Chronic Course Research Articles

An arrhythmic variant of the manifestation of paraneoplastic Loeffler endomyocarditis. Clinical case

A clinical case of chronic undulating course of parneoplastic Loeffler endomyocarditis, the leading manifestations of which were ventricular arrhythmias, is presented. The paper demonstrates the complexity of early diagnosis of a rare pathology in a polymorbid patient and attempts to identify the "keys" to the correct diagnostic and therapeutic tactics for managing such patients.

The Relationship Between Cognitive Deficits and Clinical Characteristics in Patients with Schizophrenia

Introduction: Schizophrenia is an endogenous psychotic disorder with a chronic course, which is characterized by dysfunction in multiple domains: perceptions, thinking, emotions, and cognition.

Assessed correlation between biological diversity of oropharyngeal microbiota and atopic dermatitis severity and exacerbations

Atopic dermatitis (AtD) is a multifactorial inflammatory skin disease characterized by itching, chronic recurrent course and age-related features of lesions. AtD pathogenesis has not been fully elucidated yet. An important factor for AtD emergence and progression is the imbalance in symbiotic microbiota. The research publications provide a few studies about a role for oropharyngeal microorganisms in AtD immunopathogenesis. The aim of the study is to analyze biological diversity of oropharyngeal microbial communities in varying AtD severity. 97 male patients, aged from 16 to 19 years, with different AtD severity were included in the study. Culture study of oropharyngeal discharge was also performed. Biological material was seeded on the expanded list of growth media and incubated for 5 days at the 37°С. To assess the biological diversity of the oropharyngeal microbiota, the coefficient of constancy (C) was used, in order to classify individual microorganisms as permanent, additional or transient. Statistical data processing was performed using the Stat Tech software (version 4.0.0, Stattech LLC, Russia). While examining biological diversity of the oropharyngeal microbiota in AtD patients, 58 microbial species were isolated and identified. After statistical analysis the significant differences in frequency of isolation, depending on different AtD severity were observed for microbes such asStreptococcus vestibularisandRothia dentocariosa. WhenR. dentocariosais isolated from the oropharynx, the chances of AtD exacerbation emergence decreased by 6 times, whereas in case ofS. vestibularis, on the contrary, it increased by 5 times. Therefore, identification of transitions of individual microbes from transient to additional and permanent microbiota and vice versa, depending on the AtD stage and severity, allows to analyze an influence of specific microorganisms in AtD pathological processes and to establish definite new microbiological predictors of AtD exacerbation and remission.

Associations of psychotic symptom dimensions with clinical and developmental variables in twin and general clinical samples.

Positive, negative and disorganised psychotic symptom dimensions are associated with clinical and developmental variables, but differing definitions complicate interpretation. Additionally, some variables have had little investigation. To investigate associations of psychotic symptom dimensions with clinical and developmental variables, and familial aggregation of symptom dimensions, in multiple samples employing the same definitions. We investigated associations between lifetime symptom dimensions and clinical and developmental variables in two twin and two general psychosis samples. Dimension symptom scores and most other variables were from the Operational Criteria Checklist. We used logistic regression in generalised linear mixed models for combined sample analysis (n = 875 probands). We also investigated correlations of dimensions within monozygotic (MZ) twin pairs concordant for psychosis (n = 96 pairs). Higher symptom scores on all three dimensions were associated with poor premorbid social adjustment, never marrying/cohabiting and earlier age at onset, and with a chronic course, most strongly for the negative dimension. The positive dimension was also associated with Black and minority ethnicity and lifetime cannabis use; the negative dimension with male gender; and the disorganised dimension with gradual onset, lower premorbid IQ and substantial within twin-pair correlation. In secondary analysis, disorganised symptoms in MZ twin probands were associated with lower premorbid IQ in their co-twins. These results confirm associations that dimensions share in common and strengthen the evidence for distinct associations of co-occurring positive symptoms with ethnic minority status, negative symptoms with male gender and disorganised symptoms with substantial familial influences, which may overlap with influences on premorbid IQ.

Recurrence of internet gaming disorder in Korean adolescents: a 24-month follow-up study.

