Human breast milk (HBM) is an ideal nutritional source for the growth and development of infants. In addition, HBM contains hormones, growth factors, microRNAs and exosomes that perform various physiological functions. This study investigates the immunomodulatory effects of HBM-derived exosomes on myeloid cells and chondrocytes, and implications for juvenile idiopathic arthritis. HBM-derived exosomes were isolated and characterized using nanoparticle track analyzer and Western blotting. The HBM-derived exosomes treatment decreased the expression of inflammatory mediators and proinflammatory cytokines in mouse peritoneal macrophages upon lipopolysaccharide stimulation. Flow cytometry analysis of bone marrow-derived macrophages indicated that exosomes promoted M2 polarization, as evidenced by a decrease in cells expressing CD80 (M1 marker) and a concurrent increase in cells expressing M2 marker CD206. In addition, exosome treatment attenuated the mitogen-activated protein kinase signaling pathway by reducing the phosphorylation of extracellular signal-regulated kinase, c-Jun N-terminal kinase, p38 mitogen-activated protein kinase, and IκB-α, thereby reducing the expression of inducible nitric oxide synthase, cyclooxygenase-2, metalloprotease (MMP)-1, MMP-3, and MMP-13 in SW1353 chondrocytes following IL-1β stimulation. These findings suggest that HBM-derived exosomes promote macrophage polarization toward an anti-inflammatory M2 phenotype and exert significant immunomodulatory effects.

With the increasing use of plastics worldwide, the amount of plastic waste being discarded has also risen. This plastic waste undergoes physical and chemical processes, breaking down into smaller particles known as microplastics (MPs) or nanoplastics (NPs). Advances in technology have enhanced our ability to detect these smaller particles, and it has been confirmed that plastics can be found in marine organisms as well as within the human body. However, research on the effects of MPs or NPs on living organisms has only recently been started, and our understanding remains limited. Studies on the immunological impacts are still ongoing, revealing that MPs and NPs can differentially affect various immune cells based on the material, size, and shape of the plastic particles. In this review, we aim to provide a comprehensive understanding of the effects of MPs and NPs on the immune system. We will also explore the methods for plastic removal through physicochemical, microbial, or biological means.

With the increasing use of plastics worldwide, the amount of plastic waste being discarded has also risen. This plastic waste undergoes physical and chemical processes, breaking down into smaller particles known as microplastics (MPs) or nanoplastics (NPs). Advances in technology have enhanced our ability to detect these smaller particles, and it has been confirmed that plastics can be found in marine organisms as well as within the human body. However, research on the effects of MPs or NPs on living organisms has only recently been started, and our understanding remains limited. Studies on the immunological impacts are still ongoing, revealing that MPs and NPs can differentially affect various immune cells based on the material, size, and shape of the plastic particles. In this review, we aim to provide a comprehensive understanding of the effects of MPs and NPs on the immune system. We will also explore the methods for plastic removal through physicochemical, microbial, or biological means.

With the increasing use of plastics worldwide, the amount of plastic waste being discarded has also risen. This plastic waste undergoes physical and chemical processes, breaking down into smaller particles known as microplastics (MPs) or nanoplastics (NPs). Advances in technology have enhanced our ability to detect these smaller particles, and it has been confirmed that plastics can be found in marine organisms as well as within the human body. However, research on the effects of MPs or NPs on living organisms has only recently been started, and our understanding remains limited. Studies on the immunological impacts are still ongoing, revealing that MPs and NPs can differentially affect various immune cells based on the material, size, and shape of the plastic particles. In this review, we aim to provide a comprehensive understanding of the effects of MPs and NPs on the immune system. We will also explore the methods for plastic removal through physicochemical, microbial, or biological means.

BRASH SYNDROME – A RARE CAUSE OF BRADYCARDIA WITH RENAL FAILURE The BRASH syndrome is a rare clinical pentad characterised by bradycardia, renal failure, atrioventricular (AV) blockade, shock and hyperkalaemia. Patients with BRASH syndrome typically present with bradycardia and hypotension due to the synergistic effect of AV node blocker and hyperkalaemia, compounded by underlying renal failure. In this report, we present a young patient with a history of chronic kidney disease and hypertension, who was taking regular beta-blockers and calcium channel blockers, and presented with persistent dizziness, headache and lethargy, which progressed into bradycardia and shock. These symptoms were refractory to initial resuscitation, requiring inotropic support and urgent haemodialysis. The patient was discharged in good condition after initiating regular dialysis. A high index of suspicion and early recognition are key to managing BRASH syndrome. Standard advanced cardiac life support algorithms without calcium are generally impractical for BRASH syndrome. The prognosis for BRASH syndrome is excellent with timely recognition and management.

