Background: Burning mouth syndrome (BMS) is recognized as a neuropathic pain condition that may precede autoimmune disorders. While various local and systemic pathologies have been proposed as potential causes or contributing factors to BMS, their etiopathology remains unclear. Conversely, the microbial flora—a vast community with a genome content 150 times larger than that of its host—has been implicated in chronic pain associated with neuro-inflammation, as well as the development of neurological and autoimmune diseases. Despite these associations, the role of the oral microbial community in BMS remains poorly understood. This study aims to investigate current insights into the potential connections between the oral microbiota and burning mouth syndrome. Method: An electronic search was conducted in July 2024 using the PubMed, Scopus, Web of Science, ScienceDirect, and Embase databases. The search aimed to identify articles published in English that investigated the relationship between burning mouth syndrome and hormones, immunity, or micronutrients. No restrictions were applied regarding the publication date or geographical location. Results: Individuals with burning mouth syndrome (BMS) may exhibit systemic changes influenced by alterations in the oral microbiota. These changes potentially affect hormone levels, immune system function, and micronutrient balance. Patients with BMS have shown altered levels of sex hormones, thyroid hormones, neuroendocrine hormones, and stress hormones, with the oral microbiota appearing to regulate these hormonal changes. In addition, immune system mediators, such as cytokines—particularly IL-6—are modified in these patients, which may be linked to microbial activity. The oral microbiota may also influence micronutrient levels, with deficiencies in certain nutrients, such as vitamin B12, potentially contributing to the disease's pathogenesis. These physiological alterations could play a role in the development of allodynia through complex interactions involving the oral microbiome. Conclusions: The interplay between sex hormones, thyroid hormones, neuroendocrine hormones, the immune system, and the oral microbiome in burning mouth syndrome (BMS) is complex and interconnected. Current evidence highlights significant associations among these factors, underscoring their potential roles in BMS pathogenesis. However, further research is essential to unravel the precise mechanisms and interactions underlying this condition.

Introduction: Anti-glomerular basement membrane (anti-GBM) disease is classically diagnosed based on presence of rapidly progressive glomerulonephritis, circulating anti-GBM antibodies, and the hallmark finding of linear IgG deposition along the glomerular basement membrane on kidney biopsy. These deposits are considered a defining feature of the disease, aiding in its differentiation from other pauci-immune glomerulonephritis. However, rare cases lacking IgG deposits on kidney biopsies challenge this paradigm, complicating both diagnosis and management. Case Presentation: We report the case of an 80-year-old male with metastatic rectal cancer, who presented with acute kidney injury, hematuria, and proteinuria. Serological testing confirmed elevated anti-GBM antibody levels. Surprisingly, renal biopsy revealed crescentic glomerulonephritis without characteristic linear IgG deposition, which raised diagnostic uncertainty. Despite the absence of this classic finding, the patient’s clinical course was consistent with anti-GBM disease. Given his malignancy, treatment was tailored to balance immunosuppression with oncologic and infectious considerations. The patient received a modified immunosuppressive regimen, including plasma exchange and corticosteroids, but IV cyclophosphamide was withheld due to recurrent infections. Initially, from a nephrology standpoint, his clinical course was notable for partial renal recovery, resolution of hematuria, and improvement in both creatinine and proteinuria levels. However, he ultimately passed away due to severe infectious complications. Conclusion: This case underscores the diagnostic challenges and therapeutic decision-making in patients who present with features suggestive of anti-GBM disease, characterized by positive anti-GBM antibodies but absent immune deposits, especially when accompanied by malignancy, prior exposure to immunosuppressive therapy, and concurrent infections.

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating consequence for people undergoing treatment for cancer, especially bowel cancer. Painful CIPN contributes to psychological distress, functional decline and reduced quality of life. Additionally, it is a dose-limiting factor for anticancer agents, compromising chemotherapy effectiveness and patient survival. To date, no effective long-term management options exist for painful CIPN. Whilst evidence suggests analgesic effects of repetitive transcranial magnetic stimulation (rTMS), little is known regarding its effectiveness specifically for CIPN-associated pain. The proposed study aims to evaluate the analgesic potential of rTMS in bowel cancer survivors, quantify the duration of symptom alleviation, and explore patient perspectives on using rTMS for CIPN management. Methods: Participants will be randomised into two parallel groups (allocation ratio 1:1) to receive rTMS or sham stimulation over four sessions, with each session separated by a minimum of 7 days. Pain scores will be obtained immediately before and after each treatment session, as well as at 8-week and 6-month follow-up sessions using the Visual Analogue Scale for Pain (P-VAS) as the primary outcome. P-VAS scores, along with secondary outcome measures of pain and dysaesthesia, will be compared within and between groups across time to assess short-term and long-term effectiveness of rTMS. An interview will be conducted upon completion of all treatment sessions at the 8-week follow-up for qualitative analysis of patients’ acceptance of routine rTMS for pain management. Conclusion: Findings may provide a promising long-term solution to alleviate symptoms of CIPN and enhance quality of life in bowel cancer survivors.

