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Sleep disorders in patients with spinal cord injury: A comprehensive review of assessment strategies and available treatment
No full textIntroduction. Individuals with spinal cord injury (SCI) frequently experience sleep disorders, including sleep-disordered breathing (SDB), sleep-related movement disorders (SMDs), circadian rhythm sleep disorders (CRSDs), and insomnia.
Material and methods. A literature search was conducted using PubMed, Web of Science, and Scopus to identify systematic reviews, meta-analyses, clinical guidelines, and relevant studies on sleep disorders in individuals with SCI. A systematic review proved impossible; instead, studies were selected based on their relevance. The main findings were synthesized into a narrative overview.
State of the art. Sleep disorders exacerbate SCI-related complications. However, despite their high prevalence, many patients remain undiagnosed and untreated. Therefore, the goal of research in this field is to: (i) develop home-based diagnostic methods for people who are unable or unwilling to attend an overnight sleep study, (ii) identify the reasons for missed diagnoses, side effects, and factors related to ineffectual treatment adherence, and (iii) develop safe treatment options.
Clinical implications. SDB is highly prevalent, confined primarily to high-level injuries, and presents difficult diagnostic problems because of its distinct clinical patterns. Home-based diagnostics and noninvasive treatment methods show promise, but adherence to these methods and their applicability in terms of SCI patients remain challenging. SMDs, such as periodic leg movement syndrome and restless legs syndrome, often accompany other SCI symptoms and require careful differential diagnosis. Pharmacological treatment provides partial relief, but safer, long-term alternatives are needed. Both CRSDs and insomnia tend to be aggravated by pain and psychological factors. New strategies such as melatonin and behavioral interventions offer brighter future for patients.
Future directions. Additional research is needed to develop strategies to prevent and treat exacerbations and establish personalized diagnostic/treatment approaches, including home monitoring
Nie wszystko rak, co się świeci. Downstaging raka płuca po resekcji dwóch guzów z płuca
No full textWystępowanie zmian nowotworowych w różnych płatach tego samego płuca określane jest jako T4 według klasyfikacji TNM (8. edycja, UICC). Ocena kliniczna opiera się na badaniach obrazowych, co może fałszywie zawyżać stopień zaawansowania. Rzadko możliwe jest współwystępowanie zmian nowotworowych i zapalnych. Postępowanie operacyjne umożliwia jednoznaczne ustalenie etiologii zmian, stanowi skuteczną metodę terapeutyczną i umożliwia właściwe ustalenie stopnia zaawansowania cho-roby. Opisano przypadek pacjentki z rakiem gruczołowym płuca, którego zaawansowanie wstępnie określono jako T4. Ostatecznie jedna z wyciętych zmian miała charakter zapalny, co spowodowało obniżenie stopnia zaawansowania choroby do T2a.
Limfadenopatia śródpiersia z towarzyszącym płynem w jamach opłucnowych — kliniczny labirynt pomiędzy rakiem gruczołowym płuca i sarkoidozą
No full textDiagnostyka raka płuca wymaga niejednokrotnie różnicowania z innymi nienowotworowymi chorobami układu oddechowego, przebiegającymi z limfadenopatią śródpiersia i wnęk płucnych, obecnością płynu w jamach opłucnowych w patologicznych ilościach. W artykule przedstawiono przypadek 37-letniego pacjenta skierowanego po zapaleniu mięśnia sercowego z niewydolnością serca do diagnostyki limfadenopatii uogólnionej z podejrzeniem sarkoidozy płuc i węzłów chłonnych. W wyniku przeprowadzonej diagnostyki uzyskano u chorego rozpoznanie raka gruczołowego płuca w stadium IV (M1) z rearanżacjami: EML4(13), ALK(20)
Immunochemioterapia pembrolizumabem oraz pemetreksedem i w skojarzeniu z pochodną platyny w niedrobnokomórkowym raku płuca — wyniki badania III fazy KEYNOTE-189 w zakresie przeżyć 5-letnich
No full textArtykuł przedstawia zaktualizowane wyniki badania klinicznego III fazy KEYNOTE-189, porównującego zastosowanie pembrolizumabu z chemioterapią wobec samodzielnej chemioterapii w pierwszej linii leczenia chorych na niedrobnokomórkowego raka płuca (NDRP) o typie niepłaskonabłonkowym z ocenioną ekspresją liganda białka programowanej śmierci typu 1 (PD-L1, programmed death ligand 1).
