Systemic Disease Research Articles

Morbidity rates dynamics among the military women of the Russian Ministry of Defense (2012 to 2021)

Relevance. Extreme military service conditions can reduce functional reserves of the military, provoking early development of occupational disorders.The objective is to study morbidity rates dynamics for the last decade (2012–2021) and evaluate the epidemiological significance of different disease chapters among military women to improve their health status.Methods. The study focused on women serving in the Russian military forces with the aim to analyze their morbidity rates over a decade (2012–2021), as presented in the medical report database (3/MED form) and available publications. Medical and statistical codes for main disease chapters are indicated according to the International Statistical Classification of Diseases and Health Related Problems, 10th revision (ICD-10). Morbidity was calculated per 1,000 military women or in ppm (‰), while mortality was calculated per 100,000 persons or 10–5. The average annual indicators calculated based on absolute data, arithmetic averages, errors (M ± m) are provided in study as well. Trends were assessed using dynamic time serie analysis and a second-order polynomial trend.Results and discussion. The long-term average incidence (total morbidity) was 1653.1 ‰, with primary morbidity – 770.6 ‰, regular follow-up – 186.3 ‰, hospitalization – 347.2 ‰, cases requiring a sick leave due to disability – 898.9 ‰, days of disability-related absence from work – 6964 ‰, dismissal rate – 5.11 ‰, mortality rate – 59.2 ∙ 10–5. Polynomial trends in morbidity tracking indicated decreasing trends, with varying significance of determination coefficients. In terms of their social and epidemiological significance, 8 disease chapters (listed in order of severity according to ICD-10) were the major contributors to the military women morbidity: diseases of the respiratory systems (Chapter X), neoplasms (Chapter II), diseases of the circulatory system (Chapter IX), diseases of the musculoskeletal system and connective tissue (Chapter XIII), diseases of the genitourinary system (Chapter XIV), endocrine, nutritional and metabolic diseases (Chapter IV), injury, poisoning and certain other consequences of external causes (Chapter XIX), diseases of the digestive system (Chapter XI).Conclusion. The diseases presented in the above 8 chapters of the ICD-10 were responsible for 87.8 % of socially and epidemiologically significant morbidities. Thus, timely diagnosis, treatment, rehabilitation, and prevention are required to remarkably improve the health status in military women.

Oral Health and Systemic Disease: A Systematic Review of the Impact of Dental Care on Overall Health

Oral health is increasingly recognized as a critical component of overall health, with research highlighting its potential impact on various systemic diseases. This systematic review examines the current evidence on the association between oral health, particularly dental care, and systemic conditions such as cardiovascular disease, diabetes, respiratory illnesses, and adverse pregnancy outcomes. A comprehensive literature search was conducted across multiple databases, focusing on studies published from 2016 onward. Studies indicate that periodontal disease and other oral health issues may contribute to systemic inflammation, a common factor in many chronic conditions. Specifically, findings suggest that managing oral health can have beneficial effects on cardiovascular health, glycemic control in diabetic patients, and respiratory function, as well as reduce risks for adverse pregnancy outcomes. However, while associations are evident, causality remains difficult to establish, and further longitudinal research is needed to clarify these relationships. This review underscores the importance of incorporating dental care into holistic health approaches, advocating for greater collaboration between dental and medical professionals. Public health initiatives promoting regular dental check-ups and preventive care may play a crucial role in improving overall health outcomes.

RADT-42. DISSEMINATED TUMORAL AMYLOIDOSIS OF THE CRANIAL NERVES IN THE ABSENCE OF SYSTEMIC DISEASE: CASE REPORT

Abstract Tumoral amyloidosis, characterized by tumor-like deposits without systemic disease, is rare in the central nervous system. Most often located in the periventricular white matter, tumoral amyloidosis typically consist of immunoglobulin light chains (AL). While prior reports describe cases of tumoral amyloidosis isolated to the trigeminal nerve, we report herein a first known case of diffuse cranial nerve involvement. The patient is a 43-year-old man who presented with left trigeminal dysesthesias, which led to self-excoriation and erosion of the left naris. On exam, he had absent sensation in the V1-V3 distributions, left trochlear nerve palsy, and bilateral abducens nerve palsies. Imaging demonstrated significant thickening of the left trigeminal nerve and diffuse cisternal contrast enhancement of the other cranial nerves, including the oculomotor, abducens, facial, and glossopharyngeal nerves. Work-up began with a lumbar puncture that found elevated protein with otherwise benign results, including flow cytometry. He was therefore recommended to undergo open biopsy of the left trigeminal nerve and cavernous sinus. Pathology from this surgery demonstrated congo red- positive AL amyloid deposits. Following this pathologic diagnosis, he subsequently underwent a full workup for systemic amyloidosis including bone marrow biopsy, abdominal fat pad biopsy, and a PET CT scan. Biopsy of a long nodule was negative for amyloidosis. Systemic amyloid testing did not demonstrate non-CNS sites of amyloid deposition. Medical therapy with daratumumab, cyclophosphamide, bortezomib, and dexamethasone was started but then discontinued due to ineffectiveness. He underwent radiation treatment of 4500 cGy to the left cavernous sinus where the tumoral amyloidosis was most severe. He has had no further progression of his disease. Tumoral amyloidosis of the cranial nerves remains a rare and poorly-understood disease. Prior reports have described the disease isolated to the trigeminal nerve. This report raises attention to this diagnosis in cases of rare multi-nerve involvement and suggests that radiation may be a useful first-line treatment.

Development of a Panel of Biomarkers for Differential Diagnosis of Multiple Sclerosis

Abstract— Demyelinating diseases are a group of heterogeneous pathologies that affect the nervous system and reduce the quality of life. One of such diseases is multiple sclerosis (MS), an inflammatory autoimmune neurodegenerative disease of the central nervous system (CNS). At the initial stages, MS can mimic some infectious, neoplastic, genetic, metabolic, vascular, and other pathologies. Accurate differential diagnosis of this disease is important to improve the quality of life of patients and reduce possible irreversible damage to the central nervous system. In this work, we confirmed the possibility of using our previously proposed candidate panel of MS biomarkers to distinguish MS from neuromyelitis optica spectrum disorder (NMOSD) and amyotrophic lateral sclerosis (ALS). We have shown that our proposed panel (SPTAN1601-644 + PRX451-494 + PTK6301-344 + LMP1285-330) allows us to distinguish MS from ALS (AUC = 0.796) and NMOSD (AUC = 0.779).

Brain biopsy and pathological diagnosis for drug‐associated progressive multifocal leukoencephalopathy (PML) with inflammatory reactions

AbstractProgressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by JC virus (JCV) infection. Although recognized as an AIDS complication in the 1980s, PML has emerged as a serious adverse event of immunosuppressive therapies since 2005, particularly disease‐modifying drugs (DMDs) for multiple sclerosis (MS). PML can also occur in patients with collagenous diseases receiving steroid therapy or with age‐related immunosuppression. In some cases, the etiology of immunosuppression remains unclear. These cases often present with early manifestations of PML, which, while common, are less well recognized, as PML was identified at more advanced stages in AIDS‐related cases. Early diagnosis poses difficulty due to unfamiliar magnetic resonance (MR) images and low viral loads in cerebrospinal fluid (CSF), and brain biopsy may be conducted. This review summarizes the PML pathology identified through biopsy. Early cytopathological changes of JCV‐infected cells, with the importance of dot‐shaped inclusions associated with promyelocytic leukemia nuclear bodies (PML‐NBs), are described. The variability of host immune responses, including PML immune reconstitution inflammatory syndrome (PML‐IRIS), is addressed. The potential role of immune checkpoint inhibitors (ICIs), such as pembrolizumab, is also explored. Understanding the pathology of early PML helps to optimize diagnostic strategies and therapeutic interventions, ultimately improving prognosis.

EPIDEMIOLOGY OF MALIGNANT PROSTATE NEOPLASMS IN THE SUMY REGION

Introduction. One of the most critical medical and social challenges facing the male population globally is the prevalence of malignant tumors of the prostate gland. Cancer-related mortality ranks the second position in Ukraine and worldwide, following cardiovascular diseases. Therefore, early diagnosis remains the most promising and effective strategy for combating malignant tumors. Objective: to investigate the prevalence and frequency of diagnosis of malignant prostate neoplasms in the Sumy region. Materials and Methods. The study utilized statistical data from the medical records of patients with prostate disease treated at the Urology Departments of Sumy Clinical Hospital of St. Panteleimon and Sumy City Clinical Hospital from 2018 to 2022. Results. The statistical analysis revealed that the prevalence of prostate diseases among patients aged 40-54 years was 21.5%, among those aged 55-74 years it was 34.3%, and for patients over 75 years it was 44.2%. An examination of the data regarding when patients sought medical help from the onset of the disease highlighted that most men with prostate cancer were asymptomatic, contributing to the spread of the disease and complicating early-stage diagnosis. Cardiovascular diseases and urinary system disorders (e.g., urolithiasis, benign prostatic hyperplasia, chronic prostatitis, and acute prostatitis) were common comorbidities in these patients. Conclusion. The statistical analysis identified a rising trend in the incidence of malignant prostate tumors in men over 50. Diseases of cardiovascular and urinary system were the most prevalent comorbidities in patients with prostate tumors. The majority of the patients were hospitalized late in the course of the disease.

MEDICAL-SOCIOLOGICAL ANALYSIS OF HEALTH AND QUALITY OF LIFE OF PERSONS AGE 60+ RESIDING IN THE GRODNO REGION

Aim: to analyze indicators of self-assessment of quality of life, satisfaction with health, their relationship with socio-demographic factors and objective indicators of public health, among people aged 60+ living in the Grodno region. Materials and methods: data from official demographic and health statistics, a representative database of 1270 people aged 60+ of the Grodno region of the Republic of Belarus by gender, residence, age (WHOQOL-BREF tools) were analyzed. Nonparametric statistics methods were used. Results: The Grodno region demonstrates life expectancy at birth values ​​close to the republican average. The minimum values ​​in all regions are detected among men living in the village. In the structure of causes of death rate, diseases of the cardiovascular system lead by far. When self-assessing the quality of life, the options “good” or “neither bad nor good” predominate; satisfaction with the state of health is option “3” of the five-point scale. Men compared to women, rural residents compared to urban residents, unmarried compared to married people rate the quality of life lower. The hypothesis about the positive impact on the quality of life of the respondent having children is confirmed; the hypothesis about the influence of the old-age pension is not confirmed. Health satisfaction reveals resistance to socio-demographic factors. A positive medium-strength correlation is revealed between health satisfaction and self-assessment of quality of life in all socio-demographic groups. With increasing age, there is a decrease in self-esteem of quality of life, and an even more pronounced decrease in satisfaction with health. Conclusion: men aged 60+ living in rural areas are at risk of low self-assessments of quality of life, in connection with low life expectancy; at the same time, health satisfaction does not reveal gender differences.

BIOS-03. CLINICAL PRESENTATION, MANAGEMENT, AND OUTCOME IN NEUROLYMPHOMATOSIS: A SYSTEMATIC REVIEW AND ANALYSIS OF INDIVIDUAL PATIENT DATA FROM 459 CASES

Abstract BACKGROUND Neurolymphomatosis (NL) refers to lymphomatous infiltration of the peripheral nervous system (PNS). NL diagnosis and treatment are challenging given the broad differential diagnosis of peripheral neuropathy, the lack of larger cohorts and the subsequent unavailability of prognostic factors or consensus therapy. This study aimed to define characteristics and prognostic factors of NL. METHODS A systematic review of the literature (2004-2023) was performed using PubMed and Scopus databases and reported following PRISMA guidelines. Clinical, radiological, pathological and outcome information were extracted. Multivariable survival analyses were performed using Cox proportional hazard models. RESULTS A total of 459 NL cases from 264 studies were accumulated. NL was the first manifestation of malignancy (primary NL) in 197 patients. PNS relapse of known non-Hodgkin lymphoma (secondary NL) occurred in 262 cases after a median 12 months. NL predominantly presented with rapidly deteriorating, asymmetric painful polyneuropathy. Infiltrated structures included peripheral nerves (56%), nerve roots (52%), plexus (33%) and cranial nerves (32%). Diagnosis was established at a median of 3 months after symptom onset with substantial delays in primary NL. It mainly relied on PNS biopsy or FDG-PET, which carried high diagnostic yields (> 90%). Post mortem diagnoses were rare (3%). Most cases were classified as B-cell (90%) lymphomas. Tumor-directed therapy was administered in 96% of patients and typically consisted of methotrexate or rituximab-based polychemotherapy. Median overall survival was 18 months. Primary NL without concurrent systemic disease outside the nervous system (hazard ratio [HR]: 0.44; 95% confidence interval (CI): 0.25-0.78; p = 0.005), performance status (ECOG < 2, HR: 0.30; 95% CI: 0.18-0.52; p < 0.0001), and rituximab-based treatment (HR: 0.46; 95% CI: 0.28-0.73; p = 0.001) were identified as favorable prognostic markers on multivariable analysis when adjusting for clinical and sociodemographic parameters. CONCLUSIONS Advances in neuroimaging modalities, particularly FDG-PET, facilitate NL diagnosis and offer a high diagnostic yield. Rituximab-based therapy improves NL outcome. Findings may assist clinicians in early recognition, prognostic stratification, and treatment of NL.

DISP-01. FACTORS AFFECTING POST-ABLATION OUTCOMES AND TRIAL ENROLLMENT IN DIVERSE PATIENTS UNDERGOING LASER INTERSTITIAL THERMAL THERAPY

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) is a surgical treatment for progressive brain metastases (BM) following stereotactic radiosurgery (SRS). Although LITT has been increasingly accepted, little is known regarding factors influencing presentation and outcomes of patients with diverse backgrounds. METHODS Retrospective review of all patients receiving their index LITT treatment for BM at a single center from 2015 – 2023. Patient demographics and geospatial data was used to compare differences in receipt of LITT by race or ethnicity, survival outcomes, and clinical trial enrollment. RESULTS From 2015-2023, 137 patients presented for LITT to 146 intracranial lesions. One hundred and six patients (77.3%) were non-Hispanic White (NHW), while among Hispanic or non-White (HNW) patients, 25 (18.2%) were Black or African American, 5 (3.6%) were Asian American, and 1 (0.7%) was Hispanic/Latino. Among HNW patients, women more frequently received LITT (p = 0.022), with skin cancers being a more frequent indication among NHW patients (P = 0.019). NHW patients traveled a median of 62.0 (6.2 – 1045.9) miles to receive LITT vs 25.9 (1.31 – 238.3) miles for HNW patients (p = 0.001). Length of stay, discharge location, or readmission rates did not differ between groups. In multivariate analyses, probability of clinical trial enrollment was less among those of female sex (P = 0.049), HNW race/ethnicity (P = 0.041), or external referral status (P = 0.035), while post-LITT overall survival was predicted by pre-LITT KPS (P = 0.0007) and recurrent tumor on biopsy (P = 0.0002). CONCLUSIONS Differences in presentation for LITT by race or ethnicity may be influenced by underlying patient factors, including sex, systemic disease histology, and distance from a treating center, which do not influence post-LITT procedural outcomes or survival. Accordingly, clinical trial enrollment should be prioritized for vulnerable patient populations to realize the full benefits of laser ablation.

RADT-14. EARLY OUTCOMES FROM PROTON CRANIOSPINAL IRRADIATION FOR LEPTOMENINGEAL METASTASIS FROM SOLID TUMORS

Abstract INTRODUCTION Treatment options for leptomeningeal metastasis (LM) are limited. A phase II study found that proton craniospinal irradiation (pCSI) was well-tolerated and improved survival. We report our experience with pCSI for solid-tumor LM. METHODS This is a retrospective review of patients treated with pCSI for solid-tumor LM from December 2020 to January 2024 at our center. Patient characteristics were summarized using descriptive statistics. Median overall survival (OS) and median central nervous system progression-free survival (CNS-PFS) from the first day of pCSI were estimated using Kaplan-Meier survival curves. RESULTS We identified 45 patients who completed pCSI. Median age was 54 years (range, 23-79); 73% were female, and 53% lived more than 100 miles from our center. Breast cancer (53%), lung cancer (20%), and melanoma (9%) were the most common primary cancers; 51% of patients had stable systemic disease at LM diagnosis. All had imaging evidence of LM, and 64% were confirmed by cytologic examination of the cerebrospinal fluid. Eighty percent had symptomatic LM, and the median Karnofsky Performance Scale (KPS) at LM diagnosis was 80. The median time from primary cancer diagnosis to LM diagnosis was 23.1 months (range, 0-221.3). Fifty-three percent of patients had active brain metastasis at LM diagnosis. At the first visit following pCSI, median KPS was 70. Seventy-six percent reported new or worsening nausea, 51% headache, and 31% fatigue. Following pCSI, 18% received LM surveillance, 4% intrathecal chemotherapy, 67% systemic therapy, 9% hospice care, and 2% lost to follow-up. Median OS was 13.7 months (95% confidence interval [CI], 11.2 to infinity), and median CNS-PFS was 6.5 months (95% CI, 4.9 to 12.8). CONCLUSIONS The outcomes in our cohort are comparable to those recently reported in a phase II trial. Further study is indicated to determine the optimal candidates for pCSI and sequential therapies.

CCRG-04. RIBOCICLIB RESPONSIVE MENINGIOMA IN THE TREATMENT OF BREAST CANCER

Abstract BACKGROUND Meningiomas are the most common primary intracranial tumors, typically managed with surgical resection and/or radiation therapy. Systemic therapy options are limited and reserved for cases refractory to conventional interventions. Cyclin dependent kinase (CDK) proteins are key cell cycle regulators. CDK inhibitors are clinically available, approved for treatment of breast cancer and in clinical trials for meningioma. METHODS We present a case where a patient with incidentally-discovered intracranial meningioma undergoing CDK inhibitor therapy with ribociclib for breast cancer experienced a radiographic response. RESULTS A 73-year-old female was diagnosed with estrogen receptor (ER) positive, progesterone receptor (PR) positive, HER2 negative metastatic invasive ductal carcinoma of the breast. She was treated with estrogen receptor antagonist fulvestrant and CDK 4/6 inhibitor ribociclib. MRI of the brain performed for disease staging demonstrated an extraaxial, dural-based, homogenously enhancing mass along the left posterior petrous ridge consistent with a meningioma. Two-month interval scan demonstrated a marginal decrease in size of the mass (15.6x18.3 mm to 15.4x17.5 mm). Systemic disease related to breast cancer concurrently improved. Two years later, with ongoing fulvestrant and ribociclib therapy, a repeat MRI brain demonstrated further decrease in size of the meningioma (13.4x16.8 mm). CONCLUSIONS Hormonally-directed therapies previously demonstrated limited benefit for meningiomas despite PR/ER positivity reported for these tumors. However, CDK 4/6 inhibitors abemaciclib and ribociclib have demonstrated activity in treatment of recurrent grade 2/3 meningiomas. The radiographic response noted in our case suggests there may be a role for systemic therapy even in treatment-naive cases that may not be amenable to surgical resection or radiation therapy.

OSTEOARTHRITIS AND METABOLIC SYNDROME: KEY ASPECTS OF PATIENT MANAGEMENT

Introduction: Osteoarthritis is a major health concern, and along with coronary heart disease and arterial hypertension, forms a triad of the most common diseases among the adult population. Osteoarthritis significantly reduces the quality of life, leads to disability, and increases mortality rates. Globally, nearly 240 million people suffer from osteoarthritis (about 10% of men and 18% of women over the age of 60). In terms of disease burden, osteoarthritis ranks: first in complications of the musculoskeletal system, second in the number of visits to family doctors, and third in cases of disability. Patients with osteoarthritis, particularly those with comorbid conditions and metabolic syndrome, face a high prevalence of cardiovascular diseases and an increased risk of premature death. Goal: to elucidate modern insights into the pathogenetic links between osteoarthritis and metabolic syndrome, and to justify new approaches to improving treatment for patients with this pathology. Materials and Methods: A literature search was conducted using scientific databases, employing methods of analysis, comparison, and generalization of information about the relationship between osteoarthritis and metabolic syndrome. The study was carried out at the Department of Family Medicine and Therapy at Poltava State Medical University, based in the Regional Rheumatology Center of M. V. Sklifosovskiy Poltava Regional. The study involved 40 patients, both outpatients and inpatients, including 26 women (65%) and 14 men (35%), aged 54-69 years, with primary osteoarthritis of X-ray stages I-II according to the Kellgren-Lawrence scale, in combination with metabolic syndrome. The control group consisted of 20 individuals. Results. A 12-month monitoring of this group of patient was conducted, revealing mild to moderate manifestations of metabolic syndrome along with polymorbid conditions such as chronic obstructive lung diseases and genitourinary system disorders. Most frequently, one, and rarely two, comorbid conditions were detected, along with one or two diseases unrelated to osteoarthritis. The most common progressive conditions observed were arterial hypertension, ischemic heart disease, heart failure, obesity, type 2 diabetes, and digestive system diseases. The primary goal in managing patients with osteoarthritis and metabolic syndrome is to significantly reduce cardiovascular risk and mortality. This involves developing a comprehensive concept of metabolic syndrome and osteoarthritis, identifying patients at high cardiovascular risk, and implementing preventive measures, including lifestyle modifications and the use of appropriate medications. Conclusions. The study revealed a significant clinical effect from the use of therapy that included coxibs in 78% of patients in the main group with osteoarthritis combined with metabolic syndrome. A positive outcome was observed in terms of pain reduction, a reduction in inpatient treatment duration by 2-3 days, and extended remission periods. For this category of patients, primary prevention should focus on weight loss, increased physical activity, and normalization of metabolic disorders.

NIMG-31. CASE REPORT: DIAGNOSIS OF AN INFILTRATIVE GLIOMA IN A LI-FRAUMENI SYNDROME PATIENT OBSCURED BY LESION RESPONSIVENESS TO NSCLC TREATMENT

Abstract Li-Fraumeni syndrome is a rare, autosomal dominant disorder linked to germline mutations of the TP53 suppressor gene. Patients with this syndrome are predisposed to various malignancies and a variety of brain tumors to include choroid plexus carcinoma, medulloblastoma, and glioma. We present a 46-year-old woman with a history of Li-Fraumeni syndrome which manifested with multiple systemic malignancies including breast cancer, ovarian teratoma, and leiomyosarcoma. The patient had been undergoing MRI brain surveillance since 2018, which was initially notable for a right cerebellar midline focus of enhancement associated with slowly evolving right middle cerebellar peduncle FLAIR signal, with no detectable neurologic symptoms. She underwent systemic therapy for non-small cell lung cancer (NSCLC) with pemetrexed/cisplatin. Her next MRI brain in August 2023 showed resolution of the cerebellar enhancement with small residual FLAIR signal. In April 2024, the patient presented with new neurologic symptoms to include ataxia, dizziness, difficulty swallowing, and memory loss. Repeat MRI brain revealed new infiltrative FLAIR signal throughout the right temporal lobe extending from the posterior fossa, contiguous with the previously seen cerebellar findings and consistent with infiltrative glioma. Due to fragmented records and care in multiple systems, her updated MRI initially created a diagnostic challenge with a radiographic interpretation of likely encephalitis. This is a unique case documenting a middle-aged female with Li-Fraumeni syndrome, followed for multiple cancers, presenting with new neurologic symptoms and progressive infiltrative FLAIR changes spanning from the cerebellum into the right temporal lobe. These findings highlight the natural history of a TP53 deficient tumor that ostensibly responded to a cisplatin-based regimen given for a different indication, thereby delaying time to symptom onset and need for biopsy. Surveillance of low grade lesions in patients with underlying tumor predisposition syndromes must be interpreted in context of systemic disease burden and concurrent treatments for other neoplasms.

Association between proteinuria and mineral metabolism disorders in chronic kidney disease: the Japan chronic kidney disease database extension (J-CKD-DB-Ex)

Chronic kidney disease-mineral and bone disorder (CKD-MBD) are recognized as a systemic disease affecting the prognosis of patients with CKD. Proper management of CKD-MBD is important to improve the prognosis of patients with CKD. Although proteinuria is recognized as a poor prognostic factor in these patients, few reports have examined its association with CKD-MBD. We examined the association between proteinuria and CKD-MBD using data from the Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex). Among the patients registered in the J-CKD-DB-Ex, 30,977 with CKD stages G2–G5 who had serum creatinine, albumin, calcium, and phosphate concentrations measured at least once and urinalysis performed were included. The patients were divided into four groups (negative, 1+, 2+, and 3+) according to the degree of proteinuria. The association between proteinuria and CKD-MBD was examined by a logistic regression analysis. In a model adjusted for age, sex, diabetes, and the estimated glomerular filtration rate (eGFR), the odds ratio of the 3 + group compared with the negative group significantly increased to 2.67 (95% confidence interval, 2.29–3.13) for hyperphosphatemia, 2.68 (1.94–3.71) for hypocalcemia, and 1.56 (1.24–1.98) for hypomagnesemia. Proteinuria is associated with hyperphosphatemia, hypocalcemia, and hypomagnesemia in patients with CKD independently of eGFR.

