Treatment Strategies Research Articles

Cholecystogastric fistula presenting as pyloric obstruction - a Bouveret’s syndrome: A case report

BACKGROUND Bouveret’s syndrome is a rare (1%-4%) form of cholelithiasis characterized by gastric outlet obstruction. It presents mainly in elderly women with nausea, vomiting, and abdominal pain. On physical examination, common findings include dehydration signs such as tachycardia, decreased urine output, abdominal discomfort, and distention. Diagnosis relies on computed tomography (CT) and magnetic resonance imaging, with Rigler's triad (pneumobilia, ectopic gallstone, gastric distension) being highly specific. This report aims to improve understanding of Bouveret’s syndrome and inform better management and treatment strategies. CASE SUMMARY A 60-year-old male patient presented with a three-day history of nausea, vomiting, upper abdominal pain, and loss of appetite. An upright abdominal X-ray revealed a gas shadow in the intrahepatic and extrahepatic bile ducts. Endoscopy revealed a brown and black stone measuring approximately 3030 mm in diameter in the gastric pylorus, incompletely obstructing the gastric outlet. The diagnosis of Bouveret’s syndrome was accurately confirmed via an abdominal CT scan. Endoscopic removal of the stone was successful, owing to the stone being fragmented and extracted in pieces using a crushing basket. Three weeks later, laparoscopy was attempted but failed because of severe tissue adhesions. Consequently, the procedure was converted to a laparotomy, and fistula repair and cholecystectomy were performed. He returned to the outpatient clinic for follow-up, and no further concerns were noted. CONCLUSION This case highlights the importance of timely diagnosis and adaptable endoscopic and surgical approaches for effectively managing Bouveret’s syndrome.

Research on the potential mechanism of ginsenoside Rg3 against gastric cancer based on network pharmacology

Gastric cancer (GC) remains one of the most prevalent malignancies worldwide, particularly in East Asia. Despite advancements in treatment strategies, the prognosis for advanced GC patients remains unsatisfactory. Ginsenoside Rg3, a key bioactive component derived from Panax ginseng, has demonstrated significant antitumor effects in various cancers, including GC. This study systematically explores the potential mechanisms underlying the therapeutic effects of Ginsenoside Rg3, on GC, employing network pharmacology and molecular docking technologies. Key target genes and signaling pathways were identified, highlighting their critical roles in tumor cell proliferation, apoptosis, and metastasis. Molecular docking analyses revealed strong binding affinities between Ginsenoside Rg3, and crucial protein targets, supporting its direct interaction and functional modulation. The findings provide valuable insights into the molecular basis of Ginsenoside Rg3's anticancer activity and underscore its potential as a promising therapeutic candidate for GC. Future research and clinical studies are encouraged to validate these mechanisms and evaluate the clinical applicability of Ginsenoside Rg3.

Resection of Meningiomas Invading the Cavernous Sinus: Treatment Strategy and Clinical Outcomes

Background/Objectives: Resection of tumors invading the cavernous sinus (CS) carries a risk of injury to the cranial nerves and internal carotid artery. Therefore, radical surgery involving lesions around the CS remains challenging, especially for lesions invading the CS, optic sheath, and oculomotor cave. Here, we describe a surgical strategy for meningiomas invading these structures and report on the clinical outcomes. Methods: Surgical resection was indicated in patients with neurological symptoms or rapid tumor growth for the restoration of cranial nerve function. We investigated 13 patients who had preoperative images of CS invasion, underwent surgical resection, and were followed-up with magnetic resonance imaging for at least 1 year between July 2017 and July 2024. Their preoperative symptoms, postoperative course, adjuvant therapy, postoperative complications, degree of resection, and recurrence were evaluated. Results: The mean patient age was 59.1 years (range, 23–73 years), and 10 were female. Major preoperative symptoms included oculomotor nerve paresis in 8 patients (61.5%), abducens nerve paresis in 6 (46.2%), visual disturbance in 7 (53.8%), and brain swelling in 3 (23.1%). These symptoms improved at least partially after surgery in 7 (87.5%), 5 (83.3%), 7 (100%), and 3 (100%) patients, respectively. Major postoperative complications included contralateral visual deterioration in 1 patient (7.7%) and brief transient slight hemiparesis caused by internal carotid vasospasm or dissection in 2 (15.4%). Four patients with residual atypical meningioma in the CS underwent intensity-modulated radiotherapy (IMRT). The lesions in 6 patients recurred or regrew, resulting in additional treatment with stereotactic radiosurgery in 2 patients, IMRT in 3, and resection in 1. Conclusions: Our surgical strategy for the surgical resection of meningiomas in and around the CS for the restoration of cranial nerve function is safe and effective, with only transient acceptable injuries. Even if the tumor in the CS is too stiff to be removed, it is important to open the optic nerve sheath and oculomotor cave widely to effectively remove the tumor.

