The intestinal flora forms a complex ecosystem that interacts with the host, influencing health and fitness through mechanisms that connect with distant organs like the brain, liver, muscles, and testes. The gut microbiota plays a vital role in regulating androgen production and metabolism, and can cross the blood-testis barrier to influence spermatogenesis. This review highlights the significance of the gut-testis axis in male reproductive and sexual health, based on extensive studies exploring how gut microbes impact testicular function. Gaining this understanding deepens our knowledge of the gut-testis axis and its role in male reproductive health.
Background:Lactoferrin (LF), a multifunctional glycoprotein of the transferrin family, exhibits anti-inflammatory and immunomodulatory properties. Endometriosis is an estrogen-dependent chronic inflammatory disease commonly treated with progesterone therapy; however, progesterone receptor (PGR) resistance in endometriotic lesions has increased interest in immunomodulatory approaches. Objective:To evaluate the effects of LF alone and combined with progesterone on endometriotic lesions in a rat model. Methods:An endometriosis model was induced in female Wistar Albino rats. Rats with confirmed endometriotic lesions were randomly divided into 4 equal groups and received the following oral treatments: Control (0.5% carboxymethylcellulose), bovine LF (bLF) (100 mg/kg/d), progesterone (0.3 mg/kg/day), combination therapy (bLF [100 mg/kg/d] + progesterone [0.3 mg/kg/d]). After treatment, the rats were euthanized, histopathological and biochemically anayses were done. Results:No statistically significant differences were observed in volume and adhesion scores of endometriotic lesions before and after treatment (P = 0.653, P = 0.413, P = 0.890, respectively). However, PGR and inflammatory cytocine levels were decreased in all treatment groups (P = 0.001). Although serum progesterone levels did not differ between groups (P = 0.06), serum LF levels were lower in the progesterone-only group (P = 0.001). Total antioxidant status (TAS) and Plasma total oxidant status (TOS) showed no significant differences among groups (P = 0.623 and P = 0.318, respectively). Conclusion:LF, alone or combined with progesterone, reduced inflammatory cytokine levels associated with endometriosis-related pain, suggesting potential therapeutic value. Further studies are needed to clarify its role in progesterone resistance and the clinical management of endometriosis.
Testing for ABO incompatibility between a potential blood donor and recipient is the cornerstone of pretransfusion testing. Occasionally, weak agglutination reactions occur due to low expression of A and B antigens on the surface of red blood cells. This can lead to inconsistencies in blood group typing, as seen in a case where a patient's forward and reverse typing showed discrepancies. Following a comprehensive analytical assessment, the patient was identified as having a distinctive variant of blood group A, belonging to the less common subgroups-A3, Aend, Ax, Am, Ay, and Ael. Herein, we present 3 case series of ABO subgroups identified through extended ABO blood grouping procedures.
Background:Patients with end-stage renal disease (ESRD) undergoing hemodialysis exhibit a 10-25 times greater risk of tuberculosis (TB), underscoring the urgent need for optimized treatment strategies to improve prognosis. Objective:The present study evaluates the efficacy and pharmacokinetics of personalized anti-TB dosing in hemodialysis patients with ESRD and TB, to guide treatment optimization. Methods:This retrospective study included 90 hemodialysis patients with ESRD and TB (2020 - 2024). The control group (n = 45) received conventional anti-TB dosing; the study group (n = 45) received individualized dosing/timing. All received HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) and high-flux hemodialysis or hemodiafiltration. Efficacy endpoints included sputum conversion (4, 8, and 12 weeks), imaging at 12 weeks, and clinical effectiveness. Blood samples were collected before/during/after/dialysis intervals to calculate Cmax, Cmin, AUC0-24, CL, CLDAA, ER, t½, and adverse reactions. Result:No significant baseline differences existed between groups (P > 0.05). The study group showed higher sputum conversion rates, 12-week radiographic improvement, and overall effectiveness (P < 0.05). Pharmacokinetic (PK) analysis revealed elevated Cmax, Cmin, AUC0-24 for all anti-TB drugs (P < 0.05). Rifampicin clearance was unchanged (P > 0.05), while others decreased (P < 0.05). Half-life shortened on dialysis days (P < 0.01). Adverse reactions were markedly reduced in the study group (P < 0.01). Conclusions:For hemodialysis patients with ESRD and TB, tailoring anti-TB drug regimens based on PK profiles can enhance efficacy and minimize adverse effects, offering a safe and personalized treatment pathway.
