Long-term Treatment Outcomes Research Articles

P-20 EARLY ZOLEDRONIC ACID TREATMENT IN A PEDIATRIC CASE OF OSTEOGENESIS IMPERFECTA TYPE V: CLINICAL OUTCOMES AND THE ROLE OF IFITM5 (BRIL) MUTATION

Abstract Introduction Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility, low bone mass, and frequent fractures. OI is typically associated with mutations in the COL1A1 and COL1A2 genes, but a subset of cases, such as OI type V, is linked to mutations in the IFITM5 gene, also known as BRIL (bone-restricted IFITM-like). Clinical Case This report presents a case of a 2-year-old boy diagnosed with OI type V, a rare form of the disease caused by a mutation in BRIL. The patient exhibited multiple recurrent bone fractures beginning in infancy, though there was no family history of bone disease or consanguineous marriage. Physical examination revealed that the patient was of normal weight and height for his age, with neurodevelopmental milestones met. Laboratory tests showed elevated alkaline phosphatase (ALP) levels, indicative of increased bone turnover, while other values were within normal ranges. Radiological evaluations confirmed an active fracture in the left tibia but showed no additional pathological involvement. Genetic testing identified a de novo C>T variant in the IFITM5 gene, confirming the diagnosis of OI type V. The patient was treated with intravenous zoledronic acid (ZA), a bisphosphonate therapy, which is currently being tested in infants and toddlers for OI treatment. The treatment led to a significant reduction in fracture recurrence and a decrease in ALP levels, demonstrating its efficacy in managing the disease. Despite these positive outcomes, certain hallmark features of OI type V, such as hyperplastic callus formation and new periosteal bone growth, were not observed during follow-up, possibly due to the early initiation of ZA therapy. OI type V is distinguished from other forms of OI by hyperplastic callus formation and increased osteoblast activity, often accompanied by elevated ALP levels. Radiographic and histological findings specific to this type include periosteal bone growth and a reticular lamellation pattern in the bone matrix. Although ZA has shown promise in reducing fracture risk and improving clinical outcomes, its long-term efficacy in preventing other disease manifestations, such as intramembranous ossification, remains uncertain. The underlying pathological mechanisms of OI type V, particularly the role of BRIL, are not yet fully understood. Further research into the activation of BRIL in osteoblasts could lead to the development of targeted therapies that address the root cause of the disease. While ZA therapy has been effective in managing the immediate symptoms of OI type V, a deeper understanding of the disease's genetic and molecular basis is crucial for improving long-term treatment outcomes. In conclusion, the IFITM5 (BRIL) mutation is recognized as the genetic cause of OI type V. Early intervention with ZA has shown positive effects in managing the disease, but further research is needed to fully understand the pathological mechanisms and to develop treatments that can address all aspects of the disease.Table 1:Lab workout (age 2)ALP = alkaline phosphatase; AST = aspartate transaminase; BUN = blood urea nitrogen; GGT = gamma-glutamyl transferase; CBC: complete blood count

LONG-TERM RESULTS OF COMPREHENSIVE TREATMENT OF PATIENTS WITH LOCALLY ADVANCED TONGUE CANCER USING SELECTIVE INTRAARTERIAL POLYCHEMOTHERAPY AND SYSTEMIC POLYCHEMOTHERAPY

OBJECTIVE: to evaluate the long-term results of complex treatment of patients with locally advanced tongue cancer (T3-4N0-3M0) using modified selective intra-arterial polychemotherapy and systemic polychemotherapy. METHODS: depending on the polychemotherapy regimen, taking into account the designated classifications, all patients were divided into two groups. The study group included 51 patients who received intra-arterial (group VA) polychemotherapy according to the PF regimen, followed by radiation therapy. The control group included 50 patients who received intravenous (group IV) polychemotherapy according to the PF regimen, followed by radiation therapy. With positive dynamics in the VA group and the BB group (partial tumor regression), surgical treatment was performed in the amount of hemiglossectomy. In case of complete tumor regression, the 2nd stage of the telegammatherapy course on the tongue was performed up to a total dose of 60 Gy. In case of oncological process stabilization, the 2nd stage of the telegammatherapy course on the tongue was performed up to a total dose of 60 Gy, followed by palliative courses of systemic polychemotherapy. In case of disease progression, palliative courses of systemic polychemotherapy were performed. RESULTS: Three-year survival in the VA group was 80.1±6%, while in the BB group it was 56.6±7% (p0.05). Five-year survival among patients in the VA group was 39.4±7%, while in the BB group it was 2 times lower – 18.9±5% (p0.05). About 7% of patients in the study group survived for more than 8 years. CONCLUSIONS: The treatment regimen we developed for patients with locally advanced tongue cancer, which includes selective intra-arterial polychemotherapy followed by radiation therapy to the primary tumor and areas of regional metastasis, increased the median survival, three- and five-year survival.

