Main Symptoms Research Articles

ЭФФЕКТИВНАЯ ДЕЯТЕЛьНОСТь ПЕДАГОГА — ПОКАЗАТЕЛь ПРОФЕССИОНАЛьНОГО ЗДОРОВьЯ

Ensuring labor protection and safety in the workplace is the responsibility of the employer. It is necessary to systematically carry out procedures aimed at improving working conditions and increasing the level of preparedness for actions in the conditions of localizing and eliminating the consequences of realized professional risks. One of the directions of state policy in the field of labor protection is the creation of conditions for the development of a healthy lifestyle. Note that the lives of many people are characterized by a lack of time, chronic fatigue and stressful situations. Permanent stress at work can become a source of professional burnout. This article examines teaching staff whose work is characterized by high responsibility and emotional intensity. The effectiveness of teachers’ work activities depends not only on the correct organization of educational and educational work, but also on their well-being. The professional health of teachers has a direct relationship with the level of training and education of the younger generation. Therefore, it is especially important to study the psychosocial factors that influence the professional health of teaching staff, to solve problems related to eliminating production stress and optimizing working conditions. The purpose of the work was to study the main symptoms of professional burnout and their impact on professional performance.

Single-center experience of congenital disorders of glycosylation syndrome screening in Tunisia: A retrospective study over a 15-year period (2007–2021)

BackgroundWe report the results gathered over 15 years of screening for congenital disorders of glycosylation syndrome (CDGS) in Tunisia according to clinical and biochemical characteristics. MethodsOur laboratory received 1055 analysis requests from various departments and hospitals, for children with a clinical suspicion of CDGS. The screening was carried out through separation of transferrin isoforms by capillary zone electrophoresis. ResultsDuring the 15-year period, 23 patients were diagnosed with CDGS (19 patients with CDG-Ia, three patients with CDG-IIx, and one patient with CDG-X). These patients included 13 boys and 10 girls aged between 3 months and 13 years, comprising 2.18 % of the total 1055 patients screened. The incidence for CDGS was estimated to be 1:23,720 live births (4.21 per 100,000) in Tunisia. The main clinical symptoms related to clinical disease state in newborn and younger patients were psychomotor retardation (91 %), cerebellar atrophy (91 %), ataxia (61 %), strabismus (48 %), dysmorphic symptoms (52 %), retinitis pigmentosa, cataract (35 %), hypotonia (30 %), and other symptoms. ConclusionIn Tunisia, CDGS still remains underdiagnosed or misdiagnosed. The resemblance to other diseases, especially neurological disorders, and physicians’ unawareness of the existence of these diseases are the main reasons for the underdiagnosis. In routine diagnostics, the screening for CDGS by biochemical tests is mandatory to complete the clinical diagnosis.

Ultrasonic optic nerve sheath diameter can be used as a diagnostic measure after accidental dural puncture during cesarean section: a case report

BackgroundParturients are prone to postdural puncture headache (PDPH) after epidural puncture. Cerebral venous sinus thrombosis (CVST) is a fatal complication of PDPH. The main symptom of both is headache, however, the mechanism is not similar. For persistent PDPH, early differential diagnosis from CVST is essential. Optic nerve sheath diameter (ONSD) measurements can be used to identify changes in intracranial pressure as an auxiliary tool to distinguish the cause of headache.Case presentationThe dura of a 32-year-old woman undergoing cesarean section was accidentally penetrated while administering epidural anesthesia, and the patient developed PDPH the subsequent day. The patient refused epidural blood patch (EBP) treatment and was discharged after conservative treatment. Fourteen days post-discharge, she was readmitted for a seizure. Magnetic resonance imaging (MRI) and Magnetic resonance angiography (MRA) indicated low cranial pressure syndrome and superior sagittal sinus thrombosis with acute infarction. The next morning, the EBP was performed with 15 ml autologous blood. Subsequently, the headache symptoms decreased during the day and worsened at night. ONSD measurement suggested dilation of the optic nerve sheath, and subsequently, the patient showed intracranial hypertension with papilledema. After dehydration and anticoagulant treatment, the patient’s symptoms were relieved and she was discharged from the hospital 49 days later.ConclusionsHeadache is the main symptom of PDPH and cerebral venous thrombosis, which are difficult to distinguish. ONSD measurement may help to estimate the intracranial pressure, and early measurement may be helpful for women with PDPH to avoid serious complications, such as CVST.