Background:Right ventricular apical (RVA) pacing often leads to interventricular dyssynchrony and pacing-induced cardiomyopathy. Conduction system pacing (CSP), particularly Left Bundle Branch Area Pacing, provides a physiologic alternative. In Limited Resource Countries (LRCs) like Thailand, Cardiac Resynchronization Therapy (CRT) under-penetration persists due to high costs and a shortage of operators skilled in coronary venous anatomy. Objective:To share the experience and provide clinical update of CSP as a sustainable, cost-effective physiological pacing strategy to improve access to advanced arrhythmia management in resource-constrained environments. Methods:This review explores the implementation of minimalist protocols and CSP-based CRT. Scalability strategies include specialized training programs, device reprocessing, and the establishment of regional longitudinal registries to bridge infrastructure gaps. Results:CSP-based CRT can reduce device costs by nearly 50% compared with traditional triple-lead systems. This modality effectively mitigates the hemodynamic risks of RVA pacing while bypassing the technical and financial barriers of conventional CRT. Discussion:Despite its advantages, CSP adoption requires overcoming infrastructure challenges, specifically the lack of automated remote monitoring. Optimizing clinical outcomes in LRCs necessitates standardized training, robust data collection, and innovative resource management to ensure equitable access to life-saving technology.
Background:Anti-tuberculosis drug-induced hepatotoxicity (DIH) is a common complication among people living with HIV (PLWH), potentially leading to treatment interruptions. Objective:To determine the incidence of DIH and identify risk factors in Thai and Filipino PLWH on tuberculosis (TB) treatment, compared with those with TB mono-infection. Methods:We conducted a cohort study of Thai and Filipino adults with active TB using retrospective data from Thailand (2000-2024) and prospective data from the Philippines (2024). DIH was defined as AST or ALT ≥3 times the upper limit of normal. Logistic regression was used to assess DIH risk factors among PLWH; TB treatment outcomes were compared by DIH status. Results:Among 222 participants (138 PLWH, 84 HIV-negative), median age was 38 years, 63% were male, and median body mass index (BMI) was 18.2 kg/m2. DIH occurred in 13.8% of PLWH and 9.5% of HIV-negative individuals (P = 0.35), with median onset at 10 and 3 weeks, respectively. Among PLWH, hepatitis C co-infection (aOR 5.84, 95% CI 1.51-22.55, P = 0.01) and lower BMI (aOR 0.78/kg/m2, 95% CI 0.63-0.97, P = 0.03) were independently associated with DIH. Dolutegravir use showed a non-significantly lower DIH risk (OR 0.51, 95%CI, 0.18 - 1.42). TB treatment success was similar between those with and without DIH (92.6% vs 90.3%); mortality was slightly higher with DIH (3.7% vs 1.5%). Conclusions:Hepatitis C co-infection and low BMI are key risk factors for DIH among PLWH receiving TB treatment. Despite these risks, DIH did not significantly impact treatment outcomes.
Background:Hematologic malignancies, including leukemia, lymphoma, and bone marrow disorders, are complex cancers often associated with chromosomal abnormalities. The emergence of COVID-19 raised concerns about its potential to induce genomic instability, influencing the prevalence and cytogenetics of these malignancies. Objectives:This study evaluates whether the COVID-19 pandemic affected the incidence, demographics, or chromosomal abnormalities in hematologic malignancies at King Chulalongkorn Memorial Hospital, Thailand, between 2018 and 2024. Methods:A retrospective analysis was conducted on 3,077 bone marrow samples processed for cytogenetic evaluation. Samples were categorized into pre-COVID-19 (2018-2019) and post-COVID-19 (2020-2024) periods. Trends in disease incidence, patient demographics, and chromosomal abnormalities were analyzed statistically. Results:The overall incidence rates of hematologic malignancies, including leukemia, lymphoma, and bone marrow disorders, remained stable throughout the study. Male-to-female ratios and average ages of onset showed no significant changes. Except for a transient rise in chromosomal abnormalities in chronic lymphocytic leukemia during 2023, no new or recurring abnormalities were identified. The mean age of onset for various malignancy categories remained consistent across the study period, and the pandemic did not significantly alter hematologic cancer trends. Conclusions:The findings indicate that the COVID-19 pandemic did not substantially affect the incidence, cytogenetics, or demographics of hematologic malignancies. These results provide reassurance about the resilience of diagnostic and monitoring systems during the pandemic. Further studies are recommended to explore potential long-term implications of COVID-19 on hematologic malignancies.
