Modern Therapy Research Articles

Effect of Scar Deformation on Long-Term Outcomes of Suturing Perforated Pylorobulbar Ulcers

Despite the use of modern anti-ulcer therapy, the percentage of unsatisfactory results after suturing perforated ulcers ranges from 4.8 to 57% [1, 2, 3]. It is necessary to search for reasons explaining such significantly different values in the long-term treatment outcomes of patients with perforated ulcers. Cicatricial changes in the pylorobulbar area leading to a violation of the motor-evacuation function and, as a consequence, ulcer recurrence may be one of the causes.The aim of the study was to investigate the effect of a suture row and a type of suture material on the long-term outcomes in suturing perforated ulcer. Materials and methods. The study involved results of suturing perforated ulcers in 280 patients. When suturing, a single-row and double-row sutures, absorbable and non-absorbable suture materials were used. In the immediate postoperative period, the main attention was paid to the suture failure. In the long-term period, the results were evaluated in 106 patients, which accounted for 37.8% of the operated patients. The results were analysed according to the Visick score modified by M.Y. Pantsyrev [4]. Fibrogastroduodenoscopy findings in the long-term period were also analyzed in 56 patients; 31 of them were performed suturing with a single-row suture technique using absorbable threads, 25 patients were performed suturing with a double-row suture technique using dacron or silk threads. The severity of cicatricial deformation of the pylorobular area was evaluated based on B.P. Dergachev classification (1982) [5].Results. Evaluating the immediate results of suturing, no significant increase in the percentage of suture failure was registered when using a single-row suture technique and absorbable suture material (p=0.2). In the long-term postoperative period, the number of patients with excellent results according to the Visick score was significantly higher in the group where a single-row suture was performed (p=0.023). Analyzing endoscopic examination findings, the authors obtained the following results: no pronounced scar deformation was detected under fibrogastroduodenoscopy in patients who were performed a single-row suturing. In three cases (9.7%), no signs of scarring were found. Endoscopic signs of scar deformation were detected in all cases in patients of the second group, who were performed a double-row suturing. Of these, 6 (24.0%) patients had pronounced scar deformity. After performing a double-row suturing with non-absorbable suture material, an ulcerative defect with the ligature at the bottom was detected in the duodenum under fibrogastroduodenoscopy in two cases.Conclusion. Application of a single-row suture and absorbable suture materials is a reliable option to close perforation without increased suture failures; it results in improved long-term treatment outcomes. The use of a double-row suture and non-absorbable suture materials results in a more severe deformation of the suturing area and is one of the risk factors for ulcer recurrence.

A case report on sero-negative juvenile idiopathic arthritis progressing to polyarthritis

A group of inflammatory arthritic disorders known as juvenile idiopathic arthritis (JIA) are characterized by arthritis of uncertain origin that first manifests in a child under the age of 16. This is the most common chronic rheumatological disease of childhood. The JIA is present in every country and has an incidence of 1 in 100,000. Despite the absence of a documented etiology, there are a number of genetic and environmental risk factors as well as immunologic abnormalities that can be seen and used to infer information about the pathophysiology of the illness. Although there is no cure, modern therapy can frequently reduce the underlying inflammation and enhance function and symptoms. In this case patient showed complete resolution of symptoms with no signs of recurrence. As a result, it helps patient to live a healthy life.

Biosynthesized nanoparticles: a novel approach for cancer therapeutics.

