First Group Of Patients Research Articles

Evaluation of Selected MRI Parameters in the Differentiation of Mucinous Ovarian Carcinomas and Metastatic Ovarian Tumors

Introduction: Analysis of selected MRI parameters in initial MRI for the characterization of ovarian masses enables differentiation between mucinous ovarian carcinoma and metastatic ovarian tumors. Material and Methods: A prospective analysis of contrast-enhanced MRI of patients with suspected ovarian masses diagnosed in ultrasound and CT examination. Morphological criteria, such as the size of lesion, bilateral location, presence of “mille-feuille sign”, so-called Seidman criteria, as well as the diffusion weighted imaging and dynamic contrast enhancement of each lesion, were evaluated. Patients were allocated into two groups; the first group contained patients with mucinous ovarian cancer, and the second group contained patients with metastatic ovarian tumors. Results: A total of 35 patients were enrolled into the study. Median age was 49 in the first group and 59 in the second group of patients (p = 0.04). In the first group, all patients (100%) had unilateral lesions, and in the second group, 94% had bilateral tumors (p < 0.000001). In the first group, a tumor size equal or greater than 10 cm was present in 80% of patients, and the same was true for 21% of patients in the second group. The mille-feuille sign was present in 30% of patients from the first group and in 64% of patients from the second group. In the first group of patients, TTP was 410 and Perf.Max Enhancement was 141; in the second group, they were, respectively, 154 and 167 (p = 0.0001 and p = 0.5). Median ADC values in the first group were significantly higher in the first group than in the second group (p < 0.01). Conclusions: Significant differences in TTP and ADC values as well as in Seidman criteria enable reliable differentiation between the analyzed groups of tumors.

The functional activity of the brain in patients with occupational chronic mercury intoxication against background of the treatment of insomnia disorders

Introduction. In patients with chronic mercury intoxication, insomnia disorders are much more common than in the general population. Persistent emotional disorders in combination with severe sleep disturbances may contribute to the progression of cognitive dysfunction in patients in the late post-exposure period of chronic mercury intoxication. The purpose of the study was to analyze the trend in electroencephalography indices and study cognitive evoked potentials in patients with occupational chronic mercury intoxication to optimize the treatment of insomnia. Materials and methods. Two groups of 30 patients with occupational chronic mercury intoxication, who worked at the enterprises of Usolyekhimprom LLC and Sayanskhimplast OJSC, were examined. In the first group of patients received the first treatment option, the average age was 56±0.71 years, in the second group, cases received the second treatment regimen, were of 57.1±3 years. Before and after treatment, there were carried out neurophysiological studies including polysomnography, electroencephalography, and a study of cognitive evoked potentials P300. Results. After the implementation of the treatment regimen in the first group, positive changes in the main indices of polysomnography were revealed as follows: decrease in the time of falling asleep and time of wakefulness in the bed, increase in total sleep time and the representation of delta sleep, increase in the sleep efficiency index, etc., electroencephalography (decrease in the delta index – rhythm and an increase in the alpha rhythm index), and cognitive evoked potentials (decreased latency and increased P300 amplitude). In the second group, there were registered positive alterations only in three neurophysiological indices: a decrease in the latent period of the 1st stage of sleep, a decline in the delta rhythm index and a fall in P300 latency. Limitations. The results cannot be generalized to workers as the group included only men. Conclusion. According to neurophysiological studies, improvement in polysomnography parameters during the treatment of insomnia in patients in the late post-contact period of chronic mercury intoxication was accompanied by an improvement in concentration and an increase in the rate of psychomotor response.

Prevention of Infectious Complications in Acute Pancreatitis

AIM OF STUDY. The study was aimed to evaluate the effectiveness of treating acute pancreatitis by early enteral nutrition and selective introduction of nutritional mixtures directly into the initial sections of the jejunum, bypassing the duodenum.MATERIAL AND METHODS. A comprehensive treatment method for acute pancreatitis was developed based on the use of a pancreatoduodenal catheter. The method focuses on preventing intestinal failure syndrome by isolating the duodenum and preventing any liquid from entering it while ensuring the selective introduction of glucose-saline solutions and/or enteral nutritional mixtures directly into the initial sections of the jejunum. Several Russian clinics are currently conducting the research approved by local ethics committees. This article presents preliminary results from the data analysis. The study included moderate to severe forms (according to the 2012 Atlanta classification) of acute biliary pancreatitis without indications for endoscopic retrograde cholangiopancreatography, as well as alimentary-alcoholic pancreatitis. The first group of patients received standard therapy according to the 2020 clinical guidelines of the Russian Society of Surgeons. The second group received standard therapy combined with the new selective enteral nutrition method. The observation period lasted until the end of the hospital treatment, including five mandatory visits and a final visit to the physician. A follow-up survey was conducted three months or more after discharge to identify delayed episodes of acute pancreatitis complications, focusing on the incidence of infectious complications and surgical interventions.RESULTS. A total of 148 patients were treated. Patients were evenly distributed by etiology, gender, age, and body mass index. The analysis revealed that the number of patients with infectious complications decreased from 19.3% in the comparison group to 6.67% in the study group (p=0.041). The number of patients requiring surgical interventions was 5.0% in the study group compared to 19.3% in the comparison group (p=0.017).CONCLUSIONS. The study demonstrated that the use of the new method in the comprehensive treatment of acute pancreatitis, including early enteral feeding at the onset of the disease, may improve the course of the disease by reducing the incidence of infectious complications and the number of necessary surgical interventions.

