Interaction between IL-23/Th17 immune inflammatory axis and intestinal flora in gastric mucosal atrophy caused by Helicobacter pylori infection in the elderly.

To investigate the association between denosumab use and 2-year all-cause mortality and incident skeletal-related events (SREs) in patients with lung cancer and bone metastases. This retrospective cohort study utilised electronic records from an international clinical database. The enrolment period was between January 1, 2010, and December 31, 2020, followed by a 2-year follow-up period. Data were extracted from TriNetX, a global clinical research platform with electronic medical records from more than 120 healthcare organisations for over 250 million patients in 19 countries. A total of 52,521 eligible patients were recruited and divided into 2 groups based on the use of denosumab. Propensity score matching (PSM) was used to balance baseline demographic and clinical characteristics between study groups. After PSM, the study and control groups each comprised 2735 patients with similar baseline characteristics. The primary outcome was all-cause mortality during the 2-year follow-up period. Incident SRE diagnoses, encompassing pathologic fractures, radiation therapy to bone, spinal cord compression, and hypercalcaemia, were examined as secondary outcomes. During the 2-year follow-up period, overall mortality was significantly lower in the study group than in the control group (53.8% vs 55.1%; hazard ratio [HR], 0.74; 95% CI, 0.69-0.80; P < .001). The study group also had a longer median survival time (467 days vs 292 days), a higher survival probability during the follow-up period (P < .001), and a significantly lower risk of SREs (HR, 0.42; 95% CI, 0.33-0.53; P < .001). Survival benefits and reduction of SRE risk associated with denosumab were consistent across most subgroups. In this large international cohort, patients treated with denosumab had lower mortality and fewer SREs than those who did not receive denosumab, adding to the growing body of evidence supporting its clinical benefit.

Introduction: Postoperative pain management is of prime importance to the surgeon, as it significantly influences a patient’s recovery. A multimodal approach to pain management is an essential component of postoperative care. Curcumin, a natural antioxidant and anti-inflammatory compound, also exhibits analgesic properties. However, its use in the postoperative setting has not been extensively studied. Aim: To evaluate the role of oral curcumin as an analgesic in the management of postoperative pain following breast cancer surgery. Materials and Methods: This was a single-blind, randomised controlled trial that was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India and included 60 patients undergoing surgery for breast cancer between October 2023 and April 2024. The study group was administered oral curcumin lozenges twice daily, along with standard analgesics, from Postoperative Day (POD) 1. The control group received a placebo. Postoperative pain was assessed from POD 0 to POD 7 using the 11-point Numeric Pain Scale (NPS) and compared using the independent t-test performed with the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Sixty patients were enrolled (30 in each group). One patient in the study group was excluded from the final analysis as the study protocol was not followed; therefore, 59 patients were analysed. A statistically significant difference in pain scores between the study and control groups was observed on POD 6 and POD 7 (p-value=0.006). No significant difference was observed between the groups regarding the use of SOS analgesics (p-value=0.322) or drain output (p-value&gt;0.05). No adverse events were reported by any patient in the study group. Conclusion: This study demonstrated that curcumin may be beneficial in postoperative pain management. The use of a nutraceutical such as curcumin, with its favourable safety profile and minimal side-effects, offers a promising option. A longer follow-up period is warranted to fully explore the analgesic potential of curcumin. Additionally, studies employing a doubleblind design and larger sample sizes are recommended to provide further evidence of its effectiveness in postoperative pain management.