An overview of uses and effectiveness of intracanal medicaments in endodontics

Intracanal medicaments play a crucial role in endodontics by addressing microbial infections and facilitating the healing of periapical tissues. Their effectiveness lies in their ability to disinfect the root canal system, eliminate biofilms, neutralize bacterial endotoxins, and promote tissue repair. Calcium hydroxide, a widely used traditional medicament, demonstrates strong antimicrobial properties and creates an alkaline environment unfavorable for bacterial survival. However, its limitations against certain resistant pathogens and restricted penetration into dentinal tubules have driven the development of advanced alternatives. Emerging medicaments such as nanoparticle-based formulations and bioglass offer promising solutions by overcoming these limitations. Nanoparticles, with their ability to penetrate complex canal systems, deliver potent antimicrobial effects and enhance disinfection efficiency. Bioglass not only disrupts bacterial activity but also facilitates dentinal remineralization, making it particularly valuable in regenerative procedures. Hydrogels, designed for controlled and sustained drug release, improve the delivery of medicaments into anatomical complexities, enhancing their overall efficacy. Natural products like neem, propolis, and aloe vera are gaining attention for their biocompatibility and antimicrobial capabilities, providing effective alternatives for patients’ sensitive to synthetic agents. These formulations also address concerns about resistance and toxicity associated with conventional options. Advances in delivery systems, including sonic and ultrasonic activation, further amplify the efficacy of both traditional and emerging medicaments. Comparative analyses of these approaches highlight the advantages of integrating innovative technologies with proven methods, enabling clinicians to address complex infections and improve long-term treatment outcomes. The evolving landscape of intracanal medicaments continues to push the boundaries of what can be achieved in endodontics, promising enhanced patient care through effective disinfection and tissue healing.

Severe Temozolomide-Induced Thrombocytopenia is Linked to Increased Healthcare Utilisation in Glioblastoma and Disproportionally Impacts Female Patients

Abstract Background Thrombocytopenia is a major temozolomide-induced adverse event during the standard treatment of glioblastoma. Consequently, platelet transfusions and treatment modifications may impact quality of life and long-term treatment outcomes. Understanding the impact of thrombocytopenia on healthcare utilisation is crucial to mitigate the need for healthcare resources in glioblastoma patients. Here, we assess the influence of thrombocytopenia-related healthcare among patients diagnosed with glioblastoma. Methods We retrospectively collected patient information treated at the Brain Tumor Center Amsterdam between 2008 and 2021. The occurrence of thrombocytopenia, patient demographics, treatment details and healthcare utilisation data were gathered from patients who received standard glioblastoma treatment. Associations between temporal severity of thrombocytopenia as categorised by the Common Terminology Criteria for Adverse Events, patient characteristics, and healthcare utilisation were analysed using Generalized Linear Mixed Models. Results We included 206 patients with a median age of 58 years, 35.9% were female and we found that thrombocytopenia (any grade) occurred in 61.1% of patients. The occurrence of thrombocytopenia during CRT was associated with increased healthcare utilisation and was largest in females who developed grade 4 thrombocytopenia compared to those who did not develop thrombocytopenia (OR=5.9, p<0.001 in females vs OR=4.4, p<0.001 in males). Grade 4 thrombocytopenia was also associated with heightened healthcare utilisation during the adjuvant phase (OR=7.6, p<0.001), and was comparable between sexes. Conclusions Severe thrombocytopenia during glioblastoma treatment is linked to increased healthcare utilisation, disproportionally impacting females. These data suggest that prevention and early management of thrombocytopenia can reduce healthcare utilisation in patients with glioblastoma.

