BACKGROUND/OBJECTIVES

The use of complementary and alternative medicine (CAM) has increased over the years. Although the incidence of CAM use among general and disease-specific groups has been researched, little is known about CAM use among Filipino dermatological patients. This study aims to determine the extent and nature of complementary medicine use among patients with dermatologic problems seen in this institution.

This is a descriptive, prospective study that made use of a researcher-created questionnaire to determine the prevalence of complementary and alternative medicine. Six months of research were undertaken at the Dermatology clinic of a tertiary hospital. It utilized convenience sampling technique consisting of patients who visited the Dermatology clinic for an in-person consultation.

Sixty-five percent of the participants had attempted at least one kind of CAM to treat their dermatological condition, with the majority of participants between the ages of 18 and 25 (25.3%). The most prevalent condition treated with CAM was allergies (36.7%) of unknown etiology, followed by fungal infection (17.7%) and eczema (11.4%). Herbal medicine (65.8%) was the most popular method among respondents, followed by folk medicine, which was primarily recommended by family/relatives. The majority of CAM users were influenced by others, and several were financially challenged. Most CAM users reported no or minimal disease improvement, and the majority do not recommend CAM to others.

This is the first study to investigate the use of complementary and alternative medicine in dermatologic diseases in general in the country. Board-certified dermatologist should keep an open mind towards patients who might seek out other type of treatment, either as an adjunct or an alternative, given the high prevalence of CAM users among dermatology patients.

Acrodermatitis continua of Hallopeau (ACH) is a rare, chronic, and recalcitrant inflammatory disorder classified as a localized variant of pustular psoriasis. Patients usually present with relapsing episodes of subungual pustules, nail dystrophy, and scaling. We report a case of ACH in a 32-year-old female, which developed following a nail infection and exacerbated during pregnancy, with no medication for 2 years. She presented at the clinic with severe manifestations of anonychia and multiple bone resorption on the distal phalanges. The patient was started on topical medication of combination corticosteroid and vitamin D analogue and oral methotrexate initially at l0mg/week then increased to 15mg/week due to poor response. Despite compliance to medications and avoidance of possible irritants, the patient still had relapse of pustules on the nails.

Several treatment options for ACH are available such as topical steroids, vitamin D analogue, systemic biologics, and non-biologics such as methotrexate and cyclosporine. However, systemic biologics are considered the most efficacious for ACH but financial constraints often limit their use in resource-poor settings.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Objectives: This study proposes a mobile-based explainable artificial intelligence (XAI) platform designed for diagnosing febrile illnesses. Methods: We integrated the interpretability offered by local interpretable model-agnostic explanations (LIME) and the explainability provided by generative pre-trained transformers (GPT) to bridge the gap in understanding and trust often created by machine learning models in critical healthcare decision-making. The developed system employed random forest for disease diagnosis, LIME for interpretation of the results, and GPT-3.5 for generating explanations in easy-to-understand language. Results: Our model demonstrated robust performance in detecting malaria, achieving precision, recall, and F1-scores of 85%, 91%, and 88%, respectively. It performed moderately well in detecting urinary tract and respiratory tract infections, with precision, recall, and F1-scores of 80%, 65%, and 72%, and 77%, 68%, and 72%, respectively, maintaining an effective balance between sensitivity and specificity. However, the model exhibited limitations in detecting typhoid fever and human immunodeficiency virus/acquired immune deficiency syndrome, achieving lower precision, recall, and F1-scores of 69%, 53%, and 60%, and 75%, 39%, and 51%, respectively. These results indicate missed true-positive cases, necessitating further model fine-tuning. LIME and GPT-3.5 were integrated to enhance transparency and provide natural language explanations, thereby aiding decision-making and improving user comprehension of the diagnoses. Conclusions The LIME plots revealed key symptoms influencing the diagnoses, with bitter taste in the mouth and fever showing the highest negative influence on predictions, and GPT-3.5 provided natural language explanations that increased the reliability and trustworthiness of the system, promoting improved patient outcomes and reducing the healthcare burden.

Objective: In ovarian cancer (OvCa), tumor cell high glucocorticoid receptor (GR) has been associated with poor patient prognosis. In vitro, GR activation inhibits chemotherapyinduced OvCa cell death in association with transcriptional upregulation of genes encoding anti-apoptotic proteins. A recent randomized phase II study demonstrated improvement in progression-free survival (PFS) for heavily pre-treated OvCa patients randomized to receive therapy with a selective GR modulator (SGRM) plus chemotherapy compared to chemotherapy alone. We hypothesized that SGRM therapy would improve carboplatin response in OvCa patient-derived xenograft (PDX). Methods: Six high-grade serous (HGS) OvCa PDX models expressing GR mRNA (NR3C1) and protein were treated with chemotherapy +/− SGRM. Tumor size was measured longitudinally by peritoneal transcutaneous ultrasonography. Results: One of the 6 GR-positive PDX models showed a significant improvement in PFS with the addition of a SGRM. Interestingly, the single model with an improved PFS was least carboplatin sensitive. Possible explanations for the modest SGRM activity include the high carboplatin sensitivity of 5 of the PDX tumors and the potential that SGRMs activate the tumor invasive immune cells in patients (absent from immunocompromised mice). The level of tumor GR protein expression alone appears insufficient for predicting SGRM response. Conclusion The significant improvement in PFS shown in 1 of the 6 models after treatment with a SGRM plus chemotherapy underscores the need to determine predictive biomarkers for SGRM therapy in HGS OvCa and to better identify patient subgroups that are most likely to benefit from adding GR modulation to chemotherapy.

