Background: Gut microbiome comprises a diverse microbial community, including bacteria, viruses, and fungi, which play a crucial role in human health. These microbes contribute to host well-being by producing beneficial compounds such as short-chain fatty acids and other metabolites that help maintain microbial homeostasis. Recent advancements in high-throughput sequencing techniques have identified key microbes crucial for human health and revealed that an imbalance in these communities-known as dysbiosis-can lead to various diseases, including inflammatory bowel disease (IBD), Crohn’s disease, colorectal cancer, type 2 diabetes, and liver diseases. Aim: This review aims to provide a comprehensive overview of emerging microbiome-based therapeutic strategies, including fecal microbiota transplantation (FMT), prebiotics, probiotics, next-generation probiotics, synthetic microbiome transplantation, and microbiome editing therapies, as potential interventions to restore gut microbial balance and improve health outcomes. Relevance for patients: Microbiome-based therapies have emerged as promising tools for restoring gut homeostasis and managing microbiome-associated diseases. Approaches such as FMT have shown clinical benefits in conditions such as IBD, Clostridium difficile infection, and cancer immunotherapy. Understanding these therapies may guide future personalized treatments aimed at improving patient outcomes through modulation of the gut microbiome.

Background: Chronic hepatitis B (CHB) remains a major global health challenge, with persistent covalently closed circular DNA (cccDNA) and viral integration leading to lifelong infection, cirrhosis, and hepatocellular carcinoma (HCC). Current antiviral therapies suppress replication but rarely achieve a functional cure. The multifunctional hepatitis B virus (HBV) X (HBx) protein is well known to sustain viral replication, impair host immune responses, and promote hepatocarcinogenesis, which makes it an attractive therapeutic target. Aim: This review synthesizes current literature supporting HBx as a promising therapeutic target to achieve a functional cure of CHB. Conclusion: HBx is a high-value therapeutic target with potential to accelerate progress toward a functional cure. Destabilization or downregulation of HBx would not only attenuate its oncogenic signaling but also limit relapse after treatment discontinuation and diminish the cccDNA reservoir and viral antigen load. Relevance for patients: Multitargeted treatment regimens incorporating HBx-directed therapies hold the potential to achieve durable viral suppression and a functional cure, and to reduce the risk of HCC. The combined strategies could transform the long-term management and outcomes for patients with CHB.

Background: Very early-onset inflammatory bowel disease (VEO-IBD) may have an aggressive clinical course. Upon suspicion, an immediate transfer to a pediatric gastroenterology clinic should be made, considering that diagnostic delay (DD) in referral can have profound implications. Objectives: The objectives of the study are to investigate the time, proportion, and factors associated with DD in VEO-IBD and explore the symptoms at initial presentation. Methods: An observational, retrospective, single-center study of consecutive patients with VEO-IBD confirmed by histopathology was conducted. We measured the time to diagnosis-the interval between symptom onset and the final VEO-IBD diagnosis. DD was defined as the time to diagnosis that exceeded the 75 ^th percentile. Results: Twenty-five children with VEO-IBD-16 with ulcerative colitis (UC) and 9 with Crohn’s disease (CD)-were evaluated, with a median age of 34 months. Ages at first symptoms, first visit, and diagnosis were significantly lower for the CD group. However, there was no significant difference in the time from first symptoms to diagnosis between CD and UC. Patients with weight loss, anemia, and fistulas did not meet established criteria for DD and were referred early. Conclusion: Our study underscores the importance of early recognition of VEO-IBD, with bloody diarrhea, abdominal pain, and weight loss serving as crucial warning signs. Identifying these symptoms can aid in the early diagnosis and prompt referral to a specialist, potentially reducing the risk of DD. Relevance for patients: Early recognition of bloody diarrhea, abdominal pain, and weight loss in young children can speed diagnosis of VEO-IBD and ensure timely referral to specialist care.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition that significantly affects social connection, behavior, and knowledge acquisition. Despite increasing global prevalence, timely diagnosis remains challenging due to heterogeneity in clinical presentation. Aim: The aim of this study is to develop a dual-modal framework for early detection of ASD by analyzing behavioral assessment and image data. Methods: The proposed framework consists of two independent yet complementary modules. In the behavioral module, questionnaire responses and assessment data were analyzed using an artificial neural network classifier to predict the likelihood of ASD. In the visual module, facial images were analyzed using a DenseNet121-based deep learning model with transfer learning to detect ASD-related traits. Each module independently estimates ASD probability and categorizes severity levels. Results: The DenseNet121 model achieved strong performance in image-based ASD detection, with 91.16% (95% confidence interval [CI]: 87.8–94.2) accuracy, 91.2% (95% CI: 87.8–94.2) sensitivity, and 89.8% specificity, including when trained on a relatively small dataset. Independent training of the two modules may improve robustness and reduce modality-specific bias. Conclusion: The proposed framework demonstrates potential for enhancing early ASD detection using dual modalities. The findings support the use of deep learning-based approaches to improve detection accuracy. Relevance for patients: Early screening of ASD can facilitate timely interventions and personalized care strategies. This method offers a noninvasive, data-driven approach that may support caregivers and healthcare systems in informed decision-making, ultimately benefiting individuals with ASD and their families.