Investigating the effect of aerobic exercise on the neuropathy symptoms caused by chemotherapy

Introduction: Currently, there is no effective method to prevent CIPN; and if aerobic exercise combined with drug treatment is more effective than drug treatment alone, the side effects of the drug can be prevented to an acceptable extent by reducing the dose of the relevant drug. Therefore, in the following study, we tried to investigate and compare the effectiveness of two methods of aerobic exercise and drug treatment on the improvement of neuropathy symptoms caused by chemotherapy. Research materials and methods: In this clinical trial study, the first group of patients received duloxetine (Luxta, Obidi company) at a dose of 30 mg for 6 weeks. The second group received duloxetine at a dose of 30 mg along with aerobic exercise for 6 weeks. At the end of the intervention period, all patients were re-evaluated with EMGMCV of both lower limbs. The study data was analyzed using SPSS version 24 software. Findings: Two groups of cases (50 people) with an average age of 55.56 ± 4.21 years and controls (50 people) with an average age of 53.76 ± 4.57 years participated in this study. The results of EMGMCV improved significantly in both groups after the intervention, but the two groups did not show a statistically significant difference after the intervention (P<0.05). Conclusion: Based on the results of the studies and considering that aerobic exercise therapy is simple and available, since there has been no study related to the determination of the effect of combined aerobic exercise that can determine the best and most effective exercise volume affecting neuropathy. And since the existing researches are mostly focused on the effects of exercise on improving performance and neuro-muscular indicators, more clinical studies are needed in this field.

Point-of-care ultrasound of the inflammatory bowel disease

Background. The widespread use of portable ultrasound scanners has advanced the concept of ultrasound diagnosis (POCUS), namely «ultrasound examination (US) is performed at the bedside and is interpreted directly by a physician». Pocus is not a substitute for complex ultrasound, but rather allows the ultrasound doctor to quickly access clinical images for rapid diagnosis and effective examination and treatment of patients. Purpose – the work to identify ultrasound signs of inflammatory bowel disease (IBD) using POCUS. Materials and Methods. 70 patients aged 18 to 39 years (24 men and 46 women, mean age – 30.3 ± 13.7 years). The first group of patients included 32 people with a morphologically confirmed CD diagnosis, the second group included 38 people with a morphologically confirmed UC diagnosis. The control group consisted of 2 8 patients with no clinical and laboratory data on gastrointestinal lesions. Results. It was shown that the ultrasound can assess the thickness of the intestinal wall with sensitivity – 90.3% and specificity – 87.1% and ROC – 0.882, differentiation of the wall layers, surrounding structures (omentum, mesentery, lymph nodes), as well as the localization of the affected intestinal segment. Color Doppler Mapping (CDM) method with a sensitivity of 86.5% and specificity of 81.5% and ROC of 0.852 allows not only to assume the presence of active inflammation in the wall of the affected intestinal segment, but also to monitor the dynamics of the process during treatment. Conclusion. In this work, the capabilities of POCUS for the diagnosis of IBD were evaluated. Correct and accurate interpretation of POCUS findings is not only an important diagnostic step, but also a complement to other radiation and endoscopic imaging techniques. The main advantage of POCUS over CT and MRI is its fast availability, low cost, and high level of safety. An experienced ultrasound doctor is needed to examine the gastrointestinal tract, so training with ultrasound doctors and mastering practical skills is key to ensuring the effective use of POCUS.

Comparative analysis of five-year outcomes of anterior cruciate ligament tears repaired with different techniques

