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Neural autoantibody testing is standard for patients with suspected autoimmune neurologic disorders. The number of neural antibodies has increased dramatically in the past 40 years, with over 50 disease-specific neural antibodies defined to date. The advent of immune-profiling assays such as protein array and phage immunoprecipitation sequencing (PhIP-Seq) has further expedited the rate of antibody discovery, with many recent targets identified using these methods. In this review, we discuss traditional and novel methods of antibody discovery, with an emphasis on the incorporation of protein array and PhIP-Seq into our antibody discovery approach. Advantages, limitations, and potential future uses of these platforms within the field of autoimmune neurology are also considered.
Angioid streaks (AS) are irregular breaks in a calcified Bruch's membrane that appear as pigmented linear lesions radiating from the optic disc. In approximately 50% of cases, AS are associated with systemic diseases such as pseudoxanthoma elasticum, Paget's disease, various hemoglobinopathies, and they may also be idiopathic. Visual impairment in patients with AS is primarily related to the development of choroidal neovascularization along the streaks, followed by retinal pigment epithelium atrophy. Diagnosis of AS is based on clinical examination and modern imaging methods. This literature review summarizes current data on the epidemiology, etiology, and pathogenesis of diseases associated with AS, as well as treatment approaches, including anti-angiogenic therapy, and their potential complications. Ангиоидные полосы (АП) представляют собой нерегулярные разрывы в кальцинированной мембране Бруха, которые проявляются в виде пигментированных линейных образований, радиально исходящих от диска зрительного нерва. АП в 50% случаев могут быть ассоциированы с системными заболеваниями, такими как эластическая псевдоксантома, болезнь Педжета, с различными гемоглобинопатиями и нередко бывают идиопатическими. Снижение зрительных функций у пациентов с АП обусловлено развитием хориоидальной неоваскуляризации по ходу АП и последующей атрофией ретинального пигментного эпителия. Диагностика АП осуществляется на основании клинического осмотра и современных методов визуализации. В данном литературном обзоре представлены сведения об эпидемиологии, этиологии, патогенезе заболеваний, при которых встречаются АП, о методах лечения и их осложнений, включающих антиангиогенную терапию.
To investigate the histological and immunohistochemical characteristics of epithelial neoplasia of the extrahepatic bile ducts (EHBD) and to develop a diagnostic algorithm. The study included 104 patients. All patients underwent biliary tract biopsy. Morphological and immunohistochemical parameters were compared in biopsies with inflammation, low- and high-grade biliary intraepithelial neoplasia (BilIN), low- and high-grade intraductal papillary neoplasia (IPNB), and cholangiocarcinoma (CC). The main parameters in the study of the histological characteristics of epithelial neoplasia of the EHBD were: cellular atypia, nuclear polymorphism, nuclear polarity, the state of the brush border, inflammatory infiltration, and histological architecture. Immunohistochemical studies were performed using antibodies to MUC1, MUC2, MUC5AC, MUC6, and CD10. When studying the IHC characteristics of epithelial neoplasms of the EHBD, the localization of the reaction in epithelial cells, its intensity, and prevalence were assessed, and specificity and sensitivity were evaluated. Statistical analysis of the data used the two-sided Pearson χ2 criterion (p<0.05). Based on the results of the morphological stage of the study, a scale for assessing the degree of dysplasia in biopsy specimens was developed; a certain number of points were assigned to each type of epithelial neoplasia of the EHBD. Based on the results of the IHC study, taking into account statistically significant changes, an immunophenotype was established for each type of epithelial neoplasia of the EHBD: inflammation and BilIN LG - MUC1, MUC2, MUC6, CD10; BilIN HG - MUC1, MUC2, MUC5AC, MUC6; IPNB LG - MUC1, MUC2, MUC5AC, MUC6, CD10; IPNB HG - MUC1, MUC2, MUC5AC, MUC6; CC - MUC1, MUC5AC, MUC6. For differential diagnosis of the degree of dysplasia in epithelial neoplasia of the EHBD, it is recommended to use an IHC panel with the presence of antibodies to MUC1, MUC2, CD10. It is proposed to use antibodies to MUC2, MUC5AC and MUC6 as an IHC panel for differential diagnosis of IPNB subtypes. Clear morphological and immunohistochemical criteria for the differential diagnosis of non-invasive lesions of the EHBD, inflammation and cholangiocarcinoma have been identified, and an algorithm for the comprehensive differential diagnosis of epithelial neoplasia of the EHBD has been developed. Изучить гистологические и ИГХ-характеристики эпителиальных неоплазий внепеченочных желчных протоков (ВЖП) и разработать диагностический алгоритм. В исследование включено 104 пациента. Всем пациентам