Diagnostic Methods Research Articles

P-86. Utility of Metagenomic Next-Generation Sequencing in Detecting Pathogens Causing Orthopedic and ENT Infections

Abstract Background Traditional methods such as gram stain and cultures are recommended to identify pathogens from patient specimens. Metagenomic Next-Generation Sequencing (mNGS) is a new attractive technology to detect occult infections, that does not provide susceptibilities, with not well-established utility. We compared results of mNGS tests performed at Microgen Reference lab to those of traditional culturing on patient outcomes. Methods This retrospective study includes all patients from Aug 2022 to Dec 2023 whose biopsy samples were submitted for both traditional culturing and mNGS diagnostic tests. Clinical and lab data were extracted from the electronic medical record. Patient outcomes when utilizing traditional versus mNGS diagnostic methods were compared. Results 53 orthopedics and ENT cases were studied. 31/41 (75.6%) orthopedic cases (spine, hips, and synovial fluid) had concordant results, with 19 (46.3%) concordant negative cases and 12 (29.3%) concordant positive cases showing similar organism(s). Of the discordant cases, 12.2% (5/41) mNGS results were accurate, and 9.75% (4/41) culture results were accurate. One specimen (2.44%) showed contamination with both methods. Of 12 ENT cases, overall concordance of accurate results was only 50%, 1 negative case and 5 cases showing the same organism(s) with both methods. 16.7% (2/12) the culture results were accurate while mNGS results were incorrect, and 4/12 (33.3%) specimens showed contamination by both methods. Conclusion Utilizing mNGS versus traditional methods did not result in any changes in patient management like empirical and targeted antibiotic regimen or in hospitalization outcomes including duration of therapy or length of stay. The accuracy of the testing is equivalent, while mNGS is much more expensive and not readily available in clinical labs, resulting in longer TAT (6 days vs. cultures 3 days). The quality of results is mainly affected by the quality of the specimen (33% contamination for ENT specimens). These data ultimately guided the stewardship discussions about utilizing mNGS at CUHC to discourage mNGS testing for ENT sources unless the collection method is improved and reserve the utilization of mNGS for challenging orthopedic cases. Disclosures All Authors: No reported disclosures

P-2223. Plasma Microbial Cell-free DNA Next-generation Sequencing can be a Useful Diagnostic Tool in Patients with Osteoarticular Infections

Abstract Background The introduction of shotgun metagenomic sequencing (sMGS) methods that identify the presence of microbial cell-free DNA (mcfDNA) in peripheral blood have shown promising results in various populations of patients. There is a pressing need to evaluate its application for osteoarticular infections (OAIs) in real-world setting. Baseline characteristics of the patients with suspected osteo-articular infections, including demographics, clinical characteristics, diagnosis, and KT results. Methods We retrospectively collected data on 73 adult patients who presented to the Mayo Clinic with suspected OAIs between 2019 and 2023, and for whom mcfDNA sMGS (Karius®, KT) testing was part of their diagnostic workup. We collected data on comorbidities, diagnostics, microbiological workout and its concordance with the KT. The primary objective was to evaluate its clinical impact on OAI diagnoses and management distinguishing into four categories: (1) KT was able to confirm an established diagnosis, (2) KT supported non-ID diagnosis, (3) KT established an unsuspected diagnosis, (4) KT did not add relevant information. Relevant microbiologic studies of patients with unsuspected diagnoses established by the KT (N=5) Results In our cohort KT was performed in 73 patients (Table 1). Among the infected individuals, KT yielded positive results in 22/43 (51.2%) cases. Out of these 22 cases, 11 (50%) showed agreement with conventional diagnostic workup, while in five (22.7%) cases, the KT established an unsuspected diagnosis, improving the diagnostic power from 11/43 (25.6%) to 16/43 (37.2%) (Table 2). Moreover, yielded a negative result in 19/26 (73.1%) patients with non-infectious diagnosis (Figure 1). Native Vertebral Osteomyelitis (NVO) diagnosis (p < 0.001) or OAIs with concomitant presence of endocarditis or endovascular infection (p = 0.005) were statistically associated with a definite, probable, or possible diagnostic certainty of KT result (Table 3). Overall, KT influenced antibiotic therapy in six cases (8.2%). Table 3 Factors associated with diagnostic certainty categories Conclusion This is the first retrospective study aiming to assess the real-world usefulness of the KT on the clinical management of patients with OAIs, with a special focus on NVO. It underscores KT's real-world application in cases where traditional diagnostic methods fall short. In highly complex OAIs cases, KT added 11.6% to the diagnostic power by establishing unsuspected diagnosis in 5 of 43 infective patients. Patients with NVO or OAIs with concomitant endocarditis or endovascular infections particularly benefited from KT testing. Figure 1 Distribution of KT results and their respective outcome according to the final diagnosis of suspected OAIs cases. Disclosures All Authors: No reported disclosures

