Analysis Of Clinical Cases Research Articles

Challenges and solutions in plasma cell gingivitis: A clinical case analysis

Plasma cell gingivitis (PCG) is an uncommon benign gingival condition characterized by sharply defined erythematous and oedematous gingival lesions, often extending to the mucogingival junction. This hypersensitivity reaction presents as diffuse, papillary gingival inflammation, prone to bleeding upon minimal trauma. Histologically, PCG manifests as a dense infiltration of normal plasma cells within collagenous stroma, typically localized to the free and attached gingiva. The primary management approach involves identification and avoidance of the allergen source, alongside nonsurgical periodontal therapy. We report a 26-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. Surgical treatment along with pharmacological interventions resulted in complete resolution of symptoms. This case underscores the importance of comprehensive evaluation and tailored treatment approaches in managing plasma cell gingivitis.

Pregnancy Outcomes in Patients Treated with Upadacitinib: Analysis of Data from Clinical Trials and Postmarketing Reports.

Upadacitinib is indicated for diseases affecting persons of childbearing potential including rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, atopic dermatitis, Crohn's disease, and ulcerative colitis; however, teratogenicity was observed in animal studies. Given the potential for human fetal risk, pregnancy avoidance measures were required during clinical trials. This analysis describes pregnancy outcomes in patients exposed to upadacitinib during pregnancy. Clinical trial and postmarketing cases of in utero exposure to upadacitinib were identified in AbbVie's safety database through 25 April, 2023. Analysis of clinical trial cases and postmarketing reports are presented separately; prospective and retrospectively reported pregnancy outcomes are integrated for each. Descriptive rates are presented to summarize outcomes. There were 128 maternal upadacitinib-exposed pregnancies with known outcomes identified; 80 and 48 pregnancies were reported in clinical trials and the postmarketing setting, respectively. In clinical trials (mean in utero exposure of 5 weeks, 3 days), live births (54%), spontaneous abortions (24%), elective terminations (21%), and ectopic pregnancy (1%) were reported. There was one report of a congenital malformation: a 35-week infant with an atrial septal defect. In postmarketing cases, live births (46%), spontaneous abortions (38%), elective terminations (15%), and ectopic pregnancy (2%) were reported. As the data are limited for in utero exposure to upadacitinib, definitive conclusions cannot be drawn regarding the effect of upadacitinib on pregnancy outcomes. Rates of adverse pregnancy outcomes with upadacitinib exposure were comparable to rates observed in the general population or patients with autoimmune inflammatory diseases. To date, no apparent evidence of teratogenicity exists in the analyses of human pregnancies exposed to upadacitinib during the first trimester.

Diagnostic Scale for Acute Appendicitis to Prevent General Peritonitis in Children

This article presents the development and implementation of a diagnostic scale for acute appendicitis in children over 5 years of age with the aim of effectively preventing general peritonitis in children. The study is based on an extensive analysis of clinical cases and medical observation data. The proposed diagnostic scale, based on a comprehensive analysis of the disease history, clinical signs, and laboratory parameters, demonstrates high accuracy and reliability in determining acute appendicitis in children, which contributes to the timely initiation of treatment and reducing the risk of developing intra-abdominal complications including generalized peritonitis.

Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review.

This paper examines the clinical differentiation of pigmented lesions in the oral mucosa, which poses significant diagnostic challenges across dental and medical disciplines due to their spectrum from benign to potentially malignant conditions. Through a literature review and analysis of clinical cases, this study clarifies current diagnostic methodologies, with an emphasis on differential diagnosis, to provide a practical guide for clinicians. The classification of pigmented lesions, such as endogenous, focal melanocytic, and multifocal pigmentation, based on clinical and histological features, highlights the necessity for a structured and informed approach. A retrospective examination of cases from our oral medicine and pathology clinic, coupled with analysis of photographic and histological records, aids in classifying these lesions. This fosters a better understanding and promotes informed discussions among clinicians, ultimately aiming to enhance early and precise diagnosis, thus improving patient management and outcomes.