The effect of interdisciplinary and diversified health education combined with personalized nutrition intervention on FPG, 2hPG, SDS, SAS scores and the pregnancy outcomes of gestational diabetes mellitus
Get PDFObjectives: This study aimed to explore the effect of interdisciplinary and diversified health education combined with personalized nutrition intervention on FPG, 2hPG, SDS, SAS scores and pregnancy outcome of gestational diabetes mellitus (GDM).
Material and methods: A total of 180 GDM patients, who were admitted to our hospital between June 2019 and June 2020, were enrolled as the research subjects and randomly divided into two groups: a research group and a control group (n = 90, each). The patients in the control group received routine care while the patients in the research group received interdisciplinary and diversified health education combined with personalized nutrition intervention. The fasting blood-glucose (FPG), two-hour postprandial blood glucose (2hPBG), glycated hemoglobin (HbA1C), SDS, SAS scores, and pregnancy outcome of the two groups of pregnant women were analyzed and compared.
Results: The differences in the levels of FBG, 2hPBG and HbA1C between the two groups before nursing were not statistically significant. After nursing, the levels of FBG, 2hPBG, and HbA1C of the two groups of patients decreased, and the differences in each group before and after intervention were statistically significant. These indexes were lower in the research group than in the control group, the differences being statistically significant. There were no significant differences between the two groups in SAS and SDS scores before nursing, but there were statistically significant differences after nursing. The incidence of unfavorable pregnancy outcome was lower in the research group (8.89%) than in the control group (14.44%), but the difference was not statistically significant (p > 0.05).
Conclusions: Interdisciplinary and diversified health education combined with personalized nutrition intervention can effectively reduce FPG, 2hPG, SDS, and SAS scores in GDM women
Genetic and functional analysis of TUBB1 variants in congenital hypothyroidism
Get PDFBackground: Congenital hypothyroidism (CH) is the most common neonatal disorder, primarily caused by thyroid dysgenesis (TD). While the genetic cause has been identified in less than 5% of TD cases, there is an urgent need to investigate additional gene mutations that may be responsible. In 2018, TUBB1 was identified as a novel candidate gene associated with TD. Nevertheless, further research is required to confirm the role of TUBB1 in TD pathogenesis and the association between TUBB1 mutations and TD in humans. Based on the previous genetic analysis of TUBB1 in 289 Chinese TD patients, this study aimed to further validate the association between TUBB1 and TD, and to explore the pathogenic mechanisms of TUBB1 c.952C>T at the cellular level.
Material and methods: We performed real-time polymerase chain reaction (RT-PCR), western blot, Cell Counting Kit 8 (CCK8), and wound healing assay to evaluate the effect of TUBB1 c.952C>T on gene expression, cell proliferation, and migration.
Results: The c.952C>T mutant decreased the expression of TUBB1 in both mRNA and protein level, and inhibited the proliferation of thyroid cells significantly. Also, c.952C>T mutant showed restrain effects on the migration, although there was no stistical significance. Notably, pathogenic TUBB1 variants were not detected in patients with dyshormonogenesis (DH).
Conclusions: TUBB1 variants confer genetic susceptibility to TD but not DH. The pathogenic variant in TUBB1 was identified in 1.38% (4/289) of our Chinese TD patient cohort, and burden test analysis revealed an association between TUBB1 variants and TD. Functional experimental results indicated that the c.952C>T mutant dominantly affects gene expression and proliferation of thyroid cells
Antibodies against the receptor for insulin-like growth factor 1 (IGF-1RAb), insulin-like growth factor 1 (IGF-1), and insulin-like growth factor binding protein 3 (IGFBP-3) in the serum of patients with Graves’ and Basedow’s disease with and without orbitopathy
Get PDFIntroduction: Proven risk factors for thyroid orbitopathy (TO) are thyroid dysfunction, smoking, and high levels of thyrotropin receptor antibodies (TRAb), and the role of insulin-like growth factor 1 (IGF-1), the receptor for IGF-1 (IGF-1R), and antibodies to the receptor for IGF-1 (IGF-1RAb) are also debated. IGF-1R is overexpressed in fibroblasts and orbital lymphocytes in TO patients. It forms a functional complex and mediates signal transduction through thyroid stimulating hormone receptor (TSHR). The study aimed to evaluate the levels of IGF-1RAb, IGF-1, and IGFBP-3 in a group of Graves’ and Basedow’s disease (GBD) patients with or without TO.
