comparable, and no oncological concerns associated with R-LLND were observed.

The immunosurveillance signature predicts the prognosis and immunotherapy sensitivity for colon adenocarcinoma

Colon adenocarcinoma (COAD) is a leading cause of cancer-related mortality worldwide, with immune escape being a significant factor in the failure of immunotherapy. This study investigates the correlation between Immunosurveillance-related genes and the prognosis of COAD patients, utilizing data from 1140 patients across four public databases: The Cancer Genome Atlas (TCGA), International Cancer Genome Consortium (ICGC), Array-express, and Gene Expression Omnibus (GEO). Employing Cox regression analysis, we identified 182 immune genes significantly linked to overall survival (OS) and established an Immunosurveillance score (ISs) based on 16 of these genes. The ISs score was validated using independent datasets, revealing that patients in the high-ISs group exhibited significantly poorer OS compared to those in the low-ISs group, as demonstrated by Kaplan-Meier curves and Cox regression analyses. Moreover, the ISs score showed a negative correlation with immune scores across multiple datasets. Notably, a higher ISs score was associated with improved recurrence-free survival (RFS) and OS in patients treated with PD-1 and CTLA4 inhibitors. Our findings suggest that the ISs score, derived from Immunosurveillance-related genes, has the potential to serve as a valuable prognostic marker and a tool for identifying COAD patients who may benefit from immunotherapy in clinical settings.

Hepatic dysfunction in individuals with COVID-19 and its impact on pregnancy outcomes

This study aimed to describe the incidence of abnormal liver function tests (LFTs) in pregnant women post-2019 coronavirus disease (COVID-19) and investigate the characteristics of pregnant women with abnormal LFTs and its impact on pregnancy outcomes. The data for 168 pregnant women who were infected with COVID-19 in the late stages of pregnancy were collected in Hefei Maternal and Child Health Hospital from December 2022 to January 2023, and 86 pregnant women with abnormal liver function were divided into the research group and 82 pregnant women with normal liver function into the control group for retrospective analysis. Population and laboratory data were collected and statistical analysis was conducted. Among the 168 pregnant women with COVID-19, 86 (51.2%) had elevated liver enzymes. In the control group, 4 (4.5%) had elevated liver enzymes. Differences between the 2 groups were statistically significant (P < .05). Single-factor analysis revealed that age, gestational week, and body mass index (BMI) exhibited statistically significant differences (P < .001) as potential factors influencing abnormal LFTs. Logistic regression analysis demonstrated that age (OR: 1.526), gestational week (OR: 1.321), and BMI (OR: 1.159) remained independent risk factors for liver injury (P < .05). Furthermore, the cesarean section rate, postpartum hemorrhage rate, rupture of membranes rate, and fetal intrauterine distress rate in the observation group were all significantly higher than those in the control group (P < .05). Additionally, the incidence of neonatal asphyxia, preterm birth, and low birth weight in the observation group were all significantly higher than those in the control group (P < .05). Pregnant individuals are at an elevated risk of hepatic injury following severe acute respiratory syndrome coronavirus 2 infection. Furthermore, the likelihood of hepatic injury escalates with advancing maternal age, gestational age, and BMI. Hepatic functional aberrations in the latter stages of pregnancy may precipitate adverse pregnancy outcomes.

Challenges in using virtual reality technology for pain relief

The present paper addresses two issues pertaining to the use of virtual reality (VR). One issue pertains to the equipment utilized. VR technology can be classified into two main categories: Immersive and non-immersive. The immersive type of technology necessitates the use of substantial equipment, yet it is demonstrably efficacious. Furthermore, the efficacy of this approach is enhanced when combined with relaxation and biofeedback techniques. The other issue is that the efficacy of this approach is diminished when applied to chronic pain, in comparison to acute pain. The relief of chronic pain is a challenging endeavor due to the diminished functionality of the medial prefrontal cortex (mPFC) within the default mode network. Given the close relationship between the mPFC and the reward system dopamine, it is essential to develop a program that activates the reward system dopamine through the use of VR technology.

Territories of mourning: Addressing submerged problems of grief through multidisciplinary care

Mourning and grief are natural responses to loss and can be especially complex and prolonged in the context of end-of-life care. Caregivers play a crucial role in supporting individuals through this difficult journey, often balancing their own grief with the need to provide care. This paper explores the experiences of mourning and grief in hospice settings, with a focus on the emotional challenges faced by both patients and caregivers during the grieving process. Psychological support plays a crucial role at the end of life in a multidisciplinary care approach. By addressing the complex interplay between biological disease and psychological well-being, healthcare professionals can provide more comprehensive and compassionate care. A deep understanding of mourning and elaboration of grief would improve the implementation of suitable support interventions and facilitate collaboration among family members and healthcare teams, ultimately improving the quality of end-of-life care and promoting the well-being of both patients and their families.

Evaluation of pregabalin-induced oedema using the adverse event spontaneous reporting database and the prescription claims database

OBJECTIVES

Pregabalin may reduce the quality of life due to oedema, which may lead to further adverse events if co-administered with diuretics. This study investigated the occurrence of oedema and loop diuretic prescriptions in Japanese patients treated with pregabalin, including the temporal characteristics of the onset and factors associated with oedema.

METHODS

Using the Japanese Adverse Drug Event Report database, we performed logistic regression analysis to calculate adjusted reporting odds ratios to assess the association between pregabalin and oedema, and time-of-onset analysis to identify the timing of oedema onset. Using the prescription claims database of the Japanese pharmacy group, we assessed the occurrence of loop diuretic prescriptions associated with pregabalin by calculating the adjusted sequence ratios in the prescription sequence symmetry analysis, and identified the associated factors in subgroup analyses.

KEY FINDINGS

The adjusted reporting odds ratio was 6.89 (95% confidence interval: 5.96-7.91) for pregabalin, adjusted for age and sex as covariates. The median time to onset of oedema was 16.0 days (interquartile range: 6.0-42.0 days). The adjusted sequence ratio was 1.17 (95% confidence interval: 1.09-1.25), with subgroup analyses confirming a significant association at starting doses of 150 mg/day and more.

CONCLUSIONS

This study suggests that oedema and loop diuretic prescriptions are associated with pregabalin use. Pregabalin-induced oedema was more common early in treatment and loop diuretics were more likely to be prescribed when the starting dose of pregabalin was 150 mg/day or more.

The potential role of AI in research priority setting exercises

To help achieve the goals of accountability and research excellence, funding organisations often utilise evidence from research priority setting exercises (RPSEs), which distil, from data gathered from relevant stakeholders, a systematic and 'objective' rank-order of research priorities. RPSEs are, however, costly and labour-intensive. Also, critics of RPSEs have highlighted certain limitations: insufficient representation of difficult-to-reach stakeholders, especially in low- and middle-income countries; a lack of genuine stakeholder engagement; wide variation in the extent to which exercises are documented; a lack of specificity in the identified priorities; and minimal impact of the priorities. Artificial intelligence (AI) tools such as ChatGPT may potentially help, valuably complementing conventional RPSEs. While the opacity of AI decision-making is a limitation, advantages include speed, affordability, and highly inclusive distillation of the vastness of existing human knowledge. We encourage research identifying the extent to which AI can replicate conventional RPSEs. We suggest that AI tools could complement conventional approaches either at the initial question generation stage or in generating supplementary insights for reflection at the data analysis stage. Also, under conditions of high existing stakeholder engagement and an extant prevalence of conventional RPSEs, AI-only studies may be valuable.

