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Background/aim: Type 2 diabetes mellitus (T2DM) is a prevalent disorder characterized by an increased concentration of blood glucose and impaired insulin function. Throughout the course of the disease, β-cell function fails and insulin production decreases. Studying the molecular systems responsible for insulin production, release, and action is crucial for the management and treatment of the disease. Thus, this study aimed to scrutinize the therapeutic efficacies of oxytocin (OXT) on nicotinamide (NA)/streptozotocin (STZ)-induced diabetes in rats and elucidate the underlying mechanisms.

Materials and methods: Wistar rats were supplied a single intraperitoneal (i.p.) dose of NA (120 mg/kg) 15 min before an i.p. injection of STZ (60 mg/kg) after fasting for 16 h. Ten days later, the diabetic rats were orally administered OXT every day for eight weeks at dose levels 0.5, 1, and 2 IU/kg.

Results: The treatment of diabetic rats with OXT significantly improved oral glucose tolerance, serum insulin and C-peptide concentrations, and pancreatic islets' structure and function. Furthermore, the activities of liver glucose-6-phospatase and glycogen phosphorylase significantly decreased. OXT treatment also resulted in an increase in serum adiponectin levels, while the levels of serum resistin, omentin, vaspin, and free fatty acids significantly decreased. Additionally, OXT significantly alleviated the mRNA levels of components of the PI3K-AKT and AMPK signaling pathways as well as their effectors including PPARγ, insulin receptor (IR), IR substrates 1 and 2 (IRS1 & IRS2), PI3K, AKT, AMPK, and glucose transporter 4 (GLUT4) in visceral adipose tissues of diabetic rats.

Conclusion: OXT can exert antidiabetic effects and may be useful for developing multiple targeted therapeutic strategies for diabetes treatment. The effects may be mediated via improvement in β-cell function, insulin secretory response, and insulin sensitivity.

Background/aim: Chemotherapy-induced alopecia (CIA) is a significant concern for patients with breast cancer (BC). Although scalp-cooling therapy has shown efficacy in reducing scalp hair loss, its effects on eyebrow and eyelash preservation have been unclear.

Patients and methods: We conducted a prospective observational study of 154 patients with BC who received perioperative chemotherapy from 2016 to 2024. Seventeen of these patients underwent scalp cooling using the Paxman Scalp Cooling System (Paxman, Houston, TX, USA). Patient-reported outcomes were assessed via questionnaires evaluating the degree of hair loss at the scalp, eyebrows, eyelashes, and body hair.

Results: Scalp cooling significantly reduced the incidence of severe hair loss (score 4-5) at the scalp (p<0.001). Although the differences in eyebrow and eyelash hair loss were not significant (p=0.095 and p=0.199, respectively), a trend toward reduced severe alopecia was observed. No protective effect was observed for body hair (p=0.446).

Conclusion: Scalp-cooling therapy is effective for preventing severe scalp hair loss and may offer partial protection against eyebrow and eyelash alopecia. These findings support its broader application in BC care to enhance patients' quality of life.

Background/aim: Rectal dilatation strongly affects bowel function. However, the relationship between rectal dilatation and bowel function remains unclear. Since January 2024, we have attempted to evaluate this relationship by using sagittal computed tomography (CT) imaging.

Patients and methods: Sixty patients with colon cancer, excluding obstructive cancer, who underwent surgical procedures at our hospital were retrospectively registered in this study from January 2024 to March 2025. Rectal dilatations were evaluated by using axial and sagittal CT imaging. A rectal diameter greater than that of the fifth lumbar vertebral body diameter was considered long. The diameter of the upper rectum was measured at the inferior border of the second sacral vertebra, and that of the lower rectum was measured at the inferior border of the fourth sacral vertebra.

Results: Rectal dilatations were detected in 26 (43.3%) of the patients. Twenty-two (36.7%) patients were administered laxatives orally for constipation. In nineteen (86.4%) of the twenty-two patients, dilatation in both the upper and lower rectum was detected simultaneously, and the patients were administered laxatives. No patient experienced dilatation only in the upper rectum. Thirty-eight (63%) patients with no rectal dilatation above the inferior border of the third sacral vertebra were not treated with any laxative.

Conclusion: Sagittal CT imaging is very useful for evaluating anatomical changes in the rectum. The diameter of the rectum at the inferior border of the third sacral vertebra on sagittal CT images may be a clinical diagnostic criterion for patients with anorectal motility disorders.

Background/aim: Despite advances in critical care, postoperative liver failure remains a substantial complication of liver resection, with high mortality rates. Adipose-derived stem cells (ADSCs) have demonstrated potential in various regenerative applications; however, their precise mechanisms in liver repair remain unclear. This study investigated the effects of ADSC sheets on the vascular and cellular responses in a mouse model of partial hepatectomy.

