Search Results (56,358)

Background/Objectives: Shashen Maidong Decoction (SMD) has a long history of use within the traditional Chinese medicine (TCM) system and is currently employed in modern clinical practice for the treatment of various diseases. The characterization of the chemical constituents of TCM drugs is a prerequisite and foundation for research into bioactive compounds and quality control. However, no study has yet undertaken a comprehensive identification of its chemical constituents. Therefore, it is necessary to establish suitable analytical methods to comprehensively and systematically characterize the chemical constituents of SMD. Methods: Ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry (UHPLC-Q Exactive orbitrap HRMS) and the Global Natural Products Social Molecular Networking (GNPS) technology were employed. The chemical constituents in SMD were systematically identified by comparing mass spectrometry data with reference standards, databases and relevant literature, and by analyzing mass spectrometry fragmentation patterns. Results: A total of 86 compounds were identified in SMD, including 27 flavonoids, 2 homoisoflavonoids, 34 organic acids, 2 alkaloids, 4 amino acids, 5 saccharides, 3 triterpenes and 9 other constituents. Conclusions: This study represents the first relatively comprehensive and systematic characterization of the chemical constituents in SMD, enriching modern understanding of SMD and laying the foundation for the identification of bioactive compounds, the elucidation of mechanisms of action, and further development and utilization. Full article

Motivational interviewing (MI) is gaining traction in veterinary medicine as an evidence-based approach for engaging clients in conversations that strengthen their intrinsic motivation to change behaviours that affect the welfare of animals in their care. While MI has a substantial and well-established evidence base across human healthcare and related fields, the veterinary evidence base remains small and is currently limited by study design challenges, inconsistent fidelity measurement, and outcome measures that rarely extend beyond short-term changes in communication behaviour. Existing methodological guidance addresses treatment integrity and theoretical mechanisms but does not provide an integrated framework for designing robust studies across the range of questions relevant to veterinary practice. This paper addresses that gap by providing practical methodological guidance for researchers designing MI studies in veterinary clinical settings. A novel conceptual model of the MI implementation pathway, mapping the journey from practitioner awareness through training and delivery to client outcomes, is used to organise key research questions that need to be answered in veterinary contexts. Guidance is then provided on selecting appropriate study designs, measuring fidelity and outcomes, estimating sample size, and managing the practical and ethical challenges specific to veterinary clinical settings, alongside minimum reporting standards to support more rigorous and reproducible MI research. Full article

Endophytic fungi from Malaysian medicinal plants constitute a metabolically prolific yet underexplored reservoir for natural product discovery. This scoping review of 56 studies published between 2015 and 2025 identified a fundamental methodological divergence within the field: while phenotypic bioactivity screening dominates the literature (>87% of studies), it is weakly supported by chemical characterization (<25%) and entirely disconnected from genomic investigation (0% biosynthetic gene cluster studies). This phenotype-first paradigm has largely confined the field to descriptive reporting, limiting mechanistic understanding and translational potential. Collectively, the evidence reveals a substantial disconnect between reported bioactivities and their underlying biosynthetic foundations. To address this limitation, a practical genotype-to-phenotype workflow is proposed that integrates strain prioritisation, multi-omics-guided activation, chemical mapping, and mechanism-oriented validation. By linking genomic potential with metabolite production and biological function, this framework provides a roadmap for advancing fungal natural product discovery beyond conventional phenotype-driven screening. Adoption of such approaches may improve the identification of chemically novel and biologically relevant metabolites while supporting the sustainable development of Malaysia’s endophytic fungal resources for biotechnological and pharmaceutical applications. Full article

