METHODS: The study gathered a convenience sample of 30 patients with delirium on postoperative day 1 matched to 30 controls by age, sex, ethnicity, center, and cardiopulmonary bypass time. The Olink Explore 3K platform was used to identify blood protein alterations on postoperative day 3. Protein concentrations were expressed as normalized protein expression units (log 2 fold scale). Protein expression was compared between cases and controls using a paired t test and identified significantly different biomarkers based on a false discovery rate-adjusted P value of less than 0.05.
RESULTS: Of 2,865 unique serum proteins, 26 (0.9%) were significantly associated with delirium status; all were elevated in cases versus controls at a false discovery rate of less than 0.05. Pathway analysis identified calcium-release channel activity ( Padj = 0.02) and GTP-binding ( Padj = 0.005) functions as characteristic of proteins associated with delirium. The top three differentially expressed biomarkers were FKBP1B ( Padj = 0.003), C2CD2L ( Padj = 0.004), and RAB6B ( Padj = 0.004). The inflammatory biomarker interleukin-8 (CXCL8; mean difference = 2.36; P = 3.6 × 10- 4 ) was also associated with delirium.
CONCLUSIONS: The study identified 26 biomarkers significantly associated with delirium; all are novel except for interleukin-8. An association between delirium and recognized neuroinflammatory proteins or markers of brain injury was not identifed, which supports using biomarkers to differentiate between delirium and other neurologic conditions. While exploratory, the study's findings support using biomarkers to diagnose postoperative delirium and validate using agnostic screens to identify potential delirium biomarkers.
METHODS: Ninety-six adults (59.4 ± 9.1 years; 84% female; BMI 22.7 ± 1.6 kg/m2) with hypertension were randomized into one of four groups: Breathing Exercise (BE), High-Intensity Bodyweight Interval Training (HIBIT), Combined Exercise (CE), or a Non-Exercise Control (CON) group. The intervention lasted 10 weeks, with all exercise groups having the same total training time of 3 days per week (BE: 30 min/day; HIBIT: 60 min/day; CE: BE 30 min/day plus HIBIT 60 min/day). Resting heart rate, resting blood pressure, hand grip strength, cardiorespiratory fitness assessed using 6-Minute Walking Test (6MWT) and blood lipids were measured pre- and post-intervention.
RESULTS: The BE group showed the greatest reduction in systolic blood pressure (SBP) compared to CON, although differences among the exercise groups were not statistically significant. The increase in 6MWT values in the combined exercise group differed significantly compared to the other three groups (p = 0.000 and effect size = 0.296). The combined exercise group showed significant reductions in total cholesterol, LDL and triglyceride levels compared to the control group. The average reduction in total cholesterol levels was 20.8 mg/dL (95% C: -41.9 - 0.4) with an effect size of 0.103. Meanwhile, the decrease in LDL and triglyceride levels was 20.1 mg/dL (95% CI: -37.6--2.5; p = 0.014) and -40.4 mg/dL (95% CI: -82.1-1.3; p = 0.04) with effect sizes of 0.118 and 0.101.
CONCLUSIONS: In conclusion combined exercise for 10 weeks could lower systolic and diastolic blood pressure, increase CRF, and improved lipid profile. As a clinical implication, the results of this study can be an alternative or complementary approach to treatment for hypertension, potentially reducing the need for medications and their associated side effects.
TRIAL REGISTRATION: TCTR20230707003 ( http://www.
CLINICALTRIALS: in.th/ ) registered on 28 January 2023.
METHODS: This multicentre retrospective cohort study enrolled neonates from six primary healthcare clinics, with three using KR plus TcB and three using KR only for NNJ screening. Neonates with a gestational age of ≥ 35 weeks and without prior phototherapy or exchange transfusion for hyperbilirubinemia were included in the study until reaching either day 10 of life or hospitalization for any reason, defining the study endpoint. The minimum sample size required was 379 neonates in each cohort. Generalized Poisson regression was used to compare the number of blood draws required for TSB sampling between the two cohorts.
RESULTS: Of 765 neonates included, the cohort using KR alongside TcB showed a 74% reduction in blood draw risk compared to KR alone cohort (IRR 0.26, 95% CI 0.23-0.39). There were no significant differences between cohorts in phototherapy initiation (25.5% vs. 24.4%), severe hyperbilirubinemia occurrence (0.0% vs. 0.0%) or rapid bilirubin level rise (0.3% vs. 0.8%).
CONCLUSION: Incorporating TcB alongside KR for NNJ screening significantly reduces the need for TSB sampling without causing an escalation in phototherapy initiation or severe hyperbilirubinemia occurrences, suggesting the potential to optimize NNJ management in the local primary care setting.
