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Polysaccharides exhibit a multitude of biological activities, including antioxidant, antitumor, immunoregulatory, hepatoprotective, and anti-inflammatory effects, but it is not known whether such effects occur in fish. Head kidney macrophages from turbot Scophthalmus maximus L. were isolated and cultured to examine the responsiveness to natural polysaccharides as potential immune stimulators. Polysaccharides used in the research included Echinacea purpurea polysaccharide (EPP), Astragalus polysaccharide (APS), lentinan (LNT), seaweed polysaccharide (SPS), and laminarin (LAM). The test compounds were added to the cultures and assessed for their effects on the growth and immunomodulatory functions of the cells. Based on the results of cell activity, reactive oxygen species, and nitic oxide assays, APS was selected as an immune stimulator. After addition of APS to the culture medium, a comprehensive proteomic analysis was conducted to identify signaling pathways responsible for the immune effects on macrophages. Specific immune pathway proteins were upregulated in cells in response to the addition of APS, including macrophage migration inhibitory factor, myosin-α, metalloproteinase inhibitor, and collagenase type III. In particular, compared with non-stimulated cells, the expression level of the TLR22 receptor was significantly increased in stimulated macrophages (p < 0.01). A KEGG pathway analysis indicated that relevant pathways were activated, including TNF, PI3K-Akt, and NF-κB signaling pathways. ELISA and qRT-PCR analysis also indicated that APS reduced IL-1β and TNF-α levels in the cells following lipopolysaccharide (LPS) stimulation. These data suggest that APS produced an immunoprotective effect on the head kidney macrophages of turbot at 800 µg ml-1, and enhanced cell proliferation. Our results provide evidence for anti-inflammatory properties of APS. As such, APS could be a candidate immunopotentiating agent for fish.

As pneumopatias em pacientes com Síndrome da Imunodeficiência Adquirida (SIDA) são frequentes, podendo serem insólitas e superpostas entre si, dificultando o diagnóstico e tratamento adequado. Dessa forma, o objetivo do trabalho é relatar um caso de pneumocistose com padrão radiológico atípico. Trata-se de uma mulher de 40 anos, apresentando tosse seca, dor torácica, febre e perda ponderal há 30 dias, evoluindo com dispneia aos pequenos esforços nos últimos 10 dias. Diagnóstico de infecção pelo HIV há 7 anos, em abandono de tratamento, com atual contagem de LTCD4+ 27 unidades/mm³ e Carga Viral de 1.742.987 cópias/mL. Ausculta pulmonar com roncos em hemitórax esquerdo. Radiografia simples de tórax revelou infiltrado em base de pulmão direito e consolidação em base de pulmão esquerdo. Iniciou-se tratamento para pneumocistose moderada com SMX-TMP. A Tomografia Computadorizada (TC) de tórax revelou opacidade pulmonar nodular escavada no segmento superior do lobo inferior do pulmão esquerdo, pequenos nódulos centrolobulares e ramificado com “padrão de árvore em brotamento” satélites, sugestivo de processo infeccioso granulomatoso em atividade. Foram realizados baciloscopia de escarro e teste rápido molecular para tuberculose em urina, lavado broncoalveolar e escarro, os quais foram negativos. Um mês após o início do tratamento com SMX-TMP, havia melhora clínica e nova TC de tórax apresentou apenas lesões residuais. Assim, optou-se por dar continuidade à TARV com TDF+3TC+DTG. Sabe-se que, em média, 5-10% dos casos de pneumocistose podem cursar com manifestações radiográficas atípicas, como nódulos focais escavados, padrão miliar, derrame pleural e linfonodomegalias. Ante o exposto, é notória dificuldade de estabelecer o diagnóstico etiológico das afecções pulmonares em pacientes com SIDA baseado somente em dados clínicos e radiológicos, pois há grande similaridade entre diferentes patógenos. Dessa forma, recomenda-se avaliação por broncofibroscopia, embora a cobertura empírica seja a mais utilizada devido atraso nos resultados de cultura de bacilos álcool ácidos resistentes no lavado broncoalveolar e/ou por dificuldade de seguimento nas redes de atenção à saúde.

BackgroundAlthough alcohol abstinence may be an effective intervention for alcohol-associated cirrhosis, its association with prognosis has not been systematically assessed or quantified.AimsTo determine the prevalence of alcohol abstinence, factors associated with alcohol abstinence and the impact of abstinence on morbidity and overall survival in people with alcohol-associated cirrhosis.MethodsWe searched Medline and Embase from inception to 15 April 2023 for prospective and retrospective cohort studies describing alcohol abstinence in people with known alcohol-associated cirrhosis. Meta-analysis of proportions for pooled estimates was performed. The method of inverse variance, employing a random-effects model, was used to pool the hazard ratio (HR) comparing outcomes of abstinent against non-abstinent individuals with alcohol-associated cirrhosis.ResultsWe included 19 studies involving 18,833 people with alcohol-associated cirrhosis. The prevalence of alcohol abstinence was 53.8% (CI: 44.6%-62.7%). Over a mean follow-up duration of 48.6 months, individuals who continued to consume alcohol had significantly lower overall survival compared to those who were abstinent (HR: 0.611, 95% CI: 0.506-0.738). These findings remained consistent in sensitivity/subgroup analysis for the presence of decompensation, study design and studies that assessed abstinence throughout follow-up. Alcohol abstinence was associated with a significantly lower risk of hepatic decompensation (HR: 0.612, 95% CI: 0.473-0.792).ConclusionsAlcohol abstinence is associated with substantial improvement in overall survival in alcohol-associated cirrhosis. However, only half of the individuals with known alcohol-associated cirrhosis are abstinent.

Background & aimsAlcohol is one of the leading causes of hepatocellular carcinoma (HCC). However, pooled estimates of HCC incidence in alcohol-associated cirrhosis have not been evaluated systematically. We performed a pooled analysis of time-to-event data to provide robust estimates for the incidence of HCC in alcohol-associated cirrhosis.MethodsMedline, Embase, Cochrane Central Register, Scopus, and Web of Science were searched from inception to August 2021. Individual patient data were reconstructed from published Kaplan-Meier curves, and a pooled analysis of cumulative HCC incidence was performed using a random-effects model.ResultsWe screened 5022 articles and included 18 studies (148,333 patients). In the pooled analysis, the cumulative incidence of HCC in alcohol-associated cirrhosis at 1, 5, and 10 years among studies that accounted for the competing risk of death without HCC was 1%, 3%, and 9%, respectively. A secondary analysis by traditional meta-analysis determined that the HCC incidence rate was higher in cohorts enrolled in a HCC surveillance program (18.6 vs 4.8 per 1000 person-years; P = .001) vs those who were not enrolled in a surveillance program. Meta-regression showed that diabetes, smoking, variceal bleeding, and hepatic decompensation were associated with a higher risk of HCC.ConclusionsOur analysis determined that the 5- and 10- year cumulative risk of HCC in alcohol-associated cirrhosis was 3% and 9%, respectively, with a higher incidence in cohorts that were enrolled in a HCC surveillance program. These data should be validated further in large prospective studies, and may have important implications for HCC screening and surveillance among patients with alcohol-associated cirrhosis.

Purpose of reviewThe study aims to provide a summary of recent developments for diagnosing and managing posterior cortical atrophy (PCA). We present current efforts to improve PCA characterisation and recommendations regarding use of clinical, neuropsychological and biomarker methods in PCA diagnosis and management and highlight current knowledge gaps.Recent findingsRecent multi-centre consensus recommendations provide PCA criteria with implications for different management strategies (e.g. targeting clinical features and/or disease). Studies emphasise the preponderance of primary or co-existing Alzheimer's disease (AD) pathology underpinning PCA. Evidence of approaches to manage PCA symptoms is largely derived from small studies.SummaryPCA diagnosis is frequently delayed, and people are likely to receive misdiagnoses of ocular or psychological conditions. Current treatment of PCA is symptomatic - pharmacological and non-pharmacological - and the use of most treatment options is based on small studies or expert opinion. Recommendations for non-pharmacological approaches include interdisciplinary management tailored to the PCA clinical profile - visual-spatial - rather than memory-led, predominantly young onset - and psychosocial implications. Whilst emerging disease-modifying treatments have not been tested in PCA, an accurate and timely diagnosis of PCA and determining underlying pathology is of increasing importance in the advent of disease-modifying therapies for AD and other albeit rare causes of PCA.

