Frequent Recurrence Research Articles

Consensus guidelines for the management of craniopharyngioma in low- and middle-income countries.

Craniopharyngiomas are benign, extra-axial epithelial tumours originating from the pituitary stalk, impacting areas such as the hypothalamus, optic chiasm, and various cranial nerves. These tumours present unique surgical challenges due to their proximity to critical neurovascular structures. Management typically involves maximal safe resection as the primary approach. However, in low- and middle-income countries (LMICs), factors like late presentation, higher risks of endocrine and visual complications, frequent recurrence, and potential for incomplete resection complicate treatment. These challenges are exacerbated by limited access to specialised expertise and surgical equipment, increasing the risk of damage during surgery compared to High- Income Countries. This manuscript outlines management guidelines tailored for LMICs, emphasizing that a combination of surgical resection and chemoradiation therapy, as advised by a neuro-oncology tumour board, often yields the best outcomes.

Secreted clusterin inhibits tumorigenesis by modulating tumor cells and macrophages in human meningioma.

Meningioma is the most common primary intracranial tumor with a high frequency of postoperative recurrence, yet the biology of the meningioma malignancy process is still obscure. To identify potential therapeutic targets and tumor suppressors, we performed single-cell transcriptome analysis through meningioma malignancy, which included 18 samples spanning normal meninges, benign and high-grade in situ tumors, and lung metastases, for extensive transcriptome characterization. Tumor suppressor candidate gene and molecular mechanism were functionally validated at the animal model and cellular levels. Comprehensive analysis and validation in mice and clinical cohorts indicated clusterin (CLU) had suppressive function for meningioma tumorigenesis and malignancy by inducing mitochondria damage and triggering type 1 interferon pathway dependent on its secreted isoform, and the inhibition effect was enhanced by TNFα as TNFα also induced type 1 interferon pathway. Meanwhile, both intra- and extracellular CLU overexpression enhanced macrophage polarization towards M1 phenotype and TNFα production, thus promoting tumor killing and phagocytosis. CLU might be a key brake of meningioma malignance by synchronously modulating tumor cells and their microenvironment. Our work provides comprehensive insights into meningioma malignancy and a potential therapeutic strategy.

A novel reinforcement learning policy optimization based adaptive VSG control technique for improved frequency stabilization in AC microgrids

In this paper, an improved Reinforcement Learning (RL) based approach for adaptive Virtual Synchronous Generator (VSG) control of grid-forming inverters is proposed. High penetration of inverter-based resources causes recurrent frequency stabilization issues. For this matter, a novel model-free Actor–Critic policy optimization technique is proposed to improve frequency transients metrics such as frequency nadir and Rate of Change of Frequency (RoCoF). Stability analysis of the VSG controlled system is conducted through small signal modeling to determine the stability margins of both the virtual inertia parameter J and damping coefficient Dp. The control problem is formulated in RL terms using a new technique for state, action and reward construction that improves the learning process of the agents. The proposed approach’s efficiency is tested for three RL algorithms, namely, Deep Deterministic Policy Gradient (DDPG), Soft Actor–Critic (SAC), and Twin-Delayed DDPG (TD3) with special attention given to the latter. Various performance metrics such as training time and maximum cumulative episodic reward are used to compare the three algorithms. The resulting agent based VSG adaptive controllers are simulated and then compared for power quality and frequency stabilization capabilities. Finally, a comparison between non-adaptive VSG and TD3 based VSG is presented to conclude on the efficiency improvements achieved by the proposed approach.

Emergency neurosurgical care for patients with acute cerebral circulation disorders

Aim. To improve the results of neurosurgical treatment of patients with acute cerebrovascular disorders.Material and Methods. An analysis of the results of neurosurgical treatment of 48 patients admitted to the Department of Neurosurgery of the State Institution National Medical Center - “Shifobakhsh” was carried out. The age of patients ranged from 30 to 75 years. In each case, patients underwent clinical and laboratory studies, including using CT and MRI, as well as using three-dimensional (3D) and four-dimensional (4D) reconstruction methods of cerebral vessels.Result and Discussion. The most common cause leading to the formation of intracranial hematomas was hypertension, found in 32 (66.6%) patients, while other causes were identified in 12 (25%) patients (including angiopathy, cerebral vascular pathologies, amyloidosis, and the use of certain medications, among others). All patients underwent neurosurgical operations. The highest frequency of recurrences (4.1%) was observed after surgical interventions performed within the first 24 hours following the hemorrhagic event.Conclusion. With early detection of intracranial hematomas and with the optimal choice of method for their treatment, good functional results are observed with a low incidence of deaths.