Clinical analysis of cases of otogenic sigmoid sinus thrombosis in children

Objective:To analyze the clinical characteristics of middle ear mastoiditis combined with sigmoid sinus thrombophlebitis in children. Methods:Author retrospectively analyzed the clinical data of 6 children with middle ear mastoiditis combined with sigmoid sinus thrombophlebitis who were hospitalized in the Department of Infectious Diseases and Department of Neurology with first diagnosis of fever/headache, and subsequently underwent middle ear mastoidectomy in our department. All patients underwent comprehensive otoscopic, audiologic, imaging, and pathogenetic examinations. Clinical manifestations, pathogenetic features, treatment methods and prognosis were summarized, and the follow-up period was 3-6 months. Results:All 6 cases were first diagnosed with intracranial complications such as fever and headache in the internal medicine department. Within one month, all patients developed ear symptoms including pain, discharge, and hearing loss. Audiologic examination revealed conductive hearing loss in five cases and total deafness in one case. MRI, MRV and MRA examinations suggested that there were 6 cases of middle ear infection combined with thrombophlebitis of the ethmoid sinus, of which 3 cases had thrombus in the ethmoid sinus. 6 cases received surgical treatments: 2 cases of radical mastoidectomy+grommet Insertion, and 4 cases of radical mastoidectomy. Pathogenetic examination identified Streptococcus pneumoniae in three cases, Pseudomonas aeruginosa in one case, Enterobacter cloacae complex in one case, and no pathogens were detected in one case. Postoperative pathology was inflammatory granulation in all 6 cases. Follow-up was 3-6 months with no recurrence of intracranial and middle ear lesions on regular review. Conclusion:Children with recurrent fever, headache, and a recent history of acute and chronic otitis media should be evaluated for the possibility of sigmoid sinus thrombophlebitis, and imaging tests should be performed in a timely manner to clarify the diagnosis. Once diagnosed, surgery to remove the lesions around the ethmoid sinus, smooth drainage combined with antibiotic therapy is the most direct and effective treatment, and anticoagulation therapy is given when necessary. Timely diagnosis, multidisciplinary collaboration, and accurate timing of the management of primary foci and comorbidities are crucial to the treatment of the disease.

Automatic segmentation of spine x-ray images based on multiscale feature enhancement network.

Automatic segmentation of vertebrae in spinal x-ray images is crucial for clinical diagnosis, case analysis, and surgical planning of spinal lesions. However, due to the inherent characteristics of x-ray images, including low contrast, high noise, and uneven grey scale, it remains a critical and challenging problem in computer-aided spine image analysis and disease diagnosis applications. In this paper, a Multiscale Feature Enhancement Network (MFENet), is proposed for segmenting whole spinal x-ray images, to aid doctors in diagnosing spinal-related diseases. To enhance feature extraction, the network incorporates a Dual-branch Feature Extraction Module (DFEM) and a Semantic Aggregation Module (SAM). The DFEM has a parallel dual-branch structure. The upper branch utilizes multiscale convolutional kernels to extract features from images. Employing convolutional kernels of different sizes helps capture details and structural information at different scales. The lower branch incorporates attention mechanisms to further optimize feature representation. By modeling the feature maps spatially and across channels, the network becomes more focused on key feature regions and suppresses task-irrelevant information. The SAM leverages contextual semantic information to compensate for details lost during pooling and convolution operations. It integrates high-level feature information from different scales to reduce segmentation result discontinuity. In addition, a hybrid loss function is employed to enhance the network's feature extraction capability. In this study, we conducted a multitude of experiments utilizing dataset provided by the Spine Surgery Department of Henan Provincial People's Hospital. The experimental results indicate that our proposed MFENet demonstrates superior segmentation performance in spinal segmentation on x-ray images compared to other advanced methods, achieving 92.61±0.431 for MIoU, 92.42±0.329 for DSC, and 99.51±0.037 for Global_accuracy. Our model is able to more effectively learn and extract global contextual semantic information, significantly improving spinal segmentation performance, further aiding doctors in analyzing patient conditions.