P0665 Long-term efficacy and dose intensification of ustekinumab in achieving clinical, laboratory, and endoscopic remission in Crohn’s disease

Abstract Background Although ustekinumab has been evaluated for Crohn’s disease, long-term effectiveness and the benefits of dose intensification for maintaining clinical and endoscopic remission remain underexplored. Dose intensification strategies may be critical for optimizing outcomes in patients not responding to standard regimens. This study addresses these gaps by analyzing the long-term outcomes of ustekinumab treatment and the impact of dose intensification in a real-world setting. Methods This retrospective, observational study was conducted at a tertiary referral center, investigating patients with moderate-to-severe Crohn’s disease treated with ustekinumab. We assessed rates of steroid-free clinical remission, endoscopic remission, and normalization of C-reactive protein (CRP) at baseline, 12, 24, 36, and 48 months post-initiation. Outcomes in patients undergoing dose intensification from every 8 weeks to every 6 or 4 weeks due to incomplete response or loss of efficacy were also evaluated. Clinical remission was defined as Harvey-Bradshaw Index (HBI) ≤4, endoscopic remission as SES-CD ≤2, and CRP normalization as ≤0.5 mg/dL. Results A total of 251 patients were included in this study. Of these, 228 continued ustekinumab treatment at 12 months, with 43% achieving steroid-free clinical remission. Clinical remission rates at 24, 36, and 48 months were 47%, 50%, and 40%, respectively. Ileocolonoscopy was performed at 12 months in 115 patients, showing that 31.3% achieved endoscopic remission. This trend continued, with endoscopic remission rates of 30.9% at 24 months, 39.1% at 36 months, and 40% at 48 months. Median C-reactive protein levels dropped from 1.75 mg/dL at baseline to 0.42 mg/dL at 12 months and remained below 0.5 mg/dL at 24, 36, and 48 months (0.37, 0.34, and 0.4 mg/dL, respectively). Over the four-year period, 81 patients underwent dose intensification due to loss of efficacy or insufficient response, with 24.7% achieving clinical remission thereafter. An additional 24.7% achieved a reduction of HBI of at least 3 points after dose intensification, while the remaining 50.6% failed treatment. Adverse events led to treatment discontinuation in 2.4% of patients. Conclusion Ustekinumab demonstrated significant efficacy in achieving and maintaining clinical, endoscopic, and laboratory remission over four years in patients with moderate-to-severe Crohn’s disease. Dose intensification led to favorable outcomes in approximately half of the patients, demonstrating that it is a viable option in patients with insufficient response or loss of efficacy with the standard dose.

Newborn screening of neurometabolic diseases for early treatment.

In recent years, the number of diseases included in newborn screening (NBS) tests has increased rapidly, led by the development of both technology and treatments. Many neurometabolic diseases can now be screened, but direct involvement of the brain, especially in the severe forms of these diseases, causes challenges in NBS. For example, differentiating between neuropathic and nonneuropathic types of disease is difficult but critical because the treatments used can differ. For many diseases with neurological manifestations, the long-term outcomes of new treatments and the influence of NBS are both unclear. In this review, we introduce the "new" NBS test using data from the Screening Center at National Taiwan University as an example. Subsequently, we explore the current challenges in NBS for several neurometabolic diseases.

SURGICAL TREATMENT OF CHRONIC INFECTIOUS SPONDYLITIS OF THE CERVICO-THORACIC SPINE: analysis of monocenter cohort and literature data

Background. Chronic cervico-thoracic infectious spondylitis is an etiologically heterogeneous diseases group with vertebral destruction in the C6-Th3. There is no unified surgical strategy for such patients. The aim of the study was to examine the technical features and long-term results of surgical treatment of chronic infectious spondylitis of the cervico-thoracic spine and to systematize the literature data. Materials and methods. The analyzed cohort of 18 operated patients. The follow-up results in 11 patients with chronic nonspecific and 7 with tuberculous spondylitis were evaluated. The complex of clinical and radiological parameters were studied.Results. Chronic infectious spondylitis in cohort was classified as types B.3 (n1 = 10), C.2 (n2 = 4), C.3 (n3 = 1) and C.4 (n4 = 3) according to Pola E et al. (2017). The mean age at the time of surgery was 48 years 3 months [20; 71]. The influence of etiology of chronic spondylitis on the prevalence of destructive process (F = 8.761, p = 0.009), on the intensity of back pain (F = 5.802, p = 0.028) was revealed. The analysis of quality of life indicates a greater degree of social maladaptation in tuberculous spondylitis both according to the NDI (p = 0.018) and SF-12 (p = 0.002). Conclusions. Chronic infectious cervico-thoracic spondylitis is a rare and poorly studied pathology. The analysis of the information on this issue and the evaluation of our accumulated experience allowed us to propose a number of tactical tools for planning surgery.

Basal implants as a treatment alternative for severely resorbed ridges.