Introduction: Postoperative pain management is of prime importance to the surgeon, as it significantly influences a patient’s recovery. A multimodal approach to pain management is an essential component of postoperative care. Curcumin, a natural antioxidant and anti-inflammatory compound, also exhibits analgesic properties. However, its use in the postoperative setting has not been extensively studied. Aim: To evaluate the role of oral curcumin as an analgesic in the management of postoperative pain following breast cancer surgery. Materials and Methods: This was a single-blind, randomised controlled trial that was conducted in the Department of Surgical Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India and included 60 patients undergoing surgery for breast cancer between October 2023 and April 2024. The study group was administered oral curcumin lozenges twice daily, along with standard analgesics, from Postoperative Day (POD) 1. The control group received a placebo. Postoperative pain was assessed from POD 0 to POD 7 using the 11-point Numeric Pain Scale (NPS) and compared using the independent t-test performed with the Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Sixty patients were enrolled (30 in each group). One patient in the study group was excluded from the final analysis as the study protocol was not followed; therefore, 59 patients were analysed. A statistically significant difference in pain scores between the study and control groups was observed on POD 6 and POD 7 (p-value=0.006). No significant difference was observed between the groups regarding the use of SOS analgesics (p-value=0.322) or drain output (p-value&gt;0.05). No adverse events were reported by any patient in the study group. Conclusion: This study demonstrated that curcumin may be beneficial in postoperative pain management. The use of a nutraceutical such as curcumin, with its favourable safety profile and minimal side-effects, offers a promising option. A longer follow-up period is warranted to fully explore the analgesic potential of curcumin. Additionally, studies employing a doubleblind design and larger sample sizes are recommended to provide further evidence of its effectiveness in postoperative pain management.

To compare the therapeutic efficacy of miniscrew implant anchorage with that of conventional extraoral arch anchorage, both of which are combined with orthodontic-orthognathic treatment, in patients with skeletal Class II malocclusion. This prospective nonrandomised controlled study included 130 patients. In terms of treatment method and patient preference, 58 patients received conventional orthodontic-orthognathic treatment with extraoral arch anchorage (conventional group), whereas 72 patients received treatment augmented with miniscrew implant anchorage (study group). The treatment protocol for all patients followed the conventional three-stage orthodontic-orthognathic approach. The outcomes assessed included treatment effectiveness, adverse events, root resorption (volume via CT), skeletal and dental changes (via comprehensive cephalometric analysis), soft tissue profile changes, facial aesthetics, and alveolar bone morphology (via CBCT). The total effective rate was significantly greater in the study group (95.83%) than in the conventional group (74.14%) (p < 0.05). While both groups presented significant root resorption posttreatment (p < 0.05), the degree of resorption did not differ significantly between the groups (p > 0.05). Crucially, CBCT analysis revealed significantly better preservation of the palatal bone plate and alveolar bone height in the study group (p < 0.05). The study group also demonstrated significantly greater improvements in skeletal parameters (SNA, SNB, FMA, and PP-FH), dental decompensation (U1-SN, U1-NA, L1-MP, and L1-NB), soft tissue indices, and facial aesthetics (p < 0.05). The incidence of adverse events was significantly lower in the study group (34.72% vs. 75.86%, p < 0.05). Logistic analysis revealed that oral hygiene, vertical facial pattern, peri-implant swelling, and force application time were independent risk factors for miniscrew success. The integration of miniscrew implant anchorage in orthodontic-orthognathic treatment for skeletal Class II malocclusion provides superior clinical efficacy. Its primary advantage lies in enabling enhanced control over dental decompensation and skeletal correction, leading to significantly improved facial aesthetics, a more favorable mandibular position, and better alveolar bone preservation, with a lower complication profile. This represents an effective and reliable treatment option for these patients.

