Clinical Course Of Disease Research Articles

Psycho-Neuro-EndocrinE-Immunology Therapy of Cancer, Autoimmunity, Geriatric Disorders, Covid-19, and Hypertension.

Despite the great number of experimental investigations in the area of psycho-neuro-endocrine-immunology showing that endocrine, nervous, and immune systems cannot be in vivo physiologically separated, the diagnosis and therapies of the pathologies of these three functional biological systems continue to be separately performed from a clinical practice point of view. The separation between experimental and clinical medicine became dramatic after the discovery of more than 10 human molecules provided by anti-inflammatory and antitumor activity, completely devoid of any toxicity, which may be subdivided into three fundamental classes, consisting of the pineal indole, beta-carboline, and methoxy-kynuramine hormones. Moreover, human systemic diseases, including cancer, autoimmunity, and cardiovascular pathologies, despite their different pathogenesis and symptomatology, are commonly characterized by a progressive decline in the endogenous production of pineal hormones, endocannabinoids, and Ang 1-7, with a consequent inflammatory status and diminished natural resistance against cancer. Then the evaluation of the functional status of the pineal gland, the endocannabinoid system, and ACE2-Ang 1-7 axis should have to be included within the laboratory analyses for the systemic diseases. Finally, the correction of cancer- and autoimmunity-related neuroimmune and neuroendocrine alterations could influence the clinical course of systemic diseases. In fact, preliminary clinical results would demonstrate that the neuroimmune regimen with pineal hormones, cannabinoids, and Ang 1-7 may allow clinical benefits also in patients affected by systemic pathologies, including cancer, autoimmunity, and cardiovascular diseases, who did not respond to the standard therapies.

Obstructive sleep apnea in patients with fibrotic interstitial lung disease (non-idiopathic pulmonary fibrosis): what should be offered?

Objective: The frequency of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is high. The clinical course of non-IPF interstitial lung disease (ILD) can be similar to that of IPF. We sought to assess the frequency and predictors of OSA in patients with non-IPF fibrotic ILD, as well as the impact of positive airway pressure (PAP) therapy on the quality of life of such patients. Methods: This was a prospective study in which non-IPF fibrotic ILD patients underwent a home sleep apnea test. The patients with and without OSA were compared, and a multivariate logistic regression model was used to identify independent predictors of OSA. At 3 months after initiation of PAP therapy, we evaluated the participating patients for respiratory events, nocturnal hypoxemia, and changes in quality of life. Results: Of a total of 50 patients, 50% were male, and 76% were diagnosed with OSA. The mean age was 67.8 ± 8.3 years. The patients with OSA had significantly lower TLC (p = 0.033) and awake SpO2 (p = 0.023) than did those without OSA. In the multivariate logistic regression model, SpO2 (OR = 0.46; p = 0.016) and TLC (OR = 0.95; p = 0.026) remained significantly associated with OSA risk. A total of 12 patients received PAP therapy. At 3 months after initiation of PAP therapy, 91.7% were well controlled, Epworth Sleepiness Scale scores decreased significantly (p = 0.006), and emotional well-being tended to improve (p = 0.068). PAP therapy corrected nocturnal hypoxemia in all patients. Conclusions: We found a high frequency of OSA in patients with non-IPF fibrotic ILD. A low TLC was an independent predictor of a higher risk of OSA. PAP therapy can correct nocturnal hypoxemia. There should be a low threshold for suspicion of OSA and initiation of PAP therapy in patients with non-IPF fibrotic ILD.

