Search Results (740)

Due to the stroke-protective effects of dietary fiber and anthocyanin together with the synergistic interaction, we hypothesized that the functional drink containing the anthocyanins and dietary fiber-enriched functional ingredient from banana and germinated black Jasmine rice (BR) should protect against ischemic stroke. BR at doses of 300, 600, and 900 mg/kg body weight (BW) was orally given to male Wistar rats weighing 290–350 g once daily for 21 days, and they were subjected to ischemic reperfusion injury induced by temporary occlusion of the middle cerebral artery (MCAO/IR) for 90 min. The treatment was prolonged for 21 days after MCAO/IR. They were assessed for brain infarction volume, neuron density, Nrf2, MDA, and catalase in the cortex together with serum TNF-α and IL-6. Lactobacillus and Bifidobacterium spp. in feces were also assessed. Our results showed that BR improved the increase in brain infarcted volume, MDA, TNF-α, and IL-6 and the decrease in neuron density, Nrf2, catalase, and both bacteria spp. induced by MCAO/IR. These data suggest the stroke-protective effect of the novel functional drink, and the action may involve the improvement of Nrf2, oxidative stress, inflammation, and the amount of Lactobacillus and Bifidobacterium spp. Full article

Background/Objectives: Papillary thyroid microcarcinoma (MPTC), a subset of papillary thyroid carcinoma (PTC), is increasingly detected with advanced imaging. While most MPTCs are indolent, some exhibit aggressive behavior, complicating clinical management. The BRAF V600E mutation, common in PTC, is linked to aggressive features, and its allele frequency (AF) may serve as a biomarker for tumor aggressiveness. This study explored the association between BRAF V600E AF and aggressive histopathological features in MPTC. Methods: Data from 1 January 2016 to 23 December 2023 were retrieved from two McGill University teaching hospitals. Inclusion criteria comprised patients aged ≥ 18 years with thyroid nodules ≤ 1 cm, documented BRAF V600E mutation and AF results, and available surgical pathology reports. Tumor aggressiveness was defined as the presence of lymph node metastasis, aggressive histological subtype (tall cell, hobnail, columnar, solid/trabecular or diffuse sclerosing), extra thyroidal extension, or extensive lymphovascular extension. Associations were explored using t-tests. Results: Among 1564 records, 34 met the inclusion criteria and were included in analyses. The mean BRAF V600E AF was significantly higher in aggressive tumors (23.58) compared to non-aggressive tumors (13.73) (95% CI: −18.53 to −1.16, p = 0.03). Although not statistically significant, trends were observed for higher BRAF V600E AF in tumors with lymph node metastasis (mean AF: 25.4) compared to those without (mean AF: 16.67, p = 0.08). No significant difference was noted in BRAF V600E AF by histological subtype (mean AF for aggressive: 19.57; non-aggressive: 19.15, p = 0.94). Conclusions: Elevated BRAF V600E AF is associated with aggressive behavior in MPTC, highlighting its potential as a biomarker to inform treatment strategies. Larger studies are warranted to validate these findings and enhance clinical management of MPTC patients. Full article

This study documents Black Wisconsinites’ birthing experiences and their proposed solutions to improve Black birthing people’s trust in healthcare. Between 2019 and 2022, we conducted semi-structured, longitudinal interviews (both individual and focus group interviews) with those enrolled in a local perinatal support group program for Black birthing people (N = 25), asking about their pregnancy, birthing, and postpartum experiences and their ideas for building trust in healthcare. Using the Daughtering Method and Braun and Clarke’s method of reflexive thematic analysis, we coded the interview data and then iteratively collated the codes into themes and subthemes. Participants described experiencing medical racism, including healthcare trauma and provider bias, during pregnancy and delivery. They drew connections between those experiences and the distrust they felt toward healthcare providers and the healthcare system. They provided actionable strategies that individual providers and the healthcare system can take to build the trust of Black birthing people: employ more Black providers, listen to Black birthing people, exhibit cultural humility, engage in shared decision-making, build personal connections with patients, and spend more time with patients. This study connects Black birthing people’s experiences of medical racism to feelings of medical distrust and provides community-identified actionable suggestions to build trust and shape how we combat racial disparities in healthcare provision and health outcomes. Full article