Background:Overweight and obesity represent significant public health challenges in Saudi Arabia with substantial economic implications. Objective:To estimate the economic burden of overweight and obesity in Saudi Arabia and identify associated factors. Methods:This cross-sectional study utilized a mixed-methods approach combining primary survey data with secondary national health data. A total of 667 participants were recruited through stratified random sampling using a validated structured questionnaire. Direct medical costs were estimated using healthcare utilization data, while indirect costs were calculated using the human capital approach. Logistic regression analysis identified factors associated with high economic burden. Statistical significance was set at P < 0.05. Results:The total annual economic burden of overweight and obesity in Saudi Arabia was estimated at SAR 7.6 billion (US$2.0 billion), representing 1.2% of GDP. Direct medical costs accounted for SAR 5.2 billion, while indirect costs totaled SAR 2.4 billion. Among participants, 46.8% experienced a high individual economic burden. Younger age (18-30 years) was significantly associated with higher economic burden compared to older adults (adjusted odds ratio [AOR] = 2.9, 95% confidence interval [CI]: 2.2-4.0, P = 0.004). Primary education level was associated with higher economic burden compared to university education (AOR = 3.9, 95% CI: 2.0-9.2, P = 0.045). Body mass index (BMI) ≥ 30 kg/m2 was associated with higher economic burden (AOR= 3.0, 95% CI: 2.2-3.7, P = 0.001). Conclusion:The economic burden of overweight and obesity in Saudi Arabia is substantial and disproportionately affects younger adults, individuals with lower education, and those with higher BMI. These findings support targeted interventions and policy initiatives aligned with Saudi Vision 2030 healthcare transformation goals.
Background:Despite widespread favipiravir (FPV) use for coronavirus disease 2019 (COVID-19) in Thailand, pediatric clinical evidence remains limited. Objectives:This study evaluated FPV's effectiveness and safety for treating COVID-19 in children and adolescents. Methods:This multicenter, retrospective, observational cohort study included patients ≤18 years old testing COVID-19 positive between July 2021 and December 2022 across 11 hospitals in Thailand. Patients were divided into those with and without chest X-ray-confirmed pneumonia. Patients who received FPV were treated with 35 mg/kg twice daily on day 1 and 15 mg/kg twice daily on days 2-5. Pharmacokinetic (PK) modeling estimated plasma exposure in children using scaled Thai adult data. Results:Of 2,999 patients, 68.2% had no pneumonia. FPV recipients (n = 1,886) were mostly <5 years old, had a fever, infected during the Omicron wave, had lower mean cycle threshold (Ct) values of SARS-CoV-2 gene at diagnosis, and hospitalized compared to non-recipients. FPV treatment significantly shortened fever duration and hospitalization in both pneumonia and non-pneumonia patients. For non-pneumonia patients, being <5 years old, and receiving FPV were associated with complete recovery at discharge. For pneumonia patients, a history of preterm birth, pulmonary disease, and ICU admission reduced the likelihood of complete recovery at discharge. No serious adverse events were reported. PK models predicted that FPV plasma trough concentrations in children ≥10 kg were above efficacy targets. Conclusions:Early FPV treatment shortened fever duration and hospital stays in children and adolescents with COVID-19, promoting clinical recovery in both pneumonia and non-pneumonia cases.