INVESTIGATING ETIOPATHOGENETIC FACTORS OF LEFT VENTRICULAR REMODELING AS THE UNDERLYING MECHANISM OF ISCHEMIC MITRAL REGURGITATION

The purpose of this study is to determine the etiopathogenetic features of the development of ischemic mitral regurgitation in patients with coronary heart disease by investigating the mechanisms of left ventricular remodeling. Materials and Methods. The study included 140 patients (99 male, 41 female) with ischemic mitral regurgitation who underwent myocardial revascularization and mitral valve reconstruction (either repair or replacement). The average age of participants was 65.9 ± 4.0 years, and all had a history of coronary heart disease and ischemic mitral regurgitation. All patients in the sample underwent operations for myocardial revascularization and mitral valve reconstruction (replacement). The data analyzed were obtained from primary medical documentation, including medical histories, patient medical charts, findings of physical and clinical examinations, laboratory and instrumental evaluations, as well as echocardiography findings. The data obtain were processed statistically. Results. This article presents an analysis of the etiopathogenetic features associated with the development of ischemic mitral regurgitation under the clinical course of coronary heart disease. The study examined several etiopathogenetic factors, including the presence of arterial hypertension, left ventricular hypertrophy, and the type of left ventricle remodeling. It was found that 39.1% of patients in the experimental group and 40.8% in the control group had hypertension (p ≥ 0.05). The most prevalent condition was grade II arterial hypertension, which occurred in 52.3% of the experimental group and 60.6% of the control group (p ≥ 0.05). When analyzing the occurrence rate of left ventricular hypertrophy, mild hypertrophy was significantly more common in the experimental group (44.9%) compared to the control group (26.8%) (p = 0.03, χ² = 4.27). Moderate left ventricular hypertrophy was found to be significantly higher in the control group (45.1%) compared to the experimental group (27.5%) (p = 0.04, χ² = 3.92). Eccentric hypertrophy of the left ventricle was prevalent in both groups, with values of 79.7% in the experimental group and 80.3% in the control group. In contrast, the frequency of concentric hypertrophy was higher in the control group (8.4%) compared to the experimental group (2.9%) (p ≥ 0.05). Conclusions: The study has established that the incidence of ischemic heart disease and ischemic mitral regurgitation is significantly associated with sex, with men being affected more frequently than women. Analysis of arterial hypertension revealed that 39.1% of patients in the experimental group and 40.8% in the control group were affected, with grade II arterial hypertension being the most common. Moderate and severe left ventricular hypertrophy, as well as concentric remodeling of the left ventricle, were characteristic of patients who underwent mitral valve replacement. These findings underscore the importance of left ventricular remodeling in determining the appropriate surgical treatment for mitral valve conditions.

EPID-21. PRIMARY INTRAMEDULLARY LYMPHOMA OF SPINAL CORD (PILSC): A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES FROM 2000 TO 2023

Abstract BACKGROUND AND OBJECTIVE Primary CNS lymphoma accounts for three percent of all newly diagnosed CNS tumours and 1-3% of all non-Hodgkin’s lymphomas. The oncologic origin of primary intramedullary lymphoma of the spinal cord (PILSC) is an enigma. We aim to determine the clinical manifestations, disease course and management of PILSC. MATERIALS AND METHODS A comprehensive literature search using PubMed Central and Google Scholar, was done, retrieving 17 case reports and two case series of 21 patients with PILSC and included using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, published between 2000 and 2023. RESULTS About 90.48% patients inflicted with PILSC were adult, with male predominance, 61.90%. The most common complaint at presentation was neurological deficit of motor type in 32.14% patients. MRI proved to be helpful in 76.19% cases, with spinal cord enlargement and high signal intensity in 19.04% cases. Adjuvant chemotherapy and radiotherapy was acquired by 52.38% and 38.09% patients. Non-Hodgkin type was reported in 90.47% cases and Hodgkin lymphoma was seen in 9.52% patients. Diffuse large B cell lymphoma was culprit in 41.10% cases. Five out of 21 cases had variable post-operative complications. The average follow-up was 16.16 months. CONCLUSION PILSC is a multifaceted neoplasm in all its clinico-pathological aspects of presentation. Although rare, PILSC can involve adult and paediatric populations with a clear male preponderance. The MRI findings are not reliable to make a preliminary diagnosis. Like other lymphomas, the role of chemoradiotherapy is clearly more significant than surgical intervention in improving patient prognosis. Histopathologically, it can be Non-Hodgkin or Hodgkin, B-cell type or T-cell type and has a wide array of immunohistochemistry positivity.