Alleviation of Rheumatoid Arthritis by Inducing IDO Expression with Trichinella spiralis Recombinant Protein 43.

Rheumatoid arthritis (RA) represents the autoimmune disorder that shows aggressive arthritis as the main symptom. It is difficult to treat and can lead to joint deformation and function loss. At present, Trichinella spiralis (T. spiralis) antigen has attracted much attention because it plays a role in host immune regulatory mechanisms. Therefore, we selected T. spiralis recombinant protein 43 (Tsp43) to treat the bovine collagen type II (BCII)-induced mice RA model and explored its therapeutic mechanisms. This work first verified that Tsp43 could promote the expression of indoleamine 2, 3-dioxygenase (IDO) in dendritic cells (DCs) in vitro. Then, we randomized BALB/c mice (8 weeks old) into six groups, including control, phosphate buffer saline (PBS), BCII, BCII + heat inactivated Tsp43 (HiTsp43), BCII + Tsp43, and BCII + Tsp43 + 1-methyl-troptophan (1-MT) groups. To determine the therapeutic effect of Tsp43 on the BCII-induced mice RA model, relevant cytokines in each group and pathological changes in ankle joints were detected. To explore the mechanisms of Tsp43 on the BCII-induced mice RA model, we checked the expression of IDO in each group, CD4+T cell proliferation, and apoptosis. Collectively, Tsp43 decreased tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) expression in BCII-induced mice RA model and recovered the ankle injury to a certain extent. Tsp43 promoted high expression of IDO, caused expression of related apoptotic proteins in CD4+T cells, and caused apoptosis in CD4+T cells. In addition, Tsp43 reduced the proliferation of CD4+T cells. However, these effects can be inhibited by 1-MT (IDO inhibitor). These results suggested that Tsp43 played an important role in the treatment of arthritis by inhibiting the proliferation of CD4+T cells and inducing CD4+T cells apoptosis through the high expression of IDO. The purpose of this experiment was to provide a new idea for the treatment of RA and lay a foundation for the development of parasite-derived drugs for the treatment of RA.

Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears

To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears. A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up. All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%). Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.

MANAGEMENT OF INFLAMMATORY BOWEL DISEASE IN AYURVEDA PER-SPECTIVE – A CASE STUDY

Ulcerative colitis is a chronic idiopathic inflammatory bowel disease with a relapsing nature. It is a very chal-lenging disease affecting a patient during the most active period of his life, i.e., 20 to 40 years of age. The main features are anorectal bleeding with increased frequency of bowel evacuation, general debility and abnormal structural pathology in the descending colon, particularly the sigmoid colon. Modern medical science has no permanent curative and safe treatment for this disease. Thus, the following article discusses the method of treat-ment of the disease using Ayurvedic treatment by shamana aushadhis (Guloochyadi kashayam, Hinguvachadi gulika, Dadimashtaka choorna, Dhanvantharam gulika etc). Based on the signs and symptoms observed in the patient, a treatment protocol was advised. It can become a new way to achieve effective and safe care treatment and significantly improve a patient’s condition. A patient aged 64 years. The Male complained of pain in the abdomen, very bad-smelling mucous discharge in the morning while defecating, loss of appetite, feeling of swelling in the anal region, and pain in HIP bilaterally. Based on the patient’s condition, prakruti and samprapti ghatak (pathological factors) a treatment protocol was designed with the shamana chikitsa. The combination of various powdered herbs like Guloochyadi kashayam, Hinguvachadi gulika, Dadimashtaka choorna, Dhanvantharam gulika etc were advised to the patients with prop-er dietary instructions and restrictions. The treatment protocol effectively reverses the main symptoms, and it could be extended in future cases by using different combinations of drugs based on other Ayurvedic parameters to obtain even better results. It showed marked improvement in the patient’s condition. According to one’s Pra-kriti and combinations of various potential ingredients, diets and lifestyle recommendations, it worked on overall disease management. The management strategy was efficacious in improving the patients’ main issues. The case was treated with compound ayurvedic medicines over 3 months with remarkable improvement, which is evident. The outcome of this clinical study will reveal further the effect of ayurvedic medicine on IBD.