Using Inhibitory Learning Theories to Optimise Treatment for Children with Anxiety Disorders.

Anxiety disorders in children lead to substantial impairment in functioning and development. Even the most effective gold standard treatments for childhood anxiety have 50% remission rates, suggesting a critical need to improve current treatments. Optimising exposure, the key component of anxiety treatments, represents a promising way to do so. This chapter explains how to optimise exposure outcomes for childhood anxiety through inhibitory learning theory. This chapter describes the background of inhibitory learning, including its different components and the empirical evidence supporting it. We then discuss how to improve the formation of inhibitory associations through enhancing expectancy violation, the proposed mechanism underlying inhibitory learning. Strategies to enhance inhibitory learning for child anxiety treatment are provided. These include strategies to enhance the formation of inhibitory associations, such as psychoeducation, eliminating safety signals, deepened extinction, occasional reinforced extinction, and affect-based strategies. Additionally, strategies to enhance retrieval include variability, multiple contexts, and retrieval cues. Suggestions are made on how to adapt these strategies to child populations. Further, a clinical guide for using inhibitory learning strategies in child anxiety treatment is included as an appendix. This details how clinicians can utilise these strategies to enhance current treatments, including examples of case studies and scripts.

Associations Between Adherence to the Mediterranean Diet and Incident Sarcopenia in Prospective Cohort Studies

The loss of skeletal muscle mass and strength, known as sarcopenia, is prevalent in older adults and linked to an increased risk of disability, frailty, and early mortality. Muscle health is crucial for the functionality and independence of older adults. As the aging population continuously grows, finding cost-effective strategies for preventing and treating sarcopenia is an important public health priority. While nutrition is recognized as a key factor in the development of sarcopenia, its role in preventing and treating the condition is still under investigation. In recent decades, nutritional research has shifted from a focus on individual nutrients or healthy foods to examining the combination of nutrients and foods in dietary patterns, along with their potential synergistic and antagonistic effects. A balanced diet and regular participation in physical activity are essential for maintaining musculoskeletal health. One of the healthy eating patterns with the greatest evidence of multiple health benefits is the Mediterranean diet, which has also been linked to positive effects on muscle function in observational studies. However, there is a lack of intervention studies. This review explores the updated evidence from longitudinal prospective studies on associations between adherence to the Mediterranean diet and sarcopenia in order to promote preventive and intervention strategies for healthy muscle aging.

Biomechanical aspects of gait impairments after stroke: an analytical review

Restoring gait and balance functions after stroke constitutes a major problem in modern neurology. Post-stroke static and locomotor impairments are the most common disabling consequences that are critical for patients’ quality of life and basic functional independence. This analytical review attempts to comprehensively examine and assess the biomechanical aspects affecting the gait in patients with post-stroke static and locomotor impairments. The review outlines the multifaceted nature of such impairments, including muscle weakness, changes in neuromotor coordination, proprioception and stability, as well as compensatory mechanisms developing in patients. A particular focus is on biomechanical parameters, including kinematics and kinetics of movements, to provide a deeper understanding of the nature of impairments in order to develop more effective treatment strategies. The analysis highlights the importance of a personalized rehabilitation approach to be based on specific impairments of each patient. This review is intended to enhance the understanding of the biomechanical aspects of gait impairments for further research and development of innovative approaches in rehabilitation. The data presented are of great importance for the development and elaboration of personalized medical rehabilitation plans for post-stroke patients and may contribute to improving their functional independence and quality of life.