Bone metastasis remains a significant cause of morbidity and diminished quality of life in patients with advanced breast, prostate, and lung cancers. Emerging research highlights the pivotal role of reversible epigenetic alterations, including DNA methylation, histone modifications, chromatin remodeling complex dysregulation, and non-coding RNA networks, in orchestrating each phase of skeletal colonization. Site-specific promoter hypermethylation of tumor suppressor genes such as HIN-1 and RASSF1A, alongside global DNA hypomethylation that activates metastasis-associated genes, contributes to cancer cell plasticity and facilitates epithelial-to-mesenchymal transition (EMT). Key histone modifiers, including KLF5, EZH2, and the demethylases KDM4/6, regulate osteoclastogenic signaling pathways and the transition between metastatic dormancy and reactivation. Simultaneously, SWI/SNF chromatin remodelers such as BRG1 and BRM reconfigure enhancer–promoter interactions that promote bone tropism. Non-coding RNAs, including miRNAs, lncRNAs, and circRNAs (e.g., miR-34a, NORAD, circIKBKB), circulate via exosomes to modulate the RANKL/OPG axis, thereby conditioning the bone microenvironment and fostering the formation of a pre-metastatic niche. These mechanistic insights have accelerated the development of epigenetic therapies. DNA methyltransferase inhibitors (e.g., decitabine, guadecitabine) have shown promise in attenuating osteoclast differentiation, while histone deacetylase inhibitors display context-dependent effects on tumor progression and bone remodeling. Inhibitors targeting EZH2, BET proteins, and KDM1A are now advancing through early-phase clinical trials, often in combination with bisphosphonates or immune checkpoint inhibitors. Moreover, novel approaches such as CRISPR/dCas9-based epigenome editing and RNA-targeted therapies offer locus-specific reprogramming potential. Together, these advances position epigenetic modulation as a promising axis in precision oncology aimed at interrupting the pathological crosstalk between tumor cells and the bone microenvironment. This review synthesizes current mechanistic understanding, evaluates the therapeutic landscape, and outlines the translational challenges ahead in leveraging epigenetic science to prevent and treat bone metastases. Full article

The transition to sustainable agriculture is a critical challenge for the U.S. food system. A sustainable food system must support the production of healthy and nutritious food while ensuring economic sustainability for farmers and ranchers. It should also reduce negative environmental impacts on soil, water, biodiversity, and climate, and promote equitable and inclusive access to land, farming resources, and food. This narrative review synthesizes U.S. social science literature to identify the key factors that support or impede the adoption of sustainable agricultural practices in the U.S. Our analysis reveals seven overarching factors that influence producer decision-making: awareness and knowledge, social factors, psychological factors, technologies and tools, economic factors, implementation capacity, and policies and regulations. The review highlights the critical role of social science in navigating complexity and uncertainty. Key priorities emerging from the literature include developing measurable, outcome-based programs; ensuring credible communication through trusted intermediaries; and designing tailored interventions. The findings demonstrate that initiatives will succeed when they emphasize measurable benefits, address uncertainties, and develop programs that capitalize on identified opportunities while overcoming existing barriers. Full article