Development of patient-reported outcome for adult spinal deformity: validation study

Adult spinal deformity (ASD) is a complex condition that combines scoliosis, kyphosis, pain, and postoperative range of motion limitation. The lack of a scale that can successfully capture this complex condition is a clinical challenge. We aimed to develop a disease-specific scale for ASD. The study included 106 patients (mean age; 68 years, 89 women) with ASD. We selected 29 questions that could be useful in assessing ASD and asked the patients to answer them. The factor analysis found two factors: the main symptom and the collateral symptom. The main symptom consisted of 10 questions and assessed activity of daily living (ADL), pain, and appearance. The collateral symptom consisted of five questions to assess ADL due to range of motion limitation. Cronbach’s alpha was 0.90 and 0.84, respectively. The Spearman’s correlation coefficient between the change of main symptom and satisfaction was 0.48 (p < 0.001). The effect size of Cohen’s d for comparison between preoperative and postoperative scores was 1.09 in the main symptom and 0.65 in the collateral symptom. In conclusion, we have developed a validated disease-specific scale for ASD that can simultaneously evaluate the benefits and limitations of ASD surgery with enough responsiveness in clinical practice.

Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis.

Eosinophilic gastroenteritis (EGE) is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract. Glucocorticoids remain the most common treatment method. However, disease relapse and glucocorticoid dependence remain notable problems. To date, few studies have illuminated the prognosis of EGE and risk factors for disease relapse. To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up. This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022. Clinical records were collected and analyzed. Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival (RFS). EGE showed a median onset age of 38 years and a slight female predominance (56.4%). The main clinical symptoms were abdominal pain (89.1%), diarrhea (61.8%), nausea (52.7%), distension (49.1%) and vomiting (47.3%). Forty-three (78.2%) patients received glucocorticoid treatment, and compared with patients without glucocorticoid treatments, they were more likely to have elevated serum immunoglobin E (IgE) (86.8% vs 50.0%, P = 0.022) and descending duodenal involvement (62.8% vs 27.3%, P = 0.046) at diagnosis. With a median follow-up of 67 mo, all patients survived, and 56.4% had at least one relapse. Six variables at baseline might have been associated with the overall RFS rate, including age at diagnosis < 40 years [hazard ratio (HR) 2.0408, 95% confidence interval (CI): 1.0082-4.1312, P = 0.044], body mass index (BMI) > 24 kg/m2 (HR 0.3922, 95%CI: 0.1916-0.8027, P = 0.014), disease duration from symptom onset to diagnosis > 3.5 mo (HR 2.4725, 95%CI: 1.220-5.0110, P = 0.011), vomiting (HR 3.1259, 95%CI: 1.5246-6.4093, P = 0.001), total serum IgE > 300 KU/L at diagnosis (HR 0.2773, 95%CI: 0.1204-0.6384, P = 0.022) and glucocorticoid treatment (HR 6.1434, 95%CI: 2.8446-13.2676, P = 0.003). In patients with EGE, younger onset age, longer disease course, vomiting and glucocorticoid treatment were risk factors for disease relapse, whereas higher BMI and total IgE level at baseline were protective.

Cholesteatoma of the External Auditory Canal a Rare Pathology: Case Report

Introduction: Cholesteatoma of the external auditory canal (ECA) is a rare nosological entity, it is characterized by the invasion of squamous tissue in an area of the external auditory canal (EAC), generally in the posteroinferior region, which is accompanied by bone erosion [1]. Clinical case: 30-year-old female patient with no known pathological history who presented with a 7-day history of clinical symptoms characterized by left ear otalgia associated with foul-smelling otorrhea and temperature rises at the beginning of the condition, receiving antibiotic treatment with amoxicillin (for 7 days). Without improvement, later it is associated with intense headache at the occipital level, nausea, vomiting and dizziness. Discussion: The percentage of men and women is similar in adulthood. The most frequent location is posteroinferior and in most cases the origin is primary. Otalgia and otorrhea were the main symptoms. In general, treatment is conservative, but a surgical approach was necessary in a third of patients through analoplasty or mastoidectomy, depending on the extent of the lesions [2]. Conclusion: Although we do not know the pathogenic mechanisms responsible for the formation and development of CCAE, the inclusion of keratin between the epithelium and the bone, with the participation of the periosteum, seem to be the triggers of the process. The diagnosis is clinical and its extent determines the use of local or surgical treatment, which is usually resolving [4].

