Third Week Of Treatment Research Articles

Plasma Concentrations of Benzylpenicillin and Cloxacillin in Infective Endocarditis—With Special Reference to Delayed Hypersensitivity Reactions

Background: Current antibiotic regimens for infective endocarditis (IE) are effective but pose a high risk of delayed hypersensitivity reactions (DHR). Dose adjustments guided by therapeutic drug monitoring (TDM) could mitigate these risks while maintaining treatment efficacy. This study aimed to investigate the plasma concentration of benzylpenicillin and cloxacillin in patients with IE and explore associations between antibiotic concentrations and DHR. Methods: Plasma concentrations of benzylpenicillin and cloxacillin were measured as centre (midpoint concentrations between consecutive doses) and trough values during the first and third weeks of treatment in patients with IE. Patient characteristics and outcomes, including DHR, were documented. Results: A total of 55 patients were included, with 37 patients (67%) receiving benzylpenicillin and 18 (33%) receiving cloxacillin. The 90-day mortality rate was 3%. Both centre and trough concentration exhibited substantial interpatient variation for the two antibiotics, while intra-patient variability between weeks 1 and 3 remained low for most patients. Kidney function could explain, at best, 54% of the variation, and a multiple regression model including kidney function, body mass index, age, and albumin explained up to 68% of the variation for benzylpenicillin. There was no relation between high plasma concentration and the prevalence of DHR; conversely, we observed a tendency of low plasma concentrations in these patients. Conclusions: This study revealed significant interindividual variation in plasma concentrations for both studied penicillins. TDM might be useful in situations where concentrations are hard to predict, such as severe obesity or kidney failure. Additionally, we found no indication that high plasma concentrations are related to the prevalence of DHR.

An Oxygenated Layer Coating to Enhance the Healing Process of Non-Healing Wounds—A Case Report

The ever-increasing problem of chronic, non-healing wound treatment is a challenge in contemporary medicine. This study aims to verify the effect of a designed dressing containing a coating involving oxygenating factors on the promotion of wound healing in all healing phases in a single clinical case. An alginate-based coating, which incorporates the oxygenating factor, was produced. The obtained surface physicochemical features were examined using FTIR and AFM. The bandage support was modified with the developed coating and applied to patients who suffered from chronic wounds (treated with non-modified commercially available bandages) and had required treatment at least 3 months before starting the study. During bandage application, the chosen characteristics of the wound-healing process were examined. A histological evaluation of granulation tissue confirmed the presence of fibroblasts, hemorrhage, and lymphocytes during the second week of treatment. Moreover, epithelization tissue in the third week of treatment exhibited the presence of keratinocytes. A 100% wound reduction was observed between 3 and 4 weeks of treatment with the modified dressing. It can be recommended that the applied coating, which provides a supportive effect through oxygenating elements, inducing the remodeling phase in up to 4 weeks of treatment, be developed for use in hard-to-heal wound treatment.

#1231 Atypical uremic hemolytic syndrome diagnosis, therapeutic management, control and follow-up in pregnancy: about a case