Exploring mortality risk factors and specific causes of death within 30 days after hip fracture hospitalization

AbstractThis study examined the sex-specific mortality risk and causes of death soon after hip fracture in Taiwan. The objective of this study was to evaluate the 30-day mortality risk and cause of death in patients with hip fracture and identify its associated risk factors. We conducted a retrospective cohort study using data from the National Health Insurance Research Database in Taiwan from 2000 to 2015. This study included patients aged 50 years or older who were admitted to a hospital with a hip fracture diagnosis for the first time. Of 285,891 patients hospitalized for their first hip fracture, 8,505 (2.98%) died within 30 days. The mortality risk of hip fracture declined from 3.76% in 2000 to 2.92% in 2015. Circulatory system diseases like ischemic heart disease and cerebrovascular disease were the most common cause of death and accounted for 22% of deaths within 30 days after fracture. Accidents and unintentional injuries caused 18% of deaths, followed by malignant neoplasms in 10% of deaths. Multivariate Cox regression identified older age, male sex, higher Charlson Comorbidity Index (CCI), suburban or rural residence, and lower income as risk factors for hip fracture mortality. The 30-day mortality risk of hip fractures has decreased but remains correlated with male sex, older age, and comorbidities. Circulatory diseases were the main cause of death. Early identification and treatment by experienced clinicians may optimize outcomes, minimize complications, and reduce mortality risk in the 30 days following hip fracture.

CNSC-51. PRIMARY INTRACRANIAL ALVEOLAR SOFT PART SARCOMA (PIASPS): A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES FROM 2000 – 2023

Abstract BACKGROUND AND OBJECTIVE Alveolar soft part sarcoma is a rare malignancy of the lower extremities considered to be of unknown cellular origin. Common in young female patients, the ASPS usually has a strong metastatic potential, mostly involving the lungs at the time of presentation. Cases involving the CNS primarily, without any evidence of systemic disease have emerged i.e. the primary intracranial alveolar soft part sarcoma (PIASPS). We aim to determine the clinical manifestations, natural progression and management of primary intracranial alveolar soft part sarcoma. MATERIALS AND METHODS After an extensive literature search using PubMed Central and Google Scholar, seven case reports and two case series of 14 patients with PIASPS were retrieved and included using the Preferred Reporting Items for Systemic review and Meta-analyses guidelines, published between 2000 and 2023. RESULTS Female preponderance of the neoplasm (57.14%) with an average age of 24.9 years was noted. Headache (36.36%) and papilledema (25%) were the most common presenting complaint and sign, respectively. Brain parenchymal involvement was noted in 71.42% cases, mostly the frontal lobe and left hemisphere. The lesion appeared isointense to hypointense on T1-weighted images and hyperintense on T2-weighted images (66.67%) on MRI. Gross Total Resection was possible in 57.14% lesions. On immunohistochemistry, the tumor cells manifested TFE3 and PAS positivity in 25% and 20% of the cases respectively. An average survival after follow up duration was found to be 31.79 months. CONCLUSION Surgery and radiotherapy are the mainstay of treatment of PIASPS, while meningioma an important differential diagnosis. TFE3 fusion product is readily been helpful in diagnosis. Evidence of a primary lesion in the CNS cannot rule out the presence of an occult primary elsewhere in the body. This, along with the slow growing nature of the neoplasm and delayed localized recurrences, require a long-term follow-up.

Electrospun gelatin/hyaluronic acid nanofibers as a platform for uric acid delivery to neural tissue

AbstractUric acid (UA) is an antioxidant that has been reported to be a neuroprotective compound for injuries and diseases, and specifically, diseases of the central nervous system. However, uric acid is highly insoluble in aqueous solutions, and high levels in the serum lead to gout, which limits its use in humans. Here, we develop a novel drug delivery platform that will release uric acid in a sustained manner for application to neural tissue. We demonstrate that one‐step incorporation of UA into an electrospun gelatin/hyaluronic acid nanofiber mat results in controlled release of UA in culture medium. Taking a unique approach, we made solutions of 12% gelatin and 1% hyaluronic acid in a formic acid solvent and added UA for production of nanofiber mats. We then dehydrothermally crosslinked the mats and tested for release of UA into physiological cell culture medium. To test whether the mats have any detrimental effects on healthy nervous system tissue, we cultured spinal cord explants on the mats extended and assessed extensions from the explants. We observed that comparable numbers and lengths of dendrites are extended from the spinal cord tissue, regardless of the amount UA content in the mats. Our results suggest that electrospun gelatin/hyaluronic acid nanofibers can be used as a platform for sustained uric acid delivery to neural tissue without detrimental effects.