Nanotechnology has become one of the most rapid, innovative, and adaptable sciences in modern science and cancer therapy. Traditional chemotherapy has limits owing to its non-specific nature and adverse side effects on healthy cells, and it remains a serious worldwide health issue. Because of their capacity to specifically target cancer cells and deliver therapeutic chemicals directly to them, nanoparticles have emerged as a viable strategy for cancer therapies. Nanomaterials disclose novel properties based on size, distribution, and shape. Biosynthesized or biogenic nanoparticles are a novel technique with anti-cancer capabilities, such as triggering apoptosis in cancer cells and slowing tumour growth. They may be configured to deliver medications or other therapies to specific cancer cells or tumour markers. Despite their potential, biosynthesized nanoparticles confront development obstacles such as a lack of standardisation in their synthesis and characterization, the possibility of toxicity, and their efficiency against various forms of cancer. The effectiveness and safety of biosynthesized nanoparticles must be further investigated, as well as the types of cancer they are most successful against. This review discusses the promise of biosynthesized nanoparticles as a novel approach for cancer therapeutics, as well as their mode of action and present barriers to their development.

The use of quadrotherapy of chronic heart failure in cancer patients (case series)

Background: Chronic heart failure (CHF) for a patient with cancer is complex, as it complicates antitumor treatment. In some cases, severe CHF is a contraindication to the chemotherapy or surgical treatment. Despite significant progress in CHF treatment, some groups of drugs, particularly mineralocorticoid receptor inhibitors, angiotensin receptor-neprilysin inhibitors, and sodium-glucose co-transporter type 2 inhibitors, have not been studied related to cancer patients. Clinical case description: In this report, we introduce two clinical cases in which, because of the invaluable contribution of the cardio-oncological team, we have managed to solve complex problems of treating patients with CHF and cancer. In patient 1 with severe CHF, it was possible to achieve regression of systolic dysfunction, despite the progression of bladder cancer T4N1M0. In patient 2 with severe ischemic cardiopathy and CHF, owing to the timely administration of quadruple therapy, we managed to significantly improve the cardiac status and increase the LV EF that the patient underwent gastrectomy and cholecystectomy for cancer of the cardiac part of the stomach cT2N0M0 without complications. Conclusion: The above clinical cases demonstrate the possibilities of a team, multidisciplinary approach in the treatment of complex category of patients with CHF and active oncological disease. Modern therapy of cancer patients with severe heart failure allows successful antitumor treatment.

Cerebrospinal fluid HIV-1 escape in patients with neurocognitive symptoms: pooled data from a neuro-HIV platform and the NAMACO study.

Despite modern antiretroviral therapy, HIV-1 RNA escape into the cerebrospinal fluid (CSF) may occur. We examined the prevalence of and factors associated with CSF HIV-1 escape among people living with HIV (PLWH) in Switzerland. The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is an ongoing, prospective, longitudinal, multicenter study within the Swiss HIV Cohort Study. The neuro-HIV platform is a multi-disciplinary, single-day outpatient consultation at Lausanne University Hospital. We pooled data from the NAMACO study and the neuro-HIV platform participants who underwent lumbar puncture (LP) between 2011 and 2019. Both patient groups had neurocognitive symptoms. CSF HIV-1 escape was defined as the presence of quantifiable CSF HIV-1 RNA when plasma HIV-1 RNA was suppressed or CSF HIV-1 RNA greater than plasma HIV-1 RNA when the latter was detectable. Of 1166 PLWH assessed, 288 underwent LP. CSF HIV-1 escape was observed in 25 PLWH (8.7%) of whom 19 (76%) had supressed plasma HIV-1 RNA. Characteristics of PLWH were comparable whether they had CSF HIV-1 escape or not, including comorbidities, time since HIV diagnosis (15 vs 16 years, p=0.9), median CD4 nadir (158.5/mm3 vs 171/mm3, p=0.6), antiretroviral CSF-Penetration-Effectiveness score (7 vs 7 points, p=0.8), neurocognitive diagnosis based on Frascati criteria and radiological findings. In this large pooled sample of PLWH with neurocognitive symptoms, CSF HIV-1 escape occurred in 8.7% of PLWH. PLWH with CSF HIV-1 escape presented no distinctive clinical or paraclinical characteristics. We conclude that LP is unavoidable in confirming CSF HIV-1 escape.

Ecological momentary assessment of state fluctuations in mindfulness and symptoms in psychotic disorders

Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; n = 49) and healthy controls (CN; n = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.

