Ventricular septal rupture (VSR) after acute myocardial infarction (MI) is a rare yet fatal complication. Although surgical repair is essential, the optimal timing remains controversial. We report a case of ST-Elevation Myocardial Infarction (STEMI) complicated by VSR. Fibrinolytic therapy was initially considered successful; however, the patient developed worsening dyspnoea. Further evaluation confirmed an apical VSR by echocardiography. The patient received intensive monitoring and supported with an Intra-Aortic Balloon Pump (IABP). Surgical repair was performed on day 26. Hemodynamic initially improved postoperatively, but the condition deteriorated again on the ninth day after surgery, and the patient ultimately died. This case underscores that while surgical repair is the preferred definitive treatment for VSR, the timing of intervention is critical. Proper timing requires balancing surgical risks with tissue readiness and hemodynamic stability. The interval between VSR detection and surgical repair plays a pivotal role in determining patient survival.

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.

Tartrazine (TZ) is a synthetic azo dye extensively used as a food colorant, posing potential harm to human health. This study examined whether maternal exposure to TZ at an acceptable daily intake (ADI) dosage during lactation could induce neurotoxicity in male rat pups and to investigate the potential underlying mechanism. Twelve rat dams at postnatal day 2 (PND2) were split equally into control (received vehicle), and TZ-treated (received TZ 7.5 mg/kg) groups.Administration was through oral gavage, once daily for 20 days (from PND2 to PND21). The pups’ exposure to TZ was via breastfeeding. On PND22, male pups’ brain tissues were collected for histopathological, immunohistochemical, biochemical, and gene expression analyses. Maternal TZ exposure during lactation led to brain tissue damage in rat pups, with resultant neuronal atrophy, nuclear condensation, perineuronal halos, capillary congestion, wide pericapillary spacing, hemorrhage, and neuropil vacuolation in the prefrontal cortex, cerebellar cortex, and hippocampus. Also, lactational TZ exposure was associated with oxidative stress (raised malondialdehyde, reactive oxygen species with total antioxidant capacity decline);oxidative DNA damage (overexpression of 8-OHdG protein); endoplasmic reticulum stress (upregulated XBP-1, BIP, CHOP, and JNK genes); autophagy suppression (upregulated p62 gene, downregulated Beclin-1 gene, decreased LC3-II at both protein and gene levels); synaptogenesis impairment (decreased synaptophysin protein expression and increased acetylcholinesterase activity level); inflammation (raised TNF-α, IL-1β, IL-6 with IL-10 decline). In conclusion, this study highlights neurotoxic alterations in pups associated with low-dose TZ exposure through breastfeeding, focusing on the underlying molecular mechanisms. This is crucial for developing strategies to safeguard public health.

Inferior vena cava (IVC) reconstruction is a complex procedure that, in selected cases, may be the only viable option for achieving complete oncologic resection. One such technique, the use of a peritoneal patch (PP) for IVC reconstruction, is beneficial but rarely reported. In this report, we present a successful case of IVC reconstruction using a PP during the surgical treatment of intrahepatic cholangiocarcinoma. The patient, a 60-year-old female, had an 80 × 77 × 72 mm mass located in segments I, IV, VII, and VIII, involving the IVC. After neoadjuvant chemotherapy and right liver deprivation, she underwent right hepatectomy combined with caudate lobe resection. During surgery, the anterior wall of the IVC was reconstructed using a PP, and the left portal vein was reconstructed with an end-to-end anastomosis. The total operative time was 570 minutes, with no intraoperative complications. The patient was hospitalized for 27 days, including five days in the intensive care unit. Postoperatively, she developed a Clavien–Dindo grade IIIb complication, consisting of gastroparesis, an abdominal collection with a low-output biliary fistula, pleural effusion requiring surgical drainage, and sepsis, which was successfully treated with antibiotics. At 40 months after surgery, the patient remains alive, with no evidence of tumor recurrence and a good quality of life. This case demonstrates that IVC reconstruction using a PP is a feasible alternative for achieving complete oncologic resection. Despite a high but manageable rate of postoperative morbidity, this approach enabled complete tumor resection and resulted in long-term survival.

Purpose: Down syndrome (DS) is associated with metabolic dysregulation, obesity, and increased risk of chronic inflammation. This study aimed to assess subclinical inflammation in children with DS by evaluating inflammatory biomarkers, such as high-sensitivity C-reactive protein (hs-CRP), and their association with metabolic parameters including ghrelin, lipid profiles, and vitamin D levels. Methods: A total of 49 children with DS (aged 1–18 years) and 22 age-matched healthy controls were enrolled. Anthropometric data, body fat percentage, and metabolic parameters were assessed. Inflammatory markers (hs-CRP, apolipoprotein-B [Apo B], adiponectin), metabolic hormones (ghrelin, insulin), and lipid profiles were determined from venous blood samples. Statistical analyses included bivariate correlation, analysis of variance, and multiple linear regression to identify predictors of inflammation. Results: Children with DS exhibited significantly higher hs-CRP levels than controls (p=0.03), indicative of increased systemic inflammation. Higher hs-CRP levels were associated with older age (r=0.33, p=0.006), greater obesity (body mass index: r=0.32, p=0.011), and elevated serum insulin and low-density lipoprotein levels. Ghrelin levels correlated negatively with Apo B (r=-0.41, p<0.001) and positively with hs-CRP (r=0.30, p=0.012). Predictors of inflammation (based on hs-CRP) included older age, male sex, higher gamma-glutamyl transferase level, and a diagnosis of DS (adjusted R²=0.276). Conclusion Children with DS are prone to metabolic inflammation, with increasing age and obesity exacerbating inflammatory responses. Clinicians should monitor and manage weight, dyslipidemia, and inflammation in this population to prevent long-term complications such as cardiovascular diseases and insulin resistance.

