Relief Of Symptoms Research Articles

IGF1 drives Wnt-induced joint damage and is a potential therapeutic target for osteoarthritis

Osteoarthritis is the most common joint disease and a global leading cause of pain and disability. Current treatment is limited to symptom relief, yet there is no disease-modifying therapy. Its multifactorial etiology includes excessive activation of Wnt signaling, but how Wnt causes joint destruction remains poorly understood. Here, we identify that Wnt signaling promotes the transcription of insulin-like growth factor 1 (IGF1) in articular chondrocytes and that IGF1 is a major driver of Wnt-induced joint damage. Male mice with cartilage-specific Igf1 deficiency are protected from Wnt-triggered joint disease. Mechanistically, Wnt-induced IGF1 transcription depends on β-catenin and binding of Wnt transcription factor TCF4 to the IGF1 gene promoter. In a clinically relevant mouse model of post-traumatic osteoarthritis, cartilage-specific deletion of Igf1 protects against the disease in male mice. IGF1 silencing in chondrocytes from patients with osteoarthritis restores a healthy molecular profile. Our findings reveal that reducing Wnt-induced IGF1 is a potential therapeutic strategy for osteoarthritis.

Post-operative care for patients following surgical treatment of lymphedema.

Surgical treatments are promising for the treatment of lymphedema. It is important for patients, healthcare providers, and lymphedema community to understand that surgical treatments currently are not a cure for lymphedema but have provided promising options for patients. Post-operative care for patients following surgical treatment of lymphedema is vital to optimize and sustain patient outcomes. This expert-consensus statement addresses current practice and research needs for standardized post-operative care, a core set of outcome measures, quality of care, and training of healthcare providers. Current research and clinical practice support non-surgical lymphedema therapy, also known as conservative therapy of lymphedema (e.g., compression therapy, or manual lymph drainage, or Complete Decongestive Therapy) as an essential part of post-operative care. Importantly, patient education should focus on patients' understanding that surgery is not a cure and the importance to adhere to post-operative care and life-long self-monitoring to sustain surgical results of limb volume reduction, relief of symptoms, and mitigate known or ongoing risk factors for recurrence of lymphedema. To optimize patient outcomes, it is crucial to have a multidisciplinary professional team consisting of well-qualified and credentialed healthcare providers participating in ongoing training and education. The essentials recommended by this expert-consensus are an initial and foundational step to build clinical standards for best practice and provide directions for future research.

Engineering Stimuli-Responsive Materials for Precision Medicine.

Over the past decade, precision medicine has garnered increasing attention, making significant strides in discovering new therapeutic drugs and mechanisms, resulting in notable achievements in symptom alleviation, pain reduction, and extended survival rates. However, the limited target specificity of primary drugs and inter-individual differences have often necessitated high-dosage strategies, leading to challenges such as restricted deep tissue penetration rates and systemic side effects. Material science advancements present a promising avenue for these issues. By leveraging the distinct internal features of diseased regions and the application of specific external stimuli, responsive materials can be tailored to achieve targeted delivery, controllable release, and specific biochemical reactions. This review aims to highlight the latest advancements in stimuli-responsive materials and their potential in precision medicine. Initially, we introduce disease-related internal stimuli and capable external stimuli, elucidating the reaction principles of responsive functional groups. Subsequently, we provide a detailed analysis of representative pre-clinical achievements of stimuli responsive materials across various clinical applications, including enhancements in the treatment of cancers, injury diseases, inflammatory diseases, infection diseases, and high-throughput microfluidic biosensors. Finally, we discuss some clinical challenges, such as off-target effects, long-term impacts of nano-materials, potential ethical concerns, and offer insights into future perspectives of stimuli-responsive materials.

Intra-articular corticosteroid injections for osteoarthritis: A qualitative study of patients' and clinicians' experiences.

