Modern Approaches Research Articles

Modern approaches and technologies to prevent anastomotic leakage in the gastrointestinal tract

The healing of gastrointestinal anastomoses is acomplex biological process influenced by numerous factors. Various strategies to support healing and prevent anastomotic leakage (AL) exist, encompassing preoperative, intraoperative and postoperative measures. Preoperative interventions aim to optimize the patient and the tissue environment, particularly the gut microbiome. Intraoperative measures are technical in nature and include the choice of surgical access, the anastomotic technique and anastomotic reinforcement. Various procedures of the intraoperative diagnostics enable identification of such anastomoses requiring additional protective measures. Recently, indocyanine green (ICG) fluoroscopy has become established for evaluation of tissue perfusion, while newer techniques such as spectral microscopy offer promising possibilities. Postoperative diagnostic methods aim to identify potential AL as early as possible to enable initiation of therapeutic steps even before the onset of symptoms. These procedures range from various imaging techniques to innovative bioresorbable, pH-sensitive implants for early AL detection. Due to the multifactorial genesis of AL and the diverse technical possibilities, no single method will become established for prevention of AL. Instead, acombination of measures will ultimately lead to optimal anastomotic healing. The use of artificial intelligence and analyses based on the data promises a better interpretation of the vast amount of data and therefore to be able to provide general recommendations.

Recent Progress for the Synthesis of Pyrrole Derivatives – An Update

Abstract: Pyrrole is a versatile heterocyclic moiety exhibiting a wide range of pharmacological actions with high therapeutic value. The importance of pyrrole in the pharmaceutical field lies in its versatility, selectivity, and biocompatibility, and these properties make it a valuable tool for drug design and development. The pyrrole moiety is a fundamental building block for many biologically active molecules and has gathered significant attention in the fields of medicinal and organic chemistry; hence, its synthesis has been a crucial area for research. There are various conventional as well as modern approaches to acquiring a series of pyrrole scaffolds, with a wide range of attractive features and drawbacks pertaining to each approach. An extensive amount of literature must be studied to compare the best synthetic routes. This article highlights the applications of pyrrole derivatives in various fields, such as drug discovery, material science, and catalysis, and provides an overview of modern synthetic pathways that include metals, nanomaterials, and complex heterogeneous catalysed methods for pyrrole derivatives. Special emphasis is given to the use of green chemistry principles like green solvent-based methods, microwave-aided methods, and solvent-free methods in the synthesis of pyrroles, with the recent developments and prospects in the synthetic and organic chemistry fields. Overall, this review article provides a comprehensive overview of the synthesis of pyrroles and complies with all the possible developments in the synthetic routes for pyrroles within 2015– 2022. Among all, the reactions catalysed by proline, copper oxides, and oxones have been shown to be the most effective synthetic route for pyrrole derivatives at mild reaction conditions and with excellent yields. This information will be helpful for researchers interested in the development of new pyrrole-based compounds. The categorization in this review provides an easy means for the reader to rationally select the best possible synthetic method for pyrrole derivatives.

Attitudes, fears and experiences of medical scientists towards using AI tools in their work routine

Abstract Background Artificial intelligence (AI) has experienced an explosive growth in the healthcare sector and the scientific field. Large Language Models (LLMs) are investigated as potential tool to be used in medical treatment, by e.g. producing doctor’s reports, supporting personalized medicine or educating patients. However, limitations are broadly discussed addressing patient safety and ethical concerns due to false and misleading content. Therefore, LLMs face criticism among users not only towards their integration in the patient-provider-interaction, but also in its use in medical research and health care education. In the ongoing EXPOLS (Exploring the Potential of LLMs in Statistical Consulting) study, we address the question ‘What are the attitudes, fears and experiences regarding the integration of AI tools in the clinical/scientific work routine?’ Methods We implemented an online survey that will be accessible in 07/2024. All employees at the University and Medical Center Freiburg will be asked to participate in the survey via online media. We expect a sample size of n = 600-1,200. The survey combines published measurements (e.g. TRI 2.0, result expectation measure), as well as a self-designed instrument with 15 items aiming to measure fears and attitudes towards AI. Latter was developed within a multidisciplinary team making use of ChatGPT as item generator. We will investigate its psychometric properties using exploratory factor analysis and describe distribution characteristics. Results At the time of the conference, the project will be completed and both psychometric insights and content-related results will be reported. The results could have important public health implications, since attitudes towards AI will steer its integration in the medical and clinical routine. Conclusions The EXPOLS study makes a current inventory among medical scientists in Freiburg following a modern approach in instrument development by including ChatGPT as collegial advisor. Key messages • This study explores attitudes, fears and experiences towards the integration of AI tools in the work routine from medical and scientific staff at the University of Freiburg. • The findings might be crucial in determining the integration of AI based tools in the medical and clinical work routine.