The aim of this study was to evaluate the long-term treatment outcomes of basal implants in patients with severely resorbed ridges, including the survival and success rates, patient complaints, satisfaction, and Quality of Life. An extensive electronic search was conducted on the search engines: PubMed, Web of Science, and Google Scholar using Boolean Operators (AND, OR, NOT) and the key words (basal implants, Corticobasal implants, Strategic Implants, severely resorbed ridge, severely atrophic ridge, treatment outcome, patient satisfaction) within the last 10 years. A total of 21 articles were found, encompassing 9732 basal implants placed in 1219 patients. Thirteen studies had reported a success or survival rate with a range of 90.3-100% for intraoral basal implants and 88.2% and 92.9% for orbital and nasal implants, respectively. Four studies have reported failure rates with a range of 0.3-3.2%, while seven articles documented 0.3-2.4% mobility. The pain was reported in 6 studies (0.3-0.8), marginal bone loss (0.33-7.89 mm), an increase in bone density, and peri-implant bone contact were reported in 3 and 2 studies, respectively. Basal implant-supported prostheses can be a practical treatment modality with high predictable survival or success rates, positive impacts on patient satisfaction, and improved quality of life.

Tumors of the orbit and periorbital region: 20-year experience of the N.N. Blokhin National Medical Research Center of Oncology

Introduction. Neoplasms of the orbit and periorbital region are usually represented by tumors of the eyelid skin skin of the periorbital region and paranasal mucosa. The most common histological types of this pathology are squamous cell and basal cell carcinomas. The main indications for orbital exenteration are tumor lesions in the extraocular muscles and orbital apex and irreversible vision loss in the affected eye at the time of surgery planning. In the absence of these pathologies organ-sparing surgery is recommended. Resection of orbital and periorbital tumors (including orbital exenteration) leads to cosmetic and functional defects therefore surgical treatment of this area should be performed only if other methods are impossible or ineffective.Aim. To analyze the experience of resection of orbital and periorbital tumors and to evaluate short- and long-term results of surgical treatment of this pathology.Materials and methods. Retrospective analysis of patients with tumors of the orbit and periorbital region who underwent organ-sparing and exenteration surgeries between 2003 and 2023 was performed.Results. Overall 5-year survival was 55 %. It varied depending on a number of factors. The best 5-year survival rates were observed for basal cell carcinoma of the eyelid skin and periorbital region (83 %) the worst for squamous cell carcinoma (34 %) and melanoma (41 %). For localized tumors (Т1) overall survival was 76 % for locally advanced (Т4) – 43 %.Conclusion. Orbital and periorbital neoplasms are characterized by a variety of tumor morphological types and locations which requires multidisciplinary approach to treatment and rehabilitation of patients with this pathology.

Experience in performing multivisceral resections for pelvic cancer

Background. Treatment of patients with locally advanced pelvic cancer remains challenging. The use of modern surgical techniques has expanded the feasibilities of performing multivisceral resections (MVR) in this category of patients. However, the postoperative period in patients who have undergone MVR is associated with a high risk of developing postoperative complications. The purpose of the study was to assess the short-term and long-term treatment outcomes in patients with locally advanced and multiple-primary pelvic cancer. Material and Methods. From 2009 to 2021, 114 patients treated in the clinics of Cancer Research Institute of Tomsk National Research Medical Center underwent MVR for primary or recurrent rectal cancer (n=40, 35.1 % and n=4, 3.5 %, respectively), female reproductive cancer (endometrial cancer: n=18, 17.1 % and recurrent ovarian cancer: n=18, 17.1 %), primary and recurrent bladder cancer (n=15, 13.2 % and n=2, 1.8 %, respectively), synchronous multiple primary pelvic tumors (n=8, 7.0 %) and extraorgan mesenchymal tumors of the pelvis (n=4, 3.5 %). Paraneoplastic complications were observed in 31 (27.2 %) patients. Invasion to more than 2 adjacent pelvic organs was diagnosed in 52 (45.4 %) cases. Total pelvic evisceration (TPE) was performed in 9 (7.9 %) patients, including 5 (4.4 %) patients who underwent TPE for primary rectal cancer with extensive local spread and 4 (3.5 %) patients who underwent TPE for multiple primary cancer: 2 (1.75 %) for synchronous primary rectal cancer and bladder cancer and 2 (1.75 %) for primary rectal cancer and recurrent bladder cancer. MVR for rectal cancer was the most common (n=101, 88.6 %). Resections with the formation of colorectal anastomosis were performed in 75 (65.8 %) cases and obstructive resections of the rectum were performed in 14 (12.5 %) cases. Urinary tract surgeries were performed in 66 (57.5 %) cases. One-stage plastic surgery of the resected segment as a transposition of one or both ureters into the bottom of the bladder was performed in 22 (19.3 %) cases. Heterotopic and orthotopic plastic surgery of the bladder was performed in 19 (16.6 %) and 5 (4.4 %) cases, respectively. Combined uterine extirpations, including vaginal resection, were performed in 52 (45.4 %) cases. Grade III postoperative complications according to the Clavien–Dindo classification occurred in 18.4 % of cases. Urological complications were the most common (8.7 %). Postoperative mortality rate was 0.8 %. The assessment of the long-term outcomes was carried out using the example of patients with rectal cancer (n=45), as the most homogeneous and largest subgroup. The overall 3-year survival rate was 71.1 % and the relapse-free 3-year survival rate was 60.0 %. Conclusion. Treatment of locally advanced pelvic cancer requires extensive surgeries performed by a multidisciplinary team of surgeons. The immediate results can be assessed as satisfactory. In case of resection of the urinary tract as a component of MVR, regardless of the primary localization of the tumor, primary plastic surgery of the bladder and/or ureters is preferable. Long-term outcomes allow us to consider MVR as a method of choice in the treatment of this group of patients.

