Etiological Factors Research Articles

"SWALLOWING AND ASPIRATION: HOW TO EVALUATE AND TREAT SWALLOWING DISORDERS ASSOCIATED WITH ASPIRATION PNEUMONIA IN OLDER PERSONS".

BACKGROUND Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. METHODOLOGY We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. RESULTS AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction and oral colonization by respiratory pathogens. Incidence is estimated at between 5%-15% of cases of CAP but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society (JRS), that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for healthcare professionals, new AI-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. CONCLUSIONS The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection AP.

Surgical correction of posttraumatic triphalangeal joint flexion contractures of the fingers (systematic literature review)

Introduction Triphalangeal joint flexion contracture of the fingers is a common and challeging posttraumatic hand condition. The goal of surgical treatment is to correct finger deformity and increase interphalangeal range of motion.The objective was to systematize data on the causes of post-traumatic triphalangeal joint flexion contracture of the fingers and methods of surgical correction.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), ScienceDirect, Google Scholar, Ovid databases according to PRISMA recommendations. Literature searches included both Russian and English studies, with one or more cases of post-traumatic triphalangeal joint flexion contracture of the fingers with the deformity surgically corrected. Cases of non-traumatic flexion contractures were excluded. Etiological factors of flexion contractures, heterogeneity of definitions and methods for recording the range of motion in the joint, anatomical features, surgical correction of flexion contractures and postoperative complications were reviewed.Results Common causes of flexion contractures included burns (32.3 %), dislocations and fracturedislocations of the finger joints (23.5 %). The median postoperative follow-up period was 13.5 months after surgical treatment. Surgical correction was produced with external fixation device (EFD) in 40 % of cases, open procedures performed in 50 % and a combined technique employed in one case (10 %). Based on calculations of the odds ratios of postoperative complications, a weak positive linear relationship was revealed between EFD and pain syndrome, and a weak negative linear relationship was observed between the open procedure and pain.Discussion There is heterogeneity of approaches regarding methods for correcting flexion contractures, surgical approaches, techniques for mobilizing joints and releasing the anatomical structures of the finger with open procedures, the distraction rate with EFD, methods for repair of soft tissue defects following the treatment of flexion contractures of interphalangeal joint of a finger.Conclusion Open procedures are commonly used for precise elimination of all components of flexion contracture of the joint and repair of soft tissue defects of the finger. A weak positive linear relationship was revealed between EF and pain syndrome. There was no significant correlation between open techniques and complications. There were no correlations between the treatment method and the contracture type; there are no treatment regimens for patients with this pathology.

Nomograms for predicting short-term mortality in acute-on-chronic liver disease caused by the combination of hepatitis B virus and alcohol.

This study aimed to identify predictive factors for the prognosis of acute-on-chronic liver disease (AoCLD) due to both hepatitis B virus (HBV) and alcohol and to develop prognostic models to improve treatment management. AoCLD patients with HBV and alcohol as etiological factors were selected from two multicenter prospective cohorts (NCT02457637,NCT03641872) and included in separate training and validation cohorts (n = 180 and n = 148). In the training cohort, the CATCH-LIFE A nomogram (based on age, bilirubin, international normalized ratio, serum sodium, and hepatic encephalopathy score) and CATCH-LIFE B nomogram (based on age, bilirubin, international normalized ratio, serum albumin, white blood cell, platelet count, and hepatic encephalopathy score) had discriminatory ability for predicting 28-day (c-indexes of 0.910 and 0.899) and 90-day mortality (c-indexes of 0.878 and 0.887, respectively). The area under the curve values for 28-day and 90-day mortality prediction by the CATCH-LIFE A nomogram were 0.922 (95% CI : 0.874, 0.971) and 0.905 (0.856, 0.956), respectively, while those for the CATCH-LIFE B nomogram were 0.916(0.861,0.972) and 0.915 (0.866,0.964), respectively. Similar performance results were observed in the validation cohort. Optimal cut-off scores for each nomogram could be used for patient stratification in high- and low-risk groups, and the high-risk groups showed shorter survival times than the low-risk groups in both the training and validation cohorts. Two nomograms constructed from the first short-term follow-up data from patients with AoCLD due to combined HBV infection and alcohol exposure showed good predictive performance for 28-day and 90-day mortality and might be used to guide clinical management.

Influence of maternal health status during pregnancy and the child´s medical history on molar-incisor hypomineralization in a group of Spanish children (aged 6-14 years): a retrospective case-control study.

Molar-incisor hypomineralization (MIH) is a qualitative enamel defect that is highly prevalent in children. It has been reported that patients with MIH have higher caries occurrence with an increased need and frequency of dental treatment compared to patients without MIH. The objective of this study was to analyze the association between MIH and a series of factors related to maternal health status during pregnancy and children´s medical history in early childhood. A retrospective study of cases (patients with MIH) and controls (patients without MIH) was designed between 2023 and 2024. A total of 280 children (cases = 140; controls = 140) aged 6 to 14 years (138 boys and 142 girls) were examined according to the European Academy of Pediatric Dentistry (EAPD) criteria for MIH. A survey was carried out with mothers regarding the potential exposure of their children to etiological factors of MIH. Possible prenatal and postnatal etiological factors were obtained through a personal interview with the patients' mothers. The statistical analysis was carried out with the contrast test and the chi-square test. During pregnancy, folic acid consumption, alcohol intake, systemic viral and/or bacterial infections, and gestational diabetes were statistically significantly related to MIH, as were breastfeeding, asthma, and corticosteroid consumption during childhood. Although there are different factors that may have statistically significant relationships with MIH, they cannot be predicted. Therefore, longitudinal studies, with a large sample size, are needed to determine the influence of prenatal and postnatal factors on the prevalence and severity of MIH in children.

Do preterm infants’ retinas like bovine colostrum? A randomized controlled trial

BackgroundBovine colostrum (BC) with liposomal delivery system (LDS) is a promising supplement to premature infant formula in absence of mother own milk. We propose that BC with LDS can target multiple etiological factors that threaten the developing retina, making premature infant less liable for retinopathy of prematurity (ROP). The aim of this study was to evaluate the effect of BC with LDS in the prevention of ROP.MethodsThis was a single center, randomized, controlled trial. Two hundred and eleven preterm infants of gestational age ≤ 32weeks were admitted to the NICU of Alexandria University Children Hospital, Egypt, and randomly allocated into either non-BC group (n = 105) or BC group (n = 106). Patients in BC group received 3.5 ml /kg/day of BC for 14 days. All patients were monitored for development of ROP, anemia, late onset sepsis (LOS), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC), in addition to growth assessment. Multivariate binary logistic regression analysis was performed to determine factors predicting ROP development.ResultsCompared with the non-BC group, BC group was associated with a significantly lower incidence of ROP (5/100 vs. 16/100, respectively) with a p-value of 0.033. The administration of BC significantly decreased serum C- reactive protein (CRP) level and increased weight on day-14 of the study in comparison with the CRP level and birthweight at the beginning of study, with Cohen’s D= -0.184, D = -2.246, respectively. Patients with suspected sepsis were significantly less in BC than non-BC group, p = 0.004. Patients with BC had significantly higher hemoglobin level on day-14 than non-BC-group, with median (IQR) 12.2 (11.0–13.9) and 11.7 (10.5–12.9), respectively. BC intake is one of factors that decreased development of ROP in univariate analysis. Nevertheless, weight gain and birth weight were the most significant factors affecting ROP development in multivariate-regression model.ConclusionBC may reduce the incidence of ROP in preterm neonates aged ≤ 32 weeks. This might be due to keeping better Hb level and growth rate, as well as anti-inflammatory properties through its ability to decrease CRP level.Trial registrationThis work was registered on 06/13/2022 in clinicaltrial.gov with ID no.: NCT05438680 and URL:https://classic.clinicaltrials.gov/ct2/show/NCT05438680?term=NCT05438680&draw=2&rank=1.

Occlusive lesions of retinal vessels: etiological and patogenetic factors

Background. Vascular pathology of the organ of vision is one of the most urgent problems of ophthalmology, as it is the main cause of vision loss and vision loss. Retinal vein occlusion ranks second after diabetic retinopathy in the world among vascular causes of vision loss. In a significant risk group for the occurrence of occlusions of the retinal vessels are patients with cardiovascular diseases. Today, treatment of patients with coronary heart disease and patho­logy of heart valves is impossible without surgical interventions, most of which require the use of artificial circulation (AC). During the operation of the AC due to prolonged hypothermia, hemodilution, prolonged hypotension, anemia, development of ophthalmologic complications in the early postoperative period is possible. The purpose of the study was to investigate etiological and pathogenetic factors of occlusive lesions of retinal vessels. Mate­rials and methods. The search for sources of Ukrainian and foreign literature for the ana­lytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 211 sources were selected, of which 66 were selected for this article. Results. Occlusion of the central retinal vein (CVO) deve­lops in 214 people per 100,000 population, mainly in people over 65 years of age. The frequency of branh retinal vein occlusions (BRVO) is 67.2%, of which 82.4% is a occlusion of the superior temporal branch. The main risk factors of CVO are age, hypertension, diabetes, atherosclerosis, glaucoma, coronary heart disease. A small number of sources are found in the literature regarding complications from the organ of vision in patients after cardiac surgery with AC such us thromboembolism of retinal vessels, optic ischemic optic neuropathy, retinal ischemia, optic nerve atrophy, retinal detachment, proliferative vitreoretinopathy. The authors' research showed a multiple increase in blood markers of endothelial dysfunction, including vascular endothelial cadherin (VE-cadherin, VE-C) after surgery. Conclusions. Diseases of the organ of vision due to general or local blood circulation disorders account for 10 to 28%, 2.6% of which lead to blindness. There is a relationship between occlusive lesions of retinal veins and cardiovascular diseases. The main reasons for the development of retinal vein occlusion after cardiac surgery with coronary artery disease are acute inflammation occurring during and immediately after surgery and endothelial dysfunction.

Main etiological factors and comorbid pathology in severe cerebral palsy

Introduction The largest number of factors contributing to the development of cerebral palsy (CP) relate to the pre- and intranatal periods. Premature birth and low birth weight are the most important predictors of cerebral palsy and are associated with persistent brain and motor disorders. Purpose To evaluate the main etiological factors of severe cerebral palsy and comorbid pathology in children with severe motor disorders.Material and methods A retrospective observational study included 170 patients with severe forms of cerebral palsy, divided into two groups (85 subjects each) depending on motor disorders: GMFCS IV, GMFCS V. Perinatal risk factors for severe cerebral palsy were assessed, correlations between perinatal risk factors for expressed movement disorders and height/weight indicators, comorbid pathology in children at the time of admission to the trauma and orthopaedic hospital.Results Prenatal risk factors were responsible for the development of cerebral palsy in children in 71 % of cases. In the GMFCS IV group, gestational age had an inverse correlation with preterm birth (R = –0.53; R2 = 28 %). In the GMFCS V group, disorders caused by a shorter gestational age were interrelated with the duration of the antenatal period (R = –0.79; R2 = 62 %), and also directly correlated with delivery by cesarean section (R = 0.58; R2 = 34 %). Among the comorbid pathologies, eye diseases and psychological development disorders were most often detected.Discussion Low height/weight parameters of patients were due to comorbid pathology, rather than phenotypic constitutional features. Inverse correlation between the disorders caused by the gestational age, low birth weight and duration of pregnancy, risk of developing respiratory disorders, and a direct correlation with cesarean section seem logical. Severe conmobid diseases were more frequently diagnosed in patients with GMFCS V, indicating more extensive perinatal catastrophes in the central nervous system and the relationship between the developed pathology and severe motor disorders.Conclusions The main risk factors for the development of cerebral palsy in patients with severe GMFCS IV–V motor impairments are associated with the pre- and intranatal periods. Comorbid pathology of patients with severe forms of cerebral palsy is caused by severe brain damage and movement disorders that have developed against this background.

Unique and Shared Molecular Mechanisms of Alcoholic and Non-Alcoholic Liver Cirrhosis Identified Through Transcriptomics Data Integration.

Liver cirrhosis is a severe chronic disease that results from various etiological factors and leads to substantial morbidity and mortality. Alcoholic cirrhosis (AC) and non-AC (NAC) arise from prolonged and excessive consumption of alcohol and metabolic syndromes, respectively. Precise molecular mechanisms of AC and NAC are yet to be comprehensively understood for diagnostics and therapeutic advances to materialize. This study reports novel findings to this end by utilizing high-throughput RNA sequencing and microarray data from the Gene Expression Omnibus (GEO). We performed a meta-analysis of transcriptomics data to identify the differentially expressed genes specific to AC and NAC. Functional enrichment and protein-protein interaction network analyses uncovered novel hub genes and transcription factors (TFs) critical to AC and NAC. We found that AC is primarily driven by metabolic dysregulation and oxidative stress, with key TFs such as RELA, NFKB1, and STAT3. NAC was characterized by fibrosis and tissue remodeling associated with metabolic dysfunction, with TFs including USF1, MYCN, and HIF1A. Key hub genes such as ESR1, JUN, FOS, and PKM in AC, and CD8A, MAPK3, CCND1, and CXCR4 in NAC were identified, along with their associated TFs, pointing to potential therapeutic targets. Our results underscore the unique and shared molecular mechanisms that underlie AC and NAC and inform the efforts toward precision medicine and improved patient outcomes in liver cirrhosis.

GLUT1 and cerebral glucose hypometabolism in human focal cortical dysplasia is associated with hypermethylation of key glucose regulatory genes.

Focal cortical dysplasia (FCD) is recognized as a significant etiological factor in pharmacoresistant intractable epilepsy, linked with disturbances in neurovascular metabolism. Our study investigated regulation of glucose-transporter1 (GLUT1) and cerebral hypometabolism within FCD subtypes. Surgically excised human brain specimens underwent histopathological categorization. A subset of samples (paired with matching blood) was assessed for DNA methylation changes of glucose metabolism-related genes. We evaluated GLUT1, VEGFα, MCT2, and mTOR expression by western blot analysis, measured glucose-lactate concentrations, and established correlations with patients' demographic and clinical profiles. Furthermore, we investigated the impact of DNA methylation inhibitor decitabine and hypometabolic condition on the uptake of [ 3 H]-2-deoxyglucose and ATPase in epileptic brain endothelial cells (EPI-EC). We observed hypermethylation of GLUT1 and glucose metabolic genes in FCD brain/blood samples and could distinguish FCDIIa/b from mMCD, MOGHE and non-lesional types in brain. Low GLUT1 and glucose-lactate ratios corresponded to elevated VEGFα and MCT2 in FCDIIa/b vs non-lesional tissues, independent of age, gender, seizure-onset, or duration of epilepsy. Increased mTOR signaling in FCDIIa/b tissues was evident. Decitabine stimulation increased GLUT1, decreased VEGFα expression, restored glucose uptake and ATPase activity in EPI-ECs and reduced mTOR and MCT2 levels in HEK cells. We demonstrated: 1) hypermethylation of glucose regulatory genes distinguish FCDIIa/b from mMCD, MOGHE and non-lesional types, 2) glucose uptake reduction is due to GLUT1 suppression mediated possibly by a GLUT1-mTOR mechanism; and 3) DNA methylation regulates cellular glucose update and metabolism. Together, these studies may lead to GLUT1-mediated biomarkers, glucose metabolism and identify early intervention strategies in FCD.

Cytokine Status Disorders and Their Role in the Pathogenesis of Chronic Abacterial Prostatitis of Non-Inflammatory Nature

