Epigenetic Modifications in Sensorineural Hearing Loss: Protective Mechanisms and Therapeutic Potential

Hearing loss, which currently affects more than 430 million individuals globally and is projected to exceed 700 million by 2050, predominantly manifests as sensorineural hearing loss (SNHL), for which existing technologies such as hearing aids and cochlear implants fail to restore natural auditory function. Research focusing on protecting inner ear hair cells (HCs) from harmful factors through the regulation of epigenetic modifications has gained significant attention in otology for its role in regulating gene expression without altering the DNA sequence, suggesting potential strategies for preventing and treating SNHL. By synthesizing relevant studies on the inner ear, this review summarizes the emerging roles of histone modifications, DNA methylation, and noncoding RNAs in HC damage, with a focus on their therapeutic potential through epigenetic modulation. Moreover, this review examines the therapeutic potential of epigenetic regulation for the prevention and treatment of SNHL, emphasizing the application of small-molecule epigenetic compounds and their efficacy in modulating gene expression to preserve and restore auditory function.

Homologous-Targeting Porous Type I/II Nanophotosensitizers for Efficient Delivery of STING Agonists and Enhanced Photodynamic Cancer Immunotherapy

Immunotherapy as a transformative cancer treatment modality frequently struggles with the immunosuppressive tumor microenvironment, which hinders effective immune responses. In this report, we construct biomimetic tumor cell membrane-cloaked porous covalent organic framework (COF) nanophotosensitizers (CMSCOFs) to synergistically enhance photodynamic therapy (PDT) and stimulate interferon genes (STING)-mediated immunotherapy. CMSCOF is prepared from porphyrin and benzothiadiazole-based units and cloaked with 4T1 cancer cell membranes for homologous tumor targeting. The porous structure of COF enables efficient encapsulation of the non-nucleotide STING agonist SR717. Upon 660 nm light irradiation, CMSCOFs trigger both type I and II photodynamic effects by producing both superoxide (O2•-) and singlet oxygen (1O2). The tumor cell membrane-cloaked design improves the stability of the nanophotosensitizers and mimics the natural cancer cells for enhanced blood circulation, tumor accumulation, and homologous-targeting to tumors. Inside tumor tissues, this unique CMSCOF design leads to enhanced immunogenic cell death (ICD) of tumor cells upon exposure to light irradiation. Furthermore, the encapsulated STING agonist SR717 is released after cellular internalization to activate the STING pathway and elicit a potent antitumor immune response. This synergistic approach effectively reverses the immunosuppressive tumor microenvironment, enhances cytotoxic T cell infiltration, and suppresses both primary and metastatic tumors, demonstrating the potential of CMSCOF nanophotosensitizers as a promising platform for photodynamic cancer immunotherapy.

Unraveling the immunomodulatory role of TIM-3 in head and neck squamous cell carcinoma: implications for targeted therapy

Head and neck squamous cell carcinoma (HNSCC) ranks among the most prevalent cancers globally, and despite improvements in treatment options such as surgery and radiotherapy, its survival rate remains low. With increased research in immunotherapy, antibodies against various immune checkpoints like programmed death receptor 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) have been shown to be effective against a wide range of tumors. Nonetheless, survival benefits gained by HNSCC patients remain limited. T-cell immunoglobulin mucin-3 (TIM-3), an emerging immune checkpoint molecule, is found to be expressed in HNSCC and is involved in shaping the tumor immune microenvironment (TIME). TIM-3 is significant in the initiation and progression of HNSCC by modulating effector T cells, innate immune cells, and other components of the immune system. Inhibiting TIM-3 can restore T cell function and enhance the immune response against HNSCC, making it a promising immunotherapeutic target for this disease. This article reviews the expression of TIM-3 in HNSCC and its immunomodulatory mechanism and briefly introduces the combined application and development prospects of TIM-3 as a potential immunotherapeutic target.

CD44 Marks Dormant Tumor Cells After HER2 Inhibition in Breast Cancer Cells

Therapy resistance remains a major barrier to improving outcomes in HER2-positive breast cancer, with dormant tumor cells (DTCs) and cancer stem cells (CSCs) playing critical roles in recurrence and treatment failure. Herein, we investigated the interplay between dormancy and CSCs features in HER2-amplified breast cancer cell models and evaluated the role of the JAK1-STAT3 axis in sustaining these therapy-resistant phenotypes. Using an in vitro dormancy model induced by HER2 inhibition, we observed a reversible quiescent state characterized by decreased proliferation and viability, accompanied by a significant increase in the CSC marker CD44. CD44 expression was rapidly induced following HER2 inhibition, preceding measurable effects on cell viability, and persisted throughout the dormancy phase. CD44-positive populations showed reduced sensitivity to HER2 inhibition and displayed robust proliferative recovery upon therapy withdrawal. Functional studies revealed that the inhibition of JAK1, but not STAT3, impaired the recovery of CD44-positive populations and decreased their proliferative capacity, suggesting a critical role for JAK1 in maintaining the CSC phenotype during therapy. These findings underscore the importance of CD44 as a marker and mediator of therapy resistance and suggest that targeting CD44-positive cells or the JAK1 signaling axis could improve the efficacy of HER2-targeted therapies. Our study provides novel insights into the mechanisms underlying dormancy and CSC induction in HER2-positive breast cancer and highlights potential strategies to mitigate therapy resistance and prevent disease recurrence.

Exploring the Efficacy and Safety of Argatroban as an Adjunct to Antiplatelet Therapy in Ischemic Stroke Patients: A Systematic Review and Meta-analysis

Acute ischemic stroke (AIS) is a major cause of disability and mortality worldwide. While antiplatelet therapy is standard for secondary prevention, many patients still experience early neurological deterioration (END). Argatroban, a direct thrombin inhibitor, can potentially limit thrombus progression and improve AIS's functional outcomes. This meta-analysis assessed the efficacy and safety of argatroban in combination with single (SAPT) or dual antiplatelet therapy (DAPT) compared to antiplatelets alone. Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted until January 2025. Randomized controlled trials (RCTs) and cohort studies evaluating argatroban plus antiplatelets versus antiplatelets alone in AIS patients were included. The primary outcome was a 90-day modified Rankin Score (mRS) of 0-2. Secondary outcomes included mRS 0-1 and mRS 3-5 at 90 days, END, and National Institutes of Health Stroke Scale (NIHSS) improvement, stroke recurrence, intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), and mortality. We used the mean difference (MD) for continuous variables and odds ratio (OR) for dichotomous ones at 95% confidence intervals (CI) and a P-value of 0.05. A total of 14 studies (four RCTs and 10 cohort studies) were included. Compared to antiplatelets alone, argatroban significantly improved functional outcomes, increasing the incidence of mRS 0-2 (OR = 1.36 [95%CI: 1.05, 1.76, P = 0.02]) and mRS 0-1 (OR = 1.54 [95%CI: 1.08, 2.2, P = 0.02]) while reducing END (OR = 0.42 [95%CI: 0.21, 0.85, P = 0.02]). Argatroban was also associated with greater NIHSS score improvement (MD =  - 0.52 [95%CI: - 0.89, - 0.15, P = 0.005]). No significant differences were observed in mRS 3-5, stroke recurrence, ICH, sICH, or mortality. Subgroup analysis indicated that argatroban combined with DAPT showed the greatest benefits. Argatroban combined with antiplatelet therapy improves functional recovery and reduces END without increasing bleeding risks. These findings support its use, particularly with DAPT, in mild to moderate AIS management. Further large-scale RCTs are needed to optimize dosing strategies and patient selection.

Time course for acquiring toileting independence in patients with subacute stroke: a prospective cohort study

OBJECTIVE

To determine the time course of longitudinal changes in the independence level of toileting-related subtasks in post-stroke patients.

DESIGN

Single-institution, prospective cohort study.

SUBJECTS/PATIENTS

A total of 101 consecutive patients with stroke admitted to subacute rehabilitation wards who urinated/defecated in bathrooms using wheelchairs upon admission.

METHODS

Occupational therapists assessed the independence level of patients in each of the 24 toileting subtasks on a 3-level rating scale using the Toileting Tasks Assessment Form every 2-4 weeks from admission to the endpoint (achieving independent toileting or discharge). Patients were classified based on admission and endpoint assessment form scores using a two-step cluster analysis.

RESULTS

Patients were classified into Cluster 1 (30 patients who exhibited a greater independence level in all subtasks upon admission [46.7-100% of patients performed each subtask independently] to the endpoint [73.3-100%]), Cluster 2 (41 patients who showed less independence upon admission [0-26.8%] but gained greater independence at the endpoint [34.1-73.2%]), and Cluster 3 (30 patients whose independence levels remained low in many subtasks from admission [0-26.7%] to the endpoint [3.3-26.7%]).

CONCLUSION

Changes in toileting independence levels could be classified into 3 time courses. Effective intervention strategies may differ between each group.