Systemic Inflammatory Immune Index (SII) Predicts Disease Activity in Systemic Lupus Erythematosus (SLE) Patients: A Cross-Sectional Study

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation and diverse clinical manifestations. The systemic inflammatory immune index (SII), calculated as platelet count * neutrophil count/lymphocyte count, has emerged as a potential marker of systemic inflammation in various conditions. This study aimed to investigate the relationship between SII and disease activity in SLE patients. Methods: We conducted a cross-sectional study involving 60 SLE patients diagnosed according to the 2019 EULAR/ACR classification criteria. Demographic and clinical data were collected, and disease activity was assessed using the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI). Blood samples were analyzed to determine SII values. Statistical analysis included Spearman's correlation to assess the relationship between SII and MEX-SLEDAI scores. Results: The study population predominantly consisted of women (98.3%), with a median age of 29 years. A strong positive correlation was observed between SII and MEX-SLEDAI scores (r = 0.931, p < 0.001). Patients with higher SII values exhibited significantly greater disease activity. Conclusion: Our findings suggest that SII is a promising predictor of disease activity in SLE patients. This readily available index may aid clinicians in assessing disease severity and tailoring treatment strategies. Further research is warranted to validate these findings and explore the utility of SII in monitoring disease progression and treatment response.

Beyond the Obstruction: A Case of Lung Cancer with Coincidental COPD Diagnosis

Background: Lung cancer frequently coexists with chronic obstructive pulmonary disease (COPD), particularly among smokers. The presence of both conditions can complicate diagnosis and lead to poorer outcomes. This case report presents a patient with lung cancer and concurrent COPD, highlighting the diagnostic and management challenges. Case presentation: A 60-year-old male presented with a history of smoking, progressive dyspnea, and a recent diagnosis of right lung cancer (T4N3M1c, stage IV B). He also exhibited symptoms suggestive of COPD, such as chronic cough and expectoration. Spirometry confirmed moderate restriction and severe obstruction, consistent with COPD GOLD 3. The patient was managed with both lung cancer treatment and COPD therapy. Conclusion: This case underscores the importance of considering COPD in patients with lung cancer, especially those with a history of smoking. Early diagnosis of both conditions is crucial for optimizing treatment strategies and improving patient outcomes.

Exploring Azithromycin’s Neuroprotective Role in Traumatic Brain Injury: Insights into Cognitive and Motor Recovery and Neuroinflammatory Modulation

Background: Traumatic brain injury (TBI) is a leading cause of mortality worldwide and often results in substantial cognitive, motor, and psychological impairments, triggering oxidative stress, neuroinflammation, and neurodegeneration. This study examined the neuroprotective effects of azithromycin (AZI) in TBI. Methods: TBI was induced in rats using the weight-drop method. Subsequently, rats received a daily intraperitoneal (I.P.) dose of AZI (150 mg/kg) for 28 days. Behavioral tests (Morris water maze, rotarod, and open field tests) were performed to assess cognitive and motor functions. Neurochemical analyses included oxidative stress markers (GSH, SOD, MDA, catalase), inflammatory cytokines (TNF-α, IL-1β), apoptotic markers (caspase-3, Bax, Bcl-2), mitochondrial complexes (complex I, II, III, IV, and V), and the transforming growth factor- beta (TGF-β) as a neurofilament marker. Histological evaluations focused on neuronal integrity in the cortex, hippocampus, and striatum. Results: Treatment with AZI significantly facilitated motor and cognitive function recovery in TBI-affected rats. At the molecular level, AZI effectively reduced oxidative stress markers, ameliorated neuroinflammation by decreasing TNF-α, IL-1β, and neuronal apoptosis, and differentially modulated mitochondrial complexes. Histological assessments revealed enhanced neuronal integrity and fewer pathological changes in AZI-treated rats compared to untreated TBI controls. Conclusion: AZI was shown to interfere with several pathways involved in TBI’s pathophysiology. While preclinical results are promising, further studies are necessary to establish the long-term safety and efficacy of AZI in a clinical setting. This research supports the potential re-purposing of AZI as a novel treatment strategy for TBI and related neurodegenerative disorders.

