Total Patient Sample Research Articles

Co-existence of Ovarian Teratomas With Other Gynecological Tumors.

This study aims to investigate the co-existence of ovarian teratomas with other benign or malignant gynecological tumors in women who underwent gynecological surgery. We retrospectively reviewed all women who underwent gynecological surgery over a 15-year period. Pre-operative, surgical, and histological records were obtained from women who presented with gynecological pathology, aiming to discover a possible link between ovarian teratomas and other gynecological tumors. Of the total patient sample, 288 (8.2%) had a mature teratoma, and 9 (0.3%) had an immature teratoma. The mean age was 38.0±13.3 years and 30.9±11.1 years, respectively. Women with mature teratoma showed a positive correlation with struma ovarii (SO, p=0.001). Moreover, we reported a positive linear relationship between struma ovarri and thecoma. Of the 288 women with a mature teratoma, 1 (0.3%) had co-existent endometrioid ovarian cancer, and 1 (0.3%) had borderline cancer. There were 14 women (4.9%) with a co-existent serous cystadenoma, 7 (2.4%) with a mucin cystadenoma, 1 (0.3%) with a thecoma, 4 (1.4%) with struma ovarii, 3 (1.0%) had Brenner cyst, 3 (1.0%) had ovarian fibroma, 2 had endometriosis (0.7%), and 8 (2.8%) had endometriomas. Of a total of nine women with immature teratomas, one (11.1%) had a serous cystadenoma. Ovarian teratomas may co-exist with other gynecological diseases. Our study reports various cases of the co-existence of several gynecological tumors with teratomas.

Real-world treatment patterns for patients with high-risk biochemically recurrent nonmetastatic castration-sensitive prostate cancer.

299 Background: Patients with biochemically recurrent (BCR) nonmetastatic castration-sensitive prostate cancer (nmCSPC) who are identified as high-risk of developing metastases may benefit from earlier treatment. This study analyzed treatment patterns in these patients. Methods: The Adelphi Real World nmCSPC retrospective survey was completed by urologists and radiation oncologists in the US. For this analysis, data from medical charts for patients diagnosed with high-risk BCR nmCSPC from Jan 2021–Jul 2023 were extracted; physicians completed a chart for their last 6–8 patients. Data were analyzed descriptively for first line (1L) treatment received (regardless of time) since high-risk BCR diagnosis for the total patient sample and subgroups of interest. Physicians documented those with no treatment as on observation. Results: Aggregated data were analyzed for 376 patients with high-risk BCR nmCSPC; 252 (67%) had prostate-specific antigen doubling time (PSADT) ≤9 months after BCR and initial definitive therapy of radiotherapy (RT) and/or radical prostatectomy (RP). Overall, 84% were treated by urologists and 16% by radiation oncologists. Median age was 70 years; 64% were White, 31% were Black/African American. Median PSA at high-risk BCR diagnosis was 5 ng/mL. Median follow-up after high-risk BCR diagnosis was 249 days. Median time between high-risk BCR diagnosis and initiation of 1L treatment was 17 days. Most common 1L treatments were androgen deprivation therapy (ADT) alone, salvage RT, novel hormonal therapy (NHT) + ADT, and observation alone. For patients on observation alone, median follow-up after high-risk BCR diagnosis was 181 days. Few numerical differences were seen in treatment patterns depending on how patients were determined as high-risk (Table). Patients treated by urologists rather than radiation oncologists had numerically higher proportions of 1L treatment with NHT + ADT (21% / 2%) and observation alone (17% / 8%), and numerically lower proportions of ADT alone (27% / 34%) and salvage RT (12% / 44%). Conclusions: First line treatments were typically initiated rapidly following high-risk BCR nmCSPC diagnosis, with only 15% of patients receiving observation alone during available follow-up. [Table: see text]

Integrative assessment of the effectiveness and safety of outpatient use of Picamilon

