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Optimizing V-NOTES hysterectomy: a comparative analysis of GelPoint and Glove techniques
No full textObjectives: Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) has emerged as a minimally invasive approach for hysterectomies, offering improved outcomes and patient satisfaction. Various techniques, including the GelPoint® and Glove methods, are used during V-NOTES procedures, each with potential advantages and drawbacks.
This study aims to compare the effectiveness of the GelPoint® and Glove techniques in V-NOTES hysterectomy surgeries by evaluating their impact on surgical outcomes, complication rates, operative time, patient satisfaction, aesthetic results, and costs.
This is a retrospective study analyzing data from patients who underwent V-NOTES hysterectomy between 2022 and 2024.
Material and methods: A total of 60 patients were included, divided into two groups based on the technique used: GelPoint (n = 30) and Glove (n = 30). Data on operative time, intraoperative and postoperative complications, hospital stay duration, aesthetic satisfaction, and costs were collected retrospectively.
Results: The mean operative time was significantly shorter in the GelPoint group (85 ± 12 minutes) compared to the Glove group (102 ± 15 minutes, p < 0.01). Postoperative complication rates were also lower in the GelPoint group (7%) than in the Glove group (15%, p < 0.05). The material cost for the Glove technique was 200 USD, whereas for the GelPoint technique, it was 500 USD.
Conclusions: Both GelPoint and Glove techniques are safe and effective for V-NOTES hysterectomies. The GelPoint technique is associated with shorter operative times and fewer complications, whereas the Glove technique provides a more cost-effective solution
Prolactin's diverse physiological roles and the clinical significance of hyperprolactinemia
No full textObjectives: This review aims to provide a comprehensive overview of prolactin biology, encompassing its molecular heterogeneity, neuroendocrine regulation, and multifaceted roles in human health and disease, focusing on hyperprolactinemia.
Material and methods: A comprehensive literature search was conducted to identify relevant articles on prolactin biology, physiology, and related disorders.
Results: Prolactin exists in various molecular forms, including monomeric prolactin, 'big prolactin', and macroprolactin, each with distinct biological activities. Prolactin secretion is tightly regulated by a complex interplay of hypothalamic factors, primarily dopamine and thyrotropin-releasing hormone (TRH). Prolactin exerts diverse physiological effects, including roles in lactation, reproduction, metabolic homeostasis, immune function, and neuroprotection. Dysregulation of prolactin secretion, particularly hyperprolactinemia, can lead to significant clinical manifestations. Accurate diagnosis of hyperprolactinemia requires a thorough evaluation of potential etiologies, including pituitary adenomas, medications, and systemic diseases. Management strategies encompass pharmacological therapies, such as dopamine agonists and surgical interventions.
Conclusions: Prolactin is a multifaceted neuroendocrine hormone with a diverse range of physiological functions and clinical implications. Understanding the complexities of prolactin biology is essential for recognizing and managing prolactin-related disorders, such as hyperprolactinemia, and for developing novel therapeutic strategies that target prolactin signaling pathways
Quality of bag-valve-mask ventilation in adults: a comparison of paramedic and nurse performance
No full textINTRODUCTION: Oxygen delivery is an essential skill required for healthcare providers. The quality of ventilation affects patient survival. The purpose of this study was to analyze the quality of manual ventilation delivered with a bag-valve-mask (BVM) device by paramedics and nurses in relation to their clinical experience and self-assessment. MATERIAL AND METHODS: A prospective experimental comparative simulation study was designed. Two hundred healthcare workers were invited (100 paramedics and 100 nurses) to manage an adult respiratory arrest scenario and perform a 4-minute manual ventilation cycle. Ventilation parameters were assessed with SimMan 3G human patient simulator. Data on demographics, occupation, clinical experience, and self-assessment of conducted ventilation were collected through a questionnaire. RESULTS: Statistically significant differences in gender distribution across professions (p < 0.001), relationship between experience and occupation (p = 0.018), and frequency of ventilation within a year (p < 0.001) were observed. The median value for self-assessment in skills was 3 for nurses and 4 for paramedics. The average tidal volume in nurses was 394.6 mL and 390.1 mL in the paramedics group (p = 0.674). The mean ventilation rate was 10.4 bpm and 8.9 bpm respectively (p = 0.013). Only 4% of nurses and 1% of paramedics met the European Resuscitation Council (ERC) 2021 guidelines for manual ventilation. A statistically significant correlation was found between ventilation parameters and professional experience. More experienced providers tended to ventilate faster (R = 0.158, p = 0.025) and with a higher volume (R = 0.265, p < 0.001). CONCLUSIONS: Despite ventilations being performed by experienced personnel, ERC guidelines were met incidentally. It is recommended to pay more attention to BVM ventilation training even among experienced staff
Pharmacological pain management approach for children in the emergency settings: a systematic review
No full textBackground: In emergency settings, prompt and effective pain management is crucial for alleviating distress and ensuring the well-being of pediatric patients. The pharmacological approach plays a central role in managing acute pain in children, but selecting the appropriate medications requires careful consideration of factors such as age, weight, medical history, and the urgency of the situation.