Many adolescents use internet games, and some of them experience psychological and social difficulties due to excessive gaming. Although there have been many studies on the onset and associated factors of internet gaming disorder (IGD) , research focusing specifically on its relapse is scarce. Considering that addictive disorders often have a chronic course with frequent relapse, this study prospectively observed adolescents from the general population to explore IGD recurrence rate and associated factors of recurrence. In this prospective cohort study, from 1587 middle school gaming users, 1452 (91.5%) were followed up at 12months and 24months. The results showed that the cumulative recurrence rate of IGD was 16.1%, which was higher than the initial incidence rate of 3.6%; the adjusted incidence rate ratio was 2.43 with 95% CI 1.21-4.87 (P = 0.012). In addition, starting internet gaming before entering primary school was associated with a higher risk of relapse (P = 0.004). Limiting internet gaming for children before they enter primary school may reduce the risk of relapse of IGD that they may encounter during their adolescent years.

Guideline-directed medical therapy titration for heart failure with ischaemic aetiology and its effect on cardiac remodelling and cardiovascular mortality-from a real world perspective

Abstract Background Contemporary Heart Failure (HF) pharmacological treatment has been reshaped by several landmark trials in recent years, and available evidence strongly encourages treatment up-titration to target doses. Recent literature regarding treatment sequencing demonstrated positive effects of up-titration on major outcomes regardless of HF aetiology. Purpose We investigated a contemporary Heart Failure with Reduced Ejection Fraction (HFrEF) patient cohort and ischaemic aetiology and sought to understand the effects both in terms of echocardiographic remodelling and upon mortality for cardiovascular (CV) causes of contemporary ESC guideline-directed medical therapy (GDMT) on a real-world level. Methods We retrospectively analysed data of consecutive patients with HFrEF and ischaemic genesis followed in our tertiary HF clinic between January 2019 and January 2022. Eligible patients were stratified into two groups: patients treated or not with full doses of ESC GDMT [including angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i)]. Results Overall, 203 patients (mean age 70.1±12.3 years, 165 males) were included into the analysis. Over a mean follow-up of 1223±221.2 days, 115 (56.6) patients achieved the full recommended doses of each drug. Patients with an unsuccessful up-titration had higher end-diastolic volume at transthoracic echocardiography (p for difference at first and second follow-up <0.001; figure 1, panel A), lower left ventricular ejection fraction (40.1±4.3% vs 44.3±7.8 and 38.7±4.9% vs 42.3±5.6% at the first and second follow-up, respectively) and higher CV mortality rates compared to those treated with the maximal doses (figure 1, panel B). Conclusions Up-titration of pharmacotherapy in our real-world cohort of patients with HFrEF and ischaemic aetiology demonstrated a positive effect both on pivotal echocardiographic parameters and on CV mortality. Our data suggest that timely identification and referral of patients with coronary artery disease who fail to achieve complete positive remodelling after an acute event (or during chronic disease course) for HF contemporary treatment implementation should be envisaged.Figure 1

Immunological indicators of the risk of the transition from chronic gastritis to gastric ulcer in adolescents

As is known, gastric ulcer (GCC) and duodenal ulcer (duodenal ulcer) are chronic, complex-etiology diseases, the mechanism of which is based on complex transformations of nervous, hypothalamic-pituitary, hypothalamic-pituitary-adrenal and local gastroduodenal processes that lead to a change in trophism in the mucous membrane of the stomach and duodenum. In turn, the incipient ulcerative defect is a source of irritation of the enteric receptors, supporting disorders of neurohormonal regulation. Thus, the resulting “vicious circle” causes the chronic course of peptic ulcer disease. During the study of chronic diseases of gastroduodenal localization, including peptic ulcer disease, many doctrines of its occurrence have been proposed. However, the issue of the origin of peptic ulcer disease still remains insufficiently studied; approaches and tactics for managing patients with erosive and ulcerative lesions of the upper gastrointestinal tract are being developed. The aim of the study was to evaluate immunological indicators that determine the risk of chronic gastritis turning into gastric ulcer. The study included 120 children aged 14-17 years, permanently residing in the Bukhara region of the Republic of Uzbekistan. Taking into account the importance of H. Pylori in the development of HCG, patients were distributed depending on the association of HCG with H. Pylori. To study cytokines, blood tests of patients were performed to determine the titer of antibodies (IgG and IdM) to H. Pylori, immunoglobulins A, M, G in blood serum, secretory IgA in oral fluid, IL-1β, IL-10, TNFα, VEGF in the serum of patients. At the same time, blood sampling was carried out in the periods before and 3 weeks (21 days) after treatment. Thus, the study of the value of immunological blood parameters in the progression of HCG to gastric ulcer disease dictates the need to develop immunological indicators for predicting the progression of HCG to gastric ulcer in adolescents. An increase in TNFα levels indicates a high risk of developing gastric ulcer as a result of vascular damage and impaired local circulation. In the study, an established increase in the level of IL-1β indicates activation of the synthesis of proinflammatory cytokines in HCG, especially in HCG associated with H. Pylori. The use of these recommendations contributes to the monitoring of HCG, improving the effectiveness of diagnosis and the correct choice of treatment for patients with HCG, reducing mortality and disability at the same time.