Abstract Background and Aims Atypical hemolytic uremic syndrome (aHUS) is a clinical entity characterized by non immune hemolytic anemia, thrombopenia, and renal failure in which the lesions are mediated by a process of thrombotic microangiopathy, mutations in its genes that lead to uncontrolled activation. of C5 and formation of the membrane attack complex. Its correct diagnosis allows prescribing treatment based on eculizumab, a C5 inhibitor. The clinical case of a patient with aHUS is presented, who three months after diagnosis, becomes pregnant. The objective is to highlight the importance of early differential diagnosis for the early establishment of effective treatment of this pathology, as well as management during pregnancy, childbirth and the postpartum period. The pathophysiology, diagnosis and genetic study are updated, as well as the therapeutic management of aHUS. Case Reports 27 year old women with no personal or family history of interest. She went to the emergency room in the full pandemic by SARSCov2 due to choluric urine along with fever of 38, myalgias and generalized arthralgias. At that time, PCR positive SARSCov2, deterioration of renal function was noted with Creatinine of 1.8 mg/dl (previous normal), LDH 1954 u/l, Platelets 21000, Hemoglobin 14.4 g/dl without schistocytes in smear, albumin/creatinine ratios 8700 and intense hematuria. It was interpreted as thrombotic thrombocytopenic purpura receiving corticosteroids, rituximab and plasmapheresis. After 48 hours, thrombopenia persists, schistocytes appear in smears and renal function deteriorates creatinine to 2.8 mg/dl. ADAMS 13 is received at normal values, considering at this time a diagnosis of aHUS, the previous treatment is interrupted and a dose of eculizumab 900 mg is received, doses of 900 per week are scheduled for 4 weeks in the fifth week 1200 mg and from Then on biweekly dose 1200 mg of eculizumab. At the third week of treatment, renal function has already normalized, hemolysis data have disappeared, Htcro and platelets have returned to normal. Proteinuria and hematuria disappears which has been maintained up to now. Good tolerance to treatment without any incidence, presenting a positive pregnancy test at three months. During pregnancy treatment with eculizumab is maintained. We continued with the biweekly regimen with 1200 mg of eculizumab until delivery. Labor is induced at week 37 receiving a extra dose of 1200 mg in the first 24 hours of delivery and continuing with 4 doses of 1200 mg once a week. Afterwards the dose is changed to a biweekly dose without modifying it throughout lactation until it ends. The reason is to avoid complement deregulation in the context of pregnancy and therefore ensure blockade. Subsequently it is done Switch to ravulizumab when breastfeeding begins as follows: A loading dose of 2700 mg (according to the interval of patient's weight) 15 days after the last dose of eculizumab. The maintenance dose is 3300 mg every 8 weeks starting 2 weeks after the loading dose. Normal kidney function has been maintained. She presented on debut positive serology for parvovirus B19, receiving treatment with Immunoglobulins and PCR SARSCov2 was positive prescribing treatment with remdesivir. Vitus (CMV, HBV, HCV and HIV) serology was negative and autoimmune study as well as study of complement and proteinogram were negative or within normal limits. No data suggestive of a neoplastic process. Genetic study has been detected a pathogenic variant associated with aHUS. Conclusion We found a heterozygous carrier patient in genetic study, who developed aHUS during a Sars-cov2 infection, which could have been a trigger for its clinical expression. The clinical course of this case highlights how crucial it is to identify atypical hemolytic uremic syndrome. The early initiation of eculizumab improves the prognosis and quality of life, with pregnancy becoming increasingly more likely and therapy with eculizumab does not have safety problems in this regard, although pregnant patients with aHUS should be closely monitored close during pregnancy and postpartum.

Use of vortioxetine in treating obsessive-compulsive disorder: a case report

Introduction Obsessive-compulsive disorder (OCD) is a chronic disorder with a wide range of manifestations but primarily intrusive thoughts (obsessions) and/or ritualized actions (compulsions) that can cause a huge distress in patients’ life. First-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants are used as second-line treatment due to secondary effects. Also antipsychotics such as aripiprazole are approved for treating OCD. Vortioxetine is has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. It is used in major depressive and anxiety disorders. A male 48 years old patient with an OCD diagnosis since he was 21, was reffered to psychiatry department. Previously, he had no response with SSRIs at full dosage and clomipramine 75mg was effective. At 46 years old, he had an acute myocardial infarction. He also admited not taking the medication regularly due to sexual disfunction and having affective symptoms related to the distress caused by OCD.ObjectivesTo evaluate efficacy of vortioxetine in treating OCD in a patient with contraindications for tricyclic antidepressants and no response to SSRIs.MethodsClomipramine dose was reduced until discontinuation. After one week without treatment, basal scores for Hamilton Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) were collected. Same data was collected again after 10 weeks treatment.ResultsThe dosage of vortioxetine was progressively titrated until 20mg daily in 3 weeks lapse. Diazepam 5mg was added in case of insomnia or anxiety. Aripiprazole 5mg was added in the third week of treatment as adjunctive treatment due to the recurrence of some intrusive thoughts (discontinued by himself because of akathisia). Finally, the patient reported an improvement in affective and OCD symptoms in the sixth week of treatment that was sustained until the tenth week, when data was recollected. The patient did not refer sexual disfunction.The pre and post results are summarized in tables 1 and 2. Table 1.Hamilton Depresion Rating Scale (0-52)BasalPost 10-week treatment214Dimensional Y-BOCS (0-15)BasalPost 10-week treatmentAggressive-related obsessions and compulsions102Religious-related obsessions and compulsions51Symmetry and order71Pollution and cleaning00Collecting and accumulation20Miscellaneous103ConclusionsVortioxetine might be a promising molecule for treating OCD in patients with contraindications for first and second-line treatments.Disclosure of InterestNone Declared

FEATURES OF THE TREATMENT OF HYPERMOBILITY OF THE ARTICULAR HEADS AND DISLOCATIONS OF THE LOWER JAW ON THE BACKGROUND OF FRACTURES OF THE CONDYGAL PROCESSES OF THE MANDIBLE, AS A PREVENTION OF ALLOPLASTIC REPLACEMENTS OF THE TEMPOMANDIBULAR JOINT

Acute, chronic, and recurrent dislocations are currently defined as conditions in which the mandibular process becomes dislocated from its joints and requires manipulation by another person to return to its normal position. Such conditions are usually preceded by either iatrogenic factors, including fractures of the mandibular branch, or joint instability and hypermobility of its heads. This pathology requires a personalized treatment algorithm: in each case, the clinical and radiological signs of this pathology should be clearly taken into account and the method of conservative or surgical treatment should be determined. Each of them has its advantages and disadvantages, and their combined use is also possible, which is the key to preventing more significant complications that can lead to allostatic replacements, joint components, or joint replacement as a whole.
 The purpose of the study is to conduct a comparative analysis of the data of clinical examinations, conservative and surgical treatment, complications and postoperative results, taking into account the prevalence of chronic dislocations of the mandible against the background of condylar fractures.
 Clinical cases of chronic dislocations of the mandible lasting from one to three months after osteosynthesis were analyzed by the authors. Attempts at manual reduction did not bring a positive result, so it was decided to treat the patients conservatively, using bite blocks made of self-hardening plastic and the use of elastic methods of fixation of the mandible, which gave a positive result already in the third week of treatment. Also, these patients were observed in the clinic for 6 months without visualization of complications of both mechanical and inflammatory nature.
 The analysis of clinical case data allows us to state that the goal of treatment should be to return the condyles to their original physiological position, and conservative methods should be in the first place when creating an algorithm. Early manual reduction of the joint heads is the best method of treatment, if it is possible to carry it out in a timely manner. As the duration of the dislocation increases, the joint cavity is filled with connective tissue, cartilaginous changes occur, adhesions between the articular surfaces are formed, the masticatory muscles shorten with possible fibrosis of the temporalis muscle. We have confirmed the fact that one of the best conservative treatments is the use of an elastic chin-parietal bandage, which acts as a fulcrum to move the heads back under the anterior slope of the articular tubercle, with the simultaneous use of arches and posterior occlusal rollers. If this treatment does not bring a positive result, we use intraoral splints with a fulcrum in the area of the second molar in combination with extraoral traction to move the heads in the posterior direction with simultaneous stretching of the capsule of the temporomandibular joint and its intracapsular ligaments.
 It should be noted that in each case, all the features of the pathogenesis of this disease should be taken into account and a personalized treatment algorithm should be developed, consisting of conservative methods, and, if ineffective, surgical treatment.

Beneficial Effects of Natural Alkaloids from Berberis glaucocarpa as Antidiabetic Agents: An In Vitro, In Silico, and In Vivo Approach.

Diabetes, also known as diabetes mellitus (DM), is a metabolic disorder characterized by an abnormal rise in blood sugar (glucose) levels brought on by a complete or partial lack of insulin secretion along with corresponding changes in the metabolism of lipids, proteins, and carbohydrates. It has been reported that medicinal plants play a pivotal role in the treatment of various ailments such as diabetes mellitus, dyslipidemia, and hypertension. The current study involved exploring the acute toxicity and in vivo antidiabetic activity of berberine (WA1), palmatine (WA2), and 8-trichloromethyl dihydroberberine (WA3) previously isolated from Berberis glaucocarpa Stapf using a streptozotocin (STZ)-induced diabetic rat model. Body weight and blood glucose level were assessed on a day interval for 4 weeks. Biochemical parameters, antioxidant enzymes, and oxidative stress markers were also determined. In an acute toxicity profile, the WA1, WA2, and WA3 were determined to be nontoxic up to 500 mg/kg (b.w). After the second and third weeks of treatment (14 and 21 days), the blood glucose levels in the WA1-, WA2-, and WA3-treated groups were significantly lower than those in the diabetic control group (476.81 ± 8.65 mg/dL, n = 8, P < 0.001). On the 21st day, there was a decrease in the blood glucose level and the results obtained were 176.33 ± 4.69, 197.21 ± 4.80, and 161.99 ± 4.75 mg/dL (n = 8, P < 0.001) for WA1, WA2, and WA3 at 12 mg/kg, respectively, as opposed to the diabetic control group (482.87 ± 7.11 mg/dL, n = 8, P < 0.001). Upon comparison with the diabetic group at the end of the study (28 days), a substantial drop in the glucose level of WA3 at 12 mg/kg (110.56 ± 4.11 mg/dL, n = 8, P < 0.001) was observed that was almost near the values of the normal control group. The treated groups (WA1, WA2, and WA3) treated with the samples displayed a significant decline in the levels of HbA1c. Treatment of the samples dramatically lowered the lipid level profile. In groups treated with samples, plasma levels of triglycerides, total cholesterol, and LDL were significantly lowered [F (5, 42) = 100.6, n = 8, P < 0.001]; these levels were also significantly decreased [F (5, 42) = 129.6 and 91.17, n = 8, P < 0.001]. In contrast to the diabetes group, all treated groups had significantly higher HDL levels [F (5, 42) = 15.46, n = 8, P < 0.001]. As a result, hypolipidemic activity was anticipated in the samples. In addition to that, the activity of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) was considerably elevated in the groups treated with the sample compared to the diabetic control group (n = 8, P < 0.001).