Mediational effect analysis of childhood emotional abuse on prodromal psychotic symptoms in self-taught examination students

It has been shown that childhood trauma is associated with an increased risk of prodromal psychotic symptoms. However, research on the prevalence of prodromal psychotic symptoms among self-taught examination students and the relationship with childhood trauma remains limited. The aim of this study was to investigate the prevalence of prodromal psychotic symptoms among self-taught examination students, explore the impact of childhood trauma on prodromal psychotic symptoms, and its underlying mechanisms. From January 5 to 18, 2024, a cross-sectional study was conducted on 670 self-taught examination students in Nantong University through the online survey platform "Wenjuanxing" ( www.wjx.cn ). These individuals completed the general information questionnaire, The childhood trauma questionnaire-Short Form (CTQ-SF), The Prodromal Questionnaire-Brief (PQ-B), The Depression Anxiety Stress Scale (DASS-21). Data analysis was carried out using SPSS 25.0 and the PROCESS macro. (1) The prevalence of prodromal psychotic symptoms in self-taught examination students was 20.6% (138/670); (2) The total effect of childhood emotional abuse and prodromal psychotic symptoms in self-taught examination students was 2.9859. The mediating effect of anxiety (effect value: 1.4611), depression (effect value: 0.6201), social support (effect value: - 0.1214), and health conditions (effect value: 0.1954) in the relationship between childhood emotional abuse and prodromal psychotic symptoms of self-taught examination students, accounts for 72.18% of the total effect. Childhood trauma can not only independently predict the risk of prodromal psychotic symptoms among self-taught examination students, but also predict the risk of prodromal psychotic symptoms indirectly by affecting anxiety, depression, social support, and health conditions. Targeted measures should be taken to reduce the prodromal psychotic symptoms in this neglected group of self-taught examination students.

Primary closure with self-disengaging biliary stent following laparoscopic CBD exploration in normal-diameter ducts: a propensity score matching study

Laparoscopic Common Bile Duct Exploration (LCBDE) is highly effective for treating common bile duct stones (CBDS). This study aims to evaluate the safety and feasibility of primary closure with a self-disengaging biliary stent during LCBDE in patients with normal-diameter CBDs (≤ 8 mm) and to compare perioperative outcomes and complications with those in dilated CBDs (> 8 mm). From May 2022 to May 2024, patients with CBDSs who underwent LCBDE with primary closure and a self-disengaging biliary stent were retrospectively analyzed. Patients were stratified into two subgroups based on CBD diameter (normal: ≤8 mm vs. dilated: >8 mm). Propensity score matching (PSM) was adjusted for baseline differences between normal and dilated CBD groups, and perioperative indicators and postoperative complications were compared. Multivariate analysis identified risk factors for postoperative bile leakage. Of 491 patients, 343 underwent primary closure with a self-disengaging biliary stent during LCBDE. The mean operation time was 85 (IQR 70-110) min, with blood loss of 20 (IQR 15-20) ml. The postoperative hospital stay was 8 (IQR 8-10) days, and the hospitalization cost was CNY 28,143 (IQR 25,522-32,809). The overall complication rate was 32 (9.3%), with 25 (7.3%) experiencing bile leakage. The Charlson Comorbidity Index (CCI) score was an independent risk factor for bile leakage (OR 2.587; 95% CI 1.729-3.873, P < 0.001). PSM of dilated (> 8 mm, n = 225) and normal (≤ 8 mm, n = 118) CBD groups resulted in 114 matched pairs. No significant differences were observed in operative time, blood loss, hospital stay, costs, or complications between the groups. Primary closure with a self-disengaging biliary stent following LCBDE is equally safe and effective in patients with normal-diameter CBDs as in those with dilated ducts. CBD diameter should not be a contraindication for this technique. The CCI score is a critical predictor of bile leakage and should be considered in perioperative risk assessment.

Natural bioactive compounds reprogram bile acid metabolism in MAFLD: Multi-target mechanisms and therapeutic implications

Metabolic-associated fatty liver disease (MAFLD) has become an increasingly prevalent liver disorder worldwide, being closely associated with obesity, metabolic syndrome, and insulin resistance. Bile acids (BAs), beyond their traditional role in lipid digestion, play a pivotal part in regulating lipid and glucose metabolism as well as inflammatory responses. Recent investigations have recognized BAs as key factors in the onset and progression of MAFLD, mainly via their interactions with nuclear receptors such as the farnesoid X receptor (FXR) and the G protein-coupled bile acid receptor (TGR5). Additionally, active compounds derived from traditional Chinese medicine (TCM) have shown promising potential in the treatment of MAFLD. This study systematically reviews and analyzes the molecular mechanisms and recent progress in the application of TCM active ingredients for MAFLD treatment, with a focus on their regulation of BAs. These active ingredients, including saponins, flavonoids, polysaccharides, and sterols, exert therapeutic effects through diverse mechanisms, such as modulating BA synthesis and mediating receptor-signaling pathways, and are expected to restore metabolic homeostasis.

Harnessing the human microbiome and its impact on immuno-oncology and nanotechnology for next-generation cancer therapies

The integration of microbiome research and nanotechnology represents a significant advancement in immuno-oncology, potentially improving the effectiveness of cancer immunotherapies. Recent studies highlight the influential role of the human microbiome in modulating immune responses, presenting new opportunities to enhance immune checkpoint inhibitors (ICIs) and other cancer therapies. Nanotechnology offers precise drug delivery and immune modulation capabilities, minimizing off-target effects while maximizing therapeutic outcomes. This review consolidates current knowledge on the interactions between the microbiome and the immune system, emphasizing the microbiome's impact on ICIs, and explores the incorporation of nanotechnology in cancer treatment strategies. Additionally, it provides a forward-looking perspective on the synergistic potential of microbiome modulation and nanotechnology to overcome existing challenges in immuno-oncology. This integrated approach may enhance the personalization and effectiveness of next-generation cancer treatments, paving the way for transformative patient care.

Micronanoplastic exposure due to cardiopulmonary bypass in children: A prospective observational study

Cardiopulmonary bypass (CPB) is widely used in cardiac operations. However, it remains unclear whether a CPB circuit, which is mainly made of plastics, can release micronanoplastics (MNPs) into the bloodstream. We conducted a prospective observational study involving children undergoing congenital heart disease repair with CPB support. Blood samples were collected before and after CPB and analyzed using pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS) and laser direct infrared spectroscopy (LDIR) in combination with scanning electron microscopy. A total of 22 patients were involved in this study. The Py-GC/MS analysis revealed a significant increase in total MNPs after CPB support (p < 0.0001). Notably, CPB support significantly increased the levels of polystyrene (p = 0.046), polyethylene (p = 0.038), polypropylene (p < 0.0001), polyvinyl chloride (p < 0.0001), and polyamide 6 (p = 0.027). CPB time was positively correlated to MNP exposure (r = 0.43, p = 0.047). Increases in MNP exposure were positively correlated to an increase in white blood cells (r = 0.52, p = 0.013) and neutrophils (r = 0.46, p = 0.029). The LDIR analysis found that the post-CPB count of MNPs was significantly higher than the pre-CPB count (p = 0.015). In conclusion, CPB support significantly increases exposure to MNP in children undergoing cardiac operations. Further investigations are warranted to clarify the long-term health risks of MNP exposure caused by CPB support.

Fungal dimeric xanthones as anticancer agents by novelly stimulating sodium-calcium exchanger 1

Multitude of natural products have the ability to demonstrate inhibitory effects on cancer cells by regulating ion channels/transporters functions. Eighteen xanthone dimers (Xds), including five new dimers diaporxanthones H, I, J-L (1, 2, and 12-14), were isolated and characterized through co-culture and chemical conversion methods. ECD Cotton effect analyses and chemical communication method provided fundamental role in addressing the challenges of elucidating their absolute configurations. Structure-activity relationship (SAR) analysis showed that eight xanthone-xanthone Xds (2-7, 15 and 16) demonstrated marked cytotoxic effects against gastric cancer (GC) cell line AGS, with undetectable inhibition on human colon cancer cells. The anti-proliferative potency of Xds was 2-5 fold higher than positive control drug cisplatin. Mechanistic studies were conducted on a high-yield compound, 12-O-deacetyl-phomoxanthone A (4). Compound 4 activated Na+/Ca2+ exchanger 1 (NCX1), thereby causing an increase in cellular Ca2+ signaling and subsequent inhibition of the downstream PI3K/AKT/β-catenin pathway, ultimately leading to GC cell death. Like anti-GC, Xds also possessed anti-melanoma activity in vitro and in vivo. We demonstrate Xds have effective cytotoxic actions against GC and melanoma by targeting NCX1/Ca2+ signaling in cancer cells.

