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Abstract Introduction: Knee osteoarthritis is a debilitating disease that has been increasing in prevalence, especially due to the aging population and rising incidence of obesity. Biological therapies (orthobiologics) have emerged, demonstrating efficacy in improving functional scores, including the injection of microfragmented Adipose Tissue (mFAT). The purpose of this study is to evaluate the safety of adipose tissue harvesting and mFAT injection under local anesthesia. Materials/methods: A case series involving 34 patients who underwent adipose tissue collection from the abdomen under local anesthesia, without sedation, in a sterile environment, and who received the infiltration of microfragmented adipose tissue after single-time preparation, using a fat washing and microfragmentation kit. Results: Evaluation was performed at the time of the procedure and after 7 days of follow-up. Only ecchymosis (76.5 %) and mild discomfort at the harvested site (70.6 %), as well as mild discomfort at the infiltrated knee (61.8 %), were identified. No major adverse events were identified. Conclusion: The harvesting and injection of mFAT under local anesthesia is safe, with no major adverse events identified during this procedure.

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Abstract Introduction: Cervical Human Papillomavirus (HPV) infection, a common sexually transmitted infection, can lead to cervical cancer. This study investigates the impact of Photodynamic Therapy (PDT) on cellular immune function in cervical HPV-infected patients. Methods: From October 2022 to February 2023, 60 patients with cervical HPV infection were randomly assigned to a control group (conventional treatment) or a PDT group (PDT treatment), each with 30 patients. Peripheral blood samples and cervical tissue were collected before treatment, at 3 months, and at 6 months post-treatment. Flow cytometry assessed T-cell subsets (CD4+, CD8+, CD3+), and ELISA measured cytokine levels (TNF-α, IL-6, IL-8). Results: Baseline characteristics were similar between the PDT and control groups. The PDT group showed significantly higher HPV clearance rates at 3-months (70.00 %) and 6 months (100.00 %) compared to the control group 43.33 % and 80.00 %, respectively (p < 0.05). PDT significantly increased CD3+ and CD4+ cell levels at 3- and 6-months post-treatment compared to controls (p < 0.05). CD8+ levels and the CD4+/CD8+ ratio also significantly increased in the PDT group at 6 months. Additionally, PDT significantly reduced IL-6, IL-8, and TNF-α levels at 3- and 6-months post-treatment (p < 0.05). Conclusion: PDT enhances cellular immune function in cervical HPV-infected patients by increasing CD4+ and CD8+ T-cells and reducing pro-inflammatory cytokines. These findings highlight the potential of PDT in modulating immune responses and improving therapeutic strategies for cervical HPV infection.

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Abstract Introduction: The use of Hormone Dosage (HD) in Fine Needle Aspiration Biopsy (FNA) needle washout fluid, introduced in the 1990s, initially aimed at measuring Thyroglobulin (TG). Elevated TG concentration in an extrathyroidal cervical lesion suggests metastases of Well-Differentiated Thyroid Carcinomas (WDTC). Over the years, HD has evolved to incorporate Calcitonin (CT) and Parathormone (PTH), improving sensitivity and specificity in diverse clinical scenarios. Despite varying cutoffs in the literature, existing data underscore significant advancements in diagnostic accuracy. Methods: This paper presents a case series of 762 cervical lesions with FNA cytology and HD in different cervical regions. Results: It was possible to establish the histogenesis of the lesion based on a combination of the FNA cytology and PTH HD findings, so PTH was useful to determine parathyroid origin in all regions, Thyroglobulin (TG) and PTH together provide insights on cell origin in difficult cases. Thyroglobulin (TG) dosage enhances the accuracy of detecting well-differentiated thyroid carcinomas. In post-thyroidectomy by bed lesions, dosages help to determine non-thyroid/parathyroid lesions. Discussion: The case series and review underscore the valuable contribution of HD in fine-needle aspiration for the evaluation of cervical lesions. By integrating HD with cytological, ultrasound, and clinical data, clinicians can enhance the accuracy and specificity of FNA in diagnosing various cervical lesions, ultimately improving patient care and management.

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Abstract Background and aim: Malignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate. Methods: The authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage. Results: 82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4–12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7–26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant. Conclusion: Drainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.

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Abstract Background: Lactylation plays an essential role in pancreatic cancer, but the precise role of lactylated histone in the diagnosis and prognosis of pancreatic cancer remains to be further clarified. Methods: Twenty-one patients diagnosed with pancreatic cancer were enrolled in this study, and the clinico-pathologic characteristics were collected. Lactylation levels of total proteins and histone H3 Lysine-18 (H3K18) of tissues were determined by western blotting and laboratory indicators including serum levels of lactate, Cancer Antigen 19–9 (CA19–9), and Carcinoembryogenic Antigen (CEA) were obtained. Results: Total protein lactylation was found in both pancreatic cancer tissues and para-carcinoma normal tissues, and was more potent in tumor tissues. H3K18la was also highly expressed tumor tissues. Furthermore, H3K18la protein expression correlated positively with serum lactate (r = 0.774, p < 0.001), CA19–9 (r = 0.744, p < 0.001), and CEA (r = 0.589, p < 0.01). The Area Under the Curve (AUC) of H3K18la for the diagnosis of pancreatic cancer was 0.848 in serum (p < 0.001). Conclusion: The present findings suggested that H3K18 may be used as a novel potential biomarker for the diagnosis and prognosis of pancreatic cancer patients.

