Standard Examination Research Articles

Water quality challenges in rural Ethiopia: insights from the North Mecha district on physiochemical and microbial contamination

ABSTRACT This investigation's overarching goal is to ensure that drinking water quality remains a key public health issue in rural Ethiopia. The study aimed to evaluate the physiochemical and microbial quality of drinking water sources and household storages in rural Ethiopia. A cross-sectional study was conducted in 24 kebeles of the district during the wet season. Escherichia coli presence was analyzed in water samples collected from selected community water points and household storages using membrane filtration, while physiochemical parameters were analyzed following standard water examination protocols. Findings revealed that turbidity (35.7%), pH (78.6%), iron (20%), and free residual chlorine (89.3%) levels in the water samples were not conformed with the standard. E. coli contamination was detected in 42.9% (n = 56) and 47.9% (n = 96) of samples collected at sources and household storage, respectively. This study revealed that significant water quality contamination was observed at both sources and household storages; hence, public health is at high risk. Additionally, the study emphasizes that improved water sources do not always guarantee safety and highlights the need for comprehensive protective measures. Therefore, proper source protection and treatment and appropriate treatment at the household level should be implemented to provide safe drinking water.

The Effect of the Second Forward View on the Detection Rate of Sessile Serrated Lesions in the Proximal Colon: A Single-Center Prospective Randomized Controlled Study.

The detection rate of proximal sessile serrated lesion (PSSLDR) is linked to the incidence and mortality of colorectal cancer. However, research on second forward view (SFV) examinations for PSSLDR remains limited. This first randomized controlled trial assessed the impact of the proximal SFV on the PSSLDR. Patients were randomized into two groups during proximal colonoscopy: standard colonoscopy (SC) and SFV. The SC group underwent a standard examination, whereas the SFV group underwent a second examination of the proximal colon (cecum to splenic flexure). The primary outcome was PSSLDR, with secondary outcomes, including the proximal polyp detection rate (PPDR), proximal adenoma detection rate (PADR), and lesion miss rate, compared between the two groups. Among 246 patients (SC=124; SFV=122), SFV significantly improved the PSSLDR by 7.4% compared to SC (9.8% vs. 2.4%, P=0.017). SFV increased the PPDR by 20.2% (55.7% vs. 35.5%, P=0.002) and PADR by 12.7% (37.7% vs. 25%, P=0.039). Multivariate analysis revealed that sessile serrated lesions (SSLs) (OR=7.70, 95% CI [1.58, 37.59]), inflammatory polyps (OR=4.24, 95% CI [1.73, 10.39]), and lesion size (OR=0.76, 95% CI [0.60, 0.96]) were associated with proximal missed lesions. The overall polyp miss rate was 52.9%, with miss rates of 61.0% for polyps <5 mm, 80% for SSLs, and 42.2% for adenomas. Furthermore, 12.3% of patients experienced changes in surveillance intervals from SFV examination. SFV examination of the proximal colon significantly improved the PSSLDR by 7.4%, PPDR by 20.2%, PADR by 12.7%, while shortening the detection interval by 12.3%, making it a valuable and cost-effective addition to routine colonoscopy.

Advantages of using T1-mapping in cardiac magnetic resonance imaging in patients with acromegaly

Aim. To determine the incidence of interstitial myocardial fibrosis (MF) in acromegaly, which leads to the development of cardiac arrhythmias and conduction disorders. Materials and methods. A single-center study was conducted, including 70 patients with acromegaly. All patients underwent standard medical examinations, including hormonal blood tests, electrocardiograms, echocardiography, Holter monitoring electrocardiograms and magnetic resonance imaging (MRI) of the heart with gadolinium contrast, additionally 48 patients underwent T1-mapping, which is an MRI method that allows the detection of diffuse changes by measuring the values of myocardial relaxation time – T1. Results. The study revealed a high incidence of MF – 53 (75.7%) cases (21 women, 32 men). The duration of the disease was found to be critical for myocardial remodeling (p=0.006). Compliance criteria for the T1-mapping technique were determined, with reduced T1-mapping values observed in 85.2% of cases. The ROC analysis (Receiver Operator Characteristic) determined the diagnostic value of post-contrast T1-mapping: AUC (Area Under the Curve)=0.906 (95% confidence interval 0.789–1.000), a sensitivity of 90%, and a specificity of 76.5%, indicating high diagnostic efficiency. According to the Youden index, a cut-off point of 372.5 ms was selected. Conclusion. Myocardial T1-mapping is a novel MRI method that allows to assess the degree of MF without the need for myocardial biopsy. The obtained information is crucial for the diagnosis and prognostic assessment of heart diseases, particularly in cases of hypertrophic cardiomyopathy or infiltrative diseases. The T1-mapping method, which is actively developing, can serve as a marker for early diffuse myocardial fibrosis and help determine the prognosis for patients with acromegalic cardiomyopathy.

