Prevention Of Recurrence Research Articles

Biomineralized and metallized small extracellular vesicles encapsulated in hydrogels for mitochondrial-targeted synergistic tumor therapy.

Targeted organelle therapy is a promising therapeutic method for significantly regulating the tumor microenvironment, yet it often lacks effective strategies for leveraging synergistic enhancement effect. Engineered small extracellular vesicles (sEVs) are expected to address this challenge due to their notable advantages in drug delivery, extended circulation time, and intercellular information transmission. Herein, we prepare sEVs with pH and photothermal dual-responsiveness, which are encapsulated with hydrogels for a quadruple-efficient synergistic therapy. M1-phenotype macrophages-derived sEVs, which carry cytokines that inhibit tumor progression, were separately encapsulated with calcium phosphates (CaPs) and Au@Pt nanoparticles (Au@Pt NPs), endowing them with pH and photothermal dual-responsiveness. Subsequently, they were assembled into sEV-Au@Pt NPs/CaPs nanohybrids, and functionalized with mitochondria-targeting peptides. Within tumor cells, mitochondrial targeting enhances Ca2+ accumulation, resulting in mitochondrial homeostasis imbalance. The release of Pt2+ causes nuclear damage and exacerbates mitochondrial dysfunction. Furthermore, under laser irradiation, the sEV-Au@Pt NPs absorb light, generating hyperthermia that promotes the release of Ca2+ and Pt2+ from the hydrogel and cytokines from the sEVs, thereby achieving a quadruple-efficient synergistic therapy. The hydrogel effectively prolongs the retention time of nanohybrids, aiding in the prevention of tumor recurrence. These nanohybrids exhibit favorable mitochondrial targeting ability, with a Pearson's co-localization coefficient of 0.877. In experimental trials, tumor growth was significantly inhibited after only five treatments, with the tumor volume reduced to 0.16-fold that of the control group. This strategy presents a potential tailored platform for engineered sEVs in mitochondrial-targeted therapy and holds great promise for advancing organelle-targeted therapeutic strategies. STATEMENT OF SIGNIFICANCE: Engineering small extracellular vesicles (sEVs) can significantly enhance the synergistic effects of organelle-targeted therapy, thereby improving therapeutic efficacy and reducing side effects. However, their full development is still pending. In this study, we present a promising strategy that involves engineering sEVs with pH and photothermal dual-responsiveness through biomineralization and metallization, enabling quadruple synergistic tumor therapy. Our study demonstrates the remarkable synergistic effects of mitochondrial homeostasis imbalance caused by Ca2+ bursts and nuclear damage due to Pt2+ release. After five treatments, the tumor volume in the experimental group was reduced to 0.16-fold that of the control group. This strategy holds great promise for the design of engineered sEVs as organelle-targeted therapeutic systems.

Global Delphi consensus on treatment goals for generalised pustular psoriasis.

Generalised pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease. A previous Delphi panel established areas of consensus on GPP, although patient perspectives were not included, and aspects of treatment goals remain unclear. To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation. Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorised into overarching principles, short-term treatment goals and long-term treatment goals. A global panel of 30 dermatologists and three patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥80% approval by panellists. Consensus was reached in the first round of voting and ≥90% agreement was reached for 23/26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (≥ -4 points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications, and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritise GPP. Long-term treatment goals should include minimising disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals, e.g. avoiding hair and/or nail loss to improve QoL, reflect the complexity of assessing treatment goals and emphasise the need for a patient-centred approach. In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, short-term and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of both patients and physicians in the treatment of GPP.