10.G. Practice session: Innovation technology to promote healthy lifestyles: teachings from multi-national EU funded projects

Abstract The global burden of disease attributable to lifestyle risk factors is constantly escalating on a worldwide scale. Inadequate diet and sedentary behaviors stand out as particularly impactful contributors to chronic non-communicable diseases, resulting in millions of deaths annually and projecting stable, alarming trends for the foreseeable future. These statistics raise significant concerns among public health experts, particularly regarding the pervasive influence of unhealthy lifestyles on younger generations. This demographic cohort’s susceptibility poses a substantial threat to the future trajectory of non-communicable diseases and places immense strain on healthcare systems and global health outcomes. In light of these challenges, the imperative for public health initiatives and interventions aimed at promoting healthy lifestyles becomes glaringly apparent. Addressing the root causes of unhealthy behaviors through targeted interventions is essential to reverse the projected trends and mitigate future health risks. Public health authorities shoulder the responsibility of prioritizing such endeavors, as they play a pivotal role in shaping environments conducive to healthy living for present and future generations alike. Embracing innovative methodologies, leveraging technological advancements, and adopting modern approaches are imperative to engage and mobilize younger populations effectively. Initiatives funded by entities such as the European Union serve as promising examples, highlighting the potential for collaborative efforts to drive meaningful change. Sharing the methodologies and findings of such projects within the public health community can catalyze knowledge dissemination and foster collaboration, ultimately amplifying the impact of intervention strategies worldwide. By prioritizing intervention studies for behavioral change, stakeholders can collectively address the pressing challenge of lifestyle-related diseases and pave the way for healthier, more resilient communities. The aim of this workshop is to provide an overview of multi-national EU funded projects aiming to promote healthy lifestyles in the Mediterranean region. Key messages • Innovative and more modern approaches are needed to improve the diet in the Mediterranean region. • Children and adolescents are the main targets to counteract the rise of non-communicable diseases.

Compliance of eating model of individuals with metabolic syndrome with Bulgarian dietary guidelines

Abstract Background The incidence of metabolic syndrome progressively increases among the urban population of Europe. About 1/3 of the Bulgarian adults have metabolic syndrome. Changing the dietary pattern can be a modern approach to control it. The aim of the study is to investigate the eating model of people with metabolic syndrome according to the Bulgarian dietary guidelines. Methods Two hundred individuals with metabolic syndrome aged 54.6±10.5 y. were randomly selected from general practitioners’ practices in Pleven region, Bulgaria. A Food Frequency Questionnaire method was applied to assess the eating pattern of the respondents. The frequency of food consumption of different foods was compared with the dietary guidelines for the Bulgarian population over 18 years of age. Data were processed with IBM SPSS v. 25. Results Grain consumption met the recommendations in almost all respondents. Only 29% consumed fresh fruits and 42% had intake of milk and milk products according to the requirements. Women ate more fresh vegetables and fruits and dairy products than men (p = 0,032). Risk meat consumption, 2-4 times a week, was found: men preferring more red meat (45%) and women - chicken and poultry (56%). Fish consumption met recommendation (once a week) in only 14.7% of the respondents. The food intake of eggs, vegetables, legumes and nuts were low. The preferred oils were sunflower and olive (once a day by 86% and 15% respectively), and butter (21% - 2-4 times a week). The intake of table salt corresponds to the recommendations in two thirds of the participants. One third consumed confectionery every day. Half did not drink alcohol, but 16% used concentrates once a day. Conclusions Foods that increase the nutritional risk for the development of metabolic syndrome and type 2 diabetes - high consumption of confectionery and red meat, low consumption of vegetables, fish and legumes were found. Unbalanced eating model requires new public initiatives to prevent metabolic syndrome. Key messages • Men with metabolic syndrome have a higher consumption of unhealthy foods than women. • Modern Bulgarian dietary guidelines are an important tool for prevention of metabolic syndrome.