Correction of the clinical course of non-alcoholic steatohepatitis and diabetic kidney disease in patients with type 2 diabetes

Background. The relevance of finding optimal methods to treat patients with a comorbid non-alcoholic steatohepatitis (NASH) that developed against the background of type 2 diabetes mellitus (T2DM) is due to the fact that these diseases have a number of common cause-and-effect mechanisms, and if diabetic kidney disease (DKD) develops, also mutual burden mechanisms. The purpose of the study was to find out the possible influence of a combination of metformin, rosuvastatin, essential phospholipids and quercetin on the clinical course of non-alcoholic steatohepatitis, diabetic kidney disease, type 2 diabetes mellitus, as well as on the state of the blood lipids, parameters of carbohydrate metabolism compensation, the degree of insulin resistance, which are factors for the progression of NASH and diabetic kidney disease. Materials and methods. Studies were conducted on the dynamics of treatment in 60 patients with NASH, T2DM and DKD stage I–III: 48 (80.0 %) of them had mild NASH, and 12 (20.0 %) had moderate NASH. A comorbid disease in 100 % of patients was moderate type 2 diabetes: 15 (25.0 %) people were diagnosed with diabetes in the stage of compensation, 45 (75.0 %) had subcompensated disease. Results. The positive effect of quercetin was noted by us in relation to the content of low-density lipoprotein cholesterol in the blood that was increased by 1.8 times (p < 0.05) before the treatment: a decrease after it was 1.7 times (p < 0.05) in group 2 and 1.3 times (p < 0.05) in group 1. Comprehensive therapy with the inclusion of quercetin contributed to a probable increase in anti-atherogenic high-density lipoprotein (by 1.3 times, p < 0.05) with the normalization of the indicator after the treatment, while traditional therapy in this contingent did not lead to any probable changes. Conclusions. The combination therapy for type 2 diabetes mellitus and NASH with the addition of quercetin contributed to the elimination of the main clinical and laboratory symptoms of NASH exacerbation, a probable reduction in the liver inflammation (a decrease in markers of cytolysis, mesenchymal inflammation), reversal of hepatic steatosis due to the optimization of cholesterol and triacylglycerols in the blood, a probable increase in high-density lipoproteins, normalization of glycemia, reduction of insulinemia, a decrease in the degree of insulin resistance. The effectiveness of treatment for DKD was also increased: the rate of proteinuria and the degree of hypercreatinemia decreased, and the glomerular filtration rate increased.

Characterization of a Mycoplasma hyopneumoniae aerosol infection model in pigs

The purpose of the present study was to develop and characterize an experimental aerosol model for Mycoplasma hyopneumoniae (M. hyopneumoniae) infection and respiratory disease in pigs. The experiment was carried out to determine the pathogenicity, colonization, mucosal immune response, and clinical course of disease of dose-controlled aerosols of M. hyopneumoniae. Four groups of three M. hyopneumoniae-free gilts each were individually exposed to aerosols of diluted lung homogenate containing M. hyopneumoniae strain 232 in a chamber. Each group was exposed to different doses of viable organisms (105 to 106 color changing units/mL during 15-20 or 30-35min in two consecutive days). Nasal, laryngeal, and deep-tracheal secretions were collected from each gilt at 0, 7, 14, 21, and 28 days post-exposure (dpe). Blood samples were collected at 0 and 28 dpe. At necropsy, lung lesions were assessed, and bronchial secretions and bronchoalveolar lavage fluid (BALF) were collected from each lung set. Blood was used to assess seroconversion by means of an indirect ELISA, while BALF, deep-tracheal and nasal secretions were tested by modifying the ELISA to evaluate mucosal IgG and IgA production. Nasal, laryngeal, deep-tracheal, and bronchial secretions were tested by real-time PCR to evaluate bacterial load. Gilts became infected irrespective of the infectious dose, as determined by M. hyopneumoniae detection in deep-tracheal secretions from all gilts at 7 dpe. A specific local humoral immune response starting at 14 dpe was detected in all gilts. While all experimental groups presented gilts with some extent of mycoplasmal pneumonia, only the exposure of gilts to high-dose aerosols consistently reproduced typical clinical signs and severe lung lesions. These results showed that the reproduction of mycoplasmal pneumonia by means of infectious aerosols can be successfully achieved at experimental level, making this model a valuable alternative to evaluate preventive and treatment measures against M. hyopneumoniae.