Relevance. Chronic abacterial prostatitis (CAP) of a non-inflammatory nature remains a complex disease in terms of proven etiological factors and pathogenetic mechanisms. Recent studies define it as a nosology based on homeostasis disorders with damaging effects directed towards the prostate. Pathogenetically, this is cytokine aseptic inflammation and lipid peroxidation, which occurs under conditions of compromised antioxidant protection. Objective — to study the cytokine status in the experimental reproduction of non-inflammatory CAP models.Materials and methods. 100 male white rats were studied, 25 formed a control group, and the remaining ones were divided into 3 equal groups for experiments on creating various models of CAP and systemic chronic stress. At the end of the experiment, blood was taken and the prostate was removed to obtain a homogenate. The substrates were used to determine pro- and anti-inflammatory cytokines.Results. In the isolated CAP model of category IIIB, cytokine disorders were detected in prostate tissue (to a greater extent), and at the systemic level (to a lesser extent). The model of systemic immobilization stress proved the possibility of triggering cytokine disorders in prostate tissue characteristic of CAP IIIB. Severe homeostasis disorders at the systemic and local levels were observed in experiments where both systemic stress and the local CAP model were modeled.Conclusion. Cytokine imbalance plays a key role in the pathogenesis of СAP IIIB. At the same time, systemic and organ cytokine disorders interact with each other and, under certain circumstances, aggravate the damaging effect of each other.

Metabolic and Proteomic Profiling of Coronary Microvascular Dysfunction: Insights from Rat Models

Coronary microvascular dysfunction (CMD) represents a principal etiological factor in ischemic heart disease. Nonetheless, a considerable subset of CMD patients experiences diagnostic delays attributable to the inadequacy of current diagnostic methodologies; which in turn results in deferred therapeutic interventions and elevated mortality rates. This study seeks to elucidate the distinct metabolic profile associated with CMD in rat models and to identify specific diagnostic markers that could enhance the diagnostic accuracy for CMD. In this study, 18 Wistar rats were randomly allocated into two groups: the sham group and the CMD group. The CMD group received injections of embolic microspheres into the left ventricle to establish a CMD model. Subsequently, non-targeted metabolomics and acetylated proteomics analyses were conducted. Machine-learning techniques were employed to identify the co-diagnostic markers of the disease. This study identified 53 key proteins through differential expression proteins (DEPs) and modular proteins analysis. Subsequently, four core proteins (Emc1; Ank1; Fbln2; and Hp) were determined as diagnostic markers for CMD using lasso regression, support vector machine, and random forest methodologies. Receiver operating characteristic curve analysis further demonstrated robust diagnostic performance. Gene ontology and kyoto encyclopedia of genes and genome enrichment analyses indicated that the DEPs were predominantly associated with metabolic pathways. Ultimately, the integrative analysis of proteomics and metabolomics suggested that the central metabolic mechanism underlying CMD pathogenesis may be linked to the tricarboxylic acid cycle. This study revealed specific changes in the proteomic and metabolic profiles of CMD rats and identified four diagnostic markers, which are proteins and metabolites that could be potential diagnostic biomarkers for CMD.

Comparative analysis of the primary morbidity in the population in the territory of accumulated risk over the post-operation period of a chemical enterprise

Introduction. The long-term operation of the chemical enterprise has led to the formation of an area of accumulated harm to public health. The purpose of the study is to investigate the trend in newly identified morbidity in various population groups living in areas of accumulated chemical pollution of the environment. Materials and methods. The primary morbidity rate of the population of Usolye-Sibirskoye was assessed retrospectively according to official statistical reporting – during 1985–1995. and 2016–2022. Relative rates of incidence among children and adults (per 1000 population) were calculated. The trend in the incidence of malignant neoplasms was studied using regression analysis and growth (decrease) rates. Results. Over 2016–2022 there was a gain in the incidence in the population: in 0–14 years children by classes: certain conditions in the perinatal period, blood diseases, neoplasms; in 15–17 years adolescents: by class of disease of the circulatory system, blood, endocrine and genitourinary systems, congenital malformations, neoplasms; in the adult population by classes of diseases including congenital malformations, diseases of the endocrine system, circulatory system, musculoskeletal system and blood diseases, neoplasms. Limitations are due to changes in the structure of statistical reporting forms and various etiological factors for diseases included in one class of diseases. Conclusion. During the post-operation period of the city-forming enterprise, an increase in incidence in children and adults was revealed. Undoubtedly, the formation of pathology was influenced not only by the unfavourable environmental situation in the city, but also by socio-economic conditions. To optimize medical and preventive measures to improve and preserve public health, it is necessary to conduct further studies of the health status in the population in the area of accumulated chemical pollution.

Global burden of anemia and cause among children under five years 1990-2019: findings from the global burden of disease study 2019.