To evaluate the clinical efficacy of prostheses designed using mandibular motion analysis in maxillary full-arch implant rehabilitation. Twenty patients were assigned to a study group (n = 10), receiving prostheses designed with dynamic occlusal data from an electronic jaw motion analyzer (JMA), or a control group (n = 10) using conventional static digital workflows. Between-group differences in occlusal adjustment depth (MAE), area, and chairside time were analyzed by independent t-tests. Within the study group, the stability of mandibular movement paths (provisional vs. post-restoration) was assessed using paired t-tests. Oral health-related quality of life (OHRQoL) was evaluated using the OHIP-14 questionnaire. Effect sizes were calculated as Hedges' g. The study group exhibited significantly lower occlusal adjustment depth (163.26 ± 31.42 μm vs. 213.99 ± 56.38 μm; p = 0.030, Hedges' g = 1.06) and adjustment area (95.93 ± 30.27 mm2 vs. 129.86 ± 25.82 mm2; p = 0.020, g = 1.16) compared to the control group. Chairside adjustment time was reduced by approximately 30% (23.8 ± 7.8 min vs. 33.8 ± 8.0 min; p = 0.074, g = 1.15). No significant changes in parameters of mandibular movement paths were observed within the study group post-restoration (all p > 0.05). OHIP-14 scores were significantly better in the study group for "Meal interruption", "Relaxation difficulty" (p = 0.041), reflecting improved OHRQoL. Integrating dynamic mandibular motion data into prosthesis design reduces clinical adjustments, improves OHRQoL, and preserves inherent movement patterns, demonstrating a promising approach to optimize functional outcomes in full-arch implant rehabilitation. Integrating dynamic mandibular motion data into digital prosthesis design offers a clinically valuable strategy that minimizes occlusal adjustments, supports functional stability, and enhances patient-reported quality of life in full-arch implant rehabilitation.

Adipose tissue expression of Notch signaling genes in relation to insulin sensitivity and obesity in humans.

Clinical value of the tissue Doppler derived index of myocardial performance (Tei index) in cats with hypertrophic cardiomyopathy.

Letermovir (LMV), a novel antiviral agent targeting the cytomegalovirus (CMV) terminase complex, has significantly changed the management of adult allogenic hematopoietic stem cell transplant (allo-HSCT) recipients. In this retrospective, single-center study, we assessed our real-life experience in using an implemented diagnostic protocol to identify patients needing pre-emptive therapy (PET) or at high risk of developing CMV-related disease. The study included allo-HSCT recipients who received LMV prophylaxis (LMV group), compared with a historical control group of CMV seropositive patients undergoing allo-HSCT. These patients were managed using a pre-emptive strategy. Both study groups were followed from the day of transplant for up to 200 days. Among the 110 patients receiving LMV prophylaxis, CMV DNAemia was detected in 43 cases (39.1%). However, infectious virions associated with active CMV infection were identified only in four patients (4/43, 9.3%), who required the interruption of LMV and the initiation of PET (CS-CMVi cases). We evaluated the incidence of CS-CMVi at 100 and 200 days post-transplant, comparing patients undergoing LMV prophylaxis with a historical group managed by PET. At 100 days post-transplant, the cumulative incidence of CS-CMVi was significantly lower in the LMV group compared to the control group (3.6% versus 39.1%; p<0.001). The same result was observed at 200 days post-transplant. These findings confirm that LMV has significantly decreased the incidence of CS-CMVi in CMV seropositive patients and underline the clinical utility of an implemented diagnostic protocol including DNase or RNAemia tests to discriminate between active and abortive CMV infection.

To evaluate and describe the changes in the therapeutic approach to Graves' disease at a tertiary hospital center over a 20-year period, with an emphasis on the frequency of prescription and the timing of radioactive iodine indication. We conducted a retrospective analysis of data from medical records of patients recently diagnosed with Graves' disease (GD) and followed up at a single institution during two consecutive periods: Group A diagnosed between 2002 and 2010, and Group B between 2011 and 2022. We analyzed the percentage of patients who underwent iodine therapy and were considered to have failed therapy if they did not achieve hypothyroidism or euthyroidism, comparing the results between both groups. A total of 597 GD patients were included, of which 223 underwent radioactive iodine (RAI) therapy (37.35%). In Group A, 176 patients (64%) received RAI treatment, whereas, in Group B, only 47 patients were given this therapeutic indication (14.6%) (p < 0.001). The reduction in RAI prescriptions between both periods was independent of the therapeutic indication. Interestingly, RAI prescription due to relapse after clinical treatment was uncommon in both study groups. There was a significant increase in the duration of antithyroid drug (ATD) therapy before RAI prescription in Group B compared to Group A. Significant changes were observed in GD treatment, with a decline in the use of RAI as a first-line or salvage therapy. Nonetheless, radioiodine therapy remained an effective and safe treatment modality with successful cure rates.

