Thuruthiyil Dennis Thomas

Objective: We conducted a comparative retrospective bicentric study of rectal endometriosis treatment with high‐intensity focused ultrasound (HIFU) and surgery in terms of symptoms and treatment‐related morbidity at 6 months. Methods: All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF‐36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien–Dindo classification. Results: A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien–Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% ( P = 0.002) and 0% versus 10% ( P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea ( P < 0.001), dyspareunia ( P < 0.001), diarrhea ( P < 0.001), tenesmus/spasms ( P < 0.001), pain on defecation ( P < 0.001), and urinary urgency ( P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea ( P < 0.017), diarrhea ( P < 0.002), tenesmus/spasms ( P < 0.001), and pain on defecation ( P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months. Conclusion: In selected patients with only one rectal location, HIFU treatment enables a similar symptom‐related and quality‐of‐life outcome with a significant reduction in the risk of postoperative complications.

Alzheimer’s disease (AD) is a progressive neurodegenerative disease and the most common type of dementia, characterized by cognitive decline in later years of life. Among various hypotheses explaining AD pathology, the cholinergic hypothesis is one of the most studied. Though there are Food and Drug Administration (FDA) approved drugs (donepezil, galantamine, rivastigmine and tacrine) for AD treatment, their adverse effects make it urgent to develop new drugs with minimal side effects. This review focuses on the acetylcholinesterase (AChE) inhibitory potential of plant extracts and phytochemicals that could aid in preventing and mitigating AD. From the literature search, extracts of 28 species were found to have strong inhibition against AChE, with IC50 values ranging from 0.08 μg/mL to 10.0 μg/mL. The highest number of species with AChE inhibition belongs to the Amaryllidacea family, followed by Fabaceae, Lycopodiaceae, Amaranthaceae and Anacardiaceae. Several phytochemicals, including alkaloids, terpenoids and phenolics, show a multitarget approach in AD therapy, exhibiting more than one of the following activities such as inhibition of AChE, butyrylcholinesterase (BuChE), MAO-A, beta site amyloid precursor protein cleaving enzyme 1 (BACE-1), β-amyloid (Aβ) aggregation, tau phosphorylation, and an ability to cross blood-brain barrier (BBB). With a multitarget approach and minimal side effects, they could revolutionise the treatment of AD. Many phytochemicals and their derivatives are under clinical and pre-clinical trials, potentially serving as prospective therapeutic drug candidates for treating AD. This review briefly discusses the findings and advances in knowledge about plant-derived bioactive compounds as potential new drugs acting as AChE inhibitors.