To study the efficacy and safety of the use of the drug Picamilon with various therapy regimens in patients with stage I of chronic cerebral ischemia (CCI). Material and methods. An open randomized comparative clinical trial included 44 patients with stage CCI aged 46 to 67 years (average age 55.6±6.76 years). Patients were randomized into two groups, patients of group 1 (n=23) received Picamilon orally in tablets of 50 mg 3 times/day for 60 days; group 2 (n=21) received Picamilon first parenterally at 100 mg i/m for 10 days, then in tablets of 50 mg 3 times/day for 50 days. The total duration of therapy was 60 days. The study included 4 visits (before treatment, 10 days later, 60 days later, 1.5 months after completion of treatment). The dynamics of cognitive status were assessed according to the Montreal Cognitive Function Assessment Scale (MoCA), vegetative disorders on the A.M. Wayne scale, neurological disorders on the A.I. Fedin scale, and sleep quality on the Ya.I. Levin scale. The study of the state of cerebral blood flow (dopplerography of intracranial vessels) and endothelial function (assessment of the level of methylation. During treatment, in the total sample of patients, there was a positive trend in the results of the MoCA scale, increasing in the delayed period (24.9/26.5/28.3 points, p=0.022 and p<0.001); improvement in sleep quality in 50% of patients by visit 3 and in 84% by visit 4, in the 2nd group the effect occurred in 28% of patients, in the 1st - in 11%, by the end of the study the effect was comparable (p=0.508). Improvement according to Fedin A.I. scale noted in 77% of patients, values decreased from 11.9±8.3 to 6±6.1 points (p<0.0001) and to 2.77±4.43 points by visit 4 (p<0.0001). Normalization of autonomic functions was observed in 29% of patients (p=0.024) without intergroup differences. Picamilon therapy showed high efficacy in terms of clinical outcomes (up to 89%), good tolerability (98% of patients) and a favorable safety profile (less than 8.6% of AEs). The use of Picamilon was accompanied by an increase in the linear velocity of blood flow, a decrease in the thickness of the intima-media complex and the resistance index; a decrease in elevated ADMA concentrations and ADMA/MMA and (ADMA+SDMA)/MMA ratios. The use of Picamilon is effective in patients with stage I CCI, contributes to a significant regression of neurological deficits, cognitive impairment, improved sleep quality and autonomic function; improves vascular endothelial function, reduces the risk of atherosclerosis and cardiovascular complications in patients. The optimal duration of therapy with Picamilon in stage I of chronic cerebral ischemia is 2 months.

Assessment of correlation between lipid ratios and body mass index in patients with type 2 diabetes mellitus in Sarajevo, Bosnia and Herzegovina.

Objective. Studies that have evaluated correlation between body mass index (BMI) and novel lipid indices such as triglycerides (TG)/high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC)/HDL-C, and low-density lipoprotein cholesterol (LDL-C)/HDL-C in type 2 diabetes mellitus (T2DM) are scarce. Hence, the aim of the present study was to explore the correlation between BMI and novel lipid indices in Bosnian patients with T2DM. Methods. Present study included 117 patients with T2DM (mean age: 66.51 years) and 68 controls (mean age: 68.37 years). BMI was calculated as weight/height². Lipids were measured by standard methods. TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios were separately calculated. The differences between the groups were assessed by Student's t-test or Man Whitney U test. Correlations were determined by Spearman's test. Results. In a total sample of T2DM patients, 41.0% were overweight and 44.4% were obese. In the control group, 51.5% of subjects were overweight and 25.0% were obese. In T2DM group, a significant correlation was observed between BMI and HDL-C, LDL-C, TG/HDL, TC/HDL-C, and LDL-C/HDL-C ratios. In the control group, there was a significant correlation found between BMI and HDL-C, TG, TG/HDL, TC/HDL-C, and LDL-C/HDL-C-ratios. Correlation between BMI and other lipid parameters in T2DM and the control group was not determined. Conclusion. The present study showed significant correlation between BMI and novel lipid indices in both T2DM patients and the control group of subjects. Possible explanation for the observed results might be prevalence of overweight and obese participants in this study sample. Since novel lipid indices are used in the prediction of cardiometabolic risk, results obtained in the present study have valuable clinical implications.

Combined epilepsy with generalized and focal seizures

<p>Combined epilepsy (with generalized and focal seizures) is a recently accepted and yet underreported epilepsy type. We intended to review the literature of combined epilepsy and to report the individual findings of the 31 combined epilepsy patients in our database. Thereafter, we investigated the characteristics of the patients at the group level.</p>. <p>The individual findings of the 31&nbsp;patients were tabulated. We characterized the group with special reference to epide&shy;miology, timing and the sequence of gene&shy;ralized and focal seizures, family history of seizures and severity of the electro-clinical phenotype. The variables were compared to those of the generalized epilepsy and the focal epilepsy groups of our database. We carried out statistical analyses by the two-sided Fishers&rsquo;s exact test and the Kruskal-Wallis and post-hoc Dunn tests.</p>. <p>The prevalence of combined epilepsy was 1.56% within the total sample of the classifiable epilepsy patients. Females were affected more often than males (67.7% and 32.3%, respectively). Statistically significant associations emerged firstly between the &ldquo;short interval&rdquo; subgroup (where the generalized and focal seizures occurred with short time difference) and the lack of other cerebral abnormality, and secondly between the &ldquo;long interval&rdquo; subgroup (where 4 to 37 years elapsed between the occurrence of the two seizure types) and the presence of other brain abnormality (p = 0.02). The proportion of patients with positive family history of seizures was greater in the combined epilepsy- than in the generalized epilepsy group (p = 0.03) and the focal epilepsy group (p &lt; 0.0001) of the database. The electro-clinical phenotype of the absence seizures showed more atypical findings (indicating poor prognosis) in combined epilepsy than in the generalized absence epilepsy patients of the database (p &lt; 0,0001).&nbsp;Despite dissimilar patient selection and study design, our main findings were in accord with those of prior studies. The dissection of the combined epilepsy group into the &ldquo;long interval&rdquo; and &ldquo;short interval&rdquo; subgroups was a novel approach that highlighted the dissimilar pathogenetic and clinical correlates of each.</p>. <p>The case reports might facilitate the spread of information about combined epilepsy in the medical community. Analyses of the patients at the group level resulted in clinically useful pieces of evidence.</p>.

