This review aims to analyze complex medical interventions planned and performed using image-guided robots. Such interventions, which may involve surgical or targeted drug delivery, are minimally invasive, precise, and safe therapies. The accuracy of robotic positioning is improved by reducing uncertainty and complexity, which can be achieved by matching real and virtual interventional procedures involving physical and virtual phantoms of the relevant part of the corresponding living tissues. Such tailored training includes personalized, patient, and interventional tool characteristics, and the results enable a real (with patient) intervention controlled by staff and a possible matched autonomous intervention under staff supervision. This paper discusses considerations for selecting appropriate scanners to control and monitor image-guided interventional procedures, planning personalized medical interventions using physical and virtual phantoms, involving staff in the loop, and employing augmented matched digital twins (DTs) for real interventions. Moreover, the paper positions the image-assisted robotic strategy in comparison to laparoscopic surgery. Each topic covered in this article, while self-contained, is supported by examples from the literature to facilitate a deeper understanding. The outcomes of this review highlight the importance of complex medical interventions involving image-assisted robotics or laparoscopic processes involving minimally invasive, nonionizing, and precise interventions. Furthermore, DTs already integrated into healthcare, combined with digital tools, could offer an effective solution for managing image-assisted robotics. This includes planning interventions with phantoms or patients and involving staff in the loop.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and joint damage. Transcriptomics has been utilized in RA profiling to identify locations that were previously unclear. A robust technique for examining the intricate transcriptomic landscape of RA is next-generation RNA sequencing (RNA-seq). This review has explored the use of RNA-seq to understand the pathophysiology of RA. Detailed discussions are presented on the fundamentals of RNA-seq technology, how RNA extracted from the synovium is incorporated into gene expression patterns analysis, and how RNA-seq is superior to other methods. We have explored several applications of RNA-seq in RA research, emphasizing its potential for identifying dysregulated pathways, detecting novel biomarkers, and characterizing gene expression levels. Furthermore, this review has clarified the regulatory networks and signaling pathways identified in RNA-seq research and investigated the possibility of using transcriptomic RNA-seq as a diagnostic tool for RA. In conclusion, we have highlighted the significance of using transcriptome data to achieve a more comprehensive understanding of the molecular processes underlying RA. Hence, this review underscores the revolutionary influence of RNA-seq on RA research, paving the way for improved diagnostics, tailored therapy, and the discovery of novel treatment targets for individuals with RA.

Subanesthetic ketamine offers promising potential for reducing harm in individuals with cocaine use disorder (CUD). Research indicates that even a single dose can lessen cravings and decrease drug-seeking behaviors, though achieving long-term abstinence remains challenging. However, reduced cocaine consumption itself is a meaningful outcome. Ketamine’s potential in reducing the harm of CUD is also supported by its mechanism of action in the dopaminergic system, as it counters cocaine’s effect by interacting with dopamine receptors, stabilizing brain-derived neurotrophic factor levels, and modulating lateral habenula neuron bursting. In addition, concerns about ketamine’s abuse potential are minimized when it is administered in a clinical setting under professional supervision. This is supported by its success as a treatment for depression, indicating that, with appropriate safeguards, ketamine could be a valuable pharmacological strategy for harm reduction in CUD. When developing ketamine as a CUD harm-reduction strategy, it is also important to account for sex differences, which may affect patients’ sensitivity to ketamine and the potential for misuse. Although the promising effects of ketamine in treating depression support its use for CUD, most studies have focused on depression models, and additional research is needed to confirm safety and understand its specific mechanisms in CUD. Nonetheless, subanesthetic ketamine is a promising CUD intervention and should be further explored to provide an efficient and safe solution for patients in need. This narrative review mainly elucidates the ongoing research regarding ketamine’s mechanisms of action, pharmacology, and clinical application potential in CUD.