Archival records housed at USTUR support radium dial worker dosimetry.

The American radium dial worker (RDW) cohort of over 3,200 persons is being revisited as part of the Million Person Study (MPS) to include a modern approach to RDW dosimetry. An exceptional source of data and contextualization in this project is an extensive collection of electronic records (requiring 43 gigabytes (GB) of storage) digitized from existing microfilm and microfiche housed at the United States Transuranium and Uranium Registries (USTUR). Although the type, extent, and quality (e.g., legibility) of record(s) varies between individuals, the remarkable occupational, medical and demographic data include in vivo radiation measurements (e.g., radon breath, whole body counts), autopsy results, medical records (including copies of radiographs), interviews over the years, and correspondence. Of particular dosimetric interest are the details of radiation measurements. For example, there are some instances where hand-written and transcribed values are both available, along with notes providing context for why a particular measurement in a time series of measurements was chosen to assign an intake, or if there were concerns about a particular measurement. Born prior to 1935, RDW have nearly all passed away. Thus, the updated dosimetry, especially for the bone, will allow the correlation of lifetime cumulative dose with radiation risk. Here we review typical information available in this collection of historical records, highlighting some interesting finds, and discuss the relevance to current and ongoing work related to updating the dosimetry of the RDW in the Million Person Study, including providing an example of the usefulness of information contained in these records.

Marketing of Small Business with Regard to Handloom Sector

The present paper explores the marketing practices of handloom based small business enterprises in India. It is assumed that marketing plays an immense role in promoting as well as preserving handloom products. Handloom sector plays a vital role in preservation of traditional craftmanship and also provides job opportunities for the weavers specially women in case of Northeast India. Hence, it is a sector that makes women an empowered and self- reliant person. Small businesses in the handloom sector use a variety of marketing strategies which includes both traditional and modern approaches. Small business in handloom sector face different challenges in marketing of their products.

Ectopic Mediastinal Thyroid: A Crossroad Between a Multi-Layered Endocrine Perspective and a Contemporary Approach in Thoracic Surgery

An ectopic thyroid (ET) involves numerous scenarios of detection and outcomes, while its current management is not standardised. A mediastinal ET (MET) represents a low index of suspicion. In this paper, we introduce a 47-year-old female who was accidentally identified with an MET, and a modern surgical approach was provided. An anterior mediastinal mass of 3.2 cm was found at CT upon a prior COVID-19 infection. Previous to the infection, she experienced non-specific complaints for a few months (intermittent night sweats, facial erythema, chest pressure, and dyspnoea). Also, CT identified a thymus-like mass and a left adrenal incidentaloma of 3 cm. The endocrine panel was normal, and the subject declined further investigations. She was re-admitted 12 months later: the MET had increased +1 cm (+45% volume) and was confirmed at a 99mTc pertechnetate scintigraphy. Noting the symptoms, mediastinal anatomy, and size change, the MET was removed via a minimally invasive trans-cervical approach (eutopic gland preservation) with the help of a Cooper thymectomy retractor (which also allowed for a synchronous thymus mass resection). No post-operatory complications were registered, the thyroid function remained normal, and the mentioned symptoms were remitted. A histological exam confirmed a benign MET and thymus hyperplasia, respectively. To conclude, this case pinpoints important aspects, such as the clinical picture became clear only upon thoracic surgery due to the complete remission of the complaints that initially seemed widely non-specific. The incidental MET finding was associated with a second (adrenal) incidentaloma, a scenario that might not be so rare, following multiple imaging scans amid the COVID-19 era (no common pathogenic traits have been identified so far). The co-presence of a thymus mass represented one more argument for surgery. Minimally invasive cervicotomy associated with eutopic gland conservation and the use of a Cooper thymectomy retractor highlight modern aspects in video-assisted thoracic surgery, which provided an excellent outcome, involving one of the lowest mediastinal thyroids to be removed by this specific procedure. Awareness of such unusual entities helps inform individualised, multidisciplinary decisions for optimum prognoses.

