Functional Disorders Research Articles

Navigating recovery while postpartum: examining the relationship between maternal functioning and substance use disorders

Our current understanding of postpartum people’s functioning while managing substance use disorder (SUD) recovery is limited. This study explored whether having a SUD impacts maternal functioning and examined the reliability of the Barkin Index of Maternal Functioning (BIMF) in postpartum people with SUDs. We conducted a prospective, cross-sectional survey (n = 141) by administering the BIMF and a demographic questionnaire with a sample of postpartum people with SUD (n = 48) and a comparative sample of postpartum people without SUD (n = 93). The internal reliability (Cronbach’s alpha = .86) was consistent with previous studies. SUD diagnosis was significantly associated with lower functioning, with individuals in the SUD group having an 8-point lower BIMF score compared to persons without SUDs, although both groups reported moderately high BIMF scores (>80). While not statistically significant, participants with SUDs had reduced functioning scores over time. Considering the increasing rate of overdose deaths in postpartum persons, further examination of functioning in postpartum persons with SUDs is warranted. Integration of the BIMF into SUD screening and treatment can provide a holistic view of postpartum experiences in this high-risk population and serve as a unique tool to understand the needs of new mothers navigating SUD recovery.

Peripherally induced movement disorders in the stomatognathic system after oral surgical or dental procedures.

Peripherally induced movement disorders (PIMD) are hyperkinetic movement disorders that can occur after injury to a part of the body. This study aimed to identify PIMD in the stomatognathic system following dental or oral surgical procedures. A total of 229 patients with PIMD (144 women and 85 men; mean age: 53.4 years) triggered by oral surgical or dental interventions were evaluated retrospectively. The average latency between the procedures and onset of PIMD was 14.3 days. Oral surgery (40.2%), including tooth extraction, trauma treatment, and other surgical procedures, was the most frequent trigger of PIMD. This was followed by general dental treatment, including periodontal, endodontic, and restorative procedures (36.7%), prosthetic treatment (19.7%), and orthodontic treatment (3.5%). PIMD consisted of oromandibular dystonia (73.8%), functional (psychogenic) movement disorders (11.4%), orolingual dyskinesia (7.9%), and hemimasticatory spasms (5.7%). These results suggest that even minor alterations in normal anatomy or physiology after dental procedures may result in PIMD in predisposing patients. Dental professionals should be aware that although infrequently, PIMD can develop after various dental treatments. If such symptoms precipitate, the attending physician should properly explain them to the patient and provide appropriate treatment or consultation with a movement disorder specialist.

Correlation between fall experience and life functions among community-dwelling older adults in Japan

PurposeThis study investigated the correlation between the risk of falls and life functions, including motor function, cognitive function, and urinary disorders, among older adults residing in small cities in the metropolitan areas of Japan and evaluated the contents of fall prevention instructions. MethodsSixty-nine older adults residing at home participated in this case-control study conducted between September and October 2019. The survey items included questions pertaining to the history of falls; grip strength; the 30-s Chair Stand Test (CS-30), Functional Reach Test (FRT), and Timed Up and Go Test (TUG) scores; mental and cognitive functions [Test Your Memory-Japanese version test (TYM-J)]; living conditions; and urination status [Core Lower Urinary Tract Symptom Score (CLSS)]. ResultsParticipants with a history of falls had significantly lower CS-30 and FRT scores, and significantly higher TUG scores and CLSS than those with no history of falls. Grip strength bore significant correlations with the CS-30 and TUG scores. The CS-30 scores were correlated with the FRT and TUG scores. The FRT scores were correlated with the TUG and French State Activity Index (FAI) scores. The TUG scores were correlated with the TYM-J and FAI scores. The CLSS showed no significant correlations with the remaining items. The FRT scores and CLSS exerted a significant effect on the risk of experiencing falls. ConclusionBoth balancing ability and micturition status affect fall risk and should be considered in treatment strategies for urinary disorders in fall prevention programs for older adults.