M2 Macrophages Mitigate Ocular Surface Inflammation and Promote Recovery in a Mouse Model of Dry Eye

Dry eye disease (DED) is a chronic, progressive, multifactorial condition characterized by tear film instability and ocular surface damage. Ocular surface inflammation, triggered by multiple pathogenic factors, represents one of the key mechanisms in DED pathogenesis. This study aims to investigate the therapeutic effects of anti-inflammatory M2 macrophages conditioned medium (M2-CM) on ocular surface inflammation and their potential mechanisms in improving dry eye symptoms in a mouse model. Mouse macrophages (RAW264.7) were polarized into M2 macrophages by IL-4 under different osmolarities, and M2-CM was collected. Flow cytometry and ELISA were applied to measure the cytokine expression of the M2 macrophages. Primary mouse corneal epithelial cells (CECs) were co-cultured with RAW264.7 and M2 macrophages using a Transwell system. The viability and migration of CECs were assessed using CCK-8 and scratch assays. Mouse DED was established by subcutaneous injection of scopolamine, and the therapeutic effects of M2-CM were evaluated by phenol red thread test, fluorescein staining, and tear film breakup time (TBUT). PCR and immunofluorescence staining were applied to observe inflammatory factors and cells on the ocular surface. M2 macrophages enhanced CEC viability, proliferation, and migration, but hyperosmolarity inhibited M2 macrophage polarization. In the DED model, M2-CM improved ocular surface conditions, reduced pro-inflammatory cytokine expression, and increased anti-inflammatory factors. Immunofluorescence revealed reduced pro-inflammatory cells (M1 macrophages, Th1, and Th17) and increased M2 macrophages in the ocular tissues after M2-CM treatment. These results suggest that M2-CM ameliorates ocular surface inflammation and promotes recovery in DED, offering a potential therapeutic strategy for DED.

Correlation of the sperm DNA fragmentation index with semen parameters and its impact on fresh embryo transfer outcomes-a retrospective study

Purpose

To evaluate the relationships between the sperm DNA fragmentation index (DFI) and semen parameters and its application in fresh embryos via in vitro fertilization and transfer.

Methods

A retrospective propensity score matching (PSM) study was conducted on 162 cycles of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and fresh embryo transfer (fresh IVF/ICSI-ET) from 2020-2024.

Results

Spearman correlation analysis revealed a negative correlation between the sperm DFI and sperm motility (r = -0.44, p = 3.32e-08), forward movement of sperm (r = -0.46, p = 3.25e-09), and normal morphology of sperm (r = -0.25, p = 0.000); there was no correlation between the sperm DFI and male age (r = 0.08, p = 0.31), semen volume (r = -0.15, p = 0.05), sperm concentration (r = -0.16, p = 0.32), or male body mass index (BMI) (r = 0.02, p = 0.98). There were no significant differences in the 2PN fertilization rate (64.98% vs. 67.18%, p = 0.362), D3 high-quality embryo rate (28.34% vs. 23.91%, p = 0.107), biochemical pregnancy rate (71.60% vs. 71.60%, p = 1), clinical pregnancy rate (65.00% vs. 65.00%, p = 1), delivery rate (50.72% vs. 48.44%, p = 0.928), miscarriage rate (7.25% vs. 6.25%, p = 1), or singleton birth weight (3,350 g vs. 3,200 g, p = 0.599) between the normal DFI (DFI < 30%) group and the high DFI (DFI ≥ 30%) group.

Conclusion

Sperm DFI is weakly associated with sperm motility, forward movement, and normal sperm morphology, and the correlations are not strong. However, there is no correlation between the sperm DFI and the clinical outcomes of fresh IVF/ICSI-ET.

Chitosan hydrogels: Versatile platforms for drug delivery in cancer treatment, wound dressing, and 3D bioprinting applications

Chitosan, derived from chitin, is frequently employed in various applications, including hydrogels. In cancer treatment, chitosan serves as a drug carrier, enhancing drug bioavailability while reducing side effects. Additionally, its inherent antibacterial properties and ability to maintain a moist environment facilitate faster wound healing. Its capacity for controlled drug release also ensures prolonged delivery of therapeutic agents. Furthermore, its biocompatibility and biodegradability present substantial advantages. Beyond conventional methods, chitosan is now being utilized as a bioink in 3D printing technologies. This innovation enables personalized treatments, leveraging the advantages of chitosan. However, certain challenges must be addressed to ensure the proper application of this technology. This review not only provides comprehensive insights into the synthesis and biomedical applications of chitosan hydrogels but also summarizes recent studies from the past five years, focusing on their roles in wound healing, cancer treatment, and 3D printing applications.

Ambulatory blood pressure variability in prediction of target organ injury: the SHIP AHOY study

BACKGROUND

Ambulatory hypertension is associated with elevated left ventricular mass index (LVMI), cardiac dysfunction, and increased arterial stiffness in adolescents. Whether the addition of measures of BP variability improves the prediction of subclinical cardiovascular target organ damage (TOD) over mean BP measures is not known.

METHODS

We assessed clinic and ambulatory BP (ABP), anthropometrics, and TOD in 397 adolescents. ABP means standard deviation (SD), BP, and heart rate (HR) dipping were calculated; coefficients of variability (CV) were calculated (SD/mean) to assess ABP variabilities. Measures of TOD included LVMI, left ventricular hypertrophy (LVH), LV systolic shortening, LV diastolic function (e'/a'), and pulse wave velocity. General linear models were used to determine if increased ABP variability measures were significant determinants of TOD in models containing mean ABP percentiles, age, sex, race/ethnicity, BMI z-score, and HR.

RESULTS

Mean participant age was 15.6 ± 1.7 years (63% white, 59% male) with mean casual BP 122.6/71.6 mmHg ±12.4/10.5, and mean awake systolic ABP 124.2/72.0 ± 11.3/7.7 mmHg. In linear models, increased awake CV-DBP and HR dipping were significant determinants of LVMI. CV-HR was an independent determinant of diastolic (e'/a') but not systolic dysfunction. Using logistic regression, the combination of awake and asleep diastolic ABP variability and awake systolic ABP percentile improved the prediction of LVH.

CONCLUSIONS

Consideration of ABP variability in addition to ABP percentile may aid in identifying adolescents at risk for LVH.

Causal association between depression and myalgia-related disorders: A bidirectional mendelian randomization study

OBJECTIVE

The connection between depression and myalgia-related disorders remains unclear. We investigated the bidirectional causal relationship between depression and five such disorders using Mendelian randomization (MR).

METHOD

Genetic instrumental variables for depression were obtained from a GWAS of 170,756 individuals with depression and 329,443 controls. The primary two-sample MR analysis used the inverse variance-weighted (IVW) method. Robustness was tested with MR Egger, weighted median, and weighted mode approaches. We also conducted heterogeneity, pleiotropy, and sensitivity analyses to ensure result reliability.

RESULTS

Depression showed significant positive associations with myalgia [IVW, OR = 1.468, 95 % CI: 1.246-1.729, P = 4.19 × 10-6], fibromyalgia [OR = 2.328, 95 % CI: 1.771-3.061, P = 1.39 × 10-9], and osteoarthritis [OR = 1.242, 95 % CI: 1.147-1.345, P = 9.58 × 10-8]. No causal association was found with myositis or rheumatoid arthritis (P > 0.05). In reverse MR, osteoarthritis showed a significant association with depression [OR = 1.113, 95 % CI: 1.025-1.210, P = 0.011], while other disorders did not (P > 0.05).

CONCLUSION

Our findings suggest a genetic causal relationship between depression and increased risk of myalgia, fibromyalgia, and osteoarthritis. Moreover, osteoarthritis may increase depression risk, supporting a potential bidirectional link. These results underscore the importance of timely depression management to mitigate risks of myalgia-related conditions.

The Potential Contribution of the IL-37/IL-18/IL-18BP/IL-18R Axis in the Pathogenesis of Sjögren's Syndrome

The objective of this study was to explore the expression profile of the Interleukin (IL)-37/IL-18/IL-18BP/IL-18R axis in patients with primary Sjögren's syndrome (pSS). This study included 36 patients diagnosed with pSS, 13 patients presenting with sicca symptoms without confirmed pSS, and 14 healthy controls. Serum concentrations of IL-37, IL-18, IL-18BP, and IL-18R were measured using a sandwich ELISA. These levels were then correlated with relevant clinical and biological parameters. Furthermore, expression of the same cytokines was assessed in salivary gland biopsies via immunohistochemistry. No significant difference in serum IL-37 levels was observed among the three groups (p = 0.1695). However, serum levels of IL-18 and IL-18BP were significantly elevated in pSS patients compared to healthy controls (p < 0.0001), and these levels were strongly correlated. Immunohistochemical analysis revealed significantly higher expression of IL-37 in both the excretory ducts and inflammatory infiltrates of salivary glands in pSS patients compared to sicca patients. No correlation was found between IL-37 expression and the histological severity of glandular infiltration as assessed by the Chisholm score. In addition, an enhanced expression of IL-18, IL-18BP, and IL-18Rα was observed in the salivary glands of pSS patients. These findings suggest the potential contribution of the IL-37/IL-18/IL-18BP/IL-18R signaling axis in the pathogenesis of Sjögren's syndrome, particularly through its increased expression in salivary glands and correlation with disease-specific inflammatory markers. These findings may contribute to a better understanding of pSS immunopathology and suggest new avenues for biomarker development or therapeutic targeting.