выполнена биопсия ВЖП. Проведено сравнение морфологических и иммуногистохимических параметров в биоптатах с воспалением, билиарной интраэпителиальной неоплазией (BilIN) низкой и высокой степени, внутрипротоковой папиллярной неоплазией (IPNB) желчных протоков низкой и высокой степени и холангиокарциномой (ХК). Основными параметрами при изучении гистологических характеристик эпителиальных неоплазий ВЖП являлись: клеточная атипия, ядерный полиморфизм, полярность ядер, состояние щеточной каймы, воспалительная инфильтрация, гистологическая архитектоника. Иммуногистохимические исследования проведены с антителами к MUC1, MUC2, MUC5AC, MUC6, CD10. При изучении ИГХ-характеристик эпителиальных неоплазий ВЖП оценивали локализацию реакции в эпителиальных клетках, ее интенсивность и распространенность, оценивали показатели их специфичности и чувствительности. При статистической обработке полученных данных использовали двусторонний критерий χ2 Пирсона (p<0,05). По результатам морфологического этапа исследования была разработана шкала оценки степени дисплазии в биоптатах, каждому типу эпителиальных неоплазий ВЖП было присвоено определенное количество баллов. На основании результатов ИГХ-исследования с учетом статистически значимых изменений был установлен иммунофенотип для каждого из типов эпителиальных неоплазий ВЖП: воспаление и BilIN LG — MUC1, MUC2, MUC6, CD10; BilIN HG — MUC1, MUC2, MUC5AC, MUC6; IPNB LG — MUC1, MUC2, MUC5AC, MUC6, CD10; IPNB HG — MUC1, MUC2, MUC5AC, MUC6; ХК — MUC1, MUC5AC, MUC6. В качестве дифференциальной диагностики степени дисплазии в эпителиальных неоплазиях ВЖП рекомендуется использовать ИГХ-панель с наличием антител к MUC1, MUC2, CD10. В качестве ИГХ-панели для дифференциальной диагностики подтипов IPNB рекомендовано использовать антитела к MUC2, MUC5AC и MUC6. Выявлены четкие морфологические и иммуногистохимические критерии для дифференциальной диагностики неинвазивных поражений ВЖП, воспаления и холангиокарциномой, разработан алгоритм комплексной дифференциальной диагностики эпителиальных неоплазий ВЖП.
This article reviews the issue of persistent vulvar pain and vulvodynia, which are common conditions in women of reproductive age. Vulvodynia is defined as chronic vulvar pain lasting at least 3 months with no identified cause. It is characterized by increased sensitivity of the vulvar and vestibular tissues, neuroproliferation, increased vascularization, and structural changes of the mucosa. In contrast, persistent vulvar pain is usually associated with a specific, identifiable underlying condition. Both types of pain may coexist and overlap. This article comments on the current classification of vulvar pain according to the consensus of international societies dealing with this condition. It also summarizes the principles of differential diagnosis and therapeutic options for the management of vulvar pain. Treatment should be based on a comprehensive multidisciplinary approach including local and systemic pharmacotherapy, physiotherapy, psychotherapy, and in selected cases, surgical interventions. This article focuses on novel and promising therapeutic modalities in the treatment of vulvodynia, particularly various types of laser therapy. The review is supplemented by a case report of a patient with chronic provoked vestibulodynia treated by laser vaporization.
According to the classification of the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies include various abnormalities classified as vascular tumors or vascular malformations. This classification, last updated in 2018, is intended to explain biological basis of vascular lesions and help doctors treating abnormalities. In vascular tumors, proliferative changes in endothelial cells are observed, while vascular malformations are mainly structural vascular anomalies. Vascular malformations are an extensive group of arterial, venous, and lymphatic malformations (alone and in combination with each other). X-ray examination is essential in the treatment of children with these diseases. This report describes diagnosis and treatment of a child with arteriovenous malformation of the back of the neck. Согласно классификации Международного общества по изучению сосудистых аномалий (ISSVA) сосудистые аномалии включают широкий спектр заболеваний, классифицируемых как сосудистые опухоли, или сосудистые мальформации. Эта классификация, в последний раз обновленная в 2018 г., призвана объяснить биологическую основу сосудистых поражений и помочь врачам в лечении аномалий. При сосудистых опухолях наблюдаются пролиферативные изменения эндотелиальных клеток, в то время как сосудистые мальформации в основном представляют собой структурные аномалии сосудов. Сосудистые мальформации — обширная группа пороков развития артериальной, венозной и лимфатической систем, как изолированных, так и в сочетании друг с другом. Радиологическое обследование играет ключевую роль в лечении детей с этими заболеваниями. В представленном клиническом случае описаны этапы диагностики и лечения ребенка с артериовенозной мальформацией мягких тканей задней поверхности шеи.