P0736 Analysis of endoscopic recurrence risk factors in Crohn's disease after surgical treatment within 1 year

Abstract Background Inflammatory bowel disease (IBD) treatment options are increasingly available, but there is still no definitive cure. It is estimated that 40% of IBD patients do not respond to treatment, about 80% of Crohn's disease (CD) patients will require surgery in their lifetime, and 50% of patients experience endoscopic recurrence within one year after surgery. This article aims to explore the risk factors for postoperative recurrence in CD, predictive indicators of recurrence, and prevention of recurrence, as well as how patients can better manage themselves after surgery. Methods A retrospective analysis was conducted on the clinical data of 72 patients with Crohn's disease who underwent intestinal resection surgery. All patients underwent endoscopic re examination one year after surgery and were divided into a non recurrence group of 43 cases and a recurrence group of 29 cases based on the Rutgeerts score. Use logistic regression analysis to identify the relevant risk factors for postoperative recurrence. Results Univariate analysis revealed that endoscopic recurrence was associated with smoking (OR 5.226, 95% CI 1.073-25.457, P=0.041), penetrating lesions (OR 5.25, 95% CI 1.052-26.197, P=0.043), small intestine resection (OR 3.088, 95% CI 1.064-8.966, P=0.038), preoperative high CRP (OR 1.029, 95% CI 1.001-1.029, P=0.045), and the presence of visceral obesity during surgery (OR 7.536, 95% CI 1.979-28.692, P=0.03). Multivariate regression analysis showed that visceral obesity is an independent risk factor for endoscopic recurrence in patients undergoing Crohn's disease surgery (OR 5.925, 95% CI 1.167-30.087, P=0.032). However, the patient's gender, BMI at the time of surgery, muscular dystrophy, presence of anal fistula, history of previous intestinal surgery, and the course of the disease during this surgery were not found to be related to postoperative recurrence. Conclusion Patients with Crohn's disease who undergo laparoscopic intestinal resection and have visceral obesity during surgery have a higher risk of endoscopic recurrence one year after surgery. These patients need close follow-up and timely adjustment of medication to control the risk of recurrence.

P0925 Risk of postoperative Crohn’s disease recurrence in patients smoking e-cigarettes and heat-not-burn tobacco products: a multicenter retrospective study

Abstract Background Tobacco is a known risk factor for Crohn’s disease (CD) recurrence after surgery. However, the impact of electronic cigarettes (or vape) and heat-no-burn tobacco products on post-operative recurrence is unknown. Methods We conducted a retrospective study across five centers in Italy. We included consecutive patients with CD who underwent ileocolic resections and endoscopic reassessment within 3 to 12 months after surgery, for whom smoking habit after surgery and before reassessment was known. Endoscopic recurrence was defined as a modified Rutgeerts score of i2b or higher. Recurrence rates were compared with Fisher’s exact test. Results In total 332 patients were retrieved, 65% male and 35% female, with an average age of 44, 55 (16.6%) with a history of other prior intestinal resections. (Table 1) Of these, 64 (19.3%) patients were excluded for uncertain endoscopic outcomes or missing Rutgeerts score. Additionally, because we focused the analysis on the consumption of e-cigarettes, heat-not-burn tobacco products (ie. IQOS), and traditional tobacco cigarettes, 4 patients were excluded due to mixed smoking habits (e-cigarettes and conventional cigarettes), and 1 for smoking cannabis. In the overall population, post-operative endoscopic recurrence was observed in 76% (13/17) of heat-not-burn tobacco smokers, 72% (51/71) of conventional cigarette smokers, 56% (9/16) of e-cigarette smokers, and 52% (82/159) of non-smokers. Figure A To avoid the potential confounding effect of therapy, we restricted the analysis to patients who received immunomodulators, biologics, or advanced small molecules after surgery for prevention of post-op recurrence. In the 208 patients who received prophylaxis, recurrence rates were broadly similar, 80% (12/15), 73% (43/59), 58% (7/12), and 51% (62/122) for the respective groups. Figure B Irrespective of post-operative treatment, recurrence rates were similar for heat-not-burn tobacco and traditional tobacco cigarettes (76% vs 72%, p=0.9; and 80% vs 73% p=0.7) and similar between e-cigarettes and non-smokers (56% vs 52% p=0.8; and 58% vs 51% p=0.7). Instead, as expected, tobacco increased the risk of recurrence compared to non-smoking (both p=0.005). Although not significant, a trend of progressively greater recurrence was observed from non-smoke, vape, tobacco, and heat-not-burning tobacco products. Conclusion In the first study on the impact of novel smoking habits on CD postoperative recurrence, vaping was not associated with higher recurrence rates compared to non-smoking, instead heat-not-burn tobacco products had recurrence rates similar to traditional cigarettes. A larger study is underway to confirm these results.