Modern Data Storage Technologies in the Context of Industry 4.0

Existing and currently widely used data storage technologies are considered. It is noted that the growth in the volume of digital information resources at an astronomical pace has led to the rapid development of technologies for their creation, storage, and access to them. In the context of Industry 4.0, the use of digital technologies to create intelligent and interconnected production and data processing processes is of particular importance. Blockchain technology and cloud technologies have become integral components of modern digital transformation. Taking into account the current state of data storage and blockchain technologies, network capabilities, enterprise needs and other factors, the possibilities of selecting and using storage tools and technologies, principles of joint implementation and application of different technologies, as well as modern virtualization approaches and blockchain technology for solving distributed data storage issues have been explored.

CURRENT CHALLENGES AND PROSPECTS OF LEGAL REGULATION OF PUBLIC ADMINISTRATION OF THE SOCIAL SPHERE IN THE TERRITORIAL COMMUNITIES OF UKRAINE

The article defines that public administration is a system of activities of state authorities aimed at optimizing the use of resources to achieve the priority goals of social policy. It is emphasized that the social sphere covers a wide range of services that ensure the well-being of citizens, including health care, education, social protection and other critically important elements. The study of the problems of public management of the social sphere in territorial communities reveals a number of challenges, such as insufficient financial support, the absence of a clear legal framework, and a low level of public involvement in decision-making processes. Analysis of modern approaches to legal regulation in this area showed that effective management of social policy requires the integration of innovative methods, in particular digitalization of processes, which will contribute to the transparency and accountability of local self-government bodies. As a result of the research, it was found that the public management of the social sphere in the territorial communities of Ukraine is a complex, multifaceted process that requires a comprehensive analysis and a comprehensive approach to its improvement. The development of recommendations for improving management mechanisms should become a priority for researchers and practitioners in this important field. Effective management of the social sphere requires systematic control over the implementation of state policy. This involves not only an internal audit of the activities of local self-government bodies, but also mechanisms of public control that would allow residents to actively participate in the processes of evaluating the effectiveness of social programs. The study showed that the key factors in the effectiveness of public management of the social sphere in territorial communities are: adaptability of management mechanisms; integration of modern technologies; formation of partnership relations; personnel training and development; community involvement in decision-making processes, etc. Legal regulation of public management of the social sphere in territorial communities of Ukraine is conditioned by the need to create effective management mechanisms that meet modern challenges. Among the prospects for the development of legal regulation of public management of the social sphere in the territorial communities of Ukraine, the need for: improvement of the legal framework was emphasized; strengthening of financial autonomy; development of professional training; integration of modern technologies; community involvement in decision-making processes; focus on inclusiveness; monitoring and evaluation of efficiency; cooperation with international organizations; adaptation to changes in the socio-economic environment; increasing the level of trust in the authorities, etc. It is emphasized that the successful implementation of public policy in the social sphere depends on the effective interaction of all interested parties, which in turn will ensure sustainable development and increase the quality of life of the population.