Efficacy of reminiscence therapy in improving cognitive decline: a systematic review and meta-analysis.

‌ Reminiscence therapy(RT) is used in the care of people with dementia to help improve their quality of life, but the efficacy of RT in various cognitive decline populations is unclear, and long-term effects are not sufficiently evidenced.This systematic review and meta-analysis aims to determine the efficacy of RT in improving cognitive decline and provide evidence for its implementation in care. A comprehensive search strategy utilizing MeSH terms and free-text keywords was employed to systematically search the Embase, PubMed, and Cochrane databases up to January 24, 2024. Randomized controlled trials(RCTs) investigating RT monotherapy for improving cognitive decline were included. The primary outcomes of interest were the standard Mini-Mental State Examination (MMSE) scores. Additionally, all data analyses will be performed using RevMan5.4 software. ‌ We identified 612 studies, and 24 studies met the inclusion criteria, involving 2650 participants. This meta-analysis shows that RT significantly improves immediate and long-term cognitive decline with Standardized Mean Difference(SMD) and 95% CI of 0.55 [0.37, 0.73] and 0.50 [0.11, 0.88], respectively. However, there is no significant difference in efficacy between subgroups (P > 0.05). ‌ Our findings suggestS that RT significantly improves cognitive decline, with no significant differences between subgroups. This suggests that RT is universal in improving cognition and that the way RT is implemented has no significant effect on outcomes. These findings supportS the use of RT as a reliable non-pharmacological treatment option to enhance cognitive function.

Training protocol and calibration of the International Caries Detection and Assessment System in a school-based clinical trial of elementary school-age children.

This paper demonstrates International Caries Detection and Assessment System (ICDAS) training procedures and inter/intra-examiner reliability for lesion severity, activity, and filling criteria in an elementary school setting. ICDAS training was conducted in December 2021 prior to a school-based cluster-randomized controlled trial. A total of 59 children (6-8 years old) in grades 1-2 from one school in Houston, Texas were recruited. Two licensed dentists received a 5-day training from an ICDAS trainer at the participating school. Thirty-eight children were evaluated at least once by each dental trainee, and 18 had repeat examinations. The ICDAS criteria were used to classify dental caries lesion severity (0-6), lesion activity (active/inactive), and filling material (0-9) of all visually available primary and permanent tooth surfaces. Inter and intra-examiner reliability between each dental trainee and the "gold standard" trainer was evaluated using Kappa statistics. For lesion severity, the examination indicated an inter-rater weighted Kappa of 0.77 (95% CI 0.71-0.82) and 0.82 (95% CI 0.77-0.87) for each trainee examiner compared to the gold standard examiner. The Kappas increased slightly from the first to second examinations (lesion-weighted Kappa: 0.76 to 0.84 and 0.82 to 0.84). The intra-rater reliability indicated excellent reliability for lesion and filling (0.83 to 0.94) and moderate for activity (0.58). ICDAS training/calibration were essential to ensure accuracy and reliability of dental caries measurements. The study demonstrated that ICDAS training of dentists with no prior criteria experience is feasible in a community setting and can lead to high reliability and repeatability.