P0620 Long-term impact of early medical prevention of postoperative recurrence on second intestinal resections in patients with Crohn’s Disease. Data from the ENEIDA registry

Abstract Background Postoperative recurrence (POR) in patients with Crohn’s disease (CD) can be prevented with early postoperative use of thiopurines or anti-TNFs. However, the benefit of medical prophylaxis has not been assessed in the long-term. We aimed to assess the risk of a second intestinal resection (surgical POR -sPOR-) for CD according to the use of early medical prevention of POR after a first resection. Methods Adult patients with CD who underwent a first ileocolic resection with ileocolic anastomosis between 2000 and 2020 and had at least one year of clinical follow-up, were identified from the Spanish ENEIDA registry. Medical prevention of POR was defined as any immunomodulator (IMM) or biological agent started within the first 3 months after the ileocolic resection and maintained for at least 3 months. Medical treatment of POR was defined as any IMM or biological agent started at least 6 months after the index surgery. Patients in whom ileocolic resection was due to cancer and those starting IMM or biologicals between 3-6 months, were excluded. sPOR was defined by a second intestinal resection at least 6 months after the first one. Results A total of 3,694 patients were included, of whom 2,274 (62%) started medical prevention (1,499 with IMM, 775 with biologicals). 45% exposed to IMM and 31% to biologicals before the first surgery. 30% had none, 43% had one and 27% more than one risk factor for POR. Perianal disease and penetrating behaviour were significantly more frequent among patients following prevention but active smoking at surgery was among non-prevention group. Median disease duration at first surgery of 42 months (IQR, 6-109) and median follow-up until second resection or last visit of 111 months (IQR, 63-168). Surgical POR occurred in 11% (8% prevention group vs 14% non-prevention group). SPOR-free survival was significantly higher among patients following medical prevention (P=.001). In the Cox regression analysis, medical prevention (HR 0.71, 95%CI 0.58-0.87; P=.001) was the only protective factor of sPOR, whereas having any risk factor (HR 1.58, 95%CI 1.23-2.01; P<.0001), L4 location (HR 1.99, 95%CI 1.62-2.45; P<.0001) and extraintestinal manifestations (HR 1.43, 95%CI 1.15-1.77; P=.001) increased the risk. Conclusion Postoperative medical prevention have additional benefits in the long-term by reducing the incidence of sPOR. Our findings support the use of medical prevention instead of endoscopy-driven strategies at least in patients with risk factors.

P1018 Diyushengbai tablets alleviate azathioprine-induced leukopenia in patients with Crohn’s Disease

