Pre-operative psoas muscle index, a surrogate for sarcopenia; as a predictor of post-esophagectomy complications.

BACKGROUND: Esophagectomy is the standard of care for curative esophageal cancer. However, it is associated with significant morbidity and mortality. Esophageal cancer is known to negatively affect the nutritional status of patients and many manifest cancer sarcopenia. At present, measures of sarcopenia involve complex and often subjective measurements. We assess whether the Psoas Muscle Index (PMI); an inexpensive, simple, validated method used to diagnose sarcopenia, can be used to predict adverse outcomes in patients after curative esophagectomy. METHODS: Multi-centre, retrospective cohort between 2010-2020, involving all consecutive patients undergoing curative esophagectomy for esophageal cancer in University Malaya Medical Centre, Sungai Buloh Hospital, and Sultanah Aminah Hospital. The cut-off value differentiating low and normal PMI is defined as 443mm2/m2 in males and 326326 mm2/m2 in females. Complications were recorded using the Clavien-Dindo Scale. RESULTS: There was no statistical correlation between PMI and major post-esophagectomy complications (p-value: 0.495). However, complication profile was different, and patients with low PMIs had higher 30-day mortality (21.7%) when compared with patients with normal PMI (8.1%) (p-value: 0.048). CONCLUSIONS: Although PMI did not significantly predict post-esophagectomy complications, low PMI correlates with higher 30-day mortality, reflecting a lower tolerance for complications among these patients. PMI is a useful, inexpensive tool to identify sarcopenia and aids the patient selection process. This alerts healthcare professionals to institute intensive physiotherapy and nutritional optimization prior to esophagectomy.

Embolisation of External Jugular Vein Aneurysm: A Case Report.

INTRODUCTION: Venous aneurysms are not as common as their arterial counterpart. The choice of management is debatable. Case Report: We present the case of a teenage boy with left external jugular vein aneurysm treated by endovascular technique. Embolisation was done using pushable microcoils with access via the femoral vein and direct puncture. CONCLUSION: This form of treatment provides a less-invasive option with a more concrete evaluation of the venous abnormality and its drainage during venous aneurysm occlusion.

Physicochemistry, Nutritional, and Therapeutic Potential of Ficus carica - A Promising Nutraceutical.

In an era where synthetic supplements have raised concerns regarding their effects on human health, Ficus carica has emerged as a natural alternative rich in polyphenolic compounds with potent therapeutic properties. Various studies on F. carica focusing on the analysis and validation of its pharmacological and nutritional properties are emerging. This paper summarizes present data and information on the phytochemical, nutritional values, therapeutic potential, as well as the toxicity profile of F. carica. An extensive search was conducted from various databases, including PubMed, ScienceDirect, Scopus, and Google Scholar. A total of 126 studies and articles related to F. carica that were published between 1999 and 2023 were included in this review. Remarkably, F. carica exhibits a diverse array of advantageous effects, including, but not limited to, antioxidant, anti-neurodegenerative, antimicrobial, antiviral, anti-inflammatory, anti-arthritic, antiepileptic, anticonvulsant, anti-hyperlipidemic, anti-angiogenic, antidiabetic, anti-cancer, and antimutagenic properties. Among the highlights include that antioxidants from F. carica were demonstrated to inhibit cholinesterase, potentially protecting neurons in Alzheimer's disease and other neurodegenerative conditions. The antimicrobial activities of F. carica were attributed to its high flavonoids and terpenoids content, while its virucidal action through the inhibition of DNA and RNA replication was postulated due to its triterpenes content. Inflammatory and arthritic conditions may also benefit from its anti-inflammatory and anti-arthritic properties through the modulation of various signalling proteins. Studies have also shown that F. carica extracts were generally safe and exhibit low toxicity profile, although more research in this aspect is required, specifically its effects on the skin. In conclusion, this study highlights the potential of F. carica as a valuable natural therapeutic agent and dietary supplement. However, continued exploration on F. carica's safety and efficacy is still required prior to embarking on clinical trials, as its role in personalized nutrition and medication will open a new paradigm to improve health outcomes.

Predictors of outcome in sciatica patients following an epidural steroid injection: the POiSE prospective observational cohort study protocol.

INTRODUCTION: Sciatica can be very painful and, in most cases, is due to pressure on a spinal nerve root from a disc herniation with associated inflammation. For some patients, the pain persists, and one management option is a spinal epidural steroid injection (ESI). The aim of an ESI is to relieve leg pain, improve function and reduce the need for surgery. ESIs work well in some patients but not in others, but we cannot identify these patient subgroups currently. This study aims to identify factors, including patient characteristics, clinical examination and imaging findings, that help in predicting who does well and who does not after an ESI. The overall objective is to develop a prognostic model to support individualised patient and clinical decision-making regarding ESI. METHODS: POiSE is a prospective cohort study of 439 patients with sciatica referred by their clinician for an ESI. Participants will receive weekly text messages until 12 weeks following their ESIand then again at 24 weeks following their ESI to collect data on leg pain severity. Questionnaires will be sent to participants at baseline, 6, 12 and 24 weeks after their ESI to collect data on pain, disability, recovery and additional interventions. The prognosis for the cohort will be described. The primary outcome measure for the prognostic model is leg pain at 6 weeks. Prognostic models will also be developed for secondary outcomes of disability and recovery at 6 weeks and additional interventions at 24 weeks following ESI. Statistical analyses will include multivariable linear and logistic regression with mixed effects model. ETHICS AND DISSEMINATION: The POiSE study has received ethical approval (South Central Berkshire B Research Ethics Committee 21/SC/0257). Dissemination will be guided by our patient and public engagement group and will include scientific publications, conference presentations and social media.

