Almanac of Clinical Medicine最新文献

{"title":"Evaluation of the upper extremity motor skills with a computer kinetic system in multiple sclerosis patients","authors":"Igor E. Shumakov, Artemiy S. Leshonkov, Ekaterina A. Vekhina, Dmitry S. Kasatkin","doi":"10.18786/2072-0505-2023-51-004","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-004","url":null,"abstract":"Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating neurodegenerative disorder with multiple lesions in the central nervous system. Motor abnormalities are considered to be a major cause of permanent occupational, social and daily disability of MS patients. However, due to serious limitations of existing methods for assessment of upper limb functioning, evaluation of coordinator and motor abnormalities in the upper extremities in clinical practice is difficult. Aim: To evaluate the efficacy of a computer kinetic method in the diagnosis of fine motor abnormalities of upper limbs in MS patients at early stage of the disease, when motor abnormalities in the upper limbs are not yet obvious. Materials and methods: The main study group included 42 patients with confirmed MS, who consented for testing and met the inclusion criteria (among them, absence of obvious motor and coordinator abnormalities in the arms). The mean age of the patients was 36 [29; 44] years. The control group included 31 healthy subjects with a mean age of 28 [21; 37] years. All the patients were assessed with an original computer kinetic system, including a two-minute test, when the patient had to follow a moving object on the screen with a computer mouse. Every test series resulted in 13 final characteristics. Results: The test of the dominant hand showed that compared to the control group, the MS patients without clinical motor abnormalities in the upper extremities spend 20% more time to move to the aim object (p 0.001), have a 18% lower output motor performance (p 0.001), make by 54% more recurrent returns to the aim object (p = 0.012), by 7% more crosses of the ideal trajectory of moving to the aim (p = 0.036), by 32% more deviations from the ideal trajectory of moving along the x axis and by 52% more along the y axis (p 0.001 for both comparisons), as well as they have a 12% lower mean rate of the movements during the computer test (p 0.001) and by 12% more rate picks (p = 0.003). Conclusion: Patients with confirmed MS, low degree of disability and absence of any clinically confirmed motor abnormalities in the upper limbs do have subclinical signs of motor abnormalities in the arms that can be identified by computer kinetic system.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74775963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke and peripheral vestibulopathy as a part of acute vestibular syndrome","authors":"E. Isakova","doi":"10.18786/2072-0505-2023-51-003","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-003","url":null,"abstract":"The scope of the review is the problem of differential diagnosis between stroke and peripheral vestibulopathy in patients with acute vestibular vertigo. A vertebrobasilar stroke manifesting with the isolated vertigo has been previously recognized to be extremely rare, and the symptoms have been related to the involvement of peripheral parts of the vestibular analyzer. Recently there has been growing evidence that the isolated vertigo syndrome is commonly related to the central involvement of the vestibular analyzer. The author presents published clinical cases of acute cerebrovascular accident with a single symptom of acute vestibular vertigo. It can be also a symptom of a hemispheric stroke due to an injury of vestibular pathways connecting the vestibular nuclei with the parietal cortex. These observations extend the understanding of the common classic pathognomonic picture of central vestibular vertigo, which implies that its development is related exclusively to the brain matter lesion in vestibulobasilar stroke. \u0000Current clinical rating scales and tests (NIHSS, FAST) used for the diagnosis of an acute stroke, are frequently not sensitive to the vertebrobasilar stroke, and neuroimaging, including brain magnetic resonance imaging at DWI mode, may give false negative results. The most informative differential diagnostic method in acute vestibular syndrome is an otoneurological assessment including identification of nystagmus characteristics and head turn impulse test, for the assessment of vestibuloocular reflex and at bed tests (for example, tests included into the HINTS PLUS protocol). In this regard, it is important that neurology specialists in regional vascular centers and departments for acute cerebrovascular care should master the otoneurological assessment skills.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84711169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteopontin in patients with chronic obstructive pulmonary disease and coronary heart disease","authors":"N. Suvorova, I. Gordeev, E. Luchinkina","doi":"10.18786/2072-0505-2023-51-002","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-002","url":null,"abstract":"Background: Osteopontin is a protein expressed by various cell types, such as endothelial and epithelial cells, osteoclasts, hepatocytes, smooth muscle cells, activated macrophages, and T-cells. Cardiomyocytes, heart fibroblasts, endothelial cells of coronary arteries express osteopontin in response to hypoxia, inflammation, toxic factors, mechanical strain, and other stimuli. \u0000Aim: To study osteopontin levels in patients with chronic obstructive pulmonary disease (COPD) depending on concomitant ischemic heart disease (IHD), to identify an association between osteopontin levels with severity of COPD and functional lung test parameters. \u0000Materials and methods: This open-label, prospective, non-randomized comparative study with parallel groups included 99 patients with COPD grades AD by GOLD, with 49 of them having confirmed comorbid stable IHD. Serum osteopontin levels were measured by immunoenzyme assay (Human Osteopontin Platinum ELISA; Bender MedSystems, Austria). The data is given as medians and quartiles (Me [Q1; Q3]). In all patients we performed functional lung tests with bronchodilation, a 6-minute walking test, BODE index assessment, as well as CAT and mMRC questionnaires were used. \u0000Results: In the patients with COPD and IHD, the osteopontin levels were higher than in the patients with COPD without IHD (85.55 [46.86; 110.91] vs 55.43 [20.76; 89.64] ng/mL, respectively; p = 0.027). Osteopontin levels in the patients with all COPD grades and IHD were higher than in those without IHD, but the difference was significant only in GOLD grade B patients (91.28 [73.04; 110.91] vs 37.81 [22.54; 82.95] ng/mL, respectively, р = 0.028) and GOLD grade D patients (80.79 [34.65; 111.11] vs 37.46 [13.32; 109.5] ng/mL, respectively, р = 0.027). \u0000Conclusion: A significant increase of osteopontin levels in comorbid patients with COPD and stable IHD found in this study has not been previously known. It is necessary to perform further studies to identify a threshold level of osteopontin predictive of the risk of COPD exacerbations or cardiovascular events. This would help to improve medical treatment of COPD patients, as well as to identify the risk groups.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84821039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Galectin-3 and matrix metalloproteinases 2 and 9 in peripheral blood of gastric cancer patients","authors":"E. Korotkova, E. S. Gershtein, E. V. Samoilova, I. O. Goryacheva, Aram P. Petrosyan, N. Zybina, O. Yanushevich, I. Stilidi, N. Kushlinskii","doi":"10.18786/2072-0505-2023-51-001","DOIUrl":"https://doi.org/10.18786/2072-0505-2023-51-001","url":null,"abstract":"Background: High incidence of gastric cancer (GC), its aggressive clinical course, rapid tumor dissemination, low sensitivity to chemotherapy and lack of reliable laboratory diagnostic criteria urgently require a search for the most informative markers associated with key biologic properties of the tumors. \u0000Aim: Comparative analysis of galectin-3, matