Identifying candidates for immunotherapy with cemiplimab to treat advanced cutaneous squamous cell carcinoma: an expert opinion

Cutaneous squamous cell carcinoma (CSCC) is the second most common skin malignancy in white-skinned populations. Only a minority of patients (<5%) develop advanced disease, but this is often difficult to treat and characterised by a poor prognosis. Cemiplimab, a fully human IgG4 monoclonal antibody against programmed cell death-1 receptor, is indicated for advanced (i.e. locally advanced or metastatic) CSCC. Although the definition of metastatic CSCC is clear, there is currently no agreed definition of locally advanced CSCC. In recent guidelines, locally advanced CSCC was described as non-metastatic CSCC that is unlikely to be cured with surgery, radiotherapy or combination treatment. A multi-disciplinary advisory group of Italian CSCC experts was convened to develop criteria to assist in identifying appropriate candidates for cemiplimab therapy in advanced CSCC, based on the literature and clinical experience. In locally advanced CSCC, absolute, or mandatory, criteria for the use of cemiplimab are deep invasion, multiple lesions without defined margins, inadequate surgical excision margins and multiple recurrences, whereas relative criteria include large lesions, in critical or functionally significant areas and that are surgically complex. In addition, physicians should consider patient willingness/preferences (an absolute criterion), and their age and health status/comorbidities (relative criteria). It is hoped that these proposed absolute and relative criteria will help guide rational identification of patients who will receive maximum benefit from immunotherapy, while more clinical data accumulate.

Economy of households under conditions of pandemic instability

The purpose of the academic paper lies in assessing the state of income, expenditure and savings of households under conditions of pandemic instability. The research methodology is based on the statistical analysis of data on income, resources and savings of households in Ukraine for 2010-2020. The scientific novelty involves identifying the positive and negative effects of the pandemic on the household economy. Conclusions. The positive and negative effects of the impact of spreading the pandemic on the household economy have been revealed in the research, and as a result, the decline in economic activity and the growth of unemployment in Ukraine. It has been determined that in the period of 2020 pandemic, costs decreased by 2% and resources increased by 3%. In 2020, the share of expenditures on food and non-alcoholic beverages increased from 46,6% to 48,1% in 2019, and on non-food goods and services - decreased from 41,5% to 39,8%. The population with per capita equivalent total income per month, below the actual subsistence level, was 8,9 million people in 2019 (23,1%), in 2020 – 8,8 million people (23,2%). Despite experts’ assessments of the likely increase in poverty as a result of COVID-19 spreading under two scenarios (according to the absolute criterion, it will increase from 27,2 to 43,6%; according to an absolute criterion, it will increase from 27,2 to 50,8%). It can be noted that the COVID-19 pandemic has had a negative impact on the poorest sections of the population with low incomes. It has been determined that in the context of social-economic impact of COVID-19, families who find it more difficult to diversify their own incomes are the most vulnerable ones. The following categories have been most affected by the pandemic (they will have had the largest increase in poverty compared to the baseline scenario), namely: households with three or more children; single parents with children; households with children under three; single retirees over 65 years.Along with this, thanks to the monetary policy that has ensured a stable level of inflation and return on deposits, the share of household deposits has increased the most in the last ten years to 27%. However, it is worth noting that quarantine and the COVID-19 pandemic have led to a trend towards a partial flow of population resources from time deposits to card and savings accounts. After all, citizens sought to have free money in case of unforeseen expenses due to the uncertainty of the future development of events. Key words: households, income, resources, consumer expenditures, economic crisis, pandemic instability, quarantine restrictions.

Functional assessment in left ventricular non-compaction cardiomyopathy in multimodality imaging era might improve the definition

Left ventricular non-compaction (LVNC) is an increasingly recognized phenotype. The current definition of the LVNC does not mention LV dysfunction as an absolute criterion in addition to morphological criteria. LV dilatation and decreased LV ejection fraction (LVEF) are often late manifestations of the disease and correlate with the occurrence of cardiovascular complications. However, to define LVNC as a cardiomyopathy, functional criteria must be fulfilled, in addition to the morphological ones. Multimodality imaging, such as myocardial deformation and myocardial work analysis derived from speckle tracking echocardiography (STE), in combination with cardiac magnetic resonance (CMR) might improve diagnosis and characterization of non-compaction, exposing earlier signs of LV systolic dysfunction. We present two comparative cases of LVNC in order to highlight the idea of subclinical dysfunction even in apparently benign forms with preserved LVEF, and also the importance of multimodality imaging approach.