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

Advancing Perioperative Neurocognitive Health: A Critical Review of Predictive Tools, Diagnostic Methods, and Interventional Strategies

The not-so-sweet side of mango: Mango allergy

Mango (Mangifera indica), from the Anacardiaceae family, originates from Asia and has grown globally. Despite its wide nutritional benefits, mango can induce allergic processes in some individuals. Mango allergy occurs from the body’s immune response to various proteins found in the mango fruit, peel, stem, sap, or tree. Oral allergy syndrome (burning sensation and swelling in the mouth), to severe conditions, including anaphylaxis is included in the spectrum of symptoms observed. Contact dermatitis, a delayed hypersensitivity reaction that manifests as rash, pruritus, and blisters, is also observed in patients after direct contact with mango or exposure to related allergens from the Anacardiaceae family, such as poison ivy or oak. This narrative review aims at reviewing the cutaneous manifestations of mango allergy, examining the allergenic profiles of affected individuals, cross-reactivity with other allergens, diagnostic methods, and shed light on the importance of recognizing mango allergy in clinical practice, despite its relative rarity.

ЗАСТОСУВАННЯ ФІЗИЧНОЇ ТЕРАПІЇ ДЛЯ КОРЕКЦІЇ ФУНКЦІОНАЛЬНИХ ПОРУШЕНЬ СЕРЦЕВО-СУДИННОЇ СИСТЕМИ ПРИ НЕЙРОЦИРКУЛЯТОРНІЙ ДИСТОНІЇ

In recent years, a number of works have appeared devoted to the study of the problem of neurocirculatory dystonia, the causes of its occurrence and development, and the characteristics of its diagnostic methods. However, the issues of the use of physical therapy in the rehabilitation treatment and prevention of neurocirculatory dystonia remain insufficiently studied. Therefore, the purpose of the study was to study of the influence of physical therapy on the functional state of the cardiovascular system of women of mature age with neurocirculatory dystonia. Research methods. 23 women took part in the study. We divided all women into control (11 people) and main (12 people) groups. The average age of the patients was 31.5 years. The diagnosis was neurocirculatory dystonia of the hypotonic type. Results and conclusions. The most common complaints of patients were headache, pain in the heart and abdomen, weakness, fatigue, increased respiratory rate. The physical therapy program for women with neurocirculatory dystonia included therapeutic physical culture, massage, and physiotherapy procedures. After 12 weeks of training, patients in both groups recorded an improvement in the cardiovascular system. Thus, the average heart rate in patients in the control group decreased by 13.3%, and in the main group – by 17.7%; the average systolic blood pressure in the control group increased by 4.5%, and in patients in the main group – by 8.9%; the average diastolic blood pressure in the main group increased by 1.5%, and in the main group – by 5.3%. The program we developed was more effective because the percentage changes in heart rate and blood pressure were higher in the patients in the main group. The 12-week sessions also contributed to the improvement of the autonomic nervous system in the subjects.

