Background: Mesenchymal stem cells (MSCs) have emerged as living biodrugs for myocardial repair and regeneration. Recent randomized controlled trials (RCTs) have reported that MSC-based therapy is safe and effective in heart failure patients; however, its dose-response relationship has yet to be established. We aimed to determine the optimal MSC dose for treating HF patients with reduced ejection fraction (EF) (HFrEF). Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane Handbook guidelines were followed. Four databases and registries, i.e., PubMed, EBSCO, clinicaltrials.gov, ICTRP, and other websites, were searched for RCTs. Eleven RCTs with 1098 participants (treatment group, n = 606; control group, n = 492) were selected based on our inclusion/exclusion criteria. Two independent assessors extracted the data and performed quality assessments. The data from all eligible studies were plotted for death, major adverse cardiac events (MACE), left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and 6-minute walk distance (6-MWD) as safety, efficacy, and performance parameters. For dose-escalation assessment, studies were categorized as low-dose (< 100 million cells) or high-dose (≥ 100 million cells). Results: MSC-based treatment is safe across low and high doses, with nonsignificant effects. However, low-dose treatment had a more significant protective effect than high-dose treatment. Subgroup analysis revealed the superiority of low-dose treatment in improving LVEF by 3.01% (95% CI; 0.65–5.38%) compared with high-dose treatment (-0.48%; 95% CI; -2.14-1.18). MSC treatment significantly improved the 6-MWD by 26.74 m (95% CI; 3.74–49.74 m) in the low-dose treatment group and by 36.73 m (95% CI; 6.74–66.72 m) in the high-dose treatment group. The exclusion of studies using ADRCs resulted in better safety and a significant improvement in LVEF from low- and high-dose MSC treatment. Conclusion: Low-dose MSC treatment was safe and superior to high-dose treatment in restoring efficacy and functional outcomes in heart failure patients, and further analysis in a larger patient group is warranted.

Colorectal cancer (CRC) is the most preventable malignancy globally, with a high mortality rate. Cancer stem cells (CSCs) are found previously in multiple types of cancer; CRC is one of them, and it has been correlated with several biomarkers. The two most essential markers related to colorectal CSCs are CD44 and CD133, which play a significant role in diagnosis, treatment, and prognosis. Unfortunately, the CSCs with positive CD44 and CD133 biomarkers illustrated an alarming prognosis. Several trials were trying to target those markers to improve the prognosis and cure. We aimed to review the papers that relate to the two markers in terms of diagnosis, treatment, and prognosis.

Background: Obesity is a known risk factor for developing colorectal cancer (CRC) and is associated with the formation of precancerous colonic adenomas. Bariatric surgery (BRS) is considered to reduce the cancer risk in morbidly obese patients. However, the currently available literature yields contradicting results regarding the impact of bariatric surgery on the incidence of CRC. Methods: A systematic literature search of the Medline, Embase, CENTRAL, CINAHL, Web of Science, and clinicaltrials.gov databases was undertaken following the PRISMA guidelines. A random effects model was selected. Results: Twelve retrospective cohort studies, incorporating a total of 6,279,722 patients, were eligible for inclusion in the final quantitative analysis. Eight studies originated from North America, while four reported on European patients. Patients in the Bariatric Surgery group exhibited a significantly reduced risk for developing colorectal cancer (RR 0.56, 95% CI 0.4–0.8, p < 0.001), while sleeve gastrectomy was found to be significantly associated with a smaller incidence of CRC (RR 0.55, 95% CI 0.36–0.83, p < 0.001), and gastric bypass and banding did not. Conclusions: A significant protective effect of BRS against the development of CRC is implied. In the present analysis, the incidence rate of colorectal cancer was approximately halved amongst the obese individuals that were operated on.

BACKGROUND Hypoplasia of the right hepatic lobe is a rare congenital anomaly often discovered incidentally during imaging or surgery. This anomaly can be challenging during surgery, leading to intraoperative complications. Patient with right hepatic hypoplasia usually live normally without symptoms, but it can be associated with liver cirrhosis, portal hypertension, and gallstones. While the exact pathophysiological relationship between congenital hepatic hypoplasia and cholecystitis remains unclear, a few contributing factors have been proposed. These include mutations in the hepatocyte nuclear factor 1B (HNF1B) transcription, impaired gallbladder function, and gallbladder ischemia due to malposition. CASE REPORT A 70-year-old man presented with gangrenous cholecystitis and concurrent hypoplasia of the right hepatic lobe; a combination not previously documented. The patient, initially asymptomatic, presented with sharp epigastric pain and was diagnosed with acute cholecystitis through abdominal ultrasound. However, computed tomography (CT) imaging showed severe hypoplasia of the right liver lobe with associated compensatory hypertrophy of the left lobe in addition to stones in the gallbladder. Despite normal laboratory results, we think that the anomaly delayed the diagnosis until the development of cholecystitis as a complication. The patient underwent a successful laparoscopic cholecystectomy without converting to open surgery. CONCLUSIONS This case underscores the importance of recognizing anatomical variations when planning surgery. Awareness of right hepatic lobe hypoplasia can aid in timely diagnosis and appropriate management, ultimately reducing surgical risks and complications. Furthermore, we recommend performing CT in case of vague or atypical symptoms of acute cholecystitis, as well as when the gallbladder shows malposition on abdominal ultrasound (US). However, we recommend identifying the anatomical structure during the surgery to avoid complications.