Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, affecting millions annually and posing a significant global health concern. Traditional therapies for UTIs are becoming increasingly ineffective due to rising drug resistance and their tendency to disrupt the host's healthy microbiota, leading to further side effects. Consequently, there is an urgent need to develop alternative therapeutic agents that differ from conventional regimens and have fewer or no side effects. In this context, microbiome therapeutics offer a promising solution, given their demonstrated efficacy against various infectious diseases. Advances in scientific technology, particularly next-generation sequencing, have deepened our understanding of urinary microbiome dynamics, revealing a complex interplay within the urobiome that influences the onset and progression of UTIs. Uropathogenic bacteria do not solely cause UTIs; shifts in the composition of the urinary microbiome and interactions within the microbial community, known as host-microbiota interactions, also play a significant role. Although recent studies underscore the potential of targeting the urinary microbiome to manage UTIs and related complications, this field is still emerging and faces numerous regulatory and technical challenges. Further in-depth and comprehensive research is required to advance this pioneering concept into clinical practice.

Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

Traumatic aneurysms represent less than 1 percent of intracranial aneurysms and middle meningeal artery pseudoaneurysms are even rare. Traumatic aneurysms are usually pseudoaneurysms formed by the rupture of all the layers of the vessel wall. They are associated with high mortality as they can present as epidural, subdural, and rarely intraparenchymal hematoma. However, only nine cases of traumatic pseudoaneurysms of middle meningeal artery are reported that have presented as an acute intracerebral hematoma. We report a case of ruptured pseudo aneurysm of middle meningeal artery presenting with intraparenchymal hematoma in which hematoma evacuation and aneurysm excision was done immediately. The patient recovered well in the post-operative period. In addition, we reviewed all cases of middle meningeal artery pseudoaneurysms reported in the literature either as extradural hematomas, subdural/intraparenchymal hematomas, or subarachnoid hemorrhages. However, identifying the location of the aneurysm intraoperatively may be challenging as the hematoma may obscure the same. Distance from the sphenoid ridge may serve as a good intraoperative guide. Intraoperative localization along with surgical evacuation if done immediately can lead to gratifying results.

Systemic lupus erythematosus (SLE) is an autoimmune disorder that can affect various organs. Juvenile-onset SLE (jSLE) may be more severe than the adult-onset form, but the diagnosis and classification remain challenging due to the complex nature of the condition and its resemblance to other conditions. Antinuclear antibodies (ANA) are the immunological hallmark of SLE, but their limited specificity poses challenges. The 2019 (European Alliance of Associations for Rheumatology/American College of Rheumatology) SLE proposed a weighted multi-criteria system for classifying SLE, with ANA serving as an entry criterion. However, seronegative SLE, in which a patient's clinical features and laboratory values are consistent with SLE but their ANA serology test is negative, is a rare subtype of SLE that has been reported in several cases worldwide. Here, we present two rare cases of jSLE in 13- and 11 years old girls with negative ANA. The first case presented as lupus cerebritis and lupus nephritis (LN) class IV and V which showed improvement with treatment. The other one was also diagnosed as LN class IV but showed poor outcome despite aggressive immunosuppressive treatment. These cases highlight the importance of considering lupus-like symptoms in children with negative serology and the need for further research into current diagnostic protocols and calls for a re-evaluation using a more inclusive set of criteria that does not centralize immunological serology.