Osteoarthritis is a leading cause of joint pain and disability. Intra-articular corticosteroid injections (IACs) are often used in primary care once other recommended treatments have failed. Evidence shows that IACs provide short-term relief of osteoarthritis symptoms, yet little is known about patients' and primary care clinicians' experiences and beliefs about their use. We explored patients' and primary care clinicians' views about IACs, including the benefits, disadvantages, perceived risks of treatment, when they are used, and factors that affect decision-making. We conducted individual interviews with patients and primary care clinicians and used inductive thematic analysis to investigate their views and experiences of intra-articular corticosteroid injections for osteoarthritis (IACs). We interviewed 38 patients and 19 primary care clinicians. We identified 6 patient themes: variation in access; awareness of IACs; views of risk and trust; effectiveness of IACs; variation in onset and effect duration; and an alternative to undesirable treatments. In the interviews with clinicians, we identified an overarching theme of caution and competence, which included eight subthemes: confidence and (dis)comfort with practical procedures; risk of adverse outcomes; training; uncertainty about evidence and guidelines; technical uncertainties; IACs use on the osteoarthritis pathway; perceived benefits and impacts of IACs; and the possibility of placebo. Patients and clinicians valued IACs' potential to relieve symptoms and improve quality of life. Variability in patients' access to treatment appears related to clinicians' confidence in delivering injections and their concerns about the evidence base. Variation in dose frequency and timing reflect clinicians' uncertainty about current guidance. Despite variation in effectiveness patients preferred IACs to other forms of pain medication and to delay or avoid surgery. IACs were mostly used as an adjunct treatment before surgery was offered. These findings can inform further research into the effectiveness of IACs and improvements in information and guidance.

Association between Pre-operative Vitamin-D level and Shortterm Clinical Outcomes Regarding Pain & Disability following PLID surgery

Background: Low back pain (LBP) is a common problem affecting 70% of the population in the developed countries and prevalence is also increasing in the developing countries. There were strong associations between vitamin D deficiency and LBP. According to the latest report in Bangladesh 86% (eighty-six percent) people had hypovitaminosis- D. A high prevalence of vitamin D deficiency is seen in patients with degenerative diseases of the spine. Considering the hypovitaminosis D led to musculoskeletal issues we want to examine the level of vitamin D in patients before PLID surgery and observe its impact 01 month postoperatively regarding pain & disability outcomes by Visual Analogue Scale (VAS) & Oswestry Disability Index (ODI). Objectives: The objective of this study was to evaluate an association between preoperative Vitamin-D level and short-term outcome regarding pain & disability following PLID surgery. Materials and Methods: This cross-sectional observational study will be conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University. Patient’s data will be collected in questionnaire/data collection sheet. All the patient will be evaluated by serum Vitamin-D level preoperatively. Patient will be clinically assessed by VAS (Visual Analogue Scale) score and ODI (Oswestry Disability Score) preoperatively and 01 month postoperatively. Then our aim is to determine a relationship between pre-operative Vitamin-D level and mean difference between pre and post-operative VAS & ODI Score. Statistical analysis: Data was processed and analyzed by using computer software SPSS (Statistical Package for Social Sciences) version 22. Appropriate statistical test for data analysis (Unpaired T-test) was done. Statistical significance was set at pvalue <0.05. Results: In this study population, the mean age was 42.84 ± 10.14 years ranging from 31 to 78 years. Out of 38 patients 17 (45%) patients had hypovitaminosis-D and 19 (55%) patient had normal vitamin-D level. 15 (39.5%), 11 (28.9%), 10 (26.3%) and 2 (5.3%) patients were service holder, housewife, Businessman and other (retired) respectively. T-test & Chi square test showed positive association between preoperative vitamin-D level and post-operative clinical outcome regarding pain and disability, with a significant p-value of p = <0.05. Conclusion: Our study has showed an association between Pre-operative Vitamin-D level and post-operative clinical outcome regarding pain & disability, that is, insufficient Vitamin-D level leads to decrease alleviation of symptoms following PLID surgery. Bang. J Neurosurgery 2024; 13(2): 75-85

