Diabetes mellitus (DM) is a metabolic condition marked by disrupted insulin regulation. Mesenchymal stem cellderived exosomes and conditioned medium (CM) have emerged as promising therapeutic candidates for DM. This research explored the medical benefits of exosomes and CM in treating streptozotocin-induced type 1 DM (T1DM) in rats, comparing their efficacy to bone marrow-derived mesenchymal stem cells (BM-MSCs). Fifty albino rats were grouped into five groups (n=10 each): healthy controls, untreated T1DM rats, T1DM rats treated with intravenous BM-MSCs, T1DM rats treated with intravenous exosomes, and T1DM rats treated with intravenous CM. Plasma glucose and insulin concentrations were monitored weekly. Pancreatic β-cell regeneration was analyzed via qRT-PCR, focusing on the expression levels of TGF-β, Smad3, Ngn3, Pdx1, MafA, and insulin genes. Histological evaluation of pancreatic tissue regeneration was performed at weeks 2 and 4 using hematoxylin & eosin and Masson’s trichrome stains. The exosomes- and CM-treated groups demonstrated significantly higher expression of β-cell regeneration markers (TGF-β, Smad3, Ngn3, Pdx1, MafA, and insulin) than the BM-MSCs group. Additionally, these groups demonstrated a marked rise in the area percentage of pancreatic islets and a significant reduction in pancreatic fibrosis, with more pronounced effects at week 4. Exosomes and CM exhibit superior therapeutic efficiency and regenerative potential over BM-MSCs in T1DM, suggesting their promise as cell-free alternatives for diabetes treatment.

Thioacetamide (TAA)-induced liver fibrosis, triggered by inflammation and oxidative stress, is prompted by hepatic stellate cells (HSCs) activation via several pathways. This study explores the hepatoprotective effect of aloe vera gel (AVG) extract and bone marrow mesenchymal stem cells (BM-MSCs) transplantation on regulating long intergenic noncoding RNA (lincRNA-p21) and microRNA (miR-17-5p) expressions and their impact on TGF-β1/Smad-3 and Wnt-10a/ β-Catenin cascades in TAA-induced liver damage. The study involved 48 adult male albino rats divided into four groups:control, TAA, TAA treated with BM-MSCs, and TAA treated with BM-MSCs+AVG extract. After 8 weeks, liver enzymes and hepatic oxidative parameters were evaluated alongside lincRNA-p21, miR-17-5p, TGF-β1, Smad-3, Wnt-10a, and β-Catenin expressions. Liver tissue sections were examined by light and electron microscopes and analyzed morphometrically. Group II showed increased aspartate aminotransferase, alanine aminotransferase, malondialdehyde, reduced glutathione levels, and deteriorated hepatocytes with distorted mitochondria and dilated rough endoplasmic reticulum. Group IV restored lincRNA-p21 expression, which downregulated miR-17-5p and suppressed activated HSCs by inhibiting TGF-β1/Smad-3 and Wnt-10a/β-Catenin pathways, and improved hepatic tissue architecture. Additionally, immunohistochemically, alpha-smooth muscle actin and cyclin D1 expressions were markedly decreased in group IV compared to group II. We concluded that AVG suppresses fibrotic pathways, boosts BM-MSCs differentiation, and reduces HSCs activation in liver fibrosis caused by TAA.

Background: s/Aims: Portal vein embolization (PVE) and Yttrium-90 (Y-90) radioembolization are used to induce liver hypertrophy, increasing future liver remnant volume and reducing the risk of post-resection liver failure. This systematic review compares the effectiveness of PVE and Y-90 radioembolization in promoting liver hypertrophy in patients undergoing liver resection. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, Cochrane, and Web of Science were searched for studies published between January 2000 and August 2023. Studies comparing PVE and Y-90 radioembolization with respect to liver hypertrophy were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. Pooled mean differences were calculated using an inverse-variance random-effects model. Results: Of 1,965 studies identified, three retrospective cohort studies met inclusion criteria, comprising 125 patients. Among these, 67.3% underwent PVE and 32.7% received Y-90 radioembolization. Hepatocellular carcinoma was the most common diagnosis (55.9%), followed by metastatic disease (32.3%) and cholangiocarcinoma (11.8%). PVE was more commonly used as a preoperative strategy for liver resection, while Y-90 radioembolization was primarily employed for palliative intent. One study reported greater hypertrophy with Y-90 compared to PVE (63% vs. 36%); however, hypertrophy was assessed over a longer interval (150 vs. 30 days). In pooled analysis, PVE was associated with significantly greater hypertrophy (mean difference 23.75%; 95% CI 12.02–35.48; p < 0.0001; I 2 = 48%). Conclusions Evidence directly comparing PVE and Y-90 radioembolization for liver hypertrophy remains limited. While pooled results favor PVE, procedure selection should be individualized based on clinical context.