Does the quality of endoscopic equipment influence the recurrence rate after photodynamic diagnosis-assisted transurethral resection of bladder tumor?

BackgroundPhotodynamic diagnosis-assisted transurethral resection of bladder tumor (PDD-TURBT) for nonmuscle-invasive bladder cancer is superior to conventional white-light TURBT for cancer detection. However, when performing PDD-TURBT, cystoscopy findings vary depending on the quality of the endoscopic equipment. In this study, we compared the effects of different types of endoscopic equipment on postoperative outcomes. MethodsPatients who underwent their first PDD-TURBT at our clinic were selected. Patients on whom PDD-TURBT was performed using endoscopic equipment A were sorted into Group A, and patients on whom PDD-TURBT was performed using equipment S were sorted into Group S. The characteristics, recurrence-free survival (RFS), and recurrence frequency of these patients were retrospectively investigated and compared. The prognostic factors for RFS were also analyzed. ResultsA total of 49 patients were included in Group A and 46 in Group S. In Group S, a higher detection rate (8.2% vs. 30.4 %, p < 0.01) of carcinoma in situ (CIS) was noted. RFS tended to be better in Group S (HR 0.63, p = 0.15). The frequency of recurrence also tended to be lower in Group S (4.92 vs. 3.66 per 10,000 person-days, p = 0.08). Furthermore, CIS (HR 0.30, p = 0.04) and Bacillus Calmette–Guerin therapy (HR: 0.26, p = 0.01) were significant favorable prognostic factors for RFS. ConclusionThe quality of the endoscopic equipment may influence postoperative recurrence after PDD-TURBT. Higher-quality endoscopic instruments have superior CIS detection capabilities, which can lead to improvements in postoperative outcomes with the appropriate selection of postoperative adjuvant therapy.

Recurrence rates and patterns of recurrence in stage IA p53abn endometrial cancer with and without myometrial invasion

ObjectivesOptimal management of patients with stage IA p53abn endometrial cancer without myoinvasion, classified as intermediate risk in the 2020 European Society of Gynaecological Oncology, European Society for Radiotherapy and Oncology,...

Analysis of clinical factors impacting recurrence in myxofibrosarcoma

Myxofibrosarcoma (MFS) is a malignant fibroblastic/myofibroblastic neoplasm with a prominent myxoid area. It has the clinical features of frequent local recurrence (LR) and occasional distant metastasis. Robust epidemiological data on MFS in China are lacking. The aim of this retrospective analysis was to determine the natural history of MFS, identify prognostic factors for recurrence and describe the real-life outcomes of MFS. We reviewed 52 patients with primary MFS from the First Affiliated Hospital of Nanjing Medical University diagnosed between 2016 and 2020. All tumors were subjected to retrospective univariate analysis for prognostic factors of the disease, including tumor size, grade, location and sex; patient age; planned operation; surgical margin; and laboratory results. The significant factors identified by univariate analysis were subsequently analyzed via multivariate analysis. Overall survival (OS), post-treatment LR and metastatic-free survival were assessed as outcomes. The median age was 61 years (range, 13–93). Fourteen (26.92%) patients exhibited low grade disease, and 38 (73.08%) exhibited high grade disease. Among the 29 males, and 23 females, 15 (28.85%) had tumors in the trunk, 37 (71.15%) had tumors in the extremities, 26 had undergone planned surgery, and 26 had unexpected unplanned operation. The margin was negative in 39 (75%) patients and positive in 13 patients (25%). The serum creatine kinase (CK) concentration was high level in 33 (63.46%) patients and low level in 19 (36.54%) patients. The serum lactate dehydrogenase (LDH) levels were low in 23 (44.23%) patients and high in 29 (55.77%) patients. LR was observed in 25 patients (48.08%), and 4 patients developed metastasis. A worse LR rate was found for patients with a low CK level (84.21%) than for those with a high CK level (27.27%) at 5 years (p < 0.05). The LR rate of patients who underwent planned surgery was lower than that of patients who underwent unplanned surgery (p < 0.05). There were significantly more patients with positive margins than patients with negative margins (92.30%, and 33.33%, respectively; p < 0.05). Moreover, superficial tumors were also associated with greater recurrence rate (2/20 [10%]) than deep tumors, (23/32 [71.86%]) [p < 0.05]. The probability of LR in patients with MFS was significantly greater in association with unplanned operations, positive margins, low serum CK levels or superficial tumor depth. These data could help identify high-risk patients; thus, more careful follow-up should be performed for higher-risk patients. Diagnosis and treatment at qualified regular medical centers can reduce the local recurrence rate of MFS.