Hereditary hypomagnesemia with secondary hypocalcemia in a child: a clinical case

Relevance. Magnesium is a vital cation that serves as a cofactor in numerous biochemical reactions within the human body. It plays a crucial role in various intracellular processes, including calcium homeostasis, signal transduction, and energy metabolism regulation. Deficiency of this essential micronutrient can manifest early in life and may result in a range of pathological conditions, some of which pose a significant threat to a child's health.Description of the clinical case. The parents of an 18-month-old child presented to the clinic at Kuban State Medical University, under the Ministry of Health of the Russian Federation, with concerns regarding gingival overgrowth. The child’s medical history revealed seizure episodes of unknown origin that had first occurred at three months of age, necessitating the administration of multiple high-dose anticonvulsant medications. Upon examination, edema of the subcutaneous tissue in the face, trunk, and limbs was noted, along with pronounced gingival hypertrophy in the absence of inflammatory signs. A provisional diagnosis of drug-induced gingival fibromatosis was established. To clarify the diagnosis and optimize anticonvulsant therapy, molecular genetic testing was recommended. The results confirmed autosomal recessive hypomagnesemia with secondary hypocalcemia, attributed to previously unreported genetic mutations. Inpatient treatment included magnesium supplementation with the gradual tapering of anticonvulsant medications. Over the course of treatment, a marked reduction in gingival hypertrophy was observed, and no further seizure episodes occurred.Conclusion. The diagnosis of genetically determined diseases is unattainable without the use of modern high-tech diagnostic methods. Accurate and timely identification of such conditions is essential for effectively managing pathological manifestations, ensuring the selection of appropriate treatment strategies, and preventing potential iatrogenic complications.

Artificial Intelligence for Enhancing Veterinary Healthcare: An Experiment

Background: The use of machine learning (ML) in veterinary medicine has gained significant attention, particularly for the early detection and classification of animal diseases. For example: lumpy Skin Disease (LSD) in cattle is one such condition that poses a substantial threat to livestock health. Traditional diagnostic methods can be labor-intensive and time-consuming. Therefore, leveraging ML techniques for automated disease detection could improve diagnostic efficiency and accuracy. Methods: In this study, a dataset comprising images of cattle from four breeds-Vechur, Swiss Holstein, Jersey and Ponwar-was collected to train a DenseNet-121 Convolutional Neural Network (CNN) model for identifying and classifying LSD in cattle. The dataset included both LSD-affected and non-affected cattle images, ensuring balanced representation across different breeds, ages and severity levels. Image preprocessing techniques such as resizing, normalization and data augmentation were applied to prepare the data for model training. The DenseNet-121 architecture was employed, utilizing a pretrained ImageNet model as the feature extractor, with additional layers for binary classification. Result: The model achieved excellent performance, with training accuracy reaching 99.76% and validation accuracy of 92.17%. The precision, recall and F1-score for the “Lumpy” class were 96.43%, 81.82% and 88.52%, respectively, while the “Normal” class had a precision of 92%, recall of 98.57% and F1-score of 95.17%. The overall accuracy of the model was 93.2%. Additionally, the model achieved an AUC score of 0.96 for both classes, indicating a high ability to distinguish between “Lumpy” and “Normal” cattle. These results highlight the potential of ML-based methods in enhancing the efficiency and accuracy of veterinary disease diagnostics.

A New Look at the Processes of Edema Formation of the Recipient Wound Bed and the Possibility of Its Assessment Using Modern Instrumental Diagnostic Methods in Experiment and Clinical Practice

A New Look at the Processes of Edema Formation of the Recipient Wound Bed and the Possibility of Its Assessment Using Modern Instrumental Diagnostic Methods in Experiment and Clinical Practice

Wisdom tooth dislocation into perimandibular soft tissues in a child: a clinical case