Hyperandrogenaemia and Systemic Low-Grade Inflammation in Normogonadotropic Anovulation: A Prospective Cohort Study.

Proportion of middle ear surgeries feasible via transcanal endoscopic ear surgery: A multicenter study in Japan.

Introduction: Lipids form an important constituent of the human cell membrane with wide functional importance. The alterations in lipid levels can result in an imbalance of the homeostatic reserve and, therefore, can result in a diseased state. Aim: To analyse and compare lipid profiles between diabetic and non diabetic individuals amongst the study group and find an association between diabetic status and lipid parameters. Materials and Methods: A cross-sectional study was conducted in the Outpatient Department (OPD) of a primary care health setting, Sakthi Multi-speciality clinic, Poonamallee, Chennai, South India, between July 2024 to September 2024. The present study included 55 patients who attended a primary health care setting. A convenient consecutive sampling technique was followed in recruiting both male and female patients above 18 years of age with or without co-morbid illness. The elements of lipid profile analysis were presented as median and interquartile range. The Mann-Whitney U test was employed for comparing continuous variables between diabetic and non diabetic groups and Fisher’s exact test for associations between categorical variables. Kendall’s Tau-B correlation was used to assess associations among continuous variables within the diabetic subgroup. A p-value &lt;0.05 was considered statistically significant. Results: Of the total 55 participants who consented to participate in the study, 41 were males and 14 were females. Among them, 11 participants were known cases of Diabetes Mellitus (DM). A total of 44 participants with capillary blood glucose levels less than 126 mg/dL and no prior history of co-morbid illness were considered to be apparently normal. The median and Interquartile range of Total Cholesterol (TC), Triglycerides (TG), Very Low-Density Lipoprotein (VLDL), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and ratio of cholesterol to HDL were found to be 160 (IQR=40), 105 (IQR=37.5), 34 (IQR=8), 108 (IQR=54.5), 21 (IQR=7.5), 4.7 (IQR=0.0), respectively. The analysis revealed a significant difference in the LDL (p-value &lt;0.01) and ratio of cholesterol to HDL (p-value-0.054) in the diabetic group compared to the non diabetic group. The association between diabetic status and independent variables revealed a significant association between diabetic status and LDL. TC/HDL was moderately correlated with Fasting Blood Sugar (FBS) (τ=0.59, p-value=0.03) and Postprandial Blood Sugar (PPBS) (τ=0.57, p-value=0.03). A positive correlation was observed between FBS and TC (τ=0.41, p-value=0.08), TGs (τ=0.44, p-value=0.06), HDL cholesterol (τ=0.41, p-value=0.08), LDL cholesterol (τ=0.55, p-value=0.02) and VLDL (τ=0.44, p-value=0.06) although not statistically significant. Conclusion: Strong association between altered lipid parameters and Diabetic status, with the presence of moderate effect sizes, suggests potentially meaningful relationships that warrant a greater insight into the discernment of the disease. The current pilot study may direct future research to comprehensively understand the metabolic derangements playing a causative role in the pathogenesis of DM and Metabolic Syndrome.