A133 MARGIN THERMAL ABLATION WITH SNARE-TIP SOFT COAGULATION EFFECTIVELY MITIGATES RECURRENCE AFTER ENDOSCOPIC MUCOSAL RESECTION OF LARGE NON-PEDUNCULATED COLORECTAL POLYPS

Abstract Background Recurrence following endoscopic mucosal resection (EMR) historically occurs in approximately 15-20% of large (≥20 mm) non-pedunculated colorectal polyps (LNPCPs). Margin thermal ablation with snare-tip soft coagulation (STSC) of the post-EMR defect is an evidence-based modality to mitigate recurrence. However, international validation of margin thermal ablation outcomes is needed. Aims To evaluate the frequencies of endoscopic and histologic recurrence following margin thermal ablation with STSC for LNPCPs managed by EMR. Methods Consecutive patients ampersand:003E 18 years of age who underwent endoscopic resection for a LNPCP were enrolled in a prospective single center observation cohort study (clinicaltrials.gov ID: NCT05402696). Of those lesions which underwent successful EMR, margin STSC was applied systematically aiming to create at least a 2-3mm rim of completed ablated tissue (complete whitening). Recurrence was evaluated both endoscopically, using a standardized protocol for the post-EMR scar, and histologically. Results From 06/2022-09/2023, 335 LNPCPs were endoscopically resected, including 209 by EMR. Following successful EMR, 182 (87.1%) underwent margin STSC. Of these lesions, 49 LNPCPs in 46 patients were assessed at first surveillance colonoscopy. Margin STSC was complete for 44 (89.8%) lesions and incomplete for 5 (10.2%) due to difficult angulation/positioning (n=3) and ileocecal valve location (n=2). Median interval to first surveillance colonoscopy was 6 (IQR 6-7) months. There was no evidence of recurrence noted on endoscopy. Biopsy was performed in 44 (89.8%) with no evidence of histologic recurrence. Conclusions Thermal ablation of the defect margin with STSC effectively negates recurrence and should be considered standard of care following EMR. Funding Agencies None

Gut microbiota compositional profile in patients with posner-schlossman syndrome

The cause of Posner-Schlossman syndrome (PSS) remains unknown and its frequent recurrence may eventually lead to irreversible damage of the optic nerve. The influence of immune factors in the pathophysiology of PSS is gaining more and more interest. Increasing evidence suggests that gut dysbiosis plays vital roles in a variety of neurodegenerative and immune-related diseases. However, alterations of the gut microbiota in PSS patients have not been well defined yet. In this study, 16S rRNA sequencing was used to explore the difference of gut microbiota between PSS patients and healthy controls, and the correlation between the microbiota profile and clinical features was also analyzed. Our data demonstrated a significant increase of Prevotella and Prevotellaceae, and a significant reduction of Bacteroides and Bacteroidaceae in PSS patients, and KEGG analysis showed dysfunction of gut microbiota between PSS patients and healthy controls. Interestingly, further analysis showed that the alteration of gut microbiota was correlated with the PSS attack frequency of PSS. This study demonstrated the gut microbiota compositional profile of PSS patients and speculated the risk microbiota of PSS, which is expected to provide new insights for the diagnosis and treatment of PSS.