Cutaneous mastocytosis: diagnostic challenges and dietary influences in a prolonged case report

Cutaneous mastocytosis is a rare condition characterized by abnormal mast cell proliferation in the skin. We present the case of a 65-year-old man with recurrent urticaria-like rashes persisting for more than eight years. Despite multiple misdiagnoses as insect bites, examination and biopsy revealed mast cell infiltration. The patient's unique lifestyle, particularly his frequent seafood consumption, adds an intriguing dimension to the case. Treatment with systemic antihistamines and corticosteroids provided symptomatic relief, but long-term follow-up showed the persistence of clinical lesions, indicating that the treatment did not adequately address the underlying cause of the disease. A notable improvement in disease control was observed when the patient's diet was adjusted, suggesting a potential link between food and cutaneous mastocytosis. To our knowledge, this is the first documented case of maculopapular cutaneous mastocytosis in Syria.

Amniotic bladder therapy: study of micronized amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) at 6months.

Intravesical application of birth tissue has been reported to inhibit inflammation, alleviate collagen fiber accumulation, and enhance bladder tissue generation. We have previously reported that intra-detrusor micronized amnion monolayer (AM) injections provide short-term clinical improvement in refractory IC/BPS patients. Herein, we evaluate the therapeutic responses and adverse events of micronized amnion/chorion bilayer (AC) in patients with refractory IC/BPS with 6months follow-up. Fifteen patients affected by IC/BPS who failed conventional therapy received 100mg of reconstituted micronized AC was injected intra-detrusor via cystoscopy under general anesthesia, using a 23-gauge needle. Twenty 0.5-mL injections were administered into the lateral and posterior bladder walls, avoiding the dome and trigone. Changes in interstitial cystitis symptom index (ICSI), Interstitial cystitis problem index (ICPI), Bladder pain/ interstitial cystitis symptom score (BPIC-SS) and Overactive Bladder Assessment Tool (OAB), from baseline to 6months post-injection were evaluated retrospectively.The safety of injections was analyzed. Fifteen total refractory IC/BPS patients with an average age of 41.1 ± 14.5years were included in the study, receiving intra-detrusor injections of 100mg of micronized AC. One month after injections, significant improvement in IC/BPS symptom scores was noted in all patients. All patients maintained a sustained clinical response at 6months post-injection. No product-related adverse events were observed. Our findings indicate that the AC formulation significantly reduces time to symptom relief in patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS) and maintains a sustained response up to 6months post-injection. These results suggest a promising clinical benefit of using an amnion/chorion bilayer product for treating IC/BPS. Further research is needed to confirm these findings and assess the long-term durability of this treatment approach. This study represents the first evidence supporting the clinical advantages of an amnion/chorion bilayer product in managing IC/BPS.

Neurofeedback Reduces P300 Amplitudes to Intensely Emotive Pictures in Depressed Cancer Patients.

Objective. Electroencephalographic neurofeedback (EEG NF) or its effects on event-related potentials (ERPs) in quantitative EEG have not yet been systematically studied in cancer patients. The aim of this study was to investigate the emotional arousal and valence effects on the event-related P300 in a visual oddball paradigm by an individualized EEG alpha and theta/beta NF intervention in cancer patients and survivors (N = 18, age between 31 and 73 years). Methods. ERPs to low and high arousal target stimuli with either emotional positive or negative content and depressive state were obtained in cancer patients before and after a five-week NF intervention in a waitlist paradigm, following the consensus on the reporting and experimental design of clinical and cognitive-behavioral NF studies (CRED-nf checklist). Results. Overall, P300 amplitudes decreased significantly (p < .05) from pre to post therapy. Effects concerning high arousal stimuli with negative and positive valences were on the border to significance. Moreover, patients achieved significant relief of depressive symptoms (p < .05). Especially younger participants (<55 yrs.) benefited. Conclusions. P300 observations could reflect a therapeutic effect on brain activity level. EEG NF alleviates depressive symptoms in cancer patients. Significance. Based on these findings, further studies are needed to investigate the effects on event-related potentials by NF therapy.