Anemia represents a significant global health issue affecting numerous children and women, characterized by diminished hemoglobin levels that may impede cognitive and developmental progress. Although commonly attributed to iron deficiency, the etiology of anemia in this demographic is multifaceted, encompassing nutritional, genetic, and infectious contributors. Nonetheless, there is a lack of high-quality data on anemia prevalence and causes analysis among children under 5 years. The aim of this study was to provide a comprehensive global assessment of the burden of anemia and its causes among children under 5 years, using data from the Global Burden of Disease Study 2019. This investigation utilized data from the Global Burden of Disease Study (GBD) 2019 to assess the prevalence and years lived with disability (YLD) attributable to anemia in children under five from 1990 to 2019. Analyses were conducted to delineate age-specific YLD, prevalence rates, and etiological factors, with stratification by gender and Socio-Demographic Index (SDI). In 2019, anemia imposed a substantial global burden on children under five, with a reported YLD of 1,252.88 (95% UI: 831.62-1,831.34) per 100,000 population. The prevalence of moderate anemia was highest at 985.46 (95% UI: 646.24-1,450.49) per 100,000, surpassing both severe anemia at 197.82 (95% UI: 132.53-277.80) per 100,000 and mild anemia at 69.59 (95% UI: 24.62-152.53) per 100,000. Globally, the total prevalence was 39,517.75 (95% UI: 38,784.81 - 40,239.62) cases per 100,000 population. Notably, disparities were evident between genders, with males demonstrating higher YLD and prevalence rates than females. Iron deficiency emerged as the leading cause globally, with significant contributions from hemoglobinopathies and other nutritional deficiencies. Regions with a low Socio-Demographic Index, particularly sub-Saharan Africa and South Asia, exhibited the most pronounced burdens. Despite a declining trend over three decades, persistent regional and gender-based disparities highlight the necessity for continuous and focused public health interventions. The burden of anemia among children under five continues to be considerable, marked by stark regional and socioeconomic disparities. These findings underscore the urgent need for advanced nutritional and healthcare strategies tailored to alleviate anemia in this vulnerable population, with a particular emphasis on regions exhibiting low SDIs. The sustained prevalence of high anemia rates in these areas underscores the imperative for persistent, localized intervention efforts.

The Importance of Recognizing Vaginal Melanoma, A Unique and Aggressive Subtype of Mucosal Melanoma with Undefined Staging and Treatment Protocols: Case Report and Literature Review

Abstract Introduction/Objective Primary vaginal melanoma is a highly aggressive subtype of mucosal melanoma, with few cases reported in the literature. Mucosal melanomas represent a very small subset of melanoma cases, with even fewer found in the vagina. There is a frequent delay in diagnosis due to absent or nonspecific symptoms. Methods/Case Report We report two cases of primary vaginal melanoma that were found on biopsy due to abnormal postmenopausal bleeding. Case 1 is a 62-year-old woman that was found to have a necrotic mass originating from the vaginal apex, while case 2 is a 66-year-old woman that had a vaginal polyp. Microscopic examination of both cases revealed sheets of malignant cells with prominent nucleoli, brisk mitotic activity, and patchy melanin pigment. Immunohistochemical stains for MART-1 and SOX10 were positive in both cases, supporting the diagnosis. The patient in case 1 had an upper vaginectomy and is currently on immunotherapy as part of a clinical trial. Further treatment and status of the patient in case 2 is unknown. Results (if a Case Study enter NA) N/A Conclusion Due to the rarity of cases, little is known about the etiology and risk factors. A standardized staging system is not yet accepted, with most using a combination of the AJCC and FIGO systems, however, neither are specific for vaginal melanomas. Patients are often metastatic at the time of diagnosis due to delayed diagnosis and aggressive nature of the disease. Specific treatment protocols have not yet been defined, and it is debated whether a more conservative or aggressive approach is favored. The disease control and survival rates are dismal with a poor prognosis. The role of adjuvant and targeted molecular therapies is still being investigated. The addition of our cases to the literature will hopefully bring more awareness to vaginal melanoma as a diagnostic possibility and encourage more research to be done.

