Effective Strategies for Managing Lithium Water Pollution: A Scoping Review Introduction At the moment, calls for sustainable management approaches throughout the Lithium (Li) lifecycle have increased due to growing concerns about the environmental and societal impacts of Li extraction and use. Moreover, long-term exposure to elevated Li levels has been linked to thyroid, neurological, and renal problems in humans. Currently, no comprehensive evaluation exists that thoroughly evaluates the technological, policy, and environmental surveillance strategies for addressing Li water contamination across its entire life cycle. Therefore, this review aims to synthesize evidence on integrated management strategies, including technological innovations, policy measures, and environmental surveillance approaches, to prevent and mitigate Li contamination in surface water throughout its life cycle. Methods This scoping review was developed using the Arksey and O'Malley (2005) Approach, which complied with the Meta-Analyses Extension for Scoping Reviews and the Preferred Reporting Items for Systematic Reviews. The Arksey and O'Malley (2005) framework's recommended actions were carried out. For the literature search, three databases were selected. PubMed, Web of Science, and Scopus were the three primary databases chosen for this review. This review includes only articles published over the past 20 years (2004-2024). Results A total of 403 studies were identified, of which 24 met the inclusion criteria. Among the 24 included studies, 42% were observational, 33% experimental, and 15% reviews. Seven thematic domains were identified: Surveillance (25%), Resource Recovery (33%), Water Filtration System (13%), Extraction (17%), Policy, Remediation, and Recycling (each 4%). Several interventions demonstrated high Li removal or recovery efficiencies, including adsorption and reverse osmosis, achieving up to 99% Li removal; precipitation, recovering 84–90% of Li; and bioleaching, yielding 100% Li recovery from waste batteries. Conclusions A systematic, evidence-based approach is necessary for effective management of Li pollution. Moreover, to ensure that the global transition toward renewable and electrified energy remains sustainable and safeguards public health, Li management must evolve beyond mitigation to prevention and circularity. Therefore, a multifaceted strategy combining technological innovation, regulatory enforcement, and international cooperation is necessary to effectively manage Li pollution and ensure that green energy transitions remain environmentally responsible.

Gastrointestinal involvement in Neurofibromatosis type 1 (NF1) is uncommon and colonic neurofibromas are rarely reported. We report an interesting case of a colonic neurofibroma in a patient with NF1, highlighting its clinicopathological features and differential diagnoses. The lesion manifested as a mucosal polyp in the sigmoid colon and on histopathologic examination showed fascicles of spindle cells with wavy nucleus and S100 positivity, confirming a neurofibroma. Recognition of this uncommon manifestation is important to distinguish it from other mesenchymal lesions of colon and guide appropriate clinical management and follow -up

Introduction: Arginine vasopressin deficiency (AVP-D) is characterized by impaired antidiuretic hormone secretion, leading to polyuria and a significant dehydration risk. The British Islamic Medical Association classifies AVP-D as a “very high risk” condition, advising against Ramadan fasting. However, many patients fast due to religious convictions, creating a gap between clinical guidelines and patient practice. This study evaluates the clinical outcomes and safety of fasting in this population. Methodology: A single-centre retrospective cohort study was conducted at Hospital Putrajaya. We included adults with permanent AVP-D on desmopressin therapy for more than 1 year who fasted during Ramadan 2025. Data were extracted from electronic medical records and patient consultations. Primary outcomes included hospitalization rates, dehydration symptoms, and desmopressin dose adjustments. Results: Of the 43 patients (mean age 42.4 ± 15.28 years; 53.5% female), 27 successfully fasted for a mean of 27.6 ± 6.56 days. Pre-Ramadan counseling was documented in only 55.8% of cases. While 25.9% of participants experienced dehydration symptoms (thirst, dizziness), and 22.2% broke their fast for safety reasons, there were no hospitalizations. None of the patients required additional desmopressin dose adjustments. Most patients (66.7%) maintained twicedaily desmopressin dosing (Sahur and Iftar). Anterior pituitary deficiencies were present in 70.3% of the cohort. Conclusion Despite being classified as very high risk, many AVP-D patients safely complete Ramadan fasting without severe adverse events. However, the high rate of dehydration symptoms and the significant gap in pre-Ramadan counseling (44.2% un-counseled) highlight the need for structured clinical reviews 4–6 weeks prior to Ramadan to optimize hydration and dosing
Humans ; Diabetes Insipidus, Neurogenic ; Retrospective Studies ; Arginine ; Fasting

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.

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.

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.