Semi-quantitative CT score reflecting the degree of pulmonary infection as a risk factor of hypokalemia in COVID-19 patients: a cross-sectional study.

Hypokalemia is a common electrolyte disorder observed in patients afflicted with coronavirus disease 2019 (COVID-19). When COVID-19 is accompanied by pulmonary infection, chest computed tomography (CT) is the preferred diagnostic modality. This study aimed to explore the relationship between CT semi-quantitative score reflecting the degree of pulmonary infection and hypokalemia from COVID-19 patients. A single-center, cross-sectional study was conducted to investigate patients diagnosed with COVID-19 between December 2022 and January 2023 who underwent chest CT scans upon admission revealing typical signs. These patients were categorized into two groups based on their blood potassium levels: the normokalemia group and the hypokalemia group. Medical history, symptoms, vital signs, laboratory data, and CT severity score were compared. Binary regression analysis was employed to identify risk factors associated with hypokalemia in COVID-19 patients with pulmonary infection. A total of 288 COVID-19 patients with pulmonary infection were enrolled in the study, of which 68 (23.6%) patients had hypokalemia. The CT severity score was found to be higher in the hypokalemia group compared to the normokalemia group [4.0 (3.0-5.0) vs. 3.0 (2.0-4.0), p = 0.001]. The result of binary logistic regression analysis revealed that after adjusting for sex, vomiting, sodium, and using potassium-excretion diuretics, higher CT severity score was identified as an independent risk factor for hypokalemia (OR = 1.229, 95% CI = 1.077-1.403, p = 0.002). In this cohort of patients, semi-quantitative CT score reflecting the degree of pulmonary infection may serve as a risk factor of hypokalemia in COVID-19 patients.

Y Reverse: Modified technique in challenging airway management.

Self-expanding Y-metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y-stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy. This retrospective study included 15 consecutive patients, suffering from tracheal-carina-lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y-stent insertion using the modified technique Y reverse. The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant. Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi.

PREVALENCE AND DETERMINANTS OF HYSTERECTOMY IN THE GYNECOLOGY UNIT OF AYUB TEACHING HOSPITAL, ABBOTTABAD

Hysterectomy is one of the most common obstetric surgery performed on women. It provides symptomatic relief, reduces morbidity and enhances the quality of life but can also lead to complications like mental stress, infertility, fractures and cardiovascular insults. To the best of our knowledge, no studies have provided information regarding the prevalence and risk factors of hysterectomies in Pakistani females. Objective: The goal of this study is to investigate the prevalence and socio-demographic determinants of hysterectomy in a teaching hospital in Pakistan, Methods: This descriptive cross-sectional study was done in the Gynecology C unit of Ayub Teaching Hospital, Abbottabad from 25th July 2024 to 10th Oct, 2024 after taking approval from ethical committee. 246 patients who underwent major gynaecological procedures were included in this study. Basic demographics, type of procedure and indication for hysterectomy were noted after obtaining consent from the patient. Results: The overall prevalence of hysterectomy was around 36.9% in our study. Heavy menstrual bleeding (43.95%) was found to be the leading cause of hysterectomy followed by fibroid uterus and adenomyosis in 25.27% and 16.48% cases respectively. Additionally, age group 45-49 (OR: 1.04, 95% CI: 0.5-2.1), urban residence (OR: 1.08, 95% CI: 0.64-1.8), more gravida (OR: 2.08, 95% CI: 0.88-4.92) and higher socioeconomic levels (OR: 1.28, 95% CI: 0.62-2.64) were found to increase odds of hysterectomy, whereas having a job (OR: 0.83, 95% CI: 0.47-1.44) and getting college education (OR: 0.83, 95% CI: 0.4- 1.7) were found to decrease the risk of hysterectomy. Conclusion: The prevalence of hysterectomy was found to be higher than in other countries. Urban residence, multigravida, higher socioeconomic levels and older age groups tend to increase the odds of hysterectomy.