The increasing rate of opioid consumption among Nigerian students is alarming. Despite the therapeutic benefits of opioids, their excessive use could be detrimental. Exploring knowledge gaps and implementing preventive strategies are necessary to curb opioid misuse among Nigerian students. This review aimed to identify the prevalence estimates of non-prescribed opioid use among Nigerian students and explore the cultural and societal factors favoring opioid and other drug use in this population. It further aimed to provide and discuss strategies that could offer effective and long-lasting solutions for Nigerian policymakers to curb opioid use among Nigerian students. A systematic search strategy identified relevant studies from databases such as PubMed and Google Scholar using keywords such as opioid misuse, students, Nigeria, prevention strategies, and opioid use disorder. Articles on the prevalence rates, associated factors, and preventive measures were extracted. The findings revealed a high prevalence of opioid use among Nigerian students, particularly in the southwestern (7.87%) and northeastern (6.57%) parts of Nigeria. Approximately 4.6 million Nigerians, constituting 4.7% of the population, have used opioids for non-medical purposes. Tramadol and codeine are the most commonly misused opioids. Cultural practices and belief systems often impact the knowledge, attitudes, and perceptions of opioid use among students. Efforts to prevent and control opioid misuse in Nigeria should focus on effective coordination among students. Health-promotion measures and specific protection should be promoted alongside early diagnosis, prompt treatment, and rehabilitation of affected individuals.

Postgraduate pharmaceutical students are at the forefront of drug development and application in China. In recent years, global pandemics, demand for the research and development of new drugs, and college and university requirements of outcome-based education (OBE) indicate that major reforms in postgraduate pharmaceutical education are essential. A currently neglected aspect of OBE in Chinese pharmaceutical education is bibliometric analysis. To establish a framework for bibliometric analysis training, the researchers searched the top 50 research works in major academic databases using the keywords “Pharmacy education” and “Framework.” Ten papers were selected that were closest to the desired paradigm. The procedures, theoretics, and goals of the frameworks in these papers were combined with the researchers’ teaching and research experience to construct a bibliometric analysis competency (BAC) framework. The BAC framework, which was created to fill current gaps in postgraduate pharmaceutical education, constitutes three levels: (A) knowledge; (B) familiarization; and (C) mastering. The three levels require graduate students to (A) have a preliminary understanding of the steps of bibliometrics, (B) comprehend the literature on bibliometrics, and (C) independently apply the steps to perform bibliometric analysis, respectively. This paper also describes the theoretical setup of the BAC framework and a potential assessment system. The BAC framework provides a useful reference for the reform of Chinese pharmaceutical graduate education, and its future implementation is urgently anticipated.

Artificial intelligence (AI) is transforming healthcare, with endoscopy emerging as a key area for its application. AI-driven tools are advancing gastrointestinal diagnostics by significantly improving the accuracy and efficiency of detecting conditions such as colorectal cancer, inflammatory bowel disease, and gastrointestinal bleeding. Notably, real-time AI-powered polyp detection has shown significant promise in reducing missed diagnoses, particularly for flat or subtle lesions. Furthermore, AI algorithms excel in lesion characterization, aiding in clinical decision-making and reducing the need for unnecessary biopsies. A major advantage of AI lies in its ability to mitigate variability in diagnostic performance, supporting less experienced endoscopists and contributing to standardized care across diverse clinical settings. Despite these advancements, challenges persist, including the need for large-scale validation of AI models, ensuring their generalizability across populations, addressing ethical and privacy concerns, and mitigating the risk of over-reliance on AI at the expense of human expertise. This perspective explores the transformative potential of AI in endoscopy, emphasizing the importance of thoughtful implementation, ethical considerations, and continued innovation to optimize its integration into clinical practice.

Cancer cachexia kills millions of people worldwide every decade. Attenuating or mitigating this muscle-wasting condition associated with cancer could significantly reduce cancer-related deaths. The drug development pipeline takes 10 - 15 years to complete in the United States. During this period, hundreds of thousands to millions worldwide die of cancer cachexia. Medicines already approved by the United States Food and Drug Administration that cause significant muscle mass gains in healthy individuals could be used “off-label” or “repurposed” in individuals who do not have androgen receptor-responsive cancers. These agents are testosterone and anabolic steroids. In individuals with androgen receptor-responsive tumors, repurposing anabolic agents (e.g., beta-2 adrenergic agonist albuterol), which increases muscle mass through different mechanisms than the androgen receptor, is warranted. New research suggests that phenotyping for the androgen receptor must be conducted individually, even for the same cancer. The utilization of these two types of anabolic agents - those that use the androgen receptor and those that do not - in appropriate clinical trials in cancer cachexia is also warranted.