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Abstract Background: Primary Health Care (PHC) plays a pivotal role in the healthcare system as the initial point of contact for users and patients. In the healthcare area, claims are presented and managed through a web app. It also enables systematic analysis of emerging information to drive continuous improvement. The present objective was to describe the complaints filed at PHC in 2022. Methods: A cross-sectional study was conducted, examining complaints filed by patients in 2022. For inclusion of the complaints, it was established that it had to do with the treatment received by healthcare personnel and that was presented through the web app. Complaint texts signaling dissatisfaction with the information received were subjected to qualitative coding. Results: The study involved 326 users who submitted a total of 358 complaints specifically related to treatment and information. The average age of the participants was 33.5 ± 16.2 years, and the majority were women (72.4 %, n = 236). In 2022, the Cumulative Incidence (CCI) was 55.2 complaints per 100,000 healthcare act and the Complaint Incidence Rate (CIR), defined as the number of complaints/1000 users/year, was 6.5. The prevalence of complaints related to information was 12.4 %. The main reasons for complaints about information were issues related to communication with the patient (79 %), followed by the patient’s disagreement with the techniques applied by healthcare staff (17 %). Conclusions: Results show us the fundamental characteristics of complaints in primary care with respect to the information received by health professionals, not allowing us to know where the authors can influence through interventions or training actions to try to improve.

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Abstract Introduction: The Marginal Mandibular Nerve (MMN), despite being didactically described as being a unique branch of the other branches of the Facial Nerve, has in practice an abundant anatomical variation. Both in relation to its ramifications and the positioning of these in relation to the lower edge of the mandible, as well as its anastomoses along its path, play a fundamental role in the surgical strategy during the approach of this cervicofacial site, and can generate, as underestimated its characteristics, inadvertent injuries and motor consequences to the patient. Objective: To analyze the types of anatomical variations of the MMN in relation to its position, ramification, and distance from reference points, as well as its incidence that could imply technical difficulties in surgery. Methods: A systematic review was conducted in the literature in search of anatomical studies, in vivo or in cadavers, between 1981 and 2024, which described the quantification of the MMN branches, their positioning and peculiarities in relation to anastomoses with other peripheral nerves. Results: 511 hemifaces were studied, with the identification of 290 cases of single nerve, 160 cases of double branch, 54 cases of triple branch, and 7 cases of quadruple branch. Of the 456 nerves that were possible to study, the average distance when superior to the lower limit of the mandible was 1.61 cm, while its lower analysis was 2.53 cm. The branches presented different proportions of presentation in relation to this reference point depending on how many branches it had, being more common to remain below it. Anastomoses were identified between the MMN and the buccal and cervical branch of the Facial Nerve, as well as with the Trigeminal Nerve. Conclusion: The varied presentations of the MMN, both in its anatomical positioning and in the number of branches leads us to question whether the surgical thinking when performing an exploration in this site may not be the reason whythe authors verify several motor complaints superior to described injuries.

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Abstract Background: The study was to investigate circRBM33 in septic acute lung injury (ALI). Methods: Treatment of Murine Lung Epithelial-12 cells (MLE-12) cells was performed using 10 ng/mL Lipopolysaccharide (LPS). circRBM33, miR-15a-5p, and Enhancer of zeste homolog 1 (EZH1) were ascertained through RT-qPCR or Western blot analysis. The viability of MLE-12 cells was measured using the MTT assay, and their rate of apoptosis was ascertained through flow cytometry. B-cell lymphoma-2 (Bcl-2), and Bcl-2-associated X (Bax) were determined using Western blot analysis. Oxidative stress levels were assessed with ELISA kits, and levels of malondialdehyde(MDA) content, Superoxide Dismutase (SOD) activity, and glutathione (GSH) were detected. Dual luciferase reporter gene and RIP assays verified the targeting link between miR-15a-5p and circRBM33 or EZH1. The role of circRBM33 in ALI in vivo was determined by performing cecum ligationperforation (CLP) surgery. HE staining, W/D pulmonary edema, and histological damage scores were taken to assess the extent of lung tissue damage. ELISA was performed to determine proinflammatory factors in lung tissue and cells. Results: CircRBM33 downregulation ameliorated ALI-induced edema, apoptotic, and inflammatory reactions in mouse lung tissues. In addition, apoptosis and inflammation mediated by LPS in MLE-12 cells were ameliorated by circRBM33 downregulation, whereas miR-15a-5p knockdown or EZH1 elevation eliminated the action of silencing circRBM33. circRBM33 mediated EZH1 expression by competitive adsorption of miR-15a-5p. Conclusion: CircRBM33 improves ALI in septic mice by targeting the miR-15a-5p/EZH1 axis.