Aneurysm dome and vessel pressure measurements with coiling, stent assisted coiling and flow diversion.

Variability in long-term endovascular treatment outcomes for intracranial aneurysms has prompted questions regarding the effects of these treatments on aneurysm hemodynamics. Endovascular techniques disrupt aneurysmal blood flow and shear, but their influence on intra-aneurysmal pressure remains unclear. A better understanding of aneurysm pressure effects may aid in predicting outcomes and guiding treatment decisions. Medium and large aneurysm models with intramural pressure taps on the dome and parent artery were designed and 3D-printed with vessel-like physical properties from UV-cured materials. The models were connected to a comprehensive flow system consisting of a pulsatile pump and a viscosity-matched blood analog. The system provided physiological pressure and flow control. Real-time pressures were recorded in the aneurysm dome and parent artery during initial placement of coils, stents, flow diverters, and temporary balloons under simulated surgical conditions. Coiling, stent-assisted coiling, and flow diverter placement were performed in both aneurysm sizes. Temporary balloon placement was performed in a large aneurysm model. Coiling resulted in 24-30% packing density and diminished intra-aneurysmal flow. Flow diverter placement reduced intra-aneurysmal flow with near complete flow interruption after placement of three consecutive devices across the aneurysm neck. Compared to untreated controls, real-time pressure measurements during coiling and flow diversion showed minimal changes (< 5%) in intra-aneurysmal pressures. Temporary balloon occlusion blocked the parent artery, increasing the pressure proximal to the site of occlusion (by 9%), and reducing the pressure distally (by 14%). This maneuver also dampened intra-aneurysmal pressure to the average distal vessel pressure measurement. Positive control aneurysm models were 3D-printed with a sealed, "healed" neck. These controls verified a sealed neck eliminates intra-aneurysmal pressure. Findings quantified minimal changes in intra-aneurysmal pressure during and immediately post-coiling and flow diversion. Intra-aneurysmal flow disruption alone has negligible impact on intra-aneurysmal pressures.

The predictive value of emotion regulation difficulties and negative mood on short and long-term treatment outcomes in an online guided self-help programme for adults with binge-eating disorder.

Cognitive behaviour therapy (CBT) online guided self-help programs represent efficacious and accessible treatment options for adults with binge-eating disorder (BED), but research on predictors of treatment outcome is scarce. This study aimed to investigate the predictive value of emotion regulation difficulties relative to that of negative mood on short- and longer-term treatment outcomes in an online guided self-help programme for BED above and beyond other predictors (age, sex, baseline BED severity). Participants were 63 adults (87% female, mean age 37.2years) with BED. Data was analysed using a hierarchical model approach. Emotion regulation difficulties better predicted both weekly binge-eating frequency and eating disorder (ED) pathology at posttreatment than negative mood, after controlling for the effect of age, sex and baseline BED severity. At 6-month follow-up, neither emotion regulation difficulties nor negative mood further added to the prediction of weekly binge-eating frequency, whereas negative mood, but not emotion regulation difficulties, did so for ED pathology. These findings indicate that emotion regulation difficulties at treatment begin might be a relevant predictor of immediate treatment outcome in online guided self-help for adults with BED but might have lower impact on longer-term treatment outcome than negative mood. The clinical trial register number is not given in this version of the manuscript due to anonymisation.