Relevance. The dislocation of wisdom teeth into soft tissues following extraction is a relatively rare but clinically significant complication. Optimal management requires treatment in a specialized maxillofacial surgical unit. This article presents a clinical case of successful management of a child with a third molar dislocated into the surrounding tissues.Case description. The article details the medical history of a 13-year-old patient who presented with a diagnosis of "foreign body (tooth 1.8) in the maxillary region." The authors conducted a thorough review of the patient’s medical history and complaints, performed clinical examinations, and utilized additional diagnostic methods, including cone-beam computed tomography (CBCT) of the maxillofacial area, to establish a definitive diagnosis and determine the appropriate treatment strategy. The dislocated wisdom tooth was surgically removed in a specialized pediatric maxillofacial surgery unit. The postoperative course was uneventful, and the patient was discharged in satisfactory condition.Conclusion. Patients undergoing surgical removal of third molars should be informed about potential complications. In the event of complications, prompt professional intervention is essential. Cases involving intraoral access complications require immediate referral to a maxillofacial surgery unit.

Development of a one-step multiplex RT-qPCR method for rapid detection of bovine diarrhea viruses

IntroductionViral calf diarrhea poses a significant challenge to the cattle industry worldwide due to its high morbidity and mortality rates, leading to substantial economic losses. The clinical symptoms associated with various diarrhea pathogens often overlap, complicating accurate diagnosis; thus, there is an urgent need for rapid and precise diagnostic methods to improve prevention and treatment efforts. In this study, we developed a one-step multiplex reverse-transcription quantitative real-time polymerase chain reaction (mRT-qPCR) that enables the simultaneous detection of three key viral pathogens responsible for calf diarrhea: bovine kobuvirus (BKoV), bovine astrovirus (BoAstV), and bovine torovirus (BToV). However, development of accurate and rapid methods to distinguish these three viruses is helpful for the early detection, disease surveillance, and control of viral calf diarrhea.MethodsSpecific primers and minor groove binder (MGB)-based probes were designed targeting the 3D region of BKoV, ORF1 region of BoAstV, and N region of BToV. The sensitivity, specificity, and reproducibility ability were evaluated for the mRT-qPCR. Further, 80 bovine fecal samples were subjected to the mRT-qPCR, and the results were verified using conventional reverse-transcription PCR (RT-PCR) or PCR methods and sequencing methods.ResultsThis novel method demonstrated high sensitivity and specificity,achieving a detection limit of 24 copies/mL for each pathogen. Furthermore, the assay exhibited excellent reproducibility, with coefficients of variation below 1.5%, a strong linear correlation (R2 > 0.996), and an amplification efficiency between 90% and 110%. Validation with 80 clinical samples from both diarrheic and non-diarrheic cattle across four farms in Shanghai showed a high degree of concordance with RT-PCR, with positive detection rates for BKoV, BoAstV, and BToV at 28.75%, 8.75%, and 3.75%, respectively, highlighting the predominance of BKoV and BoAstV. Notably, this study represents the first identification of BKoV, BoAstV, and BToV in the Shanghai region.DiscussionThe mRT-qPCR is a robust, rapid, and simple tool for identifying viral pathogens associated with calf diarrhea, facilitating the development of effective prevention and control measures that are vital for the future sustainability of the cattle industry.