Long-Term Infection With a Particular Human Papillomavirus (HPV) Genotype, HPV Subtype, or HPV Genomic Variant Does not Significantly Influence the Clinical Course of Recurrent Respiratory Papillomatosis.

Recurrent respiratory papillomatosis (RRP) is caused by human papillomaviruses (HPV) 6 and 11, but the role of their genomic variants in the disease's clinical course is unclear. This study investigated whether long-term persistence of a particular HPV genotype, subtype or genomic variant influences the RRP clinical course. HPV genotyping was performed in paired baseline and follow-up RRP laryngeal tissue specimens of 59 patients. HPV6 and HPV11 genomic variants were determined in paired tissue specimens taken at least 10 years apart in 20 selected patients. HPV was identified in 58/59 patients, most commonly HPV6 (40/58), followed by HPV11 (17/58). The most prevalent HPV genomic variant was HPV11 A2. HPV6 A and HPV6 B1 were most frequent in aggressive RRP. In all patients, identical HPV genomic variants were identified in both paired specimens. RRP results from a long-term infection with the same HPV genomic variant that can be identified decades after disease onset. We report the longest duration of genetically confirmed persistent HPV infection in peer-reviewed literature, during a 44-year interval in a patient with HPB6 B1. This study suggests that infection with a particular HPV genotype, subtype, or genomic variant does not significantly influence the clinical course of RRP.

Lipid-associated GWAS loci as important markers of the risk, severity, and clinical course of peripheral artery disease

ABSTRACT Background This study investigated the relationship between lipid-associated loci identified through genome-wide association studies (GWAS) and the risk of peripheral artery disease (PAD), its severity, as well as clinical and laboratory features. Research design and methods A study included 1263 unrelated Russian subjects, consisting of 620 patients diagnosed with PAD and 643 healthy controls. Thirteen single nucleotide polymorphisms (SNP) were genotyped using the MassArray-4 system. Results Polymorphisms rs1689800, rs55730499 and rs881844 were found to be associated with an increased risk of PAD, whereas SNPs rs1883025, rs3136441, rs3764261 and rs6065906 showed protective effects against disease (Pperm ≤ 0.05). SNPs rs1689800, rs217406, rs1883025, and rs3136441 exhibited combined effects with cigarette smoking on the PAD risk (Pperm ≤ 0.05). Polymorphisms rs55730499 (beta = 0.124, Pperm = 0.04), rs9987289 (beta = 0.558, Pperm = 0.03), and rs881844 beta = −0.171, Pperm = 0.03) correlated with the ankle-brachial index. Multiple associations have been found between the SNPs and clinically significant characteristics, including disease severity, risk of gangrene, early disease onset, plasma procoagulant and atherogenic lipid changes (Pperm ≤ 0.05). Conclusions We identified novel genetic markers associated with PAD susceptibility and disease-related clinical and laboratory features. The identified biomarkers enhance the potential for predictive genetic testing related to the risk and progression of PAD, facilitating the integration of molecular diagnostics into clinical decision-making processes.

Novel Emerging Targets Identification in Reducing Risk of Alzheimer's Disease.

