PurposeTo define the clinical characteristics and to analyse the factors predicting visual acuity in eyes with central serous chorioretinopathy (CSCR) with subfoveal leak.MethodsThis was a multicentric, retrospective, observational comparison of CSCR eyes with subfoveal versus extrafoveal leak, with secondary analysis identifying predictors of 12-month best corrected visual acuity (BCVA) within the subfoveal group.ResultsA total of 134 eyes of 134 patients (113 males and 21 females) with a mean age of 49.6 ± 11.1 years, were included. The median duration of symptoms before presentation was two months. The leak was subfoveal in 50 eyes and extrafoveal in 84 eyes. The duration of symptoms was significantly higher in eyes with extrafoveal leak, than subfoveal leak group (p = 0.01). Eyes with subfoveal leak had higher Haller vessel/choroidal thickness ratio at fovea at baseline. BCVA at one year was similar in both cohorts. On linear regression analysis, factors affecting poor visual acuity at 1 year in eyes with subfoveal leak were greater duration of symptoms, complex CSCR at presentation, history of persistence/recurrences, higher number of leaks, focal retinal pigment epithelium (RPE) atrophy areas, and more months waited before treatment initiation.ConclusionsPatients with CSCR and subfoveal leaks presented earlier and showed a higher baseline Haller to choroidal thickness ratio at the fovea than those without. Although 1-year visual outcomes were similar to extrafoveal leaks, worse BCVA in the subfoveal leak group was associated with complex, persistent or recurrent disease, focal RPE atrophy, longer symptom duration, multiple leaks, and delayed treatment initiation.
The 3' untranslated region of mRNAs are involved in post-transcriptional control, influencing mRNA stability, localization, and translation efficiency through its interaction with various proteins and RNAs. While eukaryotic 3' UTRs are typically several hundred nucleotides long, certain protozoan species possess remarkably short 3' UTRs and have evolved alternative genetic codes where canonical stop codons are reassigned to sense codons. This suggests a potential link between 3' UTR architecture and the efficiency of translation termination. In this study, we investigate how the length and secondary structure of the 3' UTR modulate translation termination efficiency across different species. We demonstrate that shortening of structured 3' UTRs confer a translational advantage for mRNAs bearing UAA stop codons. Using purified pre-termination complexes, we show that 3' UTR secondary structures enhance the termination rate by facilitating the spatial proximity of PABP (bound to the poly(A) tail) to eRF3a on the ribosome. Furthermore, we found that the termination rate at UGA stop codons is highly sensitive to 3' UTR length when assayed with both human and ciliate release factors. Our investigation of stop codon reassignment underscores the primary role of release factor recognition efficiency in this process. Collectively, our findings reveal a dual regulatory mechanism: while long, structured 3' UTRs can sterically hinder stop codon recognition, they simultaneously promote eRF3a-PABP interactions that facilitate the recruitment of release factors to the ribosome. This work establishes 3' UTR length as a key cis-regulatory factor fine-tuning the fundamental process of translation termination.