Evaluation of Galectin-1 and Galectin-3 levels in patients with bipolar disorder: Is Galectin-3 associated with treatment response?

Galectins (Gal) were linked with inflammatory responses in the central nervous system, may play an important role in the pathogenesis of BD.In this study,we aimed to investigate whether serum Gal-1 and Gal-3 levels are related to BD. 36 patients diagnosed with BD were included.C-Reactive Protein(CRP),Gal-1,Gal-3 blood levels were evaluated on the first day of hospitalization and the third week of treatment and compared with 41 healthy controls.The severity of the illness was evaluated with the Young Mania Rating Scale (YMRS). CRP levels of BD patients at hospitalization were significantly higher than the third week of treatment and healthy controls.Gal-1 levels on the first day of hospitalization and the third week of treatment were found higher than the healthy controls.There was no significant difference in Gal-3 levels of the patients on the day of hospitalization compared to healthy controls;at the end of the 3rd week of treatment,Gal-3 was statistically significantly higher than the first day of hospitalization. Our study is valuable in that it is the first study to show the change in Gal levels after treatment and to evaluate the role of Gal in BD.Gal-1 may play roles in the pathophysiology of BD.Gal-3 may be a biomarker candidate for the evaluation of the treatment response.

Nickel oxide nanoparticles exposure as a risk factor for male infertility: "In vitro" effects on porcine pre-pubertal Sertoli cells.

Lately, nickel oxide nanoparticles (NiO NPs) have been employed in different industrial and biomedical fields. Several studies have reported that NiO NPs may affect the development of reproductive organs inducing oxidative stress and, resulting in male infertility. We investigated the in vitro effects of NiO NPs on porcine pre-pubertal Sertoli cells (SCs) which undergone acute (24 h) and chronic (from 1 up to 3 weeks) exposure at two subtoxic doses of NiO NPs of 1 μg/ml and 5 μg/ml. After NiO NPs exposure we performed the following analysis: (a) SCs morphological analysis (Light Microscopy); (b) ROS production and oxidative DNA damage, gene expression of antioxidant enzymes (c) SCs functionality (AMH, inhibin B Real-time PCR analysis and ELISA test); (d) apoptosis (WB analysis); (e) pro-inflammatory cytokines (Real-time PCR analysis), and (f) MAPK kinase signaling pathway (WB analysis). We found that the SCs exposed to both subtoxic doses of NiO NPs didn't sustain substantial morphological changes. NiO NPs exposure, at each concentration, reported a marked increase of intracellular ROS at the third week of treatment and DNA damage at all exposure times. We demonstrated, un up-regulation of SOD and HO-1 gene expression, at both concentrations tested. The both subtoxic doses of NiO NPs detected a down-regulation of AMH and inhibin B gene expression and secreted proteins. Only the 5 μg/ml dose induced the activation of caspase-3 at the third week. At the two subtoxic doses of NiO NPs a clear pro-inflammatory response was resulted in an up-regulation of TNF-α and IL-6 in terms of mRNA. Finally, an increased phosphorylation ratio of p-ERK1/2, p-38 and p-AKT was observed up to the third week, at both concentrations. Our results show the negative impact of subtoxic doses NiO NPs chronic exposure on porcine SCs functionality and viability.

Comparison of the Thermal Reaction of Patients after Conserving Procedures and after Mastectomy to the Radiation Dose Obtained during Radiotherapy

The main aim of the study was to compare the temperature response of the body to the dose received during breast cancer radiotherapy. The control group consisted of 50 healthy volunteers. They underwent one thermographic examination and compared the temperatures between the left and right breasts. The research group consisted of 50 patients. Based on the treatment plan, the area PTV and isodose was marked on the thermograms. Five thermographs were performed in each patient (before radiotherapy and in each week of treatment). A qualitatively similar increase in mean temperature during treatment was observed in both subgroups in the analyzed areas. The highest increase in temperature was obtained in the third week of treatment. Compared with the value before treatment, the increase in the mean temperature in PTV in patients after partial surgery was 0.78 °C, these values are statistically significant p = 0.000055. In the case of post-mastectomy patients, 0.8 °C was obtained, these values are statistically significant p = 0.00369. In addition, strong correlation was calculated between isodoses read from treatment plans and isotherms obtained from the analysis of thermal images. In post-mastectomy patients for PTV r = 0.77, 30 Gy r = 0.94, 20 Gy r = 0.96, and 10 Gy r = 0.75. For patients after partial surgery for PTV r = 0.74, 30 Gy r = 0.89, 20 Gy r = 0.83, and 10 Gy r = 0.89. Infrared thermography seems to be a useful method of assessing the thermal response of the body to the dose received during radiotherapy of breast cancer and may be a clinically useful method of assessing the early skin response to radiation.