Early esophageal cancer with mucosal bridging in the resting room: A case report

BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia, which pose considerable challenges for endoscopic surgical interventions. CASE SUMMARY We present a case involving early-stage esophageal cancer discovered in a resting room, notable for the rare manifestation of esophageal mucosal bridging. Following a comprehensive multidisciplinary discussion and the development of a treatment strategy, we proceeded with endoscopic submucosal dissection for the patient. During the procedure, we encountered operational challenges due to the presence of a diverticulum and a partial absence of the muscularis propria. To facilitate the retraction of a portion of the resected specimen, we utilized dental floss. Ultimately, we successfully excised the entire lesion. After a three-day period of fasting with a water-only diet, subsequent iodine water cholangiography did not indicate any perforations, and the patient was advised to transition to a liquid diet. The patient was discharged five days post-operation. A follow-up endoscopy conducted three months later revealed scar-like changes in the mid-esophagus, with the patient reporting no significant discomfort. CONCLUSION In summary, although esophageal mucosal bridges are rarely documented, they should be considered in the differential diagnosis of mechanical dysphagia. Furthermore, endoscopic therapy represents a feasible approach for their management.

Catheter replacement combined with antiplatelet therapy in hemodialysis catheter-related right atrial thrombus: a potential treatment approach

BackgroundCatheter-related right atrial thrombus (CRAT) is a severe complication in hemodialysis patients that can lead to catheter dysfunction and pulmonary embolism (PE). However, no standardized treatment strategy currently exists for hemodialysis-related CRAT. This study aims to investigate the efficacy of catheter replacement and antiplatelet therapy in managing hemodialysis CRAT.MethodsWe conducted a retrospective cohort study on patients at West China Hospital diagnosed with catheter dysfunction caused by right atrial thrombosis between May 2019 and March 2022. All CRAT were asymptomatic and underwent catheter replacement (either guidewire exchange or insertion at a new site), with the new catheter tip repositioned away from the original location and closer to the right atrium. Antiplatelet therapy with dipyridamole was initiated post-procedure. We analyzed the efficacy of catheter replacements and antiplatelet therapy in hemodialysis-related CRAT.ResultsAmong the 178 patients with CRAT who underwent catheter replacement, the success rate was 98.9%. Preoperative examinations detected asymptomatic PE in 10 patients (5.6%). During follow-up, 3 patients (1.9%) developed new asymptomatic PE post-operation, and no fatal PE occurred. The catheter primary patency rates at 3, 6, and 12 months were 87.0%, 62.6%, and 36.7%, respectively. The secondary patency rates were 91.7%, 75.7%, and 52.3% at 3, 6, and 12 months, respectively. No patients died due to PE or other thrombotic complications.ConclusionsCatheter replacement combined with antiplatelet therapy may be a potential treatment approach for patients with hemodialysis-related CRAT < 6 cm, without other complications except from catheter dysfunction.

Two Cases of Maxillofacial Vascular Malformations Associated with Blue Rubber Bleb Nevus Syndrome And Literature Review

Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare systemic vascular malformation-related disorder that primarily affects the skin, gastrointestinal tract, and central nervous system. Approximately 55.9% of patients have lesions involving the oral and maxillofacial region. Due to the potential risks of gastrointestinal hemorrhage and intracerebral hemorrhage, it is crucial for dental practitioners to promptly identify and refer such cases to relevant departments to improve patient prognosis and enhance quality of life. This paper reports two cases of BRBNS associated with maxillofacial vascular malformations treated at the Oral and Maxillofacial Surgery Department of Henan Provincial People's Hospital. In conjunction with a literature review, this study discusses the clinical features, diagnosis, and treatment strategies of BRBNS, aiming to raise awareness among dental practitioners to avoid missed or incorrect diagnoses.