The rapid advancement of laboratory automation, robotics, and digital technologies has significantly transformed laboratory medicine worldwide, improving efficiency, diagnostic accuracy, and quality management. However, the adoption of these technologies in developing countries such as Indonesia remains uneven and is influenced by infrastructural, financial, regulatory, and workforce-related challenges. This structured narrative review aimed to critically examine the current landscape of laboratory automation and robotics in Indonesia, with particular emphasis on implementation challenges, workforce transformation among medical laboratory scientists (Ahli Teknologi Laboratorium Medik, ATLM), and pathways toward equitable integration. Studies published between 2015 and 2025 were identified through PubMed, Scopus, and Google Scholar, complemented by Indonesian regulatory documents, professional guidelines, and relevant grey literature. The review was informed by PRISMA principles and synthesized narratively to explore technological developments, operational impacts, policy contexts, and implementation barriers relevant to Indonesian laboratory systems. The findings indicate that automation and robotics offer substantial benefits, including improved turnaround time, enhanced quality assurance, reduced laboratory errors, and greater operational efficiency. Nevertheless, significant barriers persist, particularly disparities in digital infrastructure, financial constraints, limited workforce readiness, and the absence of comprehensive implementation frameworks. The review further highlights that automation is reshaping rather than replacing the role of ATLM, shifting professional responsibilities toward digital competency, automation oversight, data interpretation, and quality management. Achieving sustainable laboratory automation in Indonesia therefore requires an equity-centered and systems-oriented approach involving regulatory strengthening, workforce development, infrastructure investment, and multi-stakeholder collaboration. With strategic planning and policy alignment, laboratory automation and robotics hold considerable potential to modernize laboratory services and support Indonesia’s broader healthcare transformation agenda. Full article

Collapsin Response Mediator Protein 2 (CRMP2) has emerged as a central node in the pathogenesis of chronic pain, functioning as a multimodal ‘molecular switch’ that regulates microtubule dynamics, ion channel trafficking, and synaptic plasticity. The dysregulation of CRMP2, particularly through aberrant post-translational modifications (PTMs) such as phosphorylation and SUMOylation, is a critical driver of both peripheral and central sensitization. This review systematically examines the structure, regulation, and multifaceted roles of CRMP2 in pain signaling pathways. We then critically evaluate a spectrum of CRMP2-targeted therapeutic strategies, including small-molecule inhibitors, peptide-based agents, and gene silencing, highlighting their promising preclinical efficacy and safety profiles. Despite challenges in targeting specificity and central nervous system delivery, we posit that innovations in delivery systems, precision medicine, and AI-assisted drug design will catalyze the clinical translation of CRMP2-based, non-opioid analgesics, offering a paradigm shift in chronic pain management. Full article

Early clinical exposure (ECE) has been associated with increased confidence, professionalism, and career exploration in undergraduate medical education. Student-run free clinics (SRFCs), such as the Health Outreach Project (HOP) at Drexel University College of Medicine, provide opportunities for preclinical students to engage in patient care and community outreach. This qualitative study explored medical students’ perceptions of participation in HOP. Fourteen third- and fourth-year medical students with prior HOP experience participated in four semi-structured focus groups conducted virtually over Zoom. Data were analyzed using an inductive thematic analysis approach. Four major themes emerged: (1) early clinical exposure and clinical skills development, (2) community engagement and patient-centered perspectives, (3) professional identity formation and career exploration, and (4) opportunities, limitations, and emotional challenges of outreach work. Participants described HOP as an important source of authentic clinical exposure that increased confidence in patient interactions and broadened awareness of social determinants of health and underserved populations. Students also reflected on the influence of HOP on professional identity formation, career interests, and perspectives on patient-centered care, while acknowledging frustrations related to systemic barriers and limited resources. These findings suggest that students perceive SRFCs as valuable experiential learning environments that support clinical preparedness and professional development early in medical training. Full article