Quality of life and functional outcomes after ileocystoplasty for microcystis of tuberculous etiology

BACKGROUND: The outcome of tuberculous bladder lesions is its irreversible shrinkage, persistent disorder of accumulative function and a significant decline in the quality of patient’s life. Supratrigonal augmentation ileocystoplasty and replacement ileocystoplasty are standard treatments for microcystis of tuberculous etiology. Currently, the advantages and disadvantages of these methods have not been sufficiently studied. AIM: To conduct a comparative assessment of the quality of life and functional outcomes of patients with tuberculosis etiology microcystis after supratrigonal augmentation and replacement ileocystoplasty. MATERIALS AND METHODS: The patients of the study were divided into two groups. The first group included 19 patients who underwent supratrigonal bladder resection with augmentation ileocystoplasty, the second group included 20 patients treated with replacement ileocystoplasty. In the period from one to six years after the surgery, quality of life was assessed and a complex urodynamic study was carried out. RESULTS: Analysis of the “General health” measure according to the King’s Health Questionnaire demonstrated the worst quality of life in the patient group after bladder resection (p = 0.013). In this group, the QoL scale indicated the worst measures of “Quality of Life due to Dysuria” (p = 0.019). The measures of the filling enterocystometry were consistent between the patient cohorts and varied in the satisfactory range. All key criteria reflecting the voiding function were significantly worse in group I: larger volume of residual urine (p = 0.001), lower maximum emptying rate (p = 0.034), and higher frequency of intermittent self-catheterization (p = 0.001). Calculation of the obstruction index showed a high prevalence of chronic urinary retention in the specified patient group (p = 0.015). Thus, abdominal pressure had to be increased several-fold for the patients underwent augmentation ileocystoplasty to initiate (p = 0.001) and maintain (p = 0.036) emptying of the intestinal urinary reservoir. The incidence of reservoir-ureteral reflux and incontinence is consistent in both groups (p 0.05). CONCLUSIONS: Cystectomy with replacement ileocystoplasty, as an intervention with the best quality of life and functional results, is the optimal choice in patients with microcystis of tuberculous etiology.

TRANSTORNOS ESPECÍFICOS DE APRENDIZAGEM: DISLEXIA, DISGRAFIA, DISORTOGRAFIA E DISCALCULIA EM FOCO

Educational legislation emphasizes the need to promote the full development of reading, writing and calculation skills, highlighting these skills as essential for the individual’s insertion and meaningful action in society. However, it is not uncommon for students to complete elementary school without mastering these essential skills for professional life. This article aims to investigate the difficulties faced by some students in the process of learning reading, writing and mathematical skills. Based on theoretical research, the article addresses Specific Functional Learning Disorders — Dyslexia, Dysgraphia, Dysorthography and Dyscalculia — as possible factors that negatively interfere with the academic development of these students. Presenting a theoretical foundation on the topic contributes to the review of pedagogical practice, suggesting the need for collective work in the search for resources and procedures that promote students’ proficiency both in reading and writing and in learning mathematical concepts and operations.

Aberrant intrinsic brain activities in functional gastrointestinal disorders revealed by seed-based d mapping with permutation of subject images

Functional gastrointestinal disorders (FGIDs) are characterized by complex interactions between the gut and brain, leading to altered brain function and symptom manifestation. We used neuroimaging meta-analytic techniques in order to analyze the correlation between FGIDs and aberrant brain activity. A systematic review was performed to ascertain resting-state functional magnetic resonance imaging (rs-fMRI) studies examining brain function in FGIDs. Pooled meta-analyses by seed-based d mapping with permutation of subject images (SDM-PSI) were performed to assess variations in regional brain activity, and sensitivity analyses were applied to evaluate the robustness of findings. Meta-regression analyses were then carried out to examine possible links between demographic factors and neuroimaging changes. Our meta-analysis revealed significant changes in regional brain activities among FGIDs patients compared to healthy controls (HC). Increased brain activation was observed in several regions including the postcentral gyrus, calcarine fissure/surrounding cortex, superior frontal gyrus, and insula, while decreased activity was noted in the left posterior cingulate gyrus, right median cingulate/paracingulate gyri, and the left caudate nucleus. Furthermore, meta-regression analyses indicated negative associations between disease duration and alterations in specific brain regions. These findings underscored the intricate interplay between gut dysfunction and aberrant brain activity in FGIDs. Early intervention and multidisciplinary approaches addressing both gastrointestinal symptoms and associated emotional distress are crucial for improving the quality of life of the patients.

