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.

Association of coagulation-related indicators with postoperative venous thromboembolism occurrence in patients with pituitary tumors

This study aimed to analyze risk factors for postoperative VTE in pituitary tumor resection patients, focusing on coagulation indicators and their predictive value. This study collected clinical data from 300 patients who underwent pituitary adenoma resection from January 2021 to August 2023 in the Department of Neurosurgery, the Second Clinical College of the Army Medical University, China. Logistic regression modeling was used to identify risk factors for VTE. Restricted cubic spline curves were used to characterize the dose-response relationship between coagulation-related indicators and the risk of venous thromboembolism. The area under the curve (AUC) was calculated using the receiver operating characteristic (ROC) curve to evaluate the predictive power of coagulation-related indicators. Multivariate analysis showed that D-dimer, platelet count and hemoglobin (Hb) were significant predictors of VTE with OR (95% CI) of 1.967 (1.441-2.808), 1.020 (1.013-1.029), and 0.952 (0.914-0.994), respectively. The AUCs for D-dimer, Platelet Count, and Hb were 0.708, 0.731, and 0.712, respectively. The AUC for combining the three coagulation indices was the largest, 0.838. The combined use of D-dimer, Hb, and platelet count can identify high-risk patients early, enabling timely implementation of antithrombotic strategies.

Time in target range for systolic blood pressure and stroke in people with and without diabetes: the Kailuan prospective cohort study

Objective

Systolic blood pressure time in target range (SBP-TTR) is an independent risk factor for stroke. We aimed to investigate the associations of SBP-TTR with stroke among participants with or without diabetes using data from the Kailuan study.

Methods

We included 28,591 participants [mean age, 57.5 years; 83.8% men; 23.2% with diabetes] from the Kailuan Study. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of SBP-TTR on stroke in individuals with and without diabetes.

Results

After a median of 8.7 years follow-up, 2,206 stroke cases occurred. Among participants with diabetes, those with SBP-TTR 75%-100% (HR [95%CI]: 0.64 [0.49, 0.84]) had a lower risk of stroke compared to those with SBP-TTR 0%-25%. Among participants without diabetes, those with SBP-TTR 50%-75% (HR 0.75, 95% CI 0.64-0.88) and 75%-100% (HR [95%CI]: 0.62 [0.52, 0.73]) had a significantly lower risk of stroke. A significant interaction between diabetes status and SBP-TTR was observed (P for interaction = 0.03). Additionally, the restricted cubic spline analysis showed a non-linear relationship between SBP-TTR and stroke risk among participants with diabetes (P for non-linearity = 0.001), and a linear relationship among those without diabetes (P for non-linearity = 0.035).

Conclusion

Higher SBP-TTR was associated with a reduced risk of stroke among participants with or without diabetes. The findings underscore the importance of maintaining blood pressure within the target range to mitigate stroke risk, particularly emphasizing the need for stringent blood pressure control in diabetic patients.

Gut-brain axis and vascular dementia: a review on mechanisms and Chinese herbal medicine therapeutics

Vascular dementia (VD), the second most prevalent form of dementia among the elderly population, is a cerebrovascular disorder characterized primarily by cognitive impairment. Emerging evidence has revealed that intestinal flora dysbiosis may be implicated not only in gastrointestinal (GI) pathologies but also in central nervous system (CNS) disorders, including VD. The gut-brain axis (GBA) serves as a critical bidirectional pathway through which intestinal flora influences brain physiology and function. Notably, accumulating studies have demonstrated the therapeutic potential of Chinese herbal medicine (CHM) in VD management via modulation of gut microbial composition. This review synthesizes current understanding of the VD- intestinal flora relationship mediated by the GBA, while systematically evaluating evidence for CHM interventions that ameliorate VD through intestinal flora regulation. These insights may offer novel perspectives and methodological approaches for both fundamental research and clinical management of VD.

Immune modulation: the key to combat SARS-CoV-2 induced myocardial injury

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which caused the Coronavirus disease 2019 (COVID-19) pandemic, has posed significant healthcare challenges. In addition to respiratory complications, it has led to severe damage in other organs, particularly the cardiovascular system. Of which, myocardial injury is increasingly recognized as a most significant complication, contributing to the high mortality. Recent research indicates the pivotal role of immune dysregulation in mediating myocardial injury in patients infected with SARS-CoV-2. In this review, we provide a comprehensive analysis of the immune mechanisms involved in SARS-CoV-2-induced myocardial damage, focusing on the roles of key immune cells and molecules that contribute to this pathological process. Aiming at mitigating the myocardial injury of COVID-19, we review immune-based treatments under evaluation in preclinical and clinical trials. Along with talking about the similarities and differences in myocardial injury resulting from SARS-CoV-2, the Middle East respiratory syndrome coronavirus (MERS-CoV) and the severe acute respiratory syndrome coronavirus (SARS-CoV). This article provides a unique perspective on using past experiences to prevent myocardial injury in the face of ongoing virus mutations.

Helicobacter pylori infection might be a protective factor against Parkinson's disease

The gastrointestinal tract is not only an important component of the digestive system but also a crucial part of the body's immune system. Numerous studies have reported that gastrointestinal immunity plays a critical role in many extraintestinal diseases, including neurodegenerative disorders. However, the relationship between gastric mucosal immunity and neurodegenerative diseases, such as Parkinson's disease(PD), remains underexplored. The rate of H. pylori infection was assessed using the 13 C-Urea Breath Test (13 C-UBT) in a case-control study involving 315 PD patients and a control group of 22,383 outpatients. Multivariate regression and propensity score matching (PSM) analyses were employed to adjust for confounding factors. A lower H. pylori infection rate was found in PD cases compared to outpatient controls (DOB ≥ 8, 22.5% versus 27.5%, p = 0.049; DOB ≥ 4, 28.6% versus 33.9%, p = 0.046). After adjusting for confounding factors, the H. pylori infection rate remained lower in PD cases compared to controls. The study revealed an inverse correlation between H. pylori infection and PD, suggesting that H. pylori infection could potentially act as a protective factor against the development of PD.