Materials and methods: Human ADSCs were cultured with magnetic nanoparticle-containing liposomes and formed multilayered cell sheets. Following partial hepatectomy in BALB/c nude mice, ADSC or collagen control sheets were attached to liver resection sites. Immunohistochemical analysis assessed angiogenesis (CD31), hepatic stellate cell activation (α-SMA), and cellular origin. Mice were sacrificed on postoperative days 4 and 7. Statistical analysis was conducted using Bonferroni's method (p<0.05).

Results: Compared to cell-free collagen sheets (control), ADSC sheets demonstrated significantly enhanced neovascularization, with higher CD31 expression on postoperative days 4 and 7. Immunohistochemical analysis revealed that these CD31-positive cells were predominantly of mouse origin, rather than differentiated from transplanted human ADSCs, indicating host cell migration into the sheets. Additionally, ADSC sheets significantly increased α-SMA expression compared to that with collagen sheets, with expression levels progressively increasing from day 4 to 7, suggesting continuous activation of hepatic stellate cells. These findings indicate that ADSC sheets induce angiogenesis and hepatic stellate cell activation during liver regeneration, likely through paracrine mechanisms that recruit host cells, rather than through direct differentiation of transplanted ADSCs.

Conclusion: This study lays the groundwork for the clinical application of ADSC sheets, demonstrating their potential to enhance liver regeneration after hepatectomy by promoting host cell-mediated angiogenesis and hepatic stellate cell activation.

Background/aim: This study investigated the prognostic impact of human epidermal growth factor-2 receptor (HER2) status on the survival of patients with metastatic triple-negative breast cancer (TNBC).

Patients and methods: This multicenter, retrospective study included 168 patients diagnosed with recurrent or de novometastatic TNBC between April 2013 and September 2024. Patients were categorized into two groups: HER2-negative (n=121, 72%) and HER2-low (n=47, 28%). Clinicopathological features and survival outcomes were compared between groups.

Results: The median follow-up was 44 months [95% confidence interval (CI)=35.7-52.2]. All patients received systemic chemotherapy as part of their first-line treatment. The median progression-free survival (PFS) in all patients was 9 months (95%CI=7.7-10.3 months). The median overall survival (OS) in all patients was 22 months (95%CI=17.4-26.5 months). Higher Ki67 value at diagnosis was a significant poor prognostic factor for median OS (29 months vs. 15 months, p<0.001). HER2-negative patients had significantly worse median OS than HER2-low patients (19 months vs. 33 months, p=0.026). In multivariate analysis, the HER2-low group had significantly longer median OS than the HER2-negative group [hazard ratio=0.64 (95%CI=0.42-0.98), p=0.040].

Conclusion: HER2-low expression was associated with significantly improved survival compared with HER2-negative status in metastatic TNBC. These findings highlight HER2 status as a potential prognostic factor, particularly relevant in settings with limited access to novel therapies such as immunotherapy or antibody-drug conjugates.

Background/aim: Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting synovial joints, often causing to joint destruction and systemic comorbidities. Cervical spine involvement, especially atlantoaxial subluxation (AAS), can lead to spinal cord compression and neurological deficits. While disease-modifying antirheumatic drugs (DMARDs) are standard therapy, intolerance to agents like methotrexate (MTX) in elderly or comorbid patients limits options. Molecular hydrogen, with antioxidant and anti-inflammatory properties, has emerged as a potential adjuvant in autoimmune diseases. This case report describes an elderly woman with long-standing, treatment-refractory RA and severe cervical spine disease who received molecular hydrogen therapy, highlighting immunological changes, clinical outcomes, and challenges in managing RA with complex comorbidities.

Case report: An 85-year-old Taiwanese woman with long-standing rheumatoid arthritis (2010 American College of Rheumatology/European League Against Rheumatism criteria) and multiple comorbidities discontinued methotrexate in 2016 due to pancytopenia. Her RA was managed with oral steroids and hydroxychloroquine, but she had recurrent hospitalizations for flares with multiple joint pain. Molecular hydrogen therapy was initiated in June 2023 as an adjuvant treatment. Fatigue, assessed using the Taiwan Brief Fatigue Inventory (BFI-T), improved notably across multiple domains, accompanied by dynamic changes in immune cell populations suggesting immunomodulatory effects. During this admission, atlantoaxial subluxation was diagnosed, fulfilling surgical criteria; however, the patient and her family declined surgery due to risk and prognosis, opting for palliative care until her death.

Conclusion: This case highlights the potential immunomodulatory benefits of molecular hydrogen as an adjuvant therapy in rheumatoid arthritis. Although clinical and immunological improvements were observed, larger studies with longer follow-up are needed. It also illustrates severe cervical spine involvement, atlantoaxial subluxation, underscoring the complexity and neurological risks of advanced RA.

Background/aim: Pediatric palliative care, particularly in oncology, is aimed at improving the quality of life for children with cancer and other life-limiting conditions. With an increase in the pediatric population eligible for such care, the need for multidisciplinary approaches and the integration of personalized care strategies emerges.