Lymphangioma is a benign tumor of lymphatic system characterized by dilated lymphatic vessels. It is rare in adults (1 case per 200-250 thousand) and rarely affects the colon (1% of cases). The authors present diagnosis and endoscopic treatment of giant colon lymphangioma using the "loop and let go" technique. Лимфангиома — доброкачественная опухоль лимфатической системы, характеризующаяся наличием расширенных лимфатических сосудов, которая редко развивается у взрослых (1 случай на 200—250 тыс. населения) и крайне редко поражает толстую кишку (1% случаев). В статье представлен клинический случай диагностики и эндоскопического лечения у пациента с гигантской лимфангиомы толстой кишки с применением методики «захвати и отпусти» («loop and let go»).
Interpretation of blood leptin concentration in clinical practice and research is limited by a lack of comprehensive reference values. We aimed to establish reference ranges across the age and weight spectrum, taking into consideration important covariates age (0-75 years), pubertal status, and body weight status (normal to extreme obesity). Data from 12 629 individuals across 16 European cohorts were pooled and extracted for weight, height, Tanner stage (TS), and serum leptin concentration via ELISA (Leptin ELISA kit). Generalized additive models for location, shape, and scale were used to render reference curves stratified by sex, TS, and weight status. In boys, serum leptin concentrations increased between ages 6 and 12, followed by a decline after age 12, while girls showed an increase until age 15, with body mass index (BMI) SD score (SDS) dependent trajectories thereafter. Leptin concentrations were generally higher in girls than boys, except in boys aged 9 to 15 years with a BMI-SDS of > 3. In adults, women consistently had higher leptin concentrations across all BMI categories. In men, leptin concentrations decreased until the mid-20s for a BMI of 30 kg/m2 and until age 50 for a BMI of 40 kg/m2, stabilizing thereafter. We present the first reference curves for leptin concentrations across the entire age and weight range. An online tool and an R package for calculating leptin z-scores that are specific to age, sex, TS, and BMI (or BMI-SDS) are now available for clinical and research use at https://leptin.science.
Pleural mesothelioma (PM) is a rare, asbestos-linked cancer with a long asymptomatic latency, delaying diagnosis and limiting treatment options. Identifying blood‐based biomarkers that signal disease before symptoms onset could improve surveillance of at‐risk individuals. In our work, we conducted a prospective proteomic study of pre-diagnostic serum from 21 PM cases (< 5 years before diagnosis) and 21 asbestos‐exposed controls in the EPIC cohort using SWATH‐MS, followed by ELISA validation. Findings were tested in an independent MoMar cohort of 32 pre‐diagnostic plasma samples (< 1 year before diagnosis) and 32 matched controls. SWATH-MS identified 12 differentially expressed proteins (nominal p < 0.05, fold change > 1.3 or < 0.75). Transferrin and complement C4A were elevated, while beta‐2‐microglobulin and dermcidin were reduced in pre‐diagnostic cases. ELISA confirmed a borderline significant rise in beta‐2‐microglobulin within two years of diagnosis in EPIC. Calretinin and mesothelin were also detected in both cohorts, with the five‐marker panel achieving an AUC of 0.91 (p = 0.001) in MoMar but not reaching significance in EPIC (AUC = 0.88, p = 0.17). Integrating novel proteomic biomarker candidates with established markers enhances early PM detection in high-risk populations. Larger, multi‐cohort validation is warranted to refine this biomarker panel for clinical surveillance. The online version contains supplementary material available at 10.1007/s10238-026-02058-x.
This study aimed to evaluate the efficacy and safety of intrasalivary injections of incobotulinumtoxinA for the prevention of aspiration complications in patients with neurogenic dysphagia and posterior sialorrhea of various etiologies. This prospective study, conducted from 2024 to 2025, included 116 patients divided into two groups. The Main group (n=58) received ultrasound-guided chemodenervation of four salivary glands (two parotid and two submandibular) with incobotulinumtoxinA at a total dose of 100 U. The Control group (n=58) comprised retrospective data from patients with similar clinical profiles who did not receive botulinum toxin injections. All participants underwent a comprehensive diagnostic evaluation, including neurological assessment, instrumental methods such as a videofluoroscopic swallow study (VFSS) and a chest computed tomography (CT) scan, and non-instrumental scales for dysphagia and cognitive function. To quantify the severity of posterior sialorrhea, a Posterior Sialorrhea Intensity Visual Scale (PSIVS) ranging from 0 to 3 points was developed and applied. Efficacy was evaluated based on changes in sialorrhea intensity, feeding route, aspiration pneumonia incidence, and timing of tracheostomy decannulation. By day 28 post-injection, the majority of patients in the Main group (54 out of 58) demonstrated a significant reduction in sialorrhea intensity to 0-1 points on the PSIVS, compared to 2-3 points at baseline. Following the reduction in sialorrhea and subsequent rehabilitation, 