A mitochondrial regulator protein, mitofusin 2, is elevated in the maternal blood of women with preeclampsia

OBJECTIVE

To investigate the expression of mitofusin 2 (Mfn2) in the placenta and peripheral blood of patients with early-onset preeclampsia (eoPE) and late-onset preeclampsia (loPE), and to evaluate its possibility as a diagnostic and therapeutic target for preeclampsia.

METHODS

A total of 68 pregnant women with preeclampsia in Jiaxing Maternal and Child Health Hospital from June 2022 to June 2024 were selected, including 32 patients with eoPE and 36 patients with loPE, and 68 term pregnant women as negative controls. Real-time fluorescence reverse transcription (RT-qPCR) was used to determine the expression level of Mfn2 mRNA in placenta and peripheral blood, and the expression of Mfn2 was analyzed; enzyme-linked immunosorbent assay (ELISA) was used to determine the level of Mfn2 in peripheral blood of patients, and the outcomes of pregnant women (placental weight, neonatal birth weight, 1 min Apgar) were recorded. The correlation between the level of Mfn2 in peripheral blood and the severity of preeclampsia and pregnancy outcomes was analyzed.

RESULT

The expression of Mfn2 mRNA in the placenta tissue of the eoPE group was significantly lower than that of the term pregnancy group and the loPE group (P < 0.001), while the expression of Mfn2 in the placenta tissue of the loPE group was only lower than that of the term pregnancy group, with no significant difference(P > 0.05). The expression of Mfn2 mRNA in the peripheral blood of eoPE and loPE was significantly higher than that of term pregnancy group (all P < 0.001). In the peripheral blood, the levels of Mfn2 in eoPE group and loPE group were significantly higher than that of the term pregnancy group (all P < 0.001). The Pearson correlation analysis showed that the expression level of Mfn2 protein in peripheral blood of patients are positively correlated with blood pressure and urinary protein, and negatively correlated with neonatal birth weight and 1 min Apgar score.

CONCLUSION

In early-onset placenta, the expression of Mfn2 is significantly lower than that in full-term pregnancy, while in late-onset eclampsia, it is not, indicating that the abnormal expression of Mnf2 in placenta is related to the occurrence period of preeclampsia and the progression of the disease; Mfn2 in peripheral blood can be used as a biological marker to evaluate the occurrence and progression of preeclampsia.

Relative Adiposity and Body Dissatisfaction in Young Adult Sexual Minority Women

The purpose of this study was to examine potential differences in body mass index (BMI), relative adiposity (%Fat), and body dissatisfaction (BD) between heterosexual (HSW) and sexual minority women (SMW). Young adult women (n = 84; 23.8% SMW; 21.9 ± 3.8 years) were included in our analysis. %Fat was assessed using a four-compartment model. BD was assessed using the Body Shape Questionnaire (BSQ), the BD subscale of the Eating Disorders Inventory Questionnaire (EDI-BD), the appearance evaluation subscale of the Multidimensional Body Self-Relations Questionnaire (MBSRQ-AE), and the Photographic Figure Rating Scale (PFRS). Potential differences in BMI, %Fat, and BD between sexual orientation groups were assessed using independent samples t-tests. Bivariate correlations were assessed using Pearson's r. No differences in BMI or BD were observed between groups (all p > .05). Higher %Fat was observed in SMW when compared to HSW (p = .046), and higher %Fat was associated with higher BSQ (r = .364), EDI-BD (r = .388), lower MBSRQ-AE (r = .388), and PFRS (r = .521), collectively indicating greater BD. %Fat was higher in SMW, and higher %Fat was associated with greater BD, regardless of sexual orientation. These results suggest that SMW tend to have higher %Fat than heterosexual counterparts which would increase their risk of negative health outcomes.

ncRNAs as Key Regulators in Gastric Cancer: From Molecular Subtyping to Therapeutic Targets

Gastric cancer (GC) poses a major global health challenge, underscoring the need for advanced diagnostic and therapeutic approaches. Non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), have emerged as pivotal regulators in GC, with their dysregulated expression driving key processes such as tumorigenesis, metastasis, immune evasion, and chemoresistance. The functional diversity of ncRNAs across different GC molecular subtypes highlights their potential as biomarkers for improved subtype classification and patient stratification. Beyond their diagnostic value, ncRNAs demonstrate critical regulatory functions in tumor biology, establishing these RNA molecules as promising targets for therapeutic development. Strategies based on RNA hold considerable promise for addressing critical challenges such as immune escape and drug resistance by modulating key signaling pathways. These approaches can enhance immune responses, reprogram the tumor microenvironment, and reverse resistance mechanisms that compromise treatment efficacy, thereby improving clinical outcomes. Although ncRNAs represent a promising frontier in GC precision medicine, further research is required to fully harness their clinical potential.