Patient preferences regarding the cervix, ovaries, and fallopian tubes at the time of hysterectomy: a qualitative study

ABSTRACT Our objective is to understand patients’ preexisting values, beliefs, and preferences regarding removal or preservation of the cervix, ovaries, and fallopian tubes at the time of hysterectomy for benign indications. We performed semi-structured interviews from August 2021 to March 2022 with patients referred for hysterectomy. Participants were recruited according to pre-specified diversity axes. The interview guide was informed by literature review, expert stakeholders, and pilot testing. pers. comm. occurred prior to scheduled consultation. Responses were analyzed for themes, with thematic saturation reached. Age of participants (n = 13) ranged from 24 to 60 years. Identified themes included knowledge, decision-making, treatment goals, short- and long-term consequences, fertility, identity, and lack of concern. Many participants expressed lacking necessary knowledge of the risks and benefits of removing the cervix and adnexa. Treatment goals included symptom relief and definitive treatment. Long-term consequences included concerns about menopause and future cancer. Many patients expressed some degree of lack of knowledge, desire to remove most or all pelvic structures, or no attachment to their reproductive organs. Many patients expressed decision-making based on the effects of organ removal on long-term consequences and the relief of current symptoms, rather than immediate surgical risk. This information can help to inform patient-centered surgical counseling.

Current status of research on the diagnosis and treatment of acute ethylene glycol poisoning

Acute ethylene glycol poisoning often leads to acute kidney injury, and delays in diagnosis and treatment can lead to severe multi-organ dysfunction and even death. At present, there is a lack of specific laboratory tests that can be used for rapid clinical diagnosis, and diagnosis and evaluation only rely on medical history, clinical symptoms, and non-specific laboratory test results. Key treatments include alcohol dehydrogenase inhibitors (fomcpizole or ethanol) and hemodialysis, which is not approved in China. A clear understanding of the mechanism of toxicity, pathophysiology, clinical manifestations, efficacy and limitations of laboratory tests, and treatment options after ethylene glycol poisoning can help accelerate the early diagnosis, treatment, and prognosis of patients after ethylene glycol poisoning. This article reviews this article in order to provide a reference for clinicians.

Navigating Hormone Therapy in Postmenopausal Women: Balancing Symptom Relief With Cancer Risk.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

Total Arthroscopic Resection of the Talocalcaneal Coalition in Adults: Key Points of Surgical Technique.

Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC. A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16-57 years). The mean follow-up period was 38.93 ± 15.69 months (range, 11-59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale scores were evaluated pre- and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases. The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini-incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle-hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study. Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini-incisions were necessitated in complex situations.

Ghrelin in Depression: A Promising Therapeutic Target.

Depression is a widespread disease affecting over 300 million individuals of various ethnicities and socioeconomic backgrounds globally. It frequently strikes early in life and becomes a chronic or recurring lifelong illness. Out of the various hypotheses for the pathophysiology of depression, the gut-brain axis and stress hypothesis are the ones that need to be researched, as psychological stress impairs one or more pathways of the brain-gut axis and is likely to cause brain-gut axis dysfunction and depression. A dysfunctional reciprocal gut-brain relationship may contribute to many diseases, including inflammatory disorders, abnormal stress responses, impaired behavior, and metabolic changes. The hormone ghrelin is a topic of interest concerning the gut-brain axis as it interacts with the gut-brain axis indirectly via the central nervous system or via crossing the blood-brain barrier. Ghrelin release is also affected by the gut microbes, which has also been discussed in the review. This review elaborates on Ghrelin's role in depression and its effect on various aspects like neurogenesis, HPA axis, and neuroinflammation. Furthermore, this review focuses on ghrelin as a potential target for alleviation of depressive symptoms.

