Chitosan (CS) nanoparticles have been widely investigated for cervical cancer (CC) therapy, with tripolyphosphate (TPP) commonly used as a crosslinker. This study explored ellagic acid (EA), a natural polyphenol with anticancer activity, as an alternative crosslinker for cisplatin-loaded EA-crosslinked CS nanoparticles (CisEANP) and compared them with cisplatin-loaded TPP-crosslinked CS nanoparticles (CisTPPNP). CisEANP showed a particle size (PS) of 260.9 ± 4.40 nm and zeta potential of +35 ± 1.30 mV, with spherical morphology and good mucoadhesiveness suitable for vaginal administration. Both formulations provided sustained cisplatin (Cis) release, with higher drug release from CisEANP. CisEANP significantly reduced HeLa cell viability compared with CisTPPNP and showed increased reactive oxygen species (ROS) generation and caspase activation. Antiangiogenic activity was confirmed by the chorioallantoic membrane (CAM) assay. In an Ehrlich ascites carcinoma (EAC)-induced CC mouse model, CisEANP and CisTPPNP reduced tumor volume by 1.23- and 1.49-fold, respectively, compared with disease control, with greater tumor regression observed for CisEANP. Histopathology supported the therapeutic findings, while X-ray imaging confirmed vaginal retention for up to 8 h. Overall, EA showed potential as a functional crosslinker for localized cisplatin delivery in CC.

The Kyoto Consensus introduced a key conceptual shift in characterizing acute-on-chronic liver failure (ACLF) patients into Type-A and Type-B phenotypes. A day-long meeting was convened at Istanbul during APASL 2026 to assess the real-world applicability of Type-A and Type-B ACLF across continents. The objective was that physicians could recognize ACLF as a unified disease entity, and quality research and new therapeutic options with defined end-points could be undertaken. Data from APASL ACLF Research Consortium (AARC), EASL-CLIF and NACSELD were assessed and discussed in detail. While the applicability of Type-A and Type-B varied across cohorts, the definition required to be appended. The experts unanimously agreed that 'liver failure' as identified by serum bilirubin of ≥ 5 mg/dl and INR ≥ 1.5 should be the 'core' for both Type-A and Type-B ACLF. Type-A ACLF is considered when "a patient with compensated advanced chronic liver disease or compensated cirrhosis presents with index decompensation as liver failure followed by development of ascites and/or hepatic encephalopathy within 4 weeks." Type-B ACLF is considered when "a patient with prior or concurrent decompensated cirrhosis presents with acute decompensation as liver failure accompanied by one or more extrahepatic organ failures." New definitions of organ dysfunction and failure, as well as endpoints for clinical trials, were also deliberated and finalized. The "Istanbul Report", presents a milestone evidence based consensus document carrying harmonization of various aspects of ACLF, incorporating current evidence, critically analyzed unanimous recommendations, and key areas for future studies.