Ethical reflections on the doctor-patient relationship from the perspective of a better life involve not only the revelation of realistic concerns but also the elucidation of coping approaches， as well as the interpretation of value orientations. Based on the realistic concerns of trust crisis， the ambiguity of responsibilities and powers， and the lack of humanity faced in the construction of the doctor-patient relationship from the perspective of a better life， it is an innovative attempt to eliminate doctor-patient tensions and reshape a reasonable doctor-patient relationship by exploring the path of response in dialogue ethics based on intersubjectivity and effective negotiation， institutional ethics based on normativism and the interweaving of morality and law， and care ethics based on reverence for life and emotional resonance. This practical narrative of responding to and reshaping the doctor-patient relationship in a better life with an ethical approach reveals the values of harmony， justice， and happiness.

The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at highest risk, an inequity further exacerbated by differences in access to healthcare globally. The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies. As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges including global health disparities, resource allocation, and access to care must inform these efforts. Climate literacy should be increasingly added to radiology training programmes. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilization, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to implementation of current and future sustainable innovations.

Background: Penile Cancer is a rare and aggressive disease. Related to complex metabolic processes. Objective: This study investigates the effectiveness ­of 18F-FDG PET/CT as a noninvasive method in evaluating penile cancer patients, focusing on the correlation between tissue expression of key tumor markers involved in glucose metabolism and proliferation, and the uptake of 18F-FDG. Methods: Fifty-one patients were selected and underwent 18F-FDG PET/CT-based staging. Semiquantitative analysis wasperformed using the maximum standardized uptake value ­(SUVmax ) and volumetric SUV ­(SUV2SD ). Tissue expressionanalysis of GLUT-1, hexokinase-II, Ki67, p16, and p53 was performed by tissue microarray. PCR evaluated HPV DNA. Results: Warty SCC showed the highest SUV value and significant differences in ­SUVmax (p=0.015). Higher ­SUVmax and SUV2SD values were observed in grade 3 tumors. In typical invasive SCC, grade 3, HPV+, p16-negative, p53-negative,GLUT-1 i-3, and HK-II i-3 tumors showed a higher mean SUV. The Ki-67 value significantly differed for grade 3 tumors (p=0.001) and HK-II i-1 tumors (p=0.036). Ki-67 positivity was also higher in HPV-, p16 i-2, p53 i-3, and GLUT-1 i-3 tumors; none of the differences were statistically significant. Conclusions The study highlights correlations between the uptake of 18F-FDG and the expression of markers associated with glycolytic metabolism in penile cancer. It suggests a potential trend where increased expression of glucose transport markers is linked to higher histological grades and Ki-67 expression. There were no significant differences regarding HPV positivity, demonstrating the complexity of penile cancer molecular biology and need more studies with a higher number of patients.

Purpose: Cardiovascular disease (CVD) is more prevalent in men than women, but the mechanisms responsible for this are not fully understood. We aimed to evaluate differences in trimethylamine (TMA), a microbial metabolite and its oxidized form, trimethylamine N-oxide (TMAO), which is thought to promote atherosclerosis, between men and women with coronary heart disease (CHD), using as a reference a non-CVD population. Materials and Methods: This study was carried out within the framework of the CORDIOPREV study (NCT00924937; June 19, 2009), a clinical trial which included 827 men and 175 women with CHD, with a non-CVD population of 375 individuals (270 men and 105 women) as a reference group. Plasma TMA and TMAO were measured by HPLC-MS/MS. The carotid study was ultrasonically assessed bilaterally by the quantification of intima-media thickness of both common carotid arteries (IMT-CC). Results: We found higher TMAO levels and TMAO/TMA ratio in CHD men than CHD women (p=0.034 and p=0.026, respectively). No TMA sex differences were found in CHD patients. The TMA and TMAO levels and TMAO/TMA ratio were lower, and no differences between sexes were found in the non-CVD population. TMAO levels in CHD patients were consistent with higher IMT-CC and more carotid plaques (p=0.032 and p=0.037, respectively) and lower cholesterol efflux in CHD men than CHD women (p<0.001). Conclusions Our results suggest that CHD men have augmented TMAO levels compared with CHD women, presumably as a consequence of higher rate of TMA to TMAO oxidation, which could be associated with CVD, as these sex differences are not observed in a non-CVD population.

BACKGROUND: Soft tissue integration (STI) around dental implant abutments is a prerequisite to prevent bacterial invasion and achieve successful dental implant rehabilitation. However, peri-implant STI is a major challenge after dental abutment placement due to alterations in the immune microenvironment upon surgical dental implant installation. METHODS: Based on known immunomodulatory effects of zinc, we herein deposited zinc/chitosan/gelatin (Zn/CS/Gel) coatings onto titanium substrates to study their effect on macrophages. First, we exposed macrophages to cell culture media containing different zinc ion (Zn2+) concentrations. Next, we explored the immunomodulatory effect of Zn/CS/Gel coatings prepared via facile electrophoretic deposition (EPD). RESULTS: We found that Zn2+ effectively altered the secretome by reducing the secretion of pro-inflammatory and enhancing pro-regenerative cytokine secretion, particularly at a Zn2+ supplementation of approximately 37.5 μM. Zn/CS/Gel coatings released Zn2+ in a concentration range which effectively stimulated pro-regenerative macrophage polarization as demonstrated by M2 macrophage polarization. Additionally, the impact of these Zn2+-exposed macrophages on gingival fibroblasts incubated in conditioned medium showed stimulated adhesion, proliferation, and collagen secretion. CONCLUSION Our promising results suggest that controlled release of Zn2+ from Zn/CS/Gel coatings could be applied to immunomodulate peri-implant STI, and to enhance dental implant survival.