Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability.

Background: Social media is widely used by medical students, including for learning purposes since it facilitates their involvement in the communities of inquiry where they can share, express, and engage in the development of knowledge. Navigating the use of social media requires self-regulated learning (SRL) skills. Hence, studies on the relationships between social media use and SRL skills are necessary. Aim: This study aims to investigate the relationships between social media use and students’ SRL skills. Methods: A cross-sectional study was conducted using two validated questionnaires: the Social Networking Sites for Medical Education questionnaire (SNSME, 19 items) and the Motivated Strategies for Learning Questionnaire (MSLQ, 81 items). Cross-cultural adaptation and exploratory factor analysis (EFA) were also completed for the SNSME questionnaire, followed by descriptive and bivariate analysis. Results and discussion: The SNSME questionnaire is valid for use in the current setting and consists of three subscales: (1) attitudes towards the use of social media for learning and knowledge development, (2) the use of social media for information sharing and interaction, and (3) the use of social media for knowledge development and research. Among 1,122 respondents, male students presented lower scores than female students in the total score of social media for learning (80 vs. 82, p 0.007), and public medical students showed higher scores in terms of attitudes towards the use of social media for learning and knowledge development compared to private medical students (83 vs. 81, p 0.007). The differences in SRL scores for different education stages and among students from public and private medical schools were statistically significant (426 vs. 418, p 0.003, and 436 vs. 418, p < 0.001, respectively). Levels of correlation between social media use and SRL scores were low to moderate (R 0.195–0.462, p < 0.001). Conclusions: The adapted SNSME questionnaire in the current setting is valid and the use of social media for learning is influenced by gender and the learning environment. This study highlights the importance of supporting students in using social media for learning purposes as well as using social media as a means to increase their SRL skills.

Background. Invasive breast carcinoma of no special type (IBC-NST) is the most widespread invasive carcinoma subtype causing primarily regional metastases of the lymphatic node (LNM). The capacity of CD44 variant exon 6 (CD44v6) expression as an LNM predictor biomarker in IBC-NST was explored. Methods. We conducted a cross-sectional research with 48 paraffin blocks containing IBC-NST primary tumors that were divided into two groups by LNM. The assessment has been carried out in terms of age, tumor size, tumor grade, lymphovascular invasion (LVI), and CD44v6 expression. The expression of CD44v6 was analyzed on the grounds of immunohistochemical (IHC) staining, while other data were taken from archives. Statistical analysis is carried out by univariate, multivariate, and AUROC. Results. CD44v6 exhibits a dominant expression in IBC-NST tumor cells. Univariate analysis revealed a significant association between CD44v6 and LNM status ( ). Multiple logistic regression results showed that CD44v6 expression and LVI were significantly associated with LNM with OR 10.7 (95% CI: 2.43 to 47.08) and 6.22 (95% CI: 1.4 to 27.88), respectively. CD44v6 expression was able to discriminate against LNM with AUROC (95% CI: 0.759 to 0.967) at the H-score cut-off 133.889 (75% sensitivity and 83.3% specificity). Conclusion. CD44v6 expression and LVI are potential predictors of LNM in IBC-NST. The H-score cut-off of the CD44v6 expression can also be used as a threshold for classification in further investigation.