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Abstract Objective: To investigate the effect of Mometasone furoate (Elocon Cream) Nasal Spray (MFNS) treatment on hearing secretory Otitis Media (SOM) in younger children. Methods: Seventy-six children with SOM (ages 5 to 10 years-old) were selected as study subjects and divided into two groups of 38 cases each using a randomized numerical table. The control group was given conventional treatment, and the observation group was treated with MFNS based on the control group. Both groups were treated for 12 weeks. The improvements in clinical symptoms and hearing were compared between the two groups at weeks 4, 8 and 12 of treatment, respectively. Results: The total effective rate of treatment in the observation group was higher than that in the control group. The middle ear resonance frequency of the children in the observation group was higher than that of the control group at weeks 4, 8 and 12 of treatment, and the air-conduction hearing threshold was lower than that of the control group. The total effective rate of the observation group after 12-weeks of treatment was 92.11 %, which was significantly higher than that of the control group (73.68 %). In addition, the T-ETDQ score of the observation group was lower than that of the control group after treatment. Conclusion: MFNS has clinical efficacy in the treatment of SOM in young children, which can improve clinical symptoms, promote the recovery of hearing and eustachian tube function, reduce the local inflammatory response, and improve immune function.

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Abstract Objective: To investigate the clinical and swallowing profiles of patients with post-intubation tracheal or laryngotracheal stenosis requiring tracheostomy prior to surgical or corrective airway interventions. Methods: A retrospective cohort clinical study. Patients who met the inclusion criteria underwent a swallowing evaluation, as well as imaging studies of the neck and chest. At 6 and 12-months after the initial assessment, all patients participated in follow-up speech pathology consultations to evaluate the current state of swallowing and the progress of airway stenosis treatment. Results: Twenty-five patients with a median tracheostomy duration of 30.52 months were assessed. The study found a female predominance (68%) and a high prevalence of subglottic stenosis (44%). Most patients required intubation due to severe acute respiratory failure and airway protection due to a decreased level of consciousness. Imaging revealed additional airway abnormalities, including laryngotracheobronchitis and laryngeal edema. Swallowing assessments showed that 20% had significant dysphagia. After one year, only two patients were successfully decannulated, while others remained tracheostomy dependent. Conclusion: The study underscores the need for personalized, multidisciplinary care for these patients. It finds that while treatments like reconstructive surgeries and the Montgomery T-tube can be effective, complications such as clinical instability and dysphagia can worsen outcomes and extend the need for tracheostomy.

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Abstract Introduction This study aimed to investigate the associations among seizures, clinical characteristics, and brain injury on Magnetic Resonance Imaging (MRI) in infants with Hypoxic Ischemic Encephalopathy (HIE), and to determine whether these findings can predict unfavorable neurodevelopmental outcomes. Method Clinical and electrographic seizures were assessed by amplitude-integrated electroencephalogram, and the extent of brain injury was evaluated by using MRI. At 12‒24 months of age, developmental impairment or death was assessed. Between 2012 and 2020, 143 newborns were admitted for HIE, and 8 infants were excluded from the study. Results Eighty-five infants were diagnosed with greater than moderate HIE and 65 infants underwent therapeutic hypothermia. In addition, 38 infants experienced clinical seizures (clinical seizure group, CSG), 49 infants had electrographic seizures (Electrographic Seizure Group, ESG), and 48 infants had no seizures (no seizure group, NSG). The proportion of infants with neurodevelopmental impairment or death was significantly higher in the CSG than in the NSG (57.7 % and 26.1 %, p = 0.026). A risk factor analysis indicated that cord blood pH (adjusted Odds Ratio [aOR = 0.01]; 95 % Confidence Interval [95 % CI 0.001‒0.38]; p = 0.015) and MRI findings (aOR = 4.37; 95 % CI 1.25‒15.30; p = 0.012) were independently associated with abnormal neurodevelopment, after adjustment. Discussion Clinical seizures in infants with HIE were independently associated with abnormal neurodevelopment. However, cord blood pH and abnormal brain MRI findings were consistently linked to long-term neurodevelopmental outcomes.

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Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is a common chronic respiratory disease with a long course and recurrent symptoms, seriously affecting patients' quality of life. Objectives This study aimed to explore the interventional value of eight-section brocade exercises in combination with comprehensive measures of the physical function status of patients with COPD. Method This is a retrospective study. A total of 94 COPD patients admitted to the studied hospital were divided into two groups according to different intervention methods. The control group was treated with comprehensive intervention, and the research group received eight-section brocade exercises combined with comprehensive intervention. Results After an intervention, the research group exhibited longer exercise endurance time (p < 0.05); the modified Medical Research Council (mMRC) scores and quality of life scores in the research group were lower than those in the control group (p < 0.05); sleep quality scores of the research group being lower than those of the control group (p < 0.05); both groups experienced a decrease in adverse emotion scores, with the research group scoring lower than the control group (p < 0.05); the research group achieving better physical function status than the control group (p < 0.05); the nursing efficiency rate and satisfaction rate in the research group was higher than those in the control group (p < 0.05). Conclusions Eight-section brocade exercises can enhance the exercise endurance of and improve the lung function of COPD patients, which is of great significance for the recovery of patients’ physical function.