Analyzing Key Predictors of Postoperative Delirium Following Coronary Artery Bypass Grafting and Aortic Valve Replacement: A Machine Learning Perspective

Background and Objectives: Postoperative delirium (POD) is a frequent and severe complication following cardiac surgery, particularly in high-risk patients undergoing coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). Despite extensive research, predicting POD remains challenging due to the multifactorial and often non-linear nature of its risk factors. This study aimed to improve POD prediction using an interpretable machine learning approach and to explore the combined effects of clinical, biochemical, and perioperative variables. Materials and Methods: This study included 131 patients who underwent CABG or AVR. POD occurrence was assessed using standard diagnostic criteria. Clinical, biochemical, and perioperative variables were collected, including patient age, sedation type, and mechanical ventilation status. Machine learning analysis was performed using an XGBoost classifier, with model interpretation achieved through SHapley Additive exPlanations (SHAP). Univariate logistic regression was applied to identify significant predictors, while SHAP analysis revealed variable interactions. Results: POD occurred in 34.3% of patients (n = 45). Patients who developed POD were significantly older (67.7 ± 6.5 vs. 64.5 ± 8.7 years, p = 0.020). Sedation with mechanical ventilation and the type of sedative used were strongly associated with POD (both p < 0.001). Sedation during mechanical ventilation showed the strongest association (OR = 2520.0; 95% CI: 80.9-78,506.7; p < 0.00001). XGBoost classifier achieved excellent performance (AUC = 0.998, accuracy = 97.6%, F1 score = 0.976). SHAP analysis identified sedation, mechanical ventilation, and their interactions with fibrinogen, troponin I, leukocyte parameters, and lung infection as key predictors. Conclusions: This study demonstrates that an interpretable machine learning approach can enhance POD prediction, providing insights into the combined impact of multiple clinical, biochemical, and perioperative factors. Integration of such models into perioperative workflows may enable early identification of high-risk patients and support individualized preventive strategies.

Evaluation of Adjunctive Aminoglycoside Therapy Compared to β-Lactam Monotherapy in Critically Ill Patients with Gram-Negative Bloodstream Infections

Background/Objectives: Gram-negative bloodstream infections (GN-BSIs) in the critically ill carry significant mortality, which is exacerbated by delays in appropriate therapy. To improve the time to effective therapy, aminoglycosides are often recommended as empiric adjunctive antimicrobials. However, there is a paucity of clinical data supporting this practice. This study's objective was to evaluate the safety and efficacy of adjunctive aminoglycosides compared to β-lactam monotherapy in patients admitted to the intensive care unit (ICU) with GN-BSI. Methods: This was a retrospective, propensity-matched cohort study of critically ill patients with GN-BSI. The primary outcome was 15-day all-cause mortality. The secondary endpoints evaluated included 30-day mortality, ICU-free survival days, 60-day relapse, 30-day readmission, development of acute kidney injury (AKI), and new resistance. Results: A total of 209 propensity-matched patients were included for analysis: 136 received β-lactam monotherapy and 73 received adjunctive aminoglycoside. The primary outcome of 15-day all-cause mortality was not significantly different between groups (17% vs. 21%; p = 0.644). Additional secondary endpoints of 30-day mortality (22% vs. 25%), ICU-free survival (12.1 vs. 12.2 days), 60-day relapse (3.3% vs. 7.4%), and 30-day readmission (23% vs. 18%) did not yield significant differences. The proportion of AKI was higher in the adjunctive aminoglycoside group but was not found to be significantly different (26.5% vs. 37%). Conclusions: The use of adjunctive aminoglycosides for GN-BSI did not affect clinical outcomes in the critically ill.

Biosynthetic Mechanisms of Plant Chlorogenic Acid from a Microbiological Perspective

Chlorogenic acid (CGA), a phenolic compound with diverse bioactivities, plays a crucial role in plant defense mechanisms and has significant therapeutic potential in human inflammatory and cardiovascular diseases. The biosynthesis and accumulation of CGA in plants result from a complex interplay between internal factors (e.g., hormones, enzymes, and genes) and external factors (e.g., microbial interactions, drought, and temperature fluctuations). This review systematically investigates the influence of microbes on internal regulatory factors governing CGA biosynthesis in plants. CGA is synthesized through four distinct metabolic pathways, with hormones, enzymes, and genes as key regulators. Notably, microbes enhance CGA biosynthesis by improving plant nutrient uptake, supplying essential hormones, regulating the expression of related enzymes and genes, and the interaction between bacteria and fungi. In addition, our review summarizes the challenges currently present in the research and proposes a series of innovative strategies. These include in-depth investigations into the molecular mechanisms of microbial regulation of plant gene expression, gene editing, development of microbial inoculants, construction of synthetic microbial communities, and exogenous application of plant hormones.

Gut microbiota-derived short-chain fatty acids and their role in human health and disease

Short-chain fatty acids (SCFAs) are a group of organic compounds produced by the fermentation of dietary fibre by the human gut microbiota. They play diverse roles in different physiological processes of the host with implications for human health and disease. This Review provides an overview of the complex microbial metabolism underlying SCFA formation, considering microbial interactions and modulating factors of the gut environment. We explore the multifaceted mechanistic interactions between SCFAs and the host, with a particular focus on the local actions of SCFAs in the gut and their complex interactions with the immune system. We also discuss how these actions influence intestinal and extraintestinal diseases and emerging therapeutic strategies using SCFAs.

Prevalence and burden of chronic cough in China: results from a population-based survey

BACKGROUND

Chronic cough is associated with reduced mental and physical health and increased health care resource use. The lack of nationwide data on chronic cough hinders our understanding of the prevalence, demographics, and impacts of chronic cough in China. The aim of this study was to estimate the lifetime and annual prevalence of chronic cough in mainland China and to describe the sociodemographic and health-related characteristics of adults with chronic cough.