Sudden gains in routine clinical care: application of a permutation test for trauma-focused cognitive behavioural therapy

ABSTRACT Background: Sudden gains, defined as large and stable improvements of psychopathological symptoms, are a ubiquitous phenomenon in psychotherapy. They have been shown to occur across several clinical contexts and to be associated with better short-term and long-term treatment outcome. However, the approach of sudden gains has been criticized for its tautological character: sudden gains are included in the computation of treatment outcomes, ultimately resulting in a circular conclusion. Furthermore, some authors criticize sudden gains as merely being random fluctuations. Objective: Use of efficient methods to evaluate whether the amount of sudden gains in a given sample lies above chance level. Method: We used permutation tests in a sample of 85 patients with posttraumatic stress disorder (PTSD) treated with trauma-focused cognitive behaviour therapy in routine clinical care. Scores of self-reported PTSD symptom severity were permuted 10.000 times within sessions and between participants to receive a random distribution. Results: Altogether, 18 participants showed a total of 24 sudden gains within the first 20 sessions. The permutation test yielded that the frequency of sudden gains was not beyond chance level. No significant predictors of sudden gains were identified and sudden gains in general were not predictive of treatment outcome. However, subjects with early sudden gains had a significantly lower symptom severity after treatment. Conclusions: Our data suggest that a significant proportion of sudden gains are due to chance. Further research is needed on the differential effects of early and late sudden gains.

Long-term Results of Topical Insulin Treatment for Persistent Corneal Epithelial Defects

Purpose: To evaluate the effects of topical insulin in patients with persistent corneal epithelial defects that are refractory to the standard treatment. Methods: A retrospective, hospital-based, clinical study was performed on 17 eyes of 16 patients with different types of refractory persistent epithelial defects who were treated with topical insulin. The treatment was continued until the defect either was resolved or persisted after three months. Patients’ demographic information, etiology, comorbidities, and clinical data were reviewed. The rate of epithelial healing was considered as the primary outcome measure. Results: Neurotrophic keratitis was the most common cause of persistent epithelial defects (58.8%), and within this category, herpetic eye disease was the main comorbidity (44.4%). The mean follow-up time was 17.91 months. Eleven out of fifteen eyes (77.3%) had complete improvement and only one patient did not respond to the treatment. The mean time of reepithelization for the eyes with full recovery was 31.27 days (ranging from 6 to 61 days). The best-corrected visual acuity improved significantly after treatment (P &lt; 0.005), and there were no reports of complications or side effects during the study period. Conclusion: Our results suggest that topical insulin, due to its good safety profile, availability, and affordability, could be a good therapeutic alternative for persistent epithelial defects.

CLINIC, DIAGNOSIS AND EFFICIENCY OF NONINVASIVE METHOD OF TREATMENT YOUNG CHILDREN WITH HAEMORRHOIDS

Hemorrhoids have been known since ancient times. They have always been considered the prerogative of adult patients. Methods of conservative and surgical treatment of hemorrhoids in adults are still used in children and often have negative results. Pediatric surgical practice has not optimized methods of diagnosis and treatment of hemorrhoids in infants and preschool children. Materials and methods. The work was based on retrospective and prospective analysis of medical records and case histories of 112 children with hemorrhoids treated in the last 11 years. The number of patients under 1 year of age was 4 (0.4%); 1-3 years - 30 (26.4%); 3-6 years - 50 (44.6%); 7-12 years - 16 (14.2%); 13-18 years - 12 (10.7%). External hemorrhoids were found in 107 (95.5%), internal hemorrhoids in 4 (3.8%) and combined hemorrhoids in 1 (0.9%) patient. There were 70 (62.5%) boys and 42 (37.5%) girls. All cases underwent general clinical and laboratory examination, orthostatic exercise (squatting), rectal palpation, anoscopy and rectoscopy. Statistical processing of the research materials was carried out using the method of variance statistics. All values in the work are presented in the form of arithmetic mean with calculation of standard deviation within the confidence interval. For all compared values the achieved level of significance (p) was considered statistically reliable - &lt; 0.05. Student's t-distribution was used to compare data with normal distribution of means. When comparing 2 related groups, calculations were performed using Student's paired t-criterion. Microsoft Excel and Statistica computer programs were used for statistical data processing. Results and discussion. This paper presents clinical material from the examination and treatment of 112 children with hemorrhoids over the past 11 years. The authors compare the characteristics of the etiopathogenesis of hemorrhoids in children from the literature and their own research data. The proposed non-invasive compression methods in the complex treatment of hemorrhoids in children are more effective in children of early and preschool age. A study of long-term results of complex conservative treatment of 84 patients of young age with hemorrhoids showed good results in 86,9%, satisfactory - in 9,5% and unsatisfactory (recurrence) - in 3,6% of patients. Surgical treatment of hemorrhoids in children was used only when conservative treatment was unsuccessful in 11 (12.6%) patients, with good long-term results in all cases. Indications for hemorrhoidectomy were: frequent prolapse of hemorrhoids (HU). After surgical treatment, good results were obtained in all cases; no recurrence was observed. The optimization of conservative and surgical treatment, respecting the age characteristics of children, led to good results. Conclusions: 1. Examination of children with GU enlargement with the use of additional methods (ultrasound, RRS, FACS, PCI) of research allows to reveal and treat concomitant intestinal pathologies, which are the causes of secondary transient hemorrhoids development. For children of preschool age the most effective non-invasive method of treatment is rectal balonocompression. 3. After complex conservative treatment with rectal balonocompression of children with hemorrhoids good results were observed in 86,9% of children, satisfactory - in 9,5% and unsatisfactory - in 3,6%.