Exercise and diet in colorectal cancer prevention and therapy

Colorectal carcinoma is a leading cause of cancer diseases in Europe. Due to modern therapies survival rate is increasing. Nevertheless, cancer and its treatment is associated with significant morbidity. Physical activity appears as having a positive impact on cancer risk, as well as, reducing peri- and postoperative morbidity and mortality. We searched pubmed and googlescholar for English- and German-language studies from inception to September 2022. The search terms physical activity, colon cancer, colorectal cancer, diet, survivors. prehabilitation, postoperative morbidity, quality of life and outcome were used. Guidelines of national advisory commmittees and Cochrane reviews were included. There is considerable evidence that physical activity is associated with reduced risk of colon cancer, epigenetic mechanisms play a central role in connection. Different studies showed a risk reduction of 12 to 27 percent. A prehabilitation programme consisting of exercise, nutritional intervention, and psychosocial rehabilitation can reduce peri- and postoperative complications. Aerobic exercise and strength training can improve survival rates and overall mortality. However, a causal relationship between nutritional treatment and cancer related symptoms (e.g. fatigue) is missing. There is a wide range of scientific papers on the influence of physical activity and nutrition; nevertheless, its influence on the various stages of colorectal disease are not addressed adequately. Recommendations concerning prehabilitation and tertiary prevention can only be given on the basis of heterogeneous trial data.

ANACARDIUM OCCIDENTALE METHANOLIC NUT EXTRACT ATTENUATED TESTICULAR DYSFUNCTIONS IN HIGH-FAT DIET AND STREPTOZOTOCIN-INDUCED DIABETIC MALE WISTAR RATS

Background: Diabetes induces reproductive ailment and modern therapy is still unsatisfactory to combat diabetes-related reproductive impairment. This study investigated effect of Anacardium occidentale nut methanolic extract on testicular dysfunctions in high-fat diet (HFD)/streptozotocin-induced diabetic rats.
 Materials and Methods: Forty adult male Wistar rats weighing (180 ± 20 g) were used for the experiment. Diabetes was induced with a repeated single dose of freshly prepared streptozotocin (35 mg/kgb.wt) injected intraperitoneally after fed with HFD for six weeks. The animals were randomly allotted into five groups, 8rats/group. Group I: control; Group II: diabetic control; Group III & IV: diabetic rats + low dose (100 mg/kgb.wt) and high dose (200 mg/kgb.wt) Anacardium occidentale nut methanolic extract; Group V: diabetic rats + 200 mg/kgbwp.o metformin for 28 days. Daily food and water intake with weekly body weight and fasting blood glucose were recorded throughout the experimental phase. On the last day of the experiment, the animals were sacrificed, blood sample were collected and testes was harvested for biochemical assay.
 Results: Reproductive hormones, sperm parameters, testicular antioxidants, testicular B-cell lymphoma-2, testicular enzymes, body and weight of reproductive organs were significant (p<0.05) reduced in diabetic rats with significant (p<0.05) increase in blood glucose, insulin, sperm abnormalities, testicular caspase-3, testicular malondialdehyde (MDA), and food intake. Low dose (100 mg/kgb.wt) and high dose (200 mg/kgb.wt) Anacardium occidentale nut methanolic extract administration significantly (p<0.05) improved the testicular biochemical changes.
 Conclusion: Anacardium occidentale nut attenuated testicular dysfunctions and could be a novel therapy for diabetes-induced reproductive dysfunctions.

Excellent efficacy and beneficial safety during observational 5-year follow-up of rapid steroid withdrawal after renal transplantation (Harmony FU study).