METHODS

This was a cross-sectional study using self-reported information from a nationally representative sample of 20,051 adults. Respondents with chronic cough (daily cough for ≥ 8 weeks) during the prior 12 months were matched to respondents without chronic cough.

RESULTS

We estimated a lifetime prevalence of 7.0% and an annual prevalence of 4.1% for chronic cough among adult residents of mainland China. Affected individuals had a mean age of 43.5 years, and there were no significant differences in prevalence between men and women. Compared to matched controls, the chronic cough group had more comorbidities and included a higher proportion of individuals who had been diagnosed with respiratory and sleep-related conditions. Chronic cough was also associated with significantly worse depression and anxiety symptom severity and health-related quality of life, as well as increased impairment of work and other daily activities and higher rates of all-cause health care resource use.

CONCLUSIONS

Chinese adults with chronic cough show a middle age, equal gender distribution. Chronic cough affects an estimated 46.4 million adults in mainland China during their lifetime and is associated with significant individual and health care system burden.

TAKE HOME MESSAGE

Chronic cough affects approximately 4.1% (27.2 million) of adults per year in mainland China and is associated with worse health and health-related quality of life, impairment of work productivity and other daily activities, and increased all-cause health care resource use.

Hypopituitarism in non-neuroendocrine pituitary tumors: a systematic review

The existing evidence on pituitary function impairment in non-neuroendocrine pituitary tumors (non-PitNETs) is limited and scattered. We performed a systematic review using PubMed, Embase, Scopus, and Cochrane of all reported studies that evaluated pituitary function in craniopharyngiomas, meningiomas, germinomas, pituitary lymphomas, pituicytomas, granular cell tumors, spindle cell oncocytomas, and pituitary metastases over the past 35 years. A total of 5,614 patients from 114 studies were analyzed. The weighted mean age was 35.01 ± 2.7 years (95% CI: 34.9-35.1) and 47.5 ± 14.1% (95% CI: 47.1-47.8) were women. The overall weighted proportion of hypopituitarism was 49.1 ± 24.2% (95% CI: 48.4-49.7) and arginine vasopressin deficiency (AVD) was 18.43 ± 16.6% (95% CI: 17.9-18.9). According to tumor type, prevalence of hypopituitarism was 67.3 ± 8.1% (95% CI: 66.5-68.9) for germinomas, 61.4 ± 20.8% (95% CI: 58.8-64.1) for metastases, 58.7 ± 22.2% (95% CI: 46.2-71.3) for lymphomas, 54.4 ± 30.8% (95% CI: 45.6-63.3) for pituicytomas, 53.8 ± 12.3% (95% CI: 47.5-59.8) for oncocytomas, 49.1 ± 17.2% (95% CI: 48.6-49.6) for craniopharyngiomas, 29.7 ± 16.6% (95% CI: 22.4-36.9) for granular cell tumors, and 11.5 ± 9.1% (95% CI: 10.8-12.3) for meningiomas. When comparing the most prevalent non-PitNETs, the weighted prevalence of hypopituitarism was higher in metastases compared to craniopharyngiomas (χ2 = 696.8, df = 1), p < 0.0001. Similarly, the weighted prevalence of hypopituitarism in craniopharyngiomas was higher compared to meningiomas (χ2 = 16,278.13, df = 1), p < 0.0001. In conclusion, non-PitNETs result in hypopituitarism in approximately half of the cases and AVD in nearly one-fifth. Pituitary metastases and craniopharyngiomas demonstrate greater local aggressiveness and a higher likelihood of disrupting hypothalamic-pituitary function compared to meningiomas.

Phytochemical characterization and pharmacological mechanisms of Huazhuo Sanjie Chubi Decoction in treating gouty arthritis: A multivariant approach

ETHNOPHARMACOLOGICAL RELEVANCE

Huazhuo Sanjie Chubi Decoction (HSCD), a Chinese herbal formula, is traditionally used for the treatment of spleen deficiency with dampness accumulation and is commonly used to treat gouty arthritis (GA). However, the potential active compounds and mechanisms of HSCD remain unclear.

AIM OF THE STUDY

To elucidate the key bioactive compounds and pharmacological mechanisms of HSCD in treating GA.

MATERIALS AND METHODS

The chemical compounds in HSCD were qualitatively and quantitatively analyzed using ultraperformance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). Network pharmacology and molecular docking were employed to identify key active compounds and associated molecular pathways. Monosodium urate (MSU)-induced RAW264.7 macrophages and GA rat model were used to explore the potential therapeutic effects and mechanisms of HSCD in treating GA.

RESULTS

UPLC-MS/MS identified 184 compounds in HSCD, with 28 key compounds quantified. Network pharmacology revealed that verbenalin, limonin, and quercitrin are strongly associated with the molecular mechanisms of HSCD in treating GA via the PI3K-AKT signaling pathway. These compounds exhibited strong binding affinity to PI3K and AKT proteins. In RAW264.7 cells, HSCD and the three identified compounds dose-dependently reduced inflammation by inhibiting nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3), cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS). They also downregulated both the PI3K-AKT and apoptosis signaling pathways. In rats, HSCD exerted therapeutic effects against acute GA by alleviating swelling and pathological damage to the ankle joints. Moreover, the molecular mechanisms in vivo were confirmed to be associated with the PI3K-AKT and apoptosis signaling pathways.

CONCLUSION

This study employed a multivariant approach to demonstrate the main bioactive compounds and molecular mechanisms of HSCD in treating GA, thereby supporting its traditional use.