Physical exercise halts further functional decline in an animal model for Charcot–Marie–Tooth disease 1X at an advanced disease stage

AbstractBackground and AimsCharcot–Marie–Tooth (CMT) type 1 neuropathies are the most common inherited diseases of the peripheral nervous system. Although more than 100 causative genes have been identified so far, therapeutic options are still missing. We could previously identify that early‐onset physical exercise (voluntary wheel running, VWR) dampens peripheral nerve inflammation, improves neuropathological alterations, and clinical outcome in Cx32def mice, a model for CMT1X. We here investigate the clinical and histopathological effect of late‐onset exercise in Cx32def mice at an advanced disease stage.MethodsNine‐month‐old Cx32def mice were allowed to run for 4 days/week on a commercially available running wheel for 3 months, with timely limited access to running wheels, representing a running distance of ~2000 m. Control mutants had no access to running wheels. Afterward, mice were investigated by distinct functional tests and by immunohistochemical and electron microscopical techniques.ResultsWe found that late‐onset physical exercise (late VWRlim) prevented the robust functional decline in 12‐month‐old Cx32def mice. This was accompanied by improved neuromuscular innervation of distal muscles and axonal preservation in femoral quadriceps nerves. In contrast to a “pre‐symptomatic” start of physical exercise in Cx32def mice, late‐onset VWR did not alter nerve inflammation and myelin thickness at 12 months of age.InterpretationWe conclude that VWR has robust beneficial effects on nerve function in Cx32def mice, even when applied at a progressed disease stage. These results have important translational implications, suggesting that physical exercise might be an effective treatment option for CMT1 patients, even when disease symptoms have already progressed.

Experience of using robot-assisted (da Vinci) operations in the treatment of common endometriosis

Background. Currently, genital endometriosis is considered as one of the most severe conditions in women of reproductive age, which has detrimental consequences for social, professional and psychological functioning. It ranks third in the structure of gynecological diseases after inflammatory diseases of the female reproductive system and uterine fibroids. Because of this, it acquires a more pronounced social significance and ceases to be only a medical problem. Aim. To study the results of surgical treatment of patients with severe forms of genital endometriosis using the da Vinci surgical robotic complex.Materials and methods. A retrospective analysis of the treatment results of 51 patients operated on at the N.I. Pirogov National Medical and Surgical Center for the period from January 2015 to July 2024, who underwent robot-assisted (da Vinci) operations for deep endometriosis involving neighboring organs. The duration of surgery and hospital stay, the amount of blood loss, the frequency of intra- and postoperative complications, the clinical course of the disease in the long-term postoperative period, the frequency of detection of residual infiltration in the postoperative period, and the implementation of reproductive plans were analyzed.Results. The duration of the surgical intervention was 220.8 ± 21.87 minutes. The postoperative bed-day was 6.9 ± 1.5 bed days. The average blood loss was 160.2 ± 67.58 ml. There were no intraoperative complications. Postoperative complications accounted for 7.8 %. Residual infiltration occurred in 11.7 % of cases. 94.1 % of the patients had no clinical symptoms of endometriosis in the long-term postoperative period. The pregnancy rate was 31.9 %.Conclusion. Surgical treatment of deep endometriosis using da Vinci surgical robotic complex in the amount of radical removal of endometrioid infiltrate has a positive effect on both the clinical course of the disease and the reproductive potential of a woman. Real-time fluorescence navigation has demonstrated additional imaging capabilities in robotic surgery for deep endometriosis, potentially increasing the radicalism of surgical treatment of infiltrating endometriosis and may lead to a reduction in recurrence rates.

Formyl peptide receptors in the microglial activation: New perspectives and therapeutic potential for neuroinflammation

AbstractSecondary neurological impairment mediated by neuroinflammation is recognized as a crucial pathological factor in central nervous system (CNS) diseases. Currently, there exists a lack of specific therapies targeting neuroinflammation. Given that microglia constitute the primary immune cells involved in the neuroinflammatory response, a thorough comprehension of their role in CNS diseases is imperative for the development of efficacious treatments. Recent investigations have unveiled the significance of formyl peptide receptors (FPRs) in various neuroinflammatory diseases associated with microglial overactivation. Consequently, FPRs emerge as promising targets for modulating the neuroinflammatory response. This review aims to comprehensively explore the therapeutic potential of targeting FPRs in the management of microglia‐mediated neuroinflammation. It delineates the molecular characteristics and functions of FPRs, elucidates their involvement in the inflammatory response linked to microglial overactivation, and synthesizes therapeutic strategies for regulating microglia‐mediated neuroinflammation via FPR modulation, thereby charting a novel course for the treatment of neuroinflammatory diseases.