Background: s/Aims: The benefits of nasogastric intubation after pancreaticoduodenectomy are not well understood, and it remains unclear which patients may need nasogastric intubation in the immediate postoperative period. This study evaluated the effectiveness of nasogastric intubation following pancreaticoduodenectomy and identified factors influencing the reintubation rate. Methods: We conducted a retrospective case-control cohort study involving adult patients who underwent pancreaticoduodenectomy for either benign or malignant periampullary disease, with a 90-day follow-up. Patients were divided into two groups: the nasogastric tube (NGT) was removed at the end of the procedure (NGT-removed group, n = 110; case group) or retained during the postoperative recovery (NGT-retained group, n = 100; control group). Results: The overall postoperative complication rate (grades I–IVb) was 40.4%. The only significant difference between the groups was a higher incidence of nausea and vomiting in the NGT-removed group (p = 0.02). Additionally, 14.8% of patients required NGT reinsertion postoperatively. No preoperative or intraoperative factors were found to influence the NGT reinsertion rate. Although patients requiring reinsertion experienced a higher rate of postoperative complications, no factor remained significant in the multivariate analysis. Conclusions There were no significant differences in clinical outcomes, reinsertion rates, or postoperative complications between the two groups, indicating that the removal of the NGT after pancreaticoduodenectomy is safe. However, univariate analysis revealed that postoperative complications significantly affected the need for NGT reinsertion, suggesting that nasogastric decompression may be crucial for patients at high risk for complications.

Purpose: During diagnostic cerebral angiography, catheter navigation requires manual contrast “puff” injections, while subsequent 2D/3D runs often use automated power injectors. Using power injectors for navigation puffs has not been described. We present a closed-circuit dual-port injector system (Nemoto Press Duo Elite) that integrates both navigation puff delivery and diagnostic run injection into a single automated platform, eliminating all manual tableside contrast handling. A foot pedal interface enables operator-controlled puff timing, potentially reducing contrast waste and air embolism risk while improving single-operator ergonomics with future remote robotic implications. Materials and Methods: This retrospective comparative cohort study compared 19 consecutive patients undergoing diagnostic cerebral angiography with foot pedal-controlled puff injections (June–July 2023) to 19 historical controls using manual hand injections (May 2021). Both groups used 90% contrast concentration. Fluoroscopy time, radiation dose, contrast utilization, and safety outcomes were compared. Results: Groups were demographically matched (mean age 52.1±14.2 vs. 50.2±12.9 years; 73.7% female). All 38 procedures achieved diagnostic adequacy with no complications. The foot pedal group demonstrated significantly shorter procedure time per vessel (11.5±4.4 vs. 18.9±10.5 min/vessel, P=0.010) with no significant differences in fluoroscopy time (P=0.171), radiation dose (P=0.690), or contrast delivered (88.7±30.9 vs. 88.2±42.5 mL, P=0.966). A trend toward improved contrast efficiency was observed (23.4±9.4 vs. 27.4±10.4 mL/vessel, P=0.226). Despite undergoing significantly more 3D rotational runs (1.3±1.0 vs. 0.6±0.7, P=0.030), the foot pedal group maintained comparable safety metrics, strengthening the non-inferiority findings. Conclusion A closed-circuit dual-port injector system integrating automated navigation puff delivery with diagnostic run injection demonstrates non-inferiority to manual injection for diagnostic cerebral angiography, with shorter procedure time per vessel (39% reduction, P=0.010), though interpretation is limited by differences in indication distribution. By eliminating manual tableside contrast handling, this approach enables precise digital contrast accounting and reduces air embolism risk, establishing a foundation for remote and robotic angiography applications.