One day at a time: Life with Glanzmann thrombasthenia - Qualitative results from the GT 360 study.

Glanzmann thrombasthenia (GT) is a platelet function disorder. Symptoms include bruising and bleeding, which may be severe and life-threatening. The day-to-day experiences of those affected remain poorly documented. The Glanzmann's 360 study aimed to better understand the daily realities of living with GT, exploring psychological, social and medical challenges to identify unmet need. People with GT over 18 and caregivers of children with GT participated. Mixed methods research was used, including a survey and in-depth interviews. The interviews, reported here, were audio-recorded, transcribed and thematically analysed. Nineteen interviews were conducted; 14 with people with GT and five caregivers. Mean age of those with GT was 32.9 years (range 2-78 years). Eight themes emerged: Diagnosis, Bleeding and Treatment, Menstruation, Fatigue, Identity, Abuse, Pregnancy, and The Future. Three participants described misdiagnosis. Caregivers reported early recognition and prompt diagnosis of their children. Bruising, the most commonly reported symptom, led to assumption of abuse. Six (32%) participants reported joint bleeds. External bleeding was normalised. Access to home treatment and local care were limited. Fatigue caused by anaemia was described. All women reported heavy menstrual bleeding. Choices around pregnancy were limited by 'medical pessimism'. Nevertheless, participants remained hopeful for the development of improved treatment options. People with GT face significant and often overlooked challenges. There is need for improved medical and psychological treatment and support, increased awareness of these needs amongst healthcare professionals, and research into developing comprehensive care models that address medical and psychosocial needs of people with GT.

A machine learning approach to stratify patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders according to disorders of gut brain interaction, comorbidities and quality of life.

A high prevalence of disorders of gut-brain interaction (DGBI) exist in patients with hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorders (HSD). However, it is unknown if clusters of hEDS/HSD patients exist which overlap with different DGBIs and whether this overlap influences presence of comorbidities and quality of life. We aimed to study these knowledge gaps. A prospectively collected hEDS/HSD cohort of 1044 individuals were studied. We undertook Uniform Manifold Approximation and Projection-enabled (UMAP) dimension reduction to create a representation of nonlinear interactions between hEDS/HSD and DGBIs, from which individuals were stratified into clusters. Somatization, Postural Tachycardia Syndrome (PoTS), autonomic symptoms, psychological factors and quality of life were statistically compared between clusters. The mean age of patients was 40 ± 13.2 years; 87.8% were female. Patients segregated into three clusters: Cluster 0 (n = 466): hEDS/HSD+ functional foregut disorders (FFD) + irritable bowel syndrome (IBS); Cluster 1 (n = 180): hEDS/HSD+ IBS and Cluster 2 (n = 337): hEDS/HSD alone. In cluster 0, we demonstrated increased somatization (p <0.0001), anxiety (p <0.0001), depression (p <0.0001), PoTS prevalence (p = 0.003), autonomic symptoms (p <0.0001) and reduced quality of life (p <0.0001) compared to cluster 2. Cluster 0 had greater comorbidity burden than cluster 1. Within hEDS/HSD, subgroups exist with a high prevalence of FFD and IBS. These subgroups have a higher prevalence of psychological disorders, dysautonomia and poorer quality of life compared with hEDS/HSD alone. Further research should focus on healthcare utilization, management and prognosis in hEDS/HSD and DGBI overlap.

Reducing healthcare costs by timely diagnosis and management in functional motor disorders.

Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown. This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis. This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis. Healthcare direct costs decreased by 67%, from an average of €4,467 [95% CI 3,604-5,329] to €1,461 [95% CI 945-1,976] after diagnosis. Hospitalization costs fell from €2,618 [95% CI 1,899-3,336] to €492 [95% CI 162-821], and ER costs dropped from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Diagnostic procedure costs decreased significantly, from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Specialist visit costs remained unchanged. Rehabilitation costs increased from €371 [95% CI 194-547] to €635 [95% CI 318-915], but this rise was not statistically significant. Accurate diagnosis of FMDs significantly reduces healthcare costs by minimizing unnecessary tests, hospitalizations, and ER visits while emphasizing rehabilitation. This highlights the economic and clinical benefits of improved diagnostic accuracy and specific multidisciplinary intervention. Investing in cost-effective diagnostic tools is crucial for earlier diagnosis and reducing delays.

