Background: The blood-brain barrier (BBB) is a selective and semi-permeable barrier essential for protecting the brain's parenchyma against pathogens and toxic molecules present in the bloodstream. It consists of a monolayer of brain capillary endothelial cells, pericytes, astrocytic end-feet, and neurons. The tight junctions between endothelial cells prevent paracellular transport, further reinforcing its selectivity. However, this high level of selectivity represents a significant challenge for the delivery of therapeutic molecules to the central nervous system. Aim: Microbubble-assisted ultrasound (US) is a promising strategy for transiently permeabilizing the BBB to enable safe, non-invasive, localized, and efficient drug delivery to the brain. This approach enhances drug extravasation and bioavailability. Recently, nanodroplets (NDs) have emerged as good candidates to replace MBs. The aim of this review is to provide an updated overview of the rapidly expanding field of MB/ND-assisted US for the treatment of neurodegenerative diseases. This exciting field bridges research in biology and chemistry (MBs, NDs), US technology and the development of new drugs, small molecules, and biomedicines. The review begins with an update on MBs and NDs and discusses laboratory-manufactured and clinically approved devices such as Sonocloud^®, NaviFUS^®, and ExAblate Neuro®. It then focuses on the potential use of MB/ND-assisted US in treating neurodegenerative diseases, particularly Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and Huntington's disease (HD). Relevance for patients: Acoustically mediated BBB opening is an innovative and rapidly advancing strategy that holds great promise for improving the efficacy of existing treatments for neurodegenerative diseases. It also facilitates the discovery of new therapeutic molecules by enhancing their delivery to the brain.

Background: Pneumonia is a common respiratory infection affecting millions of people worldwide and often leads to serious complications such as pulmonary fibrosis - a progressive disorder recognized by persistent scarring, alveolar thickening, impaired gas exchange, and reduced lung capacity. The pathogenesis of pulmonary fibrosis remains complex and poorly understood. A hallmark feature is the buildup of extracellular matrix disrupting the normal architecture and function of the lung parenchyma, ultimately causing irreversible lung damage. At present, there is no known remedy for pulmonary fibrosis, and the existing treatments are often limited in efficacy and associated with adverse effects. This underscores the urgent need to identify novel molecular targets and therapeutic approaches for this debilitating condition. Aim: This review summarizes recent advances in understanding the pharmacotherapeutic potential of microRNAs (miRNAs) in reducing fibrosis associated with pneumonia and pulmonary fibrosis. It highlights the signaling mechanisms through which miRNAs regulate gene expression, as well as their role in maintaining lung development and homeostasis. The review also identifies the specific miRNAs with antifibrotic effects as demonstrated in experimental models and clinical settings. Finally, it discusses the key challenges in developing miRNA-based therapies, including delivery strategies and off-target effects. Methods: The study entailed a thorough literature review on antifibrotic effect of mi-RNA in pneumonia and lung fibrosis, conducted through the electronic searches on Google, Google Scholar, and PubMed databases. Results: In his study we provide a recent finding on antifibrotic activity of miRNA in pulmonary complications. Moreover, the evidences from animal and clinical researches are also discussed. This may further help scholars, practitioners, and legislators who are interested to do the research on mi-RNA therapies in clinical practice. Conclusion: In conclusion, miRNA-based diagnostics and therapies represent a promising frontier for the management of pneumonia and pulmonary fibrosis. Further research is warranted to deepen our understanding of miRNA mechanisms in the therapeutic context. Relevance for patients: Advances in therapies for pneumonia and pulmonary fibrosis can enhance treatment efficacy, aiding in the mitigation and treatment of the disease.