Abstract Background The goal of this study was to investigate ERBB2(HER2) and EGFR gene amplification and protein expression in gastric cancer. Fluorescence in situ hybridization (FISH) and immunohistochemistry were used to analyze ERBB2 and EGFR gene amplification and protein expression in 69 cases of gastric cancer. Results FISH analysis revealed that 20.3% of the cases exhibited ERBB2 gene amplification. Increases in ERBB2 copy number and gene amplification were present in 52.2% of the samples. Expression of the ERBB2 protein was observed in 42.0% of cases. FISH analysis detected EGFR gene amplification in 29.0% of samples. Increases in EGFR copy number and gene amplification occurred in 57.9% of samples, and EGFR protein expression was present in 52.2% of samples. Both ERBB2 and EGFR gene amplification were 3 cases (4.3%), but abnormalities in both ERBB2 and EGFR gene copy number were present 36.2% of samples. ERBB2 and EGFR gene amplification were significantly associated with the depth of tumor invasion (P < 0.05) and lymph node metastasis (P < 0.05), but not with sex, age, or histological type (P > 0.05). Conclusions Our data indicated that ERBB2 and EGFR genetic abnormalities were associated with the prognosis of gastric cancer. Clinical assessment of ERBB2 and EGFR amplification may represent an important factor for the development of personalized treatment programs for gastic cancer.

Most patients with Alzheimer's disease present with amnestic problems; however, a substantial proportion, over-represented in young-onset cases, have atypical phenotypes including predominant visual, language, executive, behavioural, or motor dysfunction. In the past, these individuals often received a late diagnosis; however, availability of CSF and PET biomarkers of Alzheimer's disease pathologies and incorporation of atypical forms of Alzheimer's disease into new diagnostic criteria increasingly allows them to be more confidently diagnosed early in their illness. This early diagnosis in turn allows patients to be offered tailored information, appropriate care and support, and individualised treatment plans. These advances will provide improved access to clinical trials, which often exclude atypical phenotypes. Research into atypical Alzheimer's disease has revealed previously unrecognised neuropathological heterogeneity across the Alzheimer's disease spectrum. Neuroimaging, genetic, biomarker, and basic science studies are providing key insights into the factors that might drive selective vulnerability of differing brain networks, with potential mechanistic implications for understanding typical late-onset Alzheimer's disease.

The practical application of high-capacity Li-rich cathode materials is hindered by capacity fading and voltage decay. The capacity fading and voltage decay could be effectively overcome by using water-soluble guar gum (GG) binder instead of traditional polyvinylidene fluoride (PVDF). However, the specific role of the GG binder is not clear yet, though the GG binder can significantly improve the electrochemical performance of Li-rich cathode. To understand the effect of GG binder on the morphology, microstructure of electrode and electrode/electrolyte interfaces, ex-situ scanning electron microscope (SEM), transmission electron microscope (TEM), X-ray adsorption near edge spectroscopy (XANES), in-situ electrochemical impedance spectroscopy (EIS) were applied to comparatively study the charge-discharge processes of Li-rich Li1.2Ni0.2Mn0.6O2 cathode when using GG and PVDF as binders. The results indicate that the GG binder can prevent electrode crack and active material loss, ascribing to the strong mechanical adhesion of GG binder with active material particles and current collector. It has found that the GG binder can also induce the formation of a uniform layer on Li1.2Ni0.2Mn0.6O2 particles’ surface. As a consequence, both the electrolyte decomposition and the electrode corrosion were significantly inhibited. The strong chelation between Mn2+ and polar OH group restrain Mn ion dissolution, which contributes to surface structural transformation mitigation. The present study reveals the role of water-soluble GG binder in reducing capacity fading and voltage decay of Li-rich material and is of great importance in design functional binders for high-performance Li-rich electrodes.