The effect of osteoarthritis exercise on pain and joint range of motion in osteoarthritis patients

Aims. Osteoarthritis is a degenerative and progressive disease characterized by abrasion of joint cartilage and irregular formation of new bone on the surface of the joints. Pain becomes the main symptom followed by a decrease in joint range of motion, causing disability and interfering with daily activities. The purpose of this study was to determine the effect of osteoarthritis exercise on pain and joint range of motion in osteoarthritis patients. Methods. The research design used a quasy experiment with a non-equivalent control group design approach. The sample used was 70 respondents for each intervention group and control group. Intervention in the form of physical exercise osteoarthritis exercise guided by an instructor and using audio-visual media. Exercise is carried out 3 times a week for 2 weeks. For stretching and flexibility exercises using yoga mats and bath towels and for strength building exercises using chairs. The pain scale was measured with a numeric rating scale (NRS) instrument and measurement of joint range of motion using a goniometer. Data analysis used numerical comparative analytic paired-sample t test and independent t test. Findings. The results showed that the results of the paired t test (p) &lt;0.05. thus indicating that there is an effect of providing osteoarthritis gymnastics training intervention on reducing the pain scale. The results of the paired t test (p) &lt;0.05. thus indicating that there is an effect of providing osteoarthritis exercise training interventions on the scale of joint range of motion. The results of the independent t test (p) &lt;0.05, meaning that there is a difference in the osteoarthritis pain scale before and after the intervention, while the test for differences in joint range of motion scale shows a non-significant value of p&gt; 0.05. Conclusion. The conclusion of the study was that there was an effect of osteoarthritis gymnastics training in reducing the osteoarthritis pain scale and joint range of motion scale. Then there is no difference between the control group and the intervention group who get gymnastic exercises and do not get osteoarthritis gymnastic exercises. Keywords: Osteoarthritis exercise; Osteoarthritis; Pain, Joint range of motion

Double Synchronous Primary Tumors: Metastatic Melanoma and Advanced Pulmonary Adenocarcinoma in a 32-Year-Old Adult: Case Report and Literature Review

Introduction: The presence of multiple primary malignant neoplasms is an unusual finding during the diagnostic approach of patients with cancer. The coexistence of melanoma with lung adenocarcinoma is extremely rare according to some cohort studies since a prevalence of 0.05% is estimated in this group of patients. The most relevant risk factors for the development of multiple malignant tumors are genetic, environmental exposures to carcinogenic substances, and treatment of a preexistent cancer. Case description: Male, 32 years old who denies family history of malignant neoplasms, drug addiction, chronic degenerative diseases, allergies, surgeries, and hospitalizations. His main symptom was a progressive weakness of the right upper and lower limb which, over a period of days, made it impossible to walk. During his hospitalization, MRI revealed metastatic lesions associated with vasogenic edema. For this reason, an evaluation was requested by the neurosurgery service, who performed a decompressive craniectomy with a biopsy that reported malignant cells consistent with metastatic melanoma. As part of the diagnostic approach, a thoracoabdominal CT with IV contrast was performed, which revealed another tumor at the lung level in the left lower lobe that obliterates the bronchus, not suggestive of metastatic activity, for this reason a lung biopsy was performed, which reported findings of poorly differentiated adenocarcinoma with angiolymphatic invasion present and extensive necrosis. The patient was discharged home with the palliative care measures due to the poor prognosis of both stage IV cancers reported synchronously. Conclusion: The coexistence of 2 primary different cancers in the same patient is an unusual phenomenon which represents a challenge for the multidisciplinary team that treats the patient. Likewise, the coexistence between melanoma and lung adenocarcinoma is exceptionally reported in the literature, which in advanced phases confers a poor prognosis and few therapeutic options.

Nasal Patency Measurement: State of the Art of Acoustic Rhinometry.