Cerebral microbleeds and asundexian in non-cardioembolic ischemic stroke: Secondary analyses of the PACIFIC-STROKE randomized trial.

Cerebral microbleeds are magnetic imaging resonance (MRI) markers of hemorrhage-prone cerebral small vessel disease that predict future risk of ischemic stroke and intracranial hemorrhage (ICrH). There exist concerns about the net benefit of antithrombotic therapy in patients with microbleeds. We aimed to investigate the effects of an oral factor-XIa inhibitor (asundexian), that is hypothesized to inhibit thrombosis without compromising hemostasis, on the development of new microbleeds over time and interactions between microbleeds and asundexian treatment on clinical outcomes. We additionally assessed associations between baseline microbleeds and the risks of clinical and neuroimaging outcomes in patients with non-cardioembolic ischemic stroke. This is a secondary analysis of the PACIFIC-STROKE, international, multi-center Phase 2b double-blind, randomized clinical trial. PACIFIC-STROKE enrolled patients aged ⩾ 45 years with mild-to-moderate non-cardioembolic ischemic stroke who presented within 48 h of symptom onset for whom antiplatelet therapy was intended. Microbleeds were centrally adjudicated, and participants with an interpretable T2*-weighted sequence at their baseline MRI were included in this analysis. Patients were randomized to asundexian (10/20/50 mg daily) versus placebo plus standard antiplatelet treatment. Regression models were used to estimate the effects of (1) all pooled asundexian doses and (2) asundexian 50 mg daily on new microbleed formation on 26-week MRIs. Cox proportional hazards or regression models were additionally used to estimate interactions between treatment assignment and microbleeds for ischemic stroke/transient ischemic attack (TIA) (primary outcome), and ICrH, all-cause mortality, hemorrhagic transformation (HT), and new microbleeds (secondary outcomes). Of 1746 participants (mean age, 67.0 ± 10.0; 34% female) with baseline MRIs, 604 (35%) had microbleeds. During a median follow-up of 10.6 months, 7.0% (n = 122) had ischemic stroke/TIA, 0.5% (n = 8) ICrH, and 2.1% (n = 37) died. New microbleeds developed in 10.3% (n = 155) of participants with adequate follow-up MRIs and HT in 31.4% (n = 345). In the total sample of patients with adequate baseline and 26-week follow-up MRIs (n = 1507), new microbleeds occurred in 10.2% of patients assigned to any asundexian dose and 10.5% of patients assigned to placebo (OR, 0.96; 95% CI, 0.66-1.41). There were no interactions between microbleeds and treatment assignment for any of the outcomes (p for interaction > 0.05). The rates of new microbleeds, HT, and ICrH were numerically less in patients with microbleeds assigned to asundexian relative to placebo. The presence of microbleeds was associated with a higher risk of HT (aOR, 1.6; 95% CI, 1.2-2.1) and new microbleeds (aOR, 4.4; 95% CI, 3.0-6.3). Factor XIa inhibition with asundexian appears safe in patients with non-cardioembolic ischemic stroke and hemorrhage-prone cerebral small vessel disease marked by microbleeds on MRI. These preliminary findings will be confirmed in the ongoing OCEANIC-STROKE randomized trial. ClinicalTrials.gov Identifier: NCT04304508.

Pain in patients with motor neuron disease: Variation of pain and association with disease severity, health-related quality of life and depression - A longitudinal study.

To describe levels of pain over time during disease progression in individual patients and for a total sample of patients with motor neuron disease (MND), respectively, and to examine associations between pain, disease severity, health-related quality of life (HRQOL), and depression. A prospective cohort study was conducted on 68 patients with MND, including data collected on five occasions over a period of 2 years. Pain was assessed using the Brief Pain Inventory - Short Form. Depression was assessed using the Amyotrophic Lateral Sclerosis (ALS)-Depression-Inventory (ADI-12). Disability progression was measured using the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version (ALSFRS-R). HRQOL was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5). Participants reported great individual variation over time. The median level of pain was 4 (min 0 and max 10). Higher levels of pain during the last 24h were associated with higher depression scores (ADI-12), poorer quality of life (ALSAQ-5), and lower reporting of fine and gross motor skills (ALSFRS-R). Baseline pain levels did not predict future values of depression and function. Individuals reporting average pain >3 experienced more hopelessness toward the future and reported higher depression scores compared with participants reporting average pain <3. Great within-individual variation of pain intensity was reported. Pain intensity was associated with depression, function and HRQOL cross-sectionally, but it did not have a strong prognostic value for future depression, function, or HRQOL. Patients with MND should be offered frequent assessment of pain and depressive symptoms in person-centered care, allowing for individualization of treatment.