Multiple sclerosis-associated uveitis in Persian population, a multicenter study

PurposeTo report the characteristics of multiple sclerosis-associated uveitis (MSU) among the Persian population. Patients and methodsRetrospective, nonrandomized, multicenter study. Epidemiological characteristics, ocular and neurologic findings, angiographic features, and visual outcomes in MSU were studied. Results92 patients (173 eyes) were included; the mean age at the time of uveitis onset was 35.9 ± 10.9 years (range; 10–60 years), 84.8 % were female, and 88.0 % had bilateral involvement. The anatomical subgroups were isolated anterior uveitis (AU) in 12.0 %, intermediate uveitis (IU) with or without AU in 84.8 % and pure retinal vasculitis in 3.3 % of patients. None of the patients were defined as having posterior or panuveitis. Uveitis had an insidious onset and chronic course in 89.1 % patients and was of granulomatous type in 81.9 %. The diagnosis of MS precedes uveitis onset in 48.8 % patients (range 1 to 35 years, median: 7 years) and was concurrent or after the uveitis onset in 52.2 % patients (range; 1 to 12 years; median: 2 years). Undifferentiated intermediate uveitis was the most common initial diagnosis (30.4 %) before MS establishment. 89.1 % of patients received at least one conventional immunotherapy agent. Peripheral retinal perivascular leakage (81.4 %) and optic disc hyperfluorescence (74.4 %) were the two most common fluorescein angiography (FA) findings The major causes of visual impairment were cataracts (52.7 %), cystoid macular edema (CME) (31.5 %), and optic neuritis (29.2 %). During an average follow-up time of 4.76 ± 3.18 years (range: 1–12 years), visual acuity improved –0.09 logMar/year and most eyes maintain relatively good visual acuity. ConclusionMSU usually presents as chronic granulomatous bilateral IU and less often isolated AU, especially in females. Retinal vasculitis can be a prominent feature. Clinically, it may resemble Undifferentiated intermediate uveitis . In geographical areas where MS is prevalent, the indication of neuroimaging should be expanded and include patients presenting with chronic granulomatous IU or AU especially if accompanied by retinal vasculitis.

Long-term courses of major depressive disorder : Characteristics, risk factors and the definitional challenge of treatment response

The definition of long-term courses of depression is heterogeneous. Chronic and treatment-resistant courses, in particular, represent ahigh-cost factor and greatly reduce the quality of life. Based on the pharmacotherapeutic treatment-resistant depression (TRD), more and more systemic approaches are becoming important. This narrative review provides an overview of the long-term course of depressive disorders, including various definitions and influencing factors. In addition, an overview of biomarker research on treatment response with afocus on neuroimaging is presented. Aselective literature search was conducted in PubMed and Google Scholar for anarrative review. Particular attention was given to larger cohort studies, systematic reviews, meta-analyses and studies on the prediction of treatment response. Chronic and treatment-resistant courses mean arelevant reduction in the quality of life and increased health risks. The assessment of treatment response is adefinitional challenge: An alternative to TRD is the systemically oriented difficult to treat depression (DTD). The focus is thus moving away from symptom reduction towards controlling the level of functioning. Biomarker research for treatment response offers potential but currently mainly serves to gain theoretical knowledge. Recording the long-term course of depressive illnesses is important, but also complex. Clinical interventions should therefore include acontinuous monitoring and the focus on maintaining the quality of life.