51 patients improved their feeding route, transitioning from tube or gastrostomy to oral or combined feeding. Decannulation was successfully performed in 14 patients. The incidence of aspiration pneumonia was 5.2% (3 cases) in the Main group, compared to 20.7% (12 cases) in the Control group. No serious adverse events were observed. Two patients experienced mild dry mouth, which resolved within one month. The integration of salivary gland chemodenervation with incobotulinumtoxinA (100 U) into the diagnostic and therapeutic algorithm for neurogenic dysphagia and posterior sialorrhea represents an effective and safe strategy for preventing aspiration complications. This intervention significantly reduces sialorrhea intensity and the incidence of aspiration pneumonia, enhances swallowing function, facilitates patient care, and improves rehabilitation outcomes for patients with severe neurological disorders, beginning in the acute phase. Adoption of this method in routine rehabilitation practice is recommended to decrease mortality and disability rates and to alleviate the financial burden on the healthcare system. Изучение эффективности и безопасности инъекций инко-БТА (Ксеомин) в околоушные и подчелюстные слюнные железы для профилактики аспирационных событий у пациентов с различной патологией, течение которой осложнилось развитием нейрогенной дисфагии (НД) и задней сиалореи (ЗС). В 2024—2025 гг. в ФГАУ «НМИЦ ЛРЦ» МЗ РФ было проведено проспективное исследование с участием 116 пациентов в возрасте старше 18 лет с оценкой акта глотания при помощи фиброларинготрахеобронхоскопии (ФЛТБ). Для оценки интенсивности слюнотечения предложена визуально-аналоговая шкала интенсивности ЗС (ВШИЗС). Пациентам основной групп (n=58) в дополнение к стандартной терапии и реабилитации проведена хемоденервация двух пар больших слюнных желез инко-БТА в общей дозе 100 ЕД. Пациенты группы сравнения (n=58) получали только стандартную терапию и реабилитационные мероприятия. Проводились оценка НД и когнитивных функций, по показаниям — видеофлюороскопия (ВФС) акта глотания и компьютерная томография органов грудной клетки. Эффективность хемоденервации оценивалась по динамике интенсивности ЗС, частоте аспирационных событий, срокам деканюляции трахеи и частоте инициации перорального или смешанного питания на 14-е и 28-е сут после хемоденервации слюнных желез. У пациентов обеих групп исходная выраженность ЗС — 2—3 балла по ВШИЗС. К 28-м суткам после хемоденервации у 54 пациентов группы лечения зарегистрировано снижение интенсивности ЗС до 0—1 баллов по ВШИСЗ. У 51 пациента осуществлен переход с энтерального на полное или частичное пероральное питание. Деканюляция трахеи в течение 28 сут выполнена у 14 пациентов. В основной группе зарегистрировано 3 (5,2%) случая аспирационной пневмонии, в группе сравнения — 12 (20,7%). Серьезных осложнений ботулинотерапии не зарегистрировано. Комплексное обследование, включая ФЛТБ, позволяет выявить бессимптомную ЗС и другие факторы риска аспирационных осложнений. Хемоденервация слюнных желез инко-БТА в дозе 100 ЕД — эффективный и безопасный метод профилактики аспирационных осложнений.
γ-Aminobutyric acid B receptor (GABABR)-IgG (immunoglobulin G) is an intermediate-risk paraneoplastic autoantibody often associated with seizures. We aimed to assess the clinical and oncological features of GABABR-IgG autoimmune encephalitis (AE) and evaluate the performance of antibody testing. Patients testing positive for GABABR-IgG in serum/cerebrospinal fluid (CSF) at Mayo Clinic Neuroimmunology Laboratory were identified. Archived sera were retested by cell-based assay (CBA) at 1:100 and 1:200 dilutions. A live-cell flow cytometry-based assay (LCFBA) was developed and validated using archived sera and CSF. True positivity included patients with classic presentations of GABABR-IgG AE or oncological explanations for antibody presence. Eighty-six patients (median age 63 years; 43 female) presented with classic presentations of GABABR-IgG AE: encephalopathy with prominent seizures (n = 55), status epilepticus (n = 23), and rapidly progressive dementia (n = 8). In addition, 44 patients (33%) had a false-positive result for GABABR-IgG characterized by non-specific symptoms/alternate diagnoses. Malignancy was identified in 78% of true-positive patients, predominantly small cell lung carcinoma (SCLC). Testing serum at 1:100 dilution on CBA and using tissue immunofluorescence assay (IFA) in serum and CSF improved the identification of true-positive patients (p < 0.001). CBA at 1:100 dilution performed better than conventional CBA (at 1:10 dilution, p < 0.001) and tissue IFA (p = 0.031). An in-house LCFBA showed 100% sensitivity and specificity in CSF, performing similarly to conventional CBA (p = 0.125) in CSF, but better than tissue IFA (p = 0.031). Furthermore, serum LCFBA performed better than conventional CBA (p = 0.022) and tissue IFA (p = 0.006). LCFBA had the highest diagnostic accuracy and was closely followed by CBA at 1:100 dilution. GABABR-IgG AE often presents as encephalopathy with seizures or status epilepticus in the context of an underlying SCLC. Multimodal evaluation using tissue IFA and fixed CBA at higher dilutions improves detection of true cases. LCFBA performs very well as a diagnostic test with very high sensitivity and specificity.