Background and aim: Cytomegalovirus (CMV) remains a critical post-transplant opportunistic infection despite significant advancements in monitoring and therapy. The impact of African-American (AA) race on CMV risk and outcomes has been insufficiently studied. This study aimed to determine secular trends in the incidence of CMV D+/R− mismatching and evaluate their association with AA race and clinical outcomes. Methods: This single-center longitudinal cohort study involved adult kidney recipients transplanted between January 2012 and June 2021, with follow-up through June 2022. Univariate and multivariate statistics were performed to analyze the data. Results: Of 2392 kidney transplant recipients, 2,261 were included in the final analysis after applying exclusion criteria. The mean age was 52 years, 41% were female, and 57% were black. In addition, 19% were classified as CMV high-risk. Secular trend analysis revealed an increase in CMV D+/R− rates over time. AAs had 51% lower odds of being CMV D+/R− (p<0.001), which remained stable over the study period (p=0.80). In adjusted models, AAs had a 50% higher risk of developing CMV infection (Hazard ratio [HR] = 1.49, confidence interval [CI]: 1.1 - 2.0) and late CMV infection (HR = 1.5, CI: 1.03 - 2.3), with no significant change over time (p>0.20). AA race was also a risk factor for acute rejection and death-censored graft loss, with no notable changes observed over the study period. Conclusion: In kidney transplant recipients, the incidence of CMV D+/R− serostatus has increased over the past decade. AAs are 50% less likely to be CMV D+/R− but have higher normalized rates of other complications, which remained relatively stable over the study period. Future studies should explore the underlying mechanisms contributing to the higher rates of CMV infection in AAs, which could facilitate the development of targeted interventions. Factors such as immunosenescence and genetic polymorphisms warrant further exploration. Relevance for patients: CMV risk, outcomes, racial disparities in kidney transplant.

Background: Video-assisted thoracoscopic surgery (VATS) is the preferred treatment for pulmonary nodules, making preoperative localization crucial. Aim: This study compared the effectiveness and complications of two computed tomography (CT)-guided localization methods for pulmonary nodules: localization needle and medical glue. Methods: This retrospective study included 86 patients with pulmonary nodules undergoing preoperative localization at the First Affiliated Hospital of Guangxi Medical University (July 2023 - April 2024). The patients were divided into two groups: the localization needle group (n=64) and the medical glue group (n=22). Clinical data, including baseline characteristics, localization-related data, complications, and surgical outcomes, were collected and analyzed, and subgroup analyses were done to identify risk factors for pneumothorax and pulmonary hemorrhage. Results: Both methods achieved a 100% localization success rate, with all nodules successfully resected. The needle group had longer localization time (17.19 vs. 15.36 min, p<0.05) and higher pneumothorax incidence (23.4% vs. 4.5%, p<0.05). The needle group also had a lower cough incidence (1.6% vs. 22.7%, p<0.05) but higher pain scores (2.89 vs. 2.36, p<0.05). No significant differences were observed in intrapulmonary hemorrhage, operative time, surgical approach, or postoperative pathology (p>0.05) between the two groups. However, subgroup analysis revealed significant differences in puncture times, localization methods, nodule size, lung history, and puncture depth related to pneumothorax and hemorrhage (p<0.05). Conclusion: Both CT-guided localization methods are safe and effective for VATS. The number of punctures is a key risk factor for complications such as pneumothorax and intrapulmonary hemorrhage, emphasizing the importance of careful planning and technique during localization. Relevance for patients: Identifying the most effective localization methods for pulmonary nodules ensures a higher success rate in surgeries, with fewer complications, ultimately leading to better patient outcomes and faster recovery. Proper preoperative localization helps reduce the risk of adverse events like pneumothorax, ensuring safer procedures and improved overall care for patients.

Background: The posterior fossa is a critical brain region housing essential structures such as the cerebellum and brainstem, crucial for coordination, balance, and autonomic functions. Abnormalities in this area significantly impact fetal development and postnatal outcomes, necessitating accurate diagnosis and characterization of fetal posterior fossa abnormalities. Aims: This review aims to analyze the diagnostic role of ultrasound, the primary imaging modality due to its accessibility and safety, and magnetic resonance imaging, which provides enhanced diagnostic accuracy in identifying central nervous system anomalies, particularly those involving the posterior fossa. A comprehensive approach is proposed to address the diagnostic complexities of cerebellar malformations, including ambiguous terminology and overlapping clinical features, which pose notable challenges. Relevance for patients: The complexity and lack of consensus regarding cerebellar malformations across medical disciplines can hinder accurate diagnosis and timely intervention. By advancing interdisciplinary research and refining diagnostic approaches, this study aims to enhance clinical management strategies and improve patient outcomes in cases of posterior fossa pathologies, ultimately fostering a more integrated and effective approach to diagnosis and treatment.