Background Root canal treatment is generally safe, but cerebral arterial air embolism (CAAE) is a rare, life-threatening complication.Case presentation A 69-year-old male with apical periodontitis of teeth #31 and #41 suffered sudden loss of consciousness and coma during endodontic treatment. Cerebral computed tomography (CT) revealed multiple intracranial punctate gas densities with cervical and maxillofacial subcutaneous emphysema. Hyperbaric oxygen therapy (HBOT) led to complete neurological recovery.Conclusion Clinicians must recognise the risk of arterial air embolism from high-pressure air syringes. Prevention hinges on minimising air pressure and duration, using the lowest effective pressure, and ensuring meticulous haemostasis. Acute neurological deterioration demands immediate imaging and urgent HBOT. Integrating these measures into dental safety standards is essential.
Background 5% dextrose perineural injection therapy (PIT) is a low-cost, accessible, and non-toxic pain relief treatment. No study examined the effects of PIT using a 5% dextrose solution for axillary nerve-related shoulder pain.Objectives We aimed to investigate the effects of 5% dextrose PIT in the proximal part of the axillary nerve (pAxN) and distal part of the axillary nerve (dAxN) compared to a sham injection, combined with self-exercise in patients with rotator cuff tendinopathy.Methods This randomized controlled trial included 40 patients with moderate to severe pain from rotator cuff tendinopathy. Participants were randomly assigned to one of 3 groups: 5% dextrose PIT in pAxN, dAxN, or a sham injection. All groups performed self-exercise at home. Pain was measured using the visual analog scale (VAS), and secondary outcomes included the oxford shoulder score (OSS) and range of motion (ROM). Blinding was maintained for participants and assessors.Results After excluding one participant, 39 individuals (13 per group) were included in the analysis. The dAxN group showed significant pain reduction at 2 and 4-weeks, with estimated mean VAS reductions of -2.46 (-3.87, -1.05) and -1.49 (-2.89, -0.08), respectively, compared to the sham group. However, the pAxN group did not demonstrate a significant difference in pain reduction compared to the sham group. There were no significant differences between groups in other outcomes.Conclusions Combining 5% dextrose PIT at the dAxN region with self-exercise led to superior short-term pain reduction in patients with rotator cuff tendinopathy. Nonetheless, further large-scale clinical trials are necessary to validate these findings.
Background:The De Ritis ratio, derived from serum aspartate aminotransferase and alanine aminotransferase levels, has shown prognostic value in cardiovascular diseases. Its role in elderly patients hospitalized with acute decompensated heart failure (ADHF) remains uncertain. Objectives:To evaluate the prognostic value of the De Ritis ratio for 1-year major adverse cardiovascular events (MACEs) in elderly patients with ADHF. Methods:A single-center, prospective cohort of 249 patients aged ≥65 years (median age 78, 53.8% female) hospitalized with ADHF was enrolled. Patients were categorized into tertiles by De Ritis ratio: <1.18 (n = 82), 1.18-1.49 (n = 88), and ≥l.49 (n = 79). The primary outcome was 1-year MACEs, including all-cause death, non-fatal myocardial infarction, stroke, and heart failure (HF) rehospitalization. Cox regression was used to identify independent predictors. Results:At 1 year, 68 patients (27.3%) died and 150 (60.2%) experienced MACEs. The event rate increased progressively across tertiles: 31.7%, 64.8%, and 84.8% (P < 0.001). The De Ritis ratio was significantly associated with age, diabetes mellitus, advanced HF symptoms, N-terminal pro-B-type natriuretic peptide, and reduced left ventricular ejection fraction. The optimal cutoff for predicting MACEs was 1.30 (C-statistic: 0.760, 95% confidence interval [CI]: 0.697-0.823, P < 0.001), with 78% sensitivity and 72.7% specificity. A De Ritis ratio >1.30 independently predicted outcomes (hazard ratio: 2.362; 95% CI: 1.536-3.634; P < 0.001). Conclusions:An elevated De Ritis ratio is an independent predictor of 1-year MACEs in elderly patients with ADHF. This simple, accessible biomarker may aid clinical risk stratification.