The accumulation of tau-containing neurofibrillary tangles and beta-amyloid deposits has been identified as the hallmark of Alzheimer's disease. Alzheimer's disease (AD) is a hereditary and neurological condition that can result in non-amnestic cognitive decline in less common forms and amnestic memory loss in its classic form. While Alzheimer's disease is the most prevalent cause of memory loss in middle-aged and older adults, other neurodegenerative and cerebrovascular disorders can have an impact on the disease's clinical course. Designing multi-target-directed ligands (MTDLs) is a very promising modern approach. This methodology was designed specifically for treating disorders with complex pathological mechanisms. Among these disorders is Alzheimer's disease (AD), which is currently the most prevalent multifactorial neurodegenerative illness. Increased amounts of the amyloid βpeptide (Aβ) and hyperphosphorylated tau protein, together with the loss of neurons and synapses, are linked to Alzheimer's disease (AD). Additionally, there is evidence that the pathophysiology of this condition is influenced by oxidative stress, metal ion dysregulation, inflammation, and failure of the cell cycle regulatory system. Since Alzheimer's disease (AD) is a multi-factor illness, there are many attractive targets for the development of anti-AD medications. These molecules can be useful in treating AD since they are multi-target-directed. This review focuses on the discovery of dual and multi-acting anti-AD drug candidates, especially hybrids made by combining chemically active moieties that function against distinct targets. The first group of substances consists of cholinesterase inhibitors with extra properties or those that function as multiple binding site inhibitors. Natural products also provide numerous options for slowing the progression and symptoms of many diseases, including Alzheimer's Meanwhile, Natural chemical structures with the following characteristics: alkaloids, sterols, triterpenes, tannins, flavonoids, polyphenols, and antioxidants as well as anti-inflammatory and anti-amyloidogenic properties. We provide an overview of Alzheimer's disease pathophysiology and therapy targets in this study. We also show several isolated chemicals and medicinal plants that are used to treat and prevent the symptoms of Alzheimer's disease.

Clinical insights into Invasive Aspergillosis in Mexican children with cancer

Abstract Background In the last years Invasive Aspergillosis (IA) has become the most frequent invasive fungal infection (IFI) affecting children with hematological malignancies. This complication results in the delay of cancer treatment and/or poor prognosis mainly due to late diagnosis and late start of antifungal treatment. Therefore, antifungal prophylaxis and preemptive approaches have been proposed for these patients based on risk factors and local epidemiological data. For this reason, we performed a unicenter, descriptive and prospective study to determine the frequency and clinical course of IA in hospitalized cancer patients with fever and neutropenia. Methods we included events of fever and neutropenia of hospitalized patients with cancer and either with persistent febrile neutropenia (PFN: fever for >96h with total neutrophil count of <500cells/mm3) or profound prolonged neutropenia (PPN: total neutrophil count of <500cells/mm3 for >7 days). Informed consent was requested prior inclusion and follow up of these events was performed with weekly measurement of serum galactomannan antigen (until the recovery of neutrophil count), lung computed tomography (CT) and/or sinus and/or central nervous system (CNS) imaging, depending on clinical findings, and if feasible bronchoscopy to obtain bronchioalveolar lavage (BAL) samples. Clinical and laboratory data were obtained; with this information diagnosis of IA was classified as possible, probable, and proven, according to the EORTC/MSG guidelines. This protocol was approved by the hospital’s research and ethics committees (INP 041/2021). For data analysis categorical variables were presented as frequencies and numerical variables as median and range. Statistical analysis was made with X2 and U Mann Whitney tests. Results Seventy events were included, 14 (20%) had IA diagnosis; 2 possible, 11 probable and 1 proved. Median of age was 10.2y (5.5 – 17) and 64.3% were male. Acute lymphoblastic leukemia was the main oncologic diagnosis (71.4%), 35.7% during induction phase; followed by acute myeloblastic leukemia (21.4%). 92.9% of events with IA presented as PFN (p=0.001) with a fever duration of 3.5 days (1-8) (p=0.004). Pulmonary disease was evident in all events with IA, two had disseminated infection. In 5/14 events serum galactomannan antigen was positive in the first measurement. Only 8 events underwent bronchoscopy: BAL was positive in 6 and 4 had positive culture with Aspergillus spp. Lung CT scan showed different findings, lobar/segmental consolidation and nodule with halo sign were the most common; 85.7% of cases presented with more than one radiological sign (p=0.003). Voriconazole monotherapy was given to 78.5% of IA cases and 21.4% required combined antifungal therapy (added caspofungine or liposomal amphotericin B) due to disseminated disease or severe clinical course. Intensive care admission resulted with statistical significance for the events with diagnosis of IA (64.3% p= 0.019). Within the IA events survival at 60 days was of 78.6%. Conclusion Frequency of IA was high among our high risk cancer patients. This study demonstrates the importance of a complete work up for invasive fungal infection in high-risk patients with persistent febrile neutropenia. The information obtained is of great use for the implementation of pre-emptive approaches and antifungal prophylaxis in this patient population.