Randomized controlled trials (RCTs) of fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome (IBS) have produced outcomes varying from no effect at all to high efficacy and durable effects over time. This review analyzed differences in the protocols used in FMT RCTs for IBS in the recently published literature with the aim of identifying the factors responsible for the success or failure of these RCTs. The results of this analysis might be useful in formulating an effective standard protocol for FMT in IBS. A systematic search was conducted in the PubMed database of the literature published in English from January 2015 to December 2023 using several search phrases comprising MeSH expressions. Those RCTs that carefully selected donors based on environmental factors that are known to affect the gut microbiota positively and ensured bacterial diversity before and during FMT produced successful outcomes. Furthermore, direct freezing of the donor’s fecal transplant, storing it at −80°C until the FMT is performed, and then thawing it at 4°C and mixing it manually appear to be factors associated with the success of FMT in IBS. Administering the donor’s fecal transplant into the small intestine results in durable effects of FMT and long-term colonization of beneficial bacteria. A standard protocol for FMT with large and durable effects should include (1) careful donor selection, (2) handling the donor’s fecal transplant in a way that preserves its microbiota contents, and (3) administering the transplant into the small intestine.

Spread through air spaces (STAS) has been identified as an invasion pattern in non–small cell lung cancer (NSCLC). This study evaluated the association between tumor STAS and various clinicopathological parameters of NSCLC, with emphasis on the prognostic role of STAS. Methods: We evaluated 96 cases of NSCLC for STAS. STAS-positive cases were graded according to the distance between the edge of the primary tumor and the furthest STAS, in millimeters, or the number of alveoli separating STAS from the tumor. Results: STAS was observed in 33 patients (34.4%). In 28 cases, STAS was located in airspaces >3 alveoli away from the primary tumor. In 18 cases, STAS was found in airspaces > 2.5 mm away from the edge of the primary tumor. Morphologically, 18 cases of STAS demonstrated a solid nest pattern, eight showed a micropapillary cluster pattern, and seven exhibited a single-cell pattern. In multivariate analysis, only high tumor grade (p = .001) was independently associated with STAS in NSCLC. The presence of STAS (p = .047), lymphovascular invasion (p = .001), positive surgical margin (p = .021), adenocarcinoma histology (p = .020), and postoperative therapy (p = .049) showed a statistically significant lower overall survival (OS). However, multivariate analyses showed that STAS is not an independent predictor of OS in NSCLC. In addition, STAS-positive cases with an extension of >2.5 mm had significantly lower disease-free survival (DFS) (p = .018). Conclusions: The findings demonstrated that STAS is independently associated with a higher tumor grade and appears to have an adverse impact on OS and DFS in the examined subpopulation.

Background: Periorificial dermatitis (POD) is a common inflammatory skin condition primarily affecting infants, children, and young women. Novel therapies such as phosphodiesterase 4 (PDE4) inhibitors provide promising non-steroidal anti-inflammatory treatment options. Objective: This study evaluated the efficacy and safety of topical crisaborole 2% ointment, a PDE4 inhibitor, for treating pediatric patients with POD. Methods: A randomized, double-blind, vehicle-controlled trial included 23 participants aged 3 months to 18 years. Patients were treated with crisaborole 2% ointment or placebo for 4 weeks, followed by a 4-week treatment-free observational period. Primary endpoints were a 50% reduction in the Perioral Dermatitis Severity Index (PODSI) and an Investigator’s Global Assessment (IGA) score of 0 or 1 by day 14. Assessments were also conducted on days 29 and 58. Secondary measures included changes in Quality-of-Life Index scores over time and safety evaluations. Results: Both groups demonstrated improvement in PODSI and IGA scores during treatment.Although a small, non-significant numerical trend favored the crisaborole group across primary and secondary endpoints, no statistically significant differences between crisaborole and placebo were observed at any time point. Mild burning or stinging were reported more frequently in the crisaborole group, but they were generally tolerable. Conclusion While there was a modest numerical trend favoring crisaborole, its efficacy was not statistically superior to placebo in this small pilot study. Larger studies are needed to further validate the efficacy of crisaborole for the treatment for POD.

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.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the leading cause of chronic liver disease worldwide, coinciding with the growing burden of obesity and type 2 diabetes mellitus. While liver biopsy remains the gold standard for assessing hepatic steatosis and fibrosis, its invasiveness, sampling variability, and limited feasibility have necessitated the establishment of non-invasive diagnostic alternatives. Among non-invasive alternatives, conventional B-mode ultrasound (US) has retained a central role as the first-line imaging modality owing to its wide availability, low cost, and reasonable sensitivity and specificity, particularly in moderate-to-severe steatosis. However, traditional B-mode US has several limitations, including operator dependence, poor sensitivity in mild steatosis, and reduced accuracy in obese individuals. Semi-quantitative scoring systems and emerging technologies such as attenuation imaging, shear wave elastography, and vibration-controlled transient elastography, have been recently introduced to improve diagnostic accuracy. Additionally, artificial intelligence (AI) is increasingly being integrated into US platforms to enhance image interpretation, standardize assessments, and reduce interobserver variability. This review provides a comprehensive appraisal of the diagnostic performance, strengths, and limitations of conventional B-mode US and its advanced products in the context of MASLD. US-based techniques are also compared with magnetic resonance spectroscopy and histological assessment, highlighting the evolving role of AI in US diagnostics. Given the global rise of MASLD, optimizing and standardizing US-based approaches are essential to improve early detection, risk stratification, and monitoring strategies. With continued technological refinement and integration of AI, US remains a cornerstone of MASLD diagnosis in clinical practice.