We previously reported excellent efficacy and improved safety aspects of rapid steroid withdrawal (RSWD) in the randomized controlled 1-year "Harmony" trial with 587 predominantly deceased-donor kidney transplant recipients randomized either to basiliximab or rabbit antithymocyte globulin induction therapy and compared with standard immunosuppressive therapy consisting of basiliximab, low tacrolimus once daily, mycophenolate mofetil and corticosteroids. The 5-year post-trial follow-up (FU) data were obtained in an observational manner at a 3- and a 5-year visit only for those Harmony patients who consented to participate and covered clinical events that occurred from the second year onwards. Biopsy-proven acute rejection and death-censored graft loss rates remained low and independent of RSWD. Rapid steroid withdrawal was an independent positive factor for patient survival (adjusted hazard ratio 0.554, 95% confidence interval 0.314-0.976; P=.041).The reduced incidence of post-transplantation diabetes mellitus in RSWD patients during the original 1-year study period was not compensated by later incidences during FU. Incidences of other important outcome parameters such as opportunistic infections, malignancies, cardiovascular morbidity/risk factors, donor-specific antibody formation or kidney function did not differ during FU period. With all the limitations of a post-trial FU study, the Harmony FU data confirm excellent efficacy and beneficial safety aspects of RSWD under modern immunosuppressive therapy over the course of 5 years after kidney transplantation in an immunologically low-risk, elderly population of Caucasian kidney transplant recipients. Trial registration: Clinical trial registration number: Investigator Initiated Trial (NCT00724022, FU study DRKS00005786).

Reactive oxygen species linked diabetes mellitus management by natural products: A Pre-clinical study in rat

The environment has a great impact on health maintenance. Environmental stress factors generate reactive oxygen species (ROS) inour bodies. As a result, pro-oxidant status of our body is dominated over the antioxidant status that induces health disorders. Diabetesmellitus (DM), a common metabolic cum lifestyle disease, is now considered as X syndrome. Environmental stressors through ROSgeneration can impose point mutation for the production of mutant enzymes, leading to cellular metabolic disorders, especiallycarbohydrate metabolism, an important cause of diabetes. Moreover, free radicals through cellular signaling system down-regulategene expression of antioxidant enzymes that produce high levels of cellular free radicals in metabolic organs, which may lead to DM.Natural products with strong antioxidant activities have a major role in managing diabetes. Nutraceuticals in E. jumbulana, Camelliasinensis, H. antidysenterica majorly contribute to such management by increasing gene expression of antioxidant enzymes andcarbohydrate metabolic enzymes that favor glucose utilization in cell. It has also been established that such nutraceuticals can generate β cells from hepatic stem cells, so plasma insulin and c-peptide levels are elevated. Insulin receptor gene expression is also corrected by such nutraceuticals in diabetic model animals. The efficacy of such nutraceuticals is comparable with antidiabetic gold standard drugs. Such studies have been confirmed by genomics and proteomics studies using real-time PCR followed by western blotting studies. This field of research unfolds a new domain known as ‘Neutrogenomics’ in health science.It is concluded that natural products may be the parallel management process of modern therapy as per the guideline of WHO.

The impact of the biodex 4 pro system dynamometer in the rehabilitation of ankle sprain in youth football players

Background: The purpose of this study was to identify impact differences in the rehabilitation the second-degree ankle sprain, more specifically the restoration of agonist-antagonist muscle balance, static and dynamic balance, and motor control in junior soccer players will have a different impact on patients who perform the recovery program with the help of Biodex 4 Pro and myofascial therapies compared to those who perform physical therapy using classical methods. (2) Methods: the study included 22 subjects divided into two equal groups in accordance with the agreement to practice modern therapies (MT) and kinesiotherapy (KT): the experimental group that performed the myofascial therapies and exercises with Biodex 4 pro and the control group that performed the KT. The parties' evaluations included: the Biodex 4 Pro for a range of motion assessment and the PodoSmart device for gait assessment. (3) Results: analysis identifies significant improvements for the subjects in the experimental group, respectively for the subjects in the control group, as follows: after completing the therapeutic plan for four weeks, the subjects gained 35.8° of flexion and 36.4° of extension compared to the initial results. In the PodoSmart gait analysis, the experimental group progressed between tests by 14.8% for the foot symmetry parameter, which was 3.8% more than in the control group, whose symmetry progress between tests was 11%. (4) Conclusion: the combined therapeutic plan containing Biodex technology and myofascial therapies is a current effective option in the rehabilitation of athletes.