Diagnostic impact of postoperative CA19-9 dynamics on pancreatic cancer recurrence: a single-institution retrospective study.

Postoperative CA19-9 elevation after pancreatic cancer resection suggests recurrence but can also occur in benign conditions. This study aimed to investigate the interpretation of postoperative CA19-9 elevation after pancreatic cancer surgery in terms of cancer recurrence. A cohort of patients undergoing pancreatectomy for pancreatic cancer at our hospital was included. Among them, 52 patients exhibited postoperative CA19-9 elevation without radiological evidence of recurrence. These patients were evaluated with follow-up CA19-9 measurements. The CA19-9 increase rates were calculated based on the first elevation and the follow-up measurement. The association between the CA19-9 increase rate and tumor recurrence was assessed. Patients with a CA19-9 increase rate of ≥ 30% had a significantly higher frequency of recurrence within 3months compared to those without such an increase (p = 0.0002). Multivariate analysis demonstrated that a CA19-9 increase rate of ≥ 30% was an independent risk factor for recurrence (odds ratio 8.17, p = 0.0309). The CA19-9 value at the first elevation (p = 0.1794) and at the follow-up measurement (p = 0.1121) were not associated with recurrence. After the first postoperative CA19-9 elevation, the CA19-9 increase rate based on follow-up measurements can serve as a predictive factor for tumor recurrence.

Comparison of Laparoscopic Intraperitoneal Onlay Mesh (IPOM) Hernioplasty With Laparoscopic IPOM-Plus: Our Initial Experience in Pakistan.

Objectives Laparoscopic intraperitoneal onlay mesh hernioplasty (IPOM) for ventral hernias has been used for a long time. However, there have been some issues associated with it, thereby leading to the introduction of a new technique that involves laparoscopic closure of the fascial defect with suture followed by intraperitoneal onlay mesh placement (IPOM-Plus). We carried out this study to compare the outcome of laparoscopic IPOM with fascial defect closure versus without defect closure in midline ventral hernia repair in terms of recurrence. Methodology This comparative study was carried out in the Department of Surgery, Services Hospital, Lahore, from October 16, 2020, to April 15, 2022. A total of 84 patients of both genders, aged between 18 and 70 years, presenting with midline ventral hernia were included in the study. Patients with recurrent hernia, unstable cardiopulmonary conditions, neurological or psychiatric diseases, chronic renal disease, congestive cardiac failure, and chronic obstructive pulmonary disease (COPD) were excluded from the study. Patients were assigned to two groups. Group 1 underwent IPOM with the closure of the defect, and Group 2 underwent IPOM without the closure of the defect. Patients were observed for immediate postoperative complications. Patients were monitored for one year to assess recurrence through clinical evaluation and ultrasonography. Results In this study, seroma formation was found in 3 (7.14%) patients for laparoscopic IPOM with fascial defect closure and 10 (23.81%) in those undergoing laparoscopic IPOM without defect closure (P-value = 0.035). Recurrence was identified in 2 (4.76%) patients undergoing laparoscopic IPOM with fascial defect closure and 9 (21.43%) in those undergoing laparoscopic IPOM without defect closure (P-value = 0.024). Conclusions This study concluded that the frequency of recurrence is less after laparoscopic IPOM with fascial defect closure in midline ventral hernia repair than after laparoscopic IPOM without fascial defect closure.

Quantification of oxygen consumption in head and neck cancer using fluorescent sensor foil technology.