Henry Hun and his family: Three foundational stories in the history of nineteenth-century American neurology, Part II. Edward Hun (1842–1880) and the beginnings of neurological research in nineteenth-century America

ABSTRACT Edward Reynolds Hun is easily eclipsed by his father, Thomas (1808–1896), and his younger brother, Henry (1854–1924), in historical accounts of the evolution of neurology as a clinical specialty and academic discipline in nineteenth-century America. His early educational pathway, including a postgraduate year in Paris, was typical for sons of the wealthy seeking a medical degree. On his return from Europe, he embarked on a research career in neuropsychiatry seeking to uncover biochemical and pathological underpinnings for psychiatric disorders. In addition to standard postmortem examinations, he used the most up-to-date technological advances such as sphygmography. He was also one of the first Americans to publish photomicrographs of muscle obtained by biopsy. In his mid-30s he became a charter member of the American Neurological Association and was appointed professor of diseases of the nervous system at Albany Medical College. His health then rapidly deteriorated, leading to his early death at age 37 of an unclear neurologic disorder. His career intersected with those of other notables in late-nineteenth-century American neurology, including John P. Gray, William A. Hammond, Edward Constant Séguin, and Edward Charles Spitzka.

Application of digital tools and artificial intelligence in the Myasthenia Gravis Core Examination.

Advances in video image analysis and artificial intelligence provide opportunities to transform how patients are evaluated. In this study, we assessed the ability to quantify Zoom video recordings of a standardized neurological examination- the Myasthenia Gravis Core Examination (MG-CE)-designed for telemedicine evaluations. We used Zoom (Zoom Video Communications) videos of patients with myasthenia gravis (MG) who underwent the MG-CE. Computer vision, in combination with artificial intelligence methods, was used to develop algorithms to analyze the videos, with a focus on eye and body motions. To assess the examinations involving vocalization, signal processing methods, such as natural language processing (NLP), were developed. A series of algorithms were developed to automatically compute the metrics of the MG-CE. A total of 51 patients with MG were assessed, with videos recorded twice on separate days, while 15 control subjects were evaluated once. We successfully quantified the positions of the lids, eyes, and arms and developed respiratory metrics based on breath counts. The cheek puff exercise was found to have limited value for quantification. Technical limitations included variations in illumination, bandwidth, and the fact that the recording was conducted from the examiner's side rather than the patient's side. Several aspects of the MG-CE can be quantified to produce continuous measurements using standard Zoom video recordings. Further development of the technology will enable trained non-physician healthcare providers to conduct precise examinations of patients with MG outside of conventional clinical settings, including for the purpose of clinical trials.

Focus ultrasound in patients with ST-elevation myocardial infarction during initial physical examination

Background. The generally algorithm for the initial physical examination of patients with STEMI, including medical history and ECG, is inadequate. Short focal ultrasound protocols can improve the diagnostic accuracy of the initial physical examination, but when they are needed, there are currently no clear and understandable algorithms. Objective. Evaluate the impact of routine focal ultrasound on the initial physical examination of STEMI patients. Material and methods. A total of 228 patients with STEMI were included in a single-center prospective cohort study. The patients will be enrolled at the I.V. Davydovsky Moscow City Clinical Hospital from 2019 to 2023. Results. The main group consisted of 126 patients undergoing routine focal ultrasound, the control group 102 patients with standard physical examination algorithm. The primary endpoint including door-to-instrument time was better in the study group compared to the control group (Me [Q1–Q3], 30 [27–37] vs. 37 [31.5–45] minutes, p &lt; 0.001). The advantage was achieved by a shorter Cath lab-to-instrument time in the study group (Me [Q1-Q3], 10 [10–15] vs. 15 [15–25] minutes, p &lt; 0.001). The secondary endpoint was the probability of a change in diagnosis, which did not differ between groups at the initial examination (abs (%), 24 (19%) vs. 25 (24.5%), p = 0.318), but occurred more frequently after invasive angiography in the control group (abs (%), 15 (11.9%) vs. 24 (23.5), p = 0.036). The detection of significant cardiac pathology during initial physical examination was higher in the main group (abs (%), 87 (69.0%) versus 24 (23.5), p&lt; 0.001). Conclusion. The routine use of focal ultrasound in patients with STEMI does not increase the time to revascularization and has a high degree of diagnostic accuracy.