Intrathoracic Sleeve Migration Following Sleeve Gastrectomy: Incidence and Outcomes.

With laparoscopic sleeve gastrectomy (LSG) taking its place as the primary metabolic bariatric procedure in the past decade, de novo or persistent gastroesophageal reflux disease (GERD) has come into the spotlight as one of the most debilitating postoperative complications. Among the causes of GERD, intrathoracic migration (ITM) of the sleeve has become an understated yet significant phenomenon. This study aims to analyze the actual incidence of spontaneous ITM at our center, as well as its relationship to the baseline characteristics of patients and perioperative outcomes. A retrospective chart review of 206 patients who had undergone LSG at our center from July 2019 to December 2022 was done. At 1-year follow-up, a non-enhanced abdominopelvic computed tomography (CT) scan and esophagogastroduodenoscopy (EGD) were performed, and these exams were repeated annually. Baseline characteristics and perioperative outcomes including the clinical disease course of GERD were compared. The incidence of ITM was 14% (n = 29). There was a significant correlation between ITM and postoperative reflux symptoms (p = 0.001). The mean duration of anti-reflux medication use was also significantly longer in the ITM group than in the no ITM group at 17 and 11months, respectively (p = 0.004). A significantly higher number of patients in the ITM group were diagnosed with esophagitis on postoperative EGD than in the no ITM group (p = 0.002). The incidence of ITM using non-enhanced CT was 14%. ITM was significantly correlated to clinical reflux and EGD-confirmed esophagitis.

S1152 The Clinical Course of Inflammatory Bowel Disease in Patients Receiving Cancer Therapy

S1152 The Clinical Course of Inflammatory Bowel Disease in Patients Receiving Cancer Therapy

Quality of Life Indices in Patients with Coronary Heart Disease with Stable Angina Pectoris Accompanied by Non-alcoholic Steatohepatitis after Complex Treatment Supplemented with Ezetimibe and Ursodeoxycholic Acid

Introduction. Coronary heart disease (CHD) is often complicated by the presence of concomitant diseases, especially non-alcoholic fatty liver disease (NAFLD). According to the data from numerous studies, it is known that the number of cardiovascular complications in patients with NAFLD is increasing. This negatively affects the clinical course of both diseases, worsens the quality of life of patients and increases the percentage of cardiovascular mortality among the population. The aim of the study. To evaluate the quality of life indicators in patients with coronary heart disease with stable angina pectoris in combination with nonalcoholic steatohepatitis after complex therapy including ezetimibe and ursodeoxycholic acid. Materials and methods. The study involved 145 patients with a verified diagnosis of coronary heart disease, stable angina pectoris II functional class combined with nonalcoholic steatohepatitis (NASH) and 100 patients with coronary heart disease without NASH. There were 140 men (57.0 %), and 105 women (43.0 %). The average age of patients is 55.3 ± 6.3 years. Results. A decrease in the number of angina attacks and the need to use nitroglycerin per week was registered in patients with coronary artery disease in combination with NASH under the influence of the treatment, which was more pronounced in the group with the addition of ezetimibe and ursodeoxycholic acid (UDCA). According to the Medical Outcomes Study 36-Item Short-Form Health Status (SF-36) questionnaire after treatment, a tendency to improve most of its indicators was revealed, which was more clearly observed in patients in the group with the addition of ezetimibe and UDCA. Also, according to the EuroQoL-5D (EQ-5D) questionnaire, significant positive dynamics of the quality of life were found for all indicators, which were more reliably increased in the group with the addition of ezetimibe and UDCA. According to the Seattle Angina Questionnaire (SAQ), after treatment, reliable positive changes on 4 scales were observed in patients in the group with the addition of ezetimibe and UDCA. Conclusion. The inclusion of ezetimibe and ursodeoxycholic acid in the basic therapy has a positive effect on the clinical course of coronary heart disease in combination with non-alcoholic steatohepatitis, the quality of life of patients and the patient's attitude to his disease.