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Abstract Objective To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN). Methods This prospective cohort study included 207 consecutive patients diagnosed with CTL. Before confirming through pathology or laboratory tests, every patient received standard ultrasound, CEUS, and MRI examinations, with the imaging results analyzed afterward. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests. Results The presence of lymph node lesions was confirmed by routine ultrasound and MRI in 207 patients, of which 102 (49.27 %) had a pathological or laboratory diagnosis of metastatic lymph nodes (MLN), and 50.8 % were tuberculous lymph nodes (TLN). According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal. Conclusion CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.

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Abstract Objective Based on Toll Like Receptor 4 (TLR4)/Nuclear Factor-κB (NF-κB) Exploring the effects of Licochalcone A (LCA) on the proliferation, invasion, and drug resistance of glioma cells through signaling pathways. Methods Cultivate human glioma cell line U251 in vitro, induce drug-resistant cell line U251/TMZ with Temozolomide (TMZ), and validate the results. Different concentrations of licorice chalcone A were used to treat U251 cells and U251/TMZ cells, and were named as control group, low-dose group, medium-dose group, and high-dose group, respectively. CCK-8 assay, cell adhesion assay, and Transwell assay were used to detect cell survival rate, cell adhesion rate, number of migrating cells, and number of invading cells, respectively. Results The cell survival rate, cell adhesion rate, number of migrating and invading cells in the high-dose group were lower than those in the medium-dose group and lower than those in the control group. High-dose group TLR4, NF-κB mRNA and protein levels were lower than those in the medium dose group and lower than those in the control group (p < 0.05). Compared with the si-NC group, the si-TLR4 group showed a decrease in cell survival rate and adhesion rate, as well as a decrease in the number of migrating and invading cells, the levels of CyclinD1 and N-cadherin proteins decreased, while the levels of E-cadherin protein increased (p < 0.05). Conclusion LCA could inhibit the proliferation and metastasis of glioma cells and reverse drug resistance, possibly by inhibiting the TLR4/NF-κB signaling pathway.

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Abstract Background Gastric Cancer (GC) was the third highest mortality rate among malignant tumors. Currently, no specific treatment is utilized to prevent the progression of GC. The detailed mechanism of GC was still elusive and this study aimed to clarify the mechanism of GC occurrence and development. Method This study was performed to clarify the molecular mechanisms of CST1 promoting GC development through activating AKT. The normal gastric tissue cells and GC cell was obtained, followed by transfection with oe-CST1 or sh-CST1, and their apoptosis and viability were evaluated. Finally, Western blot, Flow cytometry assay, Transwell assay, and Scratch assay were used to elucidate the molecular mechanisms of CST1 promoting GC development through activating the AKT pathway. Results Research outcomes show a significant elevation in CST1 and AKT protein as well as mRNA quantities in both the model and CST1-activator cohorts in relation to the control. Conversely, these proteins and mRNA concentrations were notably decreased in the presence of the CST1 inhibitor when compared to the model group, a difference that was statistically significant as evidenced by the p-value. Conclusion CST1 can promote the gastric cancer process by targeting the AKT pathway.

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ABSTRACT Background Hospitalization for Transurethral Prostate Resection (TURP) involves circadian rhythm disturbance - a possible cause of Postoperative Neurocognitive Disorder (POCD) in elderly patients. This study investigated whether melatonin ameliorated this effect. Methods A double-blind, randomized clinical trial used a battery of neuropsychological tests to evaluate cognitive performance of 118 patients aged ≥ 60, before TURP with spinal anesthesia, and at 21- and 180-days PO. Patients received 10 mg of melatonin, or a placebo, on the night before surgery and 1-, 2- and 3-days PO. Delayed neurocognitive recovery in the two groups at 21 days PO was compared using the Chi-Squared test; individual performances in each test at each date were compared using the General Mixed Model. Results with p < 0.05 were considered significant. Results Pre-surgery, both groups had significant cognitive deficits. Delayed cognitive recovery at 21 days PO was the same in both. There were no cases of POCD at 180 days. The melatonin group performed better in the delayed-recall FOME, which assesses memory, and in the Digit Span test, which assesses attention and cognitive flexibility. Unexpectedly, global neurocognitive performance was improved at 180 PO in both groups. Conclusions Melatonin had no statistical effect on POCD, but a selective beneficial effect was observed in two cognitive areas. The high prevalence of preoperative cognitive impairment may be related to the lower urinary tract symptoms which were reasons for the surgery; the unexpected improvement of cognitive performance in all patients at 180 days PO may reflect alleviation of these symptoms.