New methodological aspects in rehabilitation after proximal humerus fracture

Proximal humerus fracture ranks third in the elderly after femoral neck fractures and distal radius fractures, and seventh in adults, and the risk of occurrence is related to advancing age. In this study we aimed to analyze the efficacy of a 24-weeks physical therapy programme based on a particular methodology consisting of the reprogramming of the specific proprioceptive neuromuscular facil-itation techniques added to the classical physical therapy and by introducing modern interactive therapies and technologies: Capacitive Resistive Electric Transference, Instrument Assisted Soft Tissue Mobilization, kinesiological tapes and PRAMA system, compared with classical physical therapy. Our study included 26 patients, aged between 18 and 55 years, with proximal humerus fracture, who complete the 24-weeks rehabilitation programme. We assessed pain, shoulder range of motion, muscle strength and the ability to perform activities of daily living. The statistical analysis was performed using IBM SPSS and Excel 2021. The results showed statistically significant im-provement in all shoulder motion, increased muscle strength, decreased pain, and a better ability to perform daily activities. The physical therapy programme based on the proposed particular methodology has proven to be more effective than classical physical therapy, both regarding the improvement of the movement parameters compared to the physiological values, as well as the symmetry of both shoulders.

New methodological aspects in rehabilitation after proximal humerus fracture

Proximal humerus fracture ranks third in the elderly after femoral neck fractures and distal radius fractures, and seventh in adults, and the risk of occurrence is related to advancing age. In this study we aimed to analyze the efficacy of a 24-weeks physical therapy programme based on a particular methodology consisting of the reprogramming of the specific proprioceptive neuromuscular facil-itation techniques added to the classical physical therapy and by introducing modern interactive therapies and technologies: Capacitive Resistive Electric Transference, Instrument Assisted Soft Tissue Mobilization, kinesiological tapes and PRAMA system, compared with classical physical therapy. Our study included 26 patients, aged between 18 and 55 years, with proximal humerus fracture, who complete the 24-weeks rehabilitation programme. We assessed pain, shoulder range of motion, muscle strength and the ability to perform activities of daily living. The statistical analysis was performed using IBM SPSS and Excel 2021. The results showed statistically significant im-provement in all shoulder motion, increased muscle strength, decreased pain, and a better ability to perform daily activities. The physical therapy programme based on the proposed particular methodology has proven to be more effective than classical physical therapy, both regarding the improvement of the movement parameters compared to the physiological values, as well as the symmetry of both shoulders. Keywords: proximal humerus fracture; rehabilitation; range of motion; muscle strength; pain; activities of daily living

New approaches to the treatment of rosacea on the basis pathogenesis factors and clinical forms

Uncovering the molecular mechanisms of the rosacea pathogenesis and treatment are still of great importance. The review encompasses the modern knowledge of rosacea classification, characterization of the severity of the course of the subtypes, and pathogenesis features. Recent methods of rosacea treatment are presented, including the use of botulinum neuroprotein for the correction of the erythematous-telangiectatic subtype of the dermatosis.
 The relevance of this problem is due to the chronic course of the disease and the peculiarity of the localization of rosacea manifestations that leads to a traumatic effect and often causes social exclusion of patients.
 The rise of the rosacea incidences, along with other reasons like characteristics of the course of dermatosis, accompanied by frequent long-term relapses, is due to the resistance to generally accepted methods of drug therapy, often resulting in shortened clinical remission. All the factors lead to decreasing of patients life quality that require the search for effective therapy approaches. Among modern rosacea therapy, the application of botulinum neuroprotein is widely used; however, the clinical studies confirming the effectiveness of this technique are not presented enough.