Head and neck squamous cell carcinoma (HNSCC) patients suffer from frequent local recurrences that negatively impact on prognosis. Hence, distinguishing tumor and normal tissue is of clinical importance as it may improve the detection of residual tumor tissue in surgical resection margins and during imaging-based surgery planning. Differences in O2 consumption (OC) can be used to this aim, as they provide options for improved surgical, image-guided approaches. In the present study, the potential of a fluorescent sensor foil-based technology to quantify OC in HNSCC was evaluated in an in vitro 3D model and in situ in patients. In vitro measurements of OC using hypopharyngeal and esophageal cell lines allowed a specific detection of tumor cell spheroids embedded together with cancer-associated fibroblasts in type I collagen extracellular matrix down to a diameter of 440 µm. Pre-surgery in situ measurements were conducted with a handheld recording device and sensor foils with an oxygen permeable membrane and immobilized O2-reactive fluorescent dyes. Lateral tongue carcinoma and carcinoma of the floor of the mouth were chosen for analysis owing to their facilitated accessibility. OC was evaluated over a time span of 60 seconds and was significantly higher in tumor tissue compared to healthy mucosa in the vicinity of the tumor. Hence, OC quantification using fluorescent sensor foil-based technology is a relevant parameter for the differentiation of tumor tissue of the head and neck region and may support surgery planning.

Clinical significance of exosomal noncoding RNAs in hepatocellular carcinoma: a narrative review.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide, with poor prognosis owing to its high frequency of recurrence and metastasis. Moreover, most patients are diagnosed at an advanced stage owing to a lack of early detection markers. Exosomes, which are characterized by their cargos of stable intracellular messengers, such as DNA, RNA, proteins, and lipids, play a crucial role in regulating cell differentiation and HCC development. Recently, exosomal noncoding RNAs (ncRNAs), including microRNAs, long ncRNAs, and circular RNAs, have become increasingly important diagnostic, prognostic, and predictive markers of HCC. Herein, we discuss the clinical implications of exosomal ncRNAs, specifically those within the HCC regulatory network.

Determining optimal air leak resolution criteria when using digital pleural drainage device after lung resection

ObjectiveThere is limited clinical evidence to support any specific parenchymal air leak resolution criteria when using digital pleural drainage devices following lung resection. The aim of this study is to determine an optimal air leak resolution criteria, where duration of chest tube drainage is minimized while avoiding complications from premature chest tube removal. MethodsAirflow data averaged at 10-minute intervals was collected prospectively using a digital pleural drainage device (Thopaz; Medela) in 400 patients from 2015 to 2019. All permutations of air leak resolution criteria from <10 to 100 mL/minute for 4 to 12 hours were applied retrospectively to the pleural drainage data to determine air leak duration, and air leak recurrence frequency and volume. Air leak recurrence indicates potential for rather than occurrence of adverse events. Descriptive statistics were used to identify the optimal criteria based on patient safety (low frequency and volume of air leak recurrences), and efficiency (shortest initial air leak duration). ResultsThe majority of the 400 patients underwent lobectomy (57% [227 out of 400]), wedge resections (29% [115 out of 400]), or segmentectomies (8% [32 out of 400]) for lung cancer (90% [360 out of 400]). An airflow threshold <50 mL/minute resulted in longer air leak duration before meeting the criteria for air leak resolution (P < .0001). Air leak recurrence frequency and volume were greater in patients with a monitoring period <8 consecutive hours (P < .0001). ConclusionsWhen using a digital pleural drainage device, a postoperative air leak resolution criteria <50 mL/minute for 8 consecutive hours was associated with the best safety and efficiency profile.

Comparison between the open and the laparoscopic approach in the primary ventral hernia repair: a systematic review and meta-analysis