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Abstract Mycobacteria infections are caused by species of the Mycobacterium tuberculosis complex (MTB) and other species called Non-Tuberculosis Mycobacteria (NTM). Identification of mycobacteria species is very important to define treatment and it can be achieved by direct culture. However, the lack of clear protocols regarding the use of culture or molecular tests on specimens diagnosed with granulomatous lesions causes delays in the diagnosis of the etiological agents and, consequently, the definition of the right treatment. This work aimed to characterize the incidence of mycobacteria species in pulmonary granulomatous lesions and the contribution of Polymerase Chain Reaction (PCR) in Formalin-Fixed Paraffin-Embedded Tissue (FFPE), direct culture, and Ziehl-Neelsen histological stain to the diagnosis. The authors performed an observational, centralized, and retrospective study in a cohort of 336 cases with pulmonary granulomatous lesions. Mycobacteria were detected by ZNS in 54/323 (16.72 %) and by direct culture in 40/198 (20.20 %). MTB DNA was detected by PCR in 10/57 (17.54 %). Mycobacterial culture results revealed MTB in 26/40 (65.00 %), whereas NTM was detected in 13/40 (32.50 %). NTM was represented by M. avium (n = 4), M. intracellulare (n = 3), M. kansasii (n = 3), M. colombiense (n = 1), M. paraffinicum (n = 1), and M. abscessus subsp. massiliense (n = 1). In conclusion, this study demonstrated that mycobacteria are detected in 16.72 % to 20.20 % of pulmonary granulomatous lesions. Moreover, MTB and NTM were detected in these lesions. The use of different methods for mycobacteria detection, in addition to culture, is complementary and contributes to fastening and increasing the detection of mycobacteria in these lesions.

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Abstract Introduction People Living with Human Immunodeficiency Virus (PLHIV) appear to be at a higher risk of developing sarcopenia. Various factors seem to influence the risk of sarcopenia, and its prevalence may differ depending on the screening tool used. This study aimed to (i) Screen the risk of sarcopenia in PLHIV using the SARC-F and SARC-Calf and identify associated factors; (ii) Analyze the agreement between the instruments in PLHIV. Methods Cross-sectional study including PLHIV taking antiretroviral therapy. The authors assessed sarcopenia risk using the SARC-F and SARC-Calf tools with ≥4 and ≥11 cutoff points, respectively, and a wide spectrum of variables was analyzed. Results Participated 76 patients (44.9 ± 12.7 years). Sarcopenia risk, according to the SARC-F, was 27.6 % and was associated with socioeconomic status (p = 0.004), smoking (p = 0.001), disease status (p < 0.001), opportunistic infections (p = 0.001), CD4 T-cell count (p < 0.001), Handgrip Strength (HGS) (p < 0.001), and Gait Speed (GS) (p = 0,001). Using the SARC-Calf, sarcopenia risk was 36.8 % and was associated with work activity (p = 0.029), socioeconomic status (p = 0.004), smoking (p = 0.009), disease status (p < 0.001), opportunistic infections (p = 0.015), CD4 T-cell count (p = 0.002), HGS (p = 0.001), Appendicular Skeletal Muscle Mass Index (ASMMI) (p = 0.009), and GS (p < 0.001). The agreement between tools was moderate (k = 0.49). Conclusion Sarcopenia risk, as determined by both tools, was higher in low-income PLHIV with opportunistic infections, CD4 T-cell count ≤ 200 cells/mm3, low HGS, and low GS, and lower in asymptomatic and non-smoking individuals. The authors recommend investigating these factors in hospital and outpatient settings. The SARC-Calf proved to be more appropriate for screening sarcopenia risk in PLHIV.

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Abstract Background Fibroadenomas are common benign breast lumps that can cause anxiety due to malignancy concerns, and Centchroman, a selective estrogen receptor modulator, has shown promise in reducing their size. This study aimed to evaluate the efficacy of Centchroman in reducing fibroadenoma size, mastalgia, anxiety, and depression in affected patients. Methodology A parallel-arm randomized controlled trial was conducted at a tertiary care Breast Clinic with 104 patients aged 18‒45 years having fibroadenomas ≤ 3 cm. Group A received Centchroman (30 mg on alternate days) and Group B received a placebo for 12 weeks. The primary outcome was fibroadenoma volume reduction measured by ultrasound, while secondary outcomes included reductions in mastalgia and improvements in anxiety and depression (HADS scores). Results Both groups showed fibroadenoma volume reduction over 12-weeks, with a greater reduction in the intervention group (3.67 ± 1.65 cm3 to 2.29 ± 1.04 cm3) than the control group (3.12 ± 1.16 cm3 to 2.73 ± 0.78 cm3), though the difference was not statistically significant (p = 0.342 and p = 0.781). However, 28.8 % of the intervention group experienced over 50 % volume reduction compared to 13.5 % in the control group (p = 0.007). Mastalgia significantly improved in the intervention group (VAS: 5.76 ± 2.13 to 2.24 ± 0.93, p = 0.023), with minimal improvement in controls. Anxiety and depression scores significantly decreased in the intervention group, with anxiety dropping from 9 to 5 and depression from 6 to 4 (p = 0.001). Conclusion Centchroman effectively reduces fibroadenoma size especially those with multiple fibroadenoma, mastalgia, and psychological distress in patients with fibroadenoma.