Skin Barrier Restoration by Waste-Derived Multifunctional Adhesive Hydrogel Based on Tannin-Modified Chitosan

The development of multifunctional materials that actively enhance the wound healing process is critically important in addressing clinical and public healthcare challenges. Here, we report a multifunctional hydrogel obtained through physical cross-linking of chitosan and wood tannins for active wound management. Tannins, as polyphenolic wood-waste derivatives, act both as multifunctional additives and cross-linking agents, resulting in a stable and highly swellable hydrogel (>2000%·mg-1). The dressing is produced in the form of a dry and rigid film for easy transportation. After swelling, the material exhibits adequate Young's modulus (∼7 MPa, comparable to the stratum corneum's stiffness), improved flexibility, and suitable adhesion strength to adapt to joint movements. Polyphenolic tannins also provide the material with high antioxidant activity against DPPH radicals (100% RSA), showing potential for preventing complications during the inflammation phase. Moreover, tannins can completely block skin-damaging UV light without significantly altering the material's transparency, thus allowing constant visual wound monitoring. Wound healing investigations on abdominoplasty-derived skin demonstrated that tannins enhance the normal skin barrier restoration process, thereby facilitating the transition toward wound regeneration. This work offers a sustainable strategy for valorizing agri-food waste in a fully biobased material to address active wound management.

IL-6 and Olfactory Dysfunction: Focus on Changes, Effects, and Mechanisms

The sense of smell is vital for human life and risk identification. Many diseases can cause olfactory disorders, and early identification and intervention of olfactory disorders are crucial. Currently, the diagnosis of olfactory disorders in clinical practice mostly relies on subjective visual analog scale (VAS) evaluations, expensive and complex imaging, and neurophysiological examinations, which lead to poor patient compliance and low completion rates. Therefore, there is an urgent need to identify novel, objective, easily detectable biological indicators. Interleukin-6 (IL-6) is an inflammatory factor that is closely associated with olfactory dysfunction in various diseases. However, the role of IL-6 in the occurrence and development of olfactory disorders is not yet clear, which limits its clinical application. This article reviews the changes and possible mechanisms of IL-6 in various diseases associated with olfactory disorders, with the aim of providing a reference for the clinical application of IL-6 as a biomarker for olfactory disorders and promoting an in-depth exploration of its mechanism in the occurrence and development of olfactory disorders.

Effect of Helicobacter pylori eradication on remnant stomach neoplasms after curative gastrectomy (HELP-GC): Protocol of a HELP-GC randomized controlled trial

BACKGROUND

Limited research has examined the direct effectiveness of Helicobacter pylori eradication (HPE) on the remnant stomach neoplasms after curative gastrectomy. This study aims to assess whether HPE could prevent the development of gastric neoplasms in the remnant stomach after curative gastrectomy through a double-blinded, randomized controlled trial.

METHODS

After curative gastrectomy, patients with HP infection and pathologically proven stage 1 tumors will be enrolled and randomly assigned to eradication (n = 492) and placebo (n = 492) groups. Patients in the eradication arm will be given the eradication regimen, which will comprise 40 mg of esomeprazole, 1 g of amoxicillin, and 500 mg of clarithromycin twice a day for 14 days. The primary endpoint is the development of gastric neoplasms, including adenoma or adenocarcinoma. The secondary endpoints are the 10-year overall survival, improvement rates of gastric glandular atrophy and/or intestinal metaplasia, and incidence of new-onset hyperplastic polyps among the groups.

SIGNIFICANCE

This research will be the first randomized controlled clinical study in which a thorough long-term follow-up will be needed to evaluate the effectiveness of HPE for remnant stomach neoplasms after curative gastrectomy. Its results will serve as a basis for developing future strategies in the management of patients with HP infection who undergo curative gastrectomy.

TRIAL REGISTRATION

https://cris.nih.go.kr/ KCT0008855. October 10, 2023.

Imaging of the renal allograft vasculature without gadolinium contrast: Intraindividual comparison between relaxation-enhanced angiography without contrast and triggering (REACT) and 4D contrast-enhanced MR-angiography

BACKGROUND

Complications after kidney transplantation include transplant renal artery stenosis (TRAS), which can be assessed using Doppler ultrasonography, computed tomography angiography, and magnetic resonance angiography (MRA). Contrast-enhanced MRA (CE-MRA) has limitations, including potential allergic reactions, limited use in kidney failure, and uncertain long-term effects of gadolinium retention.

PURPOSE

To evaluate Relaxation-Enhanced Angiography without Contrast and Triggering (REACT), a novel 3D isotropic flow-independent non-CE-MRA pulse sequence, for imaging of the renal allograft vasculature by performing an intraindividual comparison to 4D CE-MRA at 3Tesla.

METHODS

Forty studies of 39 patients were included in this retrospective, single-centre study. Two board-certified radiologists independently evaluated MRA datasets for TRAS and rated their diagnostic confidence and the image quality of pelvic vessels using 5-point Likert scales (5 = excellent). Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for arterial and venous graft vessels.

RESULTS

REACT (median acquisition time 04:33 min [IQR 3:58-5:20 min]) showed 90.0 % sensitivity and 100.0 % specificity for TRAS in almost perfect agreement (r = 0.97) with 4D CE-MRA (03:41 min [3:38-4:46 min], p = 0.001) and similar diagnostic confidence (REACT: 4.0 [4.0-4.0] vs. 4D CE-MRA: 4.0 [3.0-4.0], p = 0.54). Arterial image quality was comparable (4.0 [3.7-4.4] vs. 4.0 [4.0-4.4], p = 0.49) whereas veins yielded higher scores in REACT (3.2 [3.0-3.5] vs. 2.4 [2.0-3.0], p < 0.001). Transplant renal artery (mean ± SD; 44.5 ± 18.2 vs. 45.9 ± 21.0, p = 0.71; 36.3 ± 15.0 vs. 41.0 ± 20.0, p = 0.16) and vein (37.1 ± 19.8 vs. 30.3 ± 15.2, p = 0.06; 29.4 ± 17.1 vs. 25.0 ± 14.7, p = 0.17) showed no difference in aSNR and aCNR.

CONCLUSION

REACT provides accurate detection of TRAS with image quality comparable to 4D CE-MRA, offering a risk-free alternative for imaging after renal transplantation.

Parallax-free panoramic X-ray imaging combined with minimally invasive plate osteosynthesis for treating proximal humeral shaft fractures

BACKGROUND

The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis (MIPO) in the management of proximal humeral shaft fractures.

AIM

To evaluate parallax-free panoramic X-ray images during surgery.

METHODS

A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO. The operating time and radiation exposure time were recorded, and early postoperative physical therapy and partial weight bearing were encouraged. Patients were followed at regular intervals and evaluated radiographically and clinically.

RESULTS

The mean operating time and radiation time were 73 (range, 49-95) minutes and 57 (range: 36-98) seconds, respectively. No complications occurred during the operation. All fractures healed at an average of 16.9 (range: 15-23) weeks. The average Constant-Murley score for all the patients was 89.5 (range: 75-100) points. None of the patients showed symptoms of vascular or nerve damage or wound infection. Three months after the operation, none of the patients developed subacromial impingement syndrome. No loosening or fracture of the implants occurred. The frontal and lateral radiographs showed good alignment.

CONCLUSION

We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures, and could significantly reduce operative morbidity as well as lower the rate of intra- and postoperative complications.

Early postnatal neonatal surgery is associated with a low risk of surgical site infections

PURPOSE

Despite the recognition of the negative effects of surgical site infection (SSI), data on neonatal surgery are limited. This study investigated the risk factors for SSI development in the neonatal period.

METHODS

Neonatal surgeries performed by pediatric surgeons at the Mie University Hospital between 2007 and 2023 were retrospectively reviewed. The correlation between age at surgery and the presence of SSI was analyzed, and the optimal cutoff value for age at surgery was determined with respect to SSI. The predictors of SSI were analyzed using a logistic regression analysis.

RESULTS

Among 272 neonatal surgeries, SSI was identified in 19 patients (7.0%). Patients with SSI were significantly older than those without SSI (P = 0.003), and the optimal cut-off value was age > 3 days. The incidence rate of SSI was 2.05% in the ≤ 3-day-old group and 12.7% in the > 3 day-old group (P < 0.001). A multivariate analysis revealed that intestinal perforation, preoperative elevated C-reactive protein (CRP) level, and surgery at > 3 days old were independent predictors of SSI.

CONCLUSION

Intestinal perforation, preoperative elevated CRP, and surgery after 3 days old are associated with an increased SSI risk in neonatal surgery.

Insights into Sorafenib resistance in hepatocellular carcinoma: Mechanisms and therapeutic aspects

The most prevalent primary hepatic cancer, hepatocellular carcinoma (HCC), has a bad prognosis. HCC prevalence and related deaths have increased in recent decades. Food and Drug Administration (FDA) has licensed Sorafenib as a first-line treatment for individuals with advanced HCC. Despite this, some clinical studies indicate that a significant percentage of liver cancer patients exhibit insensitivity to sorafenib. Furthermore, the overall effectiveness of sorafenib is far from adequate, and the number of patients who benefit from therapy is low. In recent years, many researchers have focused on the mechanisms underlying sorafenib resistance. Acquired resistance to sorafenib in HCC cells has been reported to be facilitated by dysregulation of signal transducer and activator of transcription 3 (STAT3) activation, angiogenesis, autophagy, hypoxia-induced pathways, epithelial-mesenchymal transition (EMT), cancer stem cells (CSCs), ferroptosis, and non-coding RNAs (ncRNAs). Recent clinical trials, including comparisons of sorafenib with immune checkpoint inhibitors like tislelizumab, have shown promise in improving patient outcomes. Additionally, combination therapies targeting complementary pathways are under investigation to overcome resistance and enhance treatment efficacy. The limitation of Sorafenib's effectiveness has been partially but not completely clarified. Furthermore, while certain regimens have demonstrated positive results, more clinical trials are required to confirm them. Future research should focus on identifying predictive biomarkers for therapy response, targeting the tumor microenvironment, and exploring novel therapeutic agents and personalized medicine strategies. A deeper understanding of these mechanisms will be essential for developing more effective therapeutic approaches and improving the prognosis of patients with advanced HCC. This article discusses strategies that may be employed to enhance the success of treatment and summarizes new research on the possible pathways that lead to sorafenib resistance.