Gastric varices (GV) are a distinct and clinically challenging manifestation of portal hypertension characterized by complex vascular anatomy and unique hemodynamic behavior. Unlike esophageal varices (EV), GVs arise from interactions between afferent portal inflow, large variceal reservoirs, and spontaneous portosystemic shunts, resulting in a low-pressure, high-flow system that often responds poorly to conventional pressure-reducing therapies. Consequently, management strategies extrapolated from EV are frequently inadequate. Advances in endoscopic ultrasound (EUS), cross-sectional imaging, and interventional radiology have facilitated a paradigm shift toward a pathophysiology-driven approach. Contemporary evaluation integrates endoscopic classification based on anatomical location (Sarin), EUS for assessment of feeding vessels and flow dynamics, and computed tomography/magnetic resonance imaging for mapping afferent and efferent pathways using Kiyosue and Saad-Caldwell classifications. These frameworks enable hemodynamic triage into shunt-dominant, pressure-dominant, and complex patterns, which directly inform therapeutic selection. Endoscopic therapies, including cyanoacrylate injection and EUS-guided coil ± glue embolization, target the variceal reservoir and inflow, providing effective local control. Radiologic interventions address systemic hemodynamics, with retrograde transvenous obliteration (Balloon-occluded retrograde transvenous obliteration/plug-assisted retrograde transvenous obliteration/coil-assisted retrograde transvenous obliteration) preferred for shunt-dominant varices and transjugular intrahepatic portosystemic shunt for pressure-driven disease. Surgical options remain relevant in selected conditions such as left-sided portal hypertension. Clinical modifiers, including hepatic reserve, encephalopathy, ascites, and portal vein patency, further refine treatment decisions. A multidisciplinary, mechanism-based strategy is essential to optimize outcomes. Future research should focus on integrated classification systems and prospective comparative studies to establish standardized, individualized management algorithms.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare mitochondrial disorder characterized by impaired oxidative phosphorylation and reduced ATP production, resulting in increased organ vulnerability to metabolic stress. Fluoropyrimidine agents, such as 5-fluorouracil (5-FU), are widely used to treat colorectal cancer and can induce gastrointestinal toxicity not only through inhibition of thymidylate synthase and suppression of nucleic acid synthesis but also via RNA misincorporation, translational defects, and mitochondrial dysfunction in intestinal epithelial cells. The coexistence of metabolic vulnerability associated with m.3243A>G-related mitochondrial dysfunction and drug-induced mitochondrial injury may synergistically exacerbate intestinal toxicity, potentially leading to severe enteritis. A 40-year-old woman with m.3243A>G-associated mitochondrial disease within the MELAS spectrum underwent radical resection for perforated rectal cancer with synchronous liver metastases. Her postoperative course was uneventful, and she was discharged without complications. CapeOX therapy (capecitabine plus oxaliplatin) was initiated as adjuvant chemotherapy. Ten days after the start of the third cycle, she developed intermittent fever, abdominal distension, and diarrhea. Computed tomography revealed diffuse edema throughout the small intestine with massive ascites. Malignant peritonitis was considered unlikely based on imaging, ascites analysis, and cytology, whereas infectious enteritis was not strongly suspected based on the clinical course. Chemotherapy-induced enteritis associated with CapeOX was therefore strongly suspected, and the regimen was discontinued. The gastrointestinal symptoms improved, and tumor marker levels normalized. This case suggests that underlying mitochondrial dysfunction may enhance fluoropyrimidine-related intestinal toxicity, indicating that careful risk assessment and close monitoring are required when administering chemotherapy to patients with underlying mitochondrial disorders.

Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy. Its typical clinical manifestations include abdominal distension, increased abdominal girth, or abdominopelvic masses. It is extremely rare for an umbilical hernia to be the initial manifestation, so this can easily lead to clinical misdiagnosis. A 60-year-old woman presented with a reducible umbilical mass for 10 months. Physical examination revealed marked abdominal distension and a 6-cm firm, irreducible umbilical mass. Serum tumor markers were normal. Computed tomography (CT) showed diffuse low-density abdominopelvic masses consistent with PMP, an appendiceal cystic lesion suggestive of mucinous neoplasm, omental thickening, and periumbilical tumor extension. Ultrasound revealed 9.4-cm ascites with mucin particles and septations. She underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Intraoperatively, extensive gelatinous mucin, a ruptured cystic appendix, and periumbilical tumor involvement were noted. Postoperative pathology confirmed a high-grade appendiceal mucinous tumor with PMP. The immunohistochemistry results were as follows: cytokeratin 20 positive, caudal type homeobox 2 positive, and Ki-67 labeling index of 30%. Telephone follow-up 3 months after surgery indicated that the patient was doing well. PMP presenting with umbilical hernia as the initial symptom is relatively rare and is often misdiagnosed as a simple umbilical hernia. For middle-aged and elderly female patients with umbilical hernia who have concurrent ascites, thickened peritoneum, or a hard and fixed hernia mass, abdominopelvic CT and ultrasound should be performed to rule out PMP to avoid blindly performing hernia repair and delaying diagnosis and treatment.