BN SO33 - The complex benign multi-disciplinary team meeting - a paradigm shift in decision making for benign oesophagogastric surgery

Abstract Background Decision making in benign OG pathology can be particularly challenging given the overlap with functional disorders, such as reflux hypersensitivity. A specialist benign oesophagogastric (OG) multidisciplinary team (MDT) may improve our ability to triage potential surgical candidates from those with functional conditions. Unlike in OG cancer, there is a paucity of evidence to support an MDT based approach in benign OG surgery. This study aims to report our experience of introducing a specialist benign OG MDT in an OG tertiary centre in the UK, examining the effect on decision making and an assessment of its acceptability and utility to clinicians. Method A review of consecutive cases discussed in the specialist benign OG MDT since inception in 2022 was undertaken. We reviewed indications, treatment plans and outcomes, any alteration in treatment pathway and final decisions. The primary outcome was the proportion of patients with a change in management as a result of MDT discussion. Where applicable, results were reported using descriptive statistics. A seven-item electronic questionnaire was also circulated to MDT members (OG surgeons, specialist gastroenterologists, GI radiographers, GI physiologists, and doctors in training), to assess the acceptability and perceived utility of the meetings. Results 74 patient cases were discussed (median age 57.5 (25-79) years). 71/74 (96.0%) of referrals were made by OG surgeons, most commonly to discuss anti-reflux procedures (53/74 (71.6%)). 34/74 (45.9%) patients had undergone previous surgery, most commonly laparoscopic fundoplication. MDT discussion led to a change in management in 43/74 (58.1%) case with recommendations of further investigation (23.0%), further OG clinic review (18.9%) and 21.6% listed for surgery. 12/74 (16.2%) were referred to other specialist services, including clinical psychology. Survey confirmed that all MDT members found their understanding of oesophageal physiology and subsequent decision-making ability in clinic was greatly enhanced. Conclusion Our results show that the complex benign MDT is an effective tool, demonstrating changes to management in over half of cases discussed, including recommending surgery less frequently following specialist review of physiology investigations. Such tests effectively identify functional disorders, such as rumination, highlighting a need for clear onward referral pathways involving specialist psychologists. The meetings have also proven to be valuable learning tools for all attendees of all grades. We strongly believe that adopting an MDT approach to benign OG conditions will enhance collaborative decision making, improve patient outcomes and therefore should be nationally mandated and recommended through AUGIS guidelines.

Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling: A Randomized Clinical Trial.

Radical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects. To assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer. This open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024. Eligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG). The primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses. Of 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (P = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant. Neurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life. Chictr.org.cn Identifier: ChiCTR2200059489.

Practical Concepts and strategies for early diagnosis and management of eosinophilic gastrointestinal disorders in East-Asian children.

Eosinophilic gastrointestinal disorders (EGIDs) are emerging as significant concerns in the Korean pediatric population and transitioning from rare to more commonly diagnosed conditions. This review discusses the increasing prevalence of EGID among children and adolescents and highlights the complexities involved in its diagnosis and management. This review begins with a thorough examination of the diverse clinical presentations of EGIDs in Korean children, with a special focus on common gastrointestinal symptoms such as abdominal pain, diarrhea, and bloody stool. Additionally, we explored extraintestinal manifestations, including growth failure, malnutrition, and associated allergic comorbidities, highlighting their importance in the clinical landscape of EGIDs. Because of its subtle and overlapping symptoms with those of other gastrointestinal disorders, EGID is frequently underdiagnosed. Addressing this challenge requires maintaining a high index of suspicion and employing a comprehensive diagnostic approach to differentiating EGID from functional gastrointestinal disorders (FGIDs) and other inflammatory or systemic diseases such as inflammatory bowel disease. The optimal management of EGID requires a collaborative multidisciplinary strategy that includes dietary management, regular monitoring, and tailored medical interventions. This review emphasizes the importance of proactive patient and caregiver education and regular follow-ups to improve long-term outcomes in affected children. Enhanced awareness among healthcare providers and better educational resources for families are critical for the early identification and effective management of EGID among pediatric patients.