Revision reverse shoulder arthroplasty has similar outcomes to primary reverse shoulder arthroplasty at 5 Year average follow-up

BackgroundShoulder arthroplasty is a successful procedure that provides pain relief and improvements in function and range of motion. Anatomic and reverse shoulder arthroplasty are both effective procedures, and their indications continue to expand. We look at the outcomes of revision reverse total shoulder arthroplasty and compare it to the outcomes of primary reverse and anatomic total shoulder arthroplasty. MethodsWe identified patients undergoing total shoulder arthroplasty at our institution between the years of 2010 and 2020. Data was prospectively collected and retrospectively reviewed for post-operative range of motion and strength in patients with revision surgery and compared to controls. Measurements were collected preoperatively and postoperatively including range of motion and strength in the affected and unaffected shoulder. We collected patient reported outcome measures in person and via phone to identify subjective outcomes of total shoulder arthroplasty. Average final follow-up was 5.27 years. ResultsOur total patient sample was split between three groups: those with primary anatomic arthroplasty those who underwent primary reverse arthroplasty, and those who were revised to a reverse shoulder arthroplasty. All three groups had significant improvements in abduction and forward elevation from their pre-operative baseline to two years follow-up. Primary reverse had a significant improvement over revision reverse in abduction at one year follow-up. For all other range of motion measurements, there was no statistically significant difference at 2 years between primary and revision reverse shoulder arthroplasty. Patient reported outcomes had a significant increase from pre-op to most recent follow-up in all three groups. ConclusionOverall, our data suggest there is an improvement in outcomes with both primary and revision surgeries, and that results after revision reverse total shoulder arthroplasty may be comparable to primary reverse total shoulder arthroplasty.

Clinical Types of Movement Disorders in Patients with Multiple Sclerosis

Background Little is known about the true prevalence and clinical characteristics of movement disorders in early multiple sclerosis (MS), associated clinical disability and their effect on QOL. We conducted a cross sectional study to fill this knowledge gap. Objectives to study the prevalence of movement disorders in early stages of multiple sclerosis, presence of other clinical disability and their effect on QOL. Patients and method This is a cross sectional observational study. The patients group included 250 patients with RRMS whom were recruited consecutively from the MS clinic of Ain Shams and Nasr institute hospitals. Each eligible patient was interviewed and examined for presence of movement disorders, Patients were divided into 2 groups, group A without movement disorders and group B showing movement disorders. General and neurological examination including Expanded Disability Status Scale (EDSS) score at time of interview for both groups. Magnetic resonance imaging (MRI) of brain and cervical spinal cord (with contrast whenever available) obtained at the time of interview with documentation of MS plaques involvement for both groups. RRMS patients with movement disorders (group B) are subjected to different assessment for depression by Beck Depression Inventory (BDI), cognitive assessment by Montreal Cognitive Assessment (MOCA) scale, disability and quality of life (QOL) by the Short Form 36 Health Survey Questionnaire. Results This study included 250 RRMS. onset of their movement disorders was 2.69 ± 2.34 years from MS diagnosis with mean EDSS 3.515 ± 1.04. Cerebellar signs are present in 97% of total number of movement disorders and 26% of total sample, regarding tremors, 36 patients in this study showed tremors representing 53.7% of movement disorders patients, 14.4% of total sample of RRMS patients. This study showed presence of 5 cases of restless leg syndrome 7.5% of total number of MD. 4 cases of dystonia are present in this study representing 6% of MD patients. Patients with MD showed presence of depressive symptoms and cognitive affection with negative impact on QOL. Tremors severity is not correlated with either cognition or depression scores where ataxia is correlated with depression score only. MRI assessment of patients with MD showed higher lesion load and involvement of infratentorial structures especially cerebellum and its connections and cerebellum. Conclusion Movement disorders are common to occur than previously known especially ataxia and tremors early in the course of the disease. Presence of MD is related to high lesion load and strategic location of these lesions. special assessment of movement disorders as independent cause of disability with concomitant depression and cognitive impairment especially early in the disease course should be taken in consideration due to their negative impact on QOL.