A predictive model based on the gut microbiota improves the diagnostic effect in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic, destructive autoimmune disorder predominantly targeting the joints, with gut microbiota dysbiosis being intricately associated with its progression. The aim of the present study was to develop of effective early diagnostic methods for early RA based on gut microbiota. A cohort comprising 262 RA patients and 475 healthy controls (HCs) was recruited. Faecal samples were collected from all participants, and microbial DNA was subsequently extracted. The V3-V4 region of the 16S rRNA gene was amplified via polymerase chain reaction (PCR) and subjected to high-throughput sequencing using the Illumina MiSeq platform. Additionally, a dataset with the accession number PRJNA450340 from the European Nucleotide Archive (ENA) was incorporated into the study. The sequencing data underwent processing and analysis utilizing QIIME2. To construct microbiome-based diagnostic models, Random Forest (RF), Support Vector Machine (SVM), and Generalized Linear Model (GLM) methodologies were employed, with the self-test data functioning as the training set and the PRJNA450340 dataset serving as the validation set. The results indicated that patients with RA exhibited a significantly reduced gut microbial α-diversity compared with the HCs group. The β-diversity analysis demonstrated notable distinctions in the gut microbiota structure between RA patients and HCs. Variations in the gut microbiome composition between RA patients and HCs were evident at both the phylum and genus levels. LEfSe analysis revealed a substantial number of significantly different microbiota between RA patients and HC, and 7 key genera were obtained by intersection of the different flora in the two data sets: Ruminococcus_gnavus_group, Fusicatenibacter, Butyricicoccus, Subdoligranulum, Erysipelotrichaceae_UCG-003, Romboutsia, and Dorea. Utilizing these seven core genera, RA diagnostic models were developed employing RF, SVM, and GLM methodologies. The GLM model exhibited consistent performance, achieving an area under the curve (AUC) of 71.03% in the training set and 74.71% in the validation set. Notable differences in gut microbiota exist between RA patients and healthy individuals. Diagnostic models based on key microbial genera hold potential for aiding in the early identification of individuals at risk for developing RA, thereby suggesting new avenues for its diagnosis.

Lack of sex- and gender-disaggregated data in diagnostics: findings from a scoping review of five tracer conditions

BackgroundSex and gender can affect all aspects of health-related behavior, yet there is limited information on how they influence diagnosis of any health condition. This scoping review examined the extent to which sex- and gender-disaggregated data on diagnostics are available for five tracer conditions: tuberculosis, coronavirus disease 2019 (COVID-19), diabetes, malaria, and schistosomiasis.MethodsPublications were searched between 2000 and 2022 on PubMed and Google Scholar and screened for relevance. Extracted data were analysed using descriptive quantitative and qualitative approaches.ResultsWe identified 29 relevant articles for tuberculosis, four for diabetes, six for schistosomiasis, eight for COVID-19, and three for malaria. For tuberculosis, most studies looked at gender-based barriers to diagnosis and disparities in health-seeking behaviors that predominantly affected women. For diabetes, studies noted that women had lower odds of being screened for prediabetes and potentially lower quality of care versus men. For schistosomiasis, studies suggested lower sensitivity diagnostic methods among women than men and low awareness of the disease. Studies suggest that women are less likely to be diagnosed for COVID-19 in certain settings. Studies on malaria reported that women show different health-seeking behaviors to men.ConclusionThis scoping review highlights a concerning lack of sex- and gender-disaggregated data on diagnostics. Consequently, further work is required to develop and implement an appropriate framework to assess gender and sex-related data around testing and diagnosis.

Trichosporon asahii: emerging challenges in pathogenesis and drug resistance.

Trichosporon asahii (T. asahii) is an opportunistic pathogenic fungus that often causes severe infections in immunosuppressed patients. Among Trichosporon species, T. asahii is the most pathogenic and lethal species. Current research faces challenges related to unknown pathogenic mechanisms, complex resistance mechanisms, insufficiently rapid and accurate diagnostic methods, and insufficient research on susceptibility to infection. These issues need to be explored in depth. This review summarizes research progress on the origin and classification of T. asahii, its virulence factors and pathogenic mechanisms, epidemiological characteristics, infection modes, diagnostic methods, drug treatment options, and drug resistance mechanisms. Traditional culture combined with molecular biology techniques, such as polymerase chain reaction and gene sequencing, has improved the accuracy and speed of detection. Treatment relies mainly on azole antifungal drugs and amphotericin B; however, patients are facing the problem of drug resistance. New techniques, such as gene knockout and gene sequencing, have identified resistance mechanisms, thus supporting the development of novel antifungal drugs. In summary, an in-depth study of T. asahii will aid in developing more effective diagnostic and therapeutic methods and improve patient prognosis.