Comparing the economic burden of disease by physical activity levels among persons with and without disabilities in the Republic of Korea

IntroductionThe World Health Organization recommends at least 150 min of physical activity per week for persons with and without disabilities. This study compared the differences in the economic burden of diseases between persons with and without disabilities based on their physical activity. What is known in the field is that physical activity is beneficial to health, but there is a disparity between persons without disabilities and persons with disabilities, and our research aims to increase physical activity among persons with disabilities.MethodsEconomic burden of disease includes service costs such as outpatient, hospitalization, and pharmaceutical expenses for disease treatment, and persons with disabilities are those who have received a disability classification legally registered by the Korean Ministry of Health and Welfare, and there are 15 types of disabilities. For exercise records, we calculated the cost in 2020 for people with exercise records in 2018 so that they can have at least 1 year of exercise records, as health checkups are available from January to December of the year. Physical activity attainment is defined as 150 min or more of physical activity per week based on World Health Organization guidelines.ResultsCalculating the economic burden of disease by physical activity for persons with and without disabilities, both experienced a difference in hospitalization costs owing to fewer hospital days with physical activity achievement, with the difference being greater for persons with disabilities. Regarding disability type, achievers showed a 41.1% difference in total costs for mental class disorders, 16.7% for external bodily function disorders, and 11.1% for internal organ disorders.DiscussionPhysical inactivity has a significant impact on the economic burden of persons with disabilities compared to persons without disabilities, with 11.8% fewer persons without disabilities who were physically active for 150 min or more per week compared to 21.4% fewer persons with disabilities. In terms of healthcare spending, exercise can help keep persons with disabilities healthy. Therefore, there is a need for exercise programs tailored to persons with disabilities to increase physical activity in line with World Health Organization recommendations to reduce health inequalities between persons with and without disabilities.

Outcomes after photodynamic therapy of basalcell carcinoma on the eyelid skin with intravenous administration of photosensitizer chloride E6

Purpose. To evaluate immediate and long-term outcomes after photodynamic therapy (PDT) of basal cell carcinoma (BCC) on the eyelid with intravenous administration of photosensitizer (PS) chlorine E6.Materials and methods. PDT was performed in 261 patients with a verified diagnosis of BCC of the eyelid cT1-3N0MO, stage I–II, aged 38 to 87 (average 68.7 ± 15.6). PS chlorin E6 (Photolon, Photoditazin, Radachlorin) was used intravenously at dosage 1.0–1.5mg/kg; 1–2 courses. Light dosage ranged from 100 to 300 J/cm2, depending on the neoplasm clinical form and the data of fluorescence diagnostics.Results. Complete regression after the first PDT course of eyelid BCC cT1-3N0M0 with intravenous administration of PS chlorin E6 was obtained in 90.4 % of cases; after 2 courses - in 96.2 % of cases. During the follow-up period from 5 to 15 years, relapses were diagnosed in 7.6 % of cases. The number of relapses depended on the process stage. In neoplasms corresponding to the symbol cT1a, the number of relapses was 1.4 %, cT1 b – 5.0 %, cT1 c– 8.3 %, cT2 a – 2.5 %, cT2 b – 5.0 %, cT2 c – 9 %, cT3 a – 5.8 %, cT3 b – 43.8 %, cT3 c – 46.7 %. Good and excellent cosmetic results were seen too.Conclusion. PDT of eyelid BCC of stage I–II with intravenous administration of PS chlorine E6 is an effective and low-risk method for anatomical and functional disorders. It can be an alternativetechnique to surgical treatment. The discussed way of treatment should be personalized and provided in specialized medical settings.

Study on the Role and Effectiveness of Physiotherapy in Cervical Brachial Syndrome

Cervicobrachial syndrome is defined as a common condition characterized by pain in the cervical and shoulder region occurring in the C5-C8 cervical root distribution territory with the main symptom being pain. The present study focuses on the need for physical therapy in the management of the pain and functional disorders present in a 46-year-old female patient diagnosed with cervicobrachial syndrome. The research was carried out over a period of 3 months, during which time the patient underwent a complex treatment programme involving both kinetic and electrotherapy techniques and aids. The results obtained were highlighted by applying evaluation tests (muscle balance, joint balance and cervical disability index) in 3 successive stages: initial, intermediate and final evaluation. Analysis of the scores obtained in the 3 tests allowed us to identify an improvement in the patient's quality of life, sleep, concentration and daily activities not disturbed by the algesic phenomena and functional disorders generated by the cervicobrachial syndrome.