IMPORTANCE: Global deaths attributable to antimicrobial resistance are rising. Hence, rapid susceptibility testing is essential for timely antibiotic de-escalation to mitigate antimicrobial resistance (AMR) development from exposure to broad-spectrum antibiotics. Compared to the costly advanced technology, direct disk diffusion from blood culture (diffusion antibiotic susceptibility testing [dAST]) is an affordable method that can be quickly adopted. However, the reliability of dAST in informing susceptibility was mainly reported from Western countries and scarcely from other regions, including Southeast Asia, where the AMR burden is high. This study from Malaysia adds insights into the performance of dAST and the potential to apply it in similar resource-limited settings from the same region. Furthermore, assessing the dAST's influence on antibiotic prescribing identifies the gap in implementation to guide areas of improvement for optimizing clinical utility.
METHODS: A prospective cross-sectional study was carried out involving 111 dengue patients and 42 healthy controls. Among the dengue cases, 85 were identified as primary, while 26 were classified as secondary dengue infections. Serum levels of endothelial markers (Ang-2, CXCL10, MCP1, and TRAIL), liver dysfunction and acute-phase markers (CRP, galectin 3, and serum amyloid protein), systemic inflammatory mediators (MIF, TNF-α, IL-1β), mast cell-derived proteases (chymase, tryptase), and tissue repair markers HGF, IL-10, IL-1Ra) were quantified using ELISA and Luminex multiplex assays. Correlations among serum analytes, severity indicators, and haematological markers were also explored.
RESULTS: Several biomarkers, Ang-2, CXCL10, TRAIL, CRP, MIF, IL-1Ra, TNF-α, and chymase showed differential expression across severity groups, indicating coordinated endothelial and inflammatory activation. Stratification of patients with primary-secondary dengue also followed a similar pattern except IL-1β, which had significant differential expression across the cohorts. Ang-2 showed strong positive correlations with markers of hepatic dysfunction, including ALT, AST, and bilirubin, suggesting a link between endothelial injury and liver involvement.
CONCLUSIONS: Severe dengue is driven by the coordinated activation of endothelial dysfunction, acute-phase responses, mast cell mediators, and counter-regulatory pathways. These processes collectively contribute to vascular leakage and organ injury, reinforcing the value of biomarkers such as Ang-2, CXCL10, CRP, and chymase for severity assessment.
METHODS: In this cross-sectional, non-randomized clinical performance study, participants aged ≥8 years were prospectively recruited. Hemoglobin was measured non-invasively using the Vivaray Hb pro and compared with venous blood samples analyzed on a calibrated Coulter counter. Agreement between methods was assessed using Bland-Altman analysis, including regression-based evaluation for proportional bias. Mean difference, mean absolute error (MAE) and proportions of measurements within tolerance limits were also calculated. Complete paired measurements were available for 763 individuals.
RESULTS: Bland-Altman analysis returned a mean difference of -0.40 g/dL. The bias was hemoglobin-dependent, being higher than the true value at low hemoglobin levels and underestimation at higher levels. Regression-based analysis showed proportional bias (β1 = -0.178), indicating decreasing difference with increasing hemoglobin concentration. The MAE was 1.5 g/dL but was lower (1.2) in the clinically predominant ranges of 8.1-13 g/dL.
CONCLUSION: The Vivaray Hb pro can function as a useful non-invsive screening and point-of-care assessment device for measuring hemoglobin, particularly in settings where rapid, painless and repeatable measurements are desirable.
METHODS: Oxidative stress was induced in male mice via oral administration of 2% hydrogen peroxide (H2O2) for seven consecutive days, followed by administration of stigmasterol (10 and 20 mg/kg b.w.) orally for another seven days. At the end of the experiment, the mice were sacrificed, then blood, testes, and cauda epididymal sperm were immediately harvested. Sperm parameters, testicular morphology, levels of serum reproductive hormones and expression of proteins (MDA, SOD, CAT, GPx, Keap-1, Nrf-2, HO-1, NqO-1 - markers for oxidative stress), (StAR - marker for steroidogenesis) and (ZO-2 and Connexin-43 - markers for blood-testes barrier integrity) were evaluated.
RESULTS: Stigmasterol restores testicular morphology, serum testosterone, LH and FSH levels, sperm parameters and Nrf2, SOD, CAT, GPx, Nqo1, HO-1, StAR, ZO-2, and Connexin-43 expression levels while decreases MDA and Keap1 expression levels in mouse testes.Stigmasterol also help to restore sperm motility, viability, its membrane integrity, and Nqo1 antioxidant levels and decreases sperm DNA fragmentation.
CONCLUSION: Stigmasterol could be used to restore male fertility following exposure to high oxidative stress condition.