Background/Objectives: Patients with an ileoanal pouch change their diet to manage their symptoms and will often resort to the internet for nutrition advice. Currently, no evidence-based dietary guidelines exist to inform online resources. Hence, this study aims to assess the quality of online nutrition information directed towards patients with an ileoanal pouch. Methods: A systematic Google search was conducted to identify consumer websites including information on nutrition for those with ileoanal pouches. Quality was assessed using the DISCERN instrument, and the readability of written content was assessed using the Flesch–Kincaid score. A summative content analysis was used to identify the frequency of particular topics. Websites were also assessed against standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision-making support tools. Results: A total of 12 websites met the inclusion criteria. Mean total DISCERN scores across all websites are 33 out of 75, indicating that overall, the websites were of poor quality. The mean Flesch–Kincaid score was 57 out of 100, or “fairly difficult” in terms of readability. The main themes according to the content analysis were “general dietary advice for pouch”, “dietary strategies for symptom management”, “addressing risks associated with having a pouch”, and “optimisation of nutritional intake”. Overall, websites did not meet the standards for shared decision-making. Conclusions: Online nutrition information for patients with an ileoanal pouch is of poor quality and difficult to understand. There is a need for higher quality online resources for these patients, ideally co-produced with a multidisciplinary team and patient, to provide patients with good quality, understandable, and accessible nutrition information. Full article

Background: The International Frontal Sinus Anatomy Classification (IFAC) is a consensus created to simplify the classification of cells affecting frontal sinus drainage. Our study aims to determine the prevalence of the frontal cell variants using the IFAC and to identify their association with the development of FS in the Korean population. Methods: A total of 1060 computed tomography scans of paranasal sinuses (PNS CT) were reviewed. Patient demographics were recorded, and the presentation of types of IFAC cells and presence of frontal sinusitis (FS) were documented. Results: The mean age of the subjects’ scans is 49.8 ± 17, ranging from 16 to 94 years old. The frequency of cells presents from most common to least common are agger nasi cells (ANCs) at 97.1%, suprabullar cells (SBCs) at 73.8%, supraagger cells (SACs) at 38.1%, supraorbital ethmoid cells (SOECs) at 23.3%, frontal septal cells (FSCs) at 19.2%, suprabullar frontal cells (SBFCs) at 16.3% and supraagger frontal cells (SAFCs) at 10.1%. A total of 183 (17.7%) frontal sinuses had an infection, of which the majority were male 67.2%. The presence of SAFCs and/or SBFCs is significantly associated with the development of FS with OR_SAFC = 1.646 and OR_SBFC = 4.483, respectively. Conclusion: The presence of SAFCs and SBFCs statistically increased the probability of developing FS. Full article

Objective: Potassium levels (KLs) influence clinical outcomes in severe traumatic brain injury (TBI). This study investigates the relationship between KLs and clinical outcomes to improve prognosis and guide management. Method: A retrospective study was conducted at a level 1 trauma center in Queens, New York, from January 2020 to December 2023. Patients with an AIS score of 3 or higher were included. KLs were measured at the time of hospital admission, ICU admission, ICU discharge, hospital discharge, and death, if applicable. Clinical outcomes such as age, race, length of hospital stay (H LOS), ICU length of stay (ICU LOS), ventilation days (VDs), Glasgow Coma Scale (GCS), and mortality were assessed. Results: KLs were categorized into five groups: extreme hypokalemia (<2.5 mEq/L), hypokalemia (2.6–3.5 mEq/L), normokalemia (3.5–5.2 mEq/L), hyperkalemia (5.2–7.0 mEq/L), and extreme hyperkalemia (>7.0 mEq/L). Significant correlations were observed between KLs at hospital admission and age (p = 0.0113), race (p = 0.003), and H LOS (p = 0.079). ICU KLs showed positive correlations with AIS head score (p = 0.038), ISS (p = 7.84 × 10⁻⁶), and GCS (p = 2.6 × 10⁻⁶). ICU KLs were also associated with LOS in the Emergency Department (ED) (p = 6.875 × 10⁻⁶) and ICU (p = 1.34 × 10⁻²¹), as well as VDs (p = 7.19 × 10⁻⁷). ICU discharge KLs correlated with ISS (p = 2.316 × 10⁻³), GCS (p = 2.201 × 10⁻³), ED LOS (p = 3.163 × 10⁻⁴), and VDs (p = 7.44 × 10⁻⁴). KLs at discharge were linked with mortality (p < 0.0001) and H LOS (p = 0.0091). Additionally, KLs at the time of death were correlated with ISS (p = 0.01965), GCS (p = 0.01219), ED LOS (p = 0.00594), ICU LOS (p = 0.049), VDs (p = 0.00005), and mortality (p < 0.0001). Conclusions: Potassium imbalances, especially hypokalemia, significantly affect outcomes in severe TBI patients. Monitoring and managing KLs may improve prognosis. Full article