Pomegranate Peel Extract Mitigates Diarrhea-Predominant Irritable Bowel Syndromes via MAPK and NF-κB Pathway Modulation in Rats

Background: Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common chronic functional gastrointestinal disorder that causes diarrheal and intestinal barrier disruptions. Although pomegranate peel extract (PPE) has been reported for the treatment of diarrheal and intestinal inflammation, its effectiveness and mechanisms specifically for the treatment of IBS-D remain unknown. Objectives: This study aimed to explore the therapeutic effect of PPE on IBS-D and elucidate its underlying mechanisms. Methods: A high-fat diet, restraint stress, and senna gavage were combined to establish a rat model mimicking IBS-D, to evaluate the therapeutic effects of PPE. Network pharmacology analysis, serum medicinal chemistry, and transcriptomics were employed to investigate potential downstream signaling pathways. Findings were further validated through molecular docking and Western blot analysis. Results: The findings revealed that PPE significantly improved the symptoms of IBS-D, ameliorated intestinal inflammation, and promoted intestinal barrier function. The target genes in the MAPK and NF-κB signaling pathways were significantly enriched and down-regulated. Molecular docking and Western blot assays were performed to verify that PPE had a high affinity for the protein candidates in these pathways, and significantly down-regulated the expression of p-IκB, p-p65, p-JNK, p-p38, and p-ERK1/2. Conclusions: The present study is the first to demonstrate that PPE alleviates diarrheal and intestinal damage in IBS-D, potentially by inhibiting MAPK and NF-κB signaling pathways. These findings suggest that PPE may provide a novel therapeutic option for IBS-D.

FRAGMENTED THIGH INJURY: TREATMENT WITH PREBIOTICS, NANOPARTICLES, AND CELL THERAPY

The purpose of this study was to investigate the possibility of staged local treatment of an infected mine-explosive wound using a gel containing Bacillus spp., cerium oxide nanoparticles, and cell therapy. Object and Methods. The article presents a clinical case demonstrating the effective staged treatment of a 57-year-old patient with a fragmentary fracture of the right femur and a large purulent wound of the right thigh. The patient underwent Ex-fix rod-type femur-tibia stabilization and resection of a post-traumatic aneurysm of the right superficial femoral artery. In the first stage of treatment, two sessions of negative pressure wound therapy (NPWT) were applied, with pressures ranging from 75-115 mm Hg and a session duration of 4-5 days. In the second stage, local treatment involved a combination of antiseptics and probiotics (Bacillus spp.) alongside cerium oxide nanoparticles. By the 7th day, the eradication of pathogenic microflora was achieved, allowing for the third stage of treatment—application of autologous mesenchymal stem cells. Results: The treatment of combat trauma has become increasingly relevant in Ukraine and globally due to its complexity and the rising proportion of multiple and combined injuries, which account for 25-60% of cases. Infectious complications occur in 25% of combat trauma cases and are responsible for 70% of related deaths. Most structural and functional disorders associated with wound infections develop at the time of injury, intensify over time, and require immediate surgical intervention, improvements in local treatment methods, and new approaches for wound closure. Conclusions: The use of a combination of probiotics and NPWT therapy led to a rapid reduction of the inflammatory process. Clinical observations showed accelerated wound cleansing from fibrin and necrotic tissue. The combined treatment significantly reduced the size and depth of wound due to the formation of active pink granulation tissue (observed by days 8-9) and marginal epithelialization by days 10-13. During this period, no pathogenic flora were detected, allowing for the subsequent application of autologous mesenchymal stem cells. This treatment approach reduced the need for antibacterial drugs and prevented the need for additional surgical interventions. The inclusion of cerium oxide nanoparticles was an effective enhancement for cell transplantation, facilitating stem cell delivery and contributing to the treatment of large wounds.