PANCREATIC CANCER DIAGNOSIS OVERCOMING BIAS AND ERRORS (CASE SERIES)

Abstract Diagnosing malignant pancreatic neoplasms presents a challenging task fraught with the possibility of diagnostic errors due to similarities with other pathologies such as pancreatitis, neuroendocrine tumors, and cystic formations. The key diagnostic method is contrast-enhanced multi-detector computed tomography, yet even this method has certain limitations that may affect diagnostic accuracy.Through the analysis of clinical cases, typical errors accompanied by visual characteristics that can be misleading in differential diagnosis have been identified. Hypodensity and tissue structure alterations, changes in ducts, or mass effect may be common features of both cancer and pancreatitis. Comparing visual signs with the clinical picture and employing additional methods aids in reaching a more precise diagnosis.It is important to note that rare pathologies such as serous oligocystic adenoma and intraductal papillary mucinous neoplasm may also pose additional challenges for accurate diagnosis due to their unusual characteristics on computed tomography scans.The conclusions of the study underscore the importance of a multimodal approach to diagnosing malignant pancreatic neoplasms, including the use of various imaging methods to ensure an accurate diagnosis and the selection of the most appropriate treatment strategy

Current positions regarding the diagnosis and screening of colorectal cancer and precancerous changes of bowel. Analysis of clinical cases

The article deals with the problem of colorectal cancer and precancerous changes of bowel. Risk factors, clinical symptoms, diagnostic methods, directions for the prevention of colorectal cancer and precancer are considered. Three clinical cases of patients with bowel tumors and precancerous conditions are given and analyzed. The article places special emphasis on the need for timely detection of tumors and screening for colorectal cancer. Screening options are shown, each of the screening methods is analyzed. Screening algorithms based on the practical guidelines of different countries are given. The relevance and importance of the problem of colorectal cancer and precancerous changes are emphasized.

A clinical study based on bidirectional Mendelian randomization: Correlation between generalized anxiety disorder and weight-bearing joints osteoarthritis

ObjectivesBidirectional Mendelian randomization (MR) combined with clinical case analysis was used to elucidate the relationship between generalized anxiety disorder (GAD) caused by mental overload and the risk of weight-bearing joint (hip/knee) osteoarthritis (OA). MethodsWe performed MR analyses using publicly released genome-wide association study summary statistics to measure the causal effects between mental overload and weight-bearing joint OA risk. The primary MR analysis utilized the inverse-variance weighted (IVW) method, complemented by additional methods, including simple mode, weighted mode, MR-Egger regression, and weighted median. The leave-one-out method was used for sensitivity analysis. Concurrently, data from patients with OA (Kellgren–Lawrence grades III–IV) who needed total knee/hip arthroplasty were collected. Patient assessments were conducted utilizing the Western Ontario and McMaster Universities arthritis index, Penn State worry questionnaire, and visual analogue scale. ResultsGenetically predisposed GAD did not correlate with the risk of weight-bearing joint OA (IVW odds ratio [OR] = 0.840, 95 % confidence interval = 0.128, 5.50, P = 0.855). In reverse MR analyses, we detected no causal effect of weight-bearing OA on GAD (IVW OR = 1.00, 95 % CI = 0.985, 1.03, P = 0.687). In the clinical case evaluation, weight overload joint OA and GAD were highly correlated. ConclusionMR analysis indicated no bidirectional causal effect of GAD caused by mental overload on weight-bearing joint (hip or knee) OA. Clinical studies support the finding that GAD is highly correlated with weight-bearing joint OA. However, whether there is a causal relationship between GAD caused by mental overload and weight-overloading joint OA requires further investigation.

