Betulinic acid (3-beta-hydroxy-lup20[29]-en-28-oic acid) has attracted significant attention due to its diverse biological and pharmacological activities, including anti-inflammatory, antimicrobial, antiviral, antidiabetic, antimalarial, anti-human immunodeficiency virus, and antitumor effects. However, its effectiveness against oral cancer remains unknown. This study aimed to evaluate the effect of betulinic acid on the induction of apoptosis in FaDu human pharyngeal carcinoma cells by performing 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay, LIVE/DEAD stain, 4',6-diamidino-2-phenylindole (DAPI) stain and western blot. In the MTT assay, LIVE/DEAD stain, and DAPI stain analyses, betulinic acid increased FaDu cell apoptosis in a concentration-dependent manner. Apoptosis induced by betulinic acid in FaDu cells was mediated by the expression of Fas and the activation of caspase-8, caspase-3, and poly (ADP-ribose) polymerase. Western blotting revealed that B-cell lymphoma 2 (Bcl-2) and B-cell lymphoma-extra large were downregulated, while Bcl-2-associated death promoter and Bcl-2-associated X protein were upregulated by betulinic acid in FaDu cells. These findings indicate that betulinic acid inhibits cell proliferation in FaDu human pharyngeal carcinoma cells and induces apoptosis through both apoptotic receptor-mediated exogenous apoptosis and mitochondrialmediated endogenous apoptosis pathways.

A posterior tracheal wall rupture is a rare but life-threatening complication of tracheostomy. Several flaps based on the sternocleidomastoid (SCM) muscle, which has sufficient length and abundant blood supply, are utilized for the reconstruction of tracheal defects. We discuss here a case of a 71-year-old male with multiple organ failure and mental retardation, with posterior tracheal wall damage that had occurred during tracheostomy tube insertion. When planning the repair of the wound, additional reinforcement was necessary due to saliva leakage secondary to decreased consciousness. Direct suturing was followed by the reinforcement of SCM muscle transposition, which was conducted through cervical and endoscopic approach.

A posterior tracheal wall rupture is a rare but life-threatening complication of tracheostomy. Several flaps based on the sternocleidomastoid (SCM) muscle, which has sufficient length and abundant blood supply, are utilized for the reconstruction of tracheal defects. We discuss here a case of a 71-year-old male with multiple organ failure and mental retardation, with posterior tracheal wall damage that had occurred during tracheostomy tube insertion. When planning the repair of the wound, additional reinforcement was necessary due to saliva leakage secondary to decreased consciousness. Direct suturing was followed by the reinforcement of SCM muscle transposition, which was conducted through cervical and endoscopic approach.

Purpose: As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy. Methods: Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B). Results: Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate. Conclusion Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Objectives: . The recent expansion of eligibility for cochlear implantation (CI) by the U.S. Food and Drug Administration (FDA) to include infants as young as 9 months has reignited debates concerning the clinically appropriate cut-off age for pediatric CI. Our study compared the early postoperative trajectories of receptive and expressive language development in children who received CI before 9 months of age with those who received it between 9 and 12 months. This study involved a unique pediatric cohort with documented etiology, where the timing of CI was based on objective criteria and efforts were made to minimize the influence of parental socioeconomic status. Methods: . A retrospective review of 98 pediatric implantees recruited at a tertiary referral center was conducted. The timing of CI was based on auditory and language criteria focused on the extent of delay corresponding to the bottom 1st percentile of language development among age-matched controls, with patients categorized into very early (CI at <9 months), early (CI at 9–12 months) and delayed (CI at 12–18 months) CI groups. Postoperative receptive/expressive language development was assessed using the Sequenced Language Scale for Infants receptive and expressive standardized scores and percentiles. Results: . Only the very early CI group showed significant improvements in receptive language starting at 3 months post-CI, aligning with normal-hearing peers by 9 months and maintaining this level until age 2 years. During this period (<2 years), all improvements were more pronounced in receptive language than in expressive language. Conclusion . CI before 9 months of age significantly improved receptive language development compared to later CI, with improvements sustained at least up to the age of 2. This study supports the consideration of earlier CI, beyond pediatric Food and Drug Administration labeling criteria (>9 months), in children with profound deafness who have a clear deafness etiology and language development delays (<1st percentile).

