Upsala Journal of Medical Sciences

Disseminated Ureaplasma infection: a case report of a patient with rheumatoid arthritis on rituximab therapy with multiple abscesses and arthritis

2026-03-20T08:07:53+00:00

A 51-year-old woman with rheumatoid arthritis treated with rituximab and leflunomide presented with a 5-month history of malodorous vaginal discharge. Initial examination revealed vulvovaginitis and cervicitis, and she was treated with metronidazole and topical corticosteroids. Pelvic ultrasound showed free fluid in the pouch of Douglas, raising suspicion of ovarian malignancy. Shortly thereafter, she was hospitalized with fever, abdominal pain, and elevated C-reactive protein. Despite broad-spectrum intravenous antibiotics and multiple surgical drainages for recurrent intra-abdominal abscesses, the infection persisted, and repeated cultures were negative. Corticosteroids led to transient improvement, but new abscesses developed despite immunosuppressive therapy, and an aseptic abscess syndrome was suspected. Given her immunosuppressed status, further testing was undertaken, and polymerase chain reaction (PCR) analyses from urine, vaginal secretions, synovial fluid, and paraspinal abscess aspirate were positive for Ureaplasma parvum, for which her partner also tested positive.

Treatment with oral doxycycline led to rapid clinical and laboratory test improvement, and moxifloxacin was added for bactericidal coverage. Because of mild hypogammaglobulinemia, monthly intravenous immunoglobulin therapy was initiated.

This case illustrates the diagnostic challenges of Ureaplasma infections in immunocompromised patients, particularly those receiving B-cell-depleting therapy such as rituximab. Standard cultures fail to detect the organism, often delaying diagnosis. Ureaplasma parvum should therefore be considered in patients presenting with sterile abscesses, systemic inflammation, and urogenital symptoms. Early recognition through molecular testing and targeted antimicrobial treatment can prevent prolonged morbidity and unnecessary surgical interventions.

Low-intensity pulsed ultrasound restores mitochondrial dynamics and function in lipopolysaccharide-stimulated astrocytes

2026-03-10T04:55:22+00:00

Background: Low-intensity pulsed ultrasound (LIPUS) is a non-invasive therapeutic modality with growing potential in the treatment of neurodegenerative diseases. However, its mechanistic role in regulating mitochondrial homeostasis in astrocytes under inflammatory stress remains poorly understood. This study aimed to investigate the effects of LIPUS on mitochondrial dynamics, morphology, oxidative stress, mitochondrial membrane potential, and mitochondrial stress response in an in vitro model of neuroinflammation.

Methods: Normal Human Astrocytes (NHA) were stimulated with lipopolysaccharide (LPS; 0.5 µg/mL, 24 h) and subsequently treated with LIPUS (1 MHz, 50% duty cycle, 100 Hz, 15 min) at intensities of 100, 300, or 500 mW/cm². The expression of mitochondrial fusion (MFN1, MFN2, OPA1) and fission (DRP1, FIS1) markers was analyzed using qPCR. Mitochondrial morphology was evaluated by confocal microscopy, while reactive oxygen species (ROS) levels and mitochondrial membrane potential (ΔΨm) were measured using specific fluorescent probes. Expression of mitochondrial stress-related genes (PGC1α, CLPP, HSP60, LONP1) was also assessed.

Results: LIPUS treatment, particularly at 300 mW/cm², significantly enhanced the expression of mitochondrial fusion markers while suppressing fission markers in a dose- and time-dependent manner, with peak effects observed 4 h post-treatment. Confocal imaging revealed that LIPUS mitigated LPS-induced mitochondrial fragmentation. Additionally, LIPUS reduced ROS accumulation, preserved ΔΨm, and attenuated the LPS-induced upregulation of mitochondrial stress-related genes, suggesting modulation of both stress response and biogenesis.

Conclusion: LIPUS ameliorates mitochondrial dysfunction in inflamed astrocytes by restoring mitochondrial dynamics and reducing stress signaling, supporting its potential as a therapeutic strategy for neuroinflammation-associated neurodegenerative disorders.

Endocan attenuates LPS-induced alveolar type II cells injury through PI3K/Akt/mTOR pathway

2026-03-04T08:27:45+00:00

Background: Alveolar type II (AT2) cell injury plays an important role in the pathogenesis of acute lung injury (ALI), but the corresponding treatment options are limited in clinical practice. Endocan has been proved to exert a protective effect in ALI, however, the underlying mechanism remains unclear. The phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) signaling pathway was found to exhibit beneficial effects in lipopolysaccharide-induced ALI. This study aimed to investigate protective effects of endocan on AT2 cells and the signal pathway in LPS-induced ALI.