Advances in the Study of the Relationship Between Orthodontics and Periodontitis

This comprehensive study employed a multifaceted research methodology encompassing a systematic review of existing literature, clinical case analyses, and a series of controlled clinical trials to explore the complex relationship between orthodontic treatments and periodontal health. The study focused on evaluating the biomechanical impacts of orthodontic procedures on the periodontium, including risks such as gum recession and bone loss, particularly in patients with varying periodontal biotypes and pre-existing periodontal conditions. The research methodology involved detailed assessments of periodontal health pre- and post-orthodontic intervention, monitoring changes in gingival and bone structures using advanced imaging techniques, and recording patient-reported outcomes regarding oral health quality. The findings of this study revealed a significant correlation between orthodontic force application and changes in periodontal tissue health, highlighting the necessity of personalized treatment planning that incorporates the patient's periodontal status. Preventive measures, including the use of controlled orthodontic forces, meticulous monitoring of tooth movement, and enhanced oral hygiene practices, were shown to be effective in minimizing periodontal complications. This study contributes significantly to the dental field by providing a deeper understanding of the orthodontic-periodontal relationship and offers practical guidelines for dental professionals in managing orthodontic treatments for patients with periodontal considerations. The study's findings underscore the importance of an interdisciplinary approach in dental care, advocating for closer collaboration between orthodontists and periodontists to optimize treatment outcomes and ensure comprehensive oral health care.

Clinical and laboratory features of COVID-19 in newborns. Analysis of a severe clinical case

Background. Since the onset of the coronavirus disease 2019 (COVID-19) epidemic until January 1, 2024, more than 5.5 million confirmed cases of COVID-19 have been detected in Ukraine according to official data, approximately 6 % of them among children under 18 years old. Aim: to improve the management of newborns based on studies of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with different course. Materials and methods. Eleven newborns (7 boys and 4 girls) diagnosed with SARS-CoV-2 confirmed by polymerase chain reaction were observed. Disease progression, results of laboratory and instrumental studies were analyzed. Results. An analysis of clinical data and the results of laboratory and instrumental investigations are presented, as well as treatment outcomes in newborns with confirmed COVID-19. It was found that in all cases, children were infected from mothers with SARS-CoV-2. The frequency of clinical symptoms is provided, revealing discrepancies between respiratory symptoms and changes identified on lung ultrasound. Most children exhibited anemia, elevated D-dimer levels in the blood, yet experienced a mild course of the disease. The average duration of illness prior to hospitalization was 3.70 ± 1.48 days, with a hospital stay of 4.01 ± 1.22 days. An exception was in case of patient N., characterized by a severe condition necessitating prolonged oxygen therapy, mechanical ventilation, and administration of remdesivir. This particular case is detailed in the article. Conclusions. In most infants under one month of age observed in this study, the course of ­COVID-19 caused by SARS-CoV-2 was characterized by symptoms such as lethargy, hyperthermia, nasal congestion, diarrhea, and changes detected only through laboratory and instrumental stu­dies: anemia, abnormalities in the coagulation system, and increased lung parenchymal density. Ho­wever, the disease course in infants of this age can also be very severe, with lung parenchymal involvement, pneumonia, COVID-19-associated coagulopathy, complicated by generalized bacterial infection, as presented in the clinical case.

Analysis of central pontine myelinolysis in HIV-infected patients

Aim: to conduct a clinical and epidemiological analysis of cases of central pontine myelinolysis (CPM) in HIV-infected patients. Materials and methods. Four patients hospitalized in the infectious diseases department of No. 1 Clinic of the South Ural State Medical University were under dynamic observation. Results and its discussion. Four patients hospitalized in the infectious diseases department of Clinic No. 1 of the South Ural State Medical University were under dynamic observation. Patient management was carried out in accordance with current clinical recommendations for the provision of medical care to patients with HIV infection with a set of clinical and laboratory methods, including examination of lumbar puncture, its cytological and biochemical composition, determination of DNA of cytomegalovirus (CMV) and Epstein-Barr viruses (EBV) herpes simplex types 1 and 2, T. gondii, Cr. Neoformans, M. Tuberculosis, Cryptococcus neoformans, the presence of pathogens of bacterial infections. All patients underwent magnetic resonance imaging (MRI) of the brain. Conclusion. The process of demyelination of the central nervous system develops regardless of the level of CD4 lymphocytes and HIV viral load. The main method for verifying the diagnosis is MRI of the brain