The CVMPO criteria were developed to standardize critical quality steps during laparoscopic inguinal hernia repair. However, consistent intraoperative compliance remains challenging, particularly during prolonged or technically difficult procedures, or under cognitive fatigue. Checklist-based approaches may be difficult to recall and apply in real time. A prospective observational study included 211 consecutive laparoscopic inguinal hernia repairs performed using a standardized technique. An original spatial cognitive framework, the V-M Pathway, mapping CVMPO criteria onto the laparoscopic view of the inguinal region, was applied as a deliberate intraoperative pause before mesh placement. Time required to verbally recall all nine CVMPO criteria was measured intraoperatively. All procedures were routinely recorded in full from the beginning to the end of the operation. Surgeon-identified corrective actions prompted by CVMPO recall were documented during the procedure. The time required to implement corrective actions was determined postoperatively based on independent review of the complete operative video recordings. All procedures underwent post hoc video verification to confirm objective adherence to the CVMPO criteria. Complete recall of all nine CVMPO criteria using the V-M Pathway was achieved in all procedures, with a median recall time of 58 s (IQR 52-64). Intraoperative recall prompted corrective actions in 20.4% of cases. Among procedures requiring corrective actions, the median time required to complete all corrections was 46 s (IQR 38-81). Independent video review confirmed complete adherence to all CVMPO criteria in 97.2% of procedures. Mesh placement was performed only after CVMPO confirmation in all cases. The V-M Pathway supported rapid intraoperative recall of CVMPO criteria, prompted timely corrective actions, and was associated with high video-verified adherence to predefined quality criteria. Importantly, the additional time required for recall and corrective actions represented only a small fraction of total operative time, suggesting that integration of the pathway is feasible without major workflow disruption. This simple spatial cognitive aid may support intraoperative verification of quality criteria during laparoscopic inguinal hernia repair without disrupting operative workflow.
Probiotics, defined as live microorganisms that confer health benefits on the host, are sensitive to environmental stresses. However, the stability of Lactobacillus casei during spray freeze drying (SFD) under different encapsulation conditions has not been thoroughly investigated. In various concentrations, the influence of three natural polymers, sodium alginate, xanthan gum, and chitosan, is evaluated on the stability and physicochemical properties of SFD-processed Lactobacillus casei powder at different storage temperatures, 4 °C, 25 °C, and 40 °C, for 90 days, as well as probiotic stability in simulated gastric and bile-containing media. In addition, the particles' physicochemical properties are evaluated by tap density, FTIR, SEM, and DSC analysis. Probiotic microparticles after SFD are composed of a highly porous amorphous phase of polymers and various polymorphous structures of sucrose. Data shows that bacterial viability exceeds 90% immediately after SFD when low sodium alginate or xanthan gum concentrations were used. In addition, chitosan negatively impacts probiotic viability. However, applying a higher polymer ratio is problematic in long-term storage and contact with gastric fluid.
In this study, the coelomic fluid of Eisenia fetida/ andrei species was used for the first time to prepare an anti-aging serum, and its antioxidant and antibacterial properties were investigated. In addition, its cytotoxicity on mouse fibroblast cells was measured as material for the production of natural anti-aging products. This study investigates the antibacterial, antioxidant, and cytotoxic properties of coelomic fluid extracted from Eisenia fetida/andrei. Earthworms were cultured for a year, and their coelomic fluid was extracted using an electroshock method, sterilized, and lyophilized into powder. Antibacterial activity was tested against Escherichia coli and Staphylococcus aureus using MIC assays. Antioxidant properties were evaluated using the DPPH radical scavenging assay. Cytotoxicity effects on L929 and NHEK cell lines were assessed using MTT assays. Oxidative stress and enzymatic activities were analyzed by measuring malondialdehyde (MDA) levels and catalase activity in NHEK cells treated with coelomic fluid. A serum formulation incorporating coelomic fluid was prepared and subjected to stability tests, including pH, temperature, mechanical, and heavy metal residue analysis. Antibacterial and antioxidant properties of the serum were also evaluated. Statistical analyses were conducted using SPSS software (version 0.26). Results highlight the multifunctional potential of coelomic fluid for biomedical and cosmetic applications. Coelomic fluid exhibited antibacterial activity with MICs of 0.15 mg/mL for both E. coli and S. aureus, showing significant inhibition at higher concentrations. Ciprofloxacin and penicillin demonstrated stronger effects compared to the coelomic fluid. Antioxidant activity increased with concentration, achieving 77% inhibition at 10 mg/mL, with an IC50 of 10.67 mg/mL. Cytotoxicity analysis revealed no significant toxicity below 20 mg/mL, with enhanced cell viability at 2.5-5 mg/mL and restorative effects on fibroblasts at 10 mg/mL. Oxidative stress assays indicated reduced lipid peroxidation and increased catalase activity without inducing significant oxidative stress. Measurement of residues of mercury and lead in the sera showed that they were less than 0.01 ppm for mercury and less than 0.03 and 0.05 ppm for lead, respectively. These levels are below the U.S. Food and Drug Administration's approved limits for these metals. Aqueous serum containing coelomic fluid showed similar antibacterial and antioxidant properties, emphasizing its potential for cosmetic and pharmaceutical applications. These results show that the use of earthworm coelomic fluid in skin care serum slows the aging process and restores damaged cells. The results of the present study can be considered as a patent.