Methods: Pulmonary function testing and hematoxylin–eosin staining were employed to evaluate the effects of endocan on the LPS-induced ALI in mice. Transmission electron microscopy (TEM) analysis, immunofluorescence and Western blot were used to assess the AT2 protection of endocan. Mouse lung epithelial cell line 12 (MLE-12) cells were facilitated to observe the activation of PI3K/AKT/mTOR pathway.

Results: Endocan administration effectively ameliorated respiratory parameters in LPS-challenged ALI mice. TEM revealed that endocan treatment preserved AT2 cell integrity and maintained lamellar body ultrastructure compared to the mice injected LPS only. Western blot analysis showed a higher surfactant protein C expression in endocan-treated mice than that of model group. Moreover, the phosph-PI3K, -AKT, -mTOR levels detected by Western blot were significantly observed upregulated after endocan treatment. However, rapamycin, an mTOR inhibitor, abolished the protective effects of endocan against ALI, indicating this pathway may be critical for its action on AT2 cells. In LPS-treated MLE-12 cells, the Western blot analysis further confirmed that rapamycin suppressed endocan-induced activation of the PI3K/AKT/mTOR pathway, thereby attenuating the protective effects of endocan on MLE-12 cells.

Conclusion: Endocan protects AT2 cells against ALI through activating PI3K/AKT/mTOR pathway, suggesting its therapeutic potential for AT2 in patients with ALI.

Comparison of best corrected visual acuity estimates between a custom-made digital chart and the ETDRS chart

2026-02-17T04:44:29+00:00

Purpose: To compare best corrected visual acuity (BCVA) measurements obtained using a digital visual acuity chart with those from the gold-standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart and to assess differences in measurement variability and examination time.

Methods: Altogether 42 subjects (≥ 55 years) were examined using both charts on two separate occasions. BCVA was recorded in logMAR. Examination time was recorded. Subjects were stratified into four visual acuity classes. A nested analysis of variance (ANOVA) was used to analyze systematic differences and variance components.

Results: A statistically significant difference in BCVA between the charts was found, but the 95% confidence interval (CI) for the mean difference (Digital − ETDRS: −0.03 ± 0.04 logMAR) was below the 0.1 logMAR resolution threshold. No significant interaction was observed between chart type and acuity class. The digital chart significantly reduced examination time by an average of 50 sec (95% CI: ±21). Variance was highest between testing occasions compared with that between-subject and for interaction between chart type and subjects.

Conclusions: The digital chart provides clinically equivalent BCVA estimates compared to the ETDRS chart, with shorter examination time. Its use in routine clinical settings is supported.

Clinical characteristics of dysplasia in UC and the correlation between dysplasia and UC recurrence

2026-02-17T04:33:25+00:00

Objective: This research aims to identify the main influencing factors for dysplasia in ulcerative colitis (UC) patients and explored the correlation between dysplasia and the recurrence frequency of UC.

Methods: This study retrospectively included 348 UC patients from the outpatient clinic of the Second Hospital of Hebei Medical University between December 2021 and December 2023 as the research subjects. The UC patients were divided into the dysplasia group and the non-dysplasia group based on pathological results. The general data and clinical data of the two groups were compared, and the typical computed tomography enterography (CTE) imaging features of the patients in the dysplasia group were explored. The main influencing factors for the occurrence of dysplasia in patients were screened using the univariate logistic regression analysis method and the ridge regression analysis method. All the follow-up data of the research subjects were complete, the recurrence situations of UC in the two groups were compared. The correlation between dysplasia and the recurrence frequency of UC was analysed using the Spearman rank correlation coefficient.

Results: This study found that there were statistically significant differences in indicators such as disease classification, disease severity, lesion extent, disease activity degree, and faecal calprotectin (FC) level between the two groups of patients. Patients with dysplasia presented usually with CTE imaging features of mesenteric lymphadenopathy, mucosal abnormal enhancement, and bowel wall thickening. Univariate logistic regression revealed that the above indicators were influencing factors for dysplasia in UC patients (P < 0.05). Collinearity test and ridge regression analysis showed that chronic continuous type/acute fulminant type disease classification, severe disease severity, E3 lesion range, moderately active stage/severely active stage of disease activity degree, and high FC level would increase the possibility of dysplasia (P < 0.05). The recurrence rate of UC diseases in the dysplasia group was higher than that in the non-dysplasia group, and recurrence types were also different (P < 0.05). Spearman rank correlation analysis indicated that the grade of dysplasia, disease severity, lesion range, and degree of disease activity were positively correlated with recurrence frequency of UC (P < 0.05).

Conclusion: Disease classification, disease severity, lesion extent, disease activity degree, and FC were independently correlated with occurrence of dysplasia in UC patients. Moreover, dysplasia increased the probability of patient recurrence. The grade of dysplasia and related influencing factors showed a positive correlation with the recurrence frequency of UC.

Regulatory T cells: the 2025 Nobel prize in physiology or medicine

2026-01-19T02:10:34+00:00