Introduction Primary repair of the anterior cruciate ligament (ACL) torn from the femur and the synovial membrane being intact can be an indication for two competing methods including dynamic intraligamentary stabilization (DIS) as the saving method and resection of the stump and primary autoplasty as a more traumatic option.The purpose was to evaluate the five-year results of DIS in comparison with early ACL reconstruction of the knee joint.Material and methods A review and statistical analysis of outcomes of 72 patients with ACL injuries (47 males and 25 females) were performed. The patients aged between 18 and 45 years (30.9 ± 8.5), with the length of time from injury ranging from 3 to 21 days (10.6 ± 5.0) and the Tegner activity score of 5 (1–9; 5.8 ± 0.9) prior to injury. DIS was performed for the first group of patients (n = 39) who arthroscopically were diagnosed with ACL torn off the femur with the synovial membrane preserved. Early ACL repair was performed for the controls (second group, n = 33).Results VAS scored 1.4 ± 0.8 in group I and 1.9 ± 0.8 in group II at 6 months, p = 0.004. Patient satisfaction scored 8.0 ± 0.8 in group I and 7.4 ± 0.8 in group II at 12 months, p = 0.003. Tegner activity level scored 6.5 ± 0.9 in group I and 6.3 ± 0.8 in group II at 12 months, p = 0.014. The Lysholm knee score measured 91.1 ± 2.2 in group I and 88.6 ± 3.5 in group II at 12 months, p = 0.001. Five-year dynamic observation showed relapses of anterior-medial instability of the knee joint in 10 patients (13.9 %), with 4 patients in group I (10.3 %) and 6 patients in group II (18.2 %).Discussion Outcomes of proximal ACL tears with intact synovium can be as good as with ACL repair. Removal of the torn cruciate ligament with the synovium being intact and grafting may be an unnecessary and aggressive approach.Conclusion Dynamic intraligamentous stabilization as compared to early ACL repair shows a faster recovery of physical activity at a short term and less relapses of knee joint instability at a long term.

Literature Review: Current Status of Surgical Treatment of Colorectal Tumor

The article is based on the study and comparison of surgical interventions on the large intestine for neoplasms. The aim of the study: to investigate and compare surgical interventions based on the efficacy, safety of mixed endoscopic surgeries and laparoscopic surgeries not subject to endoscopic removal of neoplasms. 17 randomized prospective and retrospective observations were selected for this work, the observations were divided into two groups, the first group of patients who underwent surgical intervention by hybrid laparo-endoscopic method and the second group of patients who underwent laparoscopic resection of the colon. The total number of patients amounted to 835 (100%) of which 517 (61,9%) were included in the first group and the second group consisted of 318 (38,1%) patients. The results of the study showed that in the first group the duration of the operation and the patient’s stay in hospital were statistically significantly shorter than in the second group (mean difference = -38.7 minutes; 95% CI -51.4 -26.0; p < 0.00001, bed-day mean difference = -2.3 days; 95% CI -3.17 - -1.57; p < 0.00001). And in terms of the incidence of postoperative complications, recurrence and mortality, no significant differences were observed between the groups (p = 0.05). Patients who underwent hybrid laparo-endoscopic surgeries with benign endoscopically unresectable colorectal neoplasms do not increase the incidence of postoperative complications and lethality. The advantage of this method is the reduction of bed-days and duration of the operation also time.

Integrative Approach to Risk Factors in Simple Chronic Obstructive Airway Diseases of the Lung or Associated with Metabolic Syndrome-Analysis and Prediction.

We conducted an epidemiological non-interventional cross-sectional and case-control study from 1 January 2023 until 26 May 2023 in Oltenia region, southwestern Romania. Throughout the research, 160 consecutive patients were included from two different clinical departments (1-Pneumology; 2-Diabetes and Nutritional Diseases). Subjects were voluntary adult individuals of any gender who expressed their written consent. The clinical data of the patients were correlated with the exposure to behavioral risk factors (diet, lifestyle, exposure to pollutants) to identify some negative implications that could be corrected to improve the quality of life of patients with simple chronic obstructive airway diseases of the lung or associated with metabolic syndrome (MS). In the first group of patients with respiratory diseases, there was a higher degree of exposure to toxic substances (43.75%) compared to the second group of patients with diabetes (18.75%); it is also noticeable that in the first group, there were noticeably fewer individuals who have never smoked (25%) compared to the second group (50%). Respiratory function impairment was observed to be more severe in overweight individuals. In the group of patients with known lung diseases, a positive correlation was noted between the presence of MS and respiratory dysfunctions of greater severity. Additionally, potential exacerbating factors affecting lung function, such as direct exposure to toxins and smoking, were considered. Potential secondary factors exacerbating respiratory dysfunction were considered by correlating biochemical parameters with dietary habits. These included reduced consumption of vegetables, inadequate hydration, and increased intake of sweets and products high in saturated or trans fats (commonly found in junk food), primarily due to their potential contribution to excess weight. Compared to patients without MS, the severity of the pulmonary function impairment correlated with the number of criteria met for MS and, independently, with an increase in weight.

Feasibility of endoscopic techniques in assessing the radicality of chemoradiotherapy in patients with rectal cancer