BackgroundVentral hernia repair underwent various developments in the previous decade. Laparoscopic primary ventral hernia repair may be an alternative to open repair since it prevents large abdominal incisions. However, whether laparoscopy improves clinical outcomes has not been systematically assessed.ObjectivesThe aim is to compare the clinical outcomes of the laparoscopic versus open approach of primary ventral hernias.MethodsA systematic search of MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted in February 2023. All randomized controlled trials comparing laparoscopy with the open approach in patients with a primary ventral hernia were included. A fixed-effects meta-analysis of risk ratios was performed for hernia recurrence, local infection, wound dehiscence, and local seroma. Meta-analysis for weighted mean differences was performed for postoperative pain, duration of surgery, length of hospital stay, and time until return to work.ResultsNine studies were included in the systematic review and meta-analysis. The overall hernia recurrence was twice less likely to occur in laparoscopy (RR = 0.49; 95%CI = 0.32–0.74; p < 0.001; I2 = 29%). Local infection (RR = 0.30; 95%CI = 0.19–0.49; p < 0.001; I2 = 0%), wound dehiscence (RR = 0.08; 95%CI = 0.02–0.32; p < 0.001; I2 = 0%), and local seroma (RR = 0.34; 95%CI = 0.19–0.59; p < 0.001; I2 = 14%) were also significantly less likely in patients undergoing laparoscopy. Severe heterogeneity was obtained when pooling data on postoperative pain, duration of surgery, length of hospital stay, and time until return to work.ConclusionThe results of available studies are controversial and have a high risk of bias, small sample sizes, and no well-defined protocols. However, the laparoscopic approach seems associated with a lower frequency of hernia recurrence, local infection, wound dehiscence, and local seroma.

Safety, tolerability, and effect of a single aural dose of Dornase alfa at the time of ventilation tube surgery for otitis media: A Phase 1b double randomized control trial

BackgroundOne third of children require repeat ventilation tube insertion (VTI) for otitis media. Disease recurrence is associated with persistent middle ear bacterial biofilms. With demonstration that Dornase alfa (a DNase) disrupts middle ear effusion biofilms ex vivo, we identified potential for this as an anti-biofilm therapy to prevent repeat VTI. First, safety and tolerability needed to be measured. MethodsThis was a phase 1B double-blinded randomized control trial conducted in Western Australia. Children between 6 months and 5 years undergoing VTI for bilateral middle ear effusion were recruited between 2012 and 2014 and followed for two years. Children's ears were randomized to receive either Dornase alfa (1 mg/mL) or 0.9 % sodium chloride (placebo) at time of surgery. Children were followed up at 2 weeks post-VTI and at 3-monthly intervals for 2 years. Outcomes assessed were: 1) safety and tolerability, 2) otorrhoea frequency, 3) blocked or extruded ventilation tube (VT) frequency, 4) time to blockage or extrusion, 5) time to infection recurrence and/or need for repeat VTI. ResultsSixty children (mean age 2.3 years) were enrolled with 87 % reaching study endpoint. Treatment did not change otorrhoea frequency. Hearing improved in all children following VTI, with no indication of ototoxicity. Dornase alfa had some effect on increasing time until VT extrusion (p = 0.099); and blockage and/or extrusion (p = 0.122). Frequency of recurrence and time until recurrence were similar. Fourteen children required repeat VTI within the follow-up period. ConclusionA single application of Dornase alfa into the middle ear at time of VTI was safe, non-ototoxic, and well-tolerated. Trial registrationACTRN12623000504617.

Recurrence and Survival Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Synchronous and Metachronous Peritoneal Metastases of Colorectal Origin

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved the 5-year survival for colorectal cancer (CRC) patients with peritoneal metastases (PM). Little is known about recurrence patterns and recurrence rates between synchronous (S) and metachronous (M) PM following CRS+HIPEC. We aimed to describe the recurrence patterns, overall survival (OS) and disease-free survival (DFS) in S-PM and M-PM patients after complete CRS+HIPEC. From June 2006 to December 2020, a prospective cohort study included 310 CRC patients, where 181 patients had S-PM (58.4%) and 129 patients had M-PM (41.6%). After a median 10.3-month follow-up, 247/310 (79.7%) patients experienced recurrence, and recurrence sites included isolated peritoneal (32.4%), multifocal (peritoneal and liver and/or lung(s)) (22.7%), isolated liver (17.8%), isolated lung (10.5%) and other (16.6%) sites. Recurrence patterns did not differ between S-PM and M-PM. M-PM patients had an impaired DFS compared to S-PM patients (9.4 months (95% CI: 7.3–12.1) vs. 12.5 months (95% CI: 11.2–13.9), p = 0.01). The median OS was similar for S-PM and M-PM (38.4 months (95% CI: 31.2–46.8) vs. 40.8 months (95% CI: 28.8–46.8), p = 0.86). Despite frequent recurrence at extraperitoneal locations, long-term survival was achievable after CRS+HIPEC in CRC patients with PM. The recurrence patterns and OS did not differ between groups, yet M-PM patients had a shorter DFS.