PATHOMORPHOLOGICAL FEATURES OF THE PANCREAS DEPENDING ON CHRONIC PANCREATITIS DURATION

Introduction. Chronic pancreatitis (СР) presents clinically as an inflammatory process that leads to complex morphological changes, resulting in the replacement of pancreatic parenchyma with connective tissue and the development of various complications. Defining an optimal surgical strategy remains a relevant issue today. The purpose of the study was to assess the morphological and immunohistochemical characteristics of the pancreatic parenchyma depending on СР duration. Methods. A total of 147 (57.1%) patients were examined retrospectively. A prospective comparative study involving 257 patients analyzed the short and long-term outcomes to evaluate the effectiveness of the “early surgery” strategy developed at the clinic and the surgical management methods for СР. The study conducted a morphological and immunohistochemical assessment of the pancreatic parenchyma, analyzing the long-term outcomes of the primary pathogenetic surgical treatments for СР. Results. Morpho-functional changes in the pancreatic parenchyma, observed more than three years (median 5.85 years) after the onset of CP clinical manifestations, were characterized by progressive fibrosis due to increased expression of type I collagen and fibronectin, which resulted in dense cuff-like perineural and perivascular fibrosis and stenosis of the pancreatic ducts around tubular complexes, clinically corresponding to the presence of intense pain syndrome. Conclusions. An essential role of pancreatic stellate cells in developing pancreatic parenchymal fibrosis in CP has been established. Fibrotic lesions of the pancreas are irreversible, and the resulting morphological and structural changes lead to both exocrine and endocrine dysfunction. More than three years after the onset of clinical manifestations of CP, type I collagen expression was observed in the acinar tissue, with thin strands detected within the islets of Langerhans. Intraepithelial ductal neoplasia was also identified, which may later progress to ductal adenocarcinoma of the pancreas. It has been demonstrated that the improvement in surgical outcomes for complicated forms of CP with biliary and ductal hypertension is achieved through planned surgery within the first three years of CP development, before the onset of irreversible pathological changes, including the potential for oncological transformation of the pancreas.

Laser technologies in treatment of arterial pathology

INTRODUCTION: Cardiovascular diseases hold a leading position in the structure of mortality in the world. Laser technologies permit to improve the outcomes of endovascular and surgical treatment of various forms of the coronary heart disease and diseases of peripheral arteries. Despite the development of technologies, laser angioplasty and endarterectomy are associated with a number of complications and often require additional intervention. AIM: To analyze currently available data on the use of lasers in treatment of arterial pathology. According to the results of analysis of the modern literature, the use of lasers confidently occupies its niche in endovascular treatment of acute coronary syndrome, chronic occlusions of the coronary and peripheral arteries, permits to optimize the results of stenting and balloon angioplasty. One main disadvantage of laser angioplasty is that in most cases the procedure combines with stenting and/or balloon angioplasty and requires more contrast agent and longer operation time. Large-scale studies on the open laser endarterectomy have not been conducted. CONCLUSION: Further study of the effect of laser on an atherosclerotic plaque and vessel wall in the open endarterectomy is a promising trend that may probably reduce the incidence of perioperative complications and improve long-term results of surgical treatment of diseases of peripheral arteries.