Effects of Instrumented Assisted Soft Tissue Mobilization (IASTM) Technique Versus Stretching on Ililotibal Band in Patients with Anterior Knee Pain

Background: Anterior knee pain is caused by many factors iliotibial band tightness is one of cause of knee pain. The repeated hip abduction or postural imbalance usually results in contracture and tightness of the iliotibial band. Soft tissue mobilization is hypothesized as one of effective treatment. Instrumented assisted soft tissue (IASTM) technique is a soft tissue mobilizing technique and have remarked effects. Objective: This study's objective was to assess how well IASTM improved hip adduction range of motion (ROM). Methodology: This study was quasi experimental trial. And duration for this study was 6 month after the approval of synopsis. Sample of total 46 with knee pain was recruited in two groups. Non- probability convenience sampling technique was used. Total sample size was 30(15 each group). Subjects were allocated into 02 Groups. Inclusion criteria were Age 25 to 50 years and patients with Anterior Knee Pain, Patients of both genders. One group received IASTM and other group received self stretching for flexor group. Outcome was measured on NPRS, goiniomere and lower extremity function scale (LEFS) and values were be taken at baseline and after one week of treatment and then at third week of treatment. The data was analyses using SPSS v 25. Results: The results shows no significant improvement in pain, LEFS and hip abduction range between both groups comparison but both treatments IASTM and stretching exercises shows significant results within each group.The individuals in the GT group showed better hip abduction strength after three treatment sessions. Furthermore, after the one-month follow up, the gain in strength persisted. HoweverThere was no significant difference statistically in hip adduction ROM or VAS scores for pain and function between both the control group and graston (GT) group. Practical application :This study is going to help physical therapist and instrumented assisted soft tissue mobilization practitioners that how Graston technique and stretching effective in terms of decreasing pain, improving flexibility and lower extremity functions in patient with illiotibal band tightness having anterior knee pain. Conclusion: IASTM technique and stretching was equally effective in terms of decreasing pain, improving flexibility and lower extremity functions in patient with illiotibal band tightness having anterior knee pain. Keywords: instrumented assisted soft tissue mobilization, iliotibial band, ant knee pain, soft tissue mobilization.

Bauhinia forficata Link, Antioxidant, Genoprotective, and Hypoglycemic Activity in a Murine Model.

Bauhinia forficata L. is a tree used in alternative medicine as an anti-diabetic agent, with little scientific information about its pharmacological properties. The hypoglycemic, antioxidant, and genoprotective activities of a methanolic extract of B. forficata leaves and stems combined were investigated in mice treated with streptozotocin (STZ). Secondary metabolites were determined by qualitative phytochemistry. In vitro antioxidant activity was determined by the DPPH method at four concentrations of the extract. The genoprotective activity was evaluated in 3 groups of mice: control, anthracene (10 mg/kg), and anthracene + B. forficata (500 mg/kg) and the presence of micronuclei in peripheral blood was measured for 2 weeks. To determine the hypoglycemic activity, the crude extract was prepared in a suspension and administered (500 mg/kg, i.g.) in previously diabetic mice with STZ (120 mg/kg, i.p.), measuring blood glucose levels every week as well as the animals' body weight for six weeks. The extract showed good antioxidant activity and caused a decrease in the number of micronuclei. The diabetic mice + B. forficata presented hypoglycemic effects in the third week of treatment, perhaps due to its secondary metabolites. Therefore, B. forficata is a candidate for continued use at the ethnomedical level as an adjuvant to allopathic therapy.

The Use of Infrared Thermography in the Assessment of Thermal Reaction of Patients Treated with Radiotherapy after Breast-Conserving Procedures.