Terrien's marginal degeneration is a rare idiopathic condition characterized by minimally symptomatic, typically bilateral peripheral corneal thinning without ulceration, accompanied by superficial neovascularization and lipid deposition. The absence of pathognomonic diagnostic criteria, along with the diversity of clinical manifestations and potential complications, can make establishing the diagnosis more difficult. This review summarizes current knowledge regarding the etiopathogenesis, clinical course, and diagnostic features of Terrien's marginal degeneration. It also discusses contemporary classifications and current approaches to differential diagnosis and treatment of the disease. Краевая дегенерация Терьена является редким идиопатическим заболеванием, которое характеризуется малосимптомным, чаще двусторонним периферическим истончением роговицы без изъязвления, неоваскуляризацией и отложениями липидов. Отсутствие патогномоничных критериев диагностики, многообразие клинических проявлений и осложнений заболевания может затруднять постановку диагноза. В связи с этим целью данной работы было обобщить современные знания об этиопатогенезе, особенностях клинического течения и диагностики краевой дегенерации Терьена. Освещены современные классификации, актуальные подходы к дифференциальной диагностике и лечению заболевания.
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Differentiating between functional and organic gastrointestinal disorders in infants and young children remains a diagnostic challenge. Faecal calprotectin (FC) has emerged as a non-invasive biomarker that can help to exclude organic pathology. This study aimed to establish age-specific reference ranges for FC in healthy Hungarian children aged 0-36 months, providing a practical tool for paediatric clinical decision-making. A total of 282 stool samples were obtained from 245 healthy children (142 boys, 103 girls). Eligibility was determined using strict inclusion criteria based on parental interviews and questionnaires. FC concentrations were measured with a single-test ELISA assay (Orgentec Sebia Diagnostika). Data analysis employed Random Forest Regression and non-parametric statistical methods, following the Clinical and Laboratory Standards Institute EP28-A3c guideline. Median FC concentrations by age group were: 0-4 months, 181 µg/g (IQR 92.5-289.6); 4-12 months, 40.6 µg/g (IQR 14.2-100.3); and 12-36 months, 24.7 µg/g (IQR 4.62-59.27). FC levels peaked in the youngest age group (0-4 months) and declined steadily thereafter, showing a consistent downward shift in both median and upper percentile values with increasing age. No significant associations were found between FC and gender, birth weight, mode of delivery or type of nutrition. This study provides age-specific reference values for FC in Hungarian children under 3 years of age. These results support the clinical use of FC testing to help exclude organic gastrointestinal disease, while emphasising the importance of appropriate test indication. The assay used proved to be reliable, minimally invasive, cost-effective and well suited for routine paediatric practice.
The relatively new test (European Patent granted 2022) for determining the total histamine degradation capacity [Totale Histamin Abbau Kapazität/Total Histamine Degrading Capacity] THAK®/THDC of a serum sample has been compared in various settings with the individual clinical history and the levels of histamine in stool. The measurement of THAK can be carried out regardless of the current status of the patient (independent of any acute symptoms), therefore THAK test is a useful and very reliable instrument for supporting the diagnosing histamine intolerance. As soon as the THAK falls below a threshold value the patient is most likely to suffer from HIT, even if the intensity of the symptoms is low. Low THAK values correspond with a significant increase of histamine in stool. Results were evaluated according to both age and gender, no difference between the sexes were found. However, there is a noticeable dependency on age, although this is not diagnostically relevant. THAK® is a registered trademark of Frost Diagnostika.