Modern approaches in the diagnosis, treatment and prevention from obesity

Today, from 1.0 to 1.9 billion adults are overweight, including 312-650 million of them, and 124 million children and adolescents are obese. In Russia and Europe, about 60% of residents are obese and overweight. According to WHO forecasts, by 2025 the number of obese patients will double and will account for 30-50% of the population of economically developed countries. Morbid obesity is usually a multifactorial disease that is acquired and progresses under the influence of many factors (geography, level of economic development, cultural values, lifestyle, and others) as well as hereditary predisposition. Among people suffering from comorbid obesity, there is an atypical course of concomitant comorbid diseases. Against the background of morbid obesity, the likelihood of acquiring other diseases of organs and systems increases: the cardiovascular system, hormonal system, digestive tract, erosive esophagitis, fatty liver dystrophy, cirrhosis of the liver, obstructive sleep apnea, osteoarthritis, etc. To confirm the presence of morbid obesity in humans, the following indicators are evaluated: the number of kilograms per square meter of human body area (BMI calculation), waist circumference, triglyceride index, as well as the use of instrumental diagnostics: radiation and ultrasound methods to study the level of obesity of internal organs. To date, orlistat, sibutramine and liraglutide have been registered in Russia for the conservative therapy of morbid obesity, i.e. the choice of drugs is very limited. Surgical methods and electrical stimulation of the stomach are also used. Obesity ranked 5th in the world ranking of risk factors for premature death. A targeted policy and an integrated approach aimed at improving the system of medical care for overweight and obese patients should become key factors in achieving the national goal of improving people's health and well-being. The expansion of preventive measures at the local, regional and federal levels will help significantly reduce the spread of this pathology and prevent the development of an "obesity pandemic".

P-71796771-1387 - Modern Approaches to Cystic Masses of Lateral Neck Regions

P-71796771-1387 - Modern Approaches to Cystic Masses of Lateral Neck Regions

Osteoporosis and Normocalcemic Primary Hyperparathyroidism (Conservatively or Surgically Managed)

Asymptomatic primary hyperparathyroidism (PHPT) involves 80–90% of the parathyroid tumor-associated cases of PHPT in the modern medical era, while normocalcemic PHPT (NPHPT) has a prevalence of 0.1–11%. We aimed to analyze the bone status and mineral metabolism in NPHPT amid conservative or surgical management. In this narrative review, we searched PubMed (between January 2020 and July 2024) via different keywords. Fourteen studies from the final analysis (388 patients with NPHPT; 1188 with PHPT; and 803 controls) showed that mean serum calcium levels varied between 2.57 and 2.26 mmol/L in NPHPT. Ten studies identified a similar 24 h urinary calcium in NPHPT versus hypercalcemic PHPT (HPHPT). Except for one study, a mandatory vitamin D analysis was performed, but the 25-hydroxyvitamin D cut-offs varied. Osteoporosis (n = 6 studies; N = 172 with NPHPT) was confirmed in 41.7–100% of NPHPT subjects. In surgery candidates, this rate might be overestimated. A DXA analysis was performed in eight studies (235 subjects with NPHPT, and 455 patients with HPHPT); two studies identified a lower BMD in HPHPT < NPHPT, but the results were not homogenous. A single study analyzed the TBS and found similar results in NPHPT. The prevalence of fractures (n = 9) varied between 7.4% and 42.8% in NPHPT. Bone turnover markers (N = 262 patients, n = 8 studies) showed lower bone formation markers in NPHPT versus PHPT (n = 3). Two studies analyzed the BMD and bone turnover markers following parathyroidectomy (161 patients, including 30 patients with NPHPT; mean ages over 60 years). To conclude, given the wide spectrum of complications associated with PHPT, an early diagnosis and proper management is essential. A more extensive screening in patients with osteoporosis and kidney stones might lead to the discovery of NPHPT, a more recently described form of PHPT. While it is still unclear whether NPHPT is an early stage of HPHPT or a separate entity, recent findings show similar osteoporosis and fracture occurrence, and an improvement in bone metabolism, following parathyroidectomy. More extensive prospective studies are crucial to understand the natural course of the disease, to reach a consensus regarding parathyroidectomy indications and surgery candidates’ selection, and to ensure proper personalized management for these patients. With the evolving diagnosis methods, PHPT has become a condition with a changing clinical presentation, which now requires modern evaluation and treatment approaches.