The Online Health Information-Seeking Behaviors of People Who Have Experienced Stroke: Qualitative Interview Study.

Stroke is a leading cause of death and disability worldwide. As health resources become digitized, it is important to understand how people who have experienced stroke engage with online health information. This understanding will aid in guiding the development and dissemination of online resources to support people after stroke. This study aims to explore the online health information-seeking behaviors of people who have experienced stroke and any related barriers or navigational needs. Purposeful sampling was used to recruit participants via email between March and November 2022. The sampling was done from an existing cohort of Australian stroke survivors who had previously participated in a randomized controlled trial of an online secondary prevention program. The cohort consisted of people with low levels of disability. Semistructured one-on-one interviews were conducted via phone or video calls. These calls were audio recorded and transcribed verbatim. The data were analyzed by 2 independent coders using a combined inductive-deductive approach. In the deductive analysis, responses were mapped to an online health information-seeking behavior framework. Inductive thematic analysis was used to analyze the remaining raw data that did not fit within the deductive theoretical framework. A sample of 15 relatively independent, high-functioning people who had experienced stroke from 4 Australian states, aged between 29 and 80 years, completed the interview. A broad range of online health information-seeking behaviors were identified, with most relating to participants wanting to be more informed about medical conditions and symptoms of their own or of a family member or a friend. Barriers included limited eHealth literacy and too much generalization of online information. Online resources were described to be more appealing and more accessible if they were high-quality, trustworthy, easy to use, and suggested by health care providers or trusted family members and friends. Across the interviews, there was an underlying theme of disconnection that appeared to impact not only the participants' online health information seeking, but their overall experience after stroke. These responses were grouped into 3 interrelated subthemes: disconnection from conventional stroke narratives and resources, disconnection from the continuing significance of stroke, and disconnection from long-term supports. People who have experienced stroke actively engage with the internet to search for health information with varying levels of confidence. The underlying theme of disconnection identified in the interviews highlights the need for a more comprehensive and sustained framework for support after stroke beyond the initial recovery phase. Future research should explore the development of tailored and relatable internet-based resources, improved communication and education about the diversity of stroke experiences and ongoing risks, and increased opportunities for long-term support.

Expression of Epithelial Alarmin Receptor on Innate Lymphoid Cells Type 2 in Eosinophilic Chronic Obstructive Pulmonary Disease.

Studies have shown that eosinophilic COPD (eCOPD) is a distinct phenotype of the disease. It is well established that innate lymphoid cells are involved in the development of eosinophilic inflammation. Interleukin(IL)-25, thymic stromal lymphopoietin (TSLP) and IL-33 are a group of cytokines produced by epithelium in response to danger signals, e.g., cigarette smoke, and potent activators of ILC2s. In the present study, we examined circulating and sputum ILC2 numbers and expression of intracellular IL-5 as well as receptors for TSLP, IL-33 and IL-25 by ILC2s in non-atopic COPD patients with and without (neCOPD) airway eosinophilic inflammation and healthy smokers. In addition, we examined the association between ILC2s and clinical indicators of COPD burden (i.e., symptom intensity and risk of exacerbations). ILC2s were enumerated in peripheral blood and induced sputum by means of flow cytometry. We noted significantly greater numbers of airway IL-5+ILC2s and TSLPR+ILC2s in eCOPD compared with neCOPD (p < 0.05 and p < 0.01, respectively) and HSs (p < 0.001 for both). In addition, we showed that IL-5+ILC2s, IL-17RB+ILC2s and ST2+ILC2s are significantly increased in the sputum of eCOPD patients compared with HSs. In all COPD patients, sputum ILC2s positively correlated with sputum eosinophil percentage (r = 0.48, p = 0.002). We did not find any significant correlations between sputum ILC2s and dyspnea intensity as measured by the modified Medical Research Council scale (mMRC) and symptom intensity measured by the COPD Assessment Test (CAT). These results suggest the involvement of epithelial alarmin-activated ILC2s in the pathobiology of eosinophilic COPD.