Intestinal dysbiosis and colorectal cancer

ABSTRACT

Colorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality worldwide, highlighting the urgent need for novel preventive and therapeutic strategies. Emerging research highlights the crucial role of the gut microbiota, including bacteria, fungi, viruses, and their metabolites, in the pathogenesis of CRC. Dysbiosis, characterized by an imbalance in microbial composition, contributes to tumorigenesis through immune modulation, metabolic reprogramming, and genotoxicity. Specific bacterial species, such as Fusobacterium nucleatum and enterotoxigenic Bacteroides fragilis , along with fungal agents like Candida species, have been implicated in CRC progression. Moreover, viral factors, including Epstein-Barr virus and human cytomegalovirus, are increasingly recognized for their roles in promoting inflammation and immune evasion. This review synthesizes the latest evidence on host-microbiome interactions in CRC, emphasizing microbial metabolites, such as short-chain fatty acids and bile acids, which may act as both risk factors and therapeutic agents. We further discuss the latest advances in microbiota-targeted clinical applications, including biomarker-assisted diagnosis, next-generation probiotics, and microbiome-based interventions. A deeper understanding of the role of gut microbiome in CRC pathogenesis could pave the way for diagnostic, preventive, and personalized therapeutic strategies.

Genetic landscapes of breast tumors by next-generation sequencing with focus on less common types and genotype-phenotype correlations

Next-generation sequencing (NGS) has transformed our understanding of oncogenic pathways and mutational processes underlying many breast tumors. Although large-scale NGS studies included mostly common invasive breast carcinomas, the genetic landscapes of several less common or rare special histologic types and other breast tumors have now also been elucidated. Many of these lesions harbor highly specific types of mutations or rearrangements/gene fusions, including invasive lobular carcinoma, tall cell carcinoma with reversed polarity, most salivary gland-like neoplasms, fibroepithelial neoplasms, and mesenchymal tumors such as fibromatosis, nodular fasciitis, and dermatofibrosarcoma protuberans. In some cases, surrogate immunohistochemical or RNA in situ hybridization markers evaluable by light microscopy have been shown to correlate with the underlying genetic alterations. Angiosarcomas and other special breast cancer subtypes, such as triple negative apocrine carcinomas, metaplastic carcinomas, and a subset of ER-positive carcinomas (mucinous and micropapillary carcinomas, neuroendocrine neoplasms) have not been associated with specific genetic underpinnings but are enriched for certain genetic features and oncogenic pathways. The identification of characteristic genetic alterations or their molecular surrogates can be useful to establish an accurate diagnosis, and in some cases, may point to potentially actionable therapeutic targets. This review aims to summarize the genetic landscapes of less common benign and malignant breast tumors, with special attention to genotype-phenotype correlations and to the diagnostic utility of genetics and surrogate markers when applicable. BRCA1/2-associated breast carcinomas will also be discussed due to the association of so-called BRCAness with basal-like histology.

Calcium-iron crosstalk in epileptogenesis: Unraveling mechanisms and therapeutic opportunities

Epilepsy, a chronic neurological disorder affecting millions globally, remains poorly understood in its etiology and therapeutic management. Emerging evidence highlights the intricate interplay between calcium (Ca2+) and iron (Fe2+/Fe3+) ions in modulating neuronal excitability, oxidative stress, and synaptic plasticity-key processes implicated in epileptogenesis. This review synthesizes current knowledge on the dual roles of Ca2+ and Fe2+/Fe3+ in epilepsy, emphasizing their bidirectional regulatory mechanisms and pathological synergism. Calcium dysregulation, mediated through voltage-gated channels (e.g., Cav1.2, Cav3.2), store-operated calcium entry (SOCE), and mitochondrial calcium uniporters (MCU), exacerbates neuronal hyperexcitability and seizure propagation. Concurrently, iron overload drives ferroptosis via lipid peroxidation and glutathione depletion, while iron deficiency impairs neurodevelopmental processes. Crucially, Ca2+-Fe2+ crosstalk intersects at multiple nodes: TRP channels (e.g., TRPC6, TRPML1) facilitate dual ion transport; mitochondrial dysfunction links Ca2+ overload with Fe2+-dependent ROS generation; and inflammatory cascades disrupt both ion homeostasis. Clinically, antiepileptic drugs targeting Ca2+ channels (e.g., ethosuximide, zonisamide) and emerging ferroptosis inhibitors (e.g., deferoxamine, RTA 408) underscore the therapeutic potential of modulating these pathways. However, drug resistance and incomplete seizure control necessitate novel strategies leveraging ion interaction networks. We propose that combinatorial approaches targeting Ca2+-Fe2+ signaling hubs-such as MCU-TRPML1 axes or redox-sensitive RyR channels-may offer synergistic benefits. Future research must prioritize cross-model validation, advanced neuroimaging biomarkers, and multidisciplinary frameworks to translate mechanistic insights into precision therapies. This comprehensive analysis positions Ca2+-Fe2+ crosstalk as a pivotal frontier in epilepsy research, bridging molecular pathophysiology with innovative treatment paradigms.

Short-course radiation followed by mFOLFOX-6 plus avelumab for locally-advanced microsatellite stable rectal adenocarcinoma: The Averectal study

BACKGROUND

Total neoadjuvant therapy(TNT) has improved complete pathologic response (pCR) rate and disease-free survival (DFS) in locally advanced rectal cancer (LARC), though an increased local recurrence rate (LRR) with short-course radiotherapy (SCRT) is concerning. Synergism between immunotherapy and radiotherapy may improve outcomes in LARC, even where microsatellite stable (MSS) tumours exist. The Averectal trial evaluated SCRT, followed by chemotherapy and immunotherapy with avelumab and total mesorectal excision (TME) in these patients.

METHODS

Patients with LARC received SCRT (5 Gy x5 fractions), 6 cycles of mFOLFOX-6 plus avelumab every 2 weeks, followed by TME in an investigator-initiated, open-label, single-arm, multicentre, phase II study. The primary outcome was pCR vs. historical control. Secondary outcomes were 3-year DFS, local recurrence rate (LR) and the association of the ImmunoScore (IS) with outcomes including pCR, safety, and quality of life (QoL).

RESULTS

Out Of 44 MSS patients enrolled from 3 centres (July 2018 -October 2020), 40 completed treatment and analysed (65 % male, median age 58.5 [31.0, 74.0] years). Median follow-up was 44 months (11.4, 51.4). Fifteen patients (37.5 %) achieved pCR; and 67.5 % had a major pathologic response. Mean DFS was 42 months (37.9, 46.1). Mean OS was 46.3 months (44.4, 48.2). Median DFS and OS were not reached. Three-year DFS was 85 %. LRR was 2.5 %. Patients with vs. without pCR had higher mean IS (68 vs. 52, p = 0.036). Serious adverse events occurred in 23.5 % (one was related to avelumab). Three patients died (7.5 %), due to disease progression. QOL was similar between baseline and last follow-up.

CONCLUSION

Adding avelumab to neoadjuvant chemotherapy mFOLFOX6 after SCRT, followed by TME, improved pCR without increasing LRR, with acceptable toxicity and QOL.

