Search Results (14,796)

Background/Objectives: Malva sylvestris L. is rich in mucilage and is traditionally used for the management of numerous ailments including gastrointestinal disorders. Functional constipation (FC) is a gastrointestinal condition characterized by defecation anomalies such as infrequent stools, difficulty in stool passage, or both in the absence of pathological abnormalities. FC can be reduced through lifestyle factors and dietary intervention. This consumer-based survey aimed to assess the efficacy of a M. sylvestris extract-based food supplement on the improvement of FC. Methods: Healthy participants (n = 56), enrolled in a consumer-based survey, took a food supplement containing a chemically characterized M. sylvestris extract at a dose of 20 mL/day (containing 750 mg of M. sylvestris extract rich in food fiber and polyphenols) for 20 days on the advice of their pharmacist. The study evaluated bowel movement frequency (intestinal diary), stool consistency (Bristol Stool Form Scale, BSFS), and abdominal pain (Visual Analogue Scale, VAS), at baseline (T0), after 10 days (T1), and after 20 days (T2). Results: A significant increase in bowel movement frequency and stool consistency (p < 0.001) with a significant decrease in abdominal pain (p < 0.001) was observed. Additionally, this food supplement was well-tolerated as no adverse effects were reported by the enrolled subjects. Conclusion: M. sylvestris-based food supplement showed promising effectiveness and satisfaction in improving FC in healthy subjects, however, randomized clinical studies are needed to confirm these preliminary results. Full article

Background and aims: Despite technical advances, endoscopic retrograde cholangiopancreatography (ERCP) is associated with complications and potentially lethal outcomes. Sarcopenia, a complex syndrome mainly associated with aging, has been recognized as a predictor of poor surgical outcomes. Thus far, the impact of sarcopenia on ERCP remains unknown. The present study evaluates the role of sarcopenia as a predictor of ERCP-related outcomes in a cohort of elderly patients. Methods: Patients who underwent ERCP between June 2019 and January 2023 were retrospectively included. Demographic and procedure-associated data were collected. Sarcopenia was assessed using the skeletal muscle index (SMI) measured from a single axial slice through the L3 vertebra on a CT scan. ERCP-related outcomes were recorded. Univariate and multivariate analyses were used to assess the correlation between sarcopenia and procedural outcomes. Results: In total, 256 patients were enrolled, of whom 30 (11.7%) were sarcopenic. Cardiopulmonary complications of ERCP occurred in 3.5%. Sarcopenia was associated with higher 30-day and 12-month post-ERCP mortality (OR 3.45, p = 0.03; OR 3.87, p = 0.004) and longer hospitalization time (7 vs. 11 days, p = 0.003). Conclusions: SMI is an easy and objective index of sarcopenia that could be used to predict ERCP outcomes. Indeed, sarcopenia was independently associated with prolonged hospitalization and increased mortality in a retrospective cohort of elderly patients. Full article

Background: Retinal vein occlusion (RVO) is a relatively uncommon condition with a complex pathophysiology. However, its association with traditional cardiovascular risk factors is well established. In this study, we compared arterial stiffness and endothelial function between patients with RVO and healthy controls. Methods: We enrolled 28 consecutive patients with RVO, either central (CRVO) or branch (BRVO), and 30 healthy controls. We measured: (i) perfused boundary region of the sublingual arterial microvessels (a marker of endothelial glycocalyx thickness), (ii) pulse wave velocity (PWV), augmentation index (AIx), and central systolic blood pressure (cSBP). Results: No statistically significant differences regarding age, gender, and major cardiovascular risk factors were noted between patients and controls. Compared to controls, patients with RVO had higher PBR, PWV, AIx, and cSBP values (p < 0.05). For each of these indices, no statistically significant differences were noted between patients with CRVO and BRVO (p > 0.05). Conclusions: Patients with RVO demonstrated reduced endothelial glycocalyx thickness and increased arterial stiffness compared to healthy controls. These findings further elucidate the role of atherosclerosis and endothelial dysfunction in the pathophysiology of the disease and indicate the need for the evaluation of subclinical cardiovascular disease in such patients. Full article