Prognostic Modeling of Overall Survival in Glioblastoma Using Radiomic Features Derived from Intraoperative Ultrasound: A Multi-Institutional Study

Background: Accurate prognostic models are essential for optimizing treatment strategies for glioblastoma, the most aggressive primary brain tumor. While other neuroimaging modalities have demonstrated utility in predicting overall survival (OS), intraoperative ultrasound (iUS) remains underexplored for this purpose. This study aimed to evaluate the prognostic potential of iUS radiomics in glioblastoma patients in a multi-institutional cohort. Methods: This retrospective study included patients diagnosed with glioblastoma from the multicenter Brain Tumor Intraoperative (BraTioUS) database. A single 2D iUS slice, showing the largest tumor diameter, was selected for each patient. Radiomic features were extracted and subjected to feature selection, and clinical data were collected. Using a fivefold cross-validation strategy, Cox proportional hazards models were built using radiomic features alone, clinical data alone, and their combination. Model performance was assessed via the concordance index (C-index). Results: A total of 114 patients met the inclusion criteria, with a mean age of 56.88 years, a median OS of 382 days, and a median preoperative tumor volume of 32.69 cm3. Complete tumor resection was achieved in 51.8% of the patients. In the testing cohort, the combined model achieved a mean C-index of 0.87 (95% CI: 0.76–0.98), outperforming the radiomic model (C-index: 0.72, 95% CI: 0.57–0.86) and the clinical model (C-index: 0.73, 95% CI: 0.60–0.87). Conclusions: Intraoperative ultrasound relies on acoustic properties for tissue characterization, capturing unique features of glioblastomas. This study demonstrated that radiomic features derived from this imaging modality have the potential to support the development of survival models.

Monogenic Diabetes: Genetic Insight and Precision Therapeutics in the Management of MODY

A monogenic diabetes, specifically, the Maturity-onset diabetes of the young (MODY) is the consequence of the single-gene mutations that are responsible for transcription factors such as HNF1A and GCK taking effect on the insulin synthesis, glucose detection, and the formation of beta cells. This genetic basis necessitates a precise clinical approach for accurate diagnosis and personalized treatment, emphasizing precision medicine. Sulfonylureas are a cornerstone treatment for specific MODY subtypes, especially those with KATP channel mutations, as they enhance insulin secretion and alleviate hyperglycemia by targeting the genetic defect. Genetic testing is crucial in identifying the molecular causes of monogenic diabetes, guiding clinicians in tailoring treatment strategies to optimize therapeutic outcomes. This personalized approach integrates genetic insights with precision therapeutics, revolutionizing the management of monogenic diabetes by offering targeted treatments that improve glycemic control and long-term health outcomes. Healthcare professionals can treat patients more effectively and individually by knowing the genetic pathways behind monogenic diabetes. This advances diabetology toward more effective therapeutic strategies. Even the management of diseases can benefit from the invention of precision medicine as applied to the monogenic diabetes, which allows the personalized methods that lead to a positive effect on patients and provide better care to the patient.

Dynamics of Interpersonal Relationships in Virtual Guidance and Counseling for BK Students: Challenges, Opportunities, and Intervention Strategies

The counseling process has been significantly changed by advances in information and communication technology. The digital era has paved the way for virtual counseling services, which allow wider, more flexible, and anonymous access for those who need it, especially students. One of the important services provided to students to support their emotional, social, and academic growth is counseling. Counseling in higher education is increasingly being done virtually due to the rapid development of information technology. The purpose of this study is to investigate the dynamics of interpersonal relationships in virtual counseling, find problems, and find opportunities and intervention strategies that may be used in this situation. It is important to understand these challenges and create useful solutions for them. Some of the main problems that are often faced include difficulties in building strong emotional relationships, limitations in non-verbal interactions, and technical problems that can interfere with communication. The research method is a qualitative descriptive method by taking data from several libraries that are used as consideration. After reviewing the literature from various related research sources, this article concludes that although virtual counseling services present some technical problems and limitations in non-verbal interactions, they also offer greater opportunities. Appropriate intervention strategies include technology skills training, use of safe platforms, and approaches that rely more on effective communication skills.