Introduction. The standard of treatment of rectal cancer is a combined or complex technique in the form of neoadjuvant chemoradiotherapy (CRT) followed by surgery or observation, with proven radicalization of CRT. Currently, the most adequate methods of evaluating the results of CRT are endoscopic diagnostics. The most reliable visual criteria for endoscopic examination of absence or presence of residual tumor are: complete response (flat white scar, telangiectasia), partially complete response (uneven mucosa, small nodules on mucosa, superficial ulceration, slight persistent erythema of scar) and incomplete response (visible tumor).Aim. The study is to assess sensitivity and specificity of endoscopic method in assessment of radicality of neoadjuvant CRT in patients with rectal cancer.Materials and methods. A retrospective study of 75 patients with verified rectal cancer after CRT was carried out. Inclusion criteria: histologically verified rectal cancer (adenocarcinoma); endoscopic picture of clinical response of rectal cancer to CRT; absence of established distant metastases at the moment of examination. Exclusion criteria: morphological types of tumors other than adenocarcinoma of the colorectal type; patients with primary-multiple diseases.Results. A retrospective study was conducted in 75 patients with a verified diagnosis of rectal cancer who underwent CRT at the first stage of treatment. All patients underwent endoscopic examination with evaluation of the degree of tumor regression, taking material for cytological and histological examination. In 57 (76,4 %) out of 75 patients on the basis of visual endoscopic picture the absence of residual tumor was stated, in 18 patients visual endoscopic signs were considered as presence of residual tumor. The results of morphological study in the first group of patients confirmed the absence of tumor in 51 cases (92.7 %). In the second group, in the presence of visual signs of residual tumor, morphological confirmation was obtained in 14 out of 18 patients (77.8 %). Morphological verification of residual tumor was obtained in 26.6 % of patients in the total group.Conclusion. Endoscopic and histologic data can be decisive in the evaluation of the degree of radicality of neoadjuvant CRT.

Intraoperative neurophysiological monitoring in patients with delayed cerebral ischemia after clipping of ruptured arterial aneurysms

Aim. Research of significant changes in parameters (SCP) by intraoperative neurophysiological monitoring (IONM) during clipping of ruptured cerebral aneurysms in patients with delayed cerebral ischemia (DCI) in the postoperative period.Materials and methods. The study included 16 patients, 7 (43.8 %) men and 9 (56.2 %) women, aged 51.1 ± 9.3 years, who underwent clipping of ruptured cerebral aneurysms for the period 2016–2021, in which the neurological deficit (ND) remained at the preoperative level on the first postoperative day, but increased by the end of hospitalization. In order to study the factors leading to the development of DCI, 2 groups were identified with transient SCP according to IONM: with the development of DCI – 7 patients out of the above 16 patients, including 3 men (42.9 %) and 4 women (57.1 %), aged 49.6 ± 8.5 years; and control group – 19 patients, including 9 men (47.4 %) and 10 women (52.6 %), aged 46.2 ± 10.9 years, in whom ND did not increase on the first postoperative day and by the time of discharge. The groups did not differ significantly in age, sex, aneurysm location, rupture period, and baseline ND.Results. In patients with DCI, in 9 cases (56.2 %), during the operation, SCP from the side of somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (TcMEP) was not registered, in 7 cases (43.8 %) transient SCP was registered, of which 3 patients (42.8 %) had TcMEP and SSEP, in 2 patients (28.6 %) – only TcMEP and in 2 patients (28.6 %) – only SSEP. In the control group, transient SCR of TcMEPs and SSEPs were registered in 4 patients (21.6 %), only TcMEPs – in 9 patients (47.4 %), only SSEPs – in 6 patients (31.6 %). When comparing two groups of patients with transient SCR (DCI‑group and control group), a statistically significant predominance was revealed in the first group of patients with severity 3 according to the Hunt–Hess scale (42.9 % vs 5.2 %), while in the second group patients of severity 1 and 2 prevailed (94.8 % vs 57.2 %) (p <0.05). When analyzing the data of ultrasonic duplex scanning of extra- and intracranial arteries in both groups, a statistically significant increase in peak systolic blood flow velocity in the middle cerebral artery was revealed (in the group with DCI before surgery – 100 (80–139) cm/s, after surgery – 175 (139–278) cm/s (p = 0.001), in the control group before surgery – 100 (100–118) cm/s, after surgery – 150 (116–194) cm/s (p = 0.0001)), as well as the Lindegaard index (in the group with DCI before surgery – 2.5 ± 0.7, after surgery – 3.5 ± 1.1 (p = 0.01), in the control group before surgery – 2.1 ± 0.3, after surgery 2.9 ± 1.1 (p = 0.0002)), but the differences between the groups were not statistically significant (p = 0.092).Conclusion. At this stage, it cannot be unequivocally stated that transient SCP according to IONM may be one of the risk factors for the development of DCI after clipping of ruptured cerebral aneurysms. However, patients with transient SCR according to IONM, whose severity at admission is estimated at 3 points on the Hunt–Hess scale, are statistically significantly more likely to develop DCI.