Children diagnosed with diplegic cerebral palsy frequently experience gait difficulties that can significantly affect their independence and quality of life. The development of advanced technologies presents opportunities to enhance their walking abilities and overall functional performance. The purpose of this study was to determine how children with spastic diplegia performed when walking after completing robotic-assisted treadmill gait training (RATGT). Forty children with spastic diplegia participated in this randomized controlled trial. Their ages ranged from 6 to 11years, and they were able to ambulate and displayed abnormal gait kinematics. They were randomly classified into two groups of equal number; the control group (A) received a regular physical therapy program based on the neurodevelopmental approach, while the study group (B) received RATGT using Lokomat in addition to the regular physical therapy program. Biodex Gait Trainer II was used to assess walking speed, step length, step symmetry, and the 6-min walk test to assess walking capacity for each group before and after the treatment program. There was statistically significant improvement of all measured variables in group B (p<0.05), with significant difference between groups when comparing post-treatment mean values of all measured variables (p<0.05). These findings suggested that RATGT could be used as an additional therapeutic modality to improve walking performance in children with spastic diplegia. Clinical trial registration number from the Pan African Clinical Trials Registry (PACTR) - PACTR202503598420671.

Lysosomal trafficking markers covering PSAP, PGRN, SORT1 and LRP1 in body liquids and cerebral tissue as auxiliary indicative tool of traumatic brain injury.

To measure serum insulin-regulated aminopeptidase levels in women diagnosed with polycystic ovary syndrome and to investigate their potential contribution of these levels to the development of insulin resistance, which plays a central role in the pathophysiology of polycystic ovary syndrome. The study group, recruited between May and December 2021, consisted of 40 patients diagnosed with polycystic ovary syndrome and 40 age-matched healthy controls. Serum insulin-regulated aminopeptidase levels were compared between the groups using the ELISA method. Serum insulin-regulated aminopeptidase levels were significantly lower in the polycystic ovary syndrome group compared with the control group (p < 0.001). Subparameter assessments revealed that insulin-regulated aminopeptidase levels were even lower in insulin-resistant polycystic ovary syndrome patients (p = 0.001). Moreover, insulin-regulated aminopeptidase levels demonstrated a statistically significant negative correlation with fasting blood glucose, insulin, glycated hemoglobin, and HOMA-IR values. Serum insulin-regulated aminopeptidase levels were found to be lower in women with polycystic ovary syndrome than those in healthy controls. Furthermore, these levels appear to reflect insulin resistance, a key factor in the pathogenesis of polycystic ovary syndrome. Overall, these findings suggest that insulin-regulated aminopeptidase may serve as a potential biomarker for the identifification of insulin resistance in women with polycystic ovary syndrome.

α-Glucosidase is in high demand for applications involving the digestion of α-configured glycoside and saccharide substrates. Areas of application include industrial processing in food/feed and chemistry, as well as medicine and analytics. With an analytical application for assaying α-amylase in mind, we conducted a study on the immobilization of α-glucosidases from Bacillus stearothermophilus and Saccharomyces cerevisiae on support materials based on polystyrene and polymethacrylate. The carriers had nine different surface functional groups: none (plain material), carboxylate, sulfate, thiol, hydroxy, amine, sulfonyl chloride, epoxy, and PEG300. Based on preliminary results obtained with polymer beads, we selected the α-glucosidase from B. stearothermophilus and polystyrene plates with surface functional groups for detailed studies on enzyme immobilization. Carrier activity (Ac), immobilized enzyme effectiveness (ƞ), and reusability were evaluated depending on protein loading. Sulfonyl chloride (-SO2Cl) showed efficient and stable immobilization (Ac up to 279 U/m2 carrier; ƞ 58 %; Ac after 6 uses, 171 U/m2 carrier). The α-glucosidase immobilized onto sulfonyl chloride-polystyrene carrier was used in an assay of α-amylase activity as a representative analytical application. 4-Nitrophenyl 4,6-ethylidene-α-D-maltoheptaoside was used as the chromogenic substrate in the α-amylase assay. The results indicated that the immobilized α-glucosidase was suitable for detecting α-amylase concentrations ranging from 0.1 µg/mL to 0.5 µg/mL (0.3 - 1.3 U/L as observed activities). Additionally, the results can be readily applied in a microtiter plate-based assay. Collectively, our results reveal the basic requirements for immobilizing α-glucosidase on polystyrene for the advancement of analytical assays.