Genetic aspects of hereditary pancreatitis

Hereditary pancreatitis is a genetically determined disease that occurs in 1-10% of adult patients with chronic pancreatitis and in more than 50% of pediatric patients. Patients with hereditary pancreatitis have an increased risk of developing complications, pancreatic cancer, therefore early detection is important for screening for the occurrence of malignant neoplasm. The purpose of the review was to analyze the literature data on modern approaches to the diagnosis of hereditary pancreatitis and to familiarize with diagnostic methods. Methods A literature search was conducted in the databases PubMed, Web of Science, UpToDate, genetic databases using keywords. The data of 80 articles and the expert opinion of specialists providing care to patients with pancreatitis were used. Conclusion Carrying out molecular genetic diagnostics plays an important role in the study of pathogenesis, assessment of variants of the course of the disease. The article presents the currently known aspects that are important for working with patients with hereditary pancreatitis.

Primary immunodeficiency in children: agammaglobulinemia (Bruton’s disease)

Primary Immunodeficiencies (PID) are a group of congenital immune system disorders caused by the loss, reduction, or impaired functioning of one or more components of the immune system. This article presents a detailed characterization of Bruton’s disease, the most common manifestation of inherited agammaglobulinemia, as well as modern approaches to its diagnosis and treatment. A clinical observation of the manifestation of primary immunodeficiency in a 3-year-old boy is described, while the diagnosis of “Primary Immunodeficiency: Bruton’s disease” was only established at the age of 8. The results of an 8-year follow-up of the patient are presented, and the difficulties of early diagnosis are analyzed. It is shown that a sequential diagnostic search allowed for the diagnosis of PID and the determination of the appropriate therapeutic strategy.

Outcomes of the modern management approach for locally advanced (T3-T4) laryngeal cancer: a retrospective cohort study.

Outcomes of the modern management approach for locally advanced (T3-T4) laryngeal cancer: a retrospective cohort study.

Novel Emerging Targets Identification in Reducing Risk of Alzheimer's Disease.

The accumulation of tau-containing neurofibrillary tangles and beta-amyloid deposits has been identified as the hallmark of Alzheimer's disease. Alzheimer's disease (AD) is a hereditary and neurological condition that can result in non-amnestic cognitive decline in less common forms and amnestic memory loss in its classic form. While Alzheimer's disease is the most prevalent cause of memory loss in middle-aged and older adults, other neurodegenerative and cerebrovascular disorders can have an impact on the disease's clinical course. Designing multi-target-directed ligands (MTDLs) is a very promising modern approach. This methodology was designed specifically for treating disorders with complex pathological mechanisms. Among these disorders is Alzheimer's disease (AD), which is currently the most prevalent multifactorial neurodegenerative illness. Increased amounts of the amyloid βpeptide (Aβ) and hyperphosphorylated tau protein, together with the loss of neurons and synapses, are linked to Alzheimer's disease (AD). Additionally, there is evidence that the pathophysiology of this condition is influenced by oxidative stress, metal ion dysregulation, inflammation, and failure of the cell cycle regulatory system. Since Alzheimer's disease (AD) is a multi-factor illness, there are many attractive targets for the development of anti-AD medications. These molecules can be useful in treating AD since they are multi-target-directed. This review focuses on the discovery of dual and multi-acting anti-AD drug candidates, especially hybrids made by combining chemically active moieties that function against distinct targets. The first group of substances consists of cholinesterase inhibitors with extra properties or those that function as multiple binding site inhibitors. Natural products also provide numerous options for slowing the progression and symptoms of many diseases, including Alzheimer's Meanwhile, Natural chemical structures with the following characteristics: alkaloids, sterols, triterpenes, tannins, flavonoids, polyphenols, and antioxidants as well as anti-inflammatory and anti-amyloidogenic properties. We provide an overview of Alzheimer's disease pathophysiology and therapy targets in this study. We also show several isolated chemicals and medicinal plants that are used to treat and prevent the symptoms of Alzheimer's disease.