MRI-Based Radiomics to Predict Renal Function Response to Renal Artery Stenting for Atherosclerotic Renal Artery Stenosis

PURPOSE

To investigate magnetic resonance imaging (MRI)-based radiomics for predicting renal function response for patients treated for atherosclerotic renal artery stenosis (ARAS) by endoluminal means.

MATERIAL AND METHODS

A cohort of 146 ARAS patients who underwent stenting was analyzed, with retrospective training and prospective validation groups delineated based on the treatment timing. Patients were categorized into benefit and no-benefit groups based on postoperative renal function during follow-up. Optimal radiomics labels were selected from regions of interest (ROIs) including the stenotic side and both kidneys. The nomogram combined optimal radiomics signatures with independent clinical factors using multivariable logistic regression. Shapley Additive exPlanations (SHAP), decision curve analysis (DCA), the net reclassification index (NRI), and the total integrated discrimination index (IDI) were conducted to determine the clinical usefulness of the nomogram.

RESULTS

Split renal function of the stenotic side and diabetes emerged as independent clinical predictors. A nomogram, incorporating these clinical factors and radiomics features from the stenotic side and both kidneys, achieved area under the curve (AUCs) of 0.927 (0.861-0.979) and 0.904 (0.819-0.972) in the training and test groups, respectively, for predicting benefits. The clinical-radiomics model significantly improved diagnostic performance (p = 0.001 and p = 0.011 for the training and test groups, respectively). DCA, NRI, and IDI analyses suggested the nomogram's superiority. SHAP analysis highlighted the radiomics feature from stenotic side kidney as the most critical predictive feature.

CONCLUSIONS

Both MRI radiomics and clinical factors may be valuable in pre-treatment counseling of ARAS patients who may benefit from endovascular treatment.

Senior midwives' perspectives on the transition experience of newly graduated undergraduate midwives in China: a qualitative study

INTRODUCTION

Newly graduated (NG) midwives face various challenges during their transition from school to clinical practice, which can impact their long-term professional satisfaction and development. In China, there are currently no formal support programs for NG midwives. Senior midwives, as direct supervisors and mentors of NG midwives, hold valuable insights and recommendations that could inform the development of NG midwives training programmes in clinical practice, However, these perspectives remain largely underexplored. To address this gap, this study aims to explore senior midwives' perspectives on the transition experiences of NG midwives and their suggestions to support better adaptation to clinical practice, contributing to improvements in midwifery training systems.

METHODS

Senior midwives (n = 23) from seven tertiary teaching hospitals in Guangzhou, Dongguan and Shantou participated in this study using a purposive and snowball sampling approach. Focus group interviews were conducted between February 2023 and December 2023. Data were analysed thematically using NVivo 11.

RESULTS

This study explored senior midwives' perspectives and suggestions regarding the transition experiences of NG midwives, and identified four major themes: professional quality, maternal and newborn care knowledge and skills, public health care & integrative competency, and career development and professional identity. For professional quality, NG midwives were considered to require a deeper understanding of natural birth, the ability to build trusting relationships with women, provide emotional support, and establish appropriate emotional boundaries. In terms of improving NG midwives' knowledge and skills in maternal and newborn care, senior midwives emphasized the need to expand NG midwives' professional knowledge and effectively integrate theoretical knowledge with practice through diverse learning approaches. In the area of public health care and integrative competency, NG midwives should be equipped to prevent and manage occupational exposure and possess cooperation ability. Senior midwives suggested that rational allocation of human resources could help reduce exposure risks, facilitate teamwork, and support the integration of NG midwives into the clinical environment. In addition, senior midwives generally expressed concern and expectations for the career development of NG midwives, indicating that clear career plan during the transition period could enhance their sense of satisfaction and professional belonging, thus promoting the formation of their professional identity and retention.

CONCLUSION

The transition period is a critical phase in the career of NG midwives. Currently, NG undergraduate midwives are not fully equipped with the competency and supportive environment needed for a smooth transition. Recognizing the significance of this transition is essential for training and retaining qualified practitioners. The perspectives and suggestions of senior midwives provide valuable insights into this period, complementing existing research on the transition of NG midwives. It is imperative to refine undergraduate midwifery education systems and create stable professional environments to ensure the sustained and robust development of a qualified midwifery workforce.

Lactate and lactylation in liver diseases: energy metabolism, inflammatory immunity and tumor microenvironment

Liver diseases pose a significant threat to human health. Lactate, a byproduct of glycolysis, serves various biological functions, including acting as an energy source, a signaling molecule, and a substrate for lactylation. Lactylation is a novel lactate-dependent post-translational modification that plays a role in tumor proliferation, the regulation of immune cell function, and the modulation of gene expression. In this paper, we summarize the roles of lactate and lactylation in energy metabolism, inflammatory immunity, and the tumor microenvironment, while also elucidating recent research advancements regarding lactate and lactylation in the context of hepatic fibrosis, non-alcoholic fatty liver disease, and hepatocellular carcinoma. Furthermore, lactate and lactylation are proposed as promising new targets for the treatment of liver diseases.

The role of circular RNAs in regulating cytokine signaling in cancer

Dysregulation of cytokine signaling is central to the development and progression of cancer. Cytokines are not only involved in promoting cancer development but also regulate anti-tumor immune responses. Circular RNAs (circRNAs) are single-stranded, covalently closed RNA molecules lacking free ends, which have emerged as critical regulators of cytokine signaling. Transcriptional and post-transcriptional regulation of cytokine signaling by circRNAs contributes to cancer pathogenesis. Here, we discuss the emerging role of circRNAs in modulating cytokine signaling pathways that regulate cancer development. In particular, we examine the role of circRNAs in TGF-β, IL-6, IL-10, TNF-α, VEGF, FGF, PDGF, and chemokine signaling in cancer.