The therapeutic effect of 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol on chemically induced atopic dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease worldwide. However, it is still urgent to develop innovative treatments that can effectively manage refractory patients with unpredictable chronic disease courses. In this study, we evaluated the therapeutic efficacy of 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) as a novel agent for AD treatment using a human-like mouse model of AD. PLAG significantly improved 2,4-dinitrochlorobenzene (DNCB)-induced AD skin lesions compared to those in mice treated with DNCB alone. PLAG substantially modulated the AD-induced infiltration of monocytes and eosinophils into skin lesions and humoral systemic responses involving immunoglobulin E (IgE), interleukin (IL)-4, and IL-13, restoring them to a normal state. Next, we compared the therapeutic efficacy of PLAG and abrocitinib for severe AD treatment. PLAG exhibited a significant therapeutic effect on AD skin lesions compared to abrocitinib. Unlike abrocitinib, PLAG significantly reduced AD-induced eosinophil infiltration to a level similar to that observed in untreated negative controls. Notably, both PLAG and abrocitinib downregulated IgE, IL-4, and IL-13 in a similar pattern, reaching levels similar to those in the untreated negative controls. Our findings strongly suggest that PLAG may serve as a therapeutic agent for AD with an efficacy comparable to that of abrocitinib.

8144 Hypertension in Sheehan Syndrome: A Diagnostic Challenge

Abstract Disclosure: E. Ahsan: None. F.F. Foo: None. C. Lesniak: None. M. Akula: None. K. Hu: None. R. Ong: None. K. Chalasani: None. J. Cheng: None. S. Holland: None. Introduction: Postpartum pituitary necrosis, commonly known as Sheehan syndrome (SS), is the term used to describe the necrosis of anterior pituitary gland cells that occurs after significant postpartum bleeding, hypovolemia, and shock. This typically occurs after delivery, during which the mother suffers significant blood loss. The pituitary gland fails to produce hormones due to this blood loss. Depending on the degree of tissue damage, SS can have an acute or chronic course, and patients may present with a wide range of clinical symptoms at diagnosis. Acute SS is associated with postpartum pituitary infarction, which can result in hypotension, shock, hypoglycemia, hyponatremia, headache, vision disturbances, unconsciousness, and an inability to lactate. We present a rare case of SS where the patient experienced hypertension instead of classic hypotension due to postpartum preeclampsia. Clinical Case: A 40-year-old female with no significant medical history presented to the hospital for scheduled induction of labor for polyhydramnios and underwent vacuum-assisted vaginal delivery and postpartum hysterectomy due to severe postpartum hemorrhage secondary to DIC. The postpartum course was also complicated by preeclampsia with severe features. Patients developed features like excessive fatigue, hypoglycemia, hyponatremia, hypothyroidism, polyuria, and failure of lactation, which were consistent with panhypopituitarism secondary to Sheehan syndrome. However, the patient was hypertensive to 145/91 before steroids were given. Labs were significant for serum sodium 116 mmol/L (135-145 mmol/L), FSH <0.7 mIU/mL (Follicular Phase: 2.5-10.2, Mid-cycle Peak: 3.1-17.7, Luteal Phase: 1.5-9.1, Postmenopausal: 23.0-116.3), LH <0.2 mIU/m (Follicular Phase: 1.9-12.5, Mid-Cycle Peak: 8.7-76.3, Luteal Phase: 0.5-16.9, Postmenopausal: 10.0-54.7), Prolactin: 2.4 ng/mL (Non-pregnant: 3.0-30.0, Pregnant: 10.0-209.0, Postmenopausal: 2.0-20.0), PM Cortisol on admission: 1.10 ug/dL (3.44-16.76 ug/dL), plasma ACTH 7 pg/mL( 6 - 50 pg/mL), TSH 0.430 uIU/mL (0.550 - 4.780 uIU/mL), FT4 0.59 ng/dL - 1.76 ng/dL). MRI of the brain pituitary showed- A 1.5 cm region of hypoenhancement and an additional 2 mm focus of hypoenhancement in the sella, findings represent evolving pituitary necrosis. The patient received 24 units of blood transfusion and hormone replacement therapy, followed by outpatient endocrinology follow-up. Clinical lessons: Although considerable blood loss causes hypotension in patients with SS, additional postpartum medical issues can sometimes result in atypical presentations. In our patient, postpartum preeclampsia caused hypertension. Identifying the atypical symptoms of SS is just as vital as identifying its typical features to prevent potentially fatal consequences. Presentation: 6/2/2024