Dosimetric Support of Radionuclide Therapy

Purpose: Analysis of modern approaches to dosimetric support of radionuclide therapy at the technological stages of dosimetric planning, hospitalization in a hospital and evaluation of treatment eծectiveness.Material and methods: A comparative analysis of the methodological specifics of the dosimetric support of radionuclide therapy with the introduction of radiopharmaceuticals into the body and conventional radiation therapy using sealed sources of ionizing radiation was carried out.Two methodically different approaches to dosimetric planning of the level of internal exposure from a radiopharmaceutical introduced into the patient’s body are considered.The features of radiation monitoring are discussed both for the patient’s stay in the radionuclide therapy department and for safe discharge from the department for others, and for the solid and liquid radioactive waste being removed.A comparative analysis of the functionality of various criteria for assessing the long-term and short-term effectiveness of radionuclide therapy for bone metastases was carried out.Focal absorbed doses of internal exposure are considered as one of the criteria, for the determination of which a simplified method for their calculation is proposed based on quantitative data from SPECT/CT scanning of an X-ray phantom and a real patient who has been injected with a β-γ-emitting therapeutic radiopharmaceutical.Results: On a clinical example of radionuclide therapy with 177Lu-PSMA-617 in a patient with stage 4 prostate cancer, dose estimates of internal irradiation of foci with β-particles were obtained. Calculations were made for bone metastases of 7 localizations in dynamics for each of the 5 fractions of the course of radionuclide therapy. It is shown that the total focal doses for 5 fractions of internal exposure vary from 70.6 to 116.8 Gy for different foci, which corresponds to the literature data obtained by more accurate methods of dosimetry of internal exposure. The obtained dosimetric data were compared with efficacy estimates based on metabolic, hematological, hormonal and biochemical parameters, as well as on the tumor marker PSA.Conclusion: In contrast to conventional radiation therapy, dosimetric support for planning and evaluating the effectiveness of treatment has not yet become the fundamental methodological basis of modern radionuclide therapy.

Low-Dose Radiosurgery for Brain Metastases in the Era of Modern Systemic Therapy.

Dose selection for brain metastases stereotactic radiosurgery (SRS) classically has been based on tumor diameter with a reduction of dose in the settings of prior brain irradiation, larger tumor volumes, and critical brain location. However, retrospective series have shown local control rates to be suboptimal with reduced doses. We hypothesized that lower doses could be effective for specific tumor biologies with concomitant systemic therapies. This study aims to report the local control (LC) and toxicity when using low-dose SRS in the era of modern systemic therapy. We reviewed 102 patients with 688 tumors managed between 2014 and 2021 who had low-margin dose radiosurgery, defined as ≤14 Gy. Tumor control was correlated with demographic, clinical, and dosimetric data. The main primary cancer types were lung in 48 (47.1%), breast in 31 (30.4%), melanoma in 8 (7.8%), and others in 15 patients (11.7%). The median tumor volume was 0.037cc (0.002-26.31 cm 3 ), and the median margin dose was 14 Gy (range 10-14). The local failure (LF) cumulative incidence at 1 and 2 years was 6% and 12%, respectively. On competing risk regression analysis, larger volume, melanoma histology, and margin dose were predictors of LF. The 1-year and 2-year cumulative incidence of adverse radiation effects (ARE: an adverse imaging-defined response includes increased enhancement and peritumoral edema) was 0.8% and 2%. It is feasible to achieve acceptable LC in BMs with low-dose SRS. Volume, melanoma histology, and margin dose seem to be predictors for LF. The value of a low-dose approach may be in the management of patients with higher numbers of small or adjacent tumors with a history of whole brain radio therapy or multiple SRS sessions and in tumors in critical locations with the aim of LC and preservation of neurological function.