Background/Objectives: Single-dose pre-operative antibiotic prophylaxis for cardiac-device implantation is recommended but extending antibiotic prophylaxis is common. Locally, 50–60% of patients had extended prophylaxis after pacemaker insertion or generator change. Our antimicrobial stewardship programme (ASP) incorporated behavioural change strategies in implementing a multi-pronged intervention bundle to address this and evaluated its effectiveness and safety. Methods: This single-centre, retrospective cohort study included patients aged 21 years old or older, undergoing uncomplicated pacemaker insertion or generator change at Singapore General Hospital (SGH) from October 2022 to March 2025. To improve antibiotic use, ASP interventions incorporating behaviour change strategies were implemented, namely (1) data-driven feedback, (2) targeted education, (3) identification and engagement of ASP champion, and (4) clinical pathway revision. Results: There were 779 patients evaluated; 380 (48.8%) received standard prophylaxis while 399 (51.2%) received extended prophylaxis with oral antibiotics (mean duration, 3.3 ± 0.8 days). Following ASP interventions, the practice of extended prophylaxis declined significantly from 43.8% to 24.0% (p < 0.01). The incidence of surgical site infections was low and similar in both groups (0.8%, p = 1.000); all infections were superficial. There was also significant reduction in the proportion of patients on all antibiotics from 20.7% to 16.3% (p < 0.01). Identification and engagement of ASP champion proved pivotal in changing prescribing behaviour through peer influence and credibility. Conclusions: The bundled ASP interventions, incorporating behavioural change strategies, have effectively and safely reduced the use of extended prophylaxis post-cardiac device implantation. Behavioural change interventions are essential to achieve sustained stewardship success. Full article

Curcuma spp. is a popular ornamental crop valued for its vibrant appearance and suitability for both regular and off-season production. As global emphasis on freshwater conservation increases and with a demand for compact potted plants, reducing water use while maintaining high aesthetic quality presents a key challenge for horticulturists. Potassium silicate (PS) has been proposed as a foliar spray to alleviate plant water stress. This study aimed to evaluate the effects of PS on growth, ornamental traits, and photosynthetic parameters of off-season potted Curcuma cv. ‘Jasmine Pink’ under deficit irrigation (DI). Plants were subjected to three treatments in a completely randomized design: 100% crop evapotranspiration (ETc), 50% ETc, and 50% ETc with 1000 ppm PS (weekly sprayed on leaves for 11 weeks). Both DI treatments (50% ETc and 50% ETc + PS) reduced plant height by 7.39% and 9.17%, leaf number by 16.99% and 7.03%, and total biomass by 21.13% and 20.58%, respectively, compared to 100% ETc. Notably, under DI, PS-treated plants maintained several parameters equivalent to the 100% ETc treatment, including flower bud emergence, blooming period, green bract number, effective quantum yield of PSII (ΔF/Fm′), and electron transport rate (ETR). In addition, PS application increased leaf area by 8.11% and compactness index by 9.80% relative to untreated plants. Photosynthetic rate, ΔF/Fm′, and ETR increased by 31.52%, 13.63%, and 9.93%, while non-photochemical quenching decreased by 16.51% under water-limited conditions. These findings demonstrate that integrating deficit irrigation with PS foliar application can enhance water use efficiency and maintain ornamental quality in off-season potted Curcuma, promoting sustainable water management in horticulture. Full article