Point-of-care tests (PoCTs) enable the rapid diagnosis of sexually transmitted infections (STIs) directly at the point of care and play a central role in achieving the goals of the World Health Organization (WHO) for the global elimination of AIDS and hepatitis and the reduction of STIs by 2030.The European Union's new regulation for in vitro diagnostics raises the quality standards for PoCTs. All STI tests must now undergo more rigorous reviews. Advances in PoCT development have improved testing options for HIV, syphilis, and hepatitis C, particularly through WHO prequalified tests. However, the HIV self-tests available in Germany only detect the antibody component, which means that a negative result is only reliably conclusive 12 weeks after exposure. For syphilis, PoCTs are available for antibody screening, but these still require subsequent laboratory confirmation. For infections with chlamydia, gonococci, and mycoplasma, the quality of PoCTs is still largely inadequate. Further developments in the field of nucleic acid amplification tests (NATs) show promising approaches.PoCTs are particularly beneficial for low-threshold services aimed at marginalized groups, as they enable swift diagnosis and timely treatment within the test setting. However, challenges remain, including quality assurance and potential psychological stress due to false-positive results. There remains a need for continuous development and the integration of PoCTs into the healthcare system in order to improve access to diagnostics and to reduce the spread of infections. Point-of-Care-Tests (PoCT) ermöglichen eine schnelle Diagnostik von sexuell übertragbaren Infektionen (STI) direkt am Einsatzort und spielen eine zentrale Rolle bei der Erreichung der Ziele der Weltgesundheitsorganisation (WHO) zur globalen Eliminierung von Aids und Hepatitis sowie zur Reduzierung von STI bis 2030.Die neue Verordnung der Europäischen Union für In-vitro-Diagnostika erhöht die Qualitätsstandards für PoCT. Alle STI-Tests müssen nun einer strengeren Überprüfung unterzogen werden. Fortschritte in der PoCT-Entwicklung haben die Testmöglichkeiten für HIV, Syphilis und Hepatitis C verbessert, insbesondere durch präqualifizierte Tests der WHO. Die in Deutschland verfügbaren HIV-Selbsttests detektieren jedoch nur die Antikörperkomponente, sodass ein negatives Ergebnis erst 12 Wochen nach Exposition sicher aussagekräftig ist. Für Syphilis gibt es PoCT für das Antikörperscreening, die jedoch im Labor einer Bestätigung bedürfen. Für Chlamydien‑, Gonokokken- und Mykoplasmeninfektionen ist die PoCT-Qualität größtenteils noch unzureichend. Weiterentwicklungen im Bereich der Nukleinsäureamplifikationstests (NAT) zeigen diesbezüglich vielversprechende Ansätze.PoCT sind besonders vorteilhaft für niedrigschwellige Angebote, die sich an marginalisierte Gruppen richten, da sie eine zeitnahe Diagnosestellung und Behandlung im Rahmen des Testsettings ermöglichen. Herausforderungen bleiben jedoch die Qualitätssicherung und mögliche psychologische Belastungen durch falsch-positive Ergebnisse. Es besteht weiterhin die Notwendigkeit einer kontinuierlichen Weiterentwicklung und Integration von PoCT in das Gesundheitssystem, um den Zugang zur Diagnostik zu verbessern und die Verbreitung von Infektionen zu reduzieren.
The authors herein share their experience with surgical treatment of arteriovenous fistulas (AVF), describing standard diagnostic measures and possible methods of management of this pathology, as well as analyzing the known methods of treatment of post-traumatic AVFs in a specialized vascular hospital. To determine the most effective method of surgical treatment of patients with posttraumatic AVFs in the early period of wound disease. From 2021 to 2023, a total of 58 patients with posttraumatic AVFs of the extremities were treated in the vascular centers of the National Medical Research Center of Surgery named after A.V. Vishnevsky and National Medical Research Center of High Medical Technologies - Central Military Clinical Hospital named after A.A. Vishnevsky'. Of these, 51 (88%) patients were diagnosed as having lower-limb vascular pathology and 7 (12%) had upper-limb pathology. 29 (50%) patients underwent X-ray endovascular methods of treatment, 26 (44.8%) patients were subjected to open surgical intervention, and 3 (5.2%) victims were found to have spontaneous closure of the AVF. Endovascular methods of treatment included: implantation of stent grafts in 20 (34.5%) patients, embolization with microcoils in 7 (12%) cases, and 'multilayer' stenting of the AVF zone in 2 (3.4%). Open surgical methods of treatment were as follows: arterial prosthetic repair in 20 (34.5%) patients, ligation of the arteriovenous fistula itself in 3 (5.1%) patients, autovenous plastic surgery of the arterial defect in 1 (1.7%) case, fistula disconnection with single-suture closure of the venous wall in 1 (1.7%), and resection of the damaged segment of the popliteal artery with an end-to-end anastomosis in 1 (1.7%). During the postoperative follow-up period, 3 complications developed in each study group. After endovascular treatment, these were 'local' complications in the form of thrombosis and implant dislocation in 2 patients and a recurrence of the functioning AVF in 1 case. After open surgery: wound suppuration in 1 patient, arrosive bleeding in 1 patient (with the resulting limb amputation), and a relapse of the AVF in 1 case. Each case of posttraumatic arteriovenous fistula has an individual approach to treatment. Surgical decision-making depends on such factors as the duration of AVF, diameter, localization, level of arterialization of venous blood flow, severity of changes in the walls of the affected arteries and veins. All posttraumatic arteriovenous fistulas should be treated surgically in a specialized vascular center with all modern technologies.