The aim of the study was to assess the usefulness of the infrared thermography method in the assessment of the body's thermal reaction in patients during radiotherapy. Studies have shown how the temperature distribution changes with the dose of radiation used in each treatment week. Fifty-four patients participated in the study. The control group consisted of healthy patients, among whom the difference in mean temperatures between the breasts was checked. The study group included patients after conserving procedures qualified for radiotherapy. Measurements were taken and analyzed for each patient during each week of treatment. The target area (marked by a doctor) and the 30 Gy, 20 Gy and 10 Gy isodoses (generated from the treatment plan) were transferred on thermograms and then analyzed. This way of defining the observed areas is the most accurate and individually adjusted to each treated patient. The analysis showed an increase in temperature in the tested body surface areas, whereas the highest average temperature value was achieved during the third week of treatment. The observations may be used to evaluate the skin reaction from radiation; however, they require further studies and new quantitative parameters.

Glioblastoma Response during Chemoradiation by Daily Quantitative Multiparametric MRI

<h3>Purpose/Objective(s)</h3> Quantitative Multiparametric MRI (qMP-MRI) is a fast and robust technique for providing relaxometry information such as T1, R2 and R2* maps. This information is correlated to glioblastoma (GBM) cellular density and may be useful to predict sites of tumor progression. For example, T1 has longer and R2 and R2* have shorter relaxation times for voxels adjacent to gadolinium enhancing tumor. The availability of MRI-Linac systems provides the opportunity to detect qMP-MRI changes daily through the course of radiation therapy (RT) and to adapt plans during RT. We hypothesize that qMP-MRI can detect tumor changes during a course of MRI-Linac treatment and correlates with patient outcomes. <h3>Materials/Methods</h3> We analyzed an IRB-approved prospective cohort of 21 consecutive GBM patients treated on a 0.35T MRI-Linac system with 30 fractions to 60 Gy and temozolomide. Daily qMP-MRI data were obtained with multi-TE and the Strategically Acquired Gradient Echo (STAGE) on alternating treatment days (15 qMP-MRI acquisitions during RT). For STAGE, 36 slices of 1.5 × 1.5 × 5 mm³ resolution were acquired using varying TEs and flip angles. A multi-TE sequence with 18 slices of 1.6 × 1.6 × 6 mm³ were also acquired. Quantitative T1 and R2* (1/T2*) maps were obtained from STAGE acquisitions and R2 (1/T2) maps from the multi-TE acquisition. Image changes related to tumor area and resection cavity were contoured on the T2 weighted images from daily patient setup using a standard contouring software. A ROI (Peri-tumor) was created based on a 10 mm expansion around the tumor or resection cavity. Changes of T1, R2* and R2 from each voxel within the Peri-tumor were analyzed by parametric response mapping comparing the images from each fraction to those obtained during pre-RT simulation. <h3>Results</h3> Of the 21 GBM patients, 10 had no tumor growth on first post-RT diagnostic MRI (48%), 4 (19%) were determined to have pseudoprogression based on regression or long-term stability of findings, and 7 (33%) had true progression due to continued progression of disease past 6 months, rapid patient death from disease, or tissue sampling showing active malignancy. The analysis of qMP-MRI obtained during RT showed that true progressors presented increases of T1 and decreases of R2* and R2 values for at least 10, 20 and 15%, respectively, of the voxels within the Peri-tumor when compared to patients with no change (Fisher's exact test, p<0.05 for each metric). All true progressors showed such changes before the 15^th fraction (3^rd week) of treatment. <h3>Conclusion</h3> Changes of qMP-MRI based parameters obtained during RT, such as increases in T1 and decreases in R2 and R2* within the Peri-tumor, were found to correlate with true progression. These changes were observed in images obtained before the third week of treatment, suggesting that adaptive RT or other therapies may be useful to intervene early for patients with GBM unresponsive to conventional therapy.

Effect of Recombinant Netrin-1 Protein Combined with Peripheral Blood Mesenchymal Stem Cells on Angiogenesis in Rats with Arteriosclerosis Obliterans.