Introduction: High-Intensity Focused Ultrasound (HIFU) is a widely used non-invasive esthetic treatment for facial/neck rejuvenation, inducing thermal coagulation for neocollagenesis. Despite its general safety, its non-optimal application risks neurological adverse events like tinnitus, trigeminal neuralgia, and headaches. Materials and Methods: Out of a pool of 124 patients treated with HIFU (Dual Hi; Med & Tech, Occhiobello, Italy) by experienced esthetic clinicians, four patients developed neurological or otological disturbances, which are presented as descriptive clinical case reports. These included acute tinnitus, exacerbation of pre-existing tinnitus, trigeminal neuralgia during treatment, and post-procedural headaches. To contextualize the clinical findings, relevant published literature on neurological adverse events associated with esthetic HIFU was reviewed in a non-systematic manner using major scientific databases, and used to support descriptive clinical interpretation rather than formal systematic analysis. Results: Rare transient events include acute tinnitus post-HIFU; exacerbated pre-existing tinnitus; trigeminal neuralgia during a procedure; and post-session headaches. Potential mechanisms might include thermal and mechanical nerve injury adjacent to the superficial musculoaponeurotic system (SMAS); all cases resolved successfully through tailored approaches—spontaneous resolution, corticosteroids plus hyperbaric oxygen therapy, analgesics, or ibuprofen. Conclusions: Neurological adverse effects from esthetic HIFU are uncommon/self-limiting but underscore the need for operator training, anatomical expertise, and patient history screening. Standardized protocols are essential for safety. Full article

Ulomoides dermestoides (Yangchong) is a tenebrionid beetle used in traditional medicine across Asia and Latin America. While crude extracts show effects on inflammation, oxidative stress, and other conditions, systematic integration of its bioactive substances, mechanisms, and translational potential is lacking. This review consolidates its chemical basis, comprising volatile benzoquinones, terpenes, and alkenes, alongside non-volatile fatty acids, proteins (antioxidant enzymes, glycoproteins), and phenolics. Pharmacological evidence indicates multi-target modulation of reactive oxygen species (ROS), cytokines, leukocyte recruitment, endothelial activation, and thromboinflammation. Recent advances include proteomic identification of antioxidant protein complexes, neuroprotection in a Parkinson’s disease model, chromosome-level genome assembly, and isolation of the UDP-glucose pyrophosphorylase 2a (UGP2A) glycoprotein, which alleviates thrombosis partly via toll-like receptor 4/myeloid differentiation primary response 88 (TLR4/MyD88)-mediated endothelial anti-inflammatory effects. However, most evidence remains preclinical, relying on non-standardized crude extracts, and benzoquinone-containing fractions display potential cytotoxicity and genotoxicity. Future research should integrate bioassay-guided isolation, structural characterization, multi-omics, pharmacokinetic/pharmacodynamic (PK/PD) analysis, standardized quality markers, and rigorous safety evaluation to transform U. dermestoides from an empirical insect-derived medicinal resource into a scientifically validated source of preclinical antioxidant and anti-inflammatory candidate substances. Full article

Background: Postoperative bowel dysfunction, including delayed gastrointestinal recovery and postoperative ileus, is a common complication that increases morbidity and prolongs hospitalization. In this systematic review and meta-analysis, we evaluated the effects of manual therapies on postoperative bowel function. Methods: MEDLINE/PubMed, Google Scholar, the Cochrane Library, Semantic Scholar, and ClinicalTrials.gov were searched from database inception up to 17 March 2026, and studies evaluating osteopathic manipulative treatment (OMT) or abdominal massage in postoperative patients were included in our analysis. Risk of bias and certainty were assessed using validated study design-specific tools, including the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Random-effects meta-analyses were performed for the prespecified outcomes of time to first bowel movement, time to first flatus, and hospital length of stay. Results: Seventeen studies met our inclusion criteria. Both OMT and abdominal massage were associated with a significantly shorter time to first bowel movement compared with controls (OMT: mean difference [MD] −0.57 days, 95% CI −0.96 to −0.18; abdominal massage: MD −0.91 days, 95% CI −1.47 to −0.35). OMT was also associated with reduced hospital length of stay (MD −2.46 days, 95% CI −4.52 to −0.41), while time to first flatus demonstrated favorable but non-significant trends, with substantial heterogeneity. Conclusions: Manual therapy may be associated with earlier postoperative bowel recovery, although heterogeneity and methodological limitations warrant cautious interpretation. Further high-quality multicenter studies are needed to clarify the clinical significance and reproducibility of these findings. Full article

Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is associated with adverse outcomes in sepsis, but risk stratification within MASLD remains insufficiently defined. We investigated whether an admission liver–metabolic phenotype framework combining cardiometabolic burden with liver injury/fibroinflammatory risk markers identifies clinically relevant organ-support vulnerability in community-acquired sepsis. Methods: This secondary analysis of the prospective SepsisFAT cohort (378 adults with community-acquired sepsis) classified patients into four phenotypes by cardiometabolic burden (≥2 of: diabetes, hypertension, dyslipidemia, BMI ≥ 30 kg/m²) and liver-risk positivity (FIB-4 ≥ 2.67, APRI ≥ 1.0, liver stiffness ≥ 10 kPa, or FAST ≥ 0.55). The primary outcome was acute kidney injury (AKI), while continuous renal replacement therapy (CRRT), other organ-support outcomes and in-hospital mortality were secondary endpoints. Results: Phenotype distribution was Low-risk 137 (36.2%), Cardiometabolic-only 84 (22.2%), Liver-dominant 88 (23.3%), and Mixed liver–cardiometabolic 69 (18.3%). AKI and CRRT increased across phenotypes (13.9% to 40.6% and 5.1% to 26.1%, respectively), and in-hospital mortality was highest in the Mixed phenotype (26.1%). After Firth-penalized adjustment for age, sex, and admission SOFA, the Mixed phenotype remained independently associated with AKI (aOR 2.82, 95% CI 1.37–5.90) and CRRT (aOR 3.87, 1.50–10.80), confirmed in non-renal SOFA and admission eGFR-adjusted sensitivity analyses. Cardiometabolic burden alone did not confer excess organ-support risk. The same gradient persisted within the MASLD subgroup. Conclusions: Admission liver–metabolic phenotyping identified a renal-vulnerable sepsis subgroup not captured by binary MASLD classification alone. These findings support prospective, multicenter external validation of liver–metabolic phenotyping as a pragmatic approach to renal risk stratification in community-acquired sepsis. Full article

Radiomic feature stability is a necessary condition for clinical translation, yet the impact of inter-observer segmentation variability remains insufficiently characterized for [18F]FDG PET/CT in breast carcinoma. We evaluated the inter-observer reproducibility of 107 original radiomic features extracted from [18F]FDG PET/CT images of 42 patients with biopsy-proven, treatment-naive primary breast carcinoma, using an IBSI-aligned PyRadiomics workflow. Two nuclear medicine physicians independently segmented each tumor using semi-automatic Otsu thresholding to generate an initial tumor mask, followed by manual correction. Reproducibility was quantified using ICC(A,1) with bootstrap-derived 95% confidence intervals. A two-stage reproducibility and redundancy-based feature reduction strategy, combining an ICC threshold with Spearman correlation-based redundancy removal, was applied across nine threshold combinations, and features were classified into three pre-specified stability categories. The segmentation agreement was good, with a mean Dice coefficient of 0.847. Most features showed excellent reproducibility (81/107, 75.7% with ICC ≥ 0.90; median ICC 0.972), whereas shape features based on maximum lesion extension showed poor reproducibility (ICC 0.10–0.25). The reduction strategy resulted in 19 stable non-redundant features, with eight retained across all threshold combinations; 79 features (73.8%) met high-stability criteria. These results and the proposed stability classification framework provide a methodological basis for future predictive PET radiomics studies in breast carcinoma. Full article