A case series: Three cases of Morvan's syndrome as a rare autoimmune disorder with anti-Caspr2 antibody.

Morvan syndrome (MoS) is an uncommon male-dominant autoimmune disorder marked by peripherally innervated hyperexcitability, autonomic disturbances, and encephalopathic encephalopathy, frequently with mass complaints manifesting as neuromyotonia (involuntary jerking, twitching, and stiffening of muscles), myotonia, neuropathic pain, hyperhidrosis, severe constipation, and severe sleep disturbances accompanied by dream reenactments, agrypnia agitation, and delusions, associated with autoantibodies to voltage-gated and potassium channel complexes such as anti-contactin-associated protein-like 2 (Caspr2) antibody. All this misery can be very disabling and even life-threatening. Reported cases show an unforeseeable outcome, with fatalities occurring even in those who initially responded. It has been reported that patients have reacted to immunologic therapies-corticosteroids, intravenous immunoglobulins, plasma exchanges, azathioprine, cyclophosphamide, rituximab, or carbamazepine, gabapentin, and clonazepam. However, no long-term effective cure has yet been found for this condition. Clinicians and researchers increasingly emphasize alternative and complementary medicine, with a growing trend toward traditional Chinese medicine (TCM). Following glucocorticoid therapy, all 3 patients experienced a recurrence of the disease. Patients 1 and 2 observed symptomatic relief after intravenous immunoglobulin administration; however, upon discontinuation of the treatment, their conditions relapsed and worsened compared with the previous state. The 3 patients were definitively diagnosed with serum Caspr2-positive MoS, accompanied by a constellation of neurological manifestations. The 3 patients were treated under the guidance of TCM theory. According to the principles of TCM, the patients were characterized by the deficiency of Yin, so the prescriptions were as follows: Shaoyao-Gancao decoction combined with Sanjia-Fumai decoction. After the application of TCM, there was a reversal of neuropsychiatric manifestations such as unintentional rippling, jerking, muscle stiffness, myokymia, hyperhidrosis, and extreme constipation. Patients' quality of life improved significantly; to date, they have achieved Karnofsky Performance Status scores of 100, and the anti-Caspr2 antibody result in case 2 dropped from 1:32 to normal. We first report the effective treatment of the MoS case series with TCM as complementary and alternative medicine.

Endometriosis in Focus: Modern Therapeutic Approaches for Enhanced Patient Outcomes - Review

Endometriosis (EM) is a chronic condition affecting millions of women globally, characterized by the growth of endometrial-like tissue outside the uterus. This review highlights the latest advancements in understanding and treating endometriosis, focusing on new therapeutic strategies aimed at improving patient care. The article briefly discusses the pathogenesis of endometriosis and reviews traditional treatment methods, including hormonal therapies (progestins, GnRH agonists, and oral contraceptives) and surgical interventions. It then explores the limitations of these conventional therapies and delves into newer strategies targeting specific molecular pathways, offering more effective symptom relief with fewer side effects. Emerging treatments that modulate the immune response and reduce inflammation are also examined, along with innovative approaches to pain management, both pharmacological and non-pharmacological. The review further considers alternative and supportive therapies, such as dietary changes, gut microbiota interventions, and complementary treatments like acupuncture, which may improve the overall management of endometriosis. This review emphasizes the shift toward more personalized, holistic care in treating endometriosis, with a focus on emerging therapies like Aromatase Inhibitors, GnRH receptor antagonists, and hormone receptor modulators. These approaches represent a significant advancement in improving the quality of life for women with this condition.