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Abstract Objective Acute Pulmonary Embolism (APE) is a disease with increasing incidence worldwide. Antithrombotics are the cornerstone of the treatment. Bleeding is an adverse event related to this therapy. The objective was to evaluate the prevalence of bleeding in a sample of Brazilian patients hospitalized with APE and the impact of this complication on mortality. Additionally, the performance of some bleeding predictive scores was evaluated in this sample. Methods A retrospective cohort study was carried out on patients hospitalized with APE from January 2009 through August 2017. The medical records of these patients were reviewed, and the bleeding recorded during hospital stay was classified according to the “Thrombolysis in Myocardial Infarction (TIMI) bleeding risk.” Five different predictive scores for bleeding after APE (RIETE, PE-SARD, VTE-BLEED, Kuijer, and ATRIA) were applied. Overall mortality at 30 days and one year were assessed. Results One hundred fifty-nine patients were included. The prevalence of any bleeding was 36/159 (23 %), major bleeding was 10/159 (06 %), minor bleeding was 11/159 (07 %), and bleeding requiring attention was 15/159 (10 %). Only major bleeding was associated with higher mortality at one-year follow-up with a Relative Risk (RR) of 2.00 (95 % CI 1.16-3.57; p = 0.044). All bleeding predictive scores evaluated showed low accuracy in identifying patients at higher risk of bleeding. Conclusion Patients hospitalized with APE in Brazil had a high prevalence of bleeding. The major bleeding increased the one-year mortality. The bleeding predictive scores assessed showed limited accuracy in identifying patients at high risk of bleeding.

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Abstract Background Sevoflurane (Sev) is an inhalational anesthetic for surgical procedures where it can trigger cognitive dysfunction and neuronal apoptosis. Gyosaponin (GpS) was studied for its effects on brain morphology and cognitive behaviors in Sev-anesthetized rats. Methods Male Sprague-Dawley rats were induced by 3 % Sev anesthesia, and 25 mg/kg and 100 mg/kg GpS were injected into the rats by tail vein. The in vitro model of Sev anesthesia was constructed by treating primary rat hippocampal neurons with 4.1 % Sev in the presence of GpS (5, 10, and 20 μM). The neuroprotective effects of GpS against Sev-induced cognitive deficits in rats were evaluated using the open field and Morris water maze tests. The apoptosis of hippocampal neurons was observed using HE staining and TUNEL assay. Apoptosis-related proteins and proteins related to the PI3K/Akt/mTOR pathway were determined via Western blot. Also, pro-inflammatory factors were measured via ELISA. Results GpS diminished the Sev-triggered apoptosis in neurons and Cleaved caspase-3, BAX, TNF-α, IL-6, lessened oxidative stress damage, and stimulated the PI3K/Akt/mTOR pathway. GpS therapy markedly enhanced learning and memory abilities in rats suffering from Sev-related cognitive impairments. Conclusion GpS ameliorates Sev-induced neurotoxicity and cognitive dysfunction by modulating the PI3K/Akt/mTOR pathway and alleviating neuronal apoptosis and oxidative stress.

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Highlights OSVE and multiple-choice tests can be used interchangeably in the context of formative assessment. OSVE and multiple-choice tests as effective tools to enhance intern training and monitoring. OSVE holds promise as a transformative tool, capable of ensuring the continuity and integrity of clinical skills assessment in medical education.

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Highlights We identified a distinctive pattern of serum metabolic signatures in juvenile idiopathic arthritis patients under methotrexate therapy. Methotrexate use is associated with a more efficient mitochondrial function. A decreased mitochondrial metabolism was observed in polyarticular and systemic JIA subtypes, with a decrease of several acylcarnitines’ concentrations.

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Highlights Renal Doppler marker variations within the initial 24 h in sepsis patients. RRI reduction after 24h of ICU treatment can be used for early detection of SA-AKI. Critical ultrasound for dynamic monitoring of renal perfusion.

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Highlights Incidence of frailty in elderly patients varies widely among different tools. FP and FS could be employed as tools for predicting frail conditions. Different tools had low consistency in predicting frail conditions.

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Highlights Question - Extension of the biliopancreatic loop increases l-cell activity after surgery bariatric? Findings - l-cell activity increased independent of extension of the biliopancreatic limb. Meaning - The additional beneficial effects of long BPL may be due to more rapid delivery of food and bile salts to more distal portions of the intestine.

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Highlights Guidelines recommended pulmonary rehabilitation in COPD. Self-driven pulmonary rehabilitation is an undertreatment for COPD patients in China. Chinese patients with COPD have worse clinical conditions. Treatment with pulmonary rehabilitation at institutes improves clinical outcomes. Chinese COPD patients are required to be treated as per proper guidelines.

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Highlights After cataract surgery, the prevalence rate of Descemet membrane Detachment was significantly higher in the group with keratome incisions (63.2 %) compared to that with femtolaser incisions (22.2 %).

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Highlights Restless legs syndrome is associated with lower information processing speed. Obstructive sleep apnea is not associated with lower information processing speed. Managing sleep disorders is critical for improving cognition in multiple sclerosis.