Dendritic cells (DCs) play a crucial role in controlling viral infections. Little is known about the changes in frequencies of the DC subsets in patients with chronic hepatitis C (CHC), particularly in the era of interferon-free regimens. We aimed to evaluate the impact of sofosbuvir/daclatasvir on the frequency of different peripheral DC subsets, the expression of the inhibitory CD200R and its ligand CD200 on DC, and their relation to the treatment outcome. A total of 1000 patients with CHC were enrolled and treated with a fixed oral dose of 400 mg of sofosbuvir and 60 mg of daclatasvir for 12 weeks. A total of 940 patients achieved sustained virologic response (SVR), and only 60 patients were non-responders (NRs). The frequencies of the peripheral plasmacytoid (pDC) and myeloid (mDCs) subsets and their surface expressions of CD200R and CD200 molecules were analyzed using flow cytometry. This analysis included 60 non-responders (NR group), 60 randomly selected sustained virologic responders (SVR group) at baseline, and at the end of treatment, and 60 healthy controls. HCV infection was associated with a down-regulation in the frequency of mDC, compared to healthy controls. In addition, mDC in HCV-infected patients showed lower levels of CD200R. However, neither the pDC frequency nor their CD200R expression was significantly altered. Interestingly, by the end of therapy, the frequencies of circulating mDCs and CD200R⁺mDC increased significantly in the SVR group and were even comparable to healthy controls. The levels of these cells were not normalized in the NR group. Percentages of mDCs and CD200R⁺mDC subsets showed good prognostic accuracy for predicting virologic response to therapy. Our results showed that HCV infection was associated with modulation of the mDC frequency and their surface expression of CD200R. Successful daclatasvir and sofosbuvir combined therapy was associated with the normalization of the percentages of mDC and CD200R⁺mDC. Full article

Background/Objectives: UV radiation is a primary cause of skin damage and photoaging. β-carotene, a potent antioxidant, aids in mitigating UV-induced oxidative stress and enhancing skin photoprotection. This research aimed to evaluate the efficacy of a nutraceutical product designed to prevent photoaging. Methods: The product consists of a blend of hemp seed oil and banana (Musa AA), formulated as a chewable tablet. Healthy male participants aged 35–50 years were enrolled in a randomized, parallel, single-blind, placebo-controlled clinical trial. Participants received either the chewable nutraceutical (five tablets after meals in the morning and evening, equivalent to 8 ± 2 mg/day of β-carotene and 400 mg/day of PUFA) or a chewable placebo for 16 weeks. A total of thirty-six participants successfully completed the entire 16-week study. Results: Administration of the nutraceutical resulted in a significant reduction (p < 0.05) in UV solar light stimulator-induced erythema on the dorsal skin at week 4, with a mean value of 3.76 ± 0.46 AU, compared to the initial value of 4.88 ± 0.62 AU at week 0. Additionally, serum β-carotene concentration significantly increased from 0.45 ± 0.02 µg/mL at week 0 to 0.61 ± 0.06 µg/mL at week 16 (p < 0.05). Moreover, skin intensity in the sun-exposed arm area also significantly improved at week 16, increasing from 71.33 ± 3.50 at week 0 to 81.80 ± 4.45 (p < 0.05). Conclusions: The results indicate that the developed nutraceutical may offer effective protection against erythema, making it a promising option for preventing photoaging. Full article

Background/Objectives: The aim of this study is to assess whether changes in Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) following a VtC can predict the response to fluid administration in patients undergoing surgery under general anesthesia with protective mechanical ventilation. Methods: A total of 40 patients undergoing general surgery or vascular surgery without clamping the aorta were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. The protocol began one hour after the induction of general anesthesia and the stabilization of hemodynamic parameters. The parameters PPV₆ and SVV₆ were recorded during ventilation with a Vt of 6 mL/kg Ideal Body Weight (IBW) (T1). Then, the Vt was increased to 8 mL/kg IBW for 3 min without changing other respiratory parameters. After the VtC, the parameters PPV₈ and SVV₈ (T2) were recorded. After the stabilization of hemodynamic parameters, volume expansion (VE) was administered with colloid fluid of 6 mL/kg IBW. Parameters before (T3) and 5 min after fluid challenge (T4) were recorded. The change in the Stroke Volume Index (SVI) before and after VE was used to indicate fluid responsiveness. Patients were classified as fluid responders (SVI ≥ 10%) or non-responders (SVI < 10%). Results: The parameter ΔPPV(6–8) demonstrated good predictive ability to predict fluid responsiveness, evidenced by an Area Under the Curve (AUC) of 0.86 [95% Confidence Interval (CI) 0.74 to 0.95, p < 0.0001]. The threshold of ΔPPV_6–8 exceeding 2% identified responders with a sensitivity of 83% (95% CI 0.45 to 1.0, p < 0.0001) and a specificity of 73% (95% CI 0.48 to 1.0, p < 0.0001). The parameter ΔSVV(6–8) also revealed good predictive ability, reflected by an AUC of 0.82 (95% CI 0.67 to 0.94, p < 0.0001). The criterion ΔSVV(6–8)greater than 2% pinpointed responders with a sensitivity of 83% (95% CI 0.71 to 1.0, p < 0.001) and a specificity of 77% (95% CI 0.44 to 1.0, p < 0.001). Conclusions: This study demonstrates that VtC possesses good predictive ability for fluid responsiveness in patients undergoing general surgery. Full article