Material and methods: Sixty-seven patients were included in the study, including 47 GBD and 20 control patients. In the GBD group, 31 patients were diagnosed with active TO and were treated with immunosuppressive therapy according to the standard of European Group on Graves’ Orbitopathy (EUGOGO) guidelines. In this group, 10 patients were in the sight-threatening stage of TO severity according to EUGOGO classification. IGF-1 and IGFBP-3 levels were determined with the use of chemiluminescence immunoassay (CLIA) methods. IGF-1RAb was measured by the “in-house” constructed enzyme-linked immunosorbent assay (ELISA) method.
Results: Including our cut-off value (Q75 — 232.48 ng/mL), positive serum IGF-1RAb was found in 25% of patients in the control group (5 out of 20 patients), in 38.3 % (18 out of 47 patients) of patients with GBD, and in 22.5% of GBD patients with active TO (7 out of 31 patients). In GBD patients with active TO, there were no differences in IGF-1RAb when compared to the control group but with a significantly lower level when compared to the GBD patients without active TO. The group of patients with active TO in the sight-threatening stage had significantly lower values of IGF-1RAb compared to the group of patients with GBD without the presence of TO (p = 0.004).
There was also a difference in IGF-1RAb concentration between the groups in moderate-to-severe and sight-threatening stages of TO before starting immunosuppressive treatment (p = 0.014). There was no difference in IGF-1 levels between the control group and GBD patients with active TO before starting immunosuppressive treatment and GBD patients without active TO. The was a significant difference in IGF-1 concentration between the group with moderate-to-severe and sight-threatening stages of TO before starting immunosuppressive treatment (p = 0.009). We found significantly lower IGFBP-3 concentrations in GBD patients regardless of the presence of TO compared to the control group (p = 0.016). There was no difference in IGFBP-3 concentrations between patients with moderate-to-severe and sight-threatening stages of TO (p = 0.203).
Conclusion: It seems that high IGF-1RAb levels may have a protective effect against the onset or severe course of TO, and patients with low IGF-1RAb levels are at risk for severe TO. Our results suggest that anti-receptor antibodies to IGF-1 are inhibitory antibodies
Fala J odkryta wśród artefaktów u pacjenta z umiarkowaną hipotermią
Get PDFThe paper presents a case of 48-year-old man who was admitted to the internal ward due to moderate hypothermia. The ECG, performed upon admission, showed J wave, hidden among artifacts, caused by muscle contractions. The present case indicates that even suboptimal ECG recording may be a source of important information.W pracy przedstawiono przypadek 48-letniego mężczyzny, przyjętego na oddział wewnętrzny z powodu umiarkowanej hipotermii. W zapisie EKG przy przyjęciu, wśród artefaktów wywołanych skurczami mięśniowymi, odkryto falę J. Praca wskazuje, że nawet nieoptymalny zapis EKG, może być źródłem istotnych informacji
Lumbar plexus — review
Get PDFThe lumbar plexus is a collection of nerves, and it originates from the anteriorrami of the T12–L5 laterally to the intervertebral foramina. It gives off 6 peripheralnerves, and in the available literature there are a lot of descriptions of each nerveand its possible morphological variations. In some cases, the occurrence of accessorynerve or absence of whole nerve is observed. In other cases, morphologicalvariations regarding the origin, course, or division into more branches are alsonoticed. Such variations may be associated with some clinical aspects. Understandingthe anatomical variations of the lumbar plexus’s nerves is essential forprocedures involving the lower abdomen, regional anaesthesia, and managingnerve entrapment syndromes.The main aim of this review is to present condensed information on the lumbarplexus based on the available literature. A further aim is to compare the classificationsystems and the results of previous studies in adults and foetuses. Thismanuscript also includes information on the most common clinical implicationsassociated with anatomical variations of the individual nerves of the lumbar plexus
Deltoid muscle: a proposed classification system on human foetuses
Get PDFBackground: The deltoid muscle originates from the spine of the scapula, the lateral border of the acromion, and the lateral third of the clavicle. It inserts on the deltoid tuberosity. It is divided into three parts: spinal, acromial, and clavicular. Our research shows that each part of the deltoid muscle can have up to three bellies during prenatal life.
Materials and methods: The material included 80 upper limbs of spontaneously-aborted human foetuses (32 male, 48 female; Central European population), 18–38 weeks of gestation at the time of death.
Results: Each part had one (Type I), two (Type II) or three (Type III) bellies. In all parts, the most common form was Type I: it was present in 81.25% of cases in the clavicular part, 73.75% in the acromial part, and 57.5% in the spinal part. In contrast, Type III was the rarest form in all parts: it was present in 3.75% of cases in the clavicular part, 12.5% in the acromial part, and 7.5% in the spinal part.
Conclusions: The deltoid muscle is characterised by morphological variability, even in foetuses