Diabetic retinopathy (DR) is a leading cause of vision loss in patients with diabetes mellitus (DM). Hypoxia-driven overexpression of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1α (HIF-1α) is central to diabetic retinopathy (DR) pathogenesis. The use of cellular protein kinase inhibitors is a promising approach for correcting pathological changes in DR. To determine the effect of pharmacological blockade of cellular protein kinases with sorafenib on the expression of VEGF and HIF-1α in the retina in experimental diabetic retinopathy. Diabetes mellitus (DM) was induced in male rats by administration of streptozotocin (50 mg/kg). Animals were divided into three groups: in group 1 (n=15) rapid-acting insulin at a dose of 30 U was injected intraperitoneally, in group 2 (n=15) insulin was combined with sorafenib (per os 200 mg), and in the control group (n=15) no treatment of hyperglycemia was performed. 5 animals were used to obtain baseline data (intact). The drugs were administered every other day, starting from day 7 after streptozotocin injection, for 3 months. Immunohistochemical studies were performed using monoclonal mouse antibodies against VEGF. Sections were additionally stained with hematoxylin. The content of VEGF and HIF-1α in retinal tissue lysates was determined by Western blotting. Membranes with proteins were incubated with monoclonal antibodies against VEGF and HIF-1α. After the initial incubation, the membranes were washed and treated with anti-species secondary antibodies conjugated to horseradish peroxidase. Statistica 10 software was used for statistical analysis. Descriptive statistics were calculated, including means and their standard errors. Sample averages were compared using analysis of variance (ANOVA), with p-values less than 0.05 considered statistically significant. Under the conditions of experimental DR, the content of VEGF in retinal tissues increased significantly and after 3 months of observation increased 6,8-fold for the dimeric form and 27.1-fold for the monomeric form (p<0,05) compared to intact animals. Under the same conditions, the level of HIF-1α was also significantly increased (39.6-fold; p<0.05). When insulin was administered, the content of VEGF fractions in the retina decreased by an average of 1,4-1,5 times (p<0,05), and the heterogeneity of the response to its administration was observed. The use of sorafenib with insulin in all cases blocked the increase in VEGF content caused by DR. Insulin administration reduced HIF-1α levels by 1,4-fold (p<0,05) compared to the control, whereas combined sorafenib and insulin treatment reduced HIF-1α expression to undetectable levels. Immunohistochemical examination revealed a progressive increase in the intensity of VEGF-positive staining in the retina during experimental DR, as well as the development of its degenerative changes - edema, ischemia, pathological angiogenesis, neurodegeneration, and disruption of retinal layer organization. The use of insulin did not cause changes in the retinal pattern, whereas the combined use of sorafenib and insulin prevented the development of both morphological signs of DR and an increase in the intensity of VEGF-positive staining. The significance of VEGF and HIF-1α upregulation in the pathogenesis of DR and the effectiveness of their correction by pharmacological blockade of cellular protein kinases with sorafenib have been established.