Caries trajectories from childhood to adolescence: Analysis of data from a nationwide school dental service.

The aim of the study was to assess patterns of longitudinal changes in caries status among school-going children in Singapore. Dental records for a single cohort of students who received dental examinations in six standard examination years between 2009 and 2017 were analysed (n = 24 699). Group-based trajectory modelling with a zero-inflated Poisson distribution was carried out to determine dental caries trajectories in the permanent dentition. Associations between sociodemographic factors and trajectory group membership were assessed using multinomial logistic regression. The predicted population distribution across the four caries trajectory groups identified was 65.0% ('none'), 16.8% ('low'), 14.8% ('medium') and 3.4% ('high'). The 'none' trajectory group had a decayed, missing and filled teeth (DMFT) score of 0 throughout the 8 years. Higher baseline DMFT counts and nonlinear increases in DMFT scores were noted for the 'low', 'medium' and 'high' trajectory groups. The correlation coefficient between DMFT counts in years 6 and 8 was 0.91, as compared to 0.77 between baseline and year 1. Factors associated with the 'high' caries trajectory include lower socio-economic status, female gender, Chinese race (compared to the Indian race), enrolment in primary schools in the Eastern and Western regions of Singapore, and enrolment in public secondary schools. Under a nationwide school dental service, four trajectory patterns of caries counts in the permanent dentition were identified over 8 years. Among students in the 'low', 'medium' and 'high' trajectory groups, greater caries increment was noted during the transition from primary to secondary school. The correlation between DMFT counts in successive examinations was stronger in older than younger ages.

Функція зовнішнього дихання та дифузійна здатність легень у пацієнтів із різними формами легеневої гіпертензії

The aim – to compare pulmonary function test (PFT) results and diffusion capacity of the lungs for carbon monoxide (DLCO) in patients with various forms of pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH) and healthy individuals; to establish correlations between PFT, DLCO and parameters used to stratify the risk of death in pulmonary hypertension (PH).Materials and methods. 74 patients were included: 18 with idiopathic PAH (IPAH), 15 with PAH associated with congenital heart defects (PAH-CHD), 21 with CTEPH and 20 healthy persons (control group). All participants underwent an assessment of PFT (vital capacity (VC), forced vital capacity (FVC), forced expiratory volume during one second (FEV1), peak expiratory velocity (PEV), maximum expiratory flow (MEF) 75, MEF-50, MEF-25) and measurement of DLCO. For all PH patients the standard examinations were provided, including N-terminal brain natriuretic peptide (NT-proBNP) assessment and right heart catheterization. Results. Patients of all PH groups had significantly lower parameters of PFT and DLCO, compared to the control group. The most pronounced and reliable decrease in PFT was observed among patients with PAH-CHD. The lowest DLCO was observed in CTEPH group. PH patients with DLCO &lt; 64 %, compared with DLCO ≥ 64 %, had significantly lower distance of the 6-minute walk test (6MWT) (p = 0.014), TAPSE (р = 0.015), SpO2 during pulse oximetry and direct measurement (p = 0.023 and 0.032, respectively), hemoglobin level (p = 0.031). They had a significantly higher level of NT-proBNP (p = 0.012) and they were somewhat older (p = 0.053). DLCO &lt; 64 % correlated with hemoglobin level (r = –0.31, p = 0.022), 6MWT distance (r = –0.35, p = 0.012), SpO2 (r = –0.29, p = 0.036), TAPSE (r = –0.34, p = 0.012) and NT-proBNP (r = 0.27, p = 0.048). Independent predictors of reduced DLCO were hemoglobin level (β = 0.95, CI 0.90-0.99), SpO2 (β = 0.75, CI 0.58-0.95) and TAPSE (β = 0.75, CI 0.63-0.91).Conclusions. Parameters of PFT and DLCO were significantly lower in patients of all PH groups compared to the healthy individuals. Patients with PAH-CHD had significantly worse PFT parameters. In the general population of patients with PH, PFT indicators, which characterize inspiratory capabilities, were independently correlated with the area of ​​the right atrium. The reduced DLCO (&lt; 64 %) correlated with the level of hemoglobin, SpO2 and indicators of the patient functional state. However, low levels of hemoglobin, SpO2, and TAPSE were independent predictors of low DLCO.