Abstract Background Azathiopurine (AZA) is the classic immunosuppressant for crohn’s disease (CD) and plays a critical role in induction and maintenance of remission, facilitation of mucosal healing, and prevention of postoperative recurrence. The incidence of azathiopurine-induced leukopenia (AIL) in Asians is high, posing a serious challenge for clinical medication. Diyushengbai tablets are synthetic traditional Chinese medicine, widely used to prevent and treat leukopenia caused by chemotherapy. It remains unclear about its role in treating AIL. Ziyuglycoside II is the key ingredient of Diyushengbai tablet. The mechanism of Ziyuglycoside II in preventing AIL is yet unclear. Therefore, the objectives of this study are to explore the effects of Diyushengbai tablets in the treatment of AIL and the possible mechanism of Ziyuglycoside II in the prevention of AIL. Methods CD patients with AIL were prospectively enrolled. The leukocyte counts of CD patients before, four weeks, and eight weeks after taking Diyushengbai tablets were collected. AIL mouse models were established by intragastric administration of AZA (10mg/kg) treated with or without Ziyuglycoside II (5mg/kg and 10mg/kg). The leukocyte counts of mice were measured at weeks 0, 1, 2, and 3. The bone marrow cells of mice were extracted for flow cytometry. Results 21 CD patients with AIL were enrolled in this study. The leukocyte counts before, four weeks, and eight weeks after treatment were 2.96±0.42×109/L, 3.48±0.73×109/L, and 4.26±1.85×109/L, respectively. Diyushengbai tablets increased the leukocyte counts at week four (P=0.004) and week eight (P<0.001), respectively. They maintained the leukocyte counts no less than 3.0×109/L in 76.19% (16/21) and 85.71% (18/21) of patients after four-week and eight-week treatment, respectively. They also prevented more than 95% (20/21) of patients from withholding AZA in those who developed AIL during the eight-week following-up. The decrease of leukocyte counts was significantly lower in the Ziyuglycoside II-treatment group compared with the AIL group. Ziyuglycoside II treatment increased the number of hematopoietic stem and progenitor cells (HSPCs) including long-term hematopoietic stem cells (LT-HSCs), short-term hematopoietic stem cells (ST-HSCs), and multipotent progenitor cells (MPPs). Conclusion Diyushengbai tablets can be used to treat AIL. They increase the leukocyte counts and prevent most CD patients with AIL from withholding AZA. Ziyuglycoside II increases the leukocyte counts and prevents AIL by stimulates the proliferation and differentiation of HSPCs. These findings highlight a promising role of Diyushengbai tablets in treating AIL.

P0746 Impact of timing of prophylaxis therapy on post-operative endoscopic recurrence in a real-life cohort of patients whit Crohn’s disease

Abstract Background The optimal timing for initiating biologic therapy after resection surgery (SR) in Crohn's disease (CD) has not been established, and the impact of a delayed start remains unclear, particularly outside the context of clinical trials. Methods Our study aims to assess the impact of the timing of prophylactic biologic therapy initiation on endoscopic recurrence after resection surgery in CD, and to compare prophylactic treatment strategies used in patients already on biological therapy before SR. We conducted a retrospective study evaluating endoscopic outcomes of CD patients who underwent ileo-colonic resection. All patients underwent their first endoscopic evaluation within 6-12 months after surgery to assess POR, using the Rutgeerts score (POR defined as Rutgeerts ≥ 2). All patients received biological therapy for recurrence prevention within 16 weeks after surgery. Results We included 173 patients. Prophylactic biologic therapy was administered to all patients, with initiation within 8 weeks, 8-12 weeks, and 12-16 weeks in 45%, 19%, and 36% of patients, respectively. POR was observed in 50% of the entire cohort. Comparing the timing of prophylaxis therapy initiation in univariate analysis (<8, 8-12, >12 weeks), both initiation <8 and initiation between 8-12 weeks had a significantly lower recurrence rate than initiation >12 weeks (p= 0.004, OR 0.37, 0.18, 0.73, 95% CI and p=0.039, OR 0.40, 0.16, 0.95, 95% CI respectively. Furthermore, for patients already on biologic therapy prior to SR (103), therapy was either maintained unchanged, switched, or swapped in 54%, 18%, and 28% of patients, respectively. We noted that the therapeutic swap was significantly worse (p=0.0009, OR 3.65, 1.42, 10. 1 95%CI) compared with continuation of the same therapy. There was no difference between continuation of the same therapy and treatment switch. In the cohort of patients who were already on biologic therapy prior to SR, when considering treatment strategy, timing of therapy in the multivariate analysis, the swap showed significantly higher POR than maintaining the same therapy and the switch. (OR 3.42, 1.20, 10.5 95% CI, p=0.025) while therapy timing was not significant. All the groups were homogeneous in characteristics and post-operative complications. Conclusion Prophylaxis administered within 12 weeks after resection correlates with a reduced risk of post-operative recurrence. For patients already on biological therapy before the SR, the prophylaxis strategy had a significant impact on POR.