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Highlights Adverse effects of lenalidomide for Newly Diagnosed Multiple Myeloma (NDMM) cannot be ignored. Lower-dose PLD administered with dexamethasone and subcutaneous bortezomib is associated with a good durable response. Lenalidomide is retained as maintenance or salvage therapy if the DVD regimen fails.

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Highlight TRIB3 over-expression was related to the poor prognosis of LSCC. Patients with methylation related to high TRIB3 expression had a poorer prognosis. Knock-down of TRIB3 expression suppresses the growth, invasion and migration of LSCCs via PI3K- AKT- mTOR. TRIB3 may be viewed as a possible cancer biomarker.

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Highlights hsa_circ_0000105 modulates malignancy of NPC cells. hsa_circ_0000105 influences the malignant behavior of NPC via downstream miR-541-3p. hsa_circ_0000105 positively regulates S100A11 to accelerate the malignant behavior of NPC. hsa_circ_0000105 inhibits NPC tumor growth in vivo.

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Highlights Dry eye is more frequent in the urban than in the rural population. Dry eye is associated with dyslipidemia, visual display terminal, and ocular surface problems. Dry eye is more frequent in women and the associated factors are associated with antiallergics, chronic pelvic pain, and fibromyalgia. Dry eye in the elderly has distinct clinical associated factors.

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Highlights Stem cell therapy is a promising alternative in the spinal cord injury arsenal. Challenges in stem cell treatment in SCI: phase uncertainty and cell type controversy. Umbilical cord mononuclear cells may enhance recovery via multiple mechanisms. Umbilical cord mononuclear cells can promote histological improvement after SCI.

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Highlights Construction of a personalized risk prediction model for in-hospital mortality in patients with acute myocardial infarction undergoing Percutaneous Coronary Intervention (PCI). Identification of risk factors associated with in-hospital mortality in AMI patients who underwent PCI. Development of a nomogram prediction model for in-hospital mortality in AMI patients after emergency PCI. Evaluation of the nomogram model's effectiveness through c-index, internal validation, Hosmer-Lemeshow test, and calibration curve analysis.

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Highlights circLOC375190 reduction ameliorates neuronal autophagy and apoptosis in tMCAO mice. circLOC375190 knockdown improves OGD/R-mediated neuronal autophagy and apoptosis. circLOC375190 affects OGD/R-mediated neuronal apoptosis and autophagy by adsorbing miR-93-5p. circLOC375190 affects OGD/R-mediated neuronal apoptosis and autophagy by regulating the miR-93-5p/MKNK2 axis. circLOC375190 affects AIS autophagy by regulating the mTORC1/TFEB axis.

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Highlights Respiratory symptoms of PACS are associated with high serum Myl9 levels. Patients who have had COVID-19 can be divided into two groups according to their serum Myl9 levels. The neutrophil count is correlated with the Myl9 level at 6 months after infection.

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Highlights Correlation between pathologic complete response and endoluminal complete response. Half of pathologic complete responses do not achieve an endoluminal complete response. Gross findings do not perfectly reflect microscopic findings.

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Highlights NHANES data from 1999 to 2006 show a positive link between serum CRP levels and low muscle mass risk in US adults. An inverse J-shaped pattern emerges, indicating a non-linear association between CRP levels and low muscle mass risk, with critical points at 0.273 mg/dL for the overall population, 0.172 mg/dL for males, and 0.296 mg/dL for females. This nationally representative study underscores the crucial role of inflammation in muscle function and advocates for future research and clinical strategies to address inflammation's impact on muscle mass and function.

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Highlights ADSCs increased the viability (significantly less necrosis) of a TRAM flap in rats. Vessel formation in the ischemic segment of the flap was also enhanced by the ADSCs. Fluorescence microscopy indicated no differentiation of ADSCs into endothelial cells.

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Abstract Background and objective Colon Cancer (CC) is a common malignant tumor. The aim of this study was to investigate the role and regulatory mechanism of circular RNA pappalysin-1 (circ-PAPPA; hsa_circ_0088233) in CC. Methods In cancer tissues from CC patients, circ-PAPPA expression was measured and its relationship with patients’ clinical features was analyzed. Plasmid vectors or oligonucleotides interfering with the expression of circ-PAPPA, microRNA (miR)-656-3p or G-protein subunit Gamma-5 (GNG5) were transfected into CC cells. Cell viability was detected by MTT and colony formation assay; apoptosis was detected by flow cytometry; and cell migration and invasion were detected by wound healing assay and Transwell. Glycolytic capacity of CC cells was assessed by measuring glucose uptake and lactate production using commercial kits. The targeting relationship between miR-656-3p and circ-PAPPA or GNG5 was verified by bioinformatics website starBase and dual luciferase reporter gene assay assays. Results Circ-PAPPA was upregulated in CC and was negatively correlated with benign pathological features and 5-year survival rates of CC patients. Circ-PAPPA silencing inhibited the growth and glycolysis of CC cells through upregulating miR-656-3p. GNG5, a target of miR-656-3p, could reverse the impacts of silencing circ-PAPPA on CC cells. Conclusion Circ-PAPPA may play an oncogenic role in CC by promoting cell growth and glycolysis through the miR-656-3p/GNG5 axis.