Nicotinamide (NAM), a water-soluble derivative of vitamin B3, has emerged as a potential therapeutic agent for bonerelated disorders. In particular, it promotes bone metabolism and alleviates delayed tooth eruptions associated with cleidocranial dysplasia (CCD). NAM serves as a precursor for nicotinamide adenine dinucleotide, a key coenzyme involved in cellular metabolism that plays an essential role in oxidative phosphorylation and mitochondrial function.Recent research has highlighted the capacity of NAM to enhance osteogenic differentiation and regulate the interaction between osteoblasts and osteoclasts, which is critical for maintaining bone homeostasis. Moreover, the effect of NAM in preventing delayed tooth eruptions in CCD models underscores its potential as a noninvasive therapeutic option. Considering its safety profile and therapeutic potential, NAM is a promising candidate for longterm treatment of bone diseases and prevention of age-related bone disorders.

Background/Aims: We investigated how interactions between humans and computer-aided detection (CADe) systems are influenced by the user’s experience and polyp characteristics. Methods: We developed a CADe system using YOLOv4, trained on 16,996 polyp images from 1,914 patients and 1,800 synthesized sessile serrated lesion (SSL) images. The performance of polyp detection with CADe assistance was evaluated using a computerized test module. Eighteen participants were grouped by colonoscopy experience (nurses, fellows, and experts). The value added by CADe based on the histopathology and detection difficulty of polyps were analyzed. Results: The area under the curve for CADe was 0.87 (95% confidence interval [CI], 0.83 to 0.91). CADe assistance increased overall polyp detection accuracy from 69.7% to 77.7% (odds ratio [OR], 1.88; 95% CI, 1.69 to 2.09). However, accuracy decreased when CADe inaccurately detected a polyp (OR, 0.72; 95% CI, 0.58 to 0.87). The impact of CADe assistance was most and least prominent in the nurses (OR, 1.97; 95% CI, 1.71 to 2.27) and the experts (OR, 1.42; 95% CI, 1.15 to 1.74), respectively. Participants demonstrated better sensitivity with CADe assistance, achieving 81.7% for adenomas and 92.4% for easy-to-detect polyps, surpassing the standalone CADe performance of 79.7% and 89.8%, respectively. For SSLs and difficult-to-detect polyps, participants' sensitivities with CADe assistance (66.5% and 71.5%, respectively) were below those of standalone CADe (81.1% and 74.4%). Compared to the other two groups (56.1% and 61.7%), the expert group showed sensitivity closest to that of standalone CADe in detecting SSLs (79.7% vs 81.1%, respectively). Conclusions CADe assistance boosts polyp detection significantly, but its effectiveness depends on the user’s experience, particularly for challenging lesions.

Nicotinamide (NAM), a water-soluble derivative of vitamin B3, has emerged as a potential therapeutic agent for bonerelated disorders. In particular, it promotes bone metabolism and alleviates delayed tooth eruptions associated with cleidocranial dysplasia (CCD). NAM serves as a precursor for nicotinamide adenine dinucleotide, a key coenzyme involved in cellular metabolism that plays an essential role in oxidative phosphorylation and mitochondrial function.Recent research has highlighted the capacity of NAM to enhance osteogenic differentiation and regulate the interaction between osteoblasts and osteoclasts, which is critical for maintaining bone homeostasis. Moreover, the effect of NAM in preventing delayed tooth eruptions in CCD models underscores its potential as a noninvasive therapeutic option. Considering its safety profile and therapeutic potential, NAM is a promising candidate for longterm treatment of bone diseases and prevention of age-related bone disorders.

Nicotinamide (NAM), a water-soluble derivative of vitamin B3, has emerged as a potential therapeutic agent for bonerelated disorders. In particular, it promotes bone metabolism and alleviates delayed tooth eruptions associated with cleidocranial dysplasia (CCD). NAM serves as a precursor for nicotinamide adenine dinucleotide, a key coenzyme involved in cellular metabolism that plays an essential role in oxidative phosphorylation and mitochondrial function.Recent research has highlighted the capacity of NAM to enhance osteogenic differentiation and regulate the interaction between osteoblasts and osteoclasts, which is critical for maintaining bone homeostasis. Moreover, the effect of NAM in preventing delayed tooth eruptions in CCD models underscores its potential as a noninvasive therapeutic option. Considering its safety profile and therapeutic potential, NAM is a promising candidate for longterm treatment of bone diseases and prevention of age-related bone disorders.

Ischaemic heart disorders are among the leading causes of mortality worldwide. There has been a growing occurrence of heart disease among young adults. Thus, acute myocardial infarction (MI) should be considered in all patients with central chest pain. Herein, we report the case of a young, fit, active smoker with underlying dyslipidaemia presenting with acute MI, characterised by dynamic changes in lead aVL wherein T wave flattening progressed to inversion, suggestive of early reciprocal changes. Soon after, electrocardiogram (ECG) revealed ST elevation in leads III and aVF, indicative of acute inferior wall MI. Subsequently, coronary angiogram showed right coronary artery occlusion. This case report highlights the importance of serial ECGs in patients who present with chest pain and have a high clinical suspicion for acute MI with normal or inconclusive ECG findings. Measurement of highly sensitive serum troponin based on a 1- or 3-h protocol is important in diagnosing acute MI but not ST-elevation MI. An early sign of inferior wall MI may be a new T wave inversion in lead aVL.
Myocardial Infarction ; Electrocardiography ; Coronary Artery Disease