Trends in active hepatitis B virus infection and associated risk factors among blood donor candidates from Luanda, Angola

Hepatitis B virus (HBV) infection is a global public health concern with a high burden in the African region. Assessing trends in HBV infection over time can provide insights into the effectiveness of prevention/treatment strategies in different settings. Herein, we investigate trends in active HBV infection and associated risk factors among blood donor candidates from Luanda, Angola. This was a retrospective study conducted with 96,654 medical records of blood donors consulted between 2018 and 2022 at the Angolan National Blood Institute. Participants were screened for hepatitis B surface antigen (HBsAg). Chi-square, Prevalence Ratio, and logistic regression were used to analyse interactions between demographic variables and were deemed significant when p < 0.05. Active HBV infection was 10% (95% CI: 9.4-10.6). Men (AOR: 1.38, p < 0.001), employed (AOR: 3.25, p < 0.001) and non-urbanised regions (AOR: 1.16, p = 0.019), were more likely to contract the HBV, while aged 30 years or older (AOR: 0.78, p < 0.001) and married (AOR: 0.66, p < 0.001), were less likely to contract the infection. From 2018 to 2022, HBV infections increased from 18.2 to 21.9%. Infections increased in under 30 years (31.3-52.5%, p < 0.001), males (91.1 to 91.8%, p = 0.149), urbanised regions (2.7 to 3.3%, p = 0.538), and unmarried (93.9 to 95.8%, p = 0.019). We revealed a highly active HBV infection over the past 5 years in the adult population of Luanda, Angola. Age, gender, occupation, place of residence and marital status have influenced the dissemination of HBV in Angola. Our findings may facilitate the planning and evaluation of the HBV control program in Angola.

The exposome and pancreatic cancer, lifestyle and environmental risk factors for PDAC

Pancreatic cancer (PC), particularly pancreatic ductal adenocarcinoma (PDAC), is a significant global health issue with high mortality rates. PDAC, though only 3 % of cancer diagnoses, causes 7 % of cancer deaths due to its severity and asymptomatic early stages. Risk factors include lifestyle choices, environmental exposures, and genetic predispositions. Conditions like new-onset type 2 diabetes and chronic pancreatitis also contribute significantly. Modifiable risk factors include smoking, alcohol consumption, non-alcoholic fatty pancreatic disease (NAFPD), and obesity. Smoking and heavy alcohol consumption increase PC risk, while NAFPD and obesity, particularly central adiposity, contribute through chronic inflammation and insulin resistance. Refined sugar and sugar-sweetened beverages (SSBs) are also linked to increased PC risk, especially among younger individuals. Hormonal treatments and medications like statins, aspirin, and metformin have mixed results on PC risk, with some showing protective effects. The gut microbiome influences PC through the gut-pancreas axis, with disruptions leading to inflammation and carcinogenesis. Exposure to toxic substances, including heavy metals and chemicals, is associated with increased PC risk. Glycome changes, such as abnormal glycosylation patterns, are significant in PDAC development and offer potential for early diagnosis. Interactions between environmental and genetic factors are crucial in PDAC susceptibility. Genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) linked to PDAC, but gene-environment interactions remain largely unexplored. Future research should focus on polygenic risk scores (PRS) and large-scale studies to better understand these interactions and their impact on PDAC risk.

Identification of host lncRNAs that impact Venezuelan equine encephalitis virus replication

Venezuelan equine encephalitis virus (VEEV) causes encephalitis in humans and equids, and there are no vaccines or therapeutics available for humans. In recent years, non-coding RNAs have emerged as critical regulatory factors affecting different cellular pathways. Specifically, long non-coding RNAs (lncRNAs) have been identified as regulators of antiviral pathways during various viral infections; however, their role in regulating VEEV infection has not been assessed. Here we show differential expression of several lncRNAs in primary mouse target cells infected with a vaccine strain of VEEV (TC-83) but not a pathogenic strain (TrD). Among the differentially expressed genes (DEGs), suppressing lncRNA small nucleolar RNA host gene 15 (Snhg15) resulted in about a 7-fold increase in VEEV TC-83 replication in primary mouse astrocytes. Knockdown of Snhg15 during VEEV TC-83 infection resulted in the suppression of ten genes including Irf1, Junb, Atf3, Relb, Pim1, Hbegf, Ccl5, Ankrd33b, and H2-K2, all of which were also increased during TC-83 infection when the expression of Snhg15 increased in primary mouse astrocytes. Most of these genes are involved in antiviral responses. KEGG pathway analysis confirmed the suppression of both pattern recognition receptor and inflammatory pathways after in Snhg15 knockdown. These data are the first to identify lncRNA responses in encephalitic alphavirus infection and demonstrate important roles for these overlooked RNAs on VEEV infection.

Efficacy of high-frequency sonic irrigation on removing debris from root canal isthmus: an in vitro study based on simulated root canals

Background

Infection control is important in root canal treatment. Effective cleaning and shaping are challenging due to complex anatomy, particularly in the isthmus-narrow connections between canals that can harbor bacteria. Conventional needle irrigation (CNI) is inadequate in this region, prompting the use of passive ultrasonic irrigation (PUI) and high-frequency acoustic instruments like EDDY. This study evaluates the cleaning effects of four irrigation protocols using 3D-printed isthmus models.