In Silico Identification of 2,4-Diaminopyrimidine-Based Compounds as Potential CK1ε Inhibitors

Background: Casein kinase 1 epsilon (CK1ε) plays a critical role in cancer progression by activating oncogenic signaling pathways, making it a target for cancer therapy. However, no inhibitors are currently available for clinical use, highlighting the need for novel therapeutic candidates. Methods: This study aimed to identify potential CK1ε inhibitors. To achieve this, a modified version of a previously reported pharmacophore model was applied to an ultra-large database of over 100 million compounds for virtual screening. Hits were filtered based on drug-likeness and pH-dependent pharmacophore compliance and then grouped according to their structural core. A representative compound from each structural group underwent molecular dynamic (MD) simulations and binding free energy calculations to predict its stability and affinity, allowing extrapolation of the results to the entire set of candidates. Results: Pharmacophore matching initially identified 290 compounds. After energy minimization, and an assessment of drug-likeness and pharmacophore compliance, we selected 29 structurally related candidates. MD simulations showed that most of the compounds representative of structural groups had stable binding modes, favorable intermolecular interactions, and free energies comparable to those of previously reported CK1ε inhibitors. An analysis of additional members of the most promising structural group showed that two 2,4-diaminopyrimidine-based compounds likely inhibit CK1ε. Conclusions: These findings provide structural insights into the design of CK1ε inhibitors, supporting compound optimization and the eventual development of targeted cancer therapeutics.

The roles of natural killer cells in bone and arthritic disease: a narrative review

The skeletal system is responsible for the body's support and motor functions, and can be pathologically affected by factors, such as metabolism, autoimmune inflammation, tumors, and infections. Regarding tissue localization and biological function, the immune system is deeply involved in the physiological and pathological processes of the skeletal system. As a regulator and effector cell of the innate immune system, natural killer (NK) cells can exert cytotoxic effects through cell contact and immunomodulatory effects through cytokine secretion. In the past 30 years, many advances have been made regarding the role of NK cells and their derived cytokines on bone and joints. In this review, the role of NK cells in the physiological activities of bone remodeling is summarized first, focusing on osteoclast differentiation and function. Subsequently, the roles of NK cells in osteoarthritis, bone tumors, and bone diseases caused by microbial infections are described, meanwhile, some conflicting research results are discussed. By reviewing the state-of-the-art progress of NK cells in the above-mentioned bone physiological and pathological processes, it is helpful to clarify the blind spots of current research and provide some references for the integrated evaluation of immune factors in the study of skeletal system diseases.

The accuracy of Machine learning in the prediction and diagnosis of diabetic kidney Disease: A systematic review and Meta-Analysis

PURPOSE

Machine learning (ML) has gained attention in diabetes management, particularly for predicting and diagnosing diabetic kidney disease (DKD). However, systematic evidence on its performance remains limited. This study evaluates the predictive and diagnostic accuracy of ML in DKD to support the development of tailored prevention strategies and non-invasive diagnostic tools.

METHODS

A systematic search of PubMed, Embase, Web of Science, and Cochrane (up to April 14, 2024) identified relevant studies. Risk of bias was assessed using tools for predictive models, and meta-analysis included subgroup analyses based on task type, dataset, and model type.

RESULTS

A total of 34 studies were included, with 19 on DKD risk prediction and 15 on diagnosis. For prediction, the pooled c-index was 0.81 (95% CI 0.79-0.83), sensitivity 0.81 (95% CI 0.74-0.86), and specificity 0.82 (95% CI 0.73-0.89). For diagnosis, the pooled c-index was 0.81 (95% CI 0.79-0.83), sensitivity 0.81 (95% CI 0.78-0.84), and specificity 0.75 (95% CI 0.72-0.79).

CONCLUSIONS

ML shows promising accuracy in DKD prediction and diagnosis, offering a viable tool for early screening and risk assessment.

Fair ultrasound diagnosis via adversarial protected attribute aware perturbations on latent embeddings

Deep learning techniques have significantly enhanced the convenience and precision of ultrasound image diagnosis, particularly in the crucial step of lesion segmentation. However, recent studies reveal that both train-from-scratch models and pre-trained models often exhibit performance disparities across sex and age attributes, leading to biased diagnoses for different subgroups. In this paper, we propose APPLE, a novel approach designed to mitigate unfairness without altering the parameters of the base model. APPLE achieves this by learning fair perturbations in the latent space through a generative adversarial network. Extensive experiments on both a publicly available dataset and an in-house ultrasound image dataset demonstrate that our method improves segmentation and diagnostic fairness across all sensitive attributes and various backbone architectures compared to the base models. Through this study, we aim to highlight the critical importance of fairness in medical segmentation and contribute to the development of a more equitable healthcare system.

Incidence of glucose intolerance and risk factors in patients with gestational diabetes mellitus one year postpartum: a systematic review and meta-analysis

PURPOSE

The purpose of this study is to explore the incidence and risk factors of glucose intolerance within one year postpartum in women with gestational diabetes mellitus (GDM), with the goal of informing the creation of effective preventive measures.

METHOD

A systematic literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, Ovid, Scopus, CINAHL, Wiley, China National Knowledge Infrastructure Database (CNKI), WANFANG Database, China Science and Technology Journal Database (CSTJ), and China Biology Medicine Database (CBM) for records published from January 1990 to August 2024. The index terms included 'gestational diabetes mellitus', 'glucose intolerance', 'postpartum', and 'risk factor'. Investigators assessed eligibility, extracted data, and evaluated the methodological quality. The meta-analysis was conducted using Stata 17.0 and Review Manager 5.4.

RESULT

Eighteen studies were included in the analysis, with 14 categorized as low risk of bias and 4 classified as medium risk of bias. The pooled incidence of glucose intolerance in women with GDM within 1 year postpartum was 34.5% (95% CI: 1.34-1.58). The following risk factors for glucose intolerance one year postpartum in women with GDM were identified: age (MD = 1.71; 95% CI: 0.50-2.91), pre-pregnancy BMI (MD = 1.75; 95% CI: 0.73-2.78), weight gain during pregnancy (MD = 1.25; 95% CI: 0.74-1.76), family history of diabetes (OR = 1.96; 95% CI: 1.58-2.42), fasting blood glucose at diagnosis (MD = 0.64; 95% CI: 0.39-0.88), 1-h postprandial blood glucose at diagnosis (MD = 1.24; 95% CI: 0.92-1.57), 2-h postprandial blood glucose at diagnosis (MD = 1.30; 95% CI: 0.72-1.87), history of GDM (OR = 2.62; 95% CI: 1.79-3.84), insulin use (OR = 2.41; 95% CI: 1.43-4.08), postpartum BMI (MD = 0.90; 95% CI: 0.24-1.55), diagnosed gestational weeks (MD = -1.82; 95% CI: -2.94--0.71), glycated hemoglobin (HbA1c) level at diagnosis (MD = 0.36; 95% CI: 0.14-0.58), HbA1c levels at 6-12 weeks postpartum (MD = 0.85; 95% CI: 0.42-1.29), fasting blood glucose levels 6 to 12 weeks postpartum (MD = 0.31; 95% CI: 0.05-0.57), 2-h postprandial blood glucose level 6 to 12 weeks postpartum(MD = 2.47; 95% CI: 0.68-4.26), Low-density lipoprotein (LDL) levels at diagnosis (MD = 0.20; 95% CI: 0.01-0.40), and triglyceride (TG) level at diagnosis(MD = 0.55; 95% CI: 0.34-0.75).

CONCLUSION

The incidence of glucose intolerance one year postpartum in women with GDM is relatively high. The subgroup analysis of this study revealed that the incidence is highest among Asian women and lowest among Caucasian women. 17 risk factors have been identified; these findings may help to better understand which GDM patients are more likely to experience glucose intolerance one year postpartum, and provide higher-level evidence for assessing the incidence and risk factors of glucose intolerance in GDM patients one year after delivery.

Altered gut microbiome-metabolite interactions link intestinal inflammation severity and MR enterography abnormalities in Crohn's disease

Altered gut microbiota‒metabolite interactions may result in intestinal inflammation severity variation in Crohn's disease (CD). Magnetic resonance enterography (MRE) advances anti-inflammatory strategy development. We aimed to identify inflammation-related multiomics factors and MRE interactions for CD management, analyzing 425 CD patients and 42 healthy controls undergoing MRE, ileocolonoscopy, and fecal/blood sampling (microbiota/metabolite analyses), with intestinal inflammation categorized by MRE and ileocolonoscopy. Ruminococcus species were enriched in CD patients versus healthy controls, while Pseudomonas and Staphylococcus dominated moderate-severe versus no-mild inflammation groups, suggesting inflammation-level associations. Ruminococcus gauvreauii suppressed intestinal inflammation by regulating serum PC(O-34:3), ePE(38:6), and ceramides (all p < 0.05). Serum N-acetylneuraminic acid and guanidinoacetic acid correlated with intestinal morphological changes (e.g., MRE-detectable effusion and wall thickness) and inflammation severity (P ACME < 0.05). A link was established between microscopic microbiota-metabolite markers and macroscopic imaging of inflammatory features, which could offer valuable insights into inflammation management.