Modern Possibilities for Reconstruction of Nerves of the Head and Neck

The main etiological factors of nerve damage to the head and neck include injuries, oncological diseases, iatrogenic injuries during surgical interventions. An important task of treatment is to restore the lost function of the nervous head and neck, the functions of which certainly determine the quality of life of the patient. The article presents modern methods of nerve reconstruction of the head and neck. The methods of reconstructive surgery of the facial, trigeminal, inferior alveolar, lingual, recurrent laryngeal nerves are described. This article also describes the types of rehabilitation after reconstructive operations on the nerves of the head and neck using pharmacological and non-pharmacological treatment methods such as botulinum therapy, neuromuscular retraining, taping, post-isometric relaxation, acupuncture, phonophoresis, gymnastics.

Functional associations of the gut microbiome with dopamine, serotonin, and BDNF in schizophrenia: a pilot study

BackgroundSchizophrenia is a complex neuropsychiatric disorder with various etiologic factors. Aberrant levels of neurotransmitters or growth factors such as dopamine, serotonin, and BDNF have been shown to cause cognitive impairment in schizophrenia. Recently, the gut microbiome has also been suggested as a factor in the development of the disorder. To explore this potential link, we conducted a pilot study to examine the relationship between the gut microbiome and plasma levels of neurotransmitters and growth factors in schizophrenia. Shotgun metagenome sequencing of total RNA from fecal samples were used to profile the gut microbiome of schizophrenia patients (SCZ) and healthy controls (HC). The MetaPhlAn2 and HUMaN2 pipelines were used for bioinformatic analyses. ELISA was used to measure the plasma levels of dopamine, serotonin, and BDNF. Spearman’s rank correlation coefficient was used for correlation analysis.ResultsWe found that butyrate-producing bacteria were enriched in HC, whereas succinate-producing bacteria, namely Phascolarctobacterium succinatutens and Paraprevotella clara, were enriched in SCZ. The gut microbiota of SCZ was enriched in lipid biosynthesis pathways related to bile-resistant bacteria, whereas phospholipid pathways linked with butyrate-producing bacteria were enriched in HC. Alistipes indistinctus, Dorea longicatena, and Roseburia inulinivorans were negatively correlated with dopamine levels. Roseburia intestinalis and Parabacteroides goldsteini were negatively correlated with serotonin and BDNF levels, respectively. We found a significant correlation between dopamine and serotonin levels, and the super-pathway of purine deoxyribonucleoside degradation.ConclusionsThis study provides further support that gut microbiota could modulate neurotransmitter levels. The results suggest that gut microbiome-targeted therapies may help to rebalance neurotransmitter levels, offering new hope for the treatment of schizophrenia.

The role of nutrition and gut microbiome in the progression of multiple myeloma and its precursor disease.

Multiple myeloma (MM) is the second most common hematological malignancy, characterized by unregulated monoclonal proliferation in the bone marrow. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are premalignant conditions that can progress to MM. Identifying etiological risk factors for MM and its precursor diseases is crucial for prevention. Obesity, diet, vitamin D levels, and gut microbiota alterations have been identified as lifestyle factors affecting MM and MGUS risk. Upon disease onset, treatment strategies aim to reduce disease burden, enhance prognosis, and optimize patients' quality of life. Nutrition and body weight have been shown to affect disease progression and treatment outcomes. MM patients often present with vitamin D, vitamin B12, and folate deficiencies, which worsen disease prognosis. High body mass index is linked to increased death rates among MM patients and an increased risk of MGUS transformation to MM. Gut microbiota has also been associated with disease progression and response to treatment. This literature review aims to summarize the available evidence regarding the impact of nutrition and nutritional status on MM patients beyond prevention, highlighting the significance of gut microbiome and dysbiosis in MM progression.

Identification of novel biomarkers for atherosclerosis using single-cell RNA sequencing and machine learning.