Modern management of patients with intestinal diseases. Analysis of clinical cases

The article presents the clinical experience of treating patients with various intestinal diseases in combination with other pathologies. Three cases of management of patients with different nosological forms of intestinal diseases are given: ulcerative colitis, irritable bowel syndrome, diverticular disease. Features of the course of diseases, an examination algorithm using modern innovative techno­logies and comprehensive treatment are presented. This contributed to positive dynamics and improvement of the quality of life of patients.

Evaluation of the in vitro susceptibility of clinical isolates of NDM-producing Klebsiella pneumoniae to new antibiotics included in a treatment regimen for infections.

Due to the growing resistance to routinely used antibiotics, the search for new antibiotics or their combinations with effective inhibitors against multidrug-resistant microorganisms is ongoing. In our study, we assessed the in vitro drug susceptibility of Klebsiella pneumoniae strains producing New Delhi metallo-β-lactamases (NDM) to antibiotics included in the Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommendations. A total of 60 strains of NDM-producing K. pneumoniae were obtained from different patients hospitalized at the 4th Military Hospital in Wroclaw between 2019 and 2022 and subjected to drug susceptibility to selected antibiotics, including the effects of drug combinations. Among the tested antibiotics, the highest sensitivity (100%) was observed for cefiderocol, eravacycline (interpreted according to the European Committee on Antimicrobial Susceptibility Testing [EUCAST]), and tigecycline. Sensitivity to intravenous fosfomycin varied depending on the method used. Using the "strip stacking" method, determining cumulative sensitivity to ceftazidime/avibactam and aztreonam demonstrated 100% in vitro sensitivity to this combination among the tested strains. The in vitro susceptibility assessment demonstrated that, the best therapeutic option for treating infections caused by carbapenemase-producing strains seems to be a combination of ceftazidime/avibactam with aztreonam. Due to the safety of using both drugs, cost effectiveness, and the broadest indications for use among the tested antibiotics, this therapy should be the first-line treatment for carbapenemase-producing Enterobacterales infections. Nevertheless, a comprehensive evaluation of the efficacy of treating infections caused by NDM-producing K. pneumoniae strains should include not only in vitro susceptibility assessment but also an analysis of clinical cases.

Classification Features of Severe Stages of Proliferative Diabetic Retinopathy (Clinical Cases)

Purpose: analysis of clinical cases illustrating the classification features of severe stages of proliferative diabetic retinopathy (PDR).Patient and methods. Three clinical cases of PDR are presented, in which ophthalmoscopic signs (according to the classification of the Early Treatment Diabetic Retinopathy Study, 1991) corresponded to severe PDR (high risk 1, high risk 2) and advanced PDR. The ophthalmological status was assessed using standard methods based on measuring the best corrected distance visual acuity, performing ultrasound (Opticon 2000, Italy), photographic recording of the condition of the fundus (Carl Zeiss Visucam 500, Germany) and optical coherence tomography of the macular region (on an RTVue-100 tomograph, OptoVue, USA).Results and conclusion. The presented clinical examples will provide the ophthalmologist with a more complete understanding of the clinical picture of pathological changes in the retina in diabetes mellitus, which will ultimately increase the level of diagnosis and tactics of surgical intervention both during the initial (preoperative) examination and after vitrectomy.