5´-Adenosine monophosphate (AMP)-activated protein kinase (AMPK), a cellular energy sensor, is an essential enzyme that helps cells maintain stable energy levels during metabolic stress. The hypothalamus is pivotal in regulating energy balance within the body. Certain neurons in the hypothalamus are sensitive to fluctuations in food availability and energy stores, triggering adaptive responses to preserve systemic energy equilibrium. AMPK, expressed in these hypothalamic neurons, is instrumental in these regulatory processes. Hypothalamic AMPK activity is modulated by key metabolic hormones. Anorexigenic hormones, including leptin, insulin, and glucagon-like peptide 1, suppress hypothalamic AMPK activity, whereas the hunger hormone ghrelin activates it. These hormonal influences on hypothalamic AMPK activity are central to their roles in controlling food consumption and energy expenditure. Additionally, hypothalamic AMPK activity responds to variations in glucose concentrations. It becomes active during hypoglycemia but is deactivated when glucose is introduced directly into the hypothalamus. These shifts in AMPK activity within hypothalamic neurons are critical for maintaining glucose balance. Considering the vital function of hypothalamic AMPK in the regulation of overall energy and glucose balance, developing chemical agents that target the hypothalamus to modulate AMPK activity presents a promising therapeutic approach for metabolic conditions such as obesity and type 2 diabetes mellitus.

Background: The diagnostic accuracy of preoperative radiologic findings in predicting the tumor characteristics and clinical outcomes of papillary thyroid microcarcinoma (PTMC) was evaluated across all risk groups. Methods: In total, 939 PTMC patients, comprising both low-risk and non-low-risk groups, who underwent surgery were enrolled. The preoperative tumor size and lymph node metastasis (LNM) were evaluated by ultrasonography within 6 months before surgery and compared with the postoperative pathologic findings. Discrepancies between the preoperative and postoperative tumor sizes were analyzed, and clinical outcomes were assessed. Results: The agreement rate between radiological and pathological tumor size was approximately 60%. Significant discrepancies were noted, including an increase in tumor size in 24.3% of cases. Notably, in 10.8% of patients, the postoperative tumor size exceeded 1 cm, despite being initially classified as 0.5 to 1.0 cm based on preoperative imaging. A postoperative tumor size >1 cm was associated with aggressive pathologic factors such as multiplicity, microscopic extrathyroidal extension, and LNM, as well as a higher risk of distant metastasis. In 30.1% of patients, LNM was diagnosed after surgery despite not being suspected before the procedure. This group was characterized by smaller metastatic foci and lower risks of distant metastasis or recurrence than patients with LNM detected both before and after surgery. Conclusion Among all risk groups of PTMCs, a subset showed an increase in tumor size, reaching 1 cm after surgery. These cases require special consideration due to their association with adverse clinical outcomes, including an elevated risk of distant metastasis.

Background: The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using secondgeneration drug-eluting stents (DESs). Methods: Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). Results: Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). Conclusion The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES.

A posterior tracheal wall rupture is a rare but life-threatening complication of tracheostomy. Several flaps based on the sternocleidomastoid (SCM) muscle, which has sufficient length and abundant blood supply, are utilized for the reconstruction of tracheal defects. We discuss here a case of a 71-year-old male with multiple organ failure and mental retardation, with posterior tracheal wall damage that had occurred during tracheostomy tube insertion. When planning the repair of the wound, additional reinforcement was necessary due to saliva leakage secondary to decreased consciousness. Direct suturing was followed by the reinforcement of SCM muscle transposition, which was conducted through cervical and endoscopic approach.

A posterior tracheal wall rupture is a rare but life-threatening complication of tracheostomy. Several flaps based on the sternocleidomastoid (SCM) muscle, which has sufficient length and abundant blood supply, are utilized for the reconstruction of tracheal defects. We discuss here a case of a 71-year-old male with multiple organ failure and mental retardation, with posterior tracheal wall damage that had occurred during tracheostomy tube insertion. When planning the repair of the wound, additional reinforcement was necessary due to saliva leakage secondary to decreased consciousness. Direct suturing was followed by the reinforcement of SCM muscle transposition, which was conducted through cervical and endoscopic approach.