METHODS: The cross-sectional study enrolled 156 participants, with 114 confirmed clinical dengue cases and 42 healthy controls. Serological profiling (NS1, anti-DENV IgM, and anti-DENV IgG), estimation of serum acute-phase reactants, clinico-laboratory parameters, and viral load were performed to classify dengue patients under dengue with warning signs (DWS+, n = 35), dengue without warning signs (DWS-, n = 74), and severe dengue (n = 5) (based on varying grades of severity) in accordance with the 2009 WHO guidelines. Measurement of complement factors, i.e., C1 inhibitor (C1Inh) (n = 145), C1q (n = 152), C2 (n = 146), C3a (n = 153), C3b (n = 152), mannose-binding lectin (MBL) (n = 151), C5a (n = 150), and soluble complement receptor 1 (sCR1, also designated as sCD35) (n = 139), was performed using commercial ELISA, and their concentrations were correlated with acute-phase reactants, clinical laboratory parameters, grades of dengue severity, and platelet levels.
RESULTS: Our analysis showed a significant alteration in early classical complement proteins, C1Inh, C1q, and C2. The levels of downstream factors and sCR1 remained largely unchanged across both the grades of dengue severity and primary/secondary dengue cohorts. Univariate analysis revealed NS1 positivity, IgG positivity, age, urea, and sCR1 as factors associated with disease severity. Our multivariate analysis showed sCR1 as the only independent predictor that correlated negatively with dengue severity. Every unit increase of sCR1 was associated with 22% reduced odds of dengue severity. Platelet counts showed a negative association with red cell distribution width (RDW) and basophils and a strong positive correlation with serum uric acid levels.
CONCLUSIONS: Our findings show that aberrant complement activation and levels of sCR1 could attribute to varying grades of dengue severity. Given its inverse association, the levels of sCR1 could likely render early prediction of dengue disease severity. The role of sCR1 in complement-mediated pathogenesis in dengue remains a gray area of investigation.
AIM: To investigate the effectiveness of gamma oryzanol (γ-oryzanol) in managing hyperglycaemia, oxidative stress, inflammation, and dyslipidaemia in a rodent model of diabetes mellitus.
METHODOLOGY: The review was conducted by searching PubMed, ScienceDirect, Scopus, and Web of Science for articles published from inception to July 12, 2025, with the terms (Gamma-oryzanol OR γ-oryzanol OR Oryzanol OR Cycloartenyl ferulate OR Gammariza) AND (Diabetes mellitus OR Type 2 diabetes mellitus OR hyperglycemia OR oxidative stress OR inflammation OR dyslipidaemia). The review included only articles that used rat and mouse models of diabetes mellitus and γ-oryzanol as treatments; articles that did not meet these criteria were excluded. A total of nine articles were identified, encompassing a total population of 394 rodents. SyCLE's risk of bias tool was used to assess the methodological quality of the studies.
RESULTS: Out of 1,989 records initially identified through the systematic search, nine studies met the eligibility criteria. All included studies were assessed to have an unclear to low risk of bias. The synthesised findings indicate that γ-oryzanol (γ-ORZ) exerts beneficial effects on glycaemic control by enhancing insulin secretion and sensitivity, as well as by reducing fasting blood glucose (FBG) levels. Additionally, γ-ORZ demonstrates antioxidant activity by elevating endogenous antioxidant enzyme levels and decreasing oxidative stress markers. Its lipid-modulatory effects include the elevation of beneficial lipid fractions and the reduction of atherogenic lipids, thereby alleviating diabetic dyslipidaemia. Moreover, γ-ORZ exhibits anti-inflammatory properties through the downregulation of proinflammatory biomarkers. Despite these promising results in preclinical models, further high-quality investigations, particularly well-designed clinical trials, are essential to validate these findings and support the potential integration of γ-ORZ into diabetes management strategies.
CONCLUSION: Most included studies reported that γ-ORZ positively affected hyperglycaemia, oxidative stress, dyslipidaemia, and inflammation under diabetic conditions. Further research, particularly rigorously designed clinical trials, is strongly recommended to confirm and translate these preclinical findings into clinical practice.
METHOD: This prospective study conducted on 24 feet with CTEV (18 babies) with Pirani score ranging between 2 to 6. Eighteen normal babies (36 feet) were selected as control. We used Color Doppler Ultrasound to assess dorsalis pedis and posterior tibial arteries before initiating the treatment. Second ultrasound was performed in study group upon completion of Ponseti treatment.
RESULTS: The patients were from one week to 15 weeks of life. Dorsalis pedis arterial flows were absent in 7 clubfeet (29.1%) while the remaining 17 clubfeet (70.8%) had normal flow. There was a significant association between Pirani severity score and vascular status in congenital clubfoot. There was a higher proportion of clubfeet having abnormal vascularity when the Pirani severity score was 5 and more. In study group, posterior tibial arteries were detectable and patent in all feet. All normal feet in control group had normal arterial flow. There was a significant difference in vascular flow before and after the Ponseti treatment (p 0.031).
CONCLUSION: The study concludes that there is an association between Pirani severity score and arterial deficiency in CTEV. Ponseti treatment is safe in CTEV with arterial deficiency and able to reconstitute the arterial flow in majority of cases.