Insights from the U.S. Admissions System for the Reform of International Student Recruitment in China

The current international student recruitment system in China is fraught with challenges such as an incomplete standardized examination framework and an inadequate performance-based assessment system, which fail to holistically evaluate students&amp;rsquo; true capabilities and potential for growth. By examining the successful experiences of the U.S. admissions system, particularly the shifts in Stanford University&amp;rsquo;s admission policies before and after the pandemic, this study explores the implications of these experiences for the reform of China&amp;rsquo;s international student recruitment system. It is suggested that future reforms in China should focus on establishing unified and transparent admission criteria, strengthening performance-based assessments, and improving the preparatory education system to enhance the global competitiveness of Chinese higher education institutions, attract more outstanding international students, and promote the internationalization of higher education.

Examination protocol of dismembered bodies in railway track: A suggestive review in the Indian railways backdrop

Railway-related fatalities often involve dismembered bodies, which pose unique forensic challenges. There is the need for standardized examination procedures, especially in India, where about 30% of bodies in railway track are unidentified. Distinguishing accidental trauma from criminal dismemberment requires sophisticated forensic expertise. The protocol emphasizes a systematic approach, including scene investigation, body part documentation, and post-mortem examination. Key aspects include proper handling of multiple body parts, assessment of postmortem intervals, and precise injury documentation. Ancillary investigations, such as radiological examination including PMCT and Micro CT, histological sampling, object or tool mark analysis and entomological analysis are to be used to meet the secondary objectives of autopsy. The review aims to standardize investigation procedures, improve forensic reporting accuracy, and enhance the quality of railway-related death investigations.

Associations between menstrual pain and sexual function: the role of visceral hypersensitivity on developing sexual pain.

Dyspareunia, defined as pain before, during or after intercourse, is a subset of female sexual dysfunction with overlapping gynecologic, urologic and psychosocial etiologies. This study aimed to evaluate the impact of menstrual pain and visceral hypersensitivity on sexual function and to identify risk factors for sexual pain in healthy reproductive-age females. In this prospective cohort study, we evaluated gynecologic and psychologic self-reported histories, validated sexual function questionnaires, and conducted a standardized gynecologic examination enhanced by quantitative sensory testing in reproductive-aged females with menstrual pain versus pain-free controls. Correlation analysis was conducted between the Female Sexual Function Index (FSFI) pain subdomain score and a priori hypothesized risk factors for dyspareunia: menstrual pain severity, experimentally provoked bladder sensitivity, anxiety, depression, pain catastrophizing, and vaginal pressure-pain sensitivity. The primary outcome was severity of sexual pain as measured by the FSFI, comparing participants with moderate-to-severe dysmenorrhea (n = 99), dysmenorrhea with bladder hypersensitivity (n = 49) identified on non-invasive oral water challenge, and pain-free controls (n = 37). In our young (median age 22 [IQR 19, 29]), nulliparous, predominantly heterosexual cohort (78.3%, 144/185), 64.3% (119/185) engaged in sexual intercourse within the four-week recall period. The median total FSFI score was 27.2 (22.0, 30.2). Across groups, only the dysmenorrhea with bladder hypersensitivity phenotype met the threshold for sexual dysfunction as measured by total FSFI score (24.6 [20.0, 28.1], p= 0.008). Dysfunction was driven by difficulties with lubrication and higher pain levels during and after intercourse. On physical examination, those with and without dyspareunia were largely indistinguishable, with little to no tenderness of the pelvic floor, bladder, uterus and uterosacral ligaments. Amongst the six hypothesized risk factors for sexual pain, only experimentally provoked bladder pain was significantly associated with the severity of dyspareunia (r = 0.41, corrected p< 0.001). Young, otherwise healthy individuals with dysmenorrhea and occult visceral hypersensitivity exhibit signs of sexual dysfunction and significantly higher rates of dyspareunia in the absence of reliable clinical examination findings. Strengths include the use of a nonclinical sample of almost exclusively nulliparous females with no co-morbid pelvic pain diagnoses and prospective diary confirmation of dysmenorrhea severity. The study is limited by the narrow heteronormative, cisnormative sexual experience of penile-vaginal intercourse captured by the FSFI. Sexual pain is more prevalent in those with dysmenorrhea with bladder hypersensitivity than isolated dysmenorrhea, suggesting visceral hypersensitivity may be a non-structural mechanistic driver for dyspareunia.