Obesity has an adverse effect on survival of women with ovarian cancer (OC), supporting a link between obesity, metastatic progression, and therapeutic response, but comprehensive mechanistic insight is lacking. In pre-clinical models of diet-induced obesity and OC, mice fed a high fat diet (HFD) exhibit substantially increased tumor burden relative to low fat diet (LFD) mice and respond poorly to standard-of-care (SOC) chemotherapy. Both HFD murine tumors and tumors from women with BMI>30 show increased expression and nuclear localization of sterol regulatory element binding protein 1 (SREBP1), a master regulator of lipogenesis and lipid transport. The objective of this study was to assess whether inhibition of SREBP1 processing could improve SOC chemotherapy response in obesity-associated OC. We evaluated the FDA-approved drug Nelfinavir (NFV), a pharmacologic inhibitor of site-2 protease that blocks SREBP1 processing, in combination with SOC (paclitaxel+carboplatin) chemotherapy in preclinical models of diet-induced obesity and OC. Our results demonstrate significantly improved therapeutic response, corresponding changes in intra-tumoral adipocytes, and reprogramming of the obesity-driven ascites immune microenvironment. These findings support a model in which NFV-mediated inhibition of SREBP1 processing disrupts obesity-associated metabolic pathways linked to immune suppression and therapeutic resistance, thereby enhancing response to SOC chemotherapy in obesity-associated OC. Collectively, these results highlight metabolic targeting as a strategy to improve therapeutic outcomes in obesity-associated ovarian cancer.

High-grade serous ovarian carcinoma (HGSOC) remains the most lethal gynecologic malignancy, characterized by a high recurrence rate and poor long-term survival. Although daily statin use is associated with improved survival in ovarian cancer patients, the underlying mechanism of this benefit remains unclear, in part due to the use of non-clinical high doses and reliance on immunodeficient murine models in preclinical studies. Here, we analyzed data from the TriNetX US Collaborative Network to evaluate the association between statin use and survival in ovarian cancer patients, confirming a survival benefit in a large U.S. cohort. We next investigated the protective effects in a syngeneic ascites tumor model of ovarian cancer. Mice treated with clinically relevant doses of lipophilic atorvastatin (ATO) exhibited prolonged survival. Single-cell transcriptomic analyses further revealed enhanced CD8 [+] T-cell activation programs and pro-inflammatory macrophage remodeling. Flow cytometry identified increased M1-like macrophages and activated CD8 [+] T-cell populations. Cytokine profiling and transcriptomic analyses indicated that IL-15 signaling was significantly elevated following ATO treatment. Multiplex immunofluorescence analyses demonstrated enhanced tertiary lymphoid structure (TLS)-associated immune organization in metastatic tumor tissues after ATO treatment, with increased T- and B-cell markers. Ex vivo culture of primary T cells with ascites supernatant from ATO-treated mice resulted in enhanced T-cell activation and migratory capacity compared with supernatant from DMSO-treated mice. Collectively, our results suggest that daily statin use may remodel the body environment into a more immune-activated state, leading to a long-term beneficial effect on survival in cancer patients, as observed in large epidemiological studies.

Broiler production industries are increasingly prioritizing animal welfare in line with the traditional focus on production traits such as rapid growth rate and feed efficiency. Broiler strain and stocking density are key welfare factors that are addressed in high-welfare systems. Still, it is unclear how slower-growing broilers or lower densities affect health, causes of death, and gross lesions, which are vital issues in welfare assessment. This study investigated the effects of broiler strain, stocking density, and age on causes of death and gross lesions, with particular attention to growth-related diseases in broilers that died between 7 days of age and slaughter under non-outbreak conditions. It was hypothesized that Rustic Gold broilers would have lower overall mortality and a lower prevalence of growth-related diseases (e.g., cardiovascular diseases and locomotory disorders). Stocking densities and slaughter ages included two Ross 308 broiler densities (33 and 41 kg/m[2], slaughtered at 34 days) and Rustic Gold broilers at 36 kg/m[2] (slaughtered at 41 days). The study used a repeated cross-sectional observational design with three rotations per farm/group (36 flocks in total, excluding three). Overall mortality proportions for both Ross 308 groups and Rustic Gold were nearly identical. The data showed that 81% of dead broilers on farms experienced cardiovascular collapse. No significant differences in the primary causes of death, including cardiovascular collapse, leg disorders, renal disorders, septicemia, trauma, polyserositis, cannibalism, and intestinal volvulus, were observed among the different production types. However, Ross 308 exhibited significantly higher prevalences of cardiac dilatation and ascites at both stocking densities than Rustic Gold, whereas the Rustic Gold birds showed higher prevalences of nephropathy and peritonitis. Age analysis showed lower occurrence of cardiovascular collapse and polyserositis in birds ≥28 days, but higher occurrence of leg disorders, renal disorders, and trauma in the same age group. Overall, from 7 days post-hatch to slaughter age, mortality and the distribution of causes of death in Rustic Gold broilers and Ross 308 at low densities were not significantly different from those in Ross 308 at high density.