(PM-09) PIONEERING SEXUAL HEALTH SERVICES IN NORTHEAST BRAZIL: AN EXPERIENTIAL ACCOUNT

Abstract Introduction Sexual dysfunctions remain inadequately addressed in medical education, despite their prevalence and adverse impact on quality of life. In Brazil, there are scarce university-affiliated healthcare centers that focus on sexual health. These services play a critical role in diagnosing and managing sexual disorders and can be pivotal in the training of healthcare professionals, as well as in the advancement of research and outreach in sexual medicine. Objective To describe the experience of establishing two sexual health centers in university-affiliated hospitals in Northeastern Brazil. Method This is an experiential report detailing the establishment of two distinct sexual health services. Results Both sexual health services started in different general hospitals in 2021, founded by a male and a female psychiatrists, authors of this paper. The initiative was prompted by the lack of dedicated sexual health services and the awareness of substantial patient distress stemming from sexual issues. Activities include patient consultations, case discussions, sexology seminars, and research project development, involving medical students and resident physicians, integrated into the psychiatry residency curriculum Referrals come mainly from other hospital specialties, but external referrals are also accepted. Collaboration with other healthcare professionals occurs through the analysis of clinical cases. Conclusion The establishment of sexual health services within university-affiliated hospitals has a positive impact on patient care and contributes to the study of sexual medicine, an area often overlooked in medical education. Improvements are needed in patient recruitment, counter-referral procedures, and the systematic incorporation of medical student rotations. While these services hold promise, they require greater integration with other healthcare services and a closer collaboration with undergraduate medical education. Financing No conflict.

Challenges in Diagnosing and Managing Pulmonary Conditions: A Case Series Highlighting Pulmonary Tuberculosis and Lung Cancer

This study delves into the intricate challenges encountered in diagnosing and managing pulmonary conditions, focusing on tuberculosis (TB) and lung cancer, especially in individuals with a history of cancer treatment and tobacco use. Through a detailed analysis of clinical cases, we explore the complexities associated with TB reactivation post-cancer therapy and the hurdles in timely diagnosing lung cancer in tobacco users. Three cases are presented: A 60-year-old male with a history of pulmonary TB, bidi smoking, and a diagnosis of adenocarcinoma after presenting with persistent cough and imaging findings suggestive of lung cancer. A 57-year-old male, post-cancer treatment, presenting with cough, diagnosed with TB after immunosuppression, highlighting diagnostic challenges in this population. A 63-year-old female with a prolonged cough and blood streaks in sputum, not responding to anti-TB treatment, ultimately diagnosed with lung cancer due to tobacco use. These cases underscore the need for vigilant monitoring and early intervention in post-cancer individuals vulnerable to latent TB reactivation, comprehensive diagnostic approaches for immunocompromised patients, and heightened awareness of the association between tobacco use and lung cancer. The study emphasizes the importance of thorough assessments, timely interventions, and collaborative efforts among healthcare providers to optimize outcomes in patients with overlapping health concerns. In conclusion, this study sheds light on the complexities of managing patients with a history of cancer, TB, and tobacco use, advocating for a holistic approach in diagnosis and management to improve patient outcomes and quality of life. Further research and clinical guidelines are warranted to refine treatment strategies and enhance the care of individuals facing these dual health challenges. Keywords: Lung Cancer, Pulmonary Tuberculosis, Lung Cancer and Pulmonary.

Clinical and morphological characteristics of patients with chronic gastritis and high risk of gastric cancer

The purpose of this study is to conduct a clinical and morphological analysis of cases of chronic gastritis with a high risk of gastric cancer (GC). Materials and methods. The study included 26 cases of chronic atrophic gastritis of stages 3 and 4 with a high risk of developing GC according to the assessment using the OLGA system (Operative Link for Gastritis Assessment). The cases were diagnosed on material of gastric tissue biopsy in 2022. In total, 678 histological studies were performed during the year. Cases of chronic gastritis with a high risk of developing GC accounted for 3.8% of all chronic gastritis. Results. Cases of chronic gastritis with a high risk of developing GC were more often observed in older men (average age 67±12 years, ratio 2.25:1). Multifocal atrophic gastritis was in the first place in frequency of occurrence (61.5%), the connection with helicobacter infection was confirmed only in a third of cases (34.6%). Morphological changes were characterized by a predominant lesion of the antrum of the stomach and mixed complete and incomplete intestinal metaplasia. With the exception of one case in which pseudopancreatic metaplasia was detected in the antrum of the stomach, all cases of autoimmune gastritis (n=26) were assigned to stage 2 with a low risk of developing GC, which seems controversial to us. Conclusion. The results of our study showed a high percentage of pre-existing tumor lesions of the stomach in the group of chronic gastritis with a high risk of developing GC. Dysplasia was diagnosed in 5 out of 26 cases, GC with previously performed mucosectomy in 3 out of 26 cases. In addition, the patients had other tumor and precancerous lesions of the gastrointestinal tract. These data show the validity and practical value of using the OLGA system to identify high-risk groups for the development of tumors not only of the stomach, but also of gastrointestinal tumors of other localizations.