Generative Artificial Intelligence and Large Language Models in Paediatric Dentistry: A Scoping Review.

Tonic motor activation (TOMAC) is a non-pharmacological treatment for moderate-to-severe medication-refractory Restless Legs Syndrome (RLS). This bilateral wearable device applies high-frequency electrical stimulation to the peroneal nerve, engaging the therapeutic mechanism while minimizing sleep discomfort. A recent meta-analysis evaluated TOMAC in RLS using aggregate data, which precluded subgroup analyses. The aim of our systematic review and meta-analysis was to extract individual participant data to enable the evaluation of TOMAC as adjunctive treatment and monotherapy in RLS. This study was registered on PROSPERO (CRD420251005571). Web of Science, Scopus, and PubMed were searched, from inception to March 31, 2025, to identify studies evaluating TOMAC for RLS. Risk of bias (Cochrane Risk of Bias Tool and Downs and Black checklist) and quality of evidence (Oxford Centre for Evidence-Based Medicine 2011 guidelines) of eligible studies were assessed. Primary outcomes were changes in International RLS Study Group Rating Scale (IRLS) score for efficacy and in Medical Outcomes Study Sleep Problem Index II (MOS-II) score for sleep improvement. Main safety outcome was the incidence of device-related adverse events. Subgroup analyses evaluated TOMAC as adjunctive therapy and as monotherapy, as well as by age, RLS age-of-onset, sex, RLS severity, and stimulation amplitude. Five studies from the United States were extracted including three randomized-controlled-trials with 252 participants for analyses (69 monotherapy/183 adjunctive TOMAC therapy). Relative to sham, TOMAC significantly reduced IRLS score both as adjunctive therapy (MD: 3.39, p=0.0001) and monotherapy (mean difference [MD]: 3.80, p=0.0047), and significantly reduced MOS-II score both as adjunctive therapy (MD: 8.23, p=0.0006) and monotherapy (MD: 9.65, p=0.0236). There were no significant differences in IRLS MD based on age, age of RLS onset, sex, RLS severity, and stimulation amplitude. Mild discomfort was the only adverse event with higher prevalence for TOMAC than sham. These results suggest that TOMAC is a tolerable non-pharmacological treatment that reduces RLS symptoms and improves sleep, both as adjunctive therapy and as monotherapy.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma affecting children and young adults, but few reports describe its presentation and outcomes in Africa. We conducted a retrospective chart review of patients of all ages with RMS presenting to the Butaro Cancer Center of Excellence in Rwanda between July 2012 and June 2022. Fifty-nine patients with histopathologically confirmed RMS were treated using Intergroup RMS Study Group protocols adapted to the local context. Median age was 9.1 years (interquartile range [IQR] 3.5-16.6); 54.2% were female. Median duration from symptom onset to presentation was 5 months (IQR 4-7). Most had embryonal histology (66.1%), followed by alveolar (20.3%), pleomorphic (6.8%), and anaplastic (1.7%). At presentation, 16 patients (27.1%) had stage I, 3 (5.1%) had stage II, 22 (37.3%) had stage III, and 14 (23.7%) had stage IV disease; 4 (6.8%) were unstaged. Of the 39 patients treated with curative intent, 25 (64.1%) received local control and 16 (41.0%) completed all planned therapy. Two-year event-free survival was 23.3% (95% CI 13.5%-34.8%, n=55) overall and 61.4% (95% CI 33.3%-80.5%, n=16) among those who completed treatment. Treatment of RMS in a rural district hospital is feasible. Although outcomes remain lower than in high-income countries, survival was markedly higher in patients who completed therapy. Future efforts should focus on earlier diagnosis and support for timely transitions between specialties with the goal of optimizing completion of planned care.