Diagnostic Yield of Comprehensive Coronary Function Testing in Patients with Angina and Unobstructed Coronary Arteries: Endotype Characterisation and Clinical Implications

Background: Coronary functional disorders (CFD) are significant contributors to angina with non-obstructed coronary arteries (ANOCA). Various endotypes, such as epicardial or microvascular spasm and/or coronary microvascular dysfunction (CMD), have been identified. Previous studies have shown a high prevalence of CFD in ANOCA cases, but often lacked comprehensive coronary functional testing (CFT), which ideally includes coronary spasm provocation testing and CMD assessment. This study aims to investigate the prevalence of CFD and to characterise endotypes in ANOCA patients using comprehensive CFT. Methods: A total of 89 consecutive ANOCA patients (mean age 64, 69% women) who underwent comprehensive CFT were enrolled. CFT comprised acetylcholine (ACh) spasm provocation testing and assessment of coronary flow reserve (CFR) and hyperaemic microvascular resistance using Doppler technique. Results: CFT identified at least one coronary vasomotion disorder in 91% of patients with ANOCA. Among them, microvascular spasm was the most common endotype (61%), followed by CMD (43%). Only 9% of patients had isolated CMD with the remaining CMD patients also showing coronary spasm. Low CFR was mainly associated with high resting coronary flow rather than impaired hyperaemic flow (R −0.60, p&lt;0.0001). Additionally, 48% of patients with microvascular spasm exhibited moderate to severe coronary tortuosity. Conclusion: CFT provides a high diagnostic yield of CFD in ANOCA patients. Coronary spasm, particularly microvascular spasm, is the most frequent endotype. Patients with isolated CMD are rare, highlighting the importance of spasm testing in the ANOCA population.

The First Case of Bernard-Soulier Syndrome Presenting with Isolated Hemoptysis and Probable Diffuse Alveolar Hemorrhage: A Case Report and Literature Review

Bernard-Soulier syndrome (BSS) is a rare platelet function disorder due to an impaired GPIb-V-IX complex, with an estimated incidence of one per million. Usual presentations include gingival bleeding, epistaxis, easy bruising, and post-traumatic excessive bleeding, among others, but not hemoptysis. The patient was a 46-year-old male who presented with three cups of hemoptysis two days before the presentation. He also had moderate burning chest pain for the past two weeks, which was getting better. He was diagnosed with BSS 45 years ago and had approximately 100 prior presentations for bleeding from various locations, including three prior episodes of hemoptysis. The mainstay of treatment was platelet transfusions, and the patient was carefully observed. Only one case of hemoptysis in a patient with BSS was found, but the patient had hemoptysis due to underlying pulmonary tuberculosis. Therefore, hemoptysis or DAH were never reported in the literature due to BSS. This patient was the first case of massive hemoptysis and possible DAH related to BSS, emphasizing the need for proper attention due to its possible detrimental outcomes.

The impact of surgical treatment of benign ovarian tumors on the reproductive health of women, taking into account the International Classification of Functioning

The article presents a systematic analysis of studies evaluating the impact of surgical treatment of benign ovarian tumors on reproductive health, taking into account the criteria stated by the International Classification of Functioning, Disability and Health. To identify articles, foreign and domestic scientific databases were used (PubMed, Cochrane, eLibrary). After the initial identification of 704 scientific publications, 46 articles were selected using inclusion and exclusion criteria.The conducted systemic analysis allows us to formulate the conclusion that surgical interventions performed for benign ovarian tumors contribute to damage to ovarian tissue, and as a result, a decrease in the ovarian reserve of patients, which is associated with impaired fertility. A number of authors have demonstrated some recovery of anti-Mullerian hormone (AMH) levels 3-12 months after surgery. A significant portion of the studies have demonstrated a more pronounced postoperative decrease in AMH rates in patients with endometriomas compared with women operated on for non-endometrioid ovarian tumors. Lower AMH rates were noted in women with bilateral surgeries for bilateral ovarian tumors compared to patients who had unilateral surgeries. The performed systemic analysis showed higher postoperative AMH rates in patients with intraoperative suture hemostasis in comparison with the use of bipolar energy; in addition, there is a relationship between the number of coagulations and the severity of the decrease in AMH rates. In a few studies, it was noted that patients who underwent surgical treatment of ovarian tumors experienced an earlier onset of menopause. In connection with these possible functional disorders, further clinical studies of a high level of evidence are needed, aimed at developing effective strategies for preserving the functioning of the reproductive system after surgical treatment of benign ovarian tumors.