Caught Between External Pressures and Internal Battles: Psychosocial Factors Affecting Gestational Weight Gain - A Scoping Review.

Many physical factors (including maternal comorbidities) affecting gestational weight gain (GWG) have been widely studied; however, the psychosocial aspects pertaining to this need to be put under the microscope, especially in countries characterized by low indicators of socioeconomic development. Gaining and maintaining an adequate amount of weight during pregnancy is important to prevent premature deliveries, fetal demise, fetal macrosomia, shoulder dystocia during delivery, emergency cesarean sections, postpartum weight retention, childhood obesity, etc. A scoping review of the articles published in the last five years has revealed that perinatal outcomes like gestational weight are influenced by certain psychosocial factors, including, but not limited to, intimate partner violence, lack of social support and recognition, financial distress, household food insecurity, chronic stress and depression related to pregnancy, eating pathologies, and low self-esteem. Employing a multi-disciplinary approach, which involves seeking the help of psychiatrists/psychologists, obstetricians, nutritionists, and public health specialists, can help us mitigate undesirable outcomes related to inadequate and excessive weight gain during pregnancy. More intervention-based research focusing on psychosocial factors relating to GWG is needed in regions like South Asia, which is associated with low indicators of socioeconomic development.

Protein-inspired antibiotics active against vancomycin- and daptomycin-resistant bacteria.

The public health threat posed by a looming 'post-antibiotic' era necessitates new approaches to antibiotic discovery. Drug development has typically avoided exploitation of membrane-binding properties, in contrast to nature's control of biological pathways via modulation of membrane-associated proteins and membrane lipid composition. Here, we describe the rejuvenation of the glycopeptide antibiotic vancomycin via selective targeting of bacterial membranes. Peptide libraries based on positively charged electrostatic effector sequences are ligated to N-terminal lipophilic membrane-insertive elements and then conjugated to vancomycin. These modified lipoglycopeptides, the 'vancapticins', possess enhanced membrane affinity and activity against methicillin-resistant Staphylococcus aureus (MRSA) and other Gram-positive bacteria, and retain activity against glycopeptide-resistant strains. Optimised antibiotics show in vivo efficacy in multiple models of bacterial infection. This membrane-targeting strategy has potential to 'revitalise' antibiotics that have lost effectiveness against recalcitrant bacteria, or enhance the activity of other intravenous-administered drugs that target membrane-associated receptors.

Co-regulation of cell polarization and migration by caveolar proteins PTRF/Cavin-1 and caveolin-1.

Caveolin-1 and caveolae are differentially polarized in migrating cells in various models, and caveolin-1 expression has been shown to quantitatively modulate cell migration. PTRF/cavin-1 is a cytoplasmic protein now established to be also necessary for caveola formation. Here we tested the effect of PTRF expression on cell migration. Using fluorescence imaging, quantitative proteomics, and cell migration assays we show that PTRF/cavin-1 modulates cellular polarization, and the subcellular localization of Rac1 and caveolin-1 in migrating cells as well as PKCα caveola recruitment. PTRF/cavin-1 quantitatively reduced cell migration, and induced mesenchymal epithelial reversion. Similar to caveolin-1, the polarization of PTRF/cavin-1 was dependent on the migration mode. By selectively manipulating PTRF/cavin-1 and caveolin-1 expression (and therefore caveola formation) in multiple cell systems, we unveil caveola-independent functions for both proteins in cell migration.

Mango extracts and the mango component mangiferin promote endothelial cell migration.

This study tested the hypothesis that mango extracts contain bioactive molecules capable of modulating endothelial cell migration, an essential step in the formation of new blood vessels or angiogenesis. The formation of new blood vessels is an important therapeutic target for diseases such as limb ischemia, coronary infarction or stroke. We examined the effect of mango peel and flesh extracts as well as the individual polyphenolic molecules, mangiferin and quercetin, on bovine aortic cell migration using a modified Boyden chamber assay. Our results show that mangiferin, and extracts rich in mangiferin, increase endothelial cell migration. The dose-effect relationship for various extracts further suggests that this action of mangiferin is modulated by other components present in the extracts. The promigratory effect of mango extracts or mangiferin was unrelated to an effect on cell proliferation, and did not involve a change in the production of matrix metalloprotease-2 or -9 by the endothelial cells. Taken together, these results suggest that mangiferin present in mango extracts may have health promoting effects in diseases related to the impaired formation of new blood vessels.