Posterior cortical atrophy is a clinico-radiological syndrome characterized by progressive decline in visual processing and atrophy of posterior brain regions. With the majority of cases attributable to Alzheimer's disease and recent evidence for genetic risk factors specifically related to posterior cortical atrophy, the syndrome can provide important insights into selective vulnerability and phenotypic diversity. The present study describes the first major longitudinal investigation of posterior cortical atrophy disease progression. Three hundred and sixty-one individuals (117 posterior cortical atrophy, 106 typical Alzheimer's disease, 138 controls) fulfilling consensus criteria for posterior cortical atrophy-pure and typical Alzheimer's disease were recruited from three centres in the UK, Spain and USA. Participants underwent up to six annual assessments involving MRI scans and neuropsychological testing. We constructed longitudinal trajectories of regional brain volumes within posterior cortical atrophy and typical Alzheimer's disease using differential equation models. We compared and contrasted the order in which regional brain volumes become abnormal within posterior cortical atrophy and typical Alzheimer's disease using event-based models. We also examined trajectories of cognitive decline and the order in which different cognitive tests show abnormality using the same models. Temporally aligned trajectories for eight regions of interest revealed distinct (P < 0.002) patterns of progression in posterior cortical atrophy and typical Alzheimer's disease. Patients with posterior cortical atrophy showed early occipital and parietal atrophy, with subsequent higher rates of temporal atrophy and ventricular expansion leading to tissue loss of comparable extent later. Hippocampal, entorhinal and frontal regions underwent a lower rate of change and never approached the extent of posterior cortical involvement. Patients with typical Alzheimer's disease showed early hippocampal atrophy, with subsequent higher rates of temporal atrophy and ventricular expansion. Cognitive models showed tests sensitive to visuospatial dysfunction declined earlier in posterior cortical atrophy than typical Alzheimer's disease whilst tests sensitive to working memory impairment declined earlier in typical Alzheimer's disease than posterior cortical atrophy. These findings indicate that posterior cortical atrophy and typical Alzheimer's disease have distinct sites of onset and different profiles of spatial and temporal progression. The ordering of disease events both motivates investigation of biological factors underpinning phenotypic heterogeneity, and informs the selection of measures for clinical trials in posterior cortical atrophy.

AbstractThe Third Pole (TP) is experiencing rapid warming and is currently in its warmest period in the past 2,000 years. This paper reviews the latest development in multidisciplinary TP research associated with this warming. The rapid warming facilitates intense and broad glacier melt over most of the TP, although some glaciers in the northwest are advancing. By heating the atmosphere and reducing snow/ice albedo, aerosols also contribute to the glaciers melting. Glacier melt is accompanied by lake expansion and intensification of the water cycle over the TP. Precipitation has increased over the eastern and northwestern TP. Meanwhile, the TP is greening and most regions are experiencing advancing phenological trends, although over the southwest there is a spring phenological delay mainly in response to the recent decline in spring precipitation. Atmospheric and terrestrial thermal and dynamical processes over the TP affect the Asian monsoon at different scales. Recent evidence indicates substantial roles that mesoscale convective systems play in the TP’s precipitation as well as an association between soil moisture anomalies in the TP and the Indian monsoon. Moreover, an increase in geohazard events has been associated with recent environmental changes, some of which have had catastrophic consequences caused by glacial lake outbursts and landslides. Active debris flows are growing in both frequency of occurrences and spatial scale. Meanwhile, new types of disasters, such as the twin ice avalanches in Ali in 2016, are now appearing in the region. Adaptation and mitigation measures should be taken to help societies’ preparation for future environmental challenges. Some key issues for future TP studies are also discussed.