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.

Purpose: This study aimed to assess factors associated with compliance and non-compliance among patients with tuberculosis (TB). Methods: A descriptive correlational study was conducted at the outpatient clinics of Abbassia Chest Hospital in Cairo, Egypt. A sample of 80 patients with TB who had been prescribed treatment regimens was recruited. Patients were interviewed using a structured form with fixed response options to identify factors associated with treatment compliance or non-compliance. Results: A significantly higher proportion of non-compliant patients (72.5%) experienced severe symptoms compared with patients in the compliant group (30.0%). Furthermore, most compliant patients (82.5%) demonstrated satisfactory overall knowledge of pulmonary TB, whereas only about half (52.5%) of patients in the non-compliant group did. This difference in knowledge level was statistically significant and was associated with treatment adherence. Among compliant patients, knowledge levels were also significantly influenced by age, sex, education, and employment status, a pattern that was not observed in the non-compliant group. Conclusion Key factors associated with non-compliance included insufficient income to support treatment, lack of home support for treatment regulation, and decreased motivation to improve health. These findings underscore the need for targeted patient education and counselling programs to increase disease awareness and improve treatment adherence among patients with TB.

Emerging data on finerenone have drawn significant interest from nephrologists and cardiologists for its clinical potential in patient management. Its nonsteroidal structure, greater receptor selectivity, and reduced risk of hyperkalemia make it a distinctive choice for clinicians. Mineralocorticoid receptors (MRs) are expressed in the collecting ducts, endothelial and vascular smooth muscle cells of the interlobar arteries, as well as in podocytes, mesangial cells, and renal fibroblasts. These receptors are also present in cardiovascular and inflammatory cells. MR activation contributes to ischemia-reperfusion injury (IRI) and mediates calcineurin inhibitor (CNI) toxicity, proteinuria, and fibrosis in both the cardiovascular system and kidneys. Blocking MR activation with finerenone may exert therapeutic effects in renal allografts by mitigating IRI, preventing CNI toxicity, reducing proteinuria and renal fibrosis, and lowering the risk of renal and cardiovascular events. Preclinical and clinical studies in the general population with diabetes have demonstrated that finerenone effectively reduces proteinuria and improves renal and cardiovascular outcomes. However, clinical evidence in kidney transplant recipients remains extremely limited, and the efficacy and safety of finerenone in this population are yet to be established. To date, no clinical trials specifically investigating finerenone in kidney transplantation have been published, with only the EFFEKTOR trial currently underway. This review discusses the mechanistic rationale, extrapolates evidence from nontransplant populations, identifies key knowledge gaps, and proposes future research directions to evaluate the safety and efficacy of finerenone in kidney transplant recipients.

Visual impairment due to glaucoma is irreversible; therefore, understanding its burden is important for implementing appropriate preventive measures. This study aimed to estimate the prevalence of visual impairment in patients with glaucoma. A hospital-based cross-sectional study was conducted on patients with glaucoma attending Hawassa University Comprehensive Specialized Hospital from May 1, 2022 to November 30, 2022. Visual acuity of 383 glaucomatous eyes from 275 patients was assessed using the Snellen illiterate acuity chart. Visual acuity at presentation and previous diagnoses were reviewed from the patient’s medical charts during the current checkup. Objective and subjective refractive measurements were performed for patients with a visual acuity of 6/18 or worse. Data collected using a validated structured questionnaire were cleaned, imported into Epinfo, and then exported to SPSS ver. 22. Descriptive and binary logistic regression analyses were conducted. Cofactors with a P<0.05 were considered statistically significant. Of the 383 eyes of 275 patients with glaucoma, approximately 38.12% (146/383) were visually impaired. Additionally, 35.28% (97/275) had visual impairment in at least one eye due to glaucoma, whereas 7.64% (21/275) were blind at initial presentation due to glaucoma. In the multivariable binary logistic regression analysis, age, duration of treatment, treatment adherence, distance from the hospital, laterality, and intraocular pressure at presentation were identified as factors significantly associated with visual impairment in patients with glaucoma. The burden of visual impairment in patients with glaucoma is high. Therefore, creating awareness, conducting glaucoma screening, and counseling patients about the importance of treatment adherence are important for reducing the burden of visual impairment due to glaucoma.