Objective: Radical therapies are associated with significant morbidity in patients with localized prostate cancer (PCa). While advances in nuclear magnetic resonance techniques have enabled the development of focal ablation procedures that can selectively destroy tumors, preserve the gland and surrounding structures, and minimize side effects, existing vascular-targeted photodynamic therapy (VTP) and nanodrug therapies often face limitations, such as recurrence and insufficient drug concentration at the tumor site. This study investigated a novel approach that combines VTP with systemic treatment using drug-loaded nanoparticles in a murine model, demonstrating substantial advancements beyond current monotherapies. Methods: SCID (severe combined immunodeficiency) mice were engrafted with androgen-sensitive prostate tumor cells (LNCaP-AR) and treated with a combination of VTP and two different drugs linked to fucoidan nanoparticles (Enzalutamide and Paclitaxel). Experiments were performed using different cohorts: the evaluation of oncological effect, the administration time and concentration of systemic therapy, a comparison of efficacy between VTP and radiotherapy, and the induction of the abscopal effect in untreated synchronous tumors. Results: The groups that received combination therapy showed better tumor control. After eight weeks, the recurrence-free survival rates were 87.5%, 62.5%, and 50% in the VTP + N-PAC, VTP + N-ENZ, and VTP monotherapy groups, respectively (p < 0.05). There was a significant difference in the intra-tumoral concentration of nanodrugs between the groups with combined treatment and monotherapy. After two weeks, the monotherapy groups showed almost total elimination of the drugs, whereas in the combined therapy groups, this concentration remained high, starting to decrease after three weeks (p < 0.05). Treatment with nanodrugs associated with VTP showed superior oncological benefits compared to radiotherapy alone or in combination with other therapies. The abscopal effect on synchronous tumors was not demonstrated with VTP alone or in combination with nanodrugs. Conclusions: Combining vascular photodynamic therapy with nanodrugs was highly effective in treating a prostate tumor model, leading to increased survival and a reduced risk of tumor recurrence. This approach significantly advances beyond existing VTP and nanodrug therapies by improving tumor control, ensuring sustained intra-tumoral drug concentration, and yielding superior oncological outcomes. Our results suggest that this therapy is a potential treatment option for prostate tumors treated with VTP in future clinical trials. Full article

Haploinsufficiency disorders are genetic diseases caused by reduced gene expression, leading to developmental, metabolic, and tumorigenic abnormalities. The dosage-sensitive Retinoic Acid Induced 1 (RAI1) gene, located within the 17p11.2 region, is central to the core features of Smith––Magenis syndrome (SMS) and Potocki––Lupski syndrome (PTLS), caused by the reciprocal microdeletions and microduplications of this region, respectively. SMS and PTLS present contrasting phenotypes. SMS is characterized by severe neurobehavioral manifestations, sleep disturbances, and metabolic abnormalities, and PTLS shows milder features. Here, we detail the molecular functions of RAI1 in its wild-type and haploinsufficiency conditions (RAI1+/−), as studied in animal and cellular models. RAI1 acts as a transcription factor critical for neurodevelopment and synaptic plasticity, a chromatin remodeler within the Histone 3 Lysine 4 (H3K4) writer complex, and a regulator of faulty 5′-capped pre-mRNA degradation. Alterations of RAI1 functions lead to synaptic scaling and transcriptional dysregulation in neural networks. This review highlights key molecular mechanisms of RAI1, elucidating its role in the interplay between genetics and phenotypic features and summarizes innovative therapeutic approaches for SMS. These data provide a foundation for potential therapeutic strategies targeting RAI1, its mRNA products, or downstream pathways. Full article