Atherosclerosis (AS) is a predominant etiological factor in numerous cardiovascular diseases, with its associated complications such as myocardial infarction and stroke serving as major contributors to worldwide mortality rates. Here, we devised dependable AS-related biomarkers through the utilization of single-cell RNA sequencing, weighted co-expression network (WGCNA), and differential expression analysis. Furthermore, we employed various machine learning techniques (LASSO and SVM-RFE) to enhance the identification of AS biomarkers, subsequently validating them using the GEO dataset. Following this, CIBERSORT was employed to investigate the correlation between biomarkers and infiltrating immune cells. Consequently, 256 differentially expressed genes (DEGs) were selected in samples of AS and normal. GO and KEGG analyses indicated that these DEGs may be related to the negative regulation of leukocyte-mediated immunity, leukocyte cell-cell adhesion, and immune system processes. Notably, C1QC and COL1A1 were pinpointed as potential diagnostic markers for AS, a finding that was further validated in the GSE21545 dataset. Moreover, the area under the curve (AUC) values for these markers exceeded 0.8, underscoring their diagnostic utility. Analysis of immune cell infiltration revealed that the expression of C1QC was correlated with M0 macrophages, gamma delta T cells, activated mast cells and memory B cells. Similarly, COL1A1 expression was linked to M0 macrophages, memory B cells, activated mast cells, gamma delta T cells, and CD4 native T cells. Finally, these results were validated using mice and human samples through immunofluorescence, immunohistochemistry, and ELISA analysis. Overall, C1QC and COL1A1 would be potential biomarkers for AS diagnosis, and that would provides novel perspectives on the diagnosis and treatment of AS.

Head and Neck Cancer and Sarcopenia: An Integrative Clinical and Functional Review

Sarcopenia is recognized as a crucial factor impacting the prognosis, treatment responses, and quality of life of HNC patients. This review discusses various mechanisms, including common etiological factors, such as aging, chronic inflammation, and metabolic dysregulation. Cancer-related factors, including tumor locations and treatment modalities, contribute to the development of sarcopenia. The clinical implications of sarcopenia in HNC patients extend beyond reduced muscle strength; it affects overall mobility, reduces quality of life, and increases the risk of falls and fractures. Sarcopenia serves as an independent predictor of postoperative complications, chemotherapy dose-limiting toxicity, and treatment outcomes, which affect therapy planning and perioperative management decisions. Methods to assess sarcopenia in HNC patients encompass various techniques. A sarcopenia assessment offers a potentially efficient and readily available tool for clinical practice. Interventions and management strategies for sarcopenia involve exercise interventions as a cornerstone; however, challenges arise due to patient-specific limitations during cancer treatment. A routine body composition analysis is proposed as a valuable addition to HNC patient management, with ongoing research required to refine preoperative exercise and nutrition programs for improved treatment outcomes and survival.

Hepatocellular Carcinoma Situation in Indonesia: A Systematic Review of Clinical Staging and Histological Characteristics at the Time of Diagnosis

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. However, systematic data on HCC characteristics in Indonesia are limited. Objective: To summarize the body of literature on the characteristics of HCC in Indonesia. Methods: A comprehensive search was conducted in MEDLINE, ScienceDirect, Scopus, Web of Science, and Google Scholar databases without date restrictions. Clinical studies investigating the characteristics of HCC exclusively in Indonesia were eligible for inclusion. Risk-of-bias assessments were conducted, and results were presented descriptively. Results: Ten studies comprising 1,389 HCC patients were included. The Barcelona Clinic Liver Cancer (BCLC) staging system, reported in 5 studies, revealed a predominance of intermediate to advanced stages (B and C) at diagnosis. Child-Pugh scores, available for 7 studies, indicated variability in liver function, with Child-Pugh A ranging from 12.0% to 85.7%. Hepatitis B virus (HBV) infection was the primary etiological factor, with prevalence ranging from 53.8% to 84.0%. Hepatitis C virus (HCV) infection was less common (1.0% to 25.21%). Non-viral etiologies represented a substantial proportion, reaching up to 37.4% of cases. The mean age at diagnosis ranged from 52.43 to 63.1 years. Conclusion: This review highlights the late-stage presentation of HCC in Indonesia, the predominance of HBV as an etiological factor, and a significant burden of non-viral HCC. The findings underscore the need for improved early detection strategies, strengthened HBV prevention efforts, and increased attention to metabolic risk factors. Regional variations in HCC characteristics suggest the need for tailored approaches to HCC management across different parts of Indonesia.