Background: Macular edema secondary to retinal vein occlusion (RVO-ME) impairs vision. Intravitreal ranibizumab is commonly used, but the adjunctive value of acupuncture remains unclear. Objective: To evaluate the clinical efficacy and safety of acupuncture combined with intravitreal ranibizumab injection for RVO-ME. Methods: Patients with RVO-ME (n = 45) were randomized into a control group (ranibizumab monotherapy) and an acupuncture group (ranibizumab and acupuncture). Both groups received monthly intravitreal ranibizumab (0.5 mg/0.05 mL) for 3 months, with a total follow-up of 6 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), macular vessel density (MVD) of superficial vascular complex (SVC), and deep vascular complex (DVC), foveal avascular zone (FAZ) area, and safety outcomes were assessed. Results: At 3 and 6 months post-treatment, BCVA, CMT, SVC-MVD, and DVC-MVD improved significantly in both groups (p <0.05). The acupuncture group showed significant reductions in SVC-FAZ and DVC-FAZ at 6 months (p <0.05), whereas the control group showed no such changes. Between-group differences at 6 months were significant for BCVA, CMT, DVC-MVD, and DVC-FAZ (p <0.05), with DVC-MVD differing significantly at 3 months (p <0.05). Adverse events (subconjunctival hemorrhage, elevated intraocular pressure, subcutaneous hemorrhage) were mild and comparable between groups (p >0.05). Conclusion: Acupuncture combined with ranibizumab effectively reduces RVO-ME, improves the microvascular structure of the macula, and is safe and reliable, with no serious adverse reactions. Relevance for patients: Patients with vision loss from RVO-ME may benefit from this combined treatment, which improves visual acuity, reduces retinal edema, and supports better long-term macular health with a favorable safety profile.

Background: Overweight (OW) and obesity (OB) are major public health challenges associated with metabolic disorders, chronic diseases, and rising healthcare costs. Low-carbohydrate diets (LCDs) have emerged as cost-effective strategies for prevention and treatment. Objective: The objective of the study is to evaluate the effects of an LCD (≤130 g/day) on anthropometric, metabolic, hepatic, and renal parameters in OW and obese adults over 12 months. Methods: This open-label, non-randomized, self-controlled clinical trial included 34 adults with body mass index (BMI) ≥ 25 kg/m ² who received individualized nutritional counseling and followed an LCD for up to 12 months. Clinical and laboratory parameters were assessed at baseline and during follow-up (3–6 months and 7–12 months). Statistical analyses included generalized estimating equations and non-parametric tests with Bonferroni correction. Results: Participants achieved a mean weight loss of 10%, with reductions in BMI (−2.9 kg/m ²), waist circumference (−5.4 cm), and body fat percentage. Glycated hemoglobin decreased at 7–12 months (p <0.05), while insulin levels and insulin resistance declined at 3–6 months (p =0.0497 and p =0.037). Fasting glucose remained stable. Low-density lipoprotein cholesterol increased modestly at 7–12 months (p =0.035), whereas other lipid parameters showed no significant changes. Gamma-glutamyl transferase levels decreased (p =0.0341), with no adverse effects on renal or hepatic markers. Conclusion: An LCD was associated with improvements in glycemic control, body composition, insulin sensitivity, and liver enzymes without compromising renal function or lipid profiles, supporting its role in OB management and cardiometabolic risk reduction in primary care.

Background: Succinylcholine chloride is essential for achieving neuromuscular blockade during emergency airway management. The manufacturer specifies a 14-day stability period for 20 mg/mL vials at room temperature, which limits implementation of prefilled-syringe protocols. Aim: This study aims to investigate the chemical stability of succinylcholine chloride after transfer from manufacturer vials to polypropylene syringes during extended room-temperature storage. Methods: A validated high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method was developed to quantify percent recovery. Ten 20 mg/mL succinylcholine chloride vials were used: five samples were stored refrigerated (2–8°C; controls; n = 5), and five were transferred to polypropylene syringes and stored at room temperature (20–25°C; n = 5). Samples were analyzed over 90 days. The HPLC-UV method met United States Pharmacopeia criteria for accuracy, precision (<5% error and % relative standard deviation), and linearity (R² > 0.99). Results: Succinylcholine chloride maintained >90% of the initial concentration over 90 days in polypropylene syringes stored at room temperature (93.13% on day 90) and in refrigerated controls (93.97% on day 90). No significant differences were observed between storage conditions (p >0.05). All samples remained physically stable, with no visible color change or precipitate. Conclusion: Despite its ester bonds, succinylcholine chloride remained chemically stable in polypropylene syringes for up to 90 days at room temperature. Relevance for Patients: These findings support the extended stability of prefilled succinylcholine syringes, which may improve emergency preparedness; however, sterility validation remains necessary before clinical implementation.