The effect of sugammadex sodium on muscle relaxation recovery in patients after suspension laryngoscopy surgery: A randomized controlled trial

BACKGROUND

Sugammadex sodium can antagonize aminosteroidal muscarinic drugs precisely and rapidly, so it has been widely used in fast-track anesthesia in recent years. However, it is not known whether there is an advantage of the antagonistic effect of sugammadex sodium over neostigmine at different doses and time points. In this single-center, randomized controlled study, we compared the effects of sugammadex sodium with neostigmine on postoperative myorelaxation recovery in patients undergoing suspension laryngoscopic surgery.

METHODS

A total of 90 patients scheduled for elective general anesthesia suspension laryngoscopy were selected, aged 18 to 65 years, body mass index 18 to 28 kg/m², and American Society of Anesthesiologists I-II grade. Patients were randomly divided into 3 groups: the sugammadex group (experimental groups, S1, S2), and the neostigmine group (control group, N), each comprising 30 patients. After the operation, group S1 received an intravenous injection of sugammadex sodium 2 mg/kg immediately, S2 received it when train-of-four COUNT (TOF-COUNT) > 2, and group N received intravenous injections of atropine 0.02 mg/kg + neostigmine 0.04 mg/kg when TOF-COUNT > 2. The mean arterial pressure, heart rate, pulse oxygen saturation, and bispectral index were recorded at various times: upon room entry (T1), during tracheal intubation (T2), at surgery start (T3), surgery end (T4), at extubation (T5), and upon room exit (T6). The duration of surgery, muscle relaxation recovery time from TOF-COUNT 0-2 at surgery end, and time from surgery end to extubation were recorded for each group, as well as the incidence of adverse reactions.

RESULTS

There were no statistically significant differences among the 3 groups in mean arterial pressure, heart rate, pulse oxygen saturation, and bispectral index at the 6 time points (T1, T2, T3, T4, T5, and T6). In terms of extubation timing, the S1 group showed a significantly shorter time compared with the S2 and N groups (P < .05). Compared with the S2 group, N group had significantly prolonged extubation times, showing a statistical difference. Compared with the N group, S1 and S2 groups had a significantly reduced incidence of bradycardia and increased secretions (P < .05).

CONCLUSION

The use of sugammadex sodium in otolaryngological suspension laryngoscopy surgeries offers certain advantages over neostigmine in terms of muscle relaxation recovery. Administering sugammadex sodium 2 mg/kg directly after surgery as compared with waiting until TOF-COUNT > 2 allows for earlier removal of the tracheal tube without increasing adverse reactions.

The current status and prospects of gut microbiota combined with PD-1/PD-L1 inhibitors in the treatment of colorectal cancer: a review

BACKGROUND

Colorectal cancer (CRC) is a common malignant tumor. Immune checkpoint inhibitors (ICIs), particularly those targeting programmed cell death protein 1(PD-1) and programmed cell death ligand 1(PD-L1), have shown promising potential in the treatment of CRC. Specific gut microbiota can modulate the efficacy of ICIs through immune or metabolic pathways. This review summarizes recent advances in the combined application of gut microbiota and PD-1/PD-L1 inhibitors in the treatment of CRC, aiming to provide insights for expanding clinical treatment options for CRC.

MATERIALS AND METHODS

We employed a systematic search strategy to screen relevant literature from databases such as PubMed, EMBASE, Medline, Cochrane Library, and Clinical Trial registries, with the search period covering from the inception of each database to October 2024. This study includes animal models and human trial subjects. Data extraction and literature screening were strictly carried out by two independent researchers.

RESULTS

A total of 8 animal studies and 5 clinical trials were included to evaluate the effects of gut microbiota combined with PD-1/PD-L1 inhibitors in CRC. Tumor types included Microsatellite Stability(MSS), Microsatellite Instability-Low(MSI-L), and MSI-H CRC. Main outcomes were tumor volume, weight, and incidence; one study reported survival. Study durations ranged from 20 days to 26 weeks. Two studies used human fecal microbiota transplantation(FMT), and six applied experimental microbial interventions. The 5 clinical trials used ORR as the primary endpoint.Some also reported DCR, PFS, and OS. Two studies targeted Microsatellite Instability-High(MSI-H)/Deficient Mismatch Repair(dMMR), two MSS/Proficient Mismatch Repair(pMMR), and one lacked molecular subtype specification. All trials used full microbiota transplantation; one has released preliminary data.

CONCLUSION

The treatment regimen combining gut microbiota with PD-1/PD-L1 inhibitors has shown promising therapeutic prospects in both animal studies and clinical research, although most clinical trials are data remain limited. Future studies should focus on: (1) gene-edited probiotic strains with targeted modifications; (2) the synergistic effects of multiple probiotics; and (3) conducting high-quality, multicenter clinical trials.

The role of TLR4/NF-kB signaling axis in pneumonia: from molecular mechanisms to regulation by phytochemicals

Pneumonia, a leading global health challenge, is characterized by inflammation driven by dysregulated immune responses. Central to its pathogenesis is the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) signaling axis, which orchestrates the recognition of pathogen-associated molecular patterns (PAMPs) and initiates cascades that mediate innate immunity. While this pathway is essential for bacterial clearance, its overactivation can lead to excessive inflammation, tissue damage, and severe complications, including acute respiratory distress syndrome (ARDS) and sepsis. This review examines the role of the TLR4/NF-κB axis in pneumonia caused by various pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, and SARS-CoV- 2, and highlights its dual role in immune defense and pathological inflammation. Furthermore, we explore molecular regulators and phytochemicals that modulate this axis, including baicalin, resveratrol, and sodium houttuyfonate, which exhibit promising therapeutic potential. By elucidating these mechanisms, this study provides insights into targeted interventions to balance immune responses and mitigate inflammation, paving the way for innovative treatments in pneumonia management.

Metabolic alterations and immune heterogeneity in gastric cancer metastasis

Cellular metabolic reprogramming supports tumor proliferation, invasion, and metastasis by enhancing resistance to stress and immune clearance. Understanding these metabolic changes within the tumor microenvironment is vital to developing effective therapies. We conducted single-cell RNA sequencing on 11 gastric cancer (GC) samples and eight metastatic lesions, analyzing 92,842 cells across eight cell types, including cancer cells, stromal cells, and immune cells. Our findings highlight that the mitochondrial ATP synthase subunit ATP5MC2 uniquely alters during early GC metastasis. Experiments and clinical data confirmed that ATP5MC2 upregulation facilitates cancer cell proliferation, invasion, and metastasis. Constructing a single-cell atlas revealed significant immune cell heterogeneity associated with GC metastasis and its molecular subtypes. This study underscores the role of ATP5MC2-driven metabolic changes and diverse immune landscapes in promoting GC metastasis, offering new avenues for anti-metastatic treatment development.

Tumor-associated macrophages remodel the suppressive tumor immune microenvironment and targeted therapy for immunotherapy

Despite the significant advances in the development of immune checkpoint inhibitors (ICI), primary and acquired ICI resistance remains the primary impediment to effective cancer immunotherapy. Residing in the tumor microenvironment (TME), tumor-associated macrophages (TAMs) play a pivotal role in tumor progression by regulating diverse signaling pathways. Notably, accumulating evidence has confirmed that TAMs interplay with various cellular components within the TME directly or indirectly to maintain the dynamic balance of the M1/M2 ratio and shape an immunosuppressive TME, consequently conferring immune evasion and immunotherapy tolerance. Detailed investigation of the communication network around TAMs could provide potential molecular targets and optimize ICI therapies. In this review, we systematically summarize the latest advances in understanding the origin and functional plasticity of TAMs, with a focus on the key signaling pathways driving macrophage polarization and the diverse stimuli that regulate this dynamic process. Moreover, we elaborate on the intricate interplay between TAMs and other cellular constituents within the TME, that is driving tumor initiation, progression and immune evasion, exploring novel targets for cancer immunotherapy. We further discuss current challenges and future research directions, emphasizing the need to decode TAM-TME interactions and translate preclinical findings into clinical breakthroughs. In conclusion, while TAM-targeted therapies hold significant promise for enhancing immunotherapy outcomes, addressing key challenges-such as TAM heterogeneity, context-dependent plasticity, and therapeutic resistance-remains critical to achieving optimal clinical efficacy.