A network meta-analysis of therapies for hyperphosphatemia in CKD based on randomized trials

To update the efficacy and safety of different drugs for the treatment of patients with hyperphosphatemia in chronic kidney disease, we conducted a network meta-analysis of 22 therapies for the treatment of uncontrolled hyperphosphatemia in patients with chronic kidney disease (CKD). All randomized controlled trials on hyperphosphatemia published from January 2013 to November 2023 were searched from CNKI, VIP database, Wanfang database, PubMed, Scopus, and Cochrane databases. Meta-analysis was used to evaluate the serum phosphorus, calcium levels, total effective rate and adverse events of patients with chronic kidney disease (CKD). Data collection and quality evaluation were carried out by three evaluators, RevMan (5.5.3) and Stata (1.3.0). A total of 71 RCTs, and 22 treatment strategies were included in this NMA. The results showed that all treatment strategies were effective in improving patients’ blood phosphorus levels. Among them, SL + CT, CA + CC, SL and TCM had higher overall efficacy, RT, TCM and SL + CT had lower blood phosphorus levels, SL + CT, SL and NAM had lower blood calcium levels, and OAC, CC, NAM and SL had higher safety. Among them, SL + CT seems to be the most recommended treatment strategy. In addition, multidrug combination strategies usually have a higher efficacy and safety profile.

Restorative Neurostimulation Therapy Compared to Optimal Medical Management: A Randomized Evaluation (RESTORE) for the Treatment of Chronic Mechanical Low Back Pain due to Multifidus Dysfunction.

Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year. RESTORE is a multicenter, open-label randomized controlled trial. Candidates were assessed for CLBP associated with multifidus dysfunction, with no indication for or history of lumbar spine surgery. Participants were randomized to either restorative neurostimulation with the ReActiv8 system or OMM. The primary endpoint was a comparison of the mean change in the Oswestry Disability Index (ODI) between the treatment and control arms at 1 year, and secondary endpoints included pain (numeric rating scale [NRS]) and health-related quality of life (EuroQol Five-Dimension [EQ-5D-5L]). A total of 203 patients, average age 47 years, and with an average 11-year history of low back pain, were included in the analysis. The primary endpoint was a statistically significant demonstration of a clinically relevant mean improvement in the Oswestry Disability Index (ODI) between restorative neurostimulation and OMM arms: ODI (-19.7 ± 1.4 vs. -2.9 ± 1.4; p < 0.001). Additionally, improvements in both the numeric rating scale (NRS) (-3.6 ± 0.2 vs. -0.6 ± 0.2; p < 0.001) and EuroQol Five-Dimension (EQ-5D-5L) (0.155 ± 0.012 vs. 0.008 ± 0.012; p < 0.001) were statistically and clinically significant in the restorative neurostimulation arm compared to the OMM arm. The RESTORE trial demonstrates that restorative neurostimulation is a safe, reversible, clinically effective, and highly durable option for patients suffering with nonoperative CLBP associated with multifidus dysfunction. This demonstration of treatment superiority over OMM through 1 year is a significant milestone in addressing a major health burden and unmet clinical need. ClinicalTrials.gov Identifier: NCT04803214.

The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children

Background Anxiety and obesity can have negative impacts on the health of children. Understanding the relationship between obesity and mental disorders in children and adolescents will help develop effective prevention and intervention strategies. This research investigates the impact of anxiety-related emotional disorders and self-esteem on obesity among Chinese children aged 6-12 in Anhui Province. Methods Utilizing a non-experimental, cross-sectional study design, data were from 136 participants collected through standardized instrument measures from Chinese children: the “Chinese screening for overweight and obesity among school-age children and adolescents” in the “Health Industry Standards of the People’s Republic of China” as the standard for identifying obesity, the Screen for Anxiety-Related Emotional Disorders (SCARED) for assessing anxiety disorder, and the Children’s Self-Esteem Scale (CSES) for evaluating self-esteem. Statistical analysis, including descriptive statistics, Pearson correlation analysis, and multiple regression analyses was performed using SPSS version 26 to determine the predictive relationships between the variables. Results The analysis revealed that anxiety-related emotional disorders and self-esteem contribute significantly to the prediction of obesity among Chinese children, accounting for a 13.7% variance. The study highlights the critical roles of anxiety-related emotional disorders and self-esteem in determining children’s obesity. It suggests that underscores the necessity for comprehensive interventions that address both physical and mental health aspects to combat childhood obesity effectively. The study concludes that addressing anxiety and self-esteem is essential for developing effective strategies to reduce obesity rates among Chinese children, meeting the research objectives, and contributing to the development of holistic health programs for children’s well-being.