Background/Objectives: To evaluate the visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) surgery and refractive lens exchange (RLE) surgery in moderate to high myopia patients. Methods: A retrospective cohort study was performed, and patients receiving KLEx or RLE surgeries with myopia within −3.00 to −10.00 diopter (D) were enrolled. A total of 19 and 35 patients were put into the RLE and KLEx groups after exclusion. The main outcomes are postoperative uncorrected visual acuity (UDVA), the spherical equivalent (SE), and residual astigmatism via vector analysis. Fisher’s exact test and the Mann–Whitney U test were utilized for the statistical analysis. Results: The percentages of patients who reached UDVA results of more than 20/25 and 20/20 were statistically similar between groups (both p > 0.05), and the percentages of patients who reached SE results within ±0.50 D and ±1.00 D were statistically similar between groups (both p > 0.05). The change in SE in the KLEx group was lesser compared to that in the RLE group (p = 0.021). The vector analysis showed a lower DV and ME and a higher CoI in the KLEx group than in the RLE group (all p < 0.05). The percentage of patients who reached specific UDVA and SE thresholds were statistically similar between groups with different myopia degrees (all p > 0.05). Conclusions: The postoperative visual and refractive outcomes between RLE and KLEx surgeries are grossly comparable, while the KLEx may have a slight advantage in astigmatism correction. Full article

Objective: The course of relapsing–remitting multiple sclerosis (RRMS) is highly variable and there is a lack of effective prognostic biomarkers. This study aimed to assess the potential prognostic value of the chemokines B lymphocyte chemoattractant molecule (CXCL13), eotaxin-1 (CCL11), and macrophage inflammatory protein 3-alpha (CCL20) in RRMS. Methods: Forty-two patients with MS were enrolled, along with 22 controls, 12 of the controls were idiopathic intracranial hypertension (IIH) patients, and 10 of the controls were other neurologic diseases (OND). Chemokine levels were measured using enzyme-linked immunosorbent assay (ELISA) in serum and cerebrospinal fluid (CSF) samples. Results: No significant differences were observed among the groups in serum levels of CXCL13, CCL11, and CCL20 (p = 0.509, p = 0.979, p = 0.169, respectively). CSF CXCL13 levels were significantly higher in the OND group (p = 0.016). A PATH analysis showed CSF CXCL13 was significantly associated with new T2 hyperintense lesions on brain magnetic resonance imaging (p < 0.001), and baseline serum CCL11 levels were associated with EDSS (p = 0.030), implying its potential role in indicating neurodegenerative processes and possible progression risk. Serum CCL20 correlated with EDSS (p = 0.002) and lesion burden (p < 0.001), reflecting disease severity. Conclusions: These findings suggest that CSF CXCL13 could serve as a useful biomarker for predicting active disease in RRMS, while follow-up serum CCL11 may assist in identifying progression. Although these chemokines are not specific to MS, higher levels may signal disease activity, severity, and transition to more progressive stages. Full article

Background/Objectives: Psoriasis is a chronic inflammatory disease that significantly impacts physical and emotional health. Statins, primarily used as lipid-lowering drugs, have also demonstrated anti-inflammatory effects. While some studies suggest that statins may improve psoriasis symptoms, the findings have been inconsistent. This study aims to investigate the association between prior statin use and the onset of psoriasis in a Korean population, focusing on individuals with dyslipidemia to minimize confounding factors. Methods: Using the Korean Health Insurance database (2002–2019), a nationwide nested case-control study was conducted, enrolling 8285 participants with psoriasis and 33,140 controls, matched 1:4 for sex, age, residence, and income through propensity scoring. Results: Adjusted odds ratios revealed significantly lower risks of psoriasis among short-term statin users (OR = 0.70, 95% CI = 0.66–0.74) and long-term users (OR = 0.77, 95% CI = 0.73–0.82) than in nonusers. This trend was consistent for both lipophilic and hydrophilic statins, and across subgroup analyses. Conclusions: These findings suggest that statins may reduce the incidence of psoriasis. However, further research is needed to assess their effects on psoriasis progression and severity. Full article