Background: Clinical research involving neonates often presents unique ethical and practical challenges. These difficulties may lead to the early termination of clinical trials, particularly when negative or inconclusive results occur, contributing to publication bias. Failure to report such outcomes ultimately slows the advancement of knowledge and the development of evidence-based care in neonatology. Summary: This review examines the significance of negative trial results in neonatal clinical research, with particular emphasis on interventional studies, and addresses their reliability, challenges in interpretation, and implications for clinical practice. Insights from selected negative neonatal trials were used to assess the impact of unfavorable outcomes on neonatal care. Non-interventional studies were excluded from this review to maintain a focus on controlled clinical trials. Key Messages: Properly interpreted negative trials hold significant value in neonatal research. These studies help avoid unnecessary interventions, ensuring more efficient use of resources, and guide future research directions. Despite often being undervalued or overlooked, they remain fundamental to advancing evidence-based neonatal care. Enhanced reporting and interpretation of these findings could greatly benefit both clinical practice and research development in the neonatal population.

Plain Language SummaryDementia is a chronic brain disorder that impacts memory, thinking, and the performance of daily activities. There are not sufficient trained professional caregivers for individuals with dementia in Indonesia, and family members are responsible for providing full-time care. It can be demanding and cause severe stress on the caregiver when the individual with dementia is showing stressful symptoms such as disoriented, confused, and unable to stay calm. This paper explains the protocol of a study that will assess the effectiveness of a caregiver training program using the Indonesian version of World Health Organization’s iSupport for Dementia module. It is expected that this will intensively reduce caregiver stress, improve quality of life in caregivers, reduce symptoms in dementia, and improve knowledge and skills in caregivers. There will be 20 primary caregivers divided equally into two groups. The intervention group will be provided with a seven-session training program with three face-to-face and four online meetings. Each session will include lectures, group discussion, case studies, relaxation activities, and self-reflection. The control group will not be provided with the training during the study but will be provided with educational materials within the study period. Researchers will measure caregiver stress, quality of life, symptoms of dementia, and caregivers’ knowledge at the start and the end of training. Feedback on the utility and process of the training will also be evaluated.

Introduction: Ureteroscopic procedures pose a splash hazard to urologists from irrigant contaminated with urine, blood, or caustic substances, risking health and vision. While ureteroscopic adapters aim to minimize fluid leakage, their efficacy remains unstandardized, with high-pressure irrigation potentially generating hazardous spray. This study aimed to evaluate the potential for hazardous leak of various ureteroscopic adapters. Methods: Six different ureteroscopic adapters were assessed while performing ureteroscopy through a tissue-realistic kidney and ureter model at various levels of pressurized saline generated via a pressure bag and a single-action pumping system (SAPS) with and without a stone basket in the working channel. Leaking was classified as a drip (non-projectile leakage), a spray (small-volume projectile leak), or a splash (large-volume projectile leak). Hazardous spray was defined as any projectile leakage. Ultraviolet fluorescent stain was instilled in the irrigation and utilized to measure the maximal spray distance from the surgeon. Results: The Gyrus Adjustable Biopsy Port Seal had the highest potential for splash, including at gravity. Other adapters that exhibited hazardous leakage include the Gyrus Blue Silicone Seal with a basket in place and the Merit Hemostasis Valve while under high pressure using SAPS. Only one valve demonstrated no leak under any simulated circumstances (the Medtronic Piton). The Cook Check-Flo Adapter and Boston Scientific Urolok II demonstrated nonhazardous leakage. In the second arm of the experiment, maximal spray distance using the Gyrus Adjustable Biopsy Port Seal was 14.4 feet. Conclusion: Ureteroscopic adapter leakage can be variable among adapters, and surgeons should be aware of the hazardous potential for exposure.

Introduction: Shunt nephritis is a rare immune complex-mediated glomerulonephritis associated with an infected ventriculoatrial shunt (VAS) or ventriculoperitoneal shunt (VPS). Its incidence has declined to 0.7–2% due to improved infection management. Low-grade bacteremia, particularly from VAS, often involves pathogens such as Cutibacterium acnes, Staphylococcus epidermidis, and Streptococcus species. Immune complex deposition in the kidneys leads to glomerulonephritis and nephrotic syndrome. Early diagnosis and shunt removal, alongside antibiotics, are crucial for renal recovery. Case Presentation: A 35-year-old male with a history of traumatic brain injury and VAS placement presented with generalized edema, hypertension, fatigue, and neurological decline. The patient exhibited nephrotic syndrome with low complement levels. Renal biopsy revealed diffuse membranoproliferative glomerulonephritis with subendothelial deposits. Cerebrospinal fluid (CSF) analysis showed pleocytosis and an elevated albumin ratio, with C. acnes confirmed via blood and CSF cultures. Targeted antibiotic therapy, with first externalization and then removal of the VAS, was followed by a VPS re-implantation after infection resolution. The complement levels normalized, albuminuria decreased, and renal function stabilized. Discussion: This case highlights the diagnostic challenges associated with shunt nephritis, particularly in the absence of overt infection. Early recognition, targeted antibiotics, and shunt removal are essential for preventing progressive kidney damage and resolving nephrotic syndrome. This case highlights the need for multidisciplinary management in such a complex presentation.