CircNTRK2 promotes the progression of nasopharyngeal carcinoma via sponging miR-384 to regulate SOX4 expression

Circular RNAs (circRNAs) have been reported to function critical roles in the pathogenesis and progression of nasopharyngeal carcinoma (NPC). The role of circNTRK2 (circbase ID: hsa_circ_0139142) remains dimness in this disease. This study aimed to investigate the effects and underlying mechanism of circNTRK2 in NPC. GSE143797 was downloaded from the Gene Expression Omnibus (GEO) database, and differently expressed circRNAs were analyzed by the GEO2R method. CircNTRK2 expression was confirmed in human NPC tumor tissues and cell lines by real-time PCR. Loss-of-function studies were used to explore the influence of circNTRK2 on the proliferation, invasion, apoptosis, and epithelial-mesenchymal transition (EMT) of NPC cells. Then, bioinformatic analysis, luciferase reporter assay, biotinylated miRNA pull-down assay, real-time PCR, and Western blotting were applied to clarify the detailed mechanism. We found that circNTRK2 was highly expressed in NPC tissues and cells. Silencing of circNTRK2 inhibited proliferation, invasion and EMT, but facilitated apoptosis of NPC cells in vitro. Also, downregulation of circNTRK2 suppressed tumor growth in a xenograft mouse model. CircNTRK2 directly targeted and negatively mediated miR-384 expression. SOX4 was a target gene of miR-384 in NPC. Both miR-384 inhibitor and SOX4 upregulation could reverse the effects of circNTRK2 knockdown on the proliferation, invasion, EMT, and apoptosis of NPC cells. Whereas miR-384 mimics and SOX4 knockdown abrogated the influences of circNTRK2 upregulation on NPC cells. In conclusion, circNTRK2 promoted NPC progression via sponging miR-384 and inhibiting miR-384 activity, leading to the upregulation of SOX4. This study indicated that circNTRK2 might be a potential target for the treatment of NPC.

Metalloproteinase-responsive gelatin/polylysine hydrogel microneedles for on-demand curcumin delivery in bacteria-infected wound healing

Effective management of bacterial infection and inflammatory responses is critical for accelerating infected wound healing. Herein, we develop a multifunctional hydrogel microneedle system (GMPL@GC MNs) integrating gelatin methacryloyl (GM) as the matrix material, ε-poly-L-lysine (PL) for enhanced antibacterial properties, and gelatin-curcumin nanoparticles (GC NPs) for inflammation modulation. The system exploits elevated matrix metalloproteinase (MMP) levels at wound sites to trigger specific degradation of GC NPs and controlled curcumin (Cur) release. This MMP-responsive mechanism enables reactive oxygen species (ROS) scavenging, inflammatory response suppression, and sustained drug delivery over 96 h. In bacteria-infected wound models, the GMPL@GC MNs demonstrate excellent therapeutic efficacy, achieving 99.1 % wound closure rate within 10 days through combined antibacterial, antioxidant, and anti-inflammatory actions. The system's multifunctionality and microenvironment responsiveness present strong potential for clinical wound management applications.

The clinical efficacy of percutaneous vertebroplasty combined with postural reduction versus kyphoplasty: A systematic review and meta-analysis

BACKGROUND

Osteoporotic vertebral compression fractures (OVCFs) are a significant cause of disability worldwide.

OBJECTIVE

The purpose of this meta-analysis is to explore whether postural reduction and vertebroplasty (PRVP) offers the same therapeutic efficacy as KP to provide evidence for the treatment strategy of OVCFs.

METHODS

We searched for the published results of relevant trials in PubMed (Jan 2000 to Dec 2023), Ovid (Jan 2000 to Dec 2023), Science Direct online (Jan 2000 to Dec 2023), the Cochrane Library, the Institute for Scientific Information (ISI) Web of Knowledge (Jan 2000 to Dec 2023), as well as several orthopaedics journals. The full text was obtained and reviewed for the studies meeting the inclusion and exclusion criteria.

RESULTS

Five randomized studies were adequately included and analyzed. The data was pooled using Review Manager (REVMAN) 5.3 software. The pooled results showed no significant differences between the two groups in indicated outcomes: the Cobb's angle post-operation (MDs, 2.86; 95% CIs, -0.98 to 6.71; P = 0.14), leakage of cement during operation (RR, 1.66; 95% CIs, 0.89 to 3.08; P = 0.11) and the compression rate of related vertebra (MDs, 4.32; 95% CIs, -1.69 to 10.33; P = 0.16).

CONCLUSION

PRVP and KP were equally effective and safe in the clinical outcomes of OVCFs.

A retrospective cohort analysis of plasma TAT level trends and adverse pregnancy outcomes in early pregnancy patients with newly diagnosed VTE

OBJECTIVE

Venous thromboembolism (VTE) is a leading cause of maternal mortality, yet effective biomarkers for early prediction of adverse pregnancy outcomes remain limited. We aimed to investigate the association between changes in thrombin-antithrombin complex (TAT) levels and adverse pregnancy outcomes in early-pregnancy patients with VTE.

METHODS

In this retrospective cohort study, we enrolled 89 pregnant women diagnosed with VTE during early pregnancy (< 14 weeks) who received care at Fujian Maternity and Child Health Hospital between June 2021 and May 2024. Plasma TAT levels measured in early and mid-pregnancy were collected as exposure variables, while adverse pregnancy outcomes (including miscarriage, preterm birth, and fetal growth restriction) served as outcome variables. Multivariate regression analysis was performed to evaluate the association between TAT level changes and adverse pregnancy outcomes, adjusting for potential confounding factors including age, BMI, and obstetric history. Additionally, threshold effect analysis was conducted.

RESULTS

After adjusting for potential confounding factors including age, BMI, and underlying conditions, changes in TAT levels were significantly associated with a reduced risk of adverse pregnancy outcomes (adjusted OR = 0.62, 95% CI: 0.47-0.80). Threshold effect analysis identified a critical turning point of -2.87 in TAT level changes (TATp2-1), below which the risk of adverse outcomes increased significantly (adjusted OR = 0.37, 95% CI: 0.22-0.63).

CONCLUSION

The association between TATp2-1 and adverse pregnancy outcomes in early pregnancy VTE patients was non-linear. A threshold effect was observed with an inflection point of -2.87. When the TATp2-1 were below - 2.87, there was a significantly increased risk of adverse pregnancy outcomes.

Unveiling Cleidocranial Dysplasia: An Antenatal Journey Through Ultrasound and Delivering the Importance of Taking Phenotype History; "Echoes of the Past"

Cleidocranial dysplasia (CCD) is an inherited condition predominantly affecting the clavicles and cranial structures. Advancements in prenatal imaging offer the potential for early detection. A 30-year-old pregnant woman came in for a review of 2nd trimester anomaly scan. The ultrasound suggested a diagnosis of non-lethal skeletal dysplasia. Both parents were called in for counseling. The father was observed to have facial dysmorphism. An X-ray examination clinched the final diagnosis of cleidocranial dysplasia, which was confirmed through whole exome sequencing. This case report highlights the antenatal detection of cleidocranial dysplasia and emphasizes the crucial role of taking family history in a suspected case of skeletal dysplasia.

Renal protective effects of extracellular vesicle-encapsulated tumor necrosis factor-α-induced protein 6 derived from mesenchymal stem cells

Acute kidney injury (AKI) is involved in subsequent chronic kidney disease (CKD) development, and effective treatments to prevent AKI to CKD progression are lacking. Mesenchymal stem cells (MSCs) are emerging as a promising cellular therapy to impede such progression through the secretion of various humoral factors. Among these factors, tumor necrosis factor-α-induced protein 6 (TSG-6) has a central role in the anti-inflammatory effects of MSCs. However, the mechanisms by which MSCs secrete TSG-6 and exert anti-inflammatory effects are not fully clarified. Here, we investigated these mechanisms using TSG-6-overexpressing MSCs (TSG-6 MSCs) with an adeno-associated virus. Extracellular vesicles (EVs) were isolated from MSC culture supernatants by ultracentrifugation. MSCs were injected through the abdominal aorta into rats with ischemia-reperfusion injury (IRI) to evaluate their anti-inflammatory and anti-fibrotic effects. Additionally, we explored natural compounds that increased TSG-6 expression in MSCs. Most TSG-6 was immediately secreted in EVs and was not stored intracellularly. Administration of TSG-6 MSCs strongly suppressed renal fibrosis and inflammation in IRI rats. Although EVs and conditioned medium from TSG-6 MSCs (TSG-6 MSC-CM) strongly promoted polarization of M2 macrophages, TSG-6 MSC-CM after EV depletion promoted it only slightly. Moreover, TSG-6 MSC-CM enhanced regulatory T-cell induction. MSCs treated with indole-3-carbinol had enhanced TSG-6 expression and markedly suppressed IRI-induced renal fibrosis. Taken together, TSG-6 is secreted in EVs from MSCs and exerts potent anti-inflammatory effects by promoting M2 macrophage polarization and regulatory T-cell induction. Administration of MSCs with enhanced TSG-6 secretion is a promising therapeutic strategy to impede AKI to CKD progression.

Ginsenoside Rh2 Mitigates Endoplasmic Reticulum Stress-Induced Apoptosis and Inflammation and Through Inhibition of Hepatocyte-Macrophage Inflammatory Crosstalk

Background/Objectives: Endoplasmic reticulum stress (ERS) contributes to hepatocyte inflammation, triggered by prolonged exposure to lipotoxicity, and promotes non-alcoholic fatty liver disease (NAFLD) progression by recruiting and activating hepatic macrophages, which accelerate fibrosis and exacerbate disease progression. Here, we aimed to evaluate the therapeutic potential of ginsenoside Rh2 (Rh2) in a cell model of NAFLD induced by the ERS inducer thapsigargin (THA). Methods: HepG2 cells were treated with THA to induce ERS and mimic NAFLD conditions. The effects of Rh2 on ERS, lipid accumulation, and apoptosis were assessed in HepG2 cells. Additionally, THP-1 cells were used to investigate macrophage activation upon exposure to conditioned medium (CM) from THA- and Rh2-treated HepG2 cells. Gene and protein expression of inflammatory and lipid synthesis markers were analyzed, as well as M1/M2 macrophage polarization markers. Results: Rh2 inhibited THA-induced apoptosis, ERS, and lipid accumulation in HepG2 cells. It also reduced the expression of lipid synthesis genes (SREBF1, FAS) and inflammatory markers (IL-6, IL-1β, TNF-α, MCP-1). CM from Rh2-treated HepG2 cells suppressed macrophage activation in THP-1 cells, decreased M1 polarization markers (CD80, CD86), and increased M2 markers (CD163, Arg1, MRC-1). Conclusions: These results suggest that Rh2 effectively suppresses inflammation and lipid storage in ERS-induced HepG2 cells while modulating the crosstalk between hepatocytes and macrophages. These findings underscore the potential of Rh2 as a promising therapeutic agent for the prevention and early intervention of NAFLD progression.