Modern therapies in rheumatology: the role of clinical trials

Modern therapies in rheumatology: the role of clinical trials

#3973 EXCELLENT EFFICACY AND BENEFICIAL SAFETY DURING FIVE YEAR FOLLOW-UP OF RAPID STEROID WITHDRAWAL AFTER RENAL TRANSPLANTATION (HARMONY STUDY)

Abstract Background and Aims We previously reported excellent efficacy and improved safety aspects of rapid steroid withdrawal in the randomized controlled one year “Harmony” trial with 587 predominantly deceased-donor kidney transplant recipients randomized either to basiliximab or rabbit antithymocyte globulin induction therapy and compared to standard immunosuppressive therapy consisting of basiliximab, low tacrolimus once daily, mycophenolate mofetil, and corticosteroids. The five-year post-trial follow-up (FU) data reported here were obtained in an observational manner to evaluate, how these excellent short-term surrogate parameters will translate into hard long-term outcome parameters like patient death/graft loss. Method The five-year post-trial follow-up data were obtained in an observational manner at a three and a five-year visit for patients who consented to participate and covered clinical events that occurred from the second year onwards. Results Biopsy-proven acute rejection and death-censored graft loss rates remained low and independent of rapid steroid withdrawal (see Figure 1). Rapid steroid withdrawal was an independent positive factor for patient survival (adjusted hazard ratio 0.554, 95 % confidence interval 0.314 to 0.976; p = 0.041, see Table 1). The reduced incidence of post-transplantation diabetes mellitus in rapid steroid withdrawal patients during the original one-year study period was not compensated by later incidences during follow-up. Incidences of other important outcome parameters such as opportunistic infections, malignancies, cardiovascular morbidity/risk factors, donor specific antibody formation, or kidney function did not differ during follow-up period. Conclusion The Harmony follow-up trial confirms excellent efficacy and beneficial safety aspects of rapid steroid withdrawal under modern immunosuppressive therapy demonstrating for the first time increased patient survival in an immunologically low-risk, elderly population of Caucasian kidney transplant recipients.

Cellular immunity in the era of modern multiple myeloma therapy.

Multiple myeloma (MM) is a relapsing clonal plasma cell malignancy and incurable thus far. With the increasing understanding of myeloma, highlighting the critical importance of the immune system in the pathogenesis of MM is essential. The immune changes in MM patients after treatment are associated with prognosis. In this review, we summarize currently available MM therapies and discuss how they affect cellular immunity. We find that the modern anti-MM treatments enhance antitumour immune responses. A deeper understanding of the therapeutic activity of individual drugs offers more effective treatment approaches that enhance the beneficial immunomodulatory effects. Furthermore, we show that the immune changes after treatment in MM patients can provide useful prognostic marker. Analysing cellular immune responses offers new perspectives for evaluating clinical data and making comprehensive predictions for applying novel therapies in MM patients.

Epidemiologic assessment of dental health in the military exposed to toxic chemicals

Relevance. Destruction of toxic chemicals is impregnated with hazardous working conditions. In this regard, health monitoring in such workers is subject to more stringent requirements. Occupation-related difficulties in dental care availability cause faster dental health deterioration in the military. This adds relevance to finding and developing modern, rational and effective therapy and prevention measures tailored to specific working conditions the sites of toxic waste destruction.The objective is to evaluate the prevalence and structure of dental diseases and oral cavity disorders in the military exposed to toxic chemicals.Methods. A total of 178 male and female contracted military aged 27-50 years were examined within general medical examination required for admission to work with toxic chemicals. Standard dental methods were used during the examination: interview, visual, physical, and instrumental examinations. Examination data were fed into individual military medical records (form No. 2), as well as into earlier record forms.Results and discussion. Examined patients showed high prevalence of dental diseases (99.4 %), in particular, diseases of dental hard tissues and complicated dental caries. No less than half of the examined (54.5 %) required orthopedic dental treatment. More than 80 % of the examined revealed poor oral hygiene.Conclusion. Considering the high demand (90 %) for sanitation among the military, causing the 25% level of complicated f caries, with average tooth crown destruction score of 0.9 and absence of a staff dentist due to the small size of military units, it is deemed reasonable to involve specialists based on a prior agreed schedule and ensure compliance with developed methods and recommendations.