Background Hypovolemic shock is a life-threatening condition frequently encountered in emergency care, resulting from significant blood or fluid loss that impairs oxygen delivery to vital organs. Common causes include trauma, surgery, gastrointestinal bleeding, and ruptured ectopic pregnancy. Prompt fluid resuscitation is critical, with nurses playing a central role in early recognition, timely intervention, and continuous monitoring.Objective To synthesise the best evidence for fluid resuscitation practices in hypovolemic shock and assess nursing knowledge and practice in emergency settings.Methods This systematic review was conducted using preferred reporting items for systematic reviews and metaanalyses (PRISMA) guidelines and evaluated through the grading of recommendations assessment, development, and evaluation (GRADE) system. Databases including PubMed, EMBASE, and Cochrane Library were searched for studies published between 2015 and 2024.Results The isotonic crystalloids are the preferred first-line therapy, with early goal-directed fluid administration and close patient monitoring improving outcomes. Nurse-led assessment and reassessment were key to guiding resuscitation and reducing complications. However, gaps in protocol adherence, documentation, and practice variation were identified. Knowledge deficits among nurses were also evident, highlighting the need for targeted training.Conclusions This review supports the development of a structured nursing guideline for managing hypovolemic shock, emphasising evidence-based fluid strategies and continuous clinical evaluation. Strengthening nursing competencies through education and standardised protocols can enhance emergency care delivery and patient survival.
Background Maternal anemia, particularly iron deficiency anemia (IDA), is a significant global health concern, affecting approximately 30% of women worldwide. Iron plays a crucial role in fetal brain development, influencing processes such as myelination, neurotransmitter synthesis, and oxygen transport. Despite theoretical links between prenatal iron deficiency (ID) and neurodevelopment, its actual effects on neonatal cognitive, motor, and socioemotional outcomes remain unclear. This study systematically evaluates the impact of maternal anemia on neonatal neurodevelopment.Methods A systematic literature review was conducted using PubMed, Scopus, and Web of Science, covering studies published until December 2024. Keywords related to prenatal ID, maternal anemia, and neonatal neurodevelopment were used. Eligible studies focused on maternal iron levels and neonatal outcomes, excluding animal studies, non-English publications, and reviews. Out of 1,388 screened articles, 6 studies were selected for meta-analysis. Data were synthesized using standardized methods, and pooled effect sizes were calculated. Study quality was assessed using the Newcastle-Ottawa Scale.Results The meta-analysis included 6 studies, with sample sizes ranging from 178 to 636 participants. Neonatal outcomes were assessed using the Neonatal Behavioral Assessment Scale (NBAS), Bayley Scales of Infant Development, and Mullen Scales of Early Learning. No significant correlation was found between maternal anemia and neonatal outcomes, including habituation (P = 0.93), orientation (P = 0.76), state regulation (P = 0.90), motor maturity (P = 0.71), autonomic stability (P = 0.10), early learning composite (P = 0.65), and gross motor skills (P = 0.59). Heterogeneity was low to moderate, and no significant publication bias was detected. Variability in iron supplementation did not yield consistent benefits.Conclusion Maternal anemia does not significantly impact early neonatal neurodevelopment. While additional studies are unlikely to reveal meaningful effects during the neonatal period, the potential for delayed or long-term neurodevelopmental impacts remains uncertain and warrants further longitudinal research.
Background:Evidence on the pathophysiology of insulin resistance (IR), particularly the mediating role of inflammatory markers, remains limited. Objectives:Prior studies suggest associations of C-reactive protein (CRP) and E-selectin with IR, generally examined independently of other risk factors. This study evaluates their potential mediation roles. Methods:Using biomarker data from the Midlife in the United States 3 (MIDUS3) 2017-2022 cohort, we conducted cross-sectional bias-corrected bootstrapping mediation analyses to assess whether CRP and E-selectin mediate associations between established risk factors-body mass index (BMI), waist-hip ratio (WHR), total cholesterol/HDL ratio, age, glycated hemoglobin A (HbA1c), smoking status, dietary habits, physical activity, medication use, and sex-and IR measured by log-transformed homeostatic model assessment of IR (HOMA-IR). Results:The study included 708 participants (57% female; mean age 66.2 ± 9.65 years). CRP did not mediate associations between covariates and HOMA-IR. In contrast, E-selectin showed indirect-only mediation for sex and HOMA-IR (% change in HOMA-IR [%CHIR] in females = 2.4; 95% CI: [0.46, 5.80]). Partial mediation by E-selectin was observed for HbA1c (%CHIR = 9.26; 95% CI: [3.40, 18.66]), BMI (%CHIR = 2.72; 95% CI: [0.97, 5.54]), and total/HDL cholesterol ratio (%CHIR = 1.92; 95% CI: [0.34, 4.49]). Indirect-only mediation was also found for age (%CHIR = -1.11; 95% CI: [-2.58, -0.27]), non-smoking (%CHIR = -1.55; 95% CI: [-4.09, -0.13]), and higher healthy eating index score (%CHIR = -7.87; 95% CI: [-17.48, -2.43]). Conclusion:E-selectin, but not CRP, mediates relationships between metabolic risk factors and IR, highlighting endothelial dysfunction as a key pathway.