Triple Transcranial Static Magnetic Field Stimulation System ("SHIN jiba") Modulates the Neural Activity of the Lumbar Spinal Cord: A Cross-over and Single-Blind Study in Healthy Subjects

OBJECTIVES

The triple transcranial static magnetic field stimulation (tSMS) system (SHIN jiba), a new form of tSMS, can generate a stronger magnetic field that reaches deeper regions than the conventional tSMS method. Although SHIN jiba suppresses the neural activity of the brain, the neuromodulatory effects on the spinal cord remain unclear. The aim of this study was to investigate the effects of SHIN jiba on the activity of spinal cord circuits and the ascending neural pathways in the lumbar spinal cord by measuring H-reflex and somatosensory evoked potentials (SEPs).

MATERIALS AND METHODS

This study comprised two experiments involving 19 healthy subjects and an additional experiment involving 15 healthy subjects. All experiments were cross-over and single-blind studies. In all experiments, SHIN jiba or sham stimulation was applied over the lumbar region (between the 11th and 12th thoracic vertebrae) for 20 minutes. In experiment 1, H-reflex after the electrical stimulation of the right tibial nerve was recorded before, immediately after, and 15 minutes after the intervention. In experiment 2, SEPs after the electrical stimulation of the right posterior tibial nerve were recorded at the same point as experiment 1.

RESULTS

The H-reflex amplitude was significantly suppressed immediately after SHIN jiba stimulation for 20 minutes. In contrast, the SEP amplitudes did not change before and after SHIN jiba stimulation.

CONCLUSIONS

These findings suggest that SHIN jiba has different effects on the activity of spinal cord circuits and the ascending neural pathways in the lumbar spinal cord. SHIN jiba can be a new tool for modulating the neural activity of the spinal cord.

Deep learning MRI-based radiomic models for predicting recurrence in locally advanced nasopharyngeal carcinoma after neoadjuvant chemoradiotherapy: a multi-center study

Local recurrence and distant metastasis were a common manifestation of locoregionally advanced nasopharyngeal carcinoma (LA-NPC) after neoadjuvant chemoradiotherapy (NACT). To validate the clinical value of MRI radiomic models based on deep learning for predicting the recurrence of LA-NPC patients. A total of 328 NPC patients from four hospitals were retrospectively included and divided into the training(n = 229) and validation (n = 99) cohorts randomly. Extracting 975 traditional radiomic features and 1000 deep radiomic features from contrast enhanced T1-weighted (T1WI + C) and T2-weighted (T2WI) sequences, respectively. Least absolute shrinkage and selection operator (LASSO) was applied for feature selection. Five machine learning classifiers were conducted to develop three models for LA-NPC prediction in training cohort, namely Model I: traditional radiomic features, Model II: combined the deep radiomic features with Model I, and Model III: combined Model II with clinical features. The predictive performance of these models were evaluated by receive operating characteristic (ROC) curve analysis, area under the curve (AUC), accuracy, sensitivity and specificity in both cohorts. The clinical characteristics in two cohorts showed no significant differences. Choosing 15 radiomic features and 6 deep radiomic features from T1WI + C. Choosing 9 radiomic features and 6 deep radiomic features from T2WI. In T2WI, the Model II based on Random forest (RF) (AUC = 0.87) performed best compared with other models in validation cohort. Traditional radiomic model combined with deep radiomic features shows excellent predictive performance. It could be used assist clinical doctors to predict curative effect for LA-NPC patients after NACT.

T-cell senescence: Unlocking the tumor immune "Dark Box" - A multidimensional analysis from mechanism to tumor immunotherapeutic intervention

Immunosenescence is the dysfunction of the immune system that occurs with age, a process that is complex and characterized by several features, of which T-cell senescence is one of the key manifestations. In the tumor microenvironment, senescent T cells lead to the inability of tumor cells to be effectively eliminated, triggering immunosuppression, which in turn affects the efficacy of immunotherapy. This is a strong indication that T-cell senescence significantly weakens the immune function of the body, making individuals, especially elderly patients with cancer, more vulnerable to cancer attacks. Despite the many challenges, T-cell senescence is important as a potential therapeutic target. This review provides insights into the molecular mechanisms of T-cell senescence and its research advances in patients with cancer, especially in older adults, and systematically analyzes potential intervention strategies, including molecular mechanism-based interventions, the use of immune checkpoint inhibitors, and CAR-T cell therapy. It is hoped that this will establish a theoretical framework for T-cell senescence in the field of tumor immunology and provide a scientific and prospective reference basis for subsequent in-depth research and clinical practice on senescent T cells.

Esophageal involvement of mantle cell lymphoma presenting with multiple lymphomatous polyposis: A single-center study

BACKGROUND

In addition to nodal lesions, over 30% of mantle cell lymphomas (MCLs) also have gastrointestinal involvement, characteristically presenting as multiple lymphomatous polyposis (MLP), which rarely involve the esophagus. Most related papers have been case reports, and no comprehensive studies have been conducted; thus, the actual clinical situation has remained unknown for a long time.

AIM

To elucidate the actual clinical situation of esophageal involvement of MCL presenting with MLP, including its prognosis.

METHODS

From January 2001 to December 2021, among MCL patients whose gastrointestinal lesions were histopathologically confirmed by endoscopic biopsy at our center, 6 patients with MLP in the esophagus were selected. We retrospectively examined the clinical features of these patients, including their prognosis.

RESULTS

In all patients, multiple lesions were present in the gastrointestinal tract other than the esophagus and in the lymph nodes throughout the body, and most patients also had lesions involving the bone marrow or spleen. Most of the treatments include chemotherapy, with a 50% survival period of less than 2 years and a 5-year survival rate of approximately 30%, indicating a poor prognosis.

CONCLUSION

Patients with esophageal involvement of the MCL who presented with MLP had a large tumor burden and poor survival.

Fuzi alleviates cold-related rheumatoid arthritis via regulating gut microbiota and microbial bile acid metabolism

BACKGROUND

Rheumatoid arthritis (RA) with cold pattern is an important type of RA according to the theory of traditional Chinese medicine. Fuzi (also known as the lateral roots of Aconitum carmichaelii Debx.) represents a typical traditional Chinese medicine that has been clinically used for treatment of the RA especially cold-related RA for thousands of years, yet its mechanism remains unknown.

PURPOSE

The purpose of the research was to study the therapeutic effects of Fuzi on cold-related RA, and to investigate the mechanism of its action.

METHODS

Here, we investigated the pharmacological effects of Fuzi on cold-related RA using micro-CT, histopathological analysis, and inflammatory cytokine test. Then, a gut microbiota composition analysis in combination with fecal microbiota transplantation were used to confirm the role of gut microbiota in the therapeutic effects of Fuzi. Further, targeted bile acid metabolomics was used to screen the possible differential microbial bile acids involved in the mechanism of Fuzi. In vitro bioactivity analysis of differential bile acids was used to assess their anti-inflammation activity. Finally, western blot was used to investigate the signaling pathways of Fuzi in reducing the inflammation of cold-related RA.

RESULTS

The results showed that Fuzi alleviates cold-related RA by improving arthritis index, paw swelling, bone damage, and inflammatory cytokines. In addition, the ameliorative effect of Fuzi is dependent on gut microbiota such as the taxa Lachnospiraceae and Ruminococcaceae. Targeted analysis of fecal and serum bile acids showed that TCA and THDCA were the main differential metabolites. In vitro, TCA and THDCA showed anti-inflammation effects on RAW264.7 cells. Western blot showed that Fuzi regulates TGR5-cAMP-PKA signaling and NLRP3 inflammasome to reduce cold-related arthritis.

CONCLUSION

Overall, our results demonstrated that Fuzi could regulate gut microbiota and microbial bile acid metabolism, the microbial metabolite THDCA acts on TGR5-cAMP-PKA signaling pathway and NLRP3 inflammasome to reduce cold-related arthritis. Our study suggests that supplementation of Fuzi or THDCA can be of great value for the prevention and clinical treatment of cold-related RA.

Accuracy of dual-contrast gastrointestinal ultrasonography in predicting lymph node metastasis in older adults with gastric cancer

BACKGROUND

Gastrointestinal dual-contrast ultrasonography (DCUS) is characterized by its high resolution, sensitivity, and specificity.

AIM

To determine the accuracy of DCUS in predicting lymph node metastasis in middle-aged and elderly patients with gastric cancer (GC).

METHODS

A total of 100 middle-aged and elderly patients with GC admitted to the Fourth Affiliated Hospital of Soochow University (Dushu Lake Hospital, Suzhou, China) between April 2022 and April 2024 were selected. The baseline data and lymph node metastasis status were collected. DCUS combined with intravenous contrast technology was used to calculate the enhancement time (ET), time to peak (TTP), and slope of the ascending branch wash-in rate (WIR). These indicators were used in assessing lymph node metastasis in patients with GC.

