Introduction Withania somnifera (Ashwagandha) is a widely used medicinal plant with established roles in traditional systems of medicine. Known for diverse pharmacological effects, including neuroprotection, hepatoprotection, enhancement of male fertility, and anti-inflammatory activity. Despite its longstanding use, a deeper understanding of its phytochemical composition and bioactive mechanisms is required to bridge traditional knowledge with modern therapeutic applications. Methods A comprehensive metabolomics profiling of Withania somnifera was performed to identify and quantify its bioactive secondary metabolites. Focus was placed on major classes such as alkaloids, phenolic compounds, and terpenoids. Known compounds were annotated and categorized based on their abundance, chemical class, and reported biological functions. Particular attention was given to compounds implicated in neuroprotection, liver health, reproductive support, and inflammation-modulation. Results The analysis revealed a rich but low-abundance of known metabolites. Alkaloids such as Gentianaine (8.44%) and Sauroxine (2.94%), and phenolics like Mulberrofuran A (14.58%) and Sulphuretin (9.61%), were among the most prominent. These compounds are associated with antioxidative, anti-inflammatory, and neuroregenerative activities. Terpenoids including Pinocarvone and Ergosterol contributed to hepatoprotective and anti-inflammatory properties. Compounds such as Gomphrenin-I, Sitosterol, Pfaffic acid, beta-Carotene and others (>3%) supported spermatogenesis, while Embelin and Kievitone enhanced oxidative stress response. Although most identified compounds were individually present in low percentages (<0.30%), their collective activity suggests synergistic effects. Conclusion Metabolomic analysis of Withania somnifera confirms high abundance of bioactive secondary metabolites that have hepatoprotective, neuroprotective, anti-oxidant and spermatogenesis-enhancing effects. These findings justify protective and beneficial effect of Withania in promoting stress relief, energy, and overall wellness. ![Figure][1] ### Competing Interest Statement The authors have declared no competing interest. Ministry of AYUSH, https://ror.org/03fxf3w65, S-12/1/2021-SCHEME [1]: pending:yes

PURPOSE:To evaluate the long-term safety, efficacy, and clinical outcomes of endovascular interventions [hepatic vein/inferior vena cava recanalization and Direct Intrahepatic Portosystemic Shunt (DIPS)] in patients with Budd-Chiari Syndrome (BCS). METHODS:We retrospectively analysed electronic medical records of consecutive BCS patients who underwent endovascular interventions between 2010 and 2022 with at least 2 years of follow-up. We analysed laboratory and clinical parameters, types of interventions, patency rates, and survival outcomes. RESULTS:Of 415 BCS patients, 161 patients underwent endovascular interventions (median age 33.06 (5-75) years, male-to-female ratio 2.2:1). 103 patients who underwent hepatic vein/inferior vena cava recanalization (angioplasty/stenting) and 58 patients who underwent DIPS. The DIPS group had higher baseline median Child-Turcotte-Pugh (CTP) score (8.27), MELD score (14.94) and Rotterdam score (0.96). The recanalization group had baseline CTP score (6.95), MELD score (13.01) and Rotterdam score (0.56). Both interventions resulted in significant improvements in clinical outcomes (ascites resolution and prevention of rebleeding) and ALBI grades (p < 0.01). The DIPS group had persistently higher MELD and ALBI scores (p < 0.05) and required more repeat endovascular interventions (58.6%). The recanalization group required fewer repeat interventions (7.7%). Patency rates at 1 and 5 years were 96% and 92% for recanalization, 82% and 45% for DIPS, and 100% and 60% for DIPS revisions, respectively. The 10-year survival rate was 92% for the recanalization group and 88% for the DIPS group. CONCLUSION:Endovascular interventions provide higher rates of symptom resolution and excellent long-term overall survival in BCS patients. Patients undergoing DIPS exhibited persistently higher severity scores and a higher need for repeat interventions, consistent with a more severe disease phenotype at baseline.

BackgroundWithania somnifera (Ashwagandha) is a widely used medicinal plant known for its neuroprotective, hepatoprotective, fertility-enhancing, and anti-inflammatory properties. Although it has a long history of use in traditional medicine, a detailed understanding of its phytochemical constituents and associated biological activities remains limited.AimTo perform comprehensive metabolomic profiling of Withania somnifera and identify its major bioactive secondary metabolites, with a focus on compounds contributing to neuroprotection, liver health, reproductive support, and inflammation modulation.MethodsRoot extracts of Withania somnifera (Ashwagandha) were subjected to methanol-based organic phase extraction followed by LC–MS/MS analysis, resulting in the characterization of 1,020 metabolites. Among these, 1,010 compounds were classified as putatively annotated (MSI Level 2/3 annotations) metabolites based on MS1 data, while 10 highly abundant metabolites were further confirmed by MS/MS fragmentation and assigned MSI Level 2 annotations. Relative abundance analysis was performed to determine the predominant phytochemical constituents of the extract. Key metabolites identified through this approach were subsequently correlated with the known pharmacological properties of Ashwagandha, including its immunomodulatory, anti-inflammatory, antioxidant, adaptogenic, and neuroprotective effects.ResultsThe analysis identified a diverse array of secondary metabolites, many present at low individual abundance (<0.30%). Notable compounds included the alkaloids Gentianaine (8.44%) and Sauroxine (2.94%), phenolics such as Mulberrofuran A (14.58%) and Sulphuretin (9.61%), and terpenoids including Pinocarvone and Ergosterol. (% of total annotated metabolites) These compounds were associated with anti-oxidative, neuro-regenerative, hepatoprotective, and anti-inflammatory effects. Additional metabolites, including Gomphrenin-I, Sitosterol, Pfaffic acid, and β-Carotene, were linked to reproductive health. Embelin and Kievitone were noted for their potential roles in enhancing oxidative stress responses. Despite the low abundance of individual compounds, the overall metabolite profile suggests substantial synergistic bioactivity.ConclusionMetabolomic profiling of Withania somnifera reveals a rich composition of bioactive secondary metabolites with potential roles in neuroprotection, hepatoprotection, antioxidant defense, and reproductive support. These findings support its traditional use and highlight its potential for modern therapeutic applications in promoting stress resilience, vitality, and overall wellbeing.

Nutrition supplementation and exercise are the current approaches for managing sarcopenia in patients with cirrhosis. There are limited data on benefits, if any, of supplementing testosterone in cirrhosis with sarcopenia and frailty. 127 patients with cirrhosis and sarcopenia were randomized to receive either nutrition and structured exercise with intramuscular testosterone undecanoate 1000 mg administered at 0, 6, 12, 16, 20, and 24 weeks (NExT group, n = 64) or only structured exercise and nutrition (NEx group, n = 63). Of these, 102 patients completed the 24-week study period as per protocol (NExT, n = 50; NEx, n = 52). The primary endpoint was a ≥ 10