The efficacy of PARP inhibitors in the treatment of patients with synchronous breast cancer.

e13041 Background: Currently, the role of BRCA1/2 in the development of primary and multiple malignant breast tumors is under discussion, along with the effectiveness of targeted therapy for this oncopathology. At the same time, there is a lack of sufficient research dedicated to the treatment of patients with synchronous breast cancer (BC) concurrent with ovarian cancer (OC) and the outcomes of using PARP inhibitors in this patient population. Methods: A retrospective analysis of treatment outcomes based on long-term survival indicators was conducted for 23 patients with synchronous BC, where the second tumor was OC. These patients underwent evaluation and treatment between 2017 and 2022. The average age of the patients was 45.3±5.6 years, with a prevalence of patients in stages IIb-IIIa of BC and IIb-IIIc of OC. Germline mutations in the BRCA1/2 genes were detected in 8 patients, among whom 5 exhibited the triple-negative phenotype of BC. The 1st group included 11 (47.8%) patients without BRCA1/2 mutations, who received neoadjuvant chemotherapy with paclitaxel 175 mg/m2 + carboplatin AUC 6 once every 3 weeks. In the 2nd group, consisting of 12 (52.2%) patients, olaparib 800 mg was added to this chemotherapy regimen. This group also included 8 patients with BRCA1/2 mutations. Results: In the majority of patients in both groups, a significant elevation in CA125 levels in serum was observed, averaging 563 U/mL, with practically normal CA153 levels at 32 U/mL. Identified mutations included 5382insC and 4154delA mutations in the BRCA1 gene, as well as the 6174delT mutation in the BRCA2 gene. Patients underwent three courses of treatment, and four weeks after completing the last course, surgical intervention was performed in the form of radical mastectomy, hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Following surgical treatment, patients received adjuvant chemotherapy following the same regimens. In the 2nd group, patients continued to receive olaparib for one year, and no signs of unacceptable toxicity were reported. The median overall survival in the first group of patients was 34.2 months (95% CI: 28.6-37.5), while in the second group, it was 36.8 months (95% CI: 31.4-41.1). The addition of bevacizumab significantly increased the median time to progression from 13.8 months (95% CI: 11.8-14.5) to 15.2 months (95% CI: 12.4-15.8), p=0.042. Lethal outcomes primarily occurred due to the progression of ovarian cancer. Conclusions: Thus, the addition of the PARP inhibitor olaparib to a platinum-based chemotherapy regimen in patients with synchronous breast cancer, associated with germline mutations in BRCA1/2 genes and the presence of ovarian cancer as a second tumor, has a positive impact on treatment outcomes. This contributes to the resectability of patients and significantly increases the median time to progression.

Assessment of dental mobility in elderly and senile patients with various types of dentition defects

Objective. To determine the differences in the degree of tooth mobility in elderly patients with various types of dentition defects. To establish and differentiate the degree of tooth mobility in relation to the type of dentition defect in elderly and senile patients. Materials and methods. 500 patients aged 60 to 75 divided into 4 groups were examined. In the first group of patients, terminal defects were revealed (on one or both sides). The second group consisted of patients with included defects (on one or both sides). The third group was presented by combined defects (included and not included). Patients with single standing teeth constituted the fourth group. Patients with complete absence of teeth were excluded from the study. The assessment of dental mobility was carried out using the Periodotest device. All studies on dental mobility were conducted as part of the initial examination of the patient. To obtain objective data, periotestometry was performed 2 times in each patient. Average periotestometry data were calculated for each patient. The average readings of periotestometry for different groups of patients were determined. Results. On the basis of the data obtained while comparing the results of periotestometry, in relation to the type of dentition defect, statistically significant differences were established (p 0.001) (method used: the Kraskel – Wallis criteria). The results of periotestometry obtained in patients of group 4 were significantly higher than in representatives of other examined groups. The least mobility according to the results of periotestometry was observed in groups 2 and 3. Conclusions. The study revealed significant differences in the degree of tooth mobility in relation to the type of dentition defect. In patients with single standing teeth, 2–3 degree of their mobility was determined, while patients with included defects had 1–2 degree of the mobility of existing teeth. The obtained data of periotestometry indicate the need to use unloading dentures in elderly patients, in order to preserve the remaining teeth in patients with single-standing teeth, as well as in patients with terminal defects of the dentition.

#651 Diagnostiс criteria of the functional state of the kidneys in patients with type 2 diabetes mellitus

Abstract Background and Aims The constant increase in the number of patients with type 2 diabetes is clearly explained by the incidence of microvascular complications, including diabetic nephropathy (DN). According to statistics, CKD develops initially in 15% of individuals in the general population. To assess the functional state of the kidneys in patients with type 2 diabetes mellitus. Method The study included 120 patients with T2DM and were divided into 2 groups. Gr1: 60 patients with DN C1,A1, gr2 with DN C2,A2 whose average age was 60.1 ± 7.6 years. The average DM experience was 7 ± 3.16 years, HbA1C 9 ± 1.82%, BMI 28.05 ± 3.45. Average GFR cr. was 92.6 ± 11.81 ml/min/1.73 m2, albuminuria—13.19 ± 3.1 mg/g. Results In the first group, the decrease in eGFRcr was 7.1%, although the average value was within the reference values. At the same time, the level of serum cystacin C and the calculated eGFRcys in this group were significantly different from the control. The serum concentration of cystacin C was significantly higher (0.64 ± 0.09 mg/ml versus 1.07 ± 0.08 mg, p < 0.05), and the eGFRcys indicator was significantly lower (81.32 ± 6.31 ml /min versus 96.60 ± 5.22 ml/min, p < 0.05) indicator for healthy individuals. In the second group of patients, there was a significant decrease in glomerular filtration rate for both markers compared to the control and the first group. Thus, in patients with DN C2, A2, compared with the control and the first group of patients, the eGFRcr indicator was reduced by 24.2% and 18.3%, respectively (p < 0.01 and p < 0.05), which indicates a pronounced decrease in renal function in this category of patients with type 2 diabetes. Conclusion Thus, the results obtained showed that in patients with subclinical diabetic nephropathy there is a decrease in glomerular filtration rate, determined by the level of cystacin C. Therefore, eGFRcys is a more accurate indicator of a hidden impairment of renal filtration function compared to eGFRcr.