Nasal obstruction is one of the main symptoms of different nasal pathologies. Many physiological and pathological conditions can produce nasal airflow impairment causing nasal obstruction and affecting patients' quality of life. There are different methods for the measurement of nasal obstruction, but in clinical practice the most common used are acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flow. This review describes the fundamentals of acoustic rhinometry, its normal values, the different physiological and pathological conditions that can modify nasal patency, and the utility of this instrument for the measurement of nasal obstruction in clinical practice. Acoustic rhinometry is a simple test, so it is suitable for measurements in the pediatric population, i.e., for evaluating adenoid hypertrophy. Acoustic rhinometry normal values are available, unilaterally and bilaterally for pediatric and adult populations. Acoustic rhinometry has been demonstrated to be reproducible and even superior to rhinomanometry when measuring nasal modifications during challenges. It is possible to use acoustic rhinometry before and after nasal surgery. Measuring nasal cavities volume and cross-sectional area, acoustic rhinometry is particularly indicated in rhinosurgery, especially for the evaluation of spreader grafts. Brief considerations about the correlation between nasal symptoms, in particular the subjective sensation of nasal obstruction, and the acoustic rhinometry results as well as the correlation of acoustic rhinometry with other methods for the measurement of nasal obstruction are also reported. Objective and subjective evaluation of nasal obstruction gives different information that together optimizes the diagnosis and the treatment of rhinologic patients. Acoustic rhinometry alone or in combination of other instruments for the measurement of nasal obstruction or patency should be used regularly in every outpatient clinic that treats patients with nasal obstruction as there is an increasing need of evidence-based therapies.

An inulin-type fructan CP-A from Codonopsis pilosula alleviates TNBS-induced ulcerative colitis based on serum-untargeted metabolomics.

Ulcerative colitis (UC) is an inflammatory disease with abdominal pain, diarrhea, and bloody stool as the main symptoms. Several studies have confirmed that polysaccharides are effective against UC. It is commonly accepted that the traditional benefits of Radix Codonopsis can be attributed to its polysaccharide contents, and inulin-type fructan CP-A is the main active monomer in the polysaccharide components. Herein, we established a 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced UC rat model and lipopolysaccharide (LPS)-induced colonic epithelial cell model (NCM460) to investigate the effect of CP-A on UC. Untargeted metabolomics studies were conducted to identify differential metabolites using ultra-high performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry (UHPLC-Q-TOF/MS) and enrich metabolic pathways in rat serum. The in vivo assays demonstrated that CP-A reduces colonic macroscopic injury, disease activity index (DAI), histopathological score, interleukin (IL)-8, and tumor necrosis factor-α (TNF-α) levels, as well as the expression of intercellular adhesion molecules. On the other hand, CP-A increases IL-10 and transforming growth factor-β (TGF-β) levels. The in vitro experiments indicated that CP-A treatment could reduce nitric oxide (NO) and IL-1β after LPS stimulation. The metabolomics results suggested that CP-A therapy for UC may be related to the mammalian target of rapamycin (mTOR) signaling pathway. The in vitro and in vivo validation of the pathway showed similar results, indicating that CP-A alleviates UC by preventing the activation of mTOR/p70S6K signaling pathway. These findings offer a fresh approach to treating UC and a theoretical foundation for the future advancement of CP-A.NEW & NOTEWORTHY We report that an inulin-type fructan from Codonopsis pilosula CP-A exhibits a therapeutic effect on experimental colitis. Its mechanism may be to alleviate intestinal inflammation by preventing the activation of mammalian target of rapamycin (mTOR)/p70S6K signaling pathway. These findings offer a fresh approach to treating ulcerative colitis (UC) and a theoretical foundation for the future advancement of CP-A.