Distortion-Corrected Posterior Ocular Shape in Myopic Eyes Assessed by Ultrawide OCT Detects Deformations Associated With Vision-Threatening Changes.

To develop a quantitative tool for assessing the posterior ocular shape using widefield, volumetric optical coherence tomography (OCT) in eyes with myopia. This observational, cross-sectional study included 178 eyes from 113 participants. Participants underwent a standardized eye examination, including ocular biometry and a custom ultrawide OCT. True ocular shape was reconstructed by tracing the beam propagation from the system to the posterior eye. Gaussian curvature quantified the localized ocular shape, which was further categorized into five distinct categories. An ocular shape irregularity (OSI) was calculated using principal component analysis. Linear regression with breakpoints analyzed the relationship between ocular shape parameters and axial length (AL). Increased curvature mean and variance were associated with more severe myopia (P < 0.001). Curvature categories (convex, normal, concave, and highly concave) differed significantly between the groups (all P < 0.001). Their correlations with AL revealed significant breakpoints between 27.1 and 27.2 mm. OSI, as a single metric for quantifying ocular shape distortion, was associated with more severe myopia (P < 0.001), and its correlation with AL revealed a breakpoint at 27.2 mm with a fourfold increase in slope steepness beyond this pivot. Determination of OSI was highly reproducible and could also be obtained with fewer scans. Eyes exceeding 27.2 mm in length exhibit pronounced shape changes. Our framework can be seamlessly integrated into commercial OCTs for ocular shape deformation detection, which could aid in identifying eyes with pathologic myopia.

Problem-based learning on the WeChat public platform in radiation oncology residency training programs

PurposeThis study explored the effectiveness of a Problem-based Learning (PBL) teaching model on the WeChat public platform for radiation oncology residency training programs.Materials and methodsThe WeChat PBL program was initiated in 2019. The study recruited student participants, on a voluntary basis, who were in their first and second years of standardized training in radiation oncology. We selected classic and trending issues in radiation oncology as the two main teaching topics. Students in the PBL group searched for relevant literature, summarizing PowerPoint presentations or academic speeches on specific issues published on the professional WeChat public platform after an in-depth review by teachers. The final national standardized training examination scores for resident physicians were used to evaluate teaching effectiveness. The graduation scores of the PBL and non-PBL groups were compared, and a stratified analysis was conducted based on the year of participation to assess the teaching effectiveness of this model. Moreover, questionnaires were administered to evaluate students’ experiences.ResultsAmong the 36 students who joined the study in 2019, 16 (44.0%) voluntarily joined the PBL teaching group. Nine students started teaching PBL in their first year of residency, accounting for 47.4% of that year, and seven started in their second year, accounting for 41.2%. The average graduation scores of the PBL group were superior to those of the non-PBL-focused group for the same grade. The rate of high scores among students in the PBL group (56.3%) was higher than that of students in the non-PBL group (25%). Specifically, first-year residents who joined the PBL group had an average score of 92.3 ± 2.2, significantly higher than their non-PBL counterparts, who scored an average of 88.6 ± 4.6, showing a statistically significant advantage (p = 0.042). All students were satisfied with the PBL WeChat teaching and would recommend the PBL WeChat course to others.ConclusionThe PBL residency teaching model on the WeChat platform improved residency scores and garnered student satisfaction.