Cancer in the elderly in India: Challenges, attitudes, and strategies for improvement

: India’s elderly population faces growing cancer incidences, with unique challenges rooted in cultural, socioeconomic, and healthcare disparities. Limited health literacy, delayed medical intervention, gender biases, and inadequate healthcare infrastructure, particularly in rural areas, worsen the issue. Social stigma and psychological barriers further hinder prompt cancer diagnosis and treatment, leaving many elderly patients vulnerable to advanced-stage diagnoses.:This study aims to identify and analyse the key challenges faced by elderly cancer patients in India, including cultural attitudes, access to healthcare, financial constraints, and psychosocial impacts. Additionally, the goal is to propose strategies for improving cancer care, prevention, and support for this demographic.A mixed-methods approach was utilised, incorporating quantitative and qualitative analyses to assess challenges in elderly cancer care in India. This review synthesises data from studies published between 2018 and 2023, using information from national cancer registries, Indian Council of Medical Research (ICMR) reports, and peer-reviewed literature. Studies included addressed socio-cultural, economic, and psychological barriers in elderly cancer care across India, focusing on gaps in knowledge and intervention strategies. The analysis revealed that 60% of cancers and 70% of cancer-related deaths occur in individuals aged 65 and above. Low health literacy, delayed diagnosis, and financial constraints were identified as the primary barriers. Significant treatment aversion was noted, with 58% of elderly patients perceiving chemotherapy as harmful. Rural areas lacked adequate healthcare facilities, contributing to delayed diagnosis and treatment. Psychosocial issues, including depression and anxiety, were prevalent and often aggravated by social isolation and stigma.: Addressing these issues requires a multifaceted approach, including policy interventions to expand healthcare access in rural areas, enhance health literacy, and provide financial support for elderly patients. Collaborative efforts involving government, non-governmental organisations, and community leaders are essential to improve early diagnosis, treatment accessibility, and quality of life for elderly cancer patients in India.

Gynecological complications and treatment strategies in patients after hematopoietic stem cell transplantation.

In women after hematopoietic stem cell transplantation (HSCT), complications associated with the original disease and therapies used both before and after transplantation often occur, which significantly affects their quality of life. The most common gynaecological complications include secondary cancers, premature ovarian insufficiency (POI), infertility and chronic graft-versus-host disease (cGVHD). Cervical cancer is the most common secondary genital cancer in patients after HSCT. Regular screening and vaccination against HPV (Human Papillomavirus) can significantly reduce the risk for its occurrence. The specific complication after allogeneic hematopoietic stem cell transplantation is graft-versus-host disease (GVHD), the genital form of which can lead to labial and vaginal adhesions, significantly reducing the women's quality of life. The basis of treatment is local steroid therapy and immunosuppression. A consequence of chemotherapy and radiation therapy may be damage to the gonads leading to premature ovarian insufficiency and the onset of menopause symptoms. The basis of treatment is systemic hormone therapy used until middle age when natural menopause is reached. Women after HSCT who are of reproductive age also suffer from infertility. An important role of the doctor is to educate patients about the risk for infertility and to suggest appropriate methods of preserving fertility before starting treatment. The recommended procedure for fertility preservation is cryopreservation of embryos or oocytes. The freezing and retransplantation of ovarian tissue is becoming an increasingly popular method of fertility protection. Preventive examinations and early detection and treatment of gynaecological complications significantly improve the comfort of life and health of women after HSCT.