A Retrospective Study of the Influence of Life Events and Social Support on Relapses and Recurrences in Older Patients with Bipolar Disorder.

Background/Objectives: Life events and lack of social support are risk factors for a relapse or recurrence in patients with a bipolar disorder, yet studies focusing on older adults remain limited. Our aim was to investigate the influence of life events and social support on the course of bipolar disorder in older adults. Methods: A retrospective cohort study included patients aged 55 years and older in treatment for bipolar disorder and who used lithium. During a follow-up of maximum 5 years, relapses and recurrences, life events and six social support variables were constructed based on patients' electronic medical files. Results: We included 100 older patients with a mean age of 68.1 (SD 8.6) years; 69% were female. At least one relapse or recurrence was observed within the 5 years of observation in 52% of our patients. Life events were noted in the medical files in 24 out of these 52 (46.2%) patients. Living alone, a lower quality of social support and having at least two children was significantly associated with the onset of a relapse or recurrence (p = 0.024, p < 0.001, p = 0.022, respectively). Conclusions: Older adults with bipolar disorder have a high rate of relapses or recurrences within 5 years of observation, and half of the relapses or recurrences were preceded by life events. Social factors may also play a significant role in the onset of relapses and recurrences. Our results underline the necessity for incorporating social and environmental factors into prevention of relapses or recurrences for older bipolar patients.

A Case Presenting a Novel Treatment of Palmoplantar Eczema: Dopaminergic Drugs

Palmoplantar eczema is a pruritic, painful condition presenting with clear fluid filled intraepidermal vesicles involving the lateral aspects of the fingers frequently extending into the palms, and also frequently involving the soles of the feet and tends to be recurrent. There are many topical and systemic immunosuppressive agents that have been tried, but treatment has not produced great results in either causing quick resolution of the rash nor prevention of frequent recurrence. Increased cellular permeability allowing infusion of irritants into various tissues leading to inflammation has been proposed as a common etiologic factor in a large variety of inflammatory and “autoimmune” pathological entities including various dermatologic conditions. Most of these conditions have responded well to dopaminergic drugs especially dextroamphetamine despite being refractory to standard therapy. Dopamine diminishes cellular permeability. A case is presented of using dextroamphetamine to eradicate palmoplantar eczema and prevent recurrences.

Epithelial-Mesenchymal Transition Suppression by ML210 Enhances Gemcitabine Anti-Tumor Effects on PDAC Cells.

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers in the world. Neoadjuvant chemotherapy (NAC) has become a standard treatment for patients scheduled for surgical resection, but the high rate of postoperative recurrence is a critical problem. Optimization of NAC is desirable to reduce postoperative recurrence and achieve long-term survival. However, if a patient's general condition deteriorates due to NAC toxicity, surgical outcomes may be compromised. Therefore, we aimed to identify drug(s) that can be used in combination with gemcitabine (GEM), a drug widely used for the treatment of PDAC, to inhibit distant metastatic recurrence, particularly after surgery. After several screening steps, ML210, a low molecular weight chemical, was found to suppress the epithelial-mesenchymal transition (EMT) in PDAC cells in combination with GEM. Specifically, low dose ML210 in combination with GEM was sufficient for cell migration without apparent toxicity or cell death. Mechanistically, ML210, which was developed as a glutathione peroxidase 4 (GPX4) inhibitor to induce lipid peroxidation, increased the oxidized lipid concentrations in PDAC cells. The oxidization of the cell membrane lipids may suppress EMT, including cell migration. Since EMT is a major malignant phenotype of PDAC, our findings may lead to the advancement of PDAC therapy, especially in the prevention of postoperative recurrence.