Adjuvant treatment of gastrointestinal stromal tumor: State of the art in 2025

The management of gastrointestinal stromal tumors (GISTs) has been revolutionized by the discovery of their sensitivity to imatinib. Most localized GISTs can be cured by surgery alone. The present overview aims to discuss the results of four recent randomized trials or updates assessing adjuvant imatinib. The duration of adjuvant treatments varied in these 4 trials (1 year versus zero, 2 years versus zero, 3 years versus 1 year and 6 years versus 3 years). All these trials showed that adjuvant imatinib improves disease/relapse-free survival in patients at high-risk of GIST relapse. Nevertheless, only one trial showed an overall survival improvement, in favor of 3-year treatment compared to 1-year treatment. But these randomized trials did not assess KIT or PDGFRA mutational status at study entry. Moreover, the definition of high-risk GIST differed across these trials. So, the patient subset that benefits the most from adjuvant imatinib therapy remains undetermined. The optimal duration of adjuvant imatinib therapy remain unclear.

New insights into Gremlin-1: A tumour microenvironment landscape re-engineer and potential therapeutic target

Gremlin-1 (GREM1), a well-known bone morphogenetic protein (BMP) antagonist, is highly expressed in various malignant tumours. However, the specific role of GREM1 in tumours remains controversial and may be attributed to the heterogeneity and complexity of the tumour microenvironment (TME). It is currently believed that GREM1 regulates the complex landscape of the TME, primarily by antagonising BMP signalling or BMP-independent pathways. Both GREM1 and BMP play dual roles in tumour progression. Therefore, the mutual crosstalk between tumour cells and tumour-associated fibroblasts and the regulation of various secreted factors in the TME affect the secretion level of GREM1, which in turn regulates the amplitude balance between GREM1 and BMP, affecting tumour progression. The inhibition of GREM1 activity in the TME can disrupt this amplitude balance and prevent the formation of a tumour-supportive microenvironment, demonstrating that GREM1 is a potential therapeutic target. In this study, we reviewed the specific signalling pathways via which GREM1 in the TME regulates epithelial-mesenchymal transition, construction of the tumour immune microenvironment, and maintenance of tumour cell stemness via BMP-dependent and BMP-independent regulation, and also summarised the latest clinical progress of GREM1.

"I Am Not Alone": A Photovoice Exploration of Diabetes Self-Management for Older Persons in Rural Ontario, Canada

ObjectiveTo explore diabetes self-management for older adults in rural Ontario.MethodsFourteen adults, 65 and older, with diabetes, participated in this study using a participatory, art-based approach involving photovoice and semi-structured interviews. Data underwent hermeneutic phenomenology analysis.FindingsFour themes emerged, elucidating the lived experiences of participants managing diabetes in a rural context.DiscussionThis study underscores the challenges and strategies of diabetes self-management in rural older adults. A holistic approach, encompassing physical, emotional, and mental well-being, is pivotal, augmented by proactive lifestyle choices. Effective coordination in medication management and enhanced communication among health care providers emerged as essential. The unique role of pets illuminates their profound impact on participants' activity levels and emotional fortitude, suggesting they can be vital assets in diabetes care. Collectively, these findings guide health professionals and policymakers in crafting nuanced, context-sensitive interventions to optimize diabetes management for older adults in rural contexts.

Knee Osteoarthritis SCAENet: Adaptive Knee Osteoarthritis Severity Assessment Using Spatial Separable Convolution with Attention-Based Ensemble Networks with Hybrid Optimization Strategy

Osteoarthritis (OA) of the knee is a chronic state that significantly lowers the quality of life for its patients. Early detection and lifetime monitoring of the progression of OA are necessary for preventive therapy. In the course of therapy, the Kellgren and Lawrence (KL) assessment model categorizes the rigidity of OA. Deep techniques have recently been used to increase the precision and effectiveness of OA severity assessments. The training process is compromised by low-confidence samples, which are less accurate than normal ones. In this work, a deep learning-based knee osteoarthritis severity assessment model is recommended to accurately identify the condition in patients. The phases of the designed model are data collection, feature extraction, and prediction. At first, the images are generally gathered from online resources. The gathered images are given into the feature extraction phase. A new model is implemented to predict knee osteoarthritis named Spatial Separable Convolution with Attention-based Ensemble Networks (SCAENet), which includes feature extraction, stacked target-based feature pool generation, and knee osteoarthritis prediction. The feature extraction is done using ResNet, Visual Geometry Group (VGG16), and DenseNet. The stacked target-based feature pool is obtained from the SCAENet. Hence, the stacked target-based feature pool is obtained by the Hybridization of Equilibrium Slime Mould with Bald Eagle Search Optimization (HESM-BESO). Here, the knee osteoarthritis's severity prediction is performed using the dimensional convolutional neural network (1DCNN) technique. The designed SCAENet model is validated with other conventional methods to show high performance.

Metastatic synovial sarcoma masquerading as primary neuroendocrine tumor of pancreas: a diagnostic conundrum

Metastatic sarcomas to the pancreas are extremely rare, with poor survival rates. Therefore, rapid diagnosis and differentiation from primary malignant tumors of pancreas thereby guiding the treatment is indispensable. Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is the current diagnostic modality of choice for pancreatic tumor sampling with promising results. Definitive pathologic diagnosis requires adequate tissue for performing ancillary studies. We present a rare case of metastatic synovial sarcoma in the pancreas in an elderly male to endorse the utility of EUS-FNB with imprint cytology as a rapid and effective diagnostic tool.

Designing live bacterial therapeutics for cancer

Humans are home to a diverse community of bacteria, many of which form symbiotic relationships with their host. Notably, tumors can also harbor their own unique bacterial populations that can influence tumor growth and progression. These bacteria, which selectively colonize hypoxic and acidic tumor microenvironments, present a novel therapeutic strategy to combat cancer. Advancements in synthetic biology enable us to safely and efficiently program therapeutic drug production in bacteria, further enhancing their potential. This review provides a comprehensive guide to utilizing bacteria for cancer treatment. We discuss key considerations for selecting bacterial strains, emphasizing their colonization efficiency, the delicate balance between safety and anti-tumor efficacy, and the availability of tools for genetic engineering. We also delve into strategies for precise spatiotemporal control of drug delivery to minimize adverse effects and maximize therapeutic impact, exploring recent examples of engineered bacteria designed to combat tumors. Finally, we address the underlying challenges and future prospects of bacterial cancer therapy. This review underscores the versatility of bacterial therapies and outlines strategies to fully harness their potential in the fight against cancer.

Microbiota, Gut Health, and Laryngopharyngeal Reflux Disease

Recent advances in technology have allowed examination of microbial communities in efforts to classify microbiomes of "healthy" individuals. The gut and the oral cavity have been extensively researched but the upper airway (including the pharynx and larynx) has not received the same attention. This review details the emergence of microbiota as a field of interest and reviews existing evidence supporting a relationship between microbiome alterations and laryngopharyngeal reflux symptoms, as well as potential therapeutic interventions.

Refining partial gland ablation for localised prostate cancer: the FALCON project

OBJECTIVES

To provide a contemporary statement on focal therapy (FT) for localised prostate cancer (PCa) from an international and diverse group of physicians treating localised PCa, with the aim of overcoming the limitations of previous consensus statements, which were restricted to early adopters, and to offer direction regarding the various aspects of FT application that are currently not well defined.

MATERIALS AND METHODS

The FocAL therapy CONsensus (FALCON) project began with a 154-item online survey, developed following a steering committee discussion and literature search. Invitations to participate were extended to a large, diverse group of professionals experienced in PCa management. From 2022 to 2023, a Delphi consensus study consisting of three online rounds was conducted using the Modified Delphi method. A 1-9 Likert scale was used for the survey, which was followed by an in-person expert meeting. The threshold for achieving consensus was set at 70% agreement/disagreement. Six main aspects of FT were covered: (i) patient selection; (ii) energy source selection; (iii) treatment approach; (iv) treatment evaluation and follow-up; (v) treatment cost and accessibility; and (vi) future perspectives.

