Influence of complex treatment on the functional state of the hepatobiliary system in patients with diabetes mellitus

Liver damage in diabetes mellitus is of particular interest, since this factor significantly affects the course of the disease, the level of compensation and prognosis of the underlying disease. The aim. To study the effect of complex treatment using ursosan on the functional state of the hepatobiliary system in patients with diabetes mellitus. Materials and methods. The study included 30 patients with type 1 diabetes mellitus and 48 patients with type 2 diabetes. According to the duration of diabetes, patients were divided into three subgroups: a) up to five years; b) 5–10 years; c) more than 10 years. The number of patients was: 1a group – 13, 1b group – 10, 1c group – 7 people; Group 2a – 23, 2b group – 13, 2c group – 10 people. The control group consisted of 23 apparently healthy people. Ursosan was prescribed at a dose of 10-12 mg per 1 kg of body per day for 6 months. Clinical laboratory and instrumental research methods were used to study the functional state of the liver and gallbladder. Research results. After the course of treatment with Ursosan, patients with diabetes mellitus showed normalization of protein, pigment, enzymatic metabolism and, to a lesser extent, lipid metabolism in the liver, which led to an improvement in cellular metabolism and redox processes, providing a stable course of diabetes. Conclusions. A 6-month course of treatment with Ursosan in diabetic patients promotes long-term diabetes compensation. Patients during treatment have a decrease in cytolysis syndrome indicators (alanine aminotransferase (AlAT), aspartate aminotransferase (AsAT), lactate dehydrogenesis (LDH)) by about 1.5 times in all 3 indicators compared to the indicators before treatment. The same trend was observed in terms of gamma-glutamine transferase (GGT) and alkaline phosphatase (ALP)

Effect of BCR-ABL1 Transcript Type and Body Weight on Outcome in Chronic Myeloid Leukemia

Introduction The hallmark of CML is BCR-ABL1 (breakpoint cluster region gene-Abelson murine leukemia viral oncogene homolog 1) on Philadelphia chromosome, which is the result of a reciprocal translocation between the long arms of chromosomes 9 and 22 (t[9;22][q34;q11]) [1]. Chromosome 22 breakpoints influence the BCR portions preserved in the BCL-ABL1 fusion mRNA and protein and are mainly localized to one of three BCRs, namely major-BCR (M-BCR), minor BCR (m-BCR) and micro-BCR (µ-BCR). In comparison, breaks in chromosome 9 arise most frequently by alternative splicing of the two first ABL1 exons, and can also be generated in a large genetic region, upstream of exon Ib at the 5' end, or downstream of exon Ia at the 3' end. In the majority of CML cases, the breakpoint lies within the M-BCR and gives rise to e13a2 or e14a2 fusion mRNAs (previously denoted as b2a2 and b3a2) and a p210BCR-ABL fusion protein [2]. [3] Methodology We conducted a retrospective analysis of the files of 79 patients being treated in our center for CML with known BCR-ABL1 breakpoints; there were few more patients with known transcript type but excluded because either travelled immediately on diagnosis or had a failure due to confirmed compliance issues. Patients' management and response assessment was done based on ELN 2013 guidelines. The analysis is done based on two main groups, obese versus normal BMI, and then based on BCR-ABL1 transcripts: e13a2 versus e14a2. Ethical approval was obtained from Medical Research Center for Hamad Medical Corporation (MRC-01-18-337). Results Patients included 62 males (78.5%) and 17 females (21.5%) with the mean age at diagnosis 38.8±11.8 years (median, 38; range 21 to 69 years). The characteristics (demographics, anthropometric, hematological and clinico-pathological) of the patients and their association with transcript types and obesity are summarized in Table 1. Patient outcomes, cytogenetic and molecular responses The median follow-up was 30 months (range 6 to 196 months) and 38 months (range 3 to 192 months) in normal weight and obesity groups, respectively. The median follow-up was 28 months (range 3 to 196 months) and 39 months (range 10 to 192 months) in e14a2 and e13a2 patients, respectively. A total of 22 patients distributed among different groups ended up leaving the country (censored) after a variable duration of follow-up (6 - 196 months), 18 of them CML-CP, and 4 CML-AP. 3 patients died in our cohort, all of them had e14a2 transcript, one of them was in the normal weight/BMI group, two were in the obesity group. In e14a2 group, more patients were on imatinib at the time of analysis (15 (39.5%) vs 7 (17.1%) in e13a2 group, p = 0.026). The percentage of patients of had to switch TKI was similar in both groups (47.4% vs 53.7%, p = 0.576). However, less patients in e14a2 group had to switch TKI because of failure/progression (10 (55.6%) vs 17 (77.3%), p = 0.145); however, this didn't translate into a significant difference of achieving MMR at 1 year, where in e14a2 group, 10 patients achieved MMR at 1 year (31.3%), same as in e13a2 group (10 patients = 29.3%) p 0.331 (all shown in table 1). When comparing long-term outcomes, there was also no significant difference between groups based on transcript type with regards to MMR (44.7% vs 46.3% in e14a2 vs e13a2 respectively) or DMR (26.3% vs 22% respectively) as shown in figure. In the obesity group, there were 2 patients using ponatinib due to T315I mutation, compared to none in normal weight group. However, there were no significant differences in TKI used, switch of TKI, or reason for switch. Same applies for achieving MMR at 1 year, as 11 patients in the obesity group achieved MMR (28.2%) compared to 9 patients in normal weight group (33.3%), p = 0.778 (as shown in table 1). Regarding the long-term outcomes, more patients in the obesity group achieved MMR (53.2%) compared to normal weight group (34.3%), and this response was faster, but not statistically significant. This difference was less clear with regards to DMR (25.5% in the obesity group compared to 21.9% in normal weight group) as shown in figure. Conclusion In the patient-cohort studied there were no significant differences in molecular response based on transcript type or body weight/BMI. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Urethral Stricture