Intraoral and extraoral approach for surgical treatment of Eagle's syndrome: a retrospective study

Background We evaluated the clinical characteristics and postoperative efficacy of 94 patients with Eagle’s syndrome based on their clinical symptoms, imageological examination, and physical examination. Through the multi center clinical study of Tongji Medical College and Dalian Medical University, we found some characteristics of Eagle’s syndrome in operation and imaging. Methods In total, 94 patients with Eagle’s syndrome (treated from January 2010 to January 2019) were retrospectively enrolled. The postoperative curative effect was analysed by three surgical methods: styloid process resection through the external cervical approach, tonsillectomy + styloidectomy, and preservation of the tonsil for styloidectomy. Results The average length of the styloid process was 33 mm (range, 25–61 mm). The patients were followed up for 3–36 months (average, 15 months). Of the 94 patients, 20 underwent styloid process resection through the external cervical approach, 45 underwent tonsillectomy and styloidectomy, and 29 underwent styloidectomy with preservation of the tonsil. The treatment cured 45 (48%) cases, was effective in 31 (33%), and ineffective in 18 (19%). The SPSS 19.0 software was used to conduct a rank sum test, and there was no significant difference between the three types of operations (H = 0.521, P = 0.771). Conclusions Operation is an effective method for treating Eagle’s syndrome. There were no significant differences between the effects of the intraoral and external cervical approaches. Imaging examination—especially CT scanning and 3D reconstruction of the styloid process—is very helpful for diagnosis, but not an absolute criterion for the selection of surgery protocol.

„Zarządzanie słowem” przez media prasowe w procesie dążenia do poznania i przedstawienia prawdy

“Word Management” by the Press Media in the Process of Seeking to Know and Present the Truth The importance of the press in a democratic state is beyond doubt. This requires that freedom of press expression be guaranteed. However, this is not an absolute freedom and is subject to restric­tions. In particular, the journalist must remember that “The press is under an obligation to truly present the discussed phenomena” (Article 6 par. 1 of the Press Law). However, understanding this principle too literally may raise reasonable doubts. The result of a journalist’s cognitive conduct – even with the utmost care – may turn out to be untrue. It would therefore be unreasonable to hold a journalist accountable according to an absolute criterion of the veracity of the facts. It is therefore appropriate to consider the regulation referred to here as a directional standard, the performance of which should be assessed particularly carefully in the context of the implementation of the statuto­ry obligations imposed on the press (journalist).

DIAGNOSIS AND EVALUATION OF CRITERIA FOR CONDUCTING SURGICAL TREATMENT IN WOMEN WITH CYSTOCELE AND STRESS URINARY INCONTINENCE

Purpose of the study. Clarification of absolute and relative criteria for the surgical treatment of pelvic pelvic prolapse (PMT) and stress urinary incontinence (SNA). Materials and methods. A survey was conducted on 85 patients in whom OST and SNA were detected. The women were divided into groups according to the stage of POMT and SNM: 2nd group – 32 patients with PIDs of stages I and II and SNM 2a, 2b types of lung and moderate severity; Group 3 (main) - 53 patients with MIDI III and IV stages and MSM type 3 moderate and severe severity. This group of patients subsequently undergone operative treatment according to the patent for utility model No. 109201. The main group (3rd group) included: 3a group – 28 women from the OMT III and IV stages and SNM 3rd type of medium and severe severity without delay in urination; 3b group – 25 women with STI III and IV stages and SNM of type 3 of moderate and severe degree of severity with delay of urination (chronic or acute). 15 women were examined without complaints, who entered the control group (1st group). Results. According to the results of the study, it was recorded that, regardless of the stage of the PMS and SNM, even their minimal manifestations significantly reduced the quality of life of patients (by 64%) due to the impact on the physical, but to a greater extent, on the psychological components of health. Conclusion. The absolute criterion for operative treatment is a set of prolapse of the pelvic organs (PMTCT), urinary incontinence, vesicularization of the bladder type 2a and above, an increase in the posterior urethro-vascular angle of more than 114 °. Treatment of stress urinary incontinence on the background of OST should necessarily include fixation of the uterine ligation apparatus and surgery on the Berch in connection with significant deformation of the bladder neck. Keywords: pelvic organ prolapse, urinary incontinence, methods of diagnostics.