Selection criteria for minimally invasive endoscopic treatment of urolithiasis depending on stone characteristics

Introduction. According to the guidelines, the stone maximum diameter is one of the main criteria for choosing the method of nephrolithotripsy. When planning an operation, the surgeon focuses not only on the diameter, but also on the renal pelvis anatomy, stone density and number of it, the presence of hydronephrosis, a history of surgery, etc. The maximum diameter is not an exhaustive characteristic that allows you to choose the optimal treatment.Objective. To evaluate the effect of stone volume (compared to its maximum diameter) on the duration of minimally invasive endoscopic nephrolithotripsy.Materials &amp; methods. The study was retrospective. The study included 55 patients (22 women, 33 men), the average age was 47.0 ± 1.9 years. All patients underwent minimally invasive thulium fiber laser nephrolithotripsy for stones up to 20 mm (mean maximum diameter — 13.3 ± 0.6 mm, mean density — 1041.0 ± 48.0 HU). Minimally invasive endoscopic interventions such as retrograde intrarenal surgery (RIRS, n = 30), minipercutaneous and micropercutaneous nephrolithotripsy (miniPNL, n = 16 and microPNL, n = 9, respectively) were performed. Patients with urinary system abnormalities, acute urinary tract infections and patients without stone-free status were excluded from the study. In addition to evaluating standard indicators, the stone volume was calculated in all patients using the formula of a scalene ellipsoid (median volume — 287 [144; 538] mm3). Spearman's rank correlation coefficient (r) with an assessment of the significance level was calculated for the stone maximum diameter and volume for the total sample of patients and for each surgical intervention method separately.Results. The analysis of the total sample of patients reliably revealed a weak correlation (r = 0.39) between the stone maximum diameter and surgery time. And a moderate correlation was found between the stone volume and surgery time (r = 0.53). A similar relationship with the linear distribution was also observed in the analysis in all groups.Conclusion. When choosing minimally invasive laser nephrolithotripsy, it is advisable to focus not only on the stone maximum diameter, density, and localisation, but also on the stone volume, which has a great correlation with the surgery time.

Autopsy‐confirmed minimally invasive biomarker identifies Alzheimer’s Disease even in the presence of co‐morbid pathologies

AbstractBackgroundThere are currently no FDA‐approved tests that are highly sensitive and highly specific for Alzheimer’s disease (AD). Diagnostic Accuracy has been even more difficult due to recent findings that &gt;50% of AD brains show co‐morbid pathologies such as multi‐infarct dementia and Frontal Lobe Dementia. Here, we describe an autopsy‐confirmed AD Biomarker that identifies AD pathology even with co‐morbid brain pathology.MethodA Morphometric Imaging (MI) assay was previously shown to correlate the dementia and presence of AD pathology in the brains of AD patients (Chirila et al., 2013) with abnormalities of skin fibroblasts isolated with routine punch biopsies (∼3mm). Cells were cultured on a thick layer of 3‐D Matrigel matrix and subjected to image analysis. AD cell lines formed large aggregates in contrast to non‐AD dementia (non‐ADD) or non‐demented control (NDC) cell samples. Typically skin fibroblasts formed “networks” analogous to networks formed by neurons isolated in cell culture and AD networks were slower and less connected Quantitative image analyses enabled the calculation of average unit aggregate area (A) in terms of ln(A/N). Samples were collected with a double‐blind protocol for demented patients &gt; 55 years old who eventually reached blinded autopsy examination. NDC samples were collected for Biomarker assay only.ResultThe total fibroblast patient sample (N = 74) consisted of AD (N = 26) patients and non‐ADD (N = 21) patients (all were autopsy confirmed and had blinded biomarker data); and NDC, N = 27 that had biomarker data. The cut‐off value of ln(A/N) = 6.98 was determined from the biomarker values for NDC patient samples. For the Biomarker AD vs. Non‐ADD data, True Positive = 26, False Negative = 0, False Positive = 0, with Sensitivity and Specificity calculated as 100 and 100, respectively. (AD vs. Non‐ADD, p &lt; .000001). The NDC MI assay values closely superimposed with the non‐ADD sample values.ConclusionIn these autopsy‐confirmed results, the MI Biomarker distinguished AD from Non‐ADD patients and correctly diagnosed AD even in the presence of other co‐morbid pathologies at autopsy. This highly, accurate, minimally invasive AD biomarker, therefore, was validated by rigorous reference to the NIH gold standard criteria for an AD Diagnosis, dementia in life and the presence of plaques and hyperphosphorylated tau at autopsy.

Attachment Trauma Is Associated with White Matter Fiber Microstructural Alterations in Adolescents with Anorexia Nervosa before and after Exposure to Psychotherapeutic and Nutritional Treatment.