This work was aimed to explore the effect of recombinant netrin-1 protein and peripheral blood mesenchymal stem cells (MSCs) on the angiogenesis ability of atherosclerosis. 28 Sprague Dawley (SD) rats were taken as research models. The arterial occlusion models were created by surgery and then divided into the saline control group (n =7), netrin-1 treatment group (n =7), MSCs treatment group (n =7), and netrin-1 + MSCs combined treatment group (n =7). The peripheral blood MSCs were extracted from the peritoneal cavity of diseased SD rats and cultured alone or in combination with netrin-1. The individually cultured MSCs and netrin-1 were locally injected into the ischemic tissues of SD rats. The Tarlov scoring was performed at the first, second, and third week of treatment, respectively. The expression of vascular endothelial growth factor (VEGF) was also measured by quantitative real-time polymerase chain reaction (qRT-PCR), and the capillary density was measured by immunofluorescence staining. The mean maximum contractility of the gastrocnemius muscle in each group was determined in the third week after treatment. The Tarlov score of the netrin-1 + MSCs group was significantly higher than that of the control group (P < 0.05) at the second week. To the 4th week of treatment, the Tarlov score of the netrin-1 + MSCs group was highly increased compared to the netrin-1 group and the MSCs group (P < 0.05). The expression of VEGF in the treatment groups was greatly increased each week compared to the control group (P < 0.05). Compared with the netrin-1 and the MSCs groups, the VEGF was also notably increased in the netrin-1 + MSCs group (P <0.05). The capillary densities of the treatment groups were observably greater than that of the control group in the second and third weeks (P <0.05), while the capillary density in the netrin-1 + MSCs group was also significantly increased than those in the netrin-1 group and the MSCs group (P < 0.05). The mean maximum contractility of the netrin-1 + MSCs group was remarkably higher than that of the other groups (P < 0.05). The netrin-1 + MSCs group achieved the higher Tarlov score, higher VEGF expression, higher capillary density, and better muscle recovery than netrin-1 and MSCs treatments.

EFFECT OF HYPERBARIC OXYGEN THERAPY ON NERVE REGENERATION IN RATS.

ABSTRACTObjective: To evaluate histological changes in peripheral nerves of rats after sciatic nerve neurorrhaphy, according to the time of exposure to hyperbaric oxygen chamber treatment. Methods: Twenty-five Wistar rats were divided into 5 groups according to the amount of exposure to hyperbaric oxygen chamber treatment. Group 1 was the control and there was no use of hyperbaric oxygen chamber; group 2 received one week of therapy; group 3, two weeks; group 4, three weeks; and group 5, four weeks. After the fourth postoperative week, the animals were submitted to euthanasia and a sciatic nerve sample sent for histological analysis. Axons proximal and distal to the neurorrhaphy were counted with axonal regeneration index measurement. Results: We observed that the number of axons distal to neurorrhaphy increases with the amount of hyperbaric oxygen chamber exposure, the results were more expressive from the third week of treatment. However, the statistical analysis found no significant difference between the groups. Conclusion: The descriptive analysis suggests benefit of using hyperbaric oxygen chamber directly proportional to the time of therapy. The study, however, did not present statistically relevant results, probably due to the reduced sample size. Subsequent studies with more significant sampling would be of great value. Level of Evidence II, Prospective Comparative Study.

The Efficacy of the Therapeutic Exercises on Evminov Board with Use of the Glisson Loop in Patients with Degenerative Spine Diseases

Degenerative spine changes could be detected in 57% of persons in age of 20–29 years, in more then 95% – in age group of 40–49 years and in almost all persons older then 60, which determines the need in development of the effective methods for treatment and exacerbation prevention. The objective: to evaluate the efficacy of the therapeutic exercises on the Evminov board with Glisson loop use in patients with spine degenerative diseases. Materials and methods. The study included 349 patients with spine degenerative diseases. According to spine CT/MRI the protrusions of intervertebral discs of different parts of the spine were found in 166 patients (47.6%), and intervertebral hernias were described in 91 cases (26.1%). All patients were divided into 2 groups: group I included 205 people who received personalized therapeutic exercises on Evminov’s board without the use of nonsteroidal anti inflammatory drugs (NSAIDs), group II included 144 patients who took NSAIDs to redue cpain. Results. After 4–6 weeks of treatment with Evminov’s board, all patients showed positive changes: in 47% of cases there was no pain at rest and in 53% of cases the pain decreased in intensity (from 7.8 mm to 3.7 mm on VAS). Group II patients in course of NSAIDs were recommended low-amplitude exercise therapy (up to 20°) to prevent exceeding the pain threshold, while most group I patients noted pain at an movement amplitude of 60–80° and performed exercises with the appropriate amplitude. Group I patients showed improvement in the first week of treatment, while group II patients had improvement only in the third week of treatment. Conclusion. Treatment of patients with the degenerative spine diseases on Evminov board with full-amplitude movements is more effective as for pain management and temp of pain decrease compare to low-amlitude exercises and NSAID use.

Combination of strontium chloride and photobiomodulation in the control of tooth sensitivity post-bleaching: A split-mouth randomized clinical trial.