Diabetes mellitus (DM) is one of the most urgent key problems of modern medicine with a steadily progressive increase in morbidity. Diabetic polyneuropathy (DPN) is a common complication of diabetes and leads to a decrease in the quality and life expectancy of patients, increases the risk of disability. The painful form of DPN has a particularly negative effect on the quality of life. The article discusses current views on the pathogenesis of DPN, risk factors, clinical manifestations and diagnostic methods of DPN. Most patients with DPN have vegetative disorders that are asymptomatic for a long time, however, the presence of which is associated with increased mortality. An integrated approach is important in the treatment of DPN, including both non-drug treatment methods (diet, lifestyle modification, exercise) and drug therapy aimed at correcting blood glucose levels and other risk factors, mechanisms of development and progression of DPN. The pathogenetic therapy of DPN includes the use of alpha-lipoic acid and benfotiamine, the effectiveness of which has been shown in clinical studies. As a universal antioxidant, alpha-lipoic acid is an absolutely safe drug with proven effectiveness in the treatment of pain DPN and can be recommended for use in clinical practice. Adjuvant analgesics are used as symptomatic therapy, namely drugs from the group of antiepileptic drugs (gabapentin, pregabalin) and antidepressants (duloxetine). Doctors' knowledge of the problem of diagnosis and treatment of DPN will make it possible to detect this disease at an early stage and effectively control the progression of symptoms. Сахарный диабет (СД) — одна из наиболее актуальных ключевых проблем современной медицины с неуклонно прогрессирующим ростом заболеваемости. Диабетическая полинейропатия (ДПН) является частым осложнением СД и приводит к снижению качества и продолжительности жизни пациентов, повышает риск инвалидизации. Особенно негативно на качество жизни влияет болевая форма ДПН. В статье обсуждаются современные представления о патогенезе ДПН, факторах риска, клинических проявлениях и методах диагностики ДПН. У большинства пациентов с ДПН имеются вегетативные нарушения, которые длительно протекают бессимптомно, однако наличие которых сопряжено с повышенной летальностью. В лечении ДПН важен комплексный подход, включающий как немедикаментозные методы лечения (диета, модификация образа жизни, физические упражнения), так и лекарственная терапия, направленная на коррекцию уровня глюкозы в крови и других факторов риска, механизмы развития и прогрессирования ДПН. К патогенетической терапии ДПН относятся применение альфа-липоевой кислоты (АЛК) и бенфотиамина, эффективность которых была показана в клинических исследованиях. Как универсальный антиоксидант АЛК является абсолютно безопасным препаратом с доказанной эффективностью при лечении болевой ДПН и может быть рекомендована к применению в клинической практике. В качестве симптоматической терапии используются адъювантные анальгетики, а именно препараты из группы противоэпилептических препаратов (габапентин, прегабалин) и антидепрессантов (дулоксетин). Знания врачей о проблеме диагностики и лечения ДПН позволят выявлять это заболевание на ранних стадиях и эффективно контролировать прогрессирование симптомов.
The enzyme-linked immunosorbent spot (EliSpot) assay and its fluorescence-based version, FluoroSpot, are sensitive immunoassays commonly used to quantify antigen-specific T and B lymphocytes and other immune cells in peripheral blood or homogenized tissues. Due to their high sensitivity, these assays are popular in clinical trials to evaluate the efficacy of immunotherapy and vaccines, which involve a high level of scrutiny to ensure valid study results. Besides industry consensus white papers and other research publications, there is no formal guidance for the industry on how to validate EliSpot and FluoroSpot assays to ensure their accurate performance for immune monitoring in clinical trials. Herein, we describe a comprehensive in vitro study using healthy human donor peripheral blood mononuclear cells (PBMCs) and model antigens to validate a double-color FluoroSpot assay for monitoring antigen-specific lymphocytes by detecting and quantifying IFN-γ and IL-2-producing lymphocytes. Validation parameters, acceptance criteria set-up, and assay limits-limit of detection (LOD), minimum positive control response, lower and upper limits of quantification (LLOQ and ULOQ)-were determined, and assay performance was demonstrated by assessing precision, specificity, linearity, and robustness. In addition, an inter-laboratory comparison demonstrated concordance between assay results from two laboratories. In summary, this study outlines a robust approach to EliSpot and FluoroSpot validation and demonstrates that the IFN-γ/IL-2 FluoroSpot assay is suitable for the reliable detection of antigen-specific immune responses from PBMC samples across laboratories and meets the current regulatory requirements for bioanalytical method validation.