In the present study, we explore the role of attachment for microstructural white matter (WM) changes in adolescents with anorexia nervosa (AN) before and after exposure to short-term and nutritional treatment. The case sample consisted of 22 female adolescent inpatients with AN (mean age: 15.2 ± 1.2 years) and the control sample were 18 gender-matched healthy adolescents (mean age: 16.8 ± 0.9 years). We performed a 3T MRI in the patient group during the acute state of AN and after weight restoration (duration: 2.6 ± 1 months) and compared the data to a healthy control group. To classify attachment patterns, we used the Adult Attachment Projective Picture System. In the patient sample, over 50% were classified with an attachment trauma/unresolved attachment status. Prior to treatment exposure, fractional anisotropy (FA) reductions and concordant mean diffusivity (MD) increases were evident in the fornix, the corpus callosum and WM regions of the thalamus, which normalized in the corpus callosum and the fornix post-therapy in the total patient sample (p < 0.002). In the acute state, patients with an attachment trauma demonstrated significant FA decreases compared to healthy controls, but no MD increases, in the corpus callosum and cingulum bilaterally, which remained decreased after therapy. Attachment patterns seem to be associated with region-specific changes of WM alterations in AN.

The GJB2 (Cx26) Gene Variants in Patients with Hearing Impairment in the Baikal Lake Region (Russia).

The GJB2 (Cx26) gene pathogenic variants are associated with autosomal recessive deafness type 1A (DFNB1A, OMIM #220290). Direct sequencing of the GJB2 gene among 165 hearing-impaired individuals living in the Baikal Lake region of Russia identified 14 allelic variants: pathogenic/likely pathogenic-nine variants, benign-three variants, unclassified-one variant, and one novel variant. The contribution of the GJB2 gene variants to the etiology of hearing impairment (HI) in the total sample of patients was 15.8% (26 out of 165) and significantly differed in patients of different ethnicity (5.1% in Buryat patients and 28.9% in Russian patients). In patients with DFNB1A (n = 26), HIs were congenital/early onset (92.3%), symmetric (88.5%), sensorineural (100.0%), and variable in severity (moderate-11.6%, severe-26.9% or profound-61.5%). The reconstruction of the SNP haplotypes with three frequent GJB2 pathogenic variants (c.-23+1G>A, c.35delG or c.235delC), in comparison with previously published data, supports a major role of the founder effect in the expansion of the c.-23+1G>A and c.35delG variants around the world. Comparative analysis of the haplotypes with c.235delC revealed one major haplotype G A C T (97.5%) in Eastern Asians (Chinese, Japanese and Korean patients) and two haplotypes, G A C T (71.4%) and G A C C (28.6%), in Northern Asians (Altaians, Buryats and Mongols). The variable structure of the c.235delC-haplotypes in Northern Asians requires more studies to expand our knowledge about the origin of this pathogenic variant.

Correlation of epicardial adipocytes hypertrophy with adipokines, inflammation and glucose and lipid metabolism

The changes of epicardial adipose tissue’s (EAT) morphofunctional characteristics represent an important factor of cardiometabolic impairments development. However, factor data determining the severity of EAT adipocytes’ hypertrophy in patients with coronary atherosclerosis are absent in literature.Aim: To compare the size of the EAT adipocyte and the percentage of hypertrophied adipocytes with the parameters of glucose/insulin metabolism, blood lipid transport function, adipokines’ profile and serum levels of high sensitive C-reactive protein (hsCRP) in patients with chronic coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG); to establish statistically significant determinants of a pronou ced degree of EAT adipocytes’ hypertrophy.Material and Methods. The study included 42 patients (m/f 28/14) aged 53–72 y.o. with CAD, who underwent CABG. The material for the study was EAT adipocytes obtained by the enzymatic method from intraoperative explants. The basal blood levels of glycemia, insulinemia, C-peptide, blood lipid transport function, adipokines and hsCRP were determined. The median indicators of the size of EAT adipocytes and the proportion of EAT adipocytes over 100 μm were 87.32 μm and 14.64%, respectively. The total sample of patients was divided into two groups: gr. 1 with an average size of EAT adipocytes less than or equal to 87.32 μm and gr. 2 with an average size of EAT adipocytes more than 87.32 μm. Gr. 2 had higher body mass index, waist and hip circumferences, triglycerides, hsCRP, and lower adiponectin levels, while the median proportion of hypertrophied adipocytes was three times higher than in group 1. A model of multiple logistic regression was constructed, according to which statistically significant determinants of the pronounced EAT adipocytes’ hypertrophy are represented by the decreased level of adiponectin, and increased concentrations of hsCRP and C-peptide, which reflects the biosynthesis and secretion of insulin. The predictive accuracy of the model was 82%, sensitivity 85%, specificity 79%, AUC = 0.89.Conclusion. Our results indicate a close correlation between the development of EAT adipocytes hypertrophy, impaired production of adiponectin, insulin, and inflammation processes. Concentrations of adiponectin, hsCRP, and basal C-peptide in the blood are biomarkers that accurately determine the presence of EAT adipocyte hypertrophy.