Bayesian method for comparing F1 scores in the absence of a gold standard

ABSTRACT In the field of medicine, evaluating the diagnostic performance of new diagnostic methods can be challenging, especially in the absence of a gold standard. This study proposes a methodology for assessing the performance of diagnostic tests by estimating the posterior distribution of the F 1 score using latent class analysis, without relying on a gold standard. The proposed method utilizes Markov Chain Monte Carlo sampling to estimate the posterior distribution of the F 1 score, enabling a comprehensive evaluation of diagnostic test methods. By applying this method to internet addiction, we demonstrate how latent class analysis can be effectively used to assess diagnostic performance, offering a practical solution for situations where no gold standard is available. The effectiveness of the proposed approach was evaluated through simulation studies by examining the coverage probability of the 95% highest density interval of the estimated posterior distributions.

Insulinomas: Comprehensive Review of Epidemiology, Pathophysiology, Clinical Manifestations, Diagnostic Approaches, and Treatment Options

Pancreatic neuroendocrine tumors (PNETs) are rare endocrine tumors originating from pancreatic cells, constituting 1-2% of pancreatic tumors. The incidence of PNETs has risen from 0.32 to 0.48 per 100,000 people between 2004 and 2021. Among PNETs, insulinomas are the most common type, characterized by excessive insulin production, with an occurrence rate of 1-4 per million people. This review provides a comprehensive analysis of insulinomas, focusing on their epidemiology, pathophysiology, clinical manifestations, diagnostic methods, and treatment strategies. Insulinomas can be sporadic or associated with Multiple Endocrine Neoplasia Type 1 (MEN-1) syndrome, a genetic disorder caused by mutations in the MEN1 gene. MEN-1-associated insulinomas are often diagnosed earlier and may present as multicentric lesions, whereas sporadic insulinomas are typically solitary and benign. Diagnostic approaches include biochemical tests, such as the 72-hour fasting test, and imaging techniques like CT, MRI, and nuclear medicine scans for tumor localization. Surgical resection remains the primary treatment modality, with high success rates for benign tumors, although emerging techniques like endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offer promising alternatives for small, solitary tumors. Medical management, including medications like diazoxide and somatostatin analogs, is crucial for controlling symptoms in patients not amenable to surgery. Prognosis is generally favorable with surgical intervention, but careful monitoring is required for malignant or metastatic disease. Ongoing research is essential to enhance treatment strategies and improve patient outcomes.

Leveraging Artificial Intelligence to Develop a Decision-Support Tool for Visual Symptom Assessment of Grapevine Leafroll and Red Blotch Diseases.

The timely detection of viral pathogens in vineyards is a critical aspect of management. Diagnostic methods can be labor-intensive and may require specialized training or facilities. The emergence of artificial intelligence (AI) has the potential to provide innovative solutions for disease detection but requires a significant volume of high-quality data as input. With that purpose, we partnered with wine grape growers to collect a robust dataset of verified images. We used those images to train an AI model and develop a handheld application as a decision-support tool for grapevine leafroll and red blotch diseases. The tool allows users to scan a grapevine canopy with a mobile device and view a confidence reading describing the likelihood that the imaged vine has visual symptoms consistent with leafroll, red blotch, or a healthy vine. The 86% accuracy under field conditions and generally positive user experience suggest there is potential for the trained use of AI as an investigative tool to quickly assess visual symptoms associated with these grapevine diseases.

Review of celiac disease in the pediatric population

Celiac disease (CD) is a chronic autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, primarily those with HLA-DQ2 and HLA-DQ8 haplotypes. The global prevalence of CD ranges from 0.5% to 1%. Recent advances in diagnostic methods and raising awareness of this disorder have improved detection rates, but many cases remain undiagnosed due to the disease's multifaceted presentation. CD can manifest with a wide range of symptoms, including both gastrointestinal and extraintestinal signs. In smaller children common symptoms include mainly chronic or intermittent abdominal pain, abdominal distension, diarrhea and constipation. Older children and adolescent patients may frequently present atypical, vague symptoms such as fatigue, failure to thrive, weight loss, short stature, behavioral changes and anemia. Diagnosis involves primarily serological tests in patients presenting symptoms or in patients with high-risk of developing CD. A strict gluten-free diet is the principal treatment and it is highly effective in managing symptoms and promoting intestinal healing. In this paper, we will analyze epidemiology of CD, its pathogenesis, heterogeneous clinical presentation, the diagnostic process and treatment based on recent guidelines and literature.