Background: The search and extraction of crude oil produce harmful environmental compounds and expose individuals, particularly during crucial and vulnerable stages of development like pregnancy, to a variety of negative health impacts. Aim: This study aims to assess the effects of prenatal exposure to ambient crude oil pollutants on selected newborn anthropometric measurements and maternal/cord blood thyroid hormone levels in crude oil-producing communities. Methods: Fifty pregnant women were environmentally exposed to crude oil, along with their newborns, and 30 pregnant women who were not exposed, along with their infants, were enrolled in the study. Maternal blood was obtained between weeks 29 and 39 of pregnancy, while cord blood was collected after birth. Thyroid hormones (triiodothyronine [T3], thyroxine [T4], and thyroid-stimulating hormone [TSH]) were measured using an enzyme-linked immunosorbent assay. The newborn's weight, length, and head circumference were measured, and the ponderal index (PI) was calculated for all study neonates. Results: The results indicated that selected newborn health indicators (recumbent length, head circumference, and PI) were considerably lower in infants exposed before birth compared to non-exposed neonates. TSH in cord blood was much lower, but T3 and T4 levels were significantly greater in prenatally exposed newborns than in prenatally unexposed neonates. Serum TSH levels were notably higher, whereas T3 and T4 levels were reduced in women exposed to crude oil than in expectant mothers who were not. The difference in mean glucose levels between exposed and non-exposed expectant mothers was insignificant. Both mothers and newborns exposed to ambient crude oil toxicants displayed mild or silent changes in thyroid hormone levels. Conclusion: Silent hypothyroidism in crude oil-exposed mothers and hyperthyroidism in prenatally exposed neonates might be responsible for the changes in health indicators of neonates. Health education and awareness of the dangers associated with crude oil exposure, as well as preventive measures, should be intensified in these communities. Relevance for patients: Prenatal exposure to crude oil pollutants can impair growth and development and pose a threat to the health of newborn infants.

Background: Biomimetic matrix (BMM) is a fully synthetic matrix composed of self-assembling peptides, an emerging class of biomaterials, for the treatment of chronic wounds. Aim: This preliminary case series explores the potential clinical applications of BMM in eight patients with chronic diabetic foot ulcers. The patients were selected based on wound chronicity and a lack of response to standard of care and/or previous treatments with biologics, including amniotic-derived materials, decellularized collagen, and living cell/collagen-derived products. Results: A total of eight subjects were evaluated and monitored in this case series. All subjects had diabetes, and the comorbidities included venous stasis, Charcot neuroarthropathy, obesity, osteomyelitis, peripheral vascular disease, and a history of prior partial foot amputation. All subjects treated with BMM responded after one to three applications. Overall, treatment with BMM resulted in an average percent wound area reduction of 63.6% over 6 weeks for chronic wounds that had remained open for an average of 21.5 months. Conclusion: BMM treatment reduced the wound area and depth of complex, stalled chronic diabetic lower extremity wounds. Relevance for patients: BMM, a synthetic self-assembling peptide-based matrix, demonstrated progression in treating stalled diabetic wounds that were not responsive to human- or animal-derived products.

Background: The evolving landscape of clinical and biomedical research has raised concerns about waste and quality. Poorly conducted studies mislead clinical practice and compromise patient outcomes. Reliable data from past research are essential for research quality improvement. Aim: The aim of the study was to characterize and assess the quality of research in Malaysia and Indonesia. Methods: To establish the proposed systematic review protocol, we will search PubMed, Cochrane Library, CINAHL, and PsycINFO for studies published from 1962 to 2019, supplemented by MyMedR for Malaysian research. Two reviewers will independently screen studies, extract data, and assess quality. Phase 1 will descriptively report research characteristics, including researcher profiles and journal outlets. In Phase 2, a quality screening tool will be validated across three domains: relevance, methodological credibility, and result usefulness. Associations between research characteristics and quality will be analyzed through multivariable regression and longitudinal trends will be explored. Results: Findings from the proposed systematic review protocol will generate baseline data for national and international comparisons, guiding stakeholders, researchers, funders, and policymakers on research evolution and quality trends. Results may inform improvement initiatives and resource allocation for understudied areas. Conclusion: This review aims to establish a comprehensive baseline of research outputs and the pattern of research quality in the participating countries and discipline. The findings may underscore the presence of a valid classification method to guide future research and enhance evidence-based practice in healthcare. Relevance for patients: By identifying research strengths and gaps, this proposed systematic review supports the development of robust study designs that generate reliable evidence, ultimately enhancing patient care and health outcomes.