Outcomes of microsurgical vasoepididymostomy using intussusception technique: a systematic review and meta‑analysis

A systematic review and meta-analysis of microsurgical vasoepididymostomy (MVE) for treating epididymal obstructive azoospermia (EOA) with different intussusception techniques. We conducted a comprehensive literature search using PubMed, Embase, and the Cochrane Central Register of Controlled Trials, retained literature related to obstructive azoospermia or male infertility and vasoepididymostomy, proactively reviewed other relevant literature, supplemented valuable references, and excluded studies that did not use intussusception and where valuable statistical data were difficult to obtain. Event rate and risk ratio (RR) were estimated. Patency rates were investigated. The influence of motile sperms found in the epididymal fluid, anastomotic sides and sites on patency was evaluated. 273 articles were comprised in this analysis, and 25 observational studies were eventually included, with a total patient sample of 1400. The overall mean patency rate was 69.3% (95% confidence interval [CI] 64.6–73.6%; I2 = 63.735%). We conducted a meta-analysis of the factors affecting patency after microsurgical IVE, finding that the presence of motile sperms in epididymal fluid (RR = 1.52; 95% CI 1.18–1.97%; P = 0.001), anastomosing bilaterally (RR = 1.32; 95% CI 1.15–1.50%; P < 0.0001) and distally (RR = 1.42; 95% CI 1.09–1.85%; P = 0.009) lead to higher patency rates. IVE is an effective treatment for EOA. The presence of motile sperms found in the epididymal fluid, anastomosing bilaterally and distally are significantly correlated with higher patency rates.

The prevalence of carbohydrate metabolism disorders in patients after coronavirus infection

Introduction. A single-center observational cross-sectional comparative study was conducted among&#x0D; a random population sample of the adult population of the city of Moscow who applied to the pavilion&#x0D; "Healthy Moscow". The study included 796 patients who had a coronavirus infection from one to six months&#x0D; ago. Of the 796 surveyed, 112 participants had disorders of carbohydrate metabolism (hereinafter – DCM)&#x0D; (14.1%): 9.8% (78 people) were newly diagnosed with type 2 diabetes (D2t) of the total sample, prediabetes&#x0D; – 4.2% (33 people), type 1 diabetes – 0.1% (1 person). Previously diagnosed D2t was observed in 0.5% (4&#x0D; participants) of the total sample of patients. Viral pneumonia was significantly more common in patients&#x0D; with DCM, compared with the group without DCM (45.5% vs. 19.1%, p&lt;0.001). In the group of lung injuries,&#x0D; DCM were observed with greater frequency, including D2t, the probability of which in the presence of lung&#x0D; damage increased by 3.7 times (95% CI: 2.04 – 6.67).&#x0D; Thus, the prevalence of newly detected DCM after COVID-19 was 14.1%, and the more severe the coronavirus&#x0D; infection, the more likely the DCM will develop in the future.&#x0D; The study was carried out as part of the project of the Department of Health of the city of Moscow&#x0D; "Scientific laboratory "Moscow polyclinic".&#x0D; For citation: Markova T.N., Anchutina A.A., Garib V.Yu., Yalochkina T.O., The prevalence of carbohydrate&#x0D; metabolism disorders in patients after coronavirus infection. City Healthсare. 2022;3(4):32-41 doi:10.47619/2713-2617.zm.2022.v.3i4;32-41

Prognosis of Anaplastic Thyroid Cancer with Distant Metastasis.

Anaplastic thyroid cancer (ATC) is derived from follicular thyroid cells and is associated with high mortality risk. Obtaining information to characterize ATC is difficult because ATC with distant metastasis is extremely rare. This study determined the clinical characteristics of ATC with distant metastasis. The medical records of 152 patients with ATC at Gangnam Severance Hospital were reviewed between January 2004 and March 2022. The primary endpoint was the overall survival of the total patient sample, patients with ATC and distant metastasis, and those with ATC and brain metastasis. Of the 152 patients with ATC, 88 had distant metastasis at diagnosis. The 5-year disease-specific survival was 24% for total ATC and 10% for ATC with distant metastasis. Survival for >1 year was 32% for total ATC and 15% for ATC with distant metastasis. The median survival rate differed significantly between the total ATC and ATC with distant metastasis groups (228.5 vs. 171 days). Among the ATC cases, 11% had brain metastasis; thus, brain MRI or CT is worth considering at diagnosis and follow-up, even if there were no statistical difference in overall survival between patients with ATC with and without brain metastasis.