The literature review analyzes modern concepts of attention deficit hyperactivity disorder (ADHD), the relevance of timely detection of the disease. A working classification is presented, dominant comorbid syndromes, anxiety, sleep disorders, autism are described. The possibilities of detecting the disease through parent-teacher questionnaires are considered. Age-related features of ADHD, gender differences are noted, the results of short-term and long-term courses of atomoxetine use are summarized, the results of randomized studies on the positive effect of the drug on the socialization of patients, academic performance and the possibility of correcting comorbid anxiety syndromes, autistic disorders and syncopal states are presented. In domestic practice of ADHD therapy, Atomoxetine it is a first-line drug. В обзоре литературы анализируются современные представления о синдроме дефицита внимания с гиперактивностью (СДВГ), показана актуальность своевременного выявления заболевания. Представлена рабочая классификация СДВГ, описаны доминирующие коморбидные синдромы (тревожность, нарушения сна, аутизм). Рассмотрены возможности выявления заболевания путем анкетирования «родитель — учитель». Отмечены возрастные особенности СДВГ, гендерные различия, обобщены результаты краткосрочных и долговременных курсов применения атомоксетина, приведены результаты рандомизированных исследований о положительном действии препарата на социализацию пациентов, академическую успеваемость и возможности коррекции коморбидных синдромов тревожности, аутистических расстройств и синкопальных состояний. Атомоксетин в отечественной практике терапии СДВГ является препаратом первой линии.
The aim of the study is differential diagnosis of primary chronic osteomyelitis (PCO) and fibrous dysplasia (FD) of the mandible. A retrospective comparative study of the case histories of 36 patients with PCO (average age 8.9 years) and 12 patients with FD (average age 8.5 years) who were treated at the Department of Maxillofacial surgery of the RCCH in the period from 2015 to 2023 was conducted. The features of clinical manifestations were evaluated: pain, swelling of soft tissues, trismus of the masticatory muscles, bone deformity, numbness of the lips, increased skin temperature in the area of lesions. The condition of the bone structures was assessed according to both panoramic radiographs and computed tomography (CT) scans. The bone structure, involvement of the condyle of the mandible, tooth displacement, displacement and width of the mandibular canal were evaluated. Both study groups were dominated by girls (PCO 1:2.6; FD 1:1) and unilateral jaw lesion (PCO 1:1.31; PD 1:1.4). Patients with PCO mainly complained of pain (94.4%), soft tissue edema (100.0%) and masticatory muscle trismus (100%), while patients with FD had no pain and an increase in volume of bone (83.3%) without trismus. Computed tomography of patients with PCO showed the formation of the subcortical bone, lysis of the cortical layer, dilation of the mandibular canal on the affected side, whereas in patients with FD, moderate or pronounced bone swelling, a well-defined cortical layer, displacement of teeth and the mandibular canal from the node of FD were mainly observed. The data obtained emphasize the importance of clinical and radiological signs in various diseases. Pain, edema, formation of the subcostal bone, unilateral expansion of the mandibular canal, the clarity of the boundary of the cortical and medulla and the continuity of the cortical bone are the key points allowing for the differential diagnosis of these conditions. Проведение дифференциальной диагностики первично-хронического остеомиелита (ПХО) и фиброзной дисплазии (ФД) нижней челюсти. Проведено ретроспективное сравнительное исследование данных историй болезни 36 пациентов с ПХО (средний возраст 8,9 года) и 12 пациентов с ФД (средний возраст 8,5 года), получавших лечение в отделении челюстно-лицевой хирургии РДКБ в период с 2015 по 2023 г. Оценивали особенности клинических проявлений: боли, отека мягких тканей, тризма жевательных мышц, костной деформации, онемения губ, повышения температуры кожи в области очагов поражения. Состояние костных структур оценивали по данным как панорамных рентгенограмм, так и компьютерной томографии (КТ). Оценивали структуру кости, вовлечение мыщелкового отростка нижней челюсти, смещение зубов, смещение и ширину нижнечелюстного канала. В обеих группах исследования преобладали девочки (ПХО 1:2,6; ФД 1:1) и одностороннее поражение челюсти (ПХО 1:1,31; ФД 1:1,4). Пациенты с ПХО в основном предъявляли жалобы на боль (94,4%), отек мягких тканей (100%) и тризм жевательных мышц (100%), в то время как у пациентов с ФД боль отсутствовала и наблюдалось увеличение объема нижней челюсти (83,3%) без тризма. По данным КТ у пациентов с ПХО выявлены образование поднадкостничной кости, лизис кортикального слоя, расширение нижнечелюстного канала на стороне поражения, тогда как у пациентов с ФД в основном наблюдали умеренное или выраженное вздутие кости, хорошо отграниченный кортикальный слой, смещение зубов и нижнечелюстного канала в зависимости от расположения зоны поражения. Полученные данные подчеркивают важность клинических и рентгенологических признаков при различных заболеваниях. Боль, отек, образование поднадкостничной кости, одностороннее расширение нижнечелюстного канала, четкость границы коркового и мозгового вещества и непрерывность кортикальной кости являются ключевыми признаками, позволяющими проводить дифференциальную диагностику этих состояний.