8653 A Rare Cause of a Pituitary Mass

Abstract Disclosure: L. El Musa Penna: None. W. Medina-Torres: None. L.R. Sepulveda-Garcia: None. I.C. Arroyo Gomez: None. J. Segarra-Villafane: None. Z. Maisonet -Feliciano: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. M. Alvarado: None. J. Feneque González, MD: None. M. Marcos Martínez, MD: None. M. Correa Rivas: None. Pituitary gland masses are the second most common tumor of the central nervous system (CNS) across all age group, as per Central Brain Tumor Registry in the United States. Most common lesions are adenomas, which can be categorized as functional and non-functional based on the presence of hormonal hypersecretion. In the differential diagnosis, there is also craniopharyngiomas, Rathke’s cleft cysts, pituitary hyperplasia, inflammatory lesions, malignancy and abscess. Pituitary abscess is a rare condition, and only 0.2-0.6% of pituitary lesions are diagnosed as abscesses.This is the case of a 42-year-old female with history of hypothyroidism, chronic sinusitis with nasal polyps, severe asthma, and chronic steroid use complicated by iatrogenic adrenal insufficiency and osteonecrosis of the hips bilaterally, who was evaluated for intractable headaches. On brain imaging was found with a pituitary macroadenoma. She denied any symptoms suggesting hypersecretion of hormones and was scheduled for transsphenoidal surgery. All hormonal work up was found within normal limits, except for prior iatrogenic adrenal insufficiency due to multiple systemic steroids courses to treat asthma exacerbation throughout her life.During surgery, upon mass resection, purulent secretions were found. Frozen section was done intraoperatively, showing respiratory epithelium, pus and actinomyces species. All infectious material was removed. Infectious Diseases services was consulted and patient was promptly started on IV antibiotics. Blood cultures were negative, and patient remained afebrile. Final pathology confirmed the presence of respiratory epithelium, actinomyces colonization and a fibrous capsule with acute and chronic inflammation. Special stains report was negative for fungi. She was discharge to continue home infusion of antibiotic regimen to complete 8 weeks of treatment.There is no specific imaging finding to identify pituitary abscesses so, most of them, are diagnosed intraoperatively. They can arise from hematogenous spread or from adjacent tissues or structures (ie. patient with meningitis or sinusitis). The condition is considered a life-threatening however, the majority of cases have a chronic course. Based on different reports, theses abscesses have a higher female predominance; the age range is between 12 to 76 years and the average period between onset of symptoms and diagnosis is 8 months on average. Most pituitary abscesses are sterile, however most common organisms isolated are: Gram-positive cocci (Staphylococcus and Streptococcus), and Gram-negative organisms such as Neisseria, Escherichia coli and Corynebacterium. The rarity of cases often leads to delayed diagnosis and treatment initiation, contributing to increased morbidity and mortality. Presentation: 6/2/2024

Bladder Pain Syndrome (BPS): A Comprehensive Review of Treatment Strategies and Management Approaches.

Bladder pain Syndrome presents a multifaceted challenge in contemporary urological practice, marked by LUTS, negative behavioural, sexual, or emotional experiences, and the potential for sexual dysfunction. We meticulously explored the existing literature of conservative, non-invasive and invasive interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive BPS management. We delve into the effectiveness and safety profiles from behavioural approaches through lifestyle changes and physical therapy, to oral or intravesical medications, until the definitive surgical treatment. The best option evaluated is the involvement of a multidisciplinary team, including urologists, urotherapists, gynaecologists, pain specialists, primary care physicians and psychologists, educating those patients regarding the condition and its chronic course and tailoring the perfect treatment for each person. Despite this, BPS remains a challenge for urologists. Indeed, our objective is to contribute to the evolving landscape of BPS management, fostering informed decision-making and personalized care for individuals grappling with this challenging condition.

Position paper of the Austrian Society for Rheumatology and the Austrian Society for Pneumology on the diagnosis and treatment of sarcoidosis 2024

In many cases sarcoidosis is a multisystemic disease that requires interdisciplinary medical cooperation in the diagnostics, treatment and medical care during follow-up. Due to the often chronic course, it is of utmost importance to include patients with their priorities and wishes at an early stage and extensively in disease management and to establish a shared decision making whenever possible. In the process of writing this joint position paper, the expert group on interstitial and orphan lung diseases of the Austrian Society for Pulmonology and the working group on rheumatological lung disorders of the Austrian Society for Rheumatology and Rehabilitation sought to include patient advocacy groups as well as experts for rare organ manifestations of sarcoidosis. This position paper is not only meant to reflect current scientific and clinical standards but should also focus the national expertise and by networking and exchange to be a first step to strengthen cooperation between stakeholders to ultimately improve care for patients with sarcoidosis.