Finite element analysis and clinical application of 3D-printed Ti alloy implant for the reconstruction of mandibular defects

BackgroundThe reconstruction of segmental defect of the mandible has always been a challenge. The customized reconstruction plate without a bone graft is also considered a transitional means of rehabilitation and reconstruction in some cases.MethodsThis study evaluated the biomechanical behaviors of customized plates with different structural designs comparing with commercial plates using the finite element method in reconstrution of the lateral mandible defect.ResultsSimulations revealed the stress state in the plate bodies, bone tissues and screws were associated with the width, height, thickness of the plates as well as the distribution of screws. In all of the groups, the system of 16 mm-high, 2.8 mm-thick customized reconstruction plate with 10 screws was considered to be the most ideal design because of the most harmonious biomechanical state. What’s more, the stress shielding effects were not obvious in this experiment. Based on the above findings, we conducted a clinical case analysis to verify the mechanical properties of customized reconstruction and obtained a satisfactory operation result.ConclusionsThe results show that by adjusting the contour parameters of the reconstruction plates, an ideal and reliable customized plate can be manufactured. And the customized 3D-printed Ti alloy implant will be a new way to achieve mandibular reconstruction in patients unable to perform autologous bone graft surgery.Trial registrationThe present trial has been registered with ChiCTR, the registration number is ChiCTR 2,000,038,973 on 11/10/2020.

Epidemiology of amyotrophic lateral sclerosis in the Krasnoyarsk region

Background. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes paralysis of muscles due to degeneration of motor neurons. According to available data, the incidence of ALS in different regions of the world is from 0.6 to 3.8 per 100,000 population per year. Data obtained during the study of the epidemiology of ALS at the regional level can be used in planning medical resources, in particular, calculating the necessary respiratory equipment and funds for nutritional support.Aim. Clinical and epidemiological analysis of ALS cases registered in the Krasnoyarsk region for the period 2018–2022.Materials and methods. A clinical and epidemiological analysis of ALS cases registered in the Krasnoyarsk region from 2018 to 2022 was conducted. To do this, we used data from the specialized office of neuromuscular pathology of the Regional Clinical Hospital in Krasnoyarsk and the Krasnoyarsk Regional Medical Information and Analytical Center. Diagnosis verification was carried out in accordance with the generally accepted El Escorial and Gold Coast criteria. The functional state and degree of neurological deficit were assessed using the ALS-FRS-R scale.Results. Over the period from 2018 to 2022, 78 cases of ALS were registered. The incidence rate was 0.54 cases per 100,000 population per year. In 2022, the prevalence rate was 1.16 cases per 100 thousand population. The time from symptom onset to diagnosis of the disease ranged from 4 to 57 months, with the average time to diagnosis being 17 months. Most patients were diagnosed with ALS when their ALS-FRS-R score decreased by 7–11 points. The division of patients into groups of rapid, moderate, and slow diagnostic correlates with life expectancy. Patients who are diagnosed quickly have a higher rate of disease progression, which results in a low life expectancy.Conclusion. The creation of specialized centers will improve the diagnosis and management of patients with ALS and plan the costs of palliative care. The increase in the incidence and detection of ALS emphasizes the need to develop new approaches to the treatment and rehabilitation of patients with ALS.