#1073 Changes in endothelial function in patients with impaired central and renal hemodynamics respiratory pathology

Abstract Background and Aims To determine the degree of influence of endothelial dysfunction on the hemodynamics of renal and central vessels in respiratory pathology, as well as to determine the effectiveness of complex therapy regimens with carvedilol. Method Studies were conducted in 26 patients with chronic obstructive pulmonary disease (COPD) of II- III severity (group 1, in whom the level of glomerular filtration rate of the kidneys eGFR CKD-EPI ≥6 ml/min/1.73 m2 was determined) and 32 patients with COPD of IV severity (group 2, they were determined e GFR CKD-EPI ≥60 ml/min/1.73 m2). Patients received one course of ten-day standard therapy (GOLD, 2020) in combination with a beta–blocker drug, T. carvedilol 5 mg (Vertex). Doppler echocardiographic examination of peripheral vessels, heart and renal vessels of patients was performed. Stable metabolites of nitric oxide (Cm NO) in blood plasma, ventilation and perfusion state of the lungs were determined. Results A significant decrease in the functional state of the respiratory system was parallel with a decrease in Cm NO synthesis, which was clearly reflected in the second group (by 11%) compared with the first group (by 7%). Pronounced structural changes with remodeling of the right parts of the heart, as well as a pronounced degree of pancreatic hypertrophy in the second group were accompanied by a sharp change in renal filtration function (eGFR ≤60 ml/min/1.73 m2). When measuring the state of diastolic dysfunction of the right parts of the heart, a decrease in E/As well as an increase in the circulatory vascular resistance index and mean blood pressure were significantly higher in the first group of patients (where еGFR ≥6 ml/min/1.73 m2). After a course of treatment with t. carvedilol, based on basic treatment, normalization of endothelial function was determined, reflected in an increase in the concentration of stable metabolites of nitric oxide by 1.05 and 1.5 times (p<0.05) in the biological fluid, respectively, in the first and second groups. In the dynamics of the course of therapy in groups of patients with 75% and 35% decrease in lung ventilation capacity, mean pulmonary arterial pressure decreased by 18.1 and 14.3%, respectively, and the hemodynamic resistance index decreased by 7.9% and 5.7% in parallel (p<0.05). Conclusion When monitoring the functional state of central and renal hemodynamics and ventilation-perfusion function of the bronchopulmonary system after complex treatment with carvedilol, a long-term hypotensive effect, a decrease in endothelial dysfunction, respectively, and an improvement in central and renal hemodynamics were determined.

Radiographic study of direct anterior approach hip arthroplasty: a 10–15 year follow-up of Chinese patients

BackgroundControversy remains over whether different surgical approaches exert an impact on the component positioning in total hip arthroplasty. We conducted a retrospective study to reveal the long-term position of prostheses in the first group of patients in China who underwent direct anterior hip arthroplasty.MethodsCollected were data from 350 patients who underwent direct anterior hip arthroplasty between 2008 and 2013, including demographic information, imaging data, Harris hip scores, and surgical complications. Variables, measured radiographically or by CT, included hip offset, leg length discrepancy, component position, and stability within one week after surgery and at the last follow-up. The data were subjected to statistical analysis by using paired t-tests and Pearson chi-square tests.ResultsData were harvested by follow-up and self-reported questionnaires. The postoperative follow-up lasted for 13.1 years on average (minimum, 10 years; maximum, 15 years), and the overall survival rate of hip prostheses was 96.3%. The mean Harris score at the final follow-up was 91.8 points. After excluding patients with significant preoperative hip deformities, the incidence of postoperative limb inequality (> 5 mm) was 4.9% at the last follow-up, and the incidence of hip offset discrepancy (> 5 mm) was 14.6%. The overall proportion of the acetabular components located in the Lewinnek safe zone was 77.7%, whereas the proportion of femoral prostheses in the safe zone (< 3° inclination) was 94.0%. Based on the revised data and the last follow-up imaging, the total proportion of acetabular and femoral prostheses with a radiolucence of > 2 mm was 5.1%.ConclusionDirect anterior approach hip arthroplasty could achieve excellent component positioning and long-term prosthesis survival in patients without severe hip deformities.

Discovering the Potential Value of Coenzyme Q10 as an Adjuvant Treatment in Patients With Depression.