Study on Prevention of Postoperative Recurrence of Upper Urinary Tract Stones by Self-Proposed Traditional Chinese Medicine Formula Hua Shi Tang

Study on Prevention of Postoperative Recurrence of Upper Urinary Tract Stones by Self-Proposed Traditional Chinese Medicine Formula Hua Shi Tang

A survey of NHS nurses' delivery of treatments to prevent recurrence of venous leg ulcers.

Preventing recurrence of venous leg ulcers can be achieved through strongest tolerated compression and endo-venous ablation surgery, but it is not clear how often this is done in practice. This study explores (1) nurses' awareness of strongest tolerated compression and endo-venous ablation surgery as prophylactic treatments for venous leg ulcer, (2) how often these treatments are offered, and (3) assessment of the barriers and enablers to deploying those treatments using the capabilities, opportunities and motivations model of behaviour change. An online cross-sectional survey was conducted among nurses who treat and manage venous leg ulcers across the United Kingdom. Data were analysed descriptively using within-participants ANOVA, within-participants MANOVA and multiple linear regression. We received 96 questionnaire responses. All the respondents reported that they were aware of strongest compression to prevent recurrence while 87.5% reported they were aware of endo-venous ablation surgery for recurrence prevention. Nurses' capabilities, opportunities, and motivations to offer the strongest tolerated compression were significantly greater when offering the strongest compression compared with referring to vascular surgery. Both preventative treatments were associated with marked deficits in opportunities (social and physical) and automatic motivation. Interventions targeted at increasing nurses' opportunities and boosting their motivation are needed to support the delivery of both preventive treatments. Further research is required to gain in-depth understanding of those barriers and enablers to identify candidate behaviour change techniques.

The Role of Family in Stroke Patients in The Community: A Narrative Review

Stroke has become one of the leading causes of death and disability in society, and stroke survivors are very likely to have recurrent strokes. The family is the main support system that greatly influences the success rate of treatment and care for stroke patients in the community. The purpose of this study was to determine and review the role of the family towards stroke patients in the community. This study was conducted with a narrative review design. Literature searches were conducted on national databases, namely Garuda, and international databases, namely PubMed, ProQuest, and EBSCOhost. Article searches in national databases used the words "peran keluarga" and "stroke", and in international databases used the keywords "family role" and "stroke". Article selection was carried out non-systematically with the inclusion criteria for articles being PEOS, namely Population: stroke patients in Indonesia, Exposure: family role, Outcome: patient health status, Study Design: cross-sectional. A total of 88 articles were found and 10 articles met the inclusion criteria. The results of this study found that the role of the family includes preventing recurrent stroke attacks, motivating patients to meet their needs in treatment and care programs, and training stroke patients to be independent in fulfilling daily living activities. The conclusion is that the role of the family in stroke patients includes prevention of recurrence, motivation for treatment, and training independence. Family-centered nursing interventions through health education and good therapeutic communication will be able to increase active family participation in the process of caring for stroke patients in the community.

Efficiency and safety of using a urethral catheter with ultrasound-induced drug coating with methylprednisolone for programmed balloon dilation for the prevention of recurrence of bladder neck sclerosis in patients after endoscopic prostatic procedures

Efficiency and safety of using a urethral catheter with ultrasound-induced drug coating with methylprednisolone for programmed balloon dilation for the prevention of recurrence of bladder neck sclerosis in patients after endoscopic prostatic procedures

Idiopathic Left Posterior Posterior Fascicular Ventricular Tachycardia in a Pregnant. A case report

