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Microbiome in women with endometriosis and the in vitro effects of Lactobacillus reuteri on human endometrium

2026-06-01T00:00:00Z

Title: Microbiome in women with endometriosis and the in vitro effects of Lactobacillus reuteri on human endometrium Authors: Lee, Jae Hoon; Jung, Gee Soo; Kim, Kyungmin; Park, Hyemin; Park, Yunjeong; Lee, Inha; Lee, Min Jung; Lee, Ji-Ho; Choi, Young Sik; Cho, SiHyun Abstract: Endometriosis (EMS) is a chronic inflammatory disorder affecting similar to 10% of reproductive-age women, with increasing evidence implicating the microbiome in its pathogenesis through immunomodulation and estrogen metabolism. This study investigated microbiome composition in the vagina, endometrium, and peritoneal fluid (PF) of women with and without EMS and further assessed the effects of Lactobacillus reuteri (L. reuteri) on endometrial (EM) cells in vitro. Samples from 41 patients were analyzed using 16S rRNA gene sequencing, targeting the V3-V4 regions. Western blotting, ELISA, and LC-MS/MS were employed to evaluate protein expression and estrogen metabolism during EM-L. reuteri co-culture with or without estradiol-17-glucuronide (E2G). Microbiome analysis revealed no significant differences in alpha or beta diversity between EMS and controls across all compartments. However, LEfSe analysis identified several taxa with differential abundance, with L. reuteri consistently altered in both vagina and EM. Across the menstrual cycle, EM and vaginal microbiomes were stable, whereas PF microbiota showed phase-dependent variation involving 60 genera and 76 species. In vitro, L. reuteri alone did not alter endometriosis-related proteins, but in the presence of E2G, it reduced BAX/Bcl-2 ratios and increased p-NF-kappa B, suggesting anti-apoptotic and pro-inflammatory shifts. Progesterone receptor alpha/beta expression decreased, while estrogen receptor levels remained unchanged. L. reuteri increased beta-glucuronidase activity but did not enhance E2G-to-estradiol conversion. These findings highlight L. reuteri as a potentially important species in EMS, with in vitro evidence suggesting survival-promoting effects under estrogenic conditions. Further research should explore multi-species interactions and hormonal contexts to clarify microbial contributions to EMS pathogenesis. IMPORTANCE Although Lactobacillus reuteri appeared more abundant in the vagina and endometrium of controls, suggesting a protective role, in vitro findings paradoxically indicated anti-apoptotic and pro-inflammatory effects under estrogenic conditions, underscoring the need for further investigation of multi-species microbial interactions and hormonal contexts in endometriosis pathogenesis.

Dynamic machine learning prediction of persistent AKI after cardiac surgery with modifiable perioperative risk factors

2026-05-01T00:00:00Z

Title: Dynamic machine learning prediction of persistent AKI after cardiac surgery with modifiable perioperative risk factors Authors: Han, Changho; Kim, Hyun Il; Song, Jong Wook; Shin, Heesoo; Kwak, Young-Lan; Soh, Sarah; Yoon, Dukyong Abstract: Early identification and prevention of persistent acute kidney injury (pAKI) remain challenging due to delayed biochemical markers and limited tools to differentiate between transient and persistent forms. We retrospectively analyzed data of 2,285 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) and developed 3 machine learning (ML) models for predicting pAKI: model 1 (preoperative data); model 2 (intraoperative and immediate postoperative variables); and model 3 (data up to 48 h post-ICU admission). pAKI occurred in 168 patients. Predictive performance improved across models, reflecting the value of time-updated data. SHapley Additive exPlanations highlighted baseline factors (estimated glomerular filtration rate and hemoglobin) in model 1 and perioperative factors associated with pAKI risk (post-CPB perfusion pressure, transfusion volume, and hemoglobin trends) in models 2 and 3 as dominant contributors. Our dynamic ML model enables early risk stratification and identification of perioperative factors associated with pAKI risk, providing a foundation for hypothesis generation and future investigation.