Depressive disorder or mental cold is the most common mental disorder, and depression exists all over the world and in all countries and cultures. The results of several studies have shown that using compounds with antioxidant properties has been fruitful in patients with depression. Coenzyme Q10 (CoQ10) is a fat-soluble antioxidant and exerts its antioxidant effect by directly neutralizing free radicals or reducing tocopherol and preventing the inhibition of mitochondrial activity because of oxidative stress. This study aimed to investigate the effects of oral CoQ10 in patients with depression as an adjunctive treatment. Sixty-nine patients with moderate and severe depression were randomly divided into 2 CoQ10 groups (36) and placebo (33). The first group of patients received CoQ10 supplements at a dose of 200 mg daily for 8 weeks along with standard interventions and treatments for depression, and the second group received standard treatments for depression along with a placebo. The change in the score of Montgomery-Åsberg Depression Rating Scale depression scale was evaluated 4 and 8 weeks after the intervention. Also, at baseline and 8 weeks later at the end of the study, serum levels of total antioxidant capacity, total thiol groups, nitric oxide, malondialdehyde, and interleukin 6 were assessed. The changes in the depression score at the end of the study showed that, in the group receiving the CoQ10 supplement after 8 weeks, there was a reduction in depression symptoms, which was statistically significant compared with before the start of the study Meanwhile, no significant changes were observed in the patients of the placebo group in terms of symptom reduction. Compared with baseline and the placebo condition, serum levels of nitric oxide and total thiol groups significantly decreased and increased, respectively. Also, no statistically significant changes were observed for interleukin 6, malondialdehyde, and total antioxidant capacity. A dose of 200 mg of CoQ10 supplement daily for 8 weeks can reduce depression and fatigue, as well as improve the quality of life of patients with depression. In addition, CoQ10 can significantly improve inflammation and oxidative stress status in patients with depression.

Correlation between MR semiotics and intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment

Objective. To identify the correlation between magnetic resonance (MR) semiotics and the intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Material and methods. We performed a retro- and prospective analysis of MR studies of pelvic organs in 77 female patients with pelvic pain syndrome, aged from 24 to 39 years. We assessed the intensity of the pain syndrome using a visual analog scale (VAS). The patients were divided into 2 groups: 1st-patients with external genital endometriosis (EGE) without involving the posterior pelvic compartment, 2nd-patients with EGE of the posterior pelvic compartment. The patients of the second group were divided into subgroups: 1 – endometriosis of the posterior pelvic compartment without MR signs of intestinal wall invasion, 2 – posterior compartment endometriosis with MR signs of intestinal wall invasion. The study was conducted on a GE Signa 1.5 Tesla MRI scanner. Results. In the second group of patients with endometriosis of the posterior pelvic compartment, the pain syndrome (8.00 (7.00–9.00) was more intense than in the first group of patients without endometriosis of the posterior pelvic compartment 7.00 (5.00–7.00), p&lt;0.001 and we evaluated a retrovaginal, retrocervical and posterior uterine localization. In the second subgroup of patients with signs of the intestinal wall invasion, the pelvic pain syndrome on the VAS was statistically significantly more intense 8.00 (8.00-10.00) than in the first subgroup of patients without signs of the intestinal wall invasion 7.00 (6.00–7.00) (P&lt;0.001). Conclusion. Patients with identified deep infiltrating endometriosis of the posterior pelvic compartment have more pronounced manifestations of the pelvic pain syndrome then patients with endometriosis of other localizations.

Persistent Conjunctival Chemosis after Lower Lid Blepharoplasty: A Comparison of Different Surgical Techniques.

Background: Conjunctival chemosis, a complication of lower blepharoplasty, can cause persistent discomfort and functional disturbances with worsening in the postoperative period following surgery. Methods: A review of the records of the lower blepharoplasty procedures carried out at the Humanitas Research Hospital, Rozzano, Milan, Italy was performed. Patients were categorized into two groups depending on the procedure performed: (1) transconjunctival blepharoplasty with the removal of the fatty lodges with canthopexy and (2) transcutaneous blepharoplasty with the removal of the fatty lodges with lateral canthoplasty. Each group was further divided into two more groups based on the surgical method used, that is either (a) cold blade and disposable cautery or (b) radiofrequency cut and coagulation and colorado tip (respectively 1a, 1b, 2a and 2b). All patients underwent a postoperative follow-up up to 24 months, which included an evaluation of cosmetic appearance, eyelid scarring and the severity of chemosis. The aim of the study was to investigate which of the surgical procedures causes a lower incidence of persistent type 3 conjunctival chemosis. Results: A total of 1047 patients who underwent lower lid blepharoplasty were included in the study. A total of 512 patients underwent transcutaneous blepharoplasty and 535 underwent the transconjunctival procedure. Among the first group of patients, 266 belong to group 1a and 246 to group 1b. In the second group, 264 were categorized as group 2a and 271 as group 2b. The incidence of type 3 chemosis in the transcutaneous blepharoplasty procedure with lateral canthoplasty was statistically significantly higher than in the transconjunctival approach, considering both the cold blade and the radiofrequency (p = 0.012, 0.010, 0.006, 0.004, respectively). Conclusions: A higher incidence of persistent type 3 conjunctival chemosis is associated with lateral canthus surgery and with the use of radiofrequency.