Background:Endometriosis (EMT) is a common gynecologic and hormone-dependent disease that seriously affects patients' quality of life and currently faces certain challenges in clinical treatment. Objective:To observe the clinical efficacy of gonadotropin-releasing hormone agonists (GnRH-a) in combination with Dienogest treatment in EMT and its effects on recurrence and pregnancy. Methods:In a retrospective study, 254 patients with EMT from The First Affiliated Hospital, College of Medicine, Zhejiang University were selected between October 2020 and December 2021, and were divided into DT group (Dienogest treatment group) and GD group (GnRH-a combined with dienogest treatment group) according to the treatment modality, both groups were treated with Dienogest, and the GD group was additionally treated with GnRH-a. The primary assessment of both groups was clinical efficacy, recurrence rate and pregnancy (cumulative pregnancy rate, live birth rate, miscarriage rate, multiple pregnancy rate, and ectopic pregnancy rate). Secondary outcomes included the antibody indicator positive rate (anti-endometrial antibodies [AEmAb], anti-sperm antibodies [AsAb], and anti-zona pellucida antibodies [AZpAb]), sex hormone levels (luteinizing hormone [LH], follicle-stimulating hormone [FSH], and estradiol [E2]), serum inflammatory indicator levels (Interleukin-6 [IL-6], C-reactive protein [CRP], tumor necrosis factor-α [TNF-α]), visual analog scale (VAS) scores, and adverse reactions. Results:After treatment, all indicators improved in both groups (P < 0.05). The clinical efficacy, cumulative pregnancy rate, and live birth rate of patients in the GD group were markedly higher than those in the DT group (P < 0.05). The recurrence rate, positive rate of antibody indicator, sex hormone level, serum inflammation indicator, VAS score, and incidence of adverse reactions of patients in the GD group were remarkably below the DT group (P < 0.05). No marked discrepancies were found in the rates of miscarriage, multiple pregnancy, and ectopic pregnancy in both groups (P > 0.05). Conclusion:The efficacy of GnRH-a combined with Dienogest in the treatment of EMT is remarkable, which can effectively reduce the inflammatory response, sex hormone levels, and recurrence rate, and markedly improve pregnancy, which is worth promoting its use in the clinic.
BackgroundInfectious diseases caused by antibiotic-resistant bacteria pose a significant challenge in healthcare. The development of new antibiotics, while essential, is often hindered by the complexity, cost, and time involved in the process. An alternative approach gaining traction is the conjugation of existing antibiotics with potent antimicrobial agents to improve their efficacy against resistant pathogens.ObjectiveThis study aimed to develop environmentally sustainable and cost-effective copper oxide nanoparticles (CuO NPs) synthesized using bioactive compounds extracted from Curcuma zedoaria.MethodsThese nanoparticles were subsequently conjugated with fosfomycin. Physicochemical characterization was carried out using XRD, scanning electron microscopy (SEM), FTIR, and UV-Visible spectroscopy. Release was studied using Franz diffusion cell. Antibacterial efficacy of the pure and fosfomycin-conjugated copper oxide nanoparticles (Fos-CuO NPs) was evaluated against multidrug-resistant (MDR) strains of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa using the disk diffusion method. The minimum inhibitory concentration (MIC) and antibiofilm activity were determined using the microbroth dilution method. Additionally, molecular docking analysis was performed to examine the interaction of Fos-CuO NPs with biofilm-associated proteins (LecA, CdrA, PslA, PslD, GacA, CupA, DipA, PelA, PelB) in P. aeruginosa.ResultsThe physicochemical analysis confirmed successful CuO NPs synthesis and their conjugation with fosfomycin. XRD results confirmed the crystalline structure of the nanoparticles, while SEM revealed some agglomerated, irregular spherical shapes. Fos-CuO NPs exhibited greater antibacterial activity against MDR S. aureus (42 mm), E. coli (45 mm), and P. aeruginosa (39 mm) compared with pure CuO NPs (39 mm, 27 mm, and 41 mm, respectively). The docking results showed that the fosfomycin-conjugated nanoparticle exhibited the highest binding affinity for the biofilm-associated proteins Lec A and Pel A, with docking scores of -4.4 kcal/mol and -4.9 kcal/mol, respectively, compared with blank CuO NPs, supporting their potential application as a novel antimicrobial strategy.ConclusionThis research offers significant insights into the green synthesis of fosfomycin-conjugated nanoparticles for addressing the growing challenge of multidrug-resistant bacterial infections.