Methods

Sixty digital root canal models with isthmuses in the coronal, middle, and apical thirds were designed using Ansys 19.0 and 3D printer (20 specimens per isthmus location). Specimens were prepared to 30#, 0.04 without irrigation. Debris accumulation in the isthmus was photographed and analyzed using Image J to calculate the initial debris area (S1). Specimens were then irrigated using CNI, low-frequency sonic irrigation (EndoActivator, EA; Dentsply, Charlotte, NC, USA), PUI, or high-frequency sonic irrigation (EDDY), followed by re-imaging to calculate remaining debris area (S2). Debris reduction percentage was determined using the formula: (S1-S2)/S1 × 100%.

Results

Debris reduction varied with isthmus position. In the coronal third, EDDY achieved the highest debris reduction (86.18 ± 2.25%), followed by PUI, EA, and CNI, with significant differences among groups (P < 0.05). The same trend was observed in the middle third, with EDDY showing the highest efficacy (73.96 ± 6.75%). In the apical third, debris reduction was lower overall, with no significant difference between EDDY and PUI, but both outperformed EA and CNI.

Discussion

Our results showed that EDDY demonstrated superior debris removal in the coronal and middle thirds, but all irrigation protocols showed limited efficacy in the apical third.

The effect of cognitive retraining after stroke on everyday living: A systematic review and meta-analysis

ObjectiveTo determine if the addition of cognitive retraining to rehabilitation following stroke results in better everyday living outcomes.Data sourcesElectronic databases MEDLINE, EMBASE, PsycINFO, CINAHL, OT Seeker and Cochrane Library were searched until January 2025.Review methodsRandomised controlled trials were included if they measured change in function and investigated a cognitive retraining intervention aimed at restoration of impaired cognition in one or more specific cognitive domains in the adult stroke population. Papers were excluded if they exclusively provided interventions that were not restorative, such as compensatory approaches or direct task retraining. Two independent reviewers extracted data and assessed study quality.ResultsTwenty-one studies involving 1476 participants were included. There was very low-quality evidence that basic activity of daily living (ADL) was not improved by the addition of cognitive retraining (standardised mean difference (SMD) 0.48, 95% confidence interval (CI) -0.04 to 1.01). There was moderate quality evidence that cognitive retraining had no effect on Instrumental ADL (IADL) (SMD -0.19, 95% CI -0.65 to 0.27) or other measures of functional performance (SMD -0.03, 95% CI -0.31 to 0.24).ConclusionsCognitive retraining focusing on restoration of one or more cognitive domains after stroke did not show an impact in basic ADL performance, IADL performance, or other measures of functional performance. Results were complicated by low-quality evidence and methodological factors including variations in study populations, interventions provided and outcome measures. Further research that includes suitable measures of everyday living is needed to provide more robust evidence and guide clinical practice.

The roles, signalling pathways and therapeutic implications of Apoc1 in cancer

The apolipoprotein C (Apoc) family comprises a group of low-molecular-weight proteins that are essential for modulating lipoprotein metabolism, primarily influencing lipid transport and metabolic pathways. Apoc1, a member of the Apoc family, is consistently overexpressed across various cancers, significantly correlating with poor prognosis. The multifaceted role of Apoc1 includes promoting cancer progression by activating key signalling pathways such as epithelial-mesenchymal transition (EMT), mitogen-activated protein kinases (MAPK), STAT3 and WNT3 A. Additionally, Apoc1 contributes to the regulatory networks involving lncRNAs and miRNAs, thereby influencing cancer. This comprehensive review delineates Apoc1's mechanisms within malignant tumours and assesses its prognostic implications for patients with cancer. The aim is to shed light on potential novel therapeutic strategies in oncology, potentially revolutionising patient care and thereby enhancing patient survival rates and quality of life.

Epidemiological status and genome characteristics of canine parvovirus in China from 2022 to 2024

Canine parvovirus (CPV) is a highly contagious and lethal virus that primarily affects dogs. The virulence and transmissibility of this virus have intensified over time, posing significant challenges to the prevention and control of this pathogen. In this study, to investigate the epidemiology of CPV in China, 2,654 fecal samples were collected from seven provinces, and the positive rate was found to be 50.53%. The positive rates in Liaoning, Shandong, Hubei, Hunan, Guangxi, Jiangxi, and Fujian provinces were 78.53%, 9.25%, 58.37%, 3.00%, 42.68%, 78.26%, and 41.47%, respectively. Among these samples, four genotypes were identified: CPV-2 (4.42%), CPV-2c (69.04%), new CPV-2a (23.81%), and new CPV-2b (2.7%). Notably, CPV-2c emerged as the most prevalent genotype. Amino acid sequence alignments indicated that the main substitutions in VP2 were M87L, S297A, A300G, Y324I, N375D, and N426D/E, and the main substitutions in NS1 were I60V, Y544F, E545V, and L630P. Moreover, the mutations A5G, Q370R, and N426E were observed to be nearly universal among all CPV-2c strains, and I60V, Y544F, E545V were mainly found in CPV-2c and new CPV-2b strains. Phylogenetic analysis based on VP2 sequences revealed that CPV and FPV formed two distinct clusters. Furthermore, the CPV cluster was subdivided into four groups: CPV-2, CPV-2c, new CPV-2a, and new CPV-2b. However, the sub-branch of the NS1 evolutionary tree did not correspond strictly to the CPV genotype. In summary, our findings revealed significant variation in the prevalence of CPV across different regions in China. These findings carry significant implications for our understanding of CPV transmission dynamics and will play an important role in informing vaccine development strategies.