Materials and methods: We conducted a systematic review to analyze the available evidence regarding the most effective interventions, with particular attention to pharmacological assistance, home management, and the central role of the nurse in childcare. The literature search was conducted through the databases PubMed, CINAHL, Google Scholar, and Scopus, encompassing studies published between 2000 and 2024, with a focus on children aged 0 to 2 years.

Results: Ten key studies were identified that highlighted the importance of the multimodal approach in pediatric palliative care. The main interventions include the use of sedative drugs for symptom management, electronic symptom monitoring to improve family involvement, the importance of pain therapy, and the effectiveness of home care, as preferred by most families.

Conclusion: A care model that integrates multiple strategies, supported by a multidisciplinary team, is essential to ensure the optimal well-being of children in critical conditions. However, the paucity of specific studies on the 0-2 age group and the lack of standardized protocols represent significant limitations in clinical practice.

Background/aim: Cachexia is a multifactorial syndrome that adversely affects the prognosis of patients with gastrointestinal cancer. Although anamorelin has been shown to improve appetite and body weight, the optimal timing of its initiation remains unclear. This study evaluated the effects of the timing of anamorelin initiation on nutritional recovery and clinical outcomes in patients with gastrointestinal cancer cachexia.

Patients and methods: We retrospectively reviewed 42 patients with gastric (n=17) or colorectal cancer (n=25) complicated by cachexia who received 100 mg of anamorelin once daily between August 2021 and December 2024. Changes in body weight, food intake, and nutritional status were assessed before and after anamorelin administration, and overall survival was analyzed according to the type of cancer.

Results: Initially, patients had experienced a mean body weight loss of 15.9±1.7% relative to the pre-diagnosis baseline. After four weeks, mean body weight increased by 2.9% (p<0.001), food intake improved significantly from 30.5%±0.3% to 57.1%±0.5% (p<0.001), and the Patient-Generated Subjective Global Assessment short form (PG-SGA SF) score decreased from 12.3±0.4 to 10.3±0.9 (p=0.003). The median overall survival was 17.9 months for gastric cancer and 36.8 months for colorectal cancer, with no significant difference between the two groups (p=0.089).

Conclusion: Anamorelin improved body weight, food intake, and nutritional status in patients with advanced gastrointestinal cancer cachexia. However, the modest degree of recovery suggests that earlier administration, before substantial weight and muscle loss, may maximize therapeutic benefits, support treatment continuity, and potentially improve survival outcomes. Therefore, early intervention should be considered in the clinical management of cancer cachexia.

Background/aim: Sunitinib, a second-line treatment for gastrointestinal stromal tumors (GIST), is commonly associated with adverse events (AEs) such as myelosuppression in older patients. However, an optimal dosing schedule has not been established. This study evaluated the therapeutic efficacy and toxicity management of sunitinib administration based on platelet count.

Case report: An 83-year-old man receiving imatinib for rectal GISTs was switched to sunitinib (initially 50 mg/day) due to imatinib failure. After eight days, he developed grade 2 anorexia and nausea, prompting a dose reduction to 37.5 mg/day. These AEs persisted, and sunitinib was discontinued 15 days after treatment initiation and later resumed at 25 mg/day after the symptoms improved. Thereafter, the sunitinib withdrawal period was adjusted based on neutrophil and platelet counts. As a result, the only non-hematologic AE of grade 2 or higher was hypothyroidism, with no serious AEs. He achieved a partial response according to Choi criteria but was switched to regorafenib after five cycles of sunitinib due to disease progression. Changes in neutrophil and platelet counts during the withdrawal period of each cycle of sunitinib therapy were predicted using a quadratic regression model and validated using leave-one-out cross-validation. The coefficient of determination (R²) of the neutrophil count prediction model during the withdrawal period was 0.28, and the validated R² for each cycle ranged from -26.34 to -0.11. In contrast, the platelet count model yielded an R² value of 0.86, with validated R² values ranging from 0.42 to 0.88.

Conclusion: Low-dose sunitinib monotherapy, with dosing intervals based on platelet counts, may be an effective treatment option for managing toxicity in older patients with imatinib-resistant GIST.

Background/aim: Fetal growth restriction (FGR) is a major and common complication of pregnancy. As the placenta holds the key to fetal growth, the detection of biomarkers associated with FGR is essential. The aim of the present study was to compare the expression of O-linked N-acetylglucosamine (O-GlcNAc) epitope H in placental tissues of pregnancies complicated with FGR and gestations with normal growth.

Materials and methods: Postpartum samples from chorionic villi from pregnancies were used for the present study. An immunochemical pathology study was performed in order to study the expression of O-GlcNAc epitope H.

Results: In total, 30 pregnant women were included. When the expression of epitope H between the two groups was compared, the proportion of FGR pregnancies with high expression of epitope H in chorionic villi was statistically significant higher (p<0.001).

Conclusion: Although preliminary findings regarding the expression of O-GlcNAc epitope H in chorionic villi samples of pregnancies complicated by FGR are promising, further studies are expected to contribute to a better understanding of the role of O-GlcNacylation in FGR pathogenesis and its clinical significance.