Background: Research in natural substances for their anticancer potential has become increasingly popular. Lunasin, a soybean protein, is known to inhibit cancer progression via various pathways. The aim of this study was to investigate the effect of Lunasin Extract (LE) on the expression of Intercellular Adhesion Molecule 1 (ICAM-1) and epithelial cadherins (E-Cadherin) in breast cancer. Methods: In this true-experimental in vivo study, 24 Sprague-Dawley rats that were induced by 7,12-Dimethylbenz[a]anthracene (DMBA), were used. Based on the therapy given, the groups were divided into, normal, positive control (PC), negative control (NC), adjuvant, curative, and preventive. Lunasin was extracted from soybean seeds of the Grobogan variety in Indonesia. Tissue samples were obtained, processed, stained with anti-ICAM-1 and anti-E-Cadherin antibodies, examined under a microscope, and quantified using H-score. The data were analyzed using ANOVA, which was then followed by Duncan's test. Results: Statistically significant difference in ICAM-1 expression was observed between the following groups: adjuvant and NC, normal and NC, PC and NC, adjuvant and preventive, normal and preventive, PC and preventive, adjuvant and curative, normal and curative, PC and curative. E-Cadherin expression was significantly different between preventive and NC, adjuvant and NC, PC and NC, normal and NC, adjuvant and curative, PC and curative, normal and curative, normal and preventive. Significant negative correlation was found between ICAM-1 and E-Cadherin [-0.616 (-0.8165; -0.283)] with p = 0.001. Conclusion: Preventive dose of LE was able to reduce ICAM-1 expression while increasing E-Cadherin expression.

Background: Invasive breast carcinoma of no special type (IBC-NST) is the most common type of breast cancer and mainly causes regional lymph-node metastasis (LNM). We investigated the potential for AKT2 expression as a predictive biomarker for LNM in IBC-NST.Methods: Forty-eight paraffin blocks containing IBC-NST primary tumors were divided into two groups based on presence or absence of LNM. Age, tumor grade, tumor size, lymphovascular invasion (LVI), and AKT expression were assessed. AKT2 expression was assessed based on immunohistochemical staining, while other data were collected from archives. Results: Multiple logistic regression results showed that AKT2 expression and LVI were significantly associated with LNM (odds ratio [OR], 5.32; 95% confidence interval [CI], 1.42 to 19.93 and OR, 4.46; 95% CI, 1.17 to 16.97, respectively). AKT2 expression was able to discriminate against LNM (area under the receiver operating characteristic, 0.799 ± 0.063; 95% CI, 0.676 to 0.921) at an H-score cutoff of 104.62 (83.3% sensitivity, 62.5% specificity). Conclusions: AKT2 expression has potential as a predictor of LNM in IBC-NST. The H-score cutoff for AKT2 expression can be used as a classification guide in future studies.

Background Acute anterior circulation large vessel occlusion (ACLVO) strokes represent a critical challenge in stroke management. Advancements in thrombectomy strategies, including contact aspiration (CA), stent retrievers (SR), and their combination (SRA), particularly with the addition of balloon guide catheters (BGC), aim to enhance outcomes. This systematic review and Bayesian network meta-analysis evaluates the efficacy and safety of these first-line thrombectomy strategies. Methods A systematic search was performed across nine databases up to March 15, 2025, yielding 44 studies with 19 268 participants. The risk of bias was assessed using RoB 2.0 for randomized controlled trials and ROBINS-I for observational studies. Bayesian random-effects network meta-analysis was conducted, presenting odds ratios (OR) with 95% CIs and ranking interventions via surface under the cumulative ranking curve (SUCRA). Outcomes included recanalization success (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3), first-pass effect (FPE), functional independence (modified Rankin Scale ≤2 at 90 days), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results SRA+BGC was most effective for achieving mTICI 2b–3 (OR 2.87, 95% CI 1.64 to 5.20, SUCRA 90.1) and FPE (OR 7.33, 95% CI 1.71 to 39.71, SUCRA 91.0). CA+BGC yielded the highest odds of functional independence at 90 days (OR 1.96, 95% CI 1.16 to 3.41, SUCRA 88.1) and the lowest 90-day mortality (OR 0.42, 95% CI 0.20 to 0.95). Safety outcomes favored SR+BGC and SRA+BGC for reducing sICH (OR 0.59, 95% CI 0.37 to 0.91, SUCRA 85.3). CA alone was associated with significant improvements over SR in functional outcomes (OR 1.41, 95% CI 1.09 to 1.83, SUCRA 78.5), but SRA alone was linked to higher mortality (OR 1.74, 95% CI 1.06 to 2.66). Conclusion Thrombectomy strategies incorporating BGC, particularly CA+BGC and SRA+BGC, achieve superior efficacy and safety outcomes in patients with acute ACLVO stroke.