Introduction: There are many reports on atrial fibrillation/flutter (AF) in previous elite endurance athletes (ExA) and veteran athletes (VA), but no prospective studies on AF in elite endurance athletes (EA) have been published. Most studies are on males and increased risk in males has been found, but the explanation of this has been controversial. Methods: We present a study where 15 male and 15 female EA and matched groups of sports students and non-athletes were studied with clinical examination, a questionnaire, standard ECG, echocardiography, and 24-h ECG (Holter) monitoring in 1985. Twenty-nine EA were re-examined with the same examinations in 2000, and in 2023, a follow-up of 24 of them was done with a questionnaire and ambulatory ECG recording, aiming at the effect of risk factors, training parameters and sex on the occurrence of AF in ExA. The ambulatory ECG recording was done with smartphone (ECG 247) for 72 h or more. Results: The mean age was 62.6 years. All had ended their competition career before the age of 39. Three had known AF, all males, with the sex difference being significant. Another two males and one female had a history of tachycardia, and the sex difference in total tachycardias was also significant. None of the ExA had asymptomatic AF. A paternal history of AF was significantly more frequent in males with AF than in males without AF. There were no significant sex differences in training parameters. Conclusions: We think our study does not support doing ambulatory ECG recording of all ExA at age 65, but one should be aware of increased risk in males with a paternal history of AF. Both AF and symptomatic tachycardias were significantly increased in males. However, the low number of AF is a limitation of these conclusions and does not permit concluding on whether training during middle age confers a higher risk of AF than training at a younger age. No sex differences in training in ExA indicate that biological factors (like hormones) contribute considerably to the sex difference in the risk of AF in ExA. Despite the low number of AF cases, we believe our study provides new knowledge as it is prospective, free of baseline selection bias, includes detailed investigations both at baseline and at follow-up, and addresses a gap in prospective studies on AF in EA.

Introduction: During pregnancy, placental microvasculature undergoes significant adaptations to support the developing fetus. However, studying placental microcirculation in vivo remains challenging. This study examined the potential of using retinal microvasculature measurements as a proxy, along with umbilical cord blood markers of angiogenesis and inflammation together with urine cotinine (a nicotine metabolite), to gain insights into the microvasculature changes in the human placenta. Methods: During the 24-month recruitment period (August 2019 to August 2021), the study was open to all pregnant women receiving antenatal care at Townsville University Hospital in Australia. Immediately after childbirth, the maternal central retinal artery equivalent (CRAE) diameter, the central retinal vein equivalent (CRVE) diameter, and the arteriovenous ratio (AVR) were determined using a handheld non-mydriatic retinal camera. Umbilical cord blood and maternal urine were also collected and analyzed. Results: Data from 80 women were analyzed. Multivariate analyses found a significant negative correlation between CRAE, CRVE, and tumor necrosis factor receptor 2 (TNFR2) and a significant positive correlation between CRVE and urine cotinine, the diagnosis of preeclampsia, and diabetes mellitus in pregnancy. Conclusions: We propose that the changes in the retinal artery and vein may reflect alterations in the placenta’s spiral artery and its draining vein, with TNFR2 acting as a common mediator.

Plain Language SummaryMany people use the internet to find medical information, but not all websites provide accurate or trustworthy content. It can be hard for patients and their families to know which articles they can rely on, especially when the information is complicated or presented in a confusing way. We created a tool called MedReadr to help solve this problem. MedReadr is a free browser extension that works in Google Chrome. When a person visits a health-related article online, MedReadr can quickly check the article and give it a reliability score. The score is based on specific features such as whether the article has up-to-date information, includes links to trustworthy sources, uses balanced language, and talks about the uncertainty of treatments. In this study, we tested MedReadr by comparing its scores to those given by human reviewers using two trusted scoring systems. We found that MedReadr’s scores were very similar to the scores given by people, which means it can be a reliable tool for checking medical information online. However, MedReadr is not designed to catch false or harmful information. It also does not evaluate things like how easy the article is to read or how the page is visually designed. Future versions may include more advanced features, but for now, MedReadr can help patients and healthcare providers quickly evaluate the general quality of health articles found on the web.