Jatropha Diterpenes: An Updated Review Concerning Their Structural Diversity, Therapeutic Performance, and Future Pharmaceutical Applications

The Euphorbiaceae family is a rich source of bioactive terpenoids. Among its genera, Jatropha is a conspicuous producer of diterpenes and includes approximately 175 species, many of which have medicinal uses. To date, 140 diterpenes from Jatropha (JTDs) have been reported. Given their structural diversity and notable biological activities, this work aims to highlight the pharmaceutical potential of JTDs. To achieve this goal, an extensive literature review was conducted, encompassing studies on structural elucidation through NMR and pharmacological assays, both in vitro and in vivo. Based on 132 selected papers, a thorough discussion is presented on the biosynthesis, extraction, isolation, and structural characterization of JTDs, including a compilation of their 13C NMR chemical shifts. The review also covers their synthetic production and biological effects. Additionally, an in silico analysis predicting the drug-likeness of 141 JTDs was carried out. Notably, the occurrence of macrocyclic diterpenes has doubled in the past decade, and the summary of their NMR data provides a useful resource for future research. Furthermore, 21 distinct pharmacological activities were identified, with potent cytotoxic effects targeting new molecular pathways being particularly significant. Recent advances highlight the contributions of modern approaches in organic synthesis and the pharmacological evaluation of natural products. The drug-likeness analysis identified JTD classes and compounds with favorable physicochemical and ADMET features for pharmaceutical development. In light of these findings, the use of nanotechnology is proposed as a future direction for continued research on JTDs, a fascinating class of natural compounds. This work opens up new avenues for the study of Euphorbiaceae species, particularly the Jatropha genus and its bioactive compounds.

Tumor-induced phosphopenic osteomalacia: modern approaches to diagnostics and treatment

Phosphopenic osteomalacia (PPOM) is a rare variant of paraneoplastic syndrome caused by tumor synthesis of fibroblast growth factor 23 (FGF23). FGF23 secretion leads to a decrease in phosphate reabsorption and calcitriol levels, which leads to the development of severe hypophosphataemia and hypocalcaemia. FGF23 synthesis is predominantly associated with benign mesenchymal tumors, but has also been described in malignant neoplasms. The main clinical manifestations of PPOM are generalized myalgias and myopathy, ostealgia, pathological fractures, etc. The diagnosis of the disease requires a step-by-step investigation using somatostatin receptor-based imaging techniques, as these have the highest sensitivity for the detection of neoplasms causing osteomalacia. Surgical intervention is clearly the treatment of choice. Promising non-surgical methods include treatment with burosumab and somatostatin analogues.

Mind-body medicine and altered states of consciousness in Homo

The mind-body relationship has long been a subject of inquiry from both philosophical and scientific perspectives. Ancient Greek philosophers such as Pythagoras and Plato posited dualistic models, where the mind and body are distinct substances. In contrast, modern approaches in Mind-Body Medicine (MBM) offer integrative models that emphasize the interconnectedness of mental and physical states and the proactive role of the patient in their own healing process. This review examines the evolutionary roots of altered states of consciousness (ASC) as a precursor to current MBM techniques. By tracing ASC to early hominins and their cognitive development, it posits that the ability to enter various ASC—such as those used in rituals, meditation, and other mind-body practices—provided evolutionary advantages, influencing both individual fitness and social cohesion. Moreover, this review discusses tonic immobility in animals as a survival mechanism and explores parallels in human and non-human primate behaviors involving ASC. Additionally, neurochemical pathways that govern ASC, such as serotonergic and dopaminergic regulation, are explored for their roles in promoting social behaviors, cognitive flexibility, and emotional regulation. Furthermore, the role of the default mode network is investigated in relation to psychotropic and mood altering substances and altered states of consciousness. This integrated perspective offers new insights into the origins of MBM and underscores the significance of ASC in both evolutionary and contemporary contexts.