State of the microbial spectrum (microbiome) of the ocular surface of patients with cataracts and glaucoma in the early postoperative period

Background. The occurrence of infectious complications in the early postoperative period in patients undergoing ophthalmic surgery remains a persistent challenge in contemporary clinical practice. Typically the treatment regimen involves the administration of a combination of antibiotics and corticosteroids, often utilized in a fixed-dose combination for simplicity. Despite the prevalent use of these regimens, there’s a notable disregard for comprehensive microbiological diagnostics of the conjunctiva in surgical patients, attributed to various socio-economic factors. However, the significance of such diagnostics in forecasting postoperative outcomes is indisputable. Purpose of the study: to determine the medical and economic feasibility of prescribing individual antibacterial and anti-inflammatory medications in fixed combinations (FC) in postoperative treatment regimens for patients scheduled ophthalmic surgeries. Materials and methods. The study included data from 99 patients (65 males and 34 females, mean age 74 (70–77) years) admitted for elective surgery to address cataracts or glaucoma from May to September 2023. Patients were randomly divided to 2 observation groups. The division into groups was carried out according to the drugs (medicines) used in the postoperative treatment regimens, each of which was further divided into 2 subgroups in accordance with ophthalmopathology. The first group of patients received postoperative therapy with the levofloxacin/dexamethasone FC (L-dexopt, RK.O. Rompharm Company S.R.L., RU LP-007490), the second group was treated with a tobramycin/dexamethasone FC (Tobrazon, Kadila Pharmaceuticals, RU P№015176/01). All subjects underwent a comprehensive ophthalmological examination, as well as a microbiological examination of the conjunctival cavity before surgery and 8 days after surgical treatment. Additionally, all patients completed the Ocular Surface Disease Index (OSDI) questionnaire. Results. Analysis of microbial flora changes during therapy revealed an increase in cultures exhibiting a “zero” degree of growth by 29 and 11,1 % in the “cataract” and “glaucoma” subgroups of the fi rst observation group, respectively. The second group showed a similar increase. “zero” degree of growth (11,7 and 28,6 %, respectively). The treatment costs for patients undergoing cataract surgery and receiving the FC levofloxacin/ dexamethasone were 105.9 rubles per treatment course, compared to 40.5 rubles for those undergoing surgery for glaucoma or complicated cataracts. The cost-effectiveness for those treated with the FC tobramycin/dexamethasone in the early postoperative period was 21,6 and 51,9 rubles. respectively. The OSDI scores across in all subgroups ranged from 16,6 to 25,0 points indicating normal values. The administration of FC levofloxacin/dexamethasone and tobramycin/dexamethasone in the early postoperative period for patients with cataracts and glaucoma was clinically effectively in managing the inflammatory process by influencing the microbial spectrum (microbiome) of the ocular surface. No significant differences were observed in the degrees of microflora growth during the preoperative period between the “cataract” and “glaucoma” subgroups, which does not support the hypothesis regarding the antiseptic action of topical antiglaucoma medications in patients with glaucoma at this stage. Conclusions. The conducted medical and economic analysis proved the feasibility of using both drug combination with a slight preference FC levofloxacin/dexamethasone in patients undergoing surgery for glaucoma and FC tobramycin/dexamethasone for those with uncomplicated cataracts in the early postoperative period.

Impact on Long-term Survival of a Standardized Histopathological Protocol on the R1 Incidence in Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma.

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is a pathology with a very poor prognostic, the only curative treatment option being surgery, in association with chemotherapy. This study aims to assess the influence that the use of a standardized pathology report after a pancreaticoduodenectomy (PD) has on the R1 margins rate and the impact that this has on long term survival. Material and Methods: We included 116 patients admitted to the Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor Cluj Napoca, who underwent PD for PDAC (Pancreatic Ductal Adenocarcinoma) between January 2012 and May 2017. We divided them in two groups: 59 patients for which a nonstandardized histopathological protocol was used and 57 patients for which a standardized protocol was implemented. We considered a margin to be R1 when there were tumor cells at ¤ 1 mm from the resection margin. Results: The R1 percentage in the first group of patients was of 39%, while the R1 resection rate in the second group was of 68.4%. The median survival rate was similar in the two groups, with no statistically significant difference between them, but in the prospective study when comparing R0 vs R1 margins there was a statistically differences in 5 year OS with a p-value = 0.03. Conclusion: The use of a standardized pathology report reveals a significant increase in R1 resection rates. Also study revealed not only increasing R1 incidence when using a standardized histopathology report, but also that those margins (R1) playing a determinant role in 5-year OS. The mesopancreas is the most frequently R1 resection margin.