FETOMATERNAL OUTCOMES IN PREEKLAMPSIA PATIENTS WITH PROTEINURIA AND WITHOUT PROTEINURIA

BACKGROUND AND OBJECTIVES : The high maternal mortality rate is still found mainly in Southeast Asia including Indonesia. Maternal deaths that occur are caused by various things. High blood pressure during pregnancy (preeclampsia and eclampsia) is one of the major causes of maternal death in the world besides heavy bleeding (usually postpartum) and infection. The relationship between proteinuria and poor fetal outcomes has been investigated by experts,increasing protein excretion in women with preeclampsia (PE) is generally associated with poor maternal and fetal (fetomaternal) outcomes, proteinuria levels in women with PE are poor predictors of outcomes fetomaternal. But another opinion says that proteinuria is not an absolute criterion that must be found to diagnose PE, where multiorgan dysfunction in PE patients with or without proteinuria does not have a significant difference. From these results the researchers wanted to know the fetomaternal outcomes of PE patients with proteinuria (+ 1, + 2, + 3, + 4) and preeclampsia without proteinuria. METHODS :This research is a descriptive study with a retrospective design,carried out using secondary data analysis of patients diagnosed with PE with or without proteinuria and have been terminated.This research was conducted at the General Hospital. H. Adam Malik Medan. The time of the study is from October 2017 to February 2018. The study population is PE patients treated and terminated from February 2013 to May 2017. PE patients in this study will henceforth be assessed based on protein levels in the urine (proteinuria). The sample size in this study uses the Lemeshow formula which aims to find a large proportion in a population. RESULTS: A total of 62 PE women with proteinuria and 21 PE women without proteinuria. Of all the samples, maternal and fetal outcomes were assessed.Based on Proteinuria,research subjects who were diagnosed with PE with proteinuria were 62 people.The highest number was 36.1% in PE with proteinuria + 3,followed by 18.1% in PE with proteinuria +1, then as much as 15.7% in PE with proteinuria +4,and with the smallest amount of 4.8% in PE with proteinuria +2.Research subjects diagnosed with PE without proteinuria totaled 21 people,as many as 25.3% of the total sample. CONCLUSION : Most research subjects ranged age 21-30 years with gestational age,≥ 37 weeks, multipara. Subjects were diagnosed with PE with proteinuria more than PE without proteinuria.The most maternal outcome is ICU treatment followed by HELLP syndrome, eclampsia and pulmonary edema then maternal death. The highest fetal death rate for babies with birth weight is LBW,with more normal APGAR scores

Complex evaluation of diagnostic criteria in women with cystocele and stress urinary incontinence

The purpose of the study: clarification of absolute and relative criteria for the operative treatment of prolapse of the pelvic organs (POP) and stress urinary incontinence (SUI). Patients and methods. 85 patients with POP and SUI were observed. These women were divided into groups according to the stage of POP and SUI: group 2 – 32 patients with I and II stages of POP and SUI 2a, 2b types of light and moderate severity; group 3 (main) – 53 patients with III and IV stages of POP and SUI type 3 moderate and severe severity. This group of patients subsequently undergone operative treatment according to the patent for utility model No. 109201. The main group (3rd group) included: 3a group – 28 women with III and IV stages of POP and SUI type 3 moderate and severe severity without delay in urination; 3b group – 25 women with III and IV stages of POP and SUI type 3 moderate and severe severity with delay of urination (chronic or acute). 15 women were examined without complaints, who entered the control group (1st group). Results. According to the results of the study, it was recorded that, regardless of the stage of the POP and SUI, even it’s minimal manifestation significantly reduces the quality of life of patients (by 64%) due to the impact on the physical, but greater, on the psychological components of health. Conclusion. The absolute criterion for operative treatment is a set of prolapse of the pelvic organs (POP), urinary incontinence, vesicularization of the bladder type 2a and above, an increase of the posterior urethro-vascular angle of more than 114°. Treatment of stress urinary incontinence on the background of POP should necessarily include fixation of the uterine ligaments and the Berch surgery because of significant deformation of the bladder neck. Key words: pelvic organ prolapse, urinary incontinence, methods of diagnostics.