Tumor thrombus extending into the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC), particularly at Mayo levels III and IV, presents a major surgical challenge. Although systemic treatments are evolving, surgery remains the mainstay of management. The role of cardiopulmonary bypass (CPB) in this setting is not clearly defined. We retrospectively analyzed 20 patients with RCC and Mayo level III-IV IVC tumor thrombus who underwent radical nephrectomy with IVC thrombectomy at our center between 2017 and 2024. Preoperative workup included MRI, contrast-enhanced CT, and transthoracic/transesophageal echocardiography. CPB was used selectively in five patients with tumor extension into and adherence to the right atrium. Postoperative complications were classified using the Clavien-Dindo system. Survival was assessed with Kaplan-Meier analysis and Cox regression. Median age was 61 years (IQR 51-72), and 70% were male. Level IV thrombus was present in 60% of patients, and 40% had distant metastases. Median operative time was 370 minutes and median blood loss was 2,500 mL. Postoperative complications occurred in 20% of patients, with one in-hospital death (5%). Median hospital stay was 11 days. The 1-, 3-, and 5-year overall survival rates were 66.7%, 41.6%, and 34.6%, respectively. Distant metastases were associated with lower survival (HR 2.48; p = 0.005), while immuno-targeted therapy improved outcomes (HR 0.69; p = 0.035). Radical nephrectomy with IVC thrombectomy in patients with advanced tumor thrombus can be performed safely with good long-term outcomes in selected cases. Careful preoperative imaging, intraoperative echocardiography, and the selective use of CPB are key to minimizing risks. These findings support a tailored surgical approach based on thrombus level and clinical condition. Further prospective studies are needed to refine surgical indications and clarify the role of systemic therapy.
To evaluate the effect of suction direction on zonular fibers' mechanical behavior using finite element modeling. Laboratory study. 3D finite element model experimental study. A 3D finite element model was developed, including nucleus covered by cortex and capsule. Similar to cataract surgery, a circular rapture was considered at the top of the capsule to apply suction pressure. Finally, zonular fibers were modeled as a continuum body using 3D solid elements (C3D8R). A custom FORTRAN subroutine was implemented to enforce tension-only behavior, mimicking the physiological characteristics of the zonular fibers, which are resistant to tensile but not compressive loads. This method allows for a realistic simulation of zonular mechanics during cortical aspiration. The suction processes in tangential and normal angles were simulated. The resulting relative displacements between the cortex and capsule, as a criterion of cortex separation, vs the resulting maximum zonule displacements, were recorded in each model. The cortex-capsule relative displacement vs maximum zonule displacement indicated a diagram slope of 0.09 for tangential applying pressure and 0.02 in the case of applying normal pressure. The results illustrated that zonular fibers were less tensile in a specific magnitude of cortex-capsule relative displacement under tangential applying pressure, which means that eye zonular fibers have a lower risk of failure until the separation of the lens cortex.
Myocardial infarction (MI) is an emergency situation, perceived as a unique experience by both the patient and their companion. This study aims to explore the experiences of patients and their companions throughout all stages of myocardial infarction management. A descriptive qualitative design was employed in this study. Nineteen participants, including 13 patients with a confirmed MI diagnosis and 6 companions, were selected through purposive sampling from a hospital in northeastern Iran. In-person, semi-structured interviews with open-ended questions were conducted, transcribed verbatim, and analyzed using the conventional qualitative content analysis approach. The study revealed key categories in participants' experiences before and after their MI. These included "overlooking health risks" due to neglect and misunderstanding of health, and "harmful hesitation" characterized by delays in seeking medical help, often due to denial and self-treatment. Participants also delayed in "understanding the definitive risk", which led to worsened symptoms. "Missed golden time due to system-level delays" highlighted diagnostic and treatment delays, while a greater "realization of the importance of adherence" to a healthy lifestyle was reported post-MI. The role of companions was also pivotal in influencing patient management and treatment. Delays in recognizing MI symptoms were influenced by lack of health awareness, hesitation, and healthcare inefficiencies, leading to worsened outcomes. Improving public health education, awareness of MI symptoms, and healthcare responsiveness can reduce these delays. Additionally, the support of companions plays a critical role in ensuring timely medical intervention.