BACKGROUND Chylous ascites is a rare, potentially life-threatening complication of pelvic surgery, characterized by progressive malnutrition, immune dysfunction, and massive fluid accumulation. When the condition is refractory, its management represents a complex challenge requiring sequential escalation across multiple therapeutic modalities. CASE REPORT A 72-year-old man developed refractory chylous ascites after robot-assisted radical prostatectomy with extended pelvic lymph node dissection for high-grade prostate cancer (Gleason score 5+4=9). Despite conservative measures, consisting of low-fat diet and continuous subcutaneous octreotide infusion, the ascites persisted. Repeated large-volume paracentesis with cell-free concentrated ascites reinfusion therapy (CART) and total parenteral nutrition (TPN) were required to manage worsening malnutrition. Lymphangiography and N-butyl cyanoacrylate (NBCA) embolization provided no sustained relief. Subsequent surgical lymphatic ligation identified active leakage alongside floating solidified NBCA in the internal iliac region, confirming the prior embolization site. Although the leak was temporarily controlled by ligation, chylous drainage recurred on postoperative day 2. Repeat lymphangiography revealed a new, anatomically distinct leak in the external iliac region, suggesting dynamic redistribution of lymphatic flow through a collateral pathway. Repeat NBCA embolization of this secondary site achieved definitive resolution. Supported by TPN and CART, the patient was discharged on postoperative day 117 with improved nutritional status. He had no recurrence over a 5-year follow-up, with clinical and laboratory assessment every 3 months. CONCLUSIONS This case suggests that lymphatic leak sites may shift during treatment. Repeat lymphangiography may be considered when chylous drainage recurs after apparently successful intervention. Multidisciplinary management, including TPN and CART, was integral to sustaining this patient through a prolonged and complex treatment course.

Gallbladder perforation is a rare and life-threatening event. Accurately diagnosing gallbladder perforation without cholecystitis or gallstones is difficult. The patient was admitted with abdominal pain and was diagnosed with diffuse peritonitis the following day via computed tomography (CT). Laparoscopic findings revealed the accumulation of bile-like ascites and a thinned and soft gallbladder with slight leakage of bile juice from a pinhole perforation. Laparoscopic cholecystectomy and peritoneal lavage were then performed. In the present case, it was difficult to diagnose gallbladder perforation because of the lack of cholecystitis and gallstones in the CT findings. If preoperative CT shows an acute abdomen with peritoneal effusion, especially accumulated around the gallbladder, then gallbladder perforation may be considered as a primary lesion.

Ascites, the pathological accumulation of fluid in the peritoneal cavity, is common at diagnosis and with recurrence in high-grade serous ovarian carcinoma (HGSOC). Higher volumes of ascites fluid are associated with greater likelihood of recurrent disease and poor prognosis. Due to its availability-volume and frequency-and its reflection of tumors and their microenvironments, ascites is a valuable resource for proteomic biomarker discovery. However, ascites has not been widely studied. Similar to plasma, relatively few proteins comprise the majority of the broad dynamic range of protein mass in ascites fluid, necessitating an enrichment or depletion strategy for proteomic sample preparation. ENRICH-iST and ENRICHplus kits enrich low-abundance proteins using paramagnetic beads. These enrichment strategies have not previously been validated for use with ascites fluid. Our goal was to evaluate the ENRICH-iST and ENRICHplus kits using ascites fluid from HGSOC patients with differing extents of tumor resection during debulking surgery. This Dataset Brief describes the technical performance of these enrichment strategies based on DIA-MS proteome depth, reproducibility of identified proteins, Gene Ontology (GO) term enrichment (Biological Processes, Molecular Functions, and Cellular Components), and Human Protein Atlas-based protein abundance ranking. ENRICHplus outperformed ENRICH-iST by 1.4-fold based on depth of proteome coverage. Relative to the total proteome coverage, ENRICH-iST reduced the proportional contribution of the top 12 high-abundance proteins more effectively than ENRICHplus, thereby increasing the representation of lower-abundance proteins despite identifying fewer overall proteins. Analysis of the differential abundance of the proteins enriched from ascites fluid using these enrichment strategies could greatly facilitate HGSOC biomarker development.