Influence of intestinal permeability and endotoxinemia on the course of asthma in obese patients

Objective. To study the characteristics of asthma with a severe course in obese patients and to evaluate the relationship of the level of intestinal endotoxin (ET) and fecal zonulin with clinical, laboratory and instrumental indicators in such patients. Materials and methods. The study included 98 patients with asthma combined with obesity (group 1 – mild asthma (n = 47), group 2 – severe asthma (n = 51)) and 45 obese patients without asthma composed the comparison group. A complete standard examination and tests were conducted in all the patients. Intestinal ET, fecal zonulin, TNF-a, IFN-g, IL-4, 6, 10, 17, total IgE levels were assessed as well. The IBM SPSS Statistics 26.0 application software package was used for statistical calculations. The results were considered as statistically significant at the level of p 0,05. Results. In patients of both groups, the average age of onset was 43 years. The median duration of BA characteristics was higher in patients of group 2: 14 [10; 19] years (p = 0.013). In all groups, CRPhs values increased significantly and the highest ones were in patients with severe asthma (p 0.001). Significantly lower levels of FVC, FEV1, FEV1/FVC, IL-10 (p0.001) with uncontrolled course of asthma (p = 0.008) and rare control (p = 0.009) occurred in patients of group 2. Higher levels of TNF-a, IFN-g, IL-6,17, intestinal ET, fecal zonulin were revealed in patients of group 2 (p≤0.001). The level of fecal zonulin positively correlated with the level of intestinal ET in patients of group 2 (p0.001, rs=0.813). In patients of group 2 direct correlations of the fecal zonulin and intestinal ET with BMI, WC, HC, WC/HC, lack of BA control, CRPhs, TNF-a, IL-6,17, IFN-g, LDL were established and inverse correlations were with IL-10, HDL, FEV1, AST; a negative correlation of fecal zonulin levels with FVC was also revealed. Conclusions. The obtained results allow us to speak about the existence of a clinical complex “severe asthma – obesity – intestinal endotoxemia and increased intestinal permeability” which is characterized by the predominance of pro-inflammatory markers, increased levels of intestinal ET and fecal zonulin, reduced function of external breathing.

Mechanical Properties of Inflamed Appendix Tissues.

Background/Objectives: Histopathological examination enables visualization of morphological changes in cells and tissues. In recent years, there has been increasing interest in assessing the mechanical properties of tissues that cannot be determined by standard histopathological examinations. Mechanobiology is crucial in human physiology and holds promise for uncovering new diagnostic markers for disease processes such as carcinogenesis and inflammation. In this study, we concentrated on measuring the mechanical properties of appendix biopsy specimens to identify potential mechanomarkers of inflammation. Appendix tissues provided the opportunity to measure mechanical properties both with an atomic force microscope and a shear rheometer. Methods: The atomic force microscope AFM-NanoWizard 4 BioScience JPK/Bruker was used for the evaluation of the elastic modulus (i.e., Young's modulus) of appendix tissues. Young's modulus was derived from the Hertz-Sneddon model applied to force-indentation curves. The rheological properties of macroscopic samples were measured on a parallel-plate, strain-controlled shear rheometer Anton Paar MCR302. Results: The data collected suggest that elasticity, expressed as Young's modulus and the storage modulus, could be considered a marker indicating appendix tissue inflammation. Young's modulus of inflamed appendix tissues was found to be significantly lower than that of healthy ones, with an average reduction of 67%. Furthermore, it was observed that inflamed appendix tissues, in comparison to healthy ones, respond differently under varying axial and shear stresses, enabling their identification. Conclusions: Our findings suggest that the specific mechanical properties of inflamed vermiform appendices could serve as novel mechanomarkers for the early detection and monitoring of appendicitis.

ROLE OF ISCHEMIA IN THE PATHOGENESIS OF DIABETIC VITREOPAPILLARY TRACTION SYNDROME

Objective: to evaluate the role of ischemia in the pathogenesis of diabetic vitreopapillary traction syndrome.Material and methods: The analysis is based on a sample of 30 patients with diabetic vitreopapillary traction syndrome. The study included a standard ophthalmological examination, color doppler mapping, fluorescent angiography. All patients underwent three-port vitrectomy to eliminate traction syndrome.Results: The results of the obtained data indicated that patients with diabetic vitreopapillary traction syndrome had significant changes in the hemodynamics of the eye compared to the normal parameters. А significant difference in a blood flow parameters in the posterior short ciliary arteries system was recorded in eyes with vitreopapillary traction syndrome compaired to paired eyes.Conclusion: The results of the studies indicate that patients with diabetic vitreopapillary traction syndrome have significant changes in regional hemodynamics: a decrease in blood flow velocity in the central retinal artery, posterior short ciliary arteries and an increase in peripheral vascular resistance, which indicates ischemia of the optic nerve head and may also be one of the reasons for the development of vitreopapillary traction.