Clinical characteristics, diagnosis and short-term outcomes of COVID-19-associated acute myocarditis in China.

Acute myocarditis (AM) has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) infection. This study was conducted to present the clinical characteristics, disease courses and short-term prognoses of Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induced AM in China, which has been unavailable so far. Data from 28 patients diagnosed with definite COVID-19-associated AM from 6 hospitals in China between 1 December 2022 and 30 June 2023 were collected and analysed. The diagnosis of AM was based on increased troponin level plus typical findings of AM on cardiac magnetic resonance (CMR) imaging and/or endomyocardial biopsy. Among 28 patients with definite COVID-19-related AM, median age was 37years (Q1-Q3: 22-52) and 53.6% were men. Twenty-three patients occurred within 2weeks of the onset of COVID-19 infection, 10 patients underwent endomyocardial biopsy and CMR was performed in all patients. Seven (25.0%) patients developed fulminant myocarditis that required inotropic agents or temporary mechanical circulatory support. Of the nine patients (32.1%) with left ventricular ejection fraction (LVEF) below 50% on admission, five had fully recovered LVEF and two demonstrated improvement but to levels below normal at discharge. The comparison of CMR parameters between the baseline and first follow-up showed that ECV was decreased at the first follow-up [28.95 (25.38, 32.55)% vs. 33.65 (31.58, 37.55)%, P=0.028), while other CMR parameters had no significant changes. Eighteen patients (64.3%) were prescribed with corticosteroids, and seven patients (25.0%) underwent temporary mechanical circulatory support. Only two patients died during hospitalization. The majority of COVID-19-associated AM occurred within 2weeks of Omicron variant infection. Fulminant myocarditis complicated by hemodynamic instability requiring temporary mechanical circulatory support was not uncommon. However, short-term outcome was generally good and most AM patients fully recovered.

Emulating target trials of postexposure vaccines using observational data.

Postexposure vaccination has the potential to prevent or modify the course of clinical disease among those exposed to a pathogen. However, due to logistical constraints, postexposure vaccine trials have been difficult to implement in practice. In place of trials, investigators have used observational data to estimate the effectiveness or optimal timing window for postexposure vaccines, but the relationship between these analyses and those that would be conducted in a trial is often unclear. Here, we define several possible target trials for postexposure vaccination and show how, under certain conditions, they can be emulated using observational data. We emphasize the importance of the incubation period and the timing of vaccination in trial design and emulation. As an example, we specify a protocol for postexposure vaccination against mpox and provide a step-by-step description of how to emulate it using data from a healthcare database or contact tracing program. We further illustrate some of the benefits of the target trial approach through simulation.

'Exerkines': A Comprehensive Term for the Factors Produced in Response to Exercise.

Regular exercise and physical activity are now considered lifestyle factors with positive effects on human health. Physical activity reduces disease burden, protects against the onset of pathologies, and improves the clinical course of disease. Unlike pharmacological therapies, the effects mediated by exercise are not limited to a specific target organ but act in multiple biological systems simultaneously. Despite the substantial health benefits of physical training, the precise molecular signaling processes that lead to structural and functional tissue adaptation remain largely unknown. Only recently, several bioactive molecules have been discovered that are produced following physical exercise. These molecules are collectively called "exerkines". Exerkines are released from various tissues in response to exercise, and play a crucial role in mediating the beneficial effects of exercise on the body. Major discoveries involving exerkines highlight their diverse functions and health implications, particularly in metabolic regulation, neuroprotection, and muscle adaptation. These molecules, including peptides, nucleic acids, lipids, and microRNAs, act through paracrine, endocrine, and autocrine pathways to exert their effects on various organs and tissues. Exerkines represent a complex network of signaling molecules that mediate the multiple benefits of exercise. Their roles in metabolic regulation, neuroprotection, and muscle adaptation highlight the importance of physical activity in maintaining health and preventing disease.

Is cardiac function associated with the clinical course of disease in patients with gout? A prospective study.