Background/Objectives: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). Methods: This is a retrospective cohort study analyzing data of patients who underwent LPD from 2018 to 2022. The primary endpoint was the incidence of grade B and C POPF based on the International Study Group on Pancreatic Fistula criteria and PJ anastomosis time. Incidence of postoperative complications (Clavien–Dindo classification grade ≥ III) was also investigated. Results: A total of 148 patients, 99 patients in a modified Blumgart group and 49 patients in a continuous suture group, were enrolled. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (p > 0.05). There was no significant difference in pancreas texture (p = 0.397) and diameter of pancreatic duct (p = 0.845). Grade B and C POPF occurred in five patients (5.1%) in the modified Blumgart group and three patients (6.1%) in the continuous suture group with no statistical difference (p = 0.781). A total of eleven patients (11.1%) in the modified Blumgart group and four patients (8.2%) in the continuous suture group had postoperative complication (Clavien–Dindo Classification grade 3 or more). Mortality within 90 days was 2 (2%) and 0 (0%), respectively. The PJ anastomosis times in the modified Blumgart group and continuous suture group were 28.8 ± 5.94 min and 35 ± 7.71 min, respectively (p = 0.003). Conclusions: This study suggests that modified Blumgart PJ showed shorter anastomosis time with comparable outcome to continuous suture methods in LPD. Full article

Background: The RAVE-Renal study was conducted to evaluate the real-world efficacy and safety of avelumab plus axitinib as a first-line therapy for patients with metastatic renal cell carcinoma (mRCC). Methods: RAVE-Renal was a multicenter, noninterventional, ambispective study with both retrospective and prospective components. The study included adult patients with histologically confirmed mRCC, measurable disease per RECIST version 1.1, and no prior systemic therapy. Patients received avelumab (800 mg intravenously every 2 weeks) plus axitinib (5 mg orally twice daily). The primary endpoints were median progression-free survival (PFS) and objective response rate (ORR). The secondary endpoints included median OS, 1-year overall survival (OS) rate, and safety. Results: A total of 125 patients from 13 sites were enrolled, with a median follow-up of 16.1 months. The median age was 61.0 years. The study population comprised 35.3% favorable, 49% intermediate, and 15.7% poor IMDC risk patients. The median PFS was 14.9 months (95% CI, 11.72–19.08). The ORR was 44.3% (95% CI, 32.5–56.1). The clinical benefit rate was 93.4%. The 1-year OS rate was 71.2%, with the median OS not reached. Any-grade treatment-related adverse events (TRAEs) occurred in 99 (79.2%) cases, including grade ≥3 TRAEs in 24 (19.2%). Conclusions: Avelumab in combination with axitinib showed clinical benefits in a real-world setting, consistent with findings from a pivotal trial. The regimen was effective and well tolerated across various patient subgroups. Full article

Background: Adolescents in foster care endure frequent disruptive transitions, often culminating in discharge to independent living rather than reunification or adoption. Former foster youth fare poorly once on their own, with high rates of homelessness and social disconnection. This study explored the use of the Bridges Transitions Framework near the end of placement to help youth cope with the transition to adulthood. Methods: In this exploratory study, the framework was integrated into a foster agency’s programming; then, we assessed outcomes using administrative data and youth interviews. Thirty-five youth participated. Status of employment, education, and social support was collected 18 months after exposure to the framework. Results: The participants reported moderate to high levels of social support, which is often limited or absent among foster care leavers. Relative to rates reported in state-level foster care data, participants had substantially higher rates of school enrollment after discharge. With very few empirically assessed models available for this population that specifically address internal coping with such substantial life changes, the Transitions Framework offers a tool that may help foster youth navigate aging out of care. Securing lasting and meaningful social support and employment and completing education remain elusive for former foster youth. Conclusions: To confirm the utility of the Transitions Framework, it is recommended to assess it with a large sample and matched comparison group over time. Full article