Hydrodynamic Characteristics of Bovine Pericardial and Porcine Valves Using a Mock Circulatory System Mimicking the Aortic and Pulmonary Positions

2026-04-01T00:00:00Z

Title: Hydrodynamic Characteristics of Bovine Pericardial and Porcine Valves Using a Mock Circulatory System Mimicking the Aortic and Pulmonary Positions Authors: Shin, Yu Rim; Lee, Seung-Hyun; Shim, Jae-Kwang; Kim, Yongwoo; Lee, Sak Abstract: Purpose: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions. Materials and Methods: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg). Results: Bovine pericardial valves were associated with larger opening area (0.93 +/- 0.01 vs.1.70 +/- 0.01 for 23-mm valve; 0.99 +/- 0.01 vs.1.75 +/- 0.01 for 25-mm valve; 1.58 +/- 0.01 vs. 2.25 +/- 0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27 +/- 0.05 vs. 64.79 +/- 0.14 for 23-mm valve; 46.41 +/- 0.06 vs. 64.28 +/- 0.18 for 25-mm valve; 72.64 +/- 0.17 vs.73.25 +/- 0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75 +/- 0.14 vs. 12.57 +/- 0.47 for 23-mm valve; 14.85 +/- 0.05 vs. 12.87 +/- 0.28 for 25-mm valve; 15.72 +/- 0.32 vs. 7.91 +/- 0.03 for 27-mm valve). Conclusion: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

Comparison of Dexmedetomidine Administration Strategy for Propofol-Based Pediatric Sedation for Magnetic Resonance Imaging: A Retrospective Study

2026-04-01T00:00:00Z

Title: Comparison of Dexmedetomidine Administration Strategy for Propofol-Based Pediatric Sedation for Magnetic Resonance Imaging: A Retrospective Study Authors: Kim, Tae-Won; Ji, Sang-Hwan; Park, Jung-Bin; Kang, Pyoyoon; Jang, Young-Eun; Kim, Eun-Hee; Lee, Ji-Hyun; Kim, Hee-Soo; Kim, Jin-Tae; 강표윤 Abstract: Background Intravenous dexmedetomidine is a safe and effective adjunct in propofol-based sedation. Dexmedetomidine is typically administered as a loading dose, followed by continuous infusion or not. Whether the addition of a maintenance infusion of dexmedetomidine after a loading dose in propofol-based sedation for pediatric magnetic resonance imaging (MRI) can be beneficial in terms of propofol consumption or adverse events is not clear.Aims We aimed to study whether maintaining dexmedetomidine infusion after loading dose can help reduce propofol consumption and minimize airway and cardiovascular interventions during sedation.Methods We retrospectively reviewed 884 medical records of pediatric sedation for MRI using both propofol and dexmedetomidine, performed at a single tertiary hospital between May 2021 and January 2023. We compared patients who received dexmedetomidine loading + maintenance (group LM) and dexmedetomidine loading only (group L) as an adjunct to propofol-based sedation. The consumption of propofol and time to recovery were measured. We also compared the incidence of airway rescue maneuver and hypotension requiring intervention during sedation.Results Overall, 695 patients were included in the analysis (group LM, n = 351, group L, n = 344). The total sedation duration was similar between the two groups (52 vs. 50 min, p = 0.255). Group LM showed significantly less total propofol consumption (6.62 vs. 7.63 mg & centerdot;kg-1 & centerdot;h-1, p = 0.001). The incidence of airway rescue maneuver did not differ significantly between the two groups (0.9 vs. 1.5%, p = 0.501); however, the incidence of hypotension requiring intervention was lower in group LM than in group L (4.3 vs. 8.1%, p = 0.040). The recovery time did not differ significantly between the two groups (34 vs. 34 min, p = 0.932).Conclusion In propofol-based sedation for pediatric MRI, maintenance infusion of dexmedetomidine after a loading dose reduces total propofol consumption and hemodynamic instability requiring intervention without prolonging recovery time, compared with dexmedetomidine bolus without maintenance.