Isotretinoin, or 13-cis retinoic acid, is prescribed to treat moderate to severe recalcitrant nodulocystic acne that remains untreated with other drugs, such as antibiotics. The adverse effect profile of isotretinoin has raised concerns since studies have reported a substantial elevation in the low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio, indicating the risk of cardiovascular diseases after a long-term course of isotretinoin. Assessing the impact of isotretinoin on lipid profile markers in acne patients was the aim of this systematic review. Various databases, such as PubMed, Google Scholar, SCOPUS, Embase, and Web of Science, were comprehensively searched to identify relevant clinical studies. Ten articles out of 256 were selected based on the inclusion and exclusion criteria by two independent reviewers. Each review was thoroughly evaluated using Assessment of the Methodological Quality of Systematic Reviews and the Newcastle-Ottawa Scale. A decrease in HDL was observed, whereas total cholesterol, triglyceride, and LDL levels were notably elevated. However, most changes in lipid profile parameters are non-progressive, and their clinical significance is poorly understood. Liver enzyme levels, including aspartate transaminase and alanine transaminase, were altered to a lesser degree. Long-term use of isotretinoin is associated with mild alterations in the lipid profile, resulting in increased total cholesterol, triglyceride, and LDL levels. However, since lipid alterations vary depending on factors such as the population studied, dosage, and duration of isotretinoin treatment, regular monitoring of the lipid profile along with low density lipoprotein is recommended to avoid potential risk factors of isotretinoin on lipid metabolism and, thereafter, on the cardiovascular system, but is not deemed paramount.
Safety is of critical importance to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This global consensus statement provides guidance on how to optimise the safety of CTO) PCI, addressing the following 12 areas: 1. Set-up for safe CTO PCI; 2. Guide catheter--associated vessel injuries; 3. Hydraulic dissection, extraplaque haematoma expansion, and aortic dissections; 4. Haemodynamic collapse during CTO PCI; 5. Side branch occlusion; 6. Perforations; 7. Equipment entrapment; 8. Vascular access considerations; 9. Contrast-induced acute kidney injury; 10. Radiation injury; 11 When to stop; and, 12. Proctorship. This statement complements the global CTO crossing algorithm; by advising how to prevent and deal with complications, this statement aims to facilitate clinical practice, research, and education relating to CTO PCI.
Belantamab mafodotin had single-agent activity in patients with relapsed or refractory multiple myeloma, a finding that supports further evaluation of the agent in combination with standard-care therapies. In this phase 3, open-label, randomized trial, we evaluated belantamab mafodotin, bortezomib, and dexamethasone (BVd), as compared with daratumumab, bortezomib, and dexamethasone (DVd), in patients who had progression of multiple myeloma after at least one line of therapy. The primary end point was progression-free survival. Key secondary end points were overall survival, response duration, and minimal residual disease (MRD)-negative status. In total, 494 patients were randomly assigned to receive BVd (243 patients) or DVd (251 patients). At a median follow-up of 28.2 months (range, 0.1 to 40.0), median progression-free survival was 36.6 months (95% confidence interval [CI], 28.4 to not reached) in the BVd group and 13.4 months (95% CI, 11.1 to 17.5) in the DVd group (hazard ratio for disease progression or death, 0.41; 95% CI, 0.31 to 0.53; P<0.001). Overall survival at 18 months was 84% in the BVd group and 73% in the DVd group. An analysis of the restricted mean response duration favored BVd over DVd (P<0.001). A complete response or better plus MRD-negative status occurred in 25% of the patients in the BVd group and 10% of those in the DVd group. Grade 3 or higher adverse events occurred in 95% of the patients in the BVd group and 78% of those in the DVd group. Ocular events were more common in the BVd group than in the DVd group (79% vs. 29%); such events were managed with dose modifications, and events of worsening visual acuity mostly resolved. As compared with DVd therapy, BVd therapy conferred a significant benefit with respect to progression-free survival among patients who had relapsed or refractory multiple myeloma after at least one line of therapy. Most patients had grade 3 or higher adverse events. (Funded by GSK; DREAMM-7 ClinicalTrials.gov number, NCT04246047; EudraCT number, 2018-003993-29.).