Selective serotonin reuptake inhibitors (SSRIs) are routinely used to treat patients with obsessive-compulsive disorder (OCD); however, 40 - 60% of patients with OCD do not respond to SSRIs. Glutamate dysfunction may play a key role in OCD pathogenesis. N-acetylcysteine (NAC), a glutamate-modulating drug, targets the glutamatergic system. This study aimed to assess whether the addition of NAC reduces the severity of OCD symptoms in patients with SSRI-treated moderate-to-severe OCD. A total of 60 patients with OCD were diagnosed according to the DSM-5 criteria, and severity of the symptoms was assessed using the Yale-Brown obsessive-compulsive scale (Y-BOCS). Patients were administered 2,400 mg/day of SSRIs plus placebo (placebo arm) or 2,400 mg/day (NAC arm) of SSRIs plus NAC for 10 weeks. Serum alanine aminotransferase, aspartate aminotransferase, creatinine, and electrocardiogram were monitored to evaluate the safety of NAC. The Y-BOCS score was not significantly different between the two arms at baseline; however, it was significantly different between the two arms after 4 (P = 0.03) and 10 (P = 0.00) weeks. The NAC arm had a reduction of 8.4 (25.51 - 17.15) points compared with 1.42 (25.07 - 23.65) points for the placebo arm from baseline to 10 weeks. NAC was well-tolerated and caused mild gastrointestinal adverse events. Thus, NAC is an effective glutamate-modulating drug as and can be used as an augmentation therapy with standard treatment in patients with moderate-to-severe OCD.

Multiple sclerosis (MS) is a prevalent neurological disorder affecting the central nervous system, with a global incidence exceeding 2.5 million cases. Brain-derived neurotrophic factor-antisense (BDNF-AS), a long non-coding RNA, has been identified as a factor that negatively influences the expression of brain-derived neurotrophic factor, a neurotrophin protein that exhibits heightened expression within actively demyelinating lesions in MS. This study aims to assess the relative expression of BDNF-AS across all MS subtypes, evaluate its diagnostic accuracy, and explore correlations between BDNF-AS expression and disease parameters. Quantitative real-time polymerase chain reaction was employed to quantify the expression levels of BDNF-AS in the serum samples of 54 individuals diagnosed with various types of MS and 20 healthy controls. Statistical analyses were performed to assess the correlation and diagnostic efficacy of BDNF-AS expression levels. The expression of BDNF-AS was markedly reduced in individuals with MS compared to the control group (P < 0.01). Notably, the highest expression levels were observed in patients diagnosed with secondary progressive MS. Using a defined cutoff value of 0.31, and the findings suggest that BDNF-AS expression in serum has notable potential as a specific and sensitive diagnostic marker for MS. In conclusion, this study provides a comprehensive evaluation of BDNF-AS across all MS subtypes, highlighting its diagnostic accuracy and the association between elevated BDNF-AS expression and disease progression in secondary progressive MS. Further research is needed to validate these results.

We present the case of a 69-year-old woman who developed septic cavernous sinus thrombosis (SCST) secondary to bacterial meningitis and sinusitis. She presented to the emergency department with frontal headache, neck stiffness, photophobia, exophthalmos, and fever. Initial investigations revealed extensive opacification of the paranasal sinuses on plain cranial computed tomography (CT), and blood tests indicated a bacterial infection. She initially received antibiotics and dexamethasone for suspected bacterial meningitis. Cerebrospinal fluid analysis revealed elevated glucose and protein levels as well as white and red blood cell counts, along with a negative Gram stain. An ophthalmology assessment and CT venography indicated a strong suspicion of cavernous sinus thrombosis, further confirmed by magnetic resonance venography. Anticoagulation with antibiotics and dexamethasone was initiated, leading to significant clinical improvement. This case highlights the importance of the early recognition and treatment of SCST and the role of dexamethasone in patients with coexisting bacterial meningitis.