RESULTS

Of 246 initial participants, 148 (60%) completed all three rounds. Based on participant feedback, 27 new statements were added in the second round, and 33 questions related to personal expertise, for which consensus was not necessary, were excluded. After the third and final round, consensus had not been reached for 69 items. These items were discussed at the in-person meeting, resulting in a consensus of 57 additional items. Consensus was finally not reached on 12 items. Given the volume of data, the voting outcomes are summarised in this article, with a detailed breakdown presented in the form of figures and tables.

CONCLUSIONS

The FALCON project delivered a significant consensus on the approach to FT for localised PCa. Additionally, it highlighted gaps in our knowledge that may provide guidance for future research.

Essential competencies of nurses working with AI-driven lifestyle monitoring in long-term care: A modified Delphi study

BACKGROUND

As more and more older adults prefer to stay in their homes as they age, there's a need for technology to support this. A relevant technology is Artificial Intelligence (AI)-driven lifestyle monitoring, utilizing data from sensors placed in the home. This technology is not intended to replace nurses but to serve as a support tool. Understanding the specific competencies that nurses require to effectively use it is crucial. The aim of this study is to identify the essential competencies nurses require to work with AI-driven lifestyle monitoring in long-term care.

METHODS

A three round modified Delphi study was conducted, consisting of two online questionnaires and one focus group. A group of 48 experts participated in the study: nurses, innovators, developers, researchers, managers and educators. In the first two rounds experts assessed clarity and relevance on a proposed list of competencies, with the opportunity to provide suggestions for adjustments or inclusion of new competencies. In the third round the items without consensus were bespoken in a focus group.

FINDINGS

After the first round consensus was reached on relevance and clarity on n = 46 (72 %) of the competencies, after the second round on n = 54 (83 %) of the competencies. After the third round a final list of 10 competency domains and 61 sub-competencies was finalized. The 10 competency domains are: Fundamentals of AI, Participation in AI design, Patient-centered needs assessment, Personalisation of AI to patients' situation, Data reporting, Interpretation of AI output, Integration of AI output into clinical practice, Communication about AI use, Implementation of AI and Evaluation of AI use. These competencies span from basic understanding of AI-driven lifestyle monitoring, to being able to integrate it in daily work, being able to evaluate it and communicate its use to other stakeholders, including patients and informal caregivers.

CONCLUSION

Our study introduces a novel framework highlighting the (sub)competencies, required for nurses to work with AI-driven lifestyle monitoring in long-term care. These findings provide a foundation for developing initial educational programs and lifelong learning activities for nurses in this evolving field. Moreover, the importance that experts attach to AI competencies calls for a broader discussion about a potential shift in nursing responsibilities and tasks as healthcare becomes increasingly technologically advanced and data-driven, possibly leading to new roles within nursing.

A scientometric analysis and visualization of research on fatty liver diseases in Iran from 2003 to 2023

Background

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and is now a major global health threat. Due to the mechanistic links between these conditions, along with the rising prevalence of fatty liver disease, diabetes, and obesity, MAFLD (metabolic-associatedfatty liver diseases) was introduced as a new terminology and then updated to MASLD (Metabolic Dysfunction-associated Steatotic Liver Disease. These changes reflect a growing recognition of the importance of fatty liver and its associated health risks.

Methods

This scientometric study analyzed publications on "fatty liver diseases" (FLD) indexed in Scopus from 2003 to 2023 in Iran. Online Analysis Platforms and VOSviewer were used to assess publication trends and identify research hotspots.

Results

We retrieved 1,857 English articles on fatty liver diseases published between 2003 and 2023. The Journal of Hepatitis Monthly was notable for Iranian publications on fatty liver disease. Most publications were original articles and Dr. Sahebkar AH was the most prolific author. Iranian researchers primarily collaborated with scholars from the United States. The leading institution in terms of productivity was Tehran University of Medical Sciences.

Conclusion

This study reveals an increasing trend in both the number of Iranian publications and the citations of articles in the field of FLD. We believe this study can serve as a roadmap for future research and policy development on fatty liver diseases, which are a significant public health concern in Iran. Additionally, new strategies are needed to foster multi-disciplinary research and enhance international cooperation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01606-8.

A rare case of biatrial myxoma in an 11-year-old girl patient with thromboembolic stroke: A case report

INTRODUCTION

Cardiac myxomas (CM) are benign primary tumors typically found in the left atrium, but biatrial myxomas are exceptionally rare, comprising only 3-5 % of cases. This report highlights the rarity of biatrial myxomas in a young patient, the importance of early recognition due to the risk of thromboembolic events, which can lead to stroke. Excellent surgical intervention is needed to prevent CM recurrences.

CASE PRESENTATION

An 11-year-old girl presented with sudden onset of left-sided hemiparesis, aphasia, right-sided facial drooping, cephalgia, palpitations, nausea, and intermittent chest pain over the past two months. Laboratory examination revealed anemia and elevated D-Dimer. Echocardiography and cardiac CT demonstrated large masses in the right and left atrium, suggesting myxomas. The patient was diagnosed with biatrial myxomas complicated by thromboembolic stroke.

CLINICAL DISCUSSION

Complete mass evacuation was performed through median sternotomy. Histopathology examination confirmed CM.

CONCLUSION

This case emphasizes the importance of early detection, detailed examination and surgical intervention of biatrial myxomas, especially in young patients, to prevent and manage life-threatening thromboembolic complications and recurrence of CM. Timely intervention is crucial for ensuring favorable outcomes.

IGFBP5 regulates fibrocartilage differentiation and cartilage injury induced by T-2 toxin via blocking IGF-1/IGF-1R signalling

OBJECTIVES

Kashin-Beck disease (KBD) is a form of osteoarthropathy that affects the skeletal and joint systems of children and adolescents. Insulin-like growth factor binding protein 5 (IGFBP5) plays an important role in bone growth and development. This study aimed to investigate the role of IGBFP5 in regulating the function and differentiation of chondrocytes in KBD.

METHODS

The mRNA and protein expressions of IGFBP5, IGF-1 and IGF-1R were detected by RT-qPCR and western blot assays. Commercial kits were performed to measure the mitochondrial ROS content, calcium loading and ATP synthesis in chondrocytes. 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay was used to detect the cell viability of chondrocytes. Co-IP and pull-down assays were conducted to verify the binding activity of IGFBP5 to IGF-1R. The rat KBD model was constructed by a low selenium diet and T-2 toxin.

RESULTS

The expression of IGFBP5 was upregulated in KBD patient and rat tissues. Further studies showed that interfering with IGFBP5 effectively inhibited T-2-induced chondrocyte damage and mitochondrial stress. IGFBP5 depressed the interaction between IGF-1 and IGF-1R, thereby affecting the regulation of IGF-1/IGF-1R signalling in the repair of chondrocytes. In addition, the fibrous differentiation of cartilage progenitor cells (CPCs) and the activity and migration of CPCs induced by T-2 stimulation were suppressed under IGFBP5 silence treatment.

CONCLUSION

IGFBP5 was upregulated during the pathological progression of KBD, and IGFBP5 competitively bound with IGF-1R to impede the interactions between IGF-1 and IGF-1R. Knockdown of IGFBP5 inhibited fibrotic differentiation and ameliorated the reduction of CPC function in KBD model.

Modification of the Adjustment Disorder New Module20 (ADNM-20) for Use in Military Environments (ADNM-20-MIL): A Delphi and Pilot Study

OBJECTIVES

Despite its high prevalence and strong linkages with dangerous health outcomes, research on Adjustment Disorder (AjD) is hindered by lack of diagnostic clarity. AjD is categorized as a stress-related disorder, highlighting the important role of the stressor(s) on AjD symptom onset and severity. The military community shows increased risk for AjD, and existing tools do not capture the stressors most relevant and appropriate to this unique community. A diagnostic assessment tool developed specifically for this specialized population may provide critical capability to clinical assessment.