Background: Severe traumatic brain injury (TBI) remains a leading cause of mortality and long-term morbidity, particularly in high-acuity trauma settings. We aim to evaluate the clinical, physiologic, and socioeconomic factors associated with outcomes in patients with severe traumatic brain injury (TBI) at a single urban Level 1 trauma center. Method: This is a single-center, retrospective study of patients presenting with severe TBI between 1 January 2020 and 31 December 2023 at Elmhurst Hospital Center in Queens, New York. Patients were identified using ICD trauma codes and an Abbreviated Injury Severity (AIS) Head score of ≥3. Demographic data, injury characteristics, vital signs, airway interventions, alcohol level, and insurance status were analyzed. Result: A total of 1130 patients met the inclusion criteria. The cohort was predominantly male (76.1%) with a mean age of 52.7 years. Blunt trauma accounted for 97.8% of cases, with a mortality rate of 13.8%, while penetrating trauma comprised 2.2%, with a markedly higher mortality rate of 48%. Patients who died as full code had lower mean systolic blood pressure (82.5 mmHg), oxygen saturation (63%), and shorter emergency department stays (~3.7 h). The mean Glasgow Coma Scale (GCS) score was 12.6, dropping to 6.0 in patients who died. Moreover, higher AIS Head and Injury Severity Score (ISS) values were correlated with worse outcomes. Severely intoxicated patients had higher TBI incidence, with no clear difference observed when compared to normal BAC levels. Self-pay patients exhibited the highest mortality (40%). All associations were statistically significant (p < 0.0001). Conclusions: Severe TBI outcomes are significantly influenced by injury mechanisms, physiologic parameters, and socioeconomic status. These findings emphasize the need for targeted prognostic tools and improved trauma system preparedness for TBI patients at risk of poor outcomes. Full article

Background: Laparoscopic antireflux surgery (LARS) is widely used to treat gastroesophageal reflux disease (GERD). Iatrogenic gastroesophageal injuries, when recognized intraoperatively, can be managed without major consequences, whereas undetected injuries presenting as postoperative leaks are associated with high morbidity and mortality. Despite their complexity, research on post-LARS leaks is scant. We aim to describe the diagnosis and management of such injuries at a tertiary referral center. Methods: We describe a single-center case series of patients referred for gastroesophageal perforations after LARS. Patients were identified through the personal records of surgeons at our institution. A narrative literature review was conducted to summarize publications on the topic. Results: Five patients (four female [80%]; median age, 73 years [IQR, 67–74]) were included. The median time between LARS and clinical presentation was 2 (IQR, 1–8) days (range 1–15 days). The most frequent symptoms were shortness of breath (all five patients) and pain (three [60%] patients). All patients presented with hypoxia, and four (80%) patients presented with sepsis. Two (40%) patients underwent primary repair, and three (60%) required limited esophagogastrectomy without immediate reconstruction. All patients required both thoracic and abdominal exploration, and all of them experienced significant postoperative complications (Clavien–Dindo ≥ 3). The median hospital stay was 58 days (IQR, 34–59). At a median follow-up of 14 months (IQR, 6–28), all patients were alive. Conclusions: Although infrequent, gastroesophageal perforation after LARS often requires complex surgical interventions and prolonged hospital stays. Additional efforts should focus on prevention and early recognition. Full article

Heart failure is a heterogeneous disorder that can lead to cardiogenic shock. Mechanical circulatory support (MCS) devices can replace the cardiac function in an attempt to bridge patients to transplant or they can serve as destination therapy to improve overall patient functionality and in turn quality of life. Currently utilized MCS devices include devices such as Left Ventricular Assist Devices (LVADs), Biventricular Assist Devices (BiVADs), Impella, Total Artificial Hearts (TAHs), and extracorporeal membrane oxygenation (ECMO). This literature review examines a range of studies, case reports, and meta-analyses to present current approaches to mechanical circulatory support (MCS), along with the challenges and limitations of existing devices, common complications, and overall survival and long-term outcomes following MCS therapy. Full article