Background : urethral stricture is one of the most difficult urological problems to cure adequately and is know to mankind since ages as it has been documented in ancient literature of Egyptians and Greeks. Aim of the work: the aim of our study is to evaluate and compare the outcomes of Ho:YAG laser urethrotomy with the conventional cold knife technique as regards treatment outcome, efficacy and complications Patients and methods: A total of 20 male patients presented to the urology department at El Maadi military hospital and Ain shams university hospitals diagnosed as urethral stricture requiring optical internal urethrotomy were included in this study. Patients were randomized into two groups : In group A (holmium group): 10 patients underwent internal urethrotomy with Holmium laser. In group B (cold knife group) 10 patients underwent internal urethrotomy with cold knife. Results: based upon uroflowmetry, assessment of treatment effectiveness and complications were made at 3 months follow-up. Post operative fall in the peak flow rate was noted during the follow up in both groups, but was highter fall in the holmium group than the cold knife group at the end of the third month.

Conservative treatment of early hormone-dependent breast cancer in elderly patients (65 years and older)

Background. Standard treatment for hormone-dependent operable breast cancer includes surgery, hormone therapy (HT), and radiation therapy and chemotherapy (when necessary). Some elderly patients do not undergo surgery because of the high risk or refuse to be operated on. In such case, the only possible option is conservative treatment with hormones (± radiotherapy).Objective: to compare progression-free survival, local relapse-free survival, and metastasis-free survival between elderly patients with hormone-dependent breast cancer receiving different treatments (surgery + HT vs HT alone).Materials and methods. This study included 60 patients with stage I–II hormone-dependent breast cancer aged 65 years and older. Thirty patients in the experimental group received HT only, while 30 patients in the control group received surgery + adjuvant HT. All patients were treated at Saint Petersburg Clinical Oncology Dispensary. Patients were followed up for 3 years.Results. During 3 years of the study, three women from the experimental group (10 %) were found to have local tumor growth despite treatment. Three patients in the control group (10 %) also had disease progression, but it was associated with the development of bone metastases.Conclusion. The conservative approach to treatment of early hormone-dependent breast cancer in elderly patients is a possible option in routine clinical practice; however, it requires the analysis of indications and identification of patients who will benefit from this approach.

Primary Treatment of Small-To-Medium (<3cm) Sporadic Vestibular Schwannomas: A Systematic Review And Meta-Analysis on Long-Term Hearing Preservation And Tumor Control Rates For Microsurgery Versus Radiosurgery.