Dynamics of structural and functional characteristics of the heart in patients after myocardial infarction with ST segment elevation as a marker of progression of chronic heart failure

Objective. To identify the association of a number of clinical features and structural and functional characteristics of the heart with the progression of chronic heart failure (CHF) in patients one year after ST-segment elevation myocardial infarction (MI) (STEMI) with preserved and reduced left ventricular ejection fraction (EF) (LVEF).Design and methods. 120 patients with STEMI were included in a prospective study. During the study, all patients underwent an echocardiographic study using a Sonos 2500 device (Hewlett Packard, USA) on the 1st day (point I), on the 12th day (point II) of hospitalization, and also after 1 year (point III). Depending on the parameters of EF on the 1st day of the disease, the total sample of patients was divided into two: the 1st group — with preserved LVEF was represented by 86 (71,7 %), the 2nd group — with a reduced LVEF was represented by 34 (28,3 %) patients.Results. A total of 19 (15,8 %) adverse events were registered. In two cases, a fatal outcome (1,7 %) was recorded, the cause of which was repeated MI, in five (4,2 %) patients decompensation of СHF was noted, in eight (6,7 %) patients a clinic of progressive angina was traced, in four (3, 3 %) of patients were diagnosed recurrent MI. Deterioration of systolic and diastolic function was established one year after STEMI with preserved (≥ 50 %) LVEF: 17,6 % of patients began to correspond to the intermediate range of EF (40-49 %), the number of patients with diastolic dysfunction increased by 10 % compared to with acute study.Conclusions. Within a year after a STEMI with initially preserved LVEF, there is a deterioration in myocardial function in the form of a decrease in myocardial contractility and an increase in the number of patients with diastolic dysfunction.

Effect of Facial Chuna Manual Therapy Combined with Korean Medicine Treatmeant for Bell’s Palsy

The effect of combined Korean medicine treatment including facial chuna manual therapy was retrospectively investigated in patients with Bell’s palsy. There were 16 patients (14 males) who received 2 months outpatient treatment following &gt; 14 days of hospitalization. The Yanagihara score and House- Brackmann grade were used to measure the severity of symptoms and recovery. The patients (mean age 58.5 ± 24.74 years) were categorized based on their medical history of hypertension (n = 10), diabetes millitus (n = 10), or oral intake of steroids early in the diagnosis of Bell’s palsy (n = 10). There was no difference between patients who had or did not have a previous history of diabetes mellitus or oral steroid. Both the Yanagihara-score and House-Brackmann grade improved significantly in the total patient sample after treatment (p &lt; 0.001). Combined Korean medicine including facial chuna manual therapy may have a beneficial effect on patient symptoms and recovery.

Factors of unfavorable prognosis for myocardial and coronary revascularization using hybrid and step-by-step percutaneous interventions and carotid endarterectomy

Aim. The study aimed at analysis of unfavorable prognostic factors and creation of a prognostic model for choosing the optimal strategy for cerebral and myocardial revascularization using carotid endarterectomy (CEE) and percutaneous coronary intervention (PCI).Material and Methods. A total of 263 myocardial and cerebral revascularizations were performed using PCI and CEE in patients with multifocal atherosclerosis and concomitant carotid and coronary artery disease from 2011 to 2017. Depending on selected treatment strategy, the patients were divided into two groups: group 1 (n = 133) comprised patients with stepby- step interventions in different sequences (CEE and PCI); group 2 (n = 130) comprised patients who underwent hybrid interventions (CEE + PCI). A binary logistic regression was performed with step-by-step inclusion and exclusion of predictors in order to identify predictive factors in the long-term period. A multivariate analysis was also performed, and the odds ratios were determined.Results. The analysis allowed to identify the significant effects of certain factors on death, favorable outcome (the absence of significant adverse cardiovascular events), and the availability of revascularization. The following protective factors increased the probability of favorable outcome in the general sample of patients throughout the entire follow-up period: the absence of chronic obstructive pulmonary disease (COPD), EUROSCORE II score of less than 1.5, compliance with prescribed therapy, no need for repeated planned revascularization in the long-term period, no emergency hospitalizations in the long-term followup period, PCI via the radial access, and CEE using the classical method. The statistically significant factors in the created model included surgical risk score by EUROSCORE II scale (for the total sample of patients and for the staged and hybrid strategies) and the coronary lesion severity by SYNTAX Score (for the total sample of patients and the hybrid strategy). It should be noted that the hybrid strategy was associated with a significantly greater availability of revascularization during the follow-up period compared with the step-by-step strategy.Conclusion. An important outcome of this study was a comprehensive analysis of a wide array of factors (clinical-instrumental, anatomic-angiographic, and perioperative), which allowed to identify predictors of adverse (favorable) outcome in the long-term follow-up period in patients with combined coronary and cerebral lesions when using PCI and CEE as the revascularization strategies.