Gastric carcinoma is the fifth most common and the third leading cause of cancer deaths worldwide. The incidence of diffuse-type gastric cancer, of which signet ring cell carcinoma is a subtype, is rising in the world. Due to non-specific gastritis-like symptoms, difficulty in assessing true tumor characteristics owing to its horizontal spread, and non-distinguishable endoscopic appearance from other gastric pathologies, the diagnosis of this subtype is challenging. We present a case of a 67-year-old woman with progressively worsening abdominal pain who came for an endoscopic ultrasound evaluation of an incidentally noted pancreatic cyst on a previous MRI. During endoscopy, a 1-cm gastric ulcer was noted along the lesser curvature of the gastric body. Biopsy confirmed a diagnosis of gastric signet ring cell carcinoma (SRCC) with CDX-2 and keratin positivity. The patient underwent total gastrectomy with Roux-en-Y reconstruction. Gross specimen revealed a diffuse SRCC invading the muscularis propria, along with lymphovascular and perineural invasion. In the context of our case, we discuss the morphological features of SRCC and the effectiveness of treatment options based on existing literature. Early accurate diagnosis and staging play an important role in determining treatment options as well as the clinical course of gastric SRCC.
The case highlights an unusual presentation where sleep issues preceded psychotic symptoms, implying link between disrupted sleep and psychosis onset. Earlier symptoms were viewed as depression but may have signaled psychosis exacerbated by insomnia. Sleep disorders, prevalent yet frequently overlooked in individuals with psychotic disorders, have significant associations with the onset and severity of psychosis. Here we describe the case of a patient who first presented with insomnia, but whose condition improved with the use of risperidone and was diagnosed with first-episode psychosis. Multiple studies emphasize the critical relationship between sleep disturbances and psychosis, particularly in the lead-up to first-episode psychosis. Structural abnormalities in the brain, notably the thalamus, combined with neurotransmitter imbalances involving dopamine and acetylcholine, seem pivotal in this interrelation. The connection between dopamine, sleep disturbances, and psychosis, specifically the role of D2 dopamine receptors, highlights a potential pathway bridging sleep irregularities with psychosis. The study underscores the need for further research to delineate the relationship between sleep disturbances and psychosis and to assess the efficacy of various therapeutic interventions targeting both conditions.
The Scottish doctor Robert Erskine (1677-1718) became Chief Doctor of Russia and personal physician to Tsar Peter the Great. Extensive archival material documents his remarkable career. From schooling in the village of Alva and apprenticeship to an Edinburgh apothecary, he went on to study medicine in Paris and Utrecht and was admitted to the Royal Society in London. Recruited into the service of the Tsar, to whom he became a trusted friend and counsellor, Erskine played a central role in the modernisation of Russian medicine, pharmacy and natural science in the early 18th century. His untimely death at age 41 was marked with a state funeral in St Petersburg. Some historians in Russia assert that in their country, the development of medicine and the natural sciences took place without the transitional stages of iatrochemistry and iatrophysics which characterised the shift in scientific thinking throughout Europe in the early modern period. This study of archival records shows that Erskine held iatrophysical and iatrochemical views in common with his European contemporaries. His influence ensured that Russia was thoroughly involved in European developments in science and medicine in the 18th century.