Purpose: Enhanced Recovery After Surgery (ERAS) protocols have demonstrated significant benefits, but their safety and effectiveness in high-risk patients remain unclear. This study evaluated clinical postoperative outcomes in elderly patients and those with comorbidities undergoing colon cancer surgery. Methods: This retrospective cohort study included 1,035 patients who underwent elective colon cancer surgery from 2017 to 2022. A standardized 25-element ERAS protocol was implemented across all groups. Patients were categorized into a control group (aged <70 years without comorbidities, n = 534) and high-risk groups including elderly patients (≥70 years, n = 312) and those with cardiac (n = 60), pulmonary (n = 81), renal (n = 24), or hepatic disease (n = 24). Results: ERAS compliance rates were significantly lower in all high-risk groups compared to controls (79.39% ± 10.9%), with renal disease patients showing the most pronounced reduction (69.69% ± 17.0%). Post-hoc analysis revealed that only renal disease patients demonstrated significantly higher complication rates (45.8% vs. 18.9%, P < 0.01). Despite lower compliance, multivariate analysis revealed ERAS compliance ≥70% as the strongest independent predictor of both length of stay (odds ratio [OR], 0.139; P < 0.001) and complications (OR, 0.298; P < 0.001), substantially outweighing patient risk factors. After adjusting for treatment factors, patient comorbidity groups showed no independent association with clinical outcomes. Conclusion ERAS protocols can be successfully implemented in high-risk patients with appropriate attention to compliance optimization. Treatment factors, particularly ERAS adherence, consistently outweigh patient risk factors in determining outcomes, and well-tailored ERAS implementation should be considered with high-risk patients for perioperative care.

Cancer continues to be a leading cause of morbidity and mortality globally, which necessitates the development of more effective and less toxic therapies. Quinoxaline derivatives, a class of heterocyclic compounds with versatile chemical structures, have emerged as promising candidates for anticancer drug development. These derivatives exhibit a range of biological activities and have shown significant efficacy against various tumors. However, the therapeutic potential of quinoxaline derivatives, particularly in clinical applications, remains underexplored, highlighting the need for further research to optimize their use as anticancer agents. This systematic review aims to provide an updated analysis of quinoxaline derivatives’ anticancer potential, focusing on their mechanisms of action and therapeutic applications in oncology. Following PRISMA guidelines, a thorough search was conducted in MEDLINE/PubMed and Science Direct for studies from 2020 to 2024. Relevant keywords were used to identify studies on quinoxaline derivatives and their anticancer properties, resulting in the selection of 77 studies based on pharmacological activity and mechanisms. The review included 77 studies exploring various anticancer activities of quinoxaline derivatives. Key findings indicate that these compounds effectively inhibit cancer cell growth through multiple mechanisms, including the inhibition of topoisomerases, kinases, and other critical proteins involved in cancer progression. Additionally, they demonstrate strong antiproliferative and pro-apoptotic effects across several cancer cell lines, highlighting their broad therapeutic potential. Quinoxaline derivatives represent a promising class of compounds in anticancer therapy due to their diverse biological activities and multiple molecular targets. The development of these derivatives as targeted therapies holds the potential for more effective cancer treatments.

Background/Aims: Device-assisted enteroscopy has advanced small bowel disorder management. We conducted this meta-analysis to compare the clinical and procedural outcomes between spiral enteroscopy and single-balloon enteroscopy. Methods: A systematic search was performed on December 1, 2024, in the PubMed, Scopus, and Cochrane Library databases to identify studies that compared spiral enteroscopy and single-balloon enteroscopy. The outcomes included diagnostic and therapeutic yields, total procedure time, depth of maximum insertion, and adverse event rates. Results: Five studies (including 496 patients) met the inclusion criteria. The diagnostic yield was similar between spiral enteroscopy and single-balloon enteroscopy (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.96–1.20; p=0.24). The therapeutic yield also showed no significant difference (RR, 1.10; 95% CI, 0.45–2.69; p=0.83). The total procedure time was comparable (mean difference, –22.85 minutes; 95% CI, –46.83 to 1.12; p=0.06), although motorized spiral enteroscopy reduced the procedure time (p<0.001). Spiral enteroscopy achieved greater depth of maximum insertion (standardized mean difference, 1.33; 95% CI, 0.65–2.01; p<0.001). Adverse event rates were comparable (RR, 1.72; 95% CI, 0.80–3.70; p=0.16). Conclusions Spiral and single-balloon enteroscopies demonstrated similar diagnostic and therapeutic yields and safety. Spiral enteroscopy achieved a greater insertion depth, and motorized systems improved the efficiency in terms of procedure times.

The global burden of hepatocellular carcinoma (HCC) has shifted from viral to nonviral etiologies.However, successful antiviral therapy does not fully eliminate the risk of HCC, underscoring the demand for more effective surveillance strategies. Current screening methods, such as semi-annual ultrasonography and the measurement of α-fetoprotein levels, offer suboptimal sensitivityfor early detection. A cost-effective, reliable surveillance approach remains an unmet need. The Barcelona Clinic Liver Cancer staging system provides a framework to guide HCC therapy; yet, some gray zone exists, particularly for patients with intermediate-stage disease. Although tyrosine kinase inhibitors and immunotherapies have transformed the therapeutic landscape, their efficacies vary among patients, highlighting the necessity for personalized treatment strategies.In response to these challenges, artificial intelligence (AI) approaches have emerged as transformative tools in healthcare. By processing complex, nonlinear relationships and uncovering hidden patterns in clinical data, AI methods offer capabilities beyond those of traditional statistical methods. Furthermore, AI-driven multi-omics analysis holds promise for identifying novel biomarkers, thereby advancing precision medicine for HCC patients. This review introduces the potential of AI applications in enhancing the diagnosis, treatment, and prognosis of HCC.