Mangosteen peel (Garcinia mangostana L.) is widely recognized as a rich source of xanthone derivatives, particularly α-mangostin, which exhibits diverse pharmacological activities and is increasingly utilized in herbal medicines and nutraceutical formulations. This study aimed to develop an integrated chemical fingerprinting approach combining chromatographic quantification and spectroscopic profiling to discriminate and evaluate the quality of GMP (Garcinia mangostana peel) extract collected from different Indonesian provinces. Ethanolic extracts of GMP, originating from ten distinct geographical regions, were subjected to high-performance liquid chromatography (HPLC) for the quantitative determination of α-mangostin. Fourier transform infrared (FTIR) spectroscopy was employed to generate characteristic fingerprint profiles and assess the functional group patterns present in the extracts. The correlation between chromatographic data and spectroscopic signatures was evaluated to elucidate regional variability. The geographical origin of the GMP extract significantly influences its phytochemical composition and α-mangostin content. The combined FTIR–HPLC approach offers a robust and practical framework for extract differentiation, preliminary estimation of α-mangostin content, and quality assurance of mangosteen-derived raw materials intended for 6a-standardized herbal and nutraceutical products. Full article

Cardiac arrhythmias complicate 20–50% of surgical procedures and contribute substantially to perioperative morbidity, mortality, and healthcare costs, with postoperative atrial fibrillation (POAF) being the most frequent form. Their genesis reflects the convergence of surgical stress, anaesthetic agents, autonomic imbalance, systemic inflammation, and electrolyte disturbances, explaining the limited efficacy of single-mechanism interventions. This narrative review synthesises contemporary evidence on pathophysiology, risk stratification, prevention, acute management, and emerging technologies, emphasising individualised, patient-tailored approaches. MEDLINE, Embase, and Cochrane CENTRAL were searched (January 2010–January 2026), prioritising randomised trials, meta-analyses, and guidelines. Contemporary risk stratification integrates clinical scores, biomarkers, and electrocardiographic parameters; machine-learning models show moderate discrimination (pooled AUC 0.84) and may enable more personalised prediction pending external validation. Evidence-based prophylaxis—beta-blockade, magnesium, selective amiodarone, and emerging anti-inflammatory strategies such as colchicine—reduces POAF in high-risk populations, while acute management is guided by haemodynamic status and individual risk. Anticoagulation follows CHA₂DS₂-VASc stratification, although optimal timing and duration remain undefined. Wearable monitoring, AI-based detection, and atrial-selective agents show clinical promise. Systematic, personalised integration of risk assessment, prophylaxis, monitoring, and management offers the clearest path to reducing arrhythmia-associated morbidity. Full article

African pygmy hedgehogs (APHs) are increasingly kept as companion animals, yet evidence-based nutritional recommendations for this species remain limited. Commercial cat or kitten diets are still commonly used by owners and veterinarians in practice, despite being formulated exclusively for domestic cats rather than for hedgehogs with omnivorous–insectivorous feeding habits. This cross-sectional study evaluated the association between dietary regimen and serum biochemical parameters associated with renal function in APHs. Blood samples were collected from 19 client-owned APHs aged 12–68 months: 10 hedgehogs fed a commercial kitten diet and 9 fed a commercial APH-specific diet. Serum concentrations of blood urea nitrogen, creatinine, phosphorus, and calcium were measured, and the nutritional composition of the two diets was compared using manufacturer declarations and targeted laboratory analyses. Hedgehogs fed the commercial kitten diet had significantly higher serum blood urea nitrogen (p = 0.0133), creatinine (p = 0.0279), and phosphorus (p = 0.0279) concentrations than those fed the APH-specific diet, whereas serum calcium concentrations did not differ significantly (p = 0.3846). These differences occurred despite similar dietary phosphorus content, while the commercial kitten diet had higher declared fat and lower fiber content. The findings suggest that dietary regimen may be associated with alterations in renal biochemical profiles in APHs and support the use of species-appropriate diets in clinical practice. Full article