The most frequent hyperglycemic emergency and the leading cause of death in people with diabetes mellitus is diabetic ketoacidosis (DKA). DKA is common in people with type 1 diabetes, while type 2 diabetes accounts for roughly one-third of occurrences. Although DKA mortality rates have generally decreased to low levels, they are still significant in many underdeveloped nations. In industrialized countries, its mortality rate ranges from 2 to 5%, but in underdeveloped nations, it ranges from 6 to 24%. Therefore, it is always lethal if misdiagnosed or improperly treated. According to specific research, DKA can be present at the time of type 1 diabetes onset in 25 to 30% of cases and in 4 to 29% of young people with type 2 diabetes mellitus, and its features include hyperglycemia, metabolic acidosis, and ketosis with its triggering factors commonly being infections, newly discovered diabetes, and failure to start insulin therapy. Less than 20% of DKA patients present comatose, and patients with different levels of consciousness can present at other times. A close association between abnormalities found during a mental status evaluation and osmolality seems to exist. Hospital admission is necessary for vigorous intravenous fluid therapy, insulin therapy, electrolyte replacement, diagnosis and treatment of the underlying triggers, and routine monitoring of the patient's clinical and laboratory conditions to manage DKA properly. Appropriate discharge plans should include actions to prevent a DKA recurrence and the proper selection and administration of insulin regimens.
The article summarizes data on many years of versatile research on the problem of chronic tonsillitis, which were conducted at the Department of Otorhinolaryngology named after acad. B.S. Preobrazhensky Medical Faculty of the Russian National Research Medical University N.I. Pirogov. The research results are presented in the context of the history of the department and the formation of the problem of chronic tonsillitis. В статье обобщены данные о многолетних разносторонних исследованиях, посвященных проблеме хронического тонзиллита, которые проводились на кафедре оториноларингологии имени акад. Б.С. Преображенского лечебного факультета РНИМУ им. Н.И. Пирогова. Результаты исследований представляются в контексте истории кафедры и становления проблемы хронического тонзиллита.
The article is devoted to the history of the formation and development of the department of forensic medicine named after P.A. Minakov of the medical faculty of the Pirogov russian national research medical university for 115 years. Periodicity of the development of directions in the field of scientific research, the organization of teaching, expert and public activities of the Moscow school of forensic doctors and the invaluable contribution of the heads of the department in each of the periods are shown. Статья посвящена истории становления и развития кафедры судебной медицины им. П.А. Минакова лечебного факультета РНИМУ им. Н.И. Пирогова за 115 лет. Показана периодичность развития направлений в области научных исследований, постановки преподавания, экспертной и общественной деятельности московской школы судебных медиков и вклад заведующих кафедрой в каждый из периодов ее существования.
Antioxidants may have positive impact on diabetic polyneuropathy (DPN), presumably due to alleviation of oxidative stress. We aimed to evaluate the efficacy and safety of combination of antioxidants: succinic acid, inosine, nicotinamide, and riboflavin (SINR) in the treatment of DPN. In a double-blind, placebo-controlled clinical trial, men and women aged 45-74 years with type 2 diabetes and symptomatic DPN, with initial Total Symptom Score (TSS) ˃5, were randomized into experimental (n=109) or placebo (n=107) group. Patients received study medication/placebo intravenously for 10 days, followed by oral administration for 75 days. Statistical significance was defined as a two-tailed p<0.05. In SINR group, mean TSS change after 12 weeks was -2.65 (±1.46) vs -1.73 (±1.51) in the placebo group (p<0.0001; t-test). Reduction of symptoms in the SINR group was achieved regardless of hemoglobin A1c levels, but better results were observed in patients with initial TSS <7.5. The analysis of TSS subscores revealed statistically significant between-group differences by dynamics of the intensity of paresthesia and of numbness starting from day 11 (p=0.035 and p=0.001, respectively; mixed model); by day 57, statistically significant between-group differences were detected also by dynamics of burning intensity (p=0.005; mixed model). Study limitations are small effect size, moderate proportion of patients with severe DPN symptoms, subjective assessment of outcomes, exclusion of participants who received injectable glucose-lowering medications other than insulins, and patients with uncontrolled and type 1 diabetes. The combination of SINR effectively alleviates DPN symptoms in patients with type 2 diabetes. ClinicalTrials.gov Registry (NCT04649203; Unique Protocol ID: CTF-III-DM-2019).
When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients. This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile - 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results. A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too. Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.