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Abstract Lower eyelid malposition, a commonly encountered eyelid disorder, is often linked to discomfort, visual disturbances, and cosmetic concerns. Various treatment modalities have been employed to address these conditions, but their effectiveness and safety remain subjects of debate. This systematic review, aiming to compare and evaluate these treatments, produced a comprehensive analysis of diverse approaches to managing lower eyelid malposition. The search encompassed electronic databases, clinical trial registries, and relevant journals from inception to September 2023. Fifteen studies meeting the inclusion criteria, involving 709 patients (855 eyelids), were reviewed, comprising 12 randomized controlled trials and 3 ongoing trials. We assessed the quality of each included study using the Cochrane Risk-of-Bias tool for randomized trials (RoB v2). We analyzed success rates, recurrence rates, adverse events, and patient satisfaction. Results revealed that modifications to the conventional Lateral Tarsal Strip exhibited high success rates and low recurrence rates. Other treatments, including Everting Sutures, Retraction Pelication, and Orbicularis Muscle Shortening, showed promise in specific cases. Complications, generally mild and manageable, were reported across all modalities, with patients expressing overall satisfaction. The systematic review highlights the effectiveness and safety of various surgical interventions for lower eyelid malposition, offering durable outcomes and minimal recurrence. Tailoring treatments based on patient characteristics and anatomical variations is crucial. Further research is warranted to refine indications for each treatment option in this evolving field.

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Abstract This mini-review explores the potential of precision medicine and personalized nutrition in addressing health challenges faced by perimenopausal women, focusing on the role of genetic polymorphisms in key metabolic pathways. Specifically focus on the single nucleotide polymorphisms (SNPs) in the COMT, FUT2, and MTHFR genes, which influence neurotransmitter metabolism, gut microbiota composition, and folate homeostasis, respectively. These polymorphisms are critical in modulating hormonal fluctuations, metabolic imbalances, and nutrient absorption during perimenopause. The review highlights the impact of COMT rs4680 on stress response and mood disorders, FUT2 rs602662 and rs601338 on vitamin B12 absorption and cortisol metabolism, and MTHFR rs1801133 and rs1801131 on homocysteine levels and cardiovascular risk. Furthermore, the integration of machine learning in precision medicine is discussed, offering insights into how genetic data can optimize personalized interventions. This approach enables targeted nutritional and therapeutic strategies to mitigate the metabolic and psychological effects of perimenopause. Overall, this review underscores the importance of incorporating genetic testing into preventive care for perimenopausal women to enhance quality of life and promote healthy aging.

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Abstract Introduction Autism Spectrum Disorder (ASD) is a neurodevelopment spectrum characterized by persistent deficits in social communication and interpersonal interaction, along with restricted and repetitive patterns of behavior, interest, or activities. The appropriate screening and diagnosis must be realized to improve the children's prognosis. Moreover, appropriate treatments are necessary to promote better social integration and development. In this scenario, this systematic review aims to evaluate the impacts of behavioral therapies applied in healthcare settings for patients with ASD. Methods This systematic review followed the PRISMA guidelines. The databases MEDLINE, Embase, CENTRAL (Cochrane), and Lilacs were accessed, and gray and manual searches were performed. The search strategy was created with terms referring to autism and behavioral therapy. The studies were assessed qualitatively. Results Randomized clinical trials and observational studies demonstrated improvements in cognitive and verbal components of patients who received behavioral therapies in therapeutic settings. These results indicate a positive impact of both cognitive-behavioral therapy and ESDM on the development of patients’ skills. Among the cognitive-behavioral therapies, the one based on the MASSI protocol did not impact the reduction of anxious symptoms. As for cognitive-behavioral therapy, one study demonstrated that the Behavioral Intervention for Anxiety in Children with Autism (BIACA), when compared to the Coping Cat protocol, improves cognition and reduces anxiety symptoms. Despite these results, further randomized clinical trials comparing behavioral therapies with one another are needed. Conclusion In the context of behavioral therapy within a healthcare setting, the Early Start Denver Model (ESDM) showed improvements in the cognitive, verbal, and social aspects of the evaluated patients. Improvement in scores sometimes is achieved independently of the group and related to the time of interventions.

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Highlights Ethnopharmacological knowledge is passed down through generations by women in the community, who use plants especially for sexual and postpartum care.

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Highlights Knowledge was low mainly about contraceptive methods of high effectiveness. The acceptance of the chosen contraceptive method by deaf women was satisfactory. There are no intervention studies to improve contraceptive use among deaf women.

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Highlights Mitochondria regulate cellular functions, and mtDNA mutations can affect metabolism. mtDNA mutations are promising biomarkers for cancer detection and tumor progression. These mutations might influence therapy response, drug resistance, and patient outcomes. Tools and models advance precision oncology and mitochondrial-targeted treatments.

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Highlights NMES+ can improve the aerobic capacity of individuals in functional decline. NMES+ appears to improve physical functional capacity in general. More RCTs are needed to better evaluate the evidence found.