Methods: This systematic review aims to comprehensively evaluate the efficacy, safety, and optimal use of pharmacological pain management approaches for children in emergency settings. A comprehensive search across electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Library was performed. Studies involving pediatric populations (aged 0–16 years) seeking pain management in emergency departments or urgent care settings due to various medical conditions, injuries, or procedures, reporting the utilization of pharmacological interventions were considered only. The quality of the included studies was assessed using the Cochrane Risk of Bias assessment tool to evaluate the methodological quality and risk of bias in randomized controlled trials, while for observational/cohort studies, the Newcastle-Ottawa Scale was utilized to assess the quality and potential biases.
Results: The final inclusion incorporated a total of 13 studies published between 2014 and 2024. Diverse pharmaceutical agents, single or in combination, were used through sublingual and intravenous routes for the management of pain among children. These pain management interventions generally led to reduced pain scores; however, the incidence of adverse events varied among studies, highlighting the importance of balancing efficacy with safety in pediatric pain management protocols.
Conclusion: Despite the safety and effectiveness of these pharmacological interventions, it is crucial to acknowledge the potential risks of adverse effects linked to certain pharmaceutical agents. This emphasizes the importance of conducting future clinical research in this field, particularly randomized trials and cohort studies, to gather evidence-based data that can contribute to the creation of extremely safe therapeutic protocols for this susceptible group
CANVAS as example of genetic and clinical complexity of RFC1-related disorders
No full textCerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS) is a late-onset, autosomal recessive neurodegenerative disorder characterised by the triad of cerebellar ataxia, bilateral vestibular areflexia, and sensory neuropathy. First identified more than 30 years ago, its clinical phenotype has since expanded to include chronic cough, dysautonomia, and pain, with isolated neuronopathy reported in some cases. The discovery of biallelic AAGGG repeat expansions in intron 2 of the RFC1 gene in 2019 established the genetic basis for CANVAS, with the pathogenic expansions disrupting gene function via secondary structures such as G-quadruplexes. Despite this breakthrough, the precise pathophysiological mechanisms behind CANVAS remain elusive, necessitating further research into the molecular, clinical, and genetic aspects of this disease. This review consolidates the current understanding of CANVAS, encompassing the expanding spectrum of RFC1-related disorders, clinical manifestations, molecular underpinnings, and epidemiology, while exploring future directions for diagnostics and therapeutic advancements
Pneumocystozowe zapalenie płuc — etiologia, patogeneza, diagnostyka i znaczenie kliniczne
No full textPneumocystozowe zapalenie płuc (PCP, Pneumocystis pneumonia) to oportunistyczna infekcja grzybicza wywoływana przez Pneumocystis jirovecii (P. jirovecii), stanowiąca poważne zagrożenie dla osób z osłabionym układem odpornościowym, w tym pacjentów zakażonych HIV (HIV+)/chorych na AIDS, biorców przeszczepów oraz chorych onkologicznych. Przed wprowadzeniem terapii antyretrowirusowej (ART, antiretroviral therapy) PCP było jedną z głównych przyczyn zgonów wśród pacjentów HIV+, jednak dzięki skutecznej profilaktyce częstość jego występowania spadła. Obecnie infekcja częściej dotyka pacjentów niezakażonych HIV (HIV−), zwłaszcza tych po przeszczepach i stosujących immunosupresję, u których śmiertelność jest znacznie wyższa. Patogeneza P. jirovecii opiera się na kolonizacji płuc i wywołaniu intensywnej reakcji zapalnej prowadzącej do niewydolności oddechowej. Diagnostyka PCP obejmuje metody mikroskopowe, molekularne (PCR, polymerase chain reaction) oraz serologiczne (β-D-glukan). Wytyczne Europejskiej Organizacji Badań i Leczenia Raka (EORTC, European Organisation for Research and Treatment of Cancer) i Konsorcjum Edukacyjno-Badawczego Grupy Badawczej Grzybic (MSGERC, Mycoses Study Group Education and Research Consortium) oraz Europejskiej Konferencji dotyczącej Zakażeń w Białaczkach (ECIL, European Conference on Infections in Leukemia) podkreślają znaczenie kompleksowego podejścia do diagnozy, gdzie „złotym standardem” pozostają badania mikroskopowe popłuczyn oskrzelowo-pęcherzykowych, a testy PCR pozwalają na potwierdzenie zakażenia, zwłaszcza u pacjentów HIV−. Oznaczanie β-D-glukanu jest pomocne przy wykluczeniu choroby, ale obarczone ryzykiem wyników fałszywie dodatnich. Pomimo postępu w diagnostyce i leczeniu PCP, infekcja ta nadal stanowi poważne wyzwanie kliniczne. Dalsze badania nad nowymi biomarkerami i metodami diagnostycznymi mogą przyczynić się do poprawy skuteczności wykrywania P. jirovecii i zmniejszenia śmiertelności związanej z zakażeniem
Myeloid sarcoma of the middle ear mimicking otitis media – diagnostic and therapeutic challenges
No full textMyeloid sarcoma (MS) is a rare manifestation of acute myeloid leukemia (AML), mostly developing within the skin, the bones or the lymph nodes. Here we report an ultrarare case of the middle ear MS, initially misdiagnosed as otitis media. The initial presentation was facial nerve paresis, acute otitis media symptoms, and hearing loss. Eventually a diagnosis of MS with translocation t(8;21)(q22;q22) was made with CNS and bone marrow involvement. The treatment comprised high-dosed cytarabine and allogeneic hematopoietic cell transplantation. In the manuscript we discuss the diagnostic challenges of MS of the temporal bone, as well as the potential treatment options
The role of technetium-99m isotope in sentinel lymph node identification in gynecological cancers
No full textSentinel lymph node (SLN) identification plays a crucial role in the diagnosis and management of gynecological cancers, particularly in the context of lymph node metastases that often remain undetectable through standard imaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET). Therefore, surgical assessment of lymph nodes remains an essential component of diagnostic procedures.