Neuropathological Correlates of White Matter Hyperintensities in Cerebral Amyloid Angiopathy.

White matter hyperintensities (WMHs) are frequently observed on magnetic resonance imaging (MRI) in patients with cerebral amyloid angiopathy (CAA). The neuropathological substrates that underlie WMHs in CAA are unclear, and it remains largely unexplored whether the different WMH distribution patterns associated with CAA (posterior confluent and subcortical multispot) reflect alternative pathophysiological mechanisms. We performed a combined invivo MRI-ex vivo MRI-neuropathological study in patients with definite CAA. Formalin-fixed hemispheres from 19 patients with CAA, most of whom also had invivo MRI available, underwent 3T MRI, followed by standard neuropathological examination of the hemispheres and targeted neuropathological assessment of WMH patterns. Exvivo WMH volume was independently associated with CAA severity (P=0.046) but not with arteriolosclerosis (P=0.743). In targeted neuropathological examination, compared with normal-appearing white matter, posterior confluent WMHs were associated with activated microglia (P=0.043) and clasmatodendrosis (P=0.031), a form of astrocytic injury. Trends were found for an association with white matter rarefaction (P=0.074) and arteriolosclerosis (P=0.094). An exploratory descriptive analysis suggested that the histopathological correlates of WMH multispots were similar to those underlying posterior confluent WMHs. This study confirmed that vascular amyloid β severity in the cortex is significantly associated with WMH volume in patients with definite CAA. The histopathological substrates of both posterior confluent and WMH multispots were comparable, suggesting overlapping pathophysiological mechanisms, although these exploratory observations require confirmation in larger studies.

NCOG-11. FACTORS PREDICTING SPEECH AND GAIT RECOVERY IN CHILDREN WITH POST-OPERATIVE POSTERIOR FOSSA SYNDROME (PFS)

Abstract Posterior fossa syndrome/cerebellar mutism syndrome is a surgical complication of posterior fossa tumor resection, especially midline tumors. Initially thought to involve complete mutism, PFS is now recognized as a complex syndrome involving loss of language (complete [PFS1] and incomplete [PFS2]). Additional symptoms include apraxia, movement disorder, motor and coordination deficits, and emotional lability. The aim of this study was to identify factors that influence delayed speech and independent gait recovery in children with PFS. We prospectively studied 73 children ≥3 years of age with medulloblastoma who developed PFS (SJMB12, NCT01878617). Enrolled children received standardized neurologic examinations and serial imaging before, during and up to five years after completion of therapy. Neurological examinations included scale for assessment and rating of ataxia (SARA), CTCAE grading of neurologic deficits, and severity of injury to the superior cerebellar peduncles (SCP) on post-operative MRI. Median time to speech recovery was 1.4 months (range 0.3-14.3); 81% had return of speech at 3 months and 97% at 12 months. On multivariable Cox regression analysis, complete mutism (HR 0.17, p&amp;lt;0.0001) and inability to sit (HR 0.40, p=0.001) were associated with delayed speech return. Independent ambulation was regained by 80.8% at a median of 2.3 (range 0.3-71.3) months. 70% had a return of ambulation at 12 months and 77% at 24 months. On multivariable Cox regression analysis, complete mutism (HR 0.32, p=0.016), inability to sit (HR 0.30, p=0.002), SARA score (HR 0.94, p=0.002), and right SCP injury (HR 0.47, p=0.014) were significantly associated with delayed return of ambulation. Presence of mutism, inability to sit unassisted, higher SARA score, and right SCP injury at the time of PFS diagnosis are associated with time to recovery of speech/language and ambulation. Our findings have prognostic implications for families and to help identify children in need of more intensive interventions.