A clinical case of autosomal recessive agammaglobulinemia with B-cell deficiency

Background. Primary agammaglobulinemia is the result of specific changes in B-cells that lead to low antibody production. A preliminary diagnosis is established if there is a history of frequent bacterial infections (otitis media, sinusitis, skin abscesses), including severe course, in some cases caused by opportunistic flora and atypical mycobacteria; low levels of immunoglobulins. The main symptoms of primary immunodeficiency in a child from this clinical example were frequent recidivating bronchial obstruction with the development of pneumonia.Presentation of the clinical case.The publication presents a clinical case of autosomal recessive agammaglobulinemia with B-cell deficiency in a child of 2 years, 7 months. During the follow-up period from 4 months to 2 months, 7 months, the child had 3 episodes of pneumonia, 3 episodes of purulent otitis media. The child repeatedly underwent inpatient treatment, where he received broad-spectrum antibiotics as treatment. Based on the examination (IgA (0.02 g/l), IgG (0.3 g/l), IgM (0.07 g/l) and the absence of CD19+ cells), the diagnosis of “Primary immunodeficiency, agammaglobulinemia” was made, which was subsequently confirmed by the RDC of Moscow. From the moment of diagnosis, the child receives intravenous immunoglobulins at a dose of 7.5 g. and antibacterial therapy.Conclusion. Early recognition and diagnosis of these conditions is crucial to improve outcomes and prevent complications.

Energy Management Education in Persons with Long COVID-Related Fatigue: Insights from Focus Group Results on Occupational Therapy Approach.

Long COVID is a growing condition among individuals, with fatigue being one of the main symptoms experienced. Energy Management Education (EME) is a structured occupational therapy group intervention that aims to reduce the impact of fatigue in daily life. This study utilized focus groups to explore the experiences of individuals with post-COVID-related fatigue who participated in the EME program. Six participants engaged in discussions about the program immediately after its completion and again two months later. Additionally, five occupational therapists shared their experiences. Former participants reported implementing strategies learned in the program to manage their condition effectively. They emphasized the importance of understanding fatigue and found the support provided by the peer group valuable. Occupational therapists highlighted the unique challenges faced by individuals with post-COVID-related fatigue compared to other populations with similar fatigue symptoms. Furthermore, insights were obtained regarding the ways individuals live and cope with post-COVID-related fatigue. EME participants were involved in a dynamic and complex occupational therapy process and were experiencing a slow change towards having more control over their daily routines. The study gathered valuable feedback and suggestions from participants and occupational therapists which can be used to optimize the EME program.

Follicular lymphoma with a predominantly diffuse growth pattern with 1p36 deletion: a clinicopathologic analysis of eight cases

Objective: To investigate the clinical and pathologic features and diagnosis of follicular lymphoma (FL) with a predominantly diffuse growth pattern (DFL) with 1p36 deletion. Methods: Eight cases of DFL with 1p36 deletion diagnosed at Department of Pathology, Beijing Friendship Hospital, Capital Medical University (n=5) and the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital (n=3) from January 2017 to January 2023 were included. Their clinicopathologic features and follow-up data were analyzed. Immunohistochemistry and fluorescence in situ hybridization (FISH) were performed. Results: There were five males and three females, with a median age of 67 years, and inguinal lymphadenopathy was found as the main symptom. Histologically, similar morphologic features were sheared among all cases, with effaced nodal structure and characterized by proliferation of centrocytes in a diffuse pattern, with or without follicular components. The germinal center-related markers such as CD10 and/or bcl-6 were expressed in the tumor cells, and 1p36 deletion but not bcl-2 translocation was appreciable in these cases. Conclusions: DFL with 1p36 deletion is a rare subtype of FL, with some overlaps with other types of FL or indolent B-cell lymphomas in their pathologic features. An accurate diagnosis requires comprehensive considerations based on their clinical, pathologic, immunohistochemical, and molecular features.

Endoscopic Extraction of an Unusual Foreign Body at the Somine Dolo Hospital in Mopti

The esophagus is the most common site of impaction of an ingested foreign body. The main initial symptom is acute dysphagia; Patients with complete esophageal obstruction produce excessive amounts of saliva and are unable to swallow oral secretions. Complete obstruction can cause pressure necrosis and increases the risk of perforation if present for more than approximately 24 hours. Emergency endoscopy is necessary for sharp objects, disc or button batteries, and any obstruction causing symptoms that suggest complete obstruction. We report through this observation the extraction of an unusual esophageal foreign body at the Sominé Dolo hospital in Mopti. This was a 60-year-old patient, a farmer, with no known medical or surgical history to date, and no particular psychiatric disorder. The accidentally ingested foreign body was a cap from a recycled vinegar bottle. An attempt at extraction in the ENT department was made without success, then subsequently sent to the Hepato-gastroenterology unit. The endoscopic extraction of the foreign body was carried out without incident and the evolution was favorable after the endoscopy procedure.