SLN biopsy enables the detection of small metastatic deposits while reducing the need for extensive lymphadenectomy and minimizing associated complications. Lymphoscintigraphy using technetium-99m (Tc-99m) is one of the most commonly applied techniques for lymphatic mapping and is considered the standard method for SLN identification. In clinical practice, Tc-99m is frequently combined with indocyanine green (ICG) or methylene blue (MB) to allow dual visualization. The dye method, despite its simplicity, has certain limitations, such as shorter retention time in lymph nodes and the risk of diffusion into capillaries, which may reduce detection efficiency.
Lymphoscintigraphy with Tc-99m provides precise visualization of lymphatic drainage pathways and SLNs, contributing to a more accurate determination of cancer staging and reducing the number of unnecessary lymphadenectomies. The appropriate application of this technique lowers the risk of complications, such as lymphedema, while maintaining high diagnostic accuracy.
This review summarizes current evidence on the clinical application of Tc-99m in SLN detection for gynecological cancers, analyzing both its advantages and the challenges related to its practical implementation. Additionally, it discusses the technical aspects of Tc-99m use and its role as a reliable tool for optimizing oncological outcomes.
Pseudogenes in the carcinogenesis: epithelial-to-mesenchymal transition process and cancer initiating cells
No full textInitially, pseudogenes were considered to be “junk DNA”, and their biological role was unclear. However, some of the pseudogenes are engaged in the process of cancerogenesis and perform essential functions in competing for endogenous RNA (ceRNA) networks and competing for RNA binding proteins (RBPs). They either positively or negatively regulate gene expression and act as suppressive and oncogenic transcripts.
In this review, we look at some of the pseudogenes that play a role in the epithelial-to-mesenchymal transition (EMT) process and the maintenance of cancer-initiating cells (CIC), which are essential in understanding cancer development and progression metastasis and resistance to commonly used therapies. The group of discussed pseudogenes consists of CHIAP2, PTENP1, SUMO1P3, NANOGP8, OCT4-PG1/4, or HMGA1-P6, which are connected with different molecular pathways.
Moreover, we discussed pseudogenes as potential diagnostic molecules that can be used as a new class of biomarkers. This potential usage may be valuable for oncology and personalized medicine in the future
Moderately hypofractionated partial breast reirradiation: Early clinical results and dosimetric considerations in the context of 2nd (partial) breast irradiation
No full textBackground: Patients submitted to breast conservative surgery (BCS) with whole breast irradiation at the initial disease that experience an isolated ipsilateral breast tumor recurrence, face mastectomy, as the standard treatment. Selected cases may derive good outcomes from repeat BCS and irradiation with partial breast irradiation (PBI) which limits the volume of tissue reducing the risk of increased toxicity. We report our experience with external PBI for locally recurrent breast cancer.
Materials and methods: We queried our department’s re-RT database for breast cancer treated with external beam radiation therapy (EBRT) from 2017–2021. We reviewed the electronic record for each case with PBI. Demographic, disease characteristics, primary RT/re-RT details and toxicity were collected. Local recurrence-free survival (LR-FS), distant recurrence-free survival (DR-FS) and overall survival (OS) were estimated using the Kaplan-Meier method.
Results: Eleven women were reviewed. Mean (standard deviation; SD) age was 54 (38–76) years and Eastern Cooperative Oncology Group (ECOG) Performance Status was 0–1 (100%) with median follow-up from recurrence of 41 months (27–62 months). All presented T1–2 recurrent lesions. Tumors were clinically node negative and no patients had evidence of metastatic disease before undergoing BCS. For the re-RT course, all received PBI with 40 Gy/2.67 Gy daily. Cosmesis results were good. Eight experienced grade 1 erythema and 2 grade 1 pigmentation with 1 pruritus. Major late effects were fibrosis. There were no grade 3 or higher late reactions. At 3 years, 9 patients remained free from LR, 10 from DR, and 9 were alive.
Conclusion: In our cohort, a second BCS followed by re-RT with hypofractionation EBRT showed acceptable toxicity and early promising results, though longer follow-up is needed.