We reviewed our experience using transulnar access (TUA) to obtain intraoperative cerebral angiography during prone surgery for vascular pathology, where conventional transfemoral and transradial access can be difficult. Ten consecutive patients treated between April 2020 and August 2025 were included. Ulnar artery access was obtained in the supine position before the patient was turned prone for surgery, and angiography was performed after the procedure without repositioning. Eight patients had arteriovenous malformations and 2 had dural arteriovenous fistulas. In all cases, intraoperative angiography was successfully completed through the ulnar artery. The mean ulnar artery diameter was 2.4 mm, indicating adequate vessel size for catheterization, and mean fluoroscopy time was 7.5 minutes. No immediate access-site complications occurred, and no case required conversion to another access route. These findings suggest that TUA is technically feasible and may provide a practical option for intraoperative cerebral angiography when prone positioning limits access to traditional arterial sites. Although the study is limited by its small sample size and retrospective design, the consistent procedural success supports further investigation.

Coronary artery bypass grafting (CABG) is the standard-of-care surgical treatment for patients with advanced coronary artery disease, particularly those with triple-vessel or left main coronary artery involvement. Over the years, refinements in surgical technique have led to higher success rates and improved outcomes. However, the rapid progression of atherosclerosis in native coronary arteries following CABG remains a persistent concern.Although several studies have documented this phenomenon, the exact pathophysiological processes involved are not yet fully understood. Additionally, the options for further treatment in these patients continue to pose challenges for physicians. In this review, we discuss various studies that have evaluated this phenomenon and its clinical implications, along with the proposed underlying mechanisms. Potential strategies for managing atherosclerosis following CABG are also explored.

Background/Aims: Behçet’s disease (BD) is an autoinflammatory disease of unknown etiopathogenesis. Oxylipins i.e., prostaglandins, leukotrienes, lipoxins, resolvins, and protectins are bioactive polyunsaturated fatty acids (PUFAs) derivatives involved in inflammatory response induction and resolution. The study aimed to determine the profile of selected PUFAs and oxylipins and to define a lipidomic signature for BD. Methods: A case-control study was conducted involving thirty-five patients with BD and thirty-five age and sex-matched healthy individuals as a control group. Selected plasma PUFAs and oxylipins were analyzed using a targeted LC-MS/MS method. Results: The lipidomic profile was different between the two groups. BD patients showed higher levels of oxylipins deriving from either the n-6-arachidonic acid (i.e., prostaglandin D2, E2, F2α, and 6-keto-F1α, thromboxane B2, leukotriene B4, E4 and F4, and 6-epi and 15-epi-lipoxin A4) or n-3 PUFAs (i.e., 18-hydroxyeicosapentaenoic acid, 7,17-dihydroxy docosapentaenoic acid, protectin X, and resolvin D5), but decreased levels of both n-3 and n-6 PUFAs. Multivariate analyses selected the combination of four mediators, i.e., docosapentaenoic acid, prostaglandin E2, thromboxane B2, and lipoxin A4 as an accurate lipidomic signature for BD. Conclusions The profile of PUFAs/oxylipins is altered in BD patients, characterized by increased pro-inflammatory and pro-resolving oxylipins. The findings suggest that oxylipin metabolism might be involved in BD pathophysiology and may represent a therapeutic target for the disease. Further research is required to examine the role of lipid mediators in BD.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused significant mental distress in populations globally. At the frontline of the pandemic, emergency departments (EDs) are the prime setting to observe the effects of the pandemic on the mental health of the population. We aimed to describe the trend of mental health-related ED attendances at an acute hospital in Singapore before and during the various stages of the COVID-19 pandemic. METHODS: This is a retrospective, descriptive study of patients who presented to the ED between 1 January 2019 and 31 December 2020. Patients diagnosed with mental health-related systematised nomenclature of medicine who visited the ED during this period were identified and were placed into mental health diagnosis categories for analysis. A comparison was made between patients who presented before the pandemic (2019) and during the pandemic (2020). RESULTS: During the study periods, we identified 1,421 patients, of whom 27 were excluded due to non-mental health-related diagnoses, leaving 1,394 patients for analysis. There was a 36.7% increase in mental health-related ED presentations from 2019 to 2020. The proportion of higher-acuity mental health-related ED attendances and number of suicide attempts also increased. CONCLUSION Our study described an increase in the proportion of high-acuity mental health-related ED attendances during the COVID-19 pandemic. Emergency physicians must be cognisant of the effects of the pandemic on mental health. Further research should be conducted to better equip the healthcare system for handling all aspects of the pandemic.
Humans ; COVID-19/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Retrospective Studies ; Singapore/epidemiology* ; Male ; Female ; Adult ; Middle Aged ; Mental Disorders/diagnosis* ; Mental Health ; SARS-CoV-2 ; Tertiary Care Centers ; Pandemics ; Aged ; Suicide, Attempted/statistics & numerical data* ; Young Adult ; Adolescent