Background:Viscosity plane-wave ultrasound (Vi.PLUS) measures tissue viscosity by using shear wave dispersion within tissues. The tissue viscosity is associated with the degree of liver necroinflammation, which is an important mechanism that leads to the development of liver fibrosis (LF). Objectives:This study aimed to examine the association of clinical characteristics and liver stiffness measurement (LSM) by magnetic resonance elastography (MRE) with liver viscosity measurement by shear wave elastography (SWE) in patients with non-alcoholic fatty liver disease. Methods:This monocentric cross-sectional study with retrospective data collection included 164 patients. The medical records of patients aged ≥18 years with non-alcoholic fatty liver disease (NAFLD) and who underwent MRE and Vi.PLUS at King Chulalongkorn Memorial Hospital were reviewed. The viscosity measurements were performed according to guidelines. Results:Of the 164 patients, 11 (6.7%) had invalid or unreliable measurements by elastographic technique and 4 (2.4%) were excluded due to incomplete clinical data. This resulted in 149 subjects being included in the final analysis. The study found good correlation between viscosity measurements by shear wave elastography and LSM by MRE (r = 0.74, P < 0.001). Multivariate regression analysis found that body mass index (P = 0.032) and LSM by MRE (P < 0.001) were independently associated with Vi.PLUS values. Conclusion:In conclusion, viscosity measured by shear wave elastography is a non-invasive method of assessing liver inflammation with good correlation to LF. This may aid the early diagnosis of liver inflammation in patients with NAFLD.
Background:Although ERCP with endoscopic sphincterotomy is effective for choledocholithiasis, small residual stones may be missed by cholangiography, and intraductal ultrasound may improve detection and reduce recurrence. Objective:To observe the value of intraductal ultrasound (IDUS) in endoscopic extraction of choledocholithiasis. Methods:We retrospectively analyzed 148 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST). IDUS was performed to observe whether there were any residual choledocholithiasis stones in those whose previous choledocholithiasis treatment indicated complete clearance; ERCP combined with EST was repeated to retrieve larger residual stones (≥3 mm). Postoperative follow-up was conducted to monitor the recurrence of choledocholithiasis and its influencing factors. Results:After 148 cases of endoscopic ERCP combined with EST, cholangiography confirmed the complete removal of choledochal stones. Notably, 61 cases were found to have residual stones, and 21 of them had residual stones ≥3 mm; these 21 cases were repeated until the stones were completely removed. After 3-24 months of follow-up, IDUS revealed that the stone recurrence rates were 8.33% (9/108) for 108 cases with complete stone removal and 62.50% (25/40) for 40 cases with residual stones. The difference was statistically significant (P < 0.01). The cumulative recurrence rates during the 24-month postoperative period were also significantly different (88.40% and 14.40%, respectively, P < 0.01). The results of multivariate analysis showed that choledocholithiasis, common bile duct (CBD) diameter, and angle were independent risk factors for stone recurrence, as indicated by IDUS (P < 0.05). Conclusions:IDUS can detect choledocholithiasis, particularly small stones (<3 mm), which are challenging to visualize with cholangiography. IDUS can assist in ERCP combined with EST to reduce the recurrence of postoperative stones.