Evaluation of demographic and clinical characteristics of 728 patients with mycosis fungoides and their relationship with systemic comorbidities: multicenter, registry-based (MF-TR) study from Türkiye.

Mycosis fungoides (MF) is the most common cutaneous lymphoma with a chronic disease course. MF patients may also suffer from systemic comorbidities such as cardiovascular and metabolic diseases. In this study, we aimed to evaluate the demographic and clinical features of MF patients registered in the MF-TR registry system and to examine the relationship of these features with systemic comorbidities. We collected the data from the medical files of the patients via the MF-TR registry system. Our study included 728 patients with MF, of which 396 (54.40%) were male and 332 (45.60%) were female. The most common additional systemic disease observed was hypertension, affecting 124 (17.03%) patients. This was followed by multinodular goiter in 66 (9.06%) patients, and diabetes mellitus type 2 in 61 (8.37%) patients. Twenty-two (3.02%) patients had a history of another secondary malignancy, with lung cancer being the most common type, affecting 5 (0.68%) patients. Female gender and high BMI were statistically higher in MF patients with asthma (P=0.019 and P=0.031, respectively). In patients with hypertension and hypercholesterolemia, the duration of diagnosis was significantly longer (P=0.013 and P=0.047, respectively). Dermatologists should be aware of these accompanying comorbidities in patients with MF. Multidisciplinary evaluation should be performed in the follow-up, if necessary.

Chronic Cough Related to Thyroid Cartilage Superior Cornu Abnormality.

Chronic cough is a common troublesome symptom in otolaryngology head and neck surgery practice. In rare cases, chronic cough may be related to anatomical abnormalities. In this article, we report the history of a 64-year-old female with a chronic course due to a curved superior cornu of the thyroid cartilage and related irritation of the laryngeal superior nerve. The cough was atypical and resolved after the surgical resection of the abnormal cornu. There was no recurrence at 9 months post-surgery. The findings of the present case report highlight the need to explore the laryngeal anatomy in patients with chronic cough to identify potential abnormalities, which may be treated surgically.

Tubulointerstitial nephritis in children and adolescents.

The tubulointerstitial compartment comprises most of the kidney parenchyma. Inflammation in this compartment (tubulointerstitial nephritis-TIN) can be acute and resolves if the offending factor is withdrawn or may enter a chronic process leading to irreversible kidney damage. Etiologic factors differ, including different exposures, infections, and autoimmune and genetic tendency, and the initial damage can be acute, recurrent, or permanent, determining whether the acute inflammatory process will lead to complete healing or to a chronic course of inflammation leading to fibrosis. Clinical and laboratory findings of TIN are often nonspecific, which may lead to delayed diagnosis and a poorer clinical outcome. We provide a general review of TIN, with special mention of the molecular pathophysiological mechanisms of the associated kidney damage.

Sex-dependent temporal changes in astrocyte-vessel interactions following diffuse traumatic brain injury in rats.

Traumatic brain injury (TBI) is associated with diffuse axonal injury (DAI), a primary pathology linked to progressive neurodegeneration and neuroinflammation, including chronic astrogliosis, which influences long-term post-TBI recovery and morbidity. Sex-based differences in blood-brain barrier (BBB) permeability increases the risk of accelerated brain aging and early-onset neurodegeneration. However, few studies have evaluated chronic time course of astrocytic responses around cerebrovascular in the context of aging after TBI and sex dependence. We observed increased glial fibrillary acidic protein (GFAP)-labeled accessory processes branching near and connecting with GFAP-ensheathed cortical vessels, suggesting a critical nuance in astrocyte-vessel interactions after TBI. To quantify this observation, male and female Sprague Dawley rats (∼3months old, n = 5-6/group) underwent either sham surgery or midline fluid percussion injury. Using immunohistochemical analysis, we quantified GFAP-labeled astrocyte primary and accessory processes that contacted GFAP-ensheathed vessels in the somatosensory barrel cortex at 7, 56, and 168days post-injury (DPI). TBI significantly increased GFAP-positive primary processes at 7 DPI (P < 0.01) in both sexes. At 56 DPI, these vessel-process interactions remained significantly increased exclusively in males (P < 0.05). At 168 DPI, both sexes showed a significant reduction in vessel-process interactions compared to 7 DPI (P < 0.05); however, a modest but significant injury effect reemerged in females (P < 0.05). A similar sex-dependent pattern in the number of accessory processes provides novel evidence of long-term temporal changes in astrocyte-vessel interactions. TBI-induced changes in astrocyte-vessel interactions may indicate chronic BBB vulnerability and processes responsible for early onset vascular and neurodegenerative pathology.