Actigraphy as a modern method of disease diagnostics

Medicine of the 21st century has an extensive arsenal of means for diagnosing diseases. High-tech equipment is able to detect pathologies without clinical manifestations during the latent stage of disease development. Actigraphy is portable device based on accelerometer, used for tracking sleep parameters, and also, well established as a tool for tracking circadian rhythms of a person. Actigraphy is not an alternative to the use of polysomnography, however, it has advantages in ease of use, cost, and size of the device, in addition to allowing long-term continuous recording of night and daytime sleep over several days or weeks in the patient's home sleep environment. In addition to its primary function, the study of sleep characteristics, actigraphy is widely used as a method for detecting and monitoring diseases, including cognitive impairment, psychiatric disorders, cardiovascular pathologies, and respiratory diseases. In this review, we have compiled current information on the use of actigraphy as a tool for disease diagnosis. The described results allow us to summarize the useful characteristics of such a diagnostic tool and shed light on the application of this progressive and reliable method in medicine.

Female urethral diverticular carcinoma: a case report and review of the literature

ObjectiveTo investigate the etiology, clinical manifestations, treatment methods, and prognosis of urethral diverticulum cancer to enhance understanding of this disease.MethodsThis paper reports a case of urethral diverticulum cancer with “hematuria and dysuria” as the main clinical manifestations. The case is discussed in conjunction with relevant literature.ResultsThe patient initially presented to the gynecology department due to postmenopausal bleeding but was not diagnosed with the disease. Subsequently, the patient developed hematuria and dysuria and was referred to the urology department. MRI indicated urethral diverticulum-like changes with suspected tumorous lesions. Cystourethroscopic biopsy confirmed urethral diverticulum cancer. The patient underwent urethrectomy, and postoperative pathological diagnosis was poorly differentiated urothelial adenocarcinoma.ConclusionUrethral diverticulum cancer is a rare and highly aggressive malignant tumor of the urethra with a poor prognosis. The onset of urethral diverticulum cancer is concealed, and its clinical manifestations are nonspecific and diverse. Preoperative diagnosis is challenging, and imaging studies and cystourethroscopy are the primary preoperative diagnostic methods for urethral diverticulum cancer. Pathology and immunohistochemistry serve as the basis for confirmation of diagnosis. Currently, there is no unified treatment protocol for female urethral diverticulum cancer internationally. For female patients with urethral diverticulum cancer without distant metastasis, surgery remains the primary treatment. For patients with distant metastasis, a combination of surgery, chemotherapy, and radiotherapy may be considered.Genetic testing and targeted immunotherapy offer new approaches for future treatment.

The role of mediators in the formation of leading pathological processes in psoriatic arthritis

The lecture analyzes the results of research on the role of humoral and cellular mediators, their interaction, as well as the imbalance of angiogenic factors in psoriatic arthritis. The information is presented with identification of the leading typical pathological processes: inflammation and microcirculation disorders, formed due to the activation of protein cascades and interaction of molecular proinflammatory mediators and angiogenic factors. It is known that the clinical phenotypes of psoriatic arthritis are diverse. A deeper understanding of the pathogenesis and changes in the predominant pathological process can become the basis for the development of a personalized treatment strategy based on the pathogenesis to minimize iatrogenic complications and economic costs, as well as for the introduction of modern diagnostic methods for verification, differentiation, and monitoring of psoriatic arthritis in order to timely correct drug treatment.