METHODS

A Delphi method was used to create a military-specific version of the standard assessment for Adjustment Disorders (ADNM-20), named ADNM-20-MIL. This tool was pilot-tested in a sample of U.S. Active Duty Service Members (ADSMs) with AjD diagnoses.

RESULTS

Throughout the Delphi process, military-specific stressors were identified and integrated into the ADNM-20-MIL, then refined and validated, ensuring their applicability and relevance to the military context.

CONCLUSIONS

The ADNM-20-MIL will enable timely diagnosis and targeted treatment for AjD, which remains a highly prevalent and destabilizing diagnosis in ADSMs.

Multifaceted roles of lactate dehydrogenase in liver cancer (Review)

Hepatocellular carcinoma (HCC) has high morbidity and mortality rates, and metabolic reprogramming of HCC cells supports the proliferation and development of tumor cells. Lactate dehydrogenase (LDH), a key metabolic enzyme, can maintain the rapid proliferative demand of tumor cells by promoting glycolysis and lactate production in HCC cells. In addition, LDH regulates redox homeostasis and influences lipid synthesis and signaling pathways, further promoting tumor invasion and metastasis. In the tumor microenvironment, LDH affects the function of immune cells and stromal cells by regulating the lactate concentration in and promoting the immune escape and angiogenesis of tumor cells. Since elevated levels of LDH are closely associated with tumor load, invasiveness and poor prognosis, LDH also has promising applications in the early diagnosis, treatment and prognostic assessment of HCC. The present study reviewed the roles of LDH in the occurrence, development, diagnosis, prognosis and treatment of HCC and explored its value as an important biomarker and potential therapeutic target, with the aim of providing a comprehensive reference for HCC‑related research and clinical practice.

Duration of systemic antifungal therapy for patients with invasive fungal diseases: A reassessment

Invasive fungal diseases are associated with significant morbidity and mortality, especially among immunocompromised patients, and often prompt for rapid and aggressive treatment aiming cure. Due to the expanding magnitude of patients burdened by chronic immunosuppression and affected by fungal diseases, the diversity of clinical settings has risen. This often results in prolonged therapy (induction, consolidation and maintenance) associated with potentially severe side effects, and clinicians face the challenging decisions of when and how to stop anti-fungal therapy. Adequate duration of therapy is poorly defined, hampered by the lack of dedicated trials to the question, the heterogeneity of cases (type of fungal pathogen, localization of infection, underlying host conditions) and various confounding factors that may influence the clinical response (e.g. persistence vs recovery of immunosuppression, impact of surgery). In this review, we aim to evaluate the existing data underlying the guidelines and recommendations of treatment duration for the most frequent invasive fungal diseases (cryptococcal meningitis, Pneumocystis pneumonia, invasive aspergillosis, invasive candidiasis and mucormycosis), as well as specific localizations of deep-seated diseases (osteo-articular or central nervous system diseases and endocarditis) and emerging considerations and strategies.

Trends and cross-country inequalities in the global, regional, and national burden of gallbladder and biliary tract cancer from 1990 to 2021, along with the predictions for 2035

BACKGROUND

The global burden of gallbladder and biliary tract cancer (GBTC) is on the rise.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) of GBTC from 1990 to 2021 were obtained from the Global Burden of Diseases Study (GBD) 2021. The Bayesian Age-Period-Cohort (BAPC) model was also employed to project disease trends for the next 15 years.

RESULTS

In 2021, new GBTC cases observed globally amounted to 216,768, with 171,961 mortality and 3732,121 DALYs. From 1990-2021, a notable surge was recorded in the incidence of GBTC by 101 %, mortality by 74.26 %, and DALYs by 60.45 %. Regions with superior Socio-Demographic Index (SDI) reflected elevated incidence and mortality rates. However, a significant decrease was noticed in the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR). Despite a reduction in health disparities among countries, differences remain. Prognostications predict a continual decline in global ASIR and ASMR through 2035.

CONCLUSIONS

The study found that the burden of GBTC in incidences, mortalities, and DALYs has been on the rise, with some correlation with socio-economic development.

The role of sirtuins in the regulation of reactive oxygen species in myocardial ischemia/reperfusion injury

Myocardial ischemia/reperfusion (I/R) injury has high morbidity and mortality rates, posing a significant burden on society. There is an urgent need to understand its pathogenesis and develop effective treatments. Reactive oxygen species (ROS) are crucial for the development of myocardial I/R injury, and inhibiting ROS overproduction is one of the most critical ways to delay myocardial I/R injury. Sirtuins are a group of nicotinic adenine dinucleotide ( +)-dependent histone deacetylases whose members can regulate ROS by modulating various biological processes. Numerous studies have shown that Sirtuins play an essential role in the progression of myocardial I/R injury by regulating ROS. This study focuses on the relationship between myocardial I/R injury and ROS, Sirtuins and ROS, discusses the role of Sirtuins in regulating ROS in myocardial I/R, and summarizes the therapeutic modalities aimed at targeting Sirtuins to modulate ROS in myocardial I/R injury, thereby guiding future research endeavors.

Characterization of the gut microbiota in drug abuse: prediction, prevention, and personalized medicine to benefit affected populations

Drug abuse poses an enormous threat to global public health. Long-term drug abuse can reduce the quality of life of patients and increase the healthcare burden on society. There is growing interest in developing new methods to mitigate the effects of drug abuse. The gut microbiota plays a key role in maintaining homeostasis within the brain-gut-lung axis, which is critical in drug-abusing patients. The microbiota-brain-gut-lung axis refers to the interactions of microbes with the brain, gut, and lung. The effects of drug abuse on the gut microbiota are increasingly recognized, especially the pathogenesis by which the microbiota-brain-gut-lung axis is involved in regulating organ-organ communication, to explore new therapeutic approaches for clinical drug abuse. Currently, in addition to antibiotics, antiviral drugs, anti-tumor drugs, corticosteroids, drugs for the treatment of neurodegenerative diseases, and anesthetics also cause gut microbiota imbalance. This review summarizes the effects of drug abuse on gut microbiota and the important role of the microbiota-brain-gut-lung axis in drug abuse. Identifying changes in the gut microbiota associated with drug abuse and their underlying mechanisms under the principles of predictive, preventive, and personalized medicine (PPPM) is a critical step toward achieving PPPM. These strategies include FMT, probiotic supplements, and engineered bacteria that can benefit sub-healthy individuals with gut dysbiosis caused by drug abuse.

Preoperative Prognostic Factors in Resectable Pancreatic Cancer: State of the Art and Prospects

BACKGROUND

Only 15% to 20% of patients with pancreatic ductal adenocarcinoma (PDAC) have access to surgical resection, which represents the only chance of curative treatment. Current resection classifications are almost exclusively anatomic and do not correlate sufficiently with patient survival. It is essential to develop preoperative prognostic factors to distinguish patients at high risk of early postoperative recurrence from those who will have prolonged survival after surgery. In some cases, PDACs may present biomolecular differences reflecting their aggressiveness that are not yet assessable by the current clinical-biologic assessment. This study aimed to assess the preoperative prognostic factors that are already available and the future perspectives being developed.

METHOD

This study reviewed the literature using the PubMed public database for preoperative prognostic factors for resectable PDAC.

CONCLUSION

Validated preoperative prognostic factors, whether clinical, biologic, radiologic, or histologic, are very important in anticipating the course of each patient's disease. The identification of potential new prognostic biomarkers such as genomic, transcriptomic, and proteomic analyses and the dosage of circulating tumor DNA are very serious avenues to be developed, but the extraction and analysis techniques as well as the interpretation of their results need to be standardized in prospective studies.