Modern view of surgical treatment of the lesion ileocecal zone in Crohn’s disease: when and how to operate

Crohn’s disease is an inflammatory bowel disease with a chronic recurrent course and a high risk of complications. Crohn’s disease prevalence has been increasing. Despite the era of biological therapy and new therapeutic approaches in the treatment of Crohn’s disease, the role of surgical treatment remains high. This study aimed to analyze the current trends and approaches of surgical treatment localized lesions of ileocecal zone in children with Crohn’s disease. The scientific databases eLibrary, GoogleScholar, MEDLINE, and Embase were searched. The search time interval was 2017–2024. In several recent articles, a trend toward early ileocecal resection in patients with Crohn’s disease was noted. According to some studies in adults, this approach is an alternative option for medical treatment. The advantages of early surgical approach includes decreased surgical complication level, improving the quality of life and reducing the cost of treatment. The timing of early surgical intervention varies. Notably, Crohn’s disease in children has more aggressive character, and early surgical intervention may not only create a therapeutic window of opportunity to control Crohn’s disease but also contribute to improving the long-term results of Crohn’s disease treatment. The role of surgical technique is being studied (the need to include a mesentery with fat wrapping into a resection area or not), the effect of the type of anastomosis on relapse of Crohn’s disease. Analysis of the safety of Kono-S anastomosis and its impact on development recurrence has shown a number of advantages over traditional anastomosis. However, its application in the practice of pediatric surgeons remains isolated. Similar studies are required in children to determine the optimal strategy for the treatment of Crohn’s disease in ileocecal region (determining the role of surgical treatment and type of anastomosis in achieving long-term and deep remission), preventing recurrence of Crohn’s disease and repeated intestinal resections.

Online eurythmy therapy for cancer-related fatigue: a prospective repeated-measures observational study exploring fatigue, stress, and mindfulness.

Cancer is a debilitating disease with an often chronic course. One of the most taxing and prevalent sequelae in this context is cancer-related fatigue (CRF) resulting from the disease and/or associated treatments. Over the last years mindfulness-based interventions such as eurythmy therapy (ERYT), a mindful-movement therapy from anthroposophic medicine, have emerged as promising adjunct therapies in oncology. This prospective study investigated an online implementation of ERYT for CRF using a single arm repeated-measures design based on two consecutive studies. Study 1 consisted of an initial assessment before, during, after, and at follow up of a 6-week online ERYT-based program in a mixed sample of N = 165 adults with or without cancer diagnosis. Study 2 involved a similar design with an adapted 8-week online ERYT-based program in a sample of N = 125 adults who had been diagnosed with cancer. Outcomes were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue, Perceived Stress Scale, Mindful Attention Awareness Scale, and Insomnia Severity Index (for Study 1 all, for Study 2 only the former three). We additionally performed an exploratory analysis regarding practice frequency and duration. Data were analyzed using Linear Mixed-Effect Models per outcome; ANOVA was used for practice times. For Study 1, mixed-effects model estimates showed no significant effect on fatigue, but pointed to significantly improved emotional and physical well-being, reduced stress, as well as increased mindfulness (mixed subjects). Functional and social well-being or sleep quality did not change significantly. Study 2 model estimates on the other hand showed significantly improved CRF in conjunction with the ERYT-based online intervention, as well as improved stress and mindfulness scores (cancer-diagnosed subjects). Taken together, while our results should be interpreted with caution given the single-arm design and relatively high dropout, they suggest online ERYT may be associated with a reduction in fatigue for individuals diagnosed with cancer, an increase in mindfulness, and benefits for stress and certain well-being indicators. The online group format is advantageous in view of affordability and accessibility, the latter being particularly relevant for individuals who due to high symptom severity cannot leave their homes. Randomized-controlled studies will be needed to confirm these findings.