ОСОБЕННОСТИ ИММУННОГО СТАТУСА У БОЛЬНЫХ ГЛОМЕРУЛОНЕФРИТАМИ С РЕФРАКТЕРНЫМ НЕФРОТИЧЕСКИМ СИНДРОМОМ

Abstract. Introduction. Research in the issues related to glomerulonephritis with nephrotic syndrome is an important problem of modern medicine due to their prevalence among the global population and mainly in the younger age group, with a significant proportion of patients with refractory nephrotic syndrome (frequent relapses, persistent course). Currently, there are no ways to predict the development of glomerulonephrites with refractory nephrotic syndrome. Due to the immunological nature of glomerulonephrites, it seems advisable to search for predictors of refractory nephrotic syndrome among the indicators characterizing the patient’s immune status. Aim of the study was to study the characteristic features of the immune status and their prognostic value in glomerulonephritis with refractory nephrotic syndrome. Materials and Methods. We examined 136 glomerulonephritis patients with active nephrotic syndrome, hospitalized in the nephrology department in 2015-2021. Along with conventional examinations, humoral and T-cell immunity indicators were tested in the patients. The end point of the study was in 2022 where the the clinical course of the disease was assessed in patients, and patients with nephrotic syndrome who showed refractory to steroid therapy were placed into one group, while those with non–refractory nephrotic syndrome were placed into another one. Within the selected groups of patients, we performed the comparative study of demographic, clinical and laboratory parameters, the indicators of humoral and T-cell immunity, and the ROC analysis of indicators correlating with the nephrotic syndrome recurrence frequency. Results and Discussion. In the group of patients with a refractory course of the disease, an increase was detected in the number of T helper phenotype cells and of the activated T cells carrying activation markers, HLA-DR and CD38, on their surfaces. At the same time, the relative content of regulatory T cells (Treg) among T helper cells decreased. The B system was characterized by an increase in the number of B lymphocytes, an increase in the levels of circulating immune complexes and IgM, and a decrease in IgG levels. The changes detected in the parameters of humoral and T-cell immunity may be essential to the development of refractory nephrotic syndrome. In the refractory nephrotic syndrome pathogenesis, the most important is the decrease in the number of Tregs, which correlated most closely with the nephrotic syndrome recurrence frequency. Conclusions. An association was found between refractory nephrotic syndrome and the pronounced activation of humoral immunity, and a significant imbalance was detected between various immunoregulatory and activated T-lymphocyte subpopulations. The Treg content in the blood can be a prognostic indicator: Treg content values of under 1.9% indicate a high probability of developing refractory nephrotic syndrome.

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

PurposePilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches—excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT).MethodsSingle-center retrospective evaluation of patients 1–21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann–Whitney U tests.Results18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031).ConclusionIn pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.

Mesenchymal stem cell exosomes: a promising delivery system for glioma therapy

Abstract Gliomas are particularly challenging due to their high invasiveness, frequent recurrence, and elevated mortality rates. Despite the availability of treatments like surgery, radiation, and chemotherapy, each of these methods faces significant limitations. This has led to a pressing demand for new strategies against gliomas. In this landscape, mesenchymal stem cells (MSCs) have shown significant potential in recent years. However, the application of MSCs in glioma therapy encounters various challenges. A significant advancement in this field is the utilization of exosomes (Exo), key secretions of MSCs. These exosomes not only carry the benefits inherent in MSCs but also exhibit unique physicochemical properties that make them effective drug carriers. Consequently, MSCs Exo is gaining recognition as a sophisticated drug delivery system, specifically designed for glioma treatment. The scope of MSCs Exo goes beyond being just an innovative drug delivery mechanism; it also shows potential as a standalone therapeutic option. This article aims to provide a detailed summary of the essential role of MSCs Exo in glioma progression and its growing importance as a drug delivery carrier in the fight against this formidable disease.