RESULTS

Among 100 middle-aged and elderly patients with GC, 35 (35.00%) had lymph node metastases. GC patients with lymph node metastasis had a higher proportion of stage II TNM classification and higher WIR values than those without lymph node metastasis. The ET and TTP values were lower in patients with lymph node metastases, and all differences were statistically significant (P < 0.05). The area under the curve values for ET, TTP, WIR, and combined diagnosis of GC lymph node metastasis using DCUS were all > 0.7. Optimal assessment was achieved when the cutoff values for ET, TTP, and WIR were set at 16.32 seconds, 10.67 seconds, and 7.02, respectively.

CONCLUSION

DCUS-mediated assessment of ET, TTP, and WIR can effectively predict and evaluate lymph node metastasis status in patients with GC, with higher sensitivity when used in combination.

Deciphering Acute Coronary Syndromes Pathobiology Through Proteomics

Acute coronary syndrome (ACS) refers to a spectrum of conditions characterized by a sudden decrease in blood flow to the heart. This includes unstable angina, the mildest form, as well as non-ST- and ST-segment elevation myocardial infarction. The primary cause of ACS is typically the rupture or erosion of an atherosclerotic plaque in a coronary artery, resulting in the formation of a blood clot that can, partially or completely, block the blood flow to the heart muscle. The ongoing discovery and comprehension of emerging biomarkers for atherosclerosis could enhance our capacity to predict future events, particularly when integrated alongside traditional risk factors in assessing overall risk profiles. With advancements in proteomic technologies, large-scale approaches have been increasingly instrumental in unraveling pathways implicated in atherosclerotic degeneration and identifying novel circulating markers, which may serve as early diagnostic indicators or targets for innovative therapies. Over recent decades, numerous matrices including plasma, urine, microparticles, lipoproteins, atherosclerotic plaque extracts and secretomes, as well as thrombi, have been examined to address these questions. Furthermore, proteomics has been applied to various experimental models of atherosclerosis to deepen our understanding of the mechanisms underlying atherogenesis. This review offers a critical overview of the past two decades of untargeted omics research focused on identifying circulating and tissue biomarkers relevant to ACS.

Glycoproteomics of Gastrointestinal Cancers and Its Use in Clinical Diagnostics

Cancer is a leading cause of death worldwide, resulting in substantial economic costs. Because cancer is a complex, heterogeneous group of diseases affecting a variety of cells, its detection may sometimes be difficult. Herein we review a large group of the gastrointestinal cancers (oral, esophageal, stomach, pancreatic, liver, and bowel cancers) and the possibility of using glycans conjugated to protein backbones for less-invasive diagnoses than the commonly used endoscopic approaches. The reality of bacterial N-glycosylation and the effect of epithelial mucosa on gut microbiota are discussed. Current advantages, barriers, and advantages in the prospective use of selected glycomic approaches in clinical practice are also detailed.

Health economics evaluation of diagnostic strategies for gastro-oesophageal reflux disease with reflux symptoms in China: a modelling study

OBJECTIVES

American College of Gastroenterology (ACG) and Chinese expert consensus recommended different algorithmic approaches for the diagnosis of gastro-oesophageal reflux disease (GERD) are not yet defined. We compared the two recommended diagnostic processes using a Chinese population-based health economics analysis.

METHODS

Our analysis considered a hypothetical cohort of patients with typical reflux symptoms. We constructed a decision tree model to compare the two recommended diagnostic processes described in ACG clinical guidelines (stratified endoscopy strategy) and Chinese expert consensus (endoscopy-first strategy). The first strategy begins with hazard stratification based on alarm symptoms. Patients with alarm symptoms directly undergo endoscopic examination, while patients without alarm symptoms receive proton pump inhibitors as diagnostic treatment. In the second strategy, all patients with reflux symptoms complete an endoscopic examination. Sensitivity analysis was performed to evaluate a range of cost and probability estimates on costs and health outcomes over a 1-year time horizon from the healthcare system perspective.

RESULTS

The total expected costs were US$122.51 for the stratified endoscopy strategy and US$150.12 for the endoscopy-first strategy. The incremental cost-effectiveness ratio (ICER) comparing the endoscopy-first strategy with the stratified endoscopy strategy was US$440.39 per additional correct case of GERD. The rates of detecting upper gastrointestinal carcinoma of the two strategies were 0.0088 and 0.0120, and the ICER was US$8561.34.

CONCLUSIONS

The use of endoscopy for all patients with reflux symptoms was more effective but with an increased cost compared with the strategy recommended in international guidelines.

Plant extracts with antioxidant and hepatoprotective benefits for liver health: A bibliometric analysis of drug delivery systems

BACKGROUND

The rising global burden of liver diseases, such as non-alcoholic fatty liver disease and liver fibrosis, has necessitated innovative therapeutic approaches. Plant-based therapies, recognized for their anti-inflammatory and antioxidant properties, have shown promising effects. However, poor bioavailability limits their clinical application.

AIM

To map global research trends, key contributors, and emerging themes in plant-based therapies combined with advanced drug delivery systems for liver health.

METHODS

Using the Scopus database, 645 documents were retrieved and analyzed using bibliometric tools Biblioshiny and VOSviewer. Analysis focused on publication trends, geographical contributions, and advancements in drug delivery technologies, including nanoparticles, liposomes, and polymeric micelles. Metrics such as publication growth rate, authorship collaboration, and thematic clustering were assessed.

RESULTS

The dataset spans 43 years (1981-2024), with an annual growth rate of 11.09% in the number of publications. Research output is dominated by China (33%), followed by the United States (24%) and India (18%). Collaborative studies accounted for 24.34% of publications, with an average of 5.81 co-authors per document. Key innovations include nanoparticle encapsulation of curcumin and silymarin, improving bioavailability by up to 85%. Highly cited studies demonstrated the antioxidant, anti-inflammatory, and anti-fibrotic properties of these compounds. For instance, curcumin nanoparticles showed a 70% improvement in solubility, and silymarin liposomal formulations enhanced therapeutic efficiency by 62%. Thematic analysis revealed a transition from basic clinical observations to molecular and pharmacokinetic research, with a focus on oxidative stress mitigation and hepatoprotection.

CONCLUSION

This study highlights the growing synergy between plant-based therapies and advanced drug delivery systems, with significant contributions from Asian and Western countries. Future efforts should prioritize clinical trials, standardization of plant extract formulations, and interdisciplinary approaches to maximize therapeutic outcomes. The findings provide a foundation for integrating plant-derived compounds into evidence-based hepatological therapies, addressing critical challenges in bioavailability and safety.

Epithelial barrier hypothesis in the context of nutrition, microbial dysbiosis, and immune dysregulation in metabolic dysfunction-associated steatotic liver

In recent years, the prevalence of chronic liver diseases, particularly Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), has increased significantly. This upward trend is largely associated with lifestyle-related factors such as unhealthy dietary habits, physical inactivity, and various environmental influences. Among the key elements contributing to the pathogenesis of MASLD, the integrity of the intestinal epithelial barrier emerges as a critical determinant, given its central role in maintaining immune homeostasis along the gut-liver axis. Disruption of this barrier, often driven by excessive consumption of saturated fats and refined carbohydrates in combination with low dietary fiber intake, can lead to microbial dysbiosis. This imbalance in the gut microbiota triggers immune dysregulation and promotes systemic inflammation, thereby exacerbating hepatic injury. This review discusses the contribution of epithelial barrier dysfunction to the development and progression of MASLD, with a particular focus on how increased intestinal permeability may initiate and sustain chronic liver inflammation. Additionally, the influence of dietary and environmental factors on epithelial integrity, immune responses, and the inflammatory cascade is addressed. A better understanding of the complex interplay between gut barrier impairment, immune modulation, and liver pathology may offer valuable insights into MASLD pathophysiology and contribute to the development of more targeted therapeutic strategies.

Statin use and risk of HCC in patients with MASLD and T2DM: an umbrella review and meta-analysis

BACKGROUND

The effect of statin use on hepatocellular carcinoma (HCC) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or type two diabetes mellitus (T2DM) is still unclear. In this umbrella review, we aimed to assess the available evidence for the association of statin use and HCC risk in the target population.

METHODS

We carried out an umbrella review of previous systematic reviews/meta-analyses indexed in Cochrane, Embase, Scopus, and PubMed databases and published between Jan 1st, 2013, and Oct 22, 2024. We used random effects models to recalculate summary risk estimates for HCC incidence. Using A Measurement Tool to Assess methodological quality of systematic Review (AMSTAR2) tool, two independent reviewers evaluated each article for eligibility and methodologic quality and gathered data from the included studies.

RESULTS

Of the initially identified 1,038 systematic reviews/meta-analyses, three non-overlapping studies with medium/high quality were included for qualitative synthesis. Statin use in people with T2DM was reported in six studies belonging to two meta-analyses. The results showed that statins were associated with a decreased risk of HCC (RR: 0.16, 95% CI: [0.03, 0.98]). However, the association was nonsignificant in patients with MASLD comprising five studies from one meta-analysis (RR: 0.89, 95% CI: [0.56, 1.40]).

CONCLUSION

Statin use is associated with a decreased incidence of HCC in people with T2DM. In patients with MASLD, the association is not significant. However, the effects of other variables including the stage of inflammation and/or liver fibrosis on the outcome need to be explored in future studies.