WRN loss accelerates abnormal adipocyte metabolism in Werner syndrome

BackgroundMetabolic dysfunction is one of the main symptoms of Werner syndrome (WS); however, the underlying mechanisms remain unclear. Here, we report that loss of WRN accelerates adipogenesis at an early stage both in vitro (stem cells) and in vivo (zebrafish). Moreover, WRN depletion causes a transient upregulation of late-stage of adipocyte-specific genes at an early stage.MethodsIn an in vivo study, we generated wrn−/− mutant zebrafish and performed histological stain and Oil Red O staining to assess the fat metabolism. In an in vitro study, we used RNA-seq and ATAC-seq to profile the transcriptional features and chromatin accessibility in WRN depleted adipocytes. Moreover, we performed ChIP-seq to further study the regulatory mechanisms of metabolic dysfunction in WS.ResultsOur findings show that mechanistically WRN deficiency causes SMARCA5 upregulation. SMARCA5 is crucial in chromatin remodeling and gene regulation. Additionally, rescuing WRN could normalize SMARCA5 expression and adipocyte differentiation. Moreover, we find that nicotinamide riboside (NR) supplementation restores adipocyte metabolism in both stem cells and zebrafish models.ConclusionsOur findings unravel a new mechanism for the influence of WRN in the early stage of adipogenesis and provide a possible treatment for metabolic dysfunction in WS. These data provide promising insights into potential therapeutics for ageing and ageing-related diseases.

Clinically significant effects of gait modification on knee pain: A systematic review and meta-analysis.

Knee pain is the main symptom of knee osteoarthritis. Walking is effective against knee pain, and some studies have shown that gait modification can also relieve this condition. However, the quality of evidence for the clinically significant effects of gait modification on knee pain has not been examined. This systematic review and meta-analysis aimed to evaluate the level of evidence for the clinically significant effects of gait modification on knee pain and determine if the effects are greater than the minimal clinically important difference (MCID). We comprehensively searched electronic databases such as MEDLINE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. Intervention studies with experimental groups who received gait modification and control groups who did not were evaluated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the level of evidence. Nine studies met the inclusion criteria. All were included in the systematic review and two in the meta-analysis. Results showed that gait modification have significant effects (p= 0.02), and the quality of evidence was very low. However, several studies have revealed that the effects of gait modification, when used as a foot-focused intervention, were greater than the MCID. We concluded that there is a lack of high-quality evidence that supports the general efficacy of gait modification. Although based on low-quality evidence, when applied to the foot, it may have clinically significant effects.

Primary retroperitoneal choriocarcinoma with lung and liver metastasis in a male patient: case report

Abstract Objectives Non-gestational primary choriocarcinoma is an extremely rare malignant tumor with atypical clinical symptoms, especially in males. It usually occurs in the midline of the body, such as the mediastinum and retroperitoneum. Pathological diagnosis of primary retroperitoneal choriocarcinoma presents many challenges. More importantly, it is insensitive to therapy and has a poor prognosis. To date, there is still no standard treatment strategy for primary choriocarcinoma. Case presentation This case report presented a 27-year-old male with acute abdominal pain as the main symptom. And then, retroperitoneal choriocarcinoma with lung and liver metastasis was diagnosed. Palliative surgery was performed to alleviate the abdominal pain but complete tumor removal was not achieved. Subsequently, we gave the treatment with cytotoxic chemotherapy and immune checkpoint inhibitor blockade. The tumor was significantly reduced in size after six cycles of immunotherapy and chemotherapy, and also β-hCG level returned to normal. The tumor was not in complete remission, so penpulimab immuno-maintenance therapy was given. So far, the tumor control is stable, and the patient’s quality of life is also very well. Conclusions Pathological diagnosis of primary choriocarcinoma is very necessary, and the related molecular markers can assist. Immunotherapy combined with chemotherapy is effective in the treatment of primary retroperitoneal choriocarcinoma.