Idiopathic left fascicular ventricular tachycardias (VT) are a rare form of ventricular tachycardia. In general, they represent 10-15% of all idiopathic ventricular tachycardias, and verapamil is useful in their treatment and in the prevention of recurrences. They are typical of young males (15-40 years) and although they usually occur at rest, they can be induced by catecholamines in situations of emotional stress or exercise. We present the case of an 18-year-old woman, 38.2 weeks pregnant, admitted to the Emergency Department of our center for the presence of palpitations and elevated heart rate in the context of emotional stress. She had no previous evaluations for similar symptomatology. In the electrocardiogram performed, repolarization alterations, incomplete right bundle branch block pattern, narrow QRS, electrical axis deviated to the left, atrioventricular dissociation, and sustained tachycardia refractory to treatment, deciding the termination of pregnancy due to signs of fetal distress.

Clostridioides difficile Infection: A Review of Emerging Practices for Infection Treatment and Prevention of Recurrence

<i>Clostridioides difficile</i> Infection: A Review of Emerging Practices for Infection Treatment and Prevention of Recurrence

In English

In recent years, significant progress has been made in both the synthesis of metal nanoparticles and the creation of hydrogel platforms. It is assumed that their synergistic combination will allow to create the advanced hydrogel nanocomposites for the repair of anatomical and functional disorders of the human body, as well as for the needs of reconstructive surgery. The aim of the study is to develop a porous polymeric material based on polyvinylformal with incorporated functional hydrogels and gold nanoparticles, the study of its physicochemical properties and biocompatibility in vitro and in vivo. The developed hybrid hydrogel material is intended for use in reconstructive surgery of the oculo-orbital area and for filling postoperative cavities with simultaneous prevention of recurrence. The morphology of the synthesized hybrid hydrogel composites with gold nanoparticles was investigated by means of electron microscopy (SEM), while their thermal stability was studied by TGA and DSC methods. It was proved that the synthesized hybrid hydrogel materials demonstrate thermal stability in a wide temperature range, which significantly exceeds the range of their application, and can withstand steam sterilization (121 °C) without significant changes. The synthesized hybrid hydrogels were characterized as biocompatible in vitro according to the parameters of cytotoxicity, genotoxicity and biochemical markers (ATPase and LDHase activity) using L929 cell line. The study of the soft tissue reaction to implantation in vivo demonstrated the formation of fibrous tissue on the periphery and inside the implant, and a marked decrease in macrophage-histiocyte reaction and inflammatory infiltration in favor of fibroblastic proliferation and the absence of resorption, which creates the prerequisites for a stable clinical result. Thus, the developed spongy hybrid hydrogel material can be used in reconstructive surgery of the maxillofacial and ophthalmic-orbital areas.

Emerging strategies in tackling antimicrobial resistance in urology: Narrative review and expert opinion

Urinary tract infections (UTIs) are highly prevalent and frequently treated with antibiotics, making antimicrobial stewardship (AMS) crucial in this field to benefit both individual patients and society. This narrative review examines recent advancements in managing urinary tract infections, focusing on AMS and antimicrobial resistance (AMR). AMS is essential in urology, where antibiotics are frequently prescribed for UTI. AMS promotes optimal antibiotic use to improve patient outcomes, control AMR, and safeguard public health. Key AMS practices in urology include selecting antibiotics at the appropriate dose and duration, especially for uncomplicated UTIs, asymptomatic bacteriuria, and catheter-associated infections. Following evidence-based guidelines, such as those from EAU and the IDSA, helps prioritize narrow-spectrum antibiotics and discourage empirical broad-spectrum use. Regular audits and feedback on antibiotic use help align practices with AMS goals, reducing inappropriate prescriptions. Multidisciplinary AMS teams, including urologists, microbiologists, and pharmacists, enhance treatment precision and antibiotic optimization in complex cases. Reassessing antibiotic therapy based on culture results after 48–72 h enables clinicians to refine treatment, minimizing unnecessary broad-spectrum use and strengthening AMS efforts in urology. In conclusion, addressing AMR in urology requires a careful approach that combines evidence-based antibiotic use, attention to local resistance patterns, and patient-specific factors. Non-antibiotic strategies for recurrent UTI prevention, judicious catheter management, and tailored treatment for complex infections are key AMS components. Emerging technologies in diagnostics and precision medicine offer tools for targeted, personalized therapy, enhancing AMS efforts, and helping to reduce reliance on broad-spectrum antibiotics.