What can a lymph node signal? (Our experience of using SLNB for tongue cancer)

Recently, there has been an increase in publications devoted to sentinel lymph node biopsy (SLNB) in oral cancer. It has been established that cervical lymph node involvement, even in small primary tumors, is an unfavorable prognostic sign and is associated with a more than twofold decrease in overall survival. This creates a need to develop new methods for detecting hidden regional metastases, which, in turn, can improve long-term treatment outcomes. Our study included 16 patients with primary tongue cancer cT1-2N0M0 subject to selective or modified radical neck dissection, as well as radical tongue resection. Patients under 18 years of age, with previous neck surgery or radiation therapy, and with iodine allergy were excluded. Sentinel lymph node (SN) mapping was performed using the SPY-PHI Stryker navigation system, which simultaneously displays color video and fluorescence images. Tracers such as ICG (5 mg/mL) and methylene blue (10 mg/mL) were injected around the tumor, followed by a standard neck incision and measurement of fluorescence signal to identify SNs, which were then removed for histologic examination. All patients were able to reconstruct the tongue with local tissues and there were no technique-related complications. Sentinel lymph nodes (SLNs) were successfully identified in all cases, with four patients having histologically confirmed occult metastases. Nodal classification changed in three patients from cN0 to pN1 and one to pN2, and additional blue-staining lymph nodes were found in 11 patients, all of whom remained N0. The ICG sentinel lymph node method has been used in medicine since 1957 to assess organ function and angiography. ICG quickly binds to plasma proteins and is removed by the liver, making it a safe, radiation-free indicator that is less expensive than X-ray methods. The SNB procedure with ICG NIF imaging is simple and fast, but tissue swelling may occur during the first 24 hours. However, detection of nodes through the skin is difficult in patients with normal or high body weight, since the lymphatic vessels are located deeper and are blocked by surrounding tissue. A sentinel lymph node indicates damage to a specific lymphatic channel or collector.

Exploring the behavioural determinants of compliance in resilient high-caries-risk patients who improved caries severity

Abstract Background The caries severity in childhood may predict caries conditions in the future and even in adulthood in caries risk models. Nevertheless, the rate of recurrent caries after treatment of severe early childhood caries is high and correlated with behavioural factors, rather than clinical indicators. Compliance with the caries control programme has been demonstrated to prevent root caries development in head and neck cancer patients, suggesting that compliance with treatment protocols is a more important key to bringing about successful outcomes than treatment protocols themselves. However, only few studies defined the triggers of compliance in patients with long-term successful treatment outcomes, especially in children. Furthermore, driven forces of compliant behaviours from patients’ aspects have not been described in the dental literature before. Regarding the need to improve current caries control interventions for children, in this study, behavioural determinants that shaped compliance of resilient children were investigated with a qualitative study design, for its advantage in revealing what an individual really feels which incorporates their experience without restriction from previous literature. Resilience was defined as improvement in caries conditions between primary and mixed or permanent dentitions. Methods Interviews were performed with the patient group, including eight resilient children (M/F = 5/3) and their ten caregivers (M/F = 2/8), and the dentist group, including ten paediatric dentists (M/F = 6/4; clinical experience mean = 26.9 years, minimum = 16 years). Thematic analysis was used to identify main themes. Results Four themes were identified: (1) dental things/teeth are their priority, (2) normalising, (3) tiger parenting/conscientiousness, and (4) trust. These determinants were identically described by both the patient and dentist groups. Dentists' suggestions were the priority, providing the norms in daily life of resilient patients and their caregivers. These patients found no excuses for failing to take dentists' advice, not only because they trusted their dentists, but also because they and their caregivers were conscientious about putting dentists' orders into practice. Conclusions It is implementing suggested oral health behaviours daily, but not merely agreeing with professional advice, that alters the fate of teeth in these resilient patients.

About adverse events of targeted therapy for polypous rhinosinusitis

At the present time, usage of monoclonal antibodies is the most progressive method of pathogenetic therapy of polypous rhinosinusitis. The innovation of targeted therapy is based on the inhibition of key cytokines IL-4, IL-13 involved in pathogenetic remodeling of the mucous membrane of nasal cavity and paranasal sinuses at the stages of emerging T2 inflammation. At the same time, certain issues remain unresolved, concerning administration of monoclonal antibodies for treatment of nasal polyposes. We provide a brief historical review of publications devoted to efficiency analysis of biological therapy. In this context, registration of adverse events upon usage of targeted monoclonal antibody therapy becomes extremely valuable, along with prediction of long-term treatment results and assessment of immune status of the patients.