Ainur Doszhan

Background/Objectives: Major depressive disorder (MDD) has been increasingly associated with alterations of the gut microbiome through the microbiota–gut–brain axis. However, published findings remain highly heterogeneous, limiting identification of reproducible microbial signatures associated with depression. This systematic review aimed to evaluate reproducible taxonomic and functional gut microbiome alterations in patients with MDD compared with healthy controls. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science Core Collection, and the Cochrane Library for studies published between January 2016 and December 2025. Observational human studies evaluating gut microbiome composition in adults with clinically diagnosed MDD and healthy control groups were included. Methodological quality was assessed using the Newcastle-Ottawa Scale. Due to substantial methodological heterogeneity, findings were synthesized using structured qualitative narrative analysis. Results: Sixteen observational studies were included in the qualitative synthesis. Findings related to alpha diversity were inconsistent across studies, whereas beta diversity alterations demonstrated greater reproducibility across independent cohorts. The most recurrent microbiome pattern involved depletion of short-chain fatty acid (SCFA)-producing bacteria, particularly Faecalibacterium and Roseburia, together with recurrent alterations affecting members of the Ruminococcaceae, Lachnospiraceae, and Clostridia groups. Functional microbiome alterations demonstrated greater consistency than higher-level taxonomic findings and included reduced butyrate synthesis pathways, dysregulated amino acid and tryptophan metabolism, increased lipopolysaccharide biosynthesis, and enrichment of pro-inflammatory microbial signatures. Antidepressant-naïve cohorts generally demonstrated more homogeneous dysbiosis patterns than mixed-treated populations. Conclusions: Current evidence suggests that functional gut microbiome dysregulation may represent a more reproducible biological feature of MDD than isolated taxonomic alterations alone. However, substantial heterogeneity in study design, participant characteristics, sequencing methodologies, and analytical approaches continues to limit clinical translation. Large-scale longitudinal multi-omics studies using standardized methodologies are required to clarify the role of the gut microbiome in depressive disorders and to evaluate the potential utility of microbiome-based biomarkers and interventions in mental health and public health practice.

Background: Splenic artery embolization (SAE) is commonly used in cirrhosis to manage hypersplenism and cytopenia. However, its longer-term clinical impact beyond hematologic parameters remains insufficiently characterized. Aim: To characterize longitudinal inpatient trajectories, clinical patterns, and follow-up features after SAE in patients with cirrhosis treated at a tertiary referral center in Kazakhstan. Methods: This retrospective single-center study included 149 patients with cirrhosis who underwent SAE. Clinical, laboratory, and imaging data were collected across sequential inpatient episodes. Outcomes included longitudinal patterns of hospitalization, laboratory trends, and baseline factors associated with a favorable clinical course. Subsequent hospitalization was defined as any inpatient episode following the index SAE admission, regardless of whether it was planned or unplanned. Results: During follow-up, 59.1% of patients had a second inpatient episode, with progressively fewer patients contributing to later observations. Liver disease severity remained largely stable, with no significant changes in Child–Pugh distribution. Portal hypertension manifestations, including varices and splenomegaly, remained highly prevalent, while recurrent variceal bleeding was relatively uncommon. Laboratory parameters demonstrated modest changes without sustained statistically significant improvement, and the number of recorded inpatient episodes decreased across sequential follow-up. Relatively stable documented follow-up trajectories were more frequently observed in patients with preserved liver function (Child–Pugh A), absence of ascites, and higher albumin levels. The most common causes of subsequent hospitalization were ascites and hepatic decompensation (38.9%) and varices without bleeding (26.2%), while documented major procedure-related complications were infrequent. Conclusions: In this retrospective single-center cohort, predominantly coil-based proximal or selective SAE demonstrated an acceptable documented major complication profile in selected patients with cirrhosis and portal hypertension. Because no untreated control group was available, the findings should be interpreted as descriptive real-world longitudinal data rather than causal evidence of reduced hospitalization burden.

Background/Objectives: Systemic sclerosis (SSc) is a rare and severe autoimmune disease with limited treatment options. Autologous hematopoietic stem cell transplantation (HSCT) and mesenchymal stem cell transplantation (MSCT) have emerged as promising therapeutic strategies, especially for patients with refractory or rapidly progressive forms of the disease. However, no comparative synthesis has yet evaluated the clinical outcomes, safety, and applicability of these two distinct stem-cell-based interventions. This systematic review aimed to perform a comparative qualitative synthesis of clinical outcomes, safety profiles, and evidence quality for HSCT and MSCT in patients with systemic sclerosis, focusing on survival, skin fibrosis, pulmonary function, and adverse events. Methods: A comprehensive search was conducted in PubMed, ScienceDirect, Cochrane Library, and Google Scholar for the period between 2015 and May 2025. Studies were included if they reported on adult patients with a confirmed diagnosis of SSc treated with either autologous HSCT or MSCT and provided clinical outcome data. Risk of bias was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity across studies, results were synthesized qualitatively. Results: Eleven studies met the inclusion criteria, comprising 504 patients (316 HSCT, 188 MSCT). HSCT showed consistent improvement in survival (1-, 5-, and 10-year), reduction in modified Rodnan skin scores (mRSS), and s ilization or improvement in pulmonary function (DLCO, FVC), albeit with a higher incidence of serious adverse events, including transplant-related mortality (up to 10%) and infectious complications. MSCT demonstrated favorable effects on skin fibrosis and lung involvement with a significantly lower toxicity profile. However, long-term survival data and methodological robustness were limited were more limited. HSCT was supported by multiple randomized controlled trials and international guidelines, while MSCT remains under clinical investigation with promising but still preliminary evidence. Conclusions: Both HSCT and MSCT demonstrate potential clinical benefits in systemic sclerosis, but they differ substantially in evidence strength and risk profiles. HSCT provides the most robust evidence for long-term disease modification in carefully selected patients, whereas MSCT represents a promising and safer investigational option, particularly for patients ineligible for intensive therapy. Further well-designed comparative studies are required to define their optimal clinical roles.

Primary biliary cholangitis is an autoimmune liver disease, which is less common than viral hepatitis and fatty liver disease, but in recent decades there has been a steady increase in the PBC occurrence. The development of severe complications, many concomitant pathologies, and frequent lack of response to basic ursodeoxycholic acid (UDCA) therapy requires timely dynamic monitoring of patients with PBC for effective treatment correction. Here we describe a case presentation of liver cirrhosis development in patient with PBC combined with Raynaud syndrome. Upon disease development, the patient refused to undergo liver biopsy. She was treated with non-conventional treatment regime. Our clinical case showed that the use of budesonide in PBC treatment did not show any promising result and led to rapid liver cirrhosis development.