ObjectiveThis split-mouth randomized controlled clinical trial assessed the effect of 10% strontium chloride in combination with photobiomodulation (PBM) for the control of tooth sensitivity (TS) post-bleaching.MethodsThe upper/lower, right and left quadrants of fifty volunteers were randomized and allocated to four groups (n = 25): PLACEBO—placebo gel + simulation of PBM; Placebo + PBM; STRONTIUM—10% strontium chloride + simulation of PBM; and PBM + STRONTIUM—10% strontium chloride + PBM. All groups received tooth bleaching treatment with 35% hydrogen peroxide. For the PBM treatment, the laser tip was positioned in the apical and cervical regions of the teeth bleached in the respective hemi-arch. The laser system was operated in continuous mode, using 1.7 J of energy. A dose of 60 J/cm2 was applied to each point for 16 seconds under 808 nm near-infrared light (100mW of power), with a point area of 0.028 cm2. TS was assessed during a 21-day follow-up, using the modified visual analogue scale.ResultsIn the intragroup assessment, the Friedman test indicated that PBM + STRONTIUM promoted the greatest reduction in TS after the second week of treatment (p ≤ 0.05). The Wilcoxon-Mann-Whitney test indicated that the groups Placebo + PBM, STRONTIUM, and STRONTIUM + PBM did not differ statistically (p ≥ 0.05) in the first and third weeks of treatment The group PLACEBO exhibited the greatest TS in the first three days after each bleaching session.ConclusionThe combination of 10% strontium chloride with PBM was effective in reducing post-bleaching TS; however, the combination of 10% strontium chloride with PBM was effective in reducing post-bleaching TS; however, it did not differ from the individual use of Placebo + PBM or STRONTIUM groups assessed after 21 days of follow-up.

Changes of non-specific resistance in patients with postoperative peritonitis with abdominal sepsis

Purpose: to study changes in nonspecific resistance and cytokine regulation in patients with postoperative peritonitis with abdominal sepsisMaterials and methods. The clinic treated 456 patients with postoperative peritonitis who were treated in the surgery department of the municipal non-profit enterprise Regional Clinical Hospital of Ivano-Frankivsk Regional Council in the period from 2000 to 2021. Immunological studies were performed in 66 patients with varying severity of abdominal sepsis and its complications.Research results and their discussion. In patients with postoperative peritonitis with abdominal sepsis, the phagocytic index during the first week of hospital stay was in control. However, on the 10th-11th day, the phagocytic index decreased 1.6 times, which progressed until the end of the third week of treatment - on the 14th-21st day, the phagocytic index was 2.7 times smaller than the control. The phagocytic count in patients with PP with abdominal sepsis reached maximum values in the first day of the disease (3 ± 0.26). Later in the treatment process, this figure gradually decreased and on day 14-21 came to normal and amounted to 1.96 ± 0.10. The index of completeness of phagocytosis on the first day of the disease was1,59 ± 0,20. By 2-3 days it decreased by 1.44 ± 0.20 and returned to normal by 14-21 days. Circulating immune complexes were normalized by 5-7 days of the disease.

Evaluation of margins in pelvic lymph nodes and prostate radiotherapy and the impact of bladder and rectum on prostate position

PurposeThe aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. Patients and methodsThis study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. ResultsUsing Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03mm, 5.42mm and 8.73mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5mm. The CTV to PTV margins ranged from 3.12mm to 3.25mm for external iliac vessels and from 3.12mm to 4.18mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. ConclusionsWe recommend CTV to PTV margins of 8mm, 6mm and 9mm in AP, ML and SI directions for prostate. And, we suggest 4mm and 5mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3weeks and especially the first week to check rectum volume.

Toxicological Investigations of Aristolochia longa Root Extracts

Aristolochia longa L. (Aristolochiaceae) is an herbaceous plant recognized in alternative medicine for its many therapeutic virtues. The aim of this study was to determine the pharmacotoxicological effects of this plant in order to ensure safe clinical use. The oral toxicity of the aqueous extract of A. longa roots was performed in vivo on Wistar rats at doses of 0.8, 1.25, 2, 2.5, and 5 g/kg/day for 21 days. Clinical signs were observed throughout the experimental period, followed by measurement of body weight change, while selected biochemical parameters, as well as relative organ weights and the histology of liver, kidney, and intestinal tissues, were evaluated after 6, 11, and 16 days and then at the end of 21 days of daily administration. At repeated doses for 21 days, the extract contributed to significant weight gain, in both control and treated rats. The global analysis of hepatic and renal biomarkers showed a significant increase between control and different doses of the extract, from the first to the third week of treatment, indicating the likely toxic effect of the extract on liver and kidney function. Organ toxicity was confirmed by histopathological examination, which revealed greater renal and hepatic parenchymal changes in animals treated with a high dose beyond the 16th day. At the end of the treatment, relatively small size of intestinal villi was also observed. It was concluded that ALAE has a low toxicity potential in nonprolonged oral administrations. However, at high chronic oral doses, A. longa appears to have significant toxicity on the organs tested.