Background: and Purpose In the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial, treatment with nerinetide was associated with improved outcomes in patients who did not receive intravenous alteplase. We compared the effect of nerinetide on clinical outcomes in patients without concurrent intravenous alteplase treatment within different patient subgroups. Methods: ESCAPE-NA1 was a multicenter randomized trial in which acute stroke patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) >4 undergoing endovascular treatment (EVT) were randomized to intravenous nerinetide or placebo. The primary outcome was independence (modified Rankin Scale [mRS] score 0–2) at 90 days. We assessed baseline, clinical, and imaging variables as predictors of outcome and for evidence of treatment effect modification. We constructed two multivariable models using variables known prior to randomization and variables known immediately post-EVT procedure to provide adjusted estimates of effect. We assessed for evidence of treatment effect modification using multiplicative interaction terms within each model. Results: Four hundred forty-six patients were included in the analysis. Clinical outcomes were better in patients randomized to the nerinetide arm (mRS 0–2: 59.4% vs. 49.8%). There was possible treatment effect modification by ASPECTS score; patients with ASPECTS 8–10 showed a larger treatment effect compared to those with lower ASPECTS score. Younger age, lower NIHSS score, lower baseline serum glucose, absence of atrial fibrillation at baseline, higher ASPECTS score, middle cerebral artery (vs. internal carotid artery) occlusion, use of conscious or no sedation (vs. general anesthesia), and faster treatment were all predictors of favorable outcome. Conclusion Patients in the nerinetide arm who were not treated with concurrent alteplase showed improved clinical outcomes and the treatment effect was larger among patients with favorable ASPECTS profiles.

Objective: To establish a serological baseline, assess antibody stability, and compare the efficacy of three HPAI (H5) vaccines. Methods: We analyzed over 9,000 blood samples and 6,420 swabs from approximately 1.5 million birds up to 64 weeks old. HI (β, α), RT-PCR, and SN tests were conducted, with statistical analysis performed using two-way ANOVA. Results: The serological baseline (GM titer) using H5N8 antigens from A/Chicken/Iran/162/ 2016 varied. The Re6+Re8 vaccine produced higher and more stable HI β titers than the H5N3 and baculovirus vaccines. Serum HI α neutralization ability was similar for Re6+Re8 and H5N3 vaccines, both 100 times greater than the baculovirus vaccine. Neutralization indices for H5N3, Re6+Re8, and baculovirus vaccines were 4.7, 4.5, and 4.2 (log2), respectively. Conclusions and Relevance: After two vaccinations, Re6+Re8 exhibited the most stable HI β antibody response, while H5N3 had the highest neutralization index, surpassing Re6+Re8 by 0.2 and the baculovirus vaccine by 0.5. These findings highlight discrepancies between HI β and SN test results, with SN being a stronger indicator of protective titers due to its in vivo methodology, compared to the in vitro HI assay.

Hepatic simple cysts are common benign liver lesions frequently encountered in clinical practice. While the majority are asymptomatic and detected incidentally during imaging, approximately 5% of patients may experience symptoms, often related to the size and location of the cysts or the development of complications. Management of symptomatic cysts may involve percutaneous or endoscopic ultrasound (EUS)-guided aspiration with sclerotherapy, or surgical intervention, aimed at alleviating symptoms by reducing cystic volume. Solely aspirating cystic fluid tends to lead to complete cyst recurrence. Given the high recurrence rate, various management strategies have been proposed varying primarily in the choice of sclerosing agent (e.g., ethanol, tetracycline, polidocanol), infused volume, and retention time. Generally, these studies indicate good symptom improvement, reduced cyst volume, and a favorable safety profile. This review aims to revise the management approach for simple hepatic cysts by introducing two key changes based on recent practices. First, it advocates for a proactive management strategy, suggesting that intervention should not be delayed until cysts become symptomatic. Untreated growing cysts can lead to complications, making noninvasive management more challenging and increasing the likelihood of surgical intervention. Second, the review supports the use of sclerotherapy–either EUS-guided or percutaneous–as the first-line therapy for simple hepatic cysts, based on evidence demonstrating its effectiveness and safety. By addressing these changes, the review seeks to enhance current management strategies for simple hepatic cysts.

Human papillomavirus (HPV) is a key factor in gynecological oncology. This narrative review investigates the complex connection between HPV and various gynecological cancers. For a comprehensive exploration, we examined the association between persistent HPV infection and cervical cancer and its global prevalence. Beyond the cervix, we navigated the linkages between HPV and other gynecological malignancies, shedding light on vulvar, vaginal, anal, and oropharyngeal cancers. The narrative extends to discuss the critical role of HPV vaccination in preventing these cancers and exploring challenges, controversies, and future perspectives in the field. As we have described the impact of HPV, this review underscores the significance of ongoing research and public health endeavors in shaping the trajectory of gynecological oncology.