Optimization of treatment and prevention of recurrences of bacterial vaginosis in postmenopausal women

The study aimed to improve the effectiveness of treatment and prevention of recurrences of bacterial vaginosis (BV) in postmenopausal women. 87 women with BV aged 50 to 65 who received a course of antibacterial therapy with control clinical and laboratory recovery were examined. In the future, two groups were selected: the first group (42 women) received probiotics in suppositories (live lactobacillus strains L. aktobacillus plantarum 8P-A3 or L. plantarum 38, or L. fermentum 90T-C4, or L. fermentum 39) vaginally 2 times a day for 10 days. Women of the second group (45 patients) received probiotics vaginally once a day for 20 days and a suppository with estriol 0.5 mg vaginally once a day for 2 weeks, and then 2 times a week for 3 months. Evaluation of effectiveness was carried out after 3 and 6 months. A gynecological examination, determination of the pH reaction of vaginal contents, aminotest, microscopy of vaginal smears, bacteriological cultures on nutrient media for the determination of facultatively anaerobic bacteria, Gardnerella vaginalis, quantitative analysis of vaginal microflora, species composition and frequency of lactobacilli were performed. In the women of the first group, the risk of recurrence of the laboratory criteria of BV increases after 3 months: an increase in the pH of the vaginal contents by 1.2 times (p&lt;0.05), the appearance of a positive aminotest in 38.1% of patients, the presence of Gardnerella vaginalis in 26.2% women with a pathological number of 104-105 CFU/ml, regression of the pool of lactobacilli with worsening of the situation and the appearance of clinical manifestations of the disease after 6 months. In the second group, there was a decrease in cases of recovery of laboratory markers after 3 months and clinical and laboratory criteria of BV after 6 months. The study proves the necessity of determining the laboratory criteria for the diagnosis of BV in dynamics 3 months after the main course of antimicrobial therapy in women without a clinical picture of recurrence. The effectiveness of intravaginal use of probiotics and vaginal estriol at a dose of 0.5 mg for the treatment and prevention of BV recurrences in postmenopausal women with a long course has been shown (4 months).

In Situ Fabrication of Electrospun Magnetic Film under Laparoscopic Guidance for Preventing Postoperative Recurrence of Hepatocellular Carcinoma.

Despite laparoscopic-guided minimally invasive hepatectomy emerging as the primary approach for resecting hepatocellular carcinoma (HCC), there is still a significant gap in suitable biomaterials that seamlessly integrate with these techniques to achieve effective hemostasis and suppress residual tumors at the surgical margin. Electrospun films are increasingly used for wound closure, yet the employment of prefabricated electrospun films for hemostasis during minimally invasive HCC resection is hindered by prolonged operation times, complexity in implementation, limited visibility during surgery, and inadequate postoperative prevention of HCC recurrence. In this study, montmorillonite-iron oxide sheets are integrated into the polyvinylpyrrolidone (PVP) polymer framework, enhancing the resulting electrospun PVP/montmorillonite-iron oxide (MI) film (abbreviated as PMI) with robustness, hemostatic capability, and magnetocaloric properties. In contrast to the in vitro prefabricated electrospun films, the electrospun PMI film is designed to be formed in situ on liver wounds under laparoscopic guidance during hepatectomy. This design affords superior wound adaptability, facilitating meticulous wound closure and expeditious hemostasis, thereby simplifying the operative process and ultimately alleviating the workload of healthcare professionals. Moreover, when exposed to an alternating magnetic field, the film can efficiently ablate residual tumors, significantly augmenting the treatment efficacy of HCC.