Sensory and Multisensory Processing Changes and Their Contributions to Autism and Schizophrenia

Natural environments are typically multisensory, comprising information from multiple sensory modalities. It is in the integration of these incoming sensory signals that we form our perceptual gestalt that allows us to navigate through the world with relative ease. However, differences in multisensory integration (MSI) ability are found in a number of clinical conditions. Throughout this chapter, we discuss how MSI differences contribute to phenotypic characterization of autism and schizophrenia. Although these clinical populations are often described as opposite each other on a number of spectra, we describe similarities in behavioral performance and neural functions between the two conditions. Understanding the shared features of autism and schizophrenia through the lens of MSI research allows us to better understand the neural and behavioral underpinnings of both disorders. We provide potential avenues for remediation of MSI function in these populations.

Deoxynivalenol and pigs: review of harmful effect of Mycotoxin on swine health

Mycotoxins are compounds produced by certain types of fungi, and the mycotoxin one of the most most frequently found in the tested cereal samples is deoxynivalenol (DON), naturally-occurring mycotoxin produced by Fusarium spp. An animal sensitive to the effects of this mycotoxin is the pig due to the diet containing primarily cereals and the structure of a digestive system, which causes DON to be quickly absorbed unchanged into the bloodstream and partially metabolized in the liver. An important aspect when considering the toxicity of DON is the occurrence of its modified forms, which can be transformed into DON in the digestive system. The toxic effect of DON can also be caused by other mycotoxins which co-occur in cereals. The toxic effect of DON on the body of pigs was observed mainly in the digestive, immune, and reproductive systems. The noticeable of DON's toxic effects depends on the exposure time, route of administration and mycotoxin concentration. The changes are mainly caused by impaired gene expression, inhibiting protein synthesis or the effect of DON on pathways in pigs' bodies. The negative impact of DON on the health of pigs may lead to reduced weight gain, poor health, and increased susceptibility to infections and reproductive disorders. There have also been many methods of DON elimination from cereals, but their efficiency is insufficient.

Bone marrow microenvironment in myelodysplastic neoplasms: insights into pathogenesis, biomarkers, and therapeutic targets

Myelodysplastic neoplasms (MDS) represent a heterogeneous group of malignant hematopoietic stem and progenitor cell (HSPC) disorders characterized by cytopenia, ineffective hematopoiesis, as well as the potential to progress to acute myeloid leukemia (AML). The pathogenesis of MDS is influenced by intrinsic factors, such as genetic insults, and extrinsic factors, including altered bone marrow microenvironment (BMM) composition and architecture. BMM is reprogrammed in MDS, initially to prevent the development of the disease but eventually to provide a survival advantage to dysplastic cells. Recently, inflammation or age-related inflammation in the bone marrow has been identified as a key pathogenic mechanism for MDS. Inflammatory signals trigger stress hematopoiesis, causing HSPCs to emerge from quiescence and resulting in MDS development. A better understanding of the role of the BMM in the pathogenesis of MDS has opened up new avenues for improving diagnosis, prognosis, and treatment of the disease. This article provides a comprehensive review of the current knowledge regarding the significance of the BMM to MDS pathophysiology and highlights recent advances in developing innovative therapies.

Biomarkers Related to Interferon-γ Pathway in Myocardial Ischemia-Reperfusion Injury and the Potential Molecular Mechanisms

Although reperfusion therapy can reduce the mortality of myocardial infarction, it results in myocardial ischemia-reperfusion injury (MIRI). The molecular mechanism by which the interferon-γ pathway affects MIRI is unclear, so we addressed this problem by mining transcriptome and single-cell sequencing data. The GSE160516 and GSE83472 datasets, single cell RNA sequencing (scRNA-seq) data of GSE227088 dataset and 182 interferon-γ pathway related genes (IRGs) were retrieved and incorporated into this study. The differentially expressed genes (DEGs) between MIRI and control samples were searched, the candidate genes were obtained by intersecting DEGs with IRGs. The protein-protein interaction (PPI) analysis was utilized for selecting key genes from candidate genes. Moreover, key genes with significant expression and consistent trend in GSE160516 and GSE83472 datasets were selected as biomarkers. The biological functions and regulatory mechanism of biomarkers were investigated by enrichment analysis and predicting the upstream molecules targeting them. Ulteriorly, cell clusters were identified via unsupervised cluster analysis and merged into different cell types by cell annotation. Cell types in which biomarkers observably and differentially expressed were selected as crucial cell types. Finally, cell communication and pseudo-time analysis were implemented based on crucial cell types. Totally 34 candidate genes were searched by overlapping 1,930 DEGs with 182 IRGs. Nine key genes were singled out from candidate genes, of which Myd88 and Trp53 were significantly upregulated in the MIRI samples of GSE160516 and GSE83472 datasets, so they were identified as biomarkers. Besides, they participated in pathways such as ribosome, spliceosome and cell cycle. Myd88 might be simultaneously regulated by mmu-miR-361-3p and mmu-miR-421-3p, and Trp53 could be regulated by Abl1 and Tead2. Totally 25 cell clusters were merged into six cell types, of which three crucial cell types (cardiomyocyte, fibroblast, and macrophage) could interact with each other through receptor-ligand. Pseudo-time analysis revealed states 1, 2, and 5 of macrophages might be associated with MIRI. Two biomarkers (Myd88 and Trp53) related to IRGs in MIRI were mined, providing a reference for elucidating the mechanism of interferon-γ pathway on MIRI.