To analyze the function of the left heart in patients with different courses of gout, the independent influencing factors for left heart functional changes, and interactions between left atrial and left ventricular functions. Patients with gout (n=171) were selected; 87 patients with a disease course <10 years were included in Group I, and 84 patients with a disease course ≥10 years were included in Group II. Ninety-four healthy volunteers comprised the control group. The intergroup differences in cardiac strain parameters were statistically significant (p<.05). Moreover, the differences gradually declined with disease progression. Multivariate logistic regression analysis showed that uric acid was an independent predictor of decreased left ventricular global longitudinal strain (LVGLS). Moreover, LVGLS had a positive effect on the left atrial systolic rate (LASr) and the left atrial systolic contraction time (LASct) but no interaction with the left atrial systolic contraction duration (LAScd). The course of the disease significantly affected the function of the left heart in gout patients, and uric acid was observed to be an independent predictor of decreased LVGLS in gout patients.

Факторы и уровень суммарного сердечно-сосудистого риска у населения северо-востока России

In northern regions, cardiovascular pathology tends to be more aggressive, is likely to occur at a young age already and often results in disability and even mortality among people who have not yet reached the retirement age. The aim of this study was to assess the structure and age-specific dynamics of basic factors able to cause cardiovascular diseases in men living in northern regions and the total cardiovascular risk. We conducted a one-center experimental cross-sectional comparative one-sample study of 116 men living in the north of the Magadan region. The complex study program included questioning, anthropometric examination, laboratory biochemical tests and molecular-genetic screening of candidate genes of essential hypertension (AGT (rs 4762), AGTR1 (rs5186), ADD1 (rs4961), NOS3 (rs2070744), and АСЕ (rs4340)). Genotyping was performed using real-time polymerase chain reaction. The total cardiovascular risk was calculated using the SCORE scale. The structure of basic risk factors that can cause cardiovascular diseases in men in the Magadan region includes both modifiable (smoking, obesity, essential hypertension, and dyslipidemia) and non-modifiable ones (climatic-geographic and genetic risk factors) in various age groups. With age, risk factors exert stronger influence on each other thus aggravating the clinical course of cardiovascular diseases and increasing risks of fatal cardiac events. This is especially important for northern regions where people are exposed to such non-modifiable risk factors as extreme climate. Moderate risk of cardiovascular diseases (according to the SCORE scale) was established for all men living in the North already at a young age. Therefore, a key task is to develop a strategy for active prevention of cardiovascular pathology that covers public at large starting from younger age groups.

Factors and level of the total cardiovascular risk for people in the north-eastern Russia

In northern regions, cardiovascular pathology tends to be more aggressive, is likely to occur at a young age already and often results in disability and even mortality among people who have not yet reached the retirement age. The aim of this study was to assess the structure and age-specific dynamics of basic factors able to cause cardiovascular diseases in men living in northern regions and the total cardiovascular risk. We conducted a one-center experimental cross-sectional comparative one-sample study of 116 men living in the north of the Magadan region. The complex study program included questioning, anthropometric examination, laboratory biochemical tests and molecular-genetic screening of candidate genes of essential hypertension (AGT (rs 4762), AGTR1 (rs5186), ADD1 (rs4961), NOS3 (rs2070744), and АСЕ (rs4340)). Genotyping was performed using real-time polymerase chain reaction. The total cardiovascular risk was calculated using the SCORE scale. The structure of basic risk factors that can cause cardiovascular diseases in men in the Magadan region includes both modifiable (smoking, obesity, essential hypertension, and dyslipidemia) and non-modifiable ones (climatic-geographic and genetic risk factors) in various age groups. With age, risk factors exert stronger influence on each other thus aggravating the clinical course of cardiovascular diseases and increasing risks of fatal cardiac events. This is especially important for northern regions where people are exposed to such non-modifiable risk factors as extreme climate. Moderate risk of cardiovascular diseases (according to the SCORE scale) was established for all men living in the North already at a young age. Therefore, a key task is to develop a strategy for active prevention of cardiovascular pathology that covers public at large starting from younger age groups.

54636 Clinical Features and Disease Course of Hydroa Vacciniforme: A Systematic Review

54636 Clinical Features and Disease Course of Hydroa Vacciniforme: A Systematic Review