Coenzyme Q10 (CoQ10) plays a crucial role in facilitating electron transport during oxidative phosphorylation, thus contributing to cellular energy production. Statin treatment causes a decrease in CoQ10 levels in muscle tissue as well as in serum, which may contribute to the musculoskeletal side effects. Therefore, we aimed to assess the effect of newly initiated statin treatment on serum CoQ10 levels after acute ST-elevation myocardial infarction (STEMI) and the correlation of CoQ10 levels with key biomarkers of subclinical or clinically overt myopathy. In this study, we enrolled 67 non-diabetic, statin-naïve early-onset STEMI patients with preserved renal function. Plasma CoQ10 level was determined by ultra-high-performance liquid chromatography–tandem mass spectrometry (UPLC/MS-MS), while the myopathy marker serum fatty acid-binding protein 3 (FABP3) level was measured with enzyme-linked immunosorbent assay (ELISA) at hospital admission and after 3 months of statin treatment. The treatment significantly decreased the plasma CoQ10 (by 43%) and FABP3 levels (by 79%) as well as total cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B100 (ApoB100), and oxidized LDL (oxLDL) levels. The change in CoQ10 level showed significant positive correlations with the changes in total cholesterol, LDL-C, ApoB100, and oxLDL levels, while it did not correlate with the change in FABP3 level. Our results prove the CoQ10-reducing effect of statin treatment and demonstrate its lipid-lowering efficacy but contradict the role of CoQ10 reduction in statin-induced myopathy. Full article

Background/Objectives: Diabetic macular edema (DME) is a significant cause of vision loss. The development of peripheral non-perfusion (PNP) might be associated with the natural course, severity, and treatment of DME. The present study seeks to understand the predictive power of central macular changes and clinico-demographic features for PNP in patients with clinically significant DME. Methods: A prospective study using contemporaneous multi-modal retinal imaging was performed. In total, 48 eyes with DME from 33 patients were enrolled. Demographic, clinical history, laboratory measures, ultrawide field photography, fluorescein angiography, optical coherence tomography (OCT), and OCT angiography results were acquired. Anatomic and vascular features of the central macula and peripheral retina were quantified from retinal images. Separate (generalized) linear mixed models were used to assess differences between PNP present and absent groups. Mixed effects logistic regression was used to assess which features have predictive power for PNP. Results: Variables with significant differences between eyes with and without PNP were insulin use (p = 0.0001), PRP treatment (p = 0.0003), and diffuse fluorescein leakage (p = 0.013). Importantly, there were no significant differences for any of the macular vascular metrics including vessel density (p = 0.15) and foveal avascular zone (FAZ) area (p = 0.58 and capillary tortuosity (p = 0.55). Features with significant predictive power (all p < 0.001) were subretinal fluid, FAZ eccentricity, ellipsoid zone disruption, past anti-VEGF therapy, insulin use, and no ischemic heart disease. Conclusions: In the setting of DME, macular vascular changes did not predict the presence of PNP. Therefore, in order to detect peripheral non-perfusion in DME, our results implicate the importance of peripheral retinal vascular imaging. Full article

Background/Objectives: Multiple immune-modulatory strategies have been tested in efforts to mitigate the pro-tumor microenvironment in pediatric high-grade glioma. HSV1716 is an oncolytic virus that previously demonstrated evidence of response in adult and pediatric patients. PBTC-037 was a single-center phase I trial developed and performed by the Pediatric Brain Tumor Consortium (PBTC) to estimate the maximum tolerated dose or recommended phase II dose of HSV1716 administered during surgical resection. Methods: Patients aged 12 to 21 years with recurrent or refractory high-grade glioma for whom surgical resection was clinically indicated were eligible. After maximal tumor resection, patients received one intraoperative dose of HSV1716. Results: Two patients were enrolled; one was later deemed ineligible yet was continued in follow up for safety. Both patients underwent complete tumor resection with the administration of HSV1716. Shortly after the enrollment of the two patients, this study was closed to accrual due to a change in the sponsor’s investment focus. One patient completed the 8-week reporting period without toxicity. The second patient who was later deemed ineligible had no evidence of dose-limiting toxicity. The two patients had progressive disease at 1.9 and 2.9 months after enrollment; both eventually died due to progressive disease at 7.5 months. Conclusion: We describe the administration of HSV1716 to two pediatric patients with recurrent high-grade glioma, without evidence of dose-limiting toxicity. Oncolytic viruses are currently being tested in pediatric patients in larger combinatorial trials. Despite the limited numbers, the data presented here will hopefully provide incremental steps toward improved immunovirotherapy of pediatric brain tumors. Full article