BackgroundOver the past two decades, the treatment of small-to-medium (<3cm) sporadic vestibular schwannomas (VS) has experienced a definite shift to stereotactic radiosurgery vis-a-vis microsurgery. We performed a systematic review and meta-analysis of VS patients primarily treated with stereotactic radiosurgery (SRS) or microsurgery (MS), with particular attention to hearing preservation outcomes (HPO), tumor control (TC), and facial nerve dysfunction (FND).MethodsA systematic review was conducted (Medline and Scopus database) for the period, January 2010 to June 2020 with appropriate MeSH. English language articles for small-to-medium sporadic VS (<3cm) utilizing SRS or MS as treatment modality, with minimum follow-up of 3 years, were included. Studies had to report an acceptable standardized hearing metric. HPO, TC, and FND rates were analyzed. ResultsThirty-two studies met inclusion criteria: 10 for microsurgery; 23 for radiosurgery (one comparative study included in both). HPO, at ~65 months follow-up, were comparable between MS group (10 studies; 809 patients) and SRS group (23 studies; 1234 patients) (56% versus 59%, p=0.1527). TC, at ~70 months follow-up, was significantly better in MS group (9 studies; 1635 patients) versus SRS group (19 studies; 2260 patients) (98% versus 92%, p < 0.0001). FND, at ~ 12 months follow-up, was significantly higher in MS group (8 studies; 1101 patients) versus SRS group (17 studies; 2285 patients) (10% versus 2%, p < 0.0001).ConclusionMS and SRS are comparable primary treatment options for small (<3cm) sporadic VS with respect to HPO at 5-year follow-up in patients with serviceable hearing at presentation. Approximately 50% patients for both modalities will likely lose serviceable hearing by that time-point. High TC rates (>90%) were seen with both modalities, with MS (98%) significantly better than SRS (92%). The post-treatment FND was significantly less with SRS group (2%) versus MS group (10%).

Exosomes Derived From Adipose-Derived Mesenchymal Stem Cells Ameliorate Radiation-Induced Brain Injury by Activating the SIRT1 Pathway

ObjectiveStudies have shown that the therapeutic effects of mesenchymal stem cells (MSCs) are mediated in a paracrine manner, mainly through extracellular vesicles such as exosomes. Here, we designed a study to investigate whether exosomes derived from adipose-derived mesenchymal stem cells (ADMSC-Exos) had protective effects in a rat model of radiation-induced brain injury and in microglia.MethodsMale adult Sprague-Dawley (SD) rats were randomly divided into three groups: the control group, the radiation group (30 Gy), and the radiation + exosomes group (30 Gy + 100 ug exosomes). Meanwhile, microglia were divided into four groups: the control group, the radiation group (10 Gy), the radiation + exosomes group (10 Gy + 4 ug exosomes), and radiation + exosomes + EX527 group (10 Gy + 4 ug exosomes + 100 nM EX527). Tissue samples and the levels of oxidative stress and inflammatory factors in each group were compared.ResultsStatistical analysis showed that after irradiation, ADMSC-Exos intervention in vivo significantly reduced the levels of caspase-3, malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), and promoted the recovery of superoxide dismutase (SOD), catalase (CAT), IL-4, and IL-10. Moreover, ADMSC-Exos intervention inhibited microglial infiltration and promoted the expression of SIRT1. Furthermore, the results in vitro showed that the above effects of ADMSC-Exos could be reversed by SIRT-1 inhibitor EX527.ConclusionThis study demonstrated that ADMSC-Exos exerted protective effects against radiation-induced brain injury by reducing oxidative stress, inflammation and microglial infiltration via activating the SIRT1 pathway. ADMSC-Exos may serve as a promising therapeutic tool for radiation-induced brain injury.

A review on Charakokta Shonitasthapaka mahakashaya: Ayurvedic as well as modern view.

Blood being one among the seven tissues has its significant role in regulating the function of all vital organs and giving life to individuals. Without proper quantity and quality of blood, the body cannot remain healthy. The fourth chapter of Charaka samhita ie related to fifty various groups. In each group, 10 herbs are included having common action. Shonita sthapaka mahakashaya is pronounced for action related to restoring the normalcy of blood. Shonita sthapaka mahakashaya is very specific and only mahakashaya in which only 5 medicines of herbal origin, one metallic compound, one jantav dravya and two byproducts and Mrutkapala. Shonitasthapakaa gana included actions like Raktashodhana [haemostatic], Raktastambhana [ blood coagulation], Raktavilayaka [blood thinning], Raktavardhanaa [ haemopoitic]. Rakta and pitta dosha are the same in nature, so Rakta is mainly vitiated by pitta dosha. Thus, dravyas included in Shonitasthapaka gana have pittashamak properties. So, according to different conditions of Raktavikara [disorders related to blood], we can categorize Shonitasthapaka dravyas in treatment.