Genome-wide transcriptome and DNA methylome profiling of acquired cystic disease-associated renal cell carcinoma

Acquired cystic disease (ACD)-associated renal cell carcinoma (RCC) develops uniquely and frequently in patients receiving long-term dialysis for end-stage renal disease (ESRD). In our previous study, the molecular alteration profiles of ACD-associated RCC were partially similar to those of papillary RCC (PRCC). However, the specific profiles of molecular alterations in ACD-associated RCC and their pathogenic mechanisms remain largely unknown. Therefore, we compared genome-wide transcription and DNA methylation profiles of 12 ACD-associated RCC and 26 PRCC samples, which comprised eight ESRD-induced and 18 sporadic (arising in non-dialysis kidney) PRCC samples. RNA-seq and Infinium Methylation EPIC were used to identify the unique genetic and epigenetic profiles in ACD-associated RCC. ACD-associated RCC harboured a unique expression profile from that of PRCC. Its profile was characterised by the upregulation of pathways related to amino acid metabolism. In addition, ACD-associated RCC exhibited a unique DNA methylation profile that was characterised by the hypomethylation of pathways related to amino acid metabolism. This reflected a significant difference between the expression profiles of ACD-associated RCC and PRCC. The present genome-wide transcriptome and DNA methylome profiling revealed that aberrant activation of amino acid metabolism-related pathways, potentially induced by DNA hypomethylation, may be involved in the pathogenesis of ACD-associated RCC.

AI-powered precision medicine: utilizing genetic risk factor optimization to revolutionize healthcare

The convergence of artificial intelligence (AI) and biomedical data is transforming precision medicine by enabling the use of genetic risk factors (GRFs) for customized healthcare services based on individual needs. Although GRFs play an essential role in disease susceptibility, progression, and therapeutic outcomes, a gap exists in exploring their contribution to AI-powered precision medicine. This paper addresses this need by investigating the significance and potential of utilizing GRFs with AI in the medical field. We examine their applications, particularly emphasizing their impact on disease prediction, treatment personalization, and overall healthcare improvement. This review explores the application of AI algorithms to optimize the use of GRFs, aiming to advance precision medicine in disease screening, patient stratification, drug discovery, and understanding disease mechanisms. Through a variety of case studies and examples, we demonstrate the potential of incorporating GRFs facilitated by AI into medical practice, resulting in more precise diagnoses, targeted therapies, and improved patient outcomes. This review underscores the potential of GRFs, empowered by AI, to enhance precision medicine by improving diagnostic accuracy, treatment precision, and individualized healthcare solutions.

Three-Dimensional Transjugular Intrahepatic Portosystemic Shunt Geometry Predicts Shunt Dysfunction

BACKGROUND

Patients with decompensated cirrhosis are at risk of portal hypertension-related complications, such as refractory ascites or variceal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) insertion is the most effective treatment to reduce portal hypertension. However, patients are at risk for TIPS dysfunction.

AIMS

We aimed to investigate the prognostic value of three-dimensional (3D) TIPS geometry in predicting TIPS dysfunction.

METHODS

A total of 107 patients who underwent TIPS insertion between 2014 and 2019 and received a computed tomography (CT) scan after TIPS insertion during routine clinical practice were included. We used a semiautomated algorithm and multiplanar reconstructions of these CT scans to calculate parameters of 3D TIPS geometry. The primary outcome of this study was the development of TIPS dysfunction (defined as need for invasive TIPS revision). To identify predictors for the development of TIPS dysfunction, Cox regression analyses were performed with TIPS dysfunction as the endpoint.

RESULTS

Thirty-two patients developed TIPS dysfunction and were compared to the dysfunction-free 75 patients. A larger distance from the cranial TIPS stent end to the vena cava inferior (p < 0.001, HR 1.061, 95% CI 1.030-1.093) and the maximum stent curvature (p = 0.003, HR 1.020, 95% CI 1.007-1.034) were significantly associated with TIPS dysfunction in a multivariate Cox regression analysis.

CONCLUSION

A more pronounced stent curvature and a longer cranial stent distance from the inferior vena cava were identified as independent predictors of TIPS dysfunction. Interventionalists should choose a more central and less curved TIPS tract during the TIPS procedure to reduce the risk of development of TIPS dysfunction.

TRIAL REGISTRATION

This retrospective monocentric study includes patients from the NEPTUN cohort (registered at ClinicalTrials.gov; Identifier: NCT03628807).

MRI-based radiomic nomogram for predicting disease-free survival in patients with locally advanced rectal cancer

PURPOSE

Individual prognosis assessment is of paramount importance for treatment decision-making and active surveillance in cancer patients. We aimed to propose a radiomic model based on pre- and post-therapy MRI features for predicting disease-free survival (DFS) in locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (nCRT) and subsequent surgical resection.

METHODS

This retrospective study included a total of 126 LARC patients, which were randomly assigned to a training set (n = 84) and a validation set (n = 42). All patients underwent pre- and post-nCRT MRI scans. Radiomic features were extracted from higher resolution T2-weighted images. Pearson correlation analysis and ANOVA or Relief were utilized for identifying radiomic features associated with DFS. Pre-treatment, post-treatment, and delta radscores were constructed by machine learning algorithms. An individualized nomogram was developed based on significant radscores and clinical variables using multivariate Cox regression analysis. Predictive performance was evaluated by the C-index, calibration curve, and decision curve analysis.

RESULTS

The results demonstrated that in the validation set, the clinical model including pre-surgery carcinoembryonic antigen (CEA), chemotherapy after radiotherapy, and pathological stage yielded a C-index of 0.755 (95% confidence interval [CI]: 0.739-0.771). While the optimal pre-, post-, and delta-radscores achieved C-indices of 0.724 (95%CI: 0.701-0.747), 0.701 (95%CI: 0.671-0.731), and 0.625 (95%CI: 0.589-0.661), respectively. The nomogram integrating pre-surgery CEA, pathological stage, alongside pre- and post-nCRT radscore, obtained the highest C-index of 0.833 (95%CI: 0.815-0.851). The calibration curve and decision curves exhibited good calibration and clinical usefulness of the nomogram. Furthermore, the nomogram categorized patients into high- and low-risk groups exhibiting distinct DFS (both P < 0.0001).

CONCLUSIONS

The nomogram incorporating pre- and post-therapy radscores and clinical factors could predict DFS in patients with LARC, which helps clinicians in optimizing decision-making and surveillance in real-world settings.

Wolbachia: A bacterial weapon against dengue fever- a narrative review of risk factors for dengue fever outbreaks

Arboviruses constitute the largest known group of viruses and are responsible for various infections that impose significant socioeconomic burdens worldwide, particularly due to their link with insect-borne diseases. The increasing incidence of dengue fever in non-endemic regions underscores the urgent need for innovative strategies to combat this public health threat. Wolbachia, a bacterium, presents a promising biological control method against mosquito vectors, offering a novel approach to managing dengue fever. We systematically investigated biomedical databases (PubMed, Web of Science, Google Scholar, Science Direct, and Embase) using "AND" as a Boolean operator with keywords such as "dengue fever," "dengue virus," "risk factors," "Wolbachia," and "outbreak." We prioritized articles that offered significant insights into the risk factors contributing to the outbreak of dengue fever and provided an overview of Wolbachia's characteristics and functions in disease management, considering studies published until December 25, 2024. Field experiments have shown that introducing Wolbachia-infected mosquitoes can effectively reduce mosquito populations and lower dengue transmission rates, signifying its potential as a practical approach for controlling this disease.

Clinical high risk for psychosis in bipolar disorder: Clinical features, cognition and functioning

Bipolar disorder (BD) is a heterogeneous disease in terms of clinical course, neurocognitive and social-cognitive features, and functioning. Given the overlap between BD and schizophrenia, psychosis high-risk criteria that persist during euthymia may define a subgroup that differs in clinical features and functioning. In this study, we defined a subgroup of BD as ' Bipolar Disorder with Clinical High-Risk for Psychosis (BD-CHR-P)'. Our main aim was to investigate the differences in neurocognition, social cognition, psychosocial functioning, thought disorder, and clinical features in this subgroup and compare them with the BD group without this syndrome. 77 participants are included in this study. According to the Structured Interview for Prodromal Syndromes (SIPS), 25 participants were included in the BD-CHR-P group. Clinical features, cognition, functionality, thought disorder, apathy, impulsivity, and schizotypy were compared between the groups. Individuals with BD-CHR-P showed a higher rate of psychotic features in their manic episodes, and they displayed more Schneiderian symptoms in psychotic manic episodes (p = 0.049). BD-CHR-P group displayed worse functioning (F = 14.153, p < 0.001). The scores of anticipatory anhedonia (F = 5.27, p = 0.024) and positive formal thought disorder were higher in BD-CHR-P (F = 4.486, p = 0.037). In self-report evaluations impulsivity, self-report apathy, and schizotypy scores in the BD-CHR-P group were significantly higher than the BD-nonCHR-P group (F = 5.305, p = 0.024, F = 5.487, p = 0.022, F = 22.759, p < 0.001, respectively). The BD-CHR-P group exhibited poorer functioning. Further studies are needed to elucidate the mechanisms underlying the between-group differences. Moreover, cross-sectional characteristics of the BD-CHR-P group may help identify a subgroup that will develop psychotic disorders in the future.

Imaging-based surveillance in patients with initially detected pancreatic cystic lesions

PURPOSE

To determine the long-term outcomes of pancreatic cystic lesions (PCLs) undergoing surveillance, and evaluate the associations between imaging monitoring plans and detection of malignant progression.

METHODS

This retrospective observational study included patients with incidentally detected PCLs (0.5-4.0 cm) on MRI between January 2015 and December 2016. Imaging modalities, time intervals, cumulative number of imaging examinations, and occurrence of malignant progression were recorded. The impact of cumulative CT/MRI examinations on detection of malignant progression at 1, 2, and 3-years was assessed using Cox-regression analyses.

RESULTS

A total of 911 patients (mean age, 68.8-years; 445 with intraductal papillary mucinous neoplasm [IPMN]) underwent an average of five examinations during follow-up (median, 45.0-months). All 20 cases of malignant progression occurred in patients with IPMN, increasing steadily over the maximum 9-year follow-up. The cumulative number of MRI examinations was significantly associated with detection of malignant progression at 1-year (hazard ratio [HR] = 1.40; P = 0.035), and 2-year (HR = 1.38; P = 0.047) landmark points, while CT showed no such association. The cumulative number of MRI examinations was associated with malignant progression at both 1-year (HR = 1.63; P = 0.007) and 2-year (HR = 1.59; P = 0.013) landmark points in 350 patients with IPMN without worrisome features, but not in 95 patients with IPMN with worrisome features.

CONCLUSION

Imaging surveillance of incidentally detected PCLs for detecting malignant progression should prioritize IPMNs. MRI-based surveillance would be beneficial in the initial 2-years, especially for patients with IPMN lacking worrisome features.

Electrochemical tracking of gluten in marketed foods by using a recombinant antibody fragment based-platform

The only treatment to effectively manage celiac disease is the avoidance of gluten containing foods. Therefore, and given its high prevalence, it is of utmost importance to have reliable and efficient methods for the detection of gluten to ensure the well-being and quality of life of celiacs. This work presents the development of an electrochemical immunoplatform exhibiting many practical advantages including simplicity, reduced cost and high sensitivity for the screening of gluten-containing products. The methodology exploited the unique features offered by a recombinant antibody fragment with high affinity towards gliadin together with the use of magnetic microcarriers (MμCs) as scaffolds for the implementation of an indirect competitive immunoassay. Using amperometric transduction on disposable electrodes and the horseradish peroxidase/hydrogen peroxide/hydroquinone system, a dynamic range between 7.3 and 1982 ng mL-1 was obtained for gliadin standards, with a limit of detection of 1.4 ng mL-1. The developed immunoplatform was successfully employed for the analysis of a variety of processed foodstuffs, demonstrating the ability to discriminate between gluten-free and gluten-containing foods according to the legislated threshold (20 mg kg-1 of gluten). The agreement with the results provided by the R5-based ELISA and qPCR methods confirmed the suitability of the bioplatform as a competitive tool in terms of assay time (results in just 60 min after gliadin extraction) sensitivity and applicability, even at the point of need.

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.

Does Extramural Vascular Invasion Predict Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer?

INTRODUCTION

Extramural vascular invasion (EMVI) is associated with distant recurrence after treatment of locogionally advanced rectal adenocarcinomas (LARCs), but its use as a marker for response to neoadjuvant therapy is less well understood. We examined the relationship between EMVI and tumor or nodal category downstaging after treatment of LARCs with neoadjuvant therapy.

METHODS

Patients with EMVI categorized on initial staging pelvic MRI for LARC who underwent curative-intent surgery after neoadjuvant therapy at MD Anderson Cancer Center from 2016 to 2022 were identified. Patients received either preoperative chemoradiation or total neoadjuvant therapy (TNT). Associations between EMVI and demographic, radiologic, and clinicopathologic variables were analyzed.

RESULTS

EMVI was associated with higher rates of lymphovascular invasion (LVI) (46.2% vs. 27.8%, P = .001) and perineural invasion (PNI) (51.9% vs. 28.4%, P < .001) on final pathology. Patients with EMVI were more likely to have cT4 tumors (31.7% vs. 16.3%, P = .004) and cN+ status (86.8% vs. 66.3%, P = .001) and more likely to be treated with TNT rather than chemoradiation alone (62.3% vs. 41.9%, P = .005). EMVI was associated with a lower rate of pathologic complete or near-complete response (20.1% vs. 34.2%, P = .018), downstaging to ypT0-2 from cT3/4 tumors (14.9% vs. 44.4%, P = .0001), and downstaging to ypN0 from cN+ status (47.9% vs. 66.4%, P = .015).

CONCLUSIONS

Rectal tumors with EMVI are more likely to have higher clinical stage, less likely to respond to neoadjuvant therapy despite increased use of TNT, and more likely to have high-risk features for recurrence. This suggests EMVI is a marker of disease with poorer response to neoadjuvant therapy. Disease biology should be strongly considered in treatment decision-making, and new treatment strategies are needed to improve disease response.

Effect of Rectal Cancer Treatment Timing Standardization on Patient Outcomes

OBJECTIVES

The National Accreditation Program for Rectal Cancer (NAPRC) was established in 2017 to decrease rectal cancer treatment variation and improve oncologic outcomes. Initiating curative intent treatment <60 days of first evaluation is one NAPRC standard. We evaluated whether oncologic outcomes improved with timely treatment and factors associated with its receipt.

METHODS

Using the NCDB, we identified stage I to III rectal cancer patients treated from 2004 to 2020 treated with curative-intent surgery. Patients were stratified into 2 cohorts (timely [<60 d], delayed [≥60 d]) for survival analysis and exploration of variables associated with timely treatment.

RESULTS

We included 117,459 patients with a median age of 61 years (interquartile range: 52 to 70 y). Most patients were male (61.1%), White (86.2%), Charlson 0 (77.1%) with stage II (33.5%) or III (44.3%) cancer treated with chemoradiation (58.1%), or surgery (27.0%) first. Timely treatment was associated with improved overall survival (OS; median OS: 153.26 vs. 128.59 m). Patients in the highest income bracket (odds ratio [OR] 1.30) with stage II (OR: 1.27) or III (OR: 1.50) cancer receiving neoadjuvant chemotherapy (OR: 2.24) or chemoradiation (OR: 1.73) as the first treatment received more timely treatment. Patients with Charlson ≥2 (OR: 0.83) of Black (OR: 0.56) or Hispanic (OR: 0.73) race received more delayed treatment (all P <0.01).

CONCLUSIONS

Timely rectal cancer treatment is associated with improved survival. Socioeconomic disparities limit timely treatment with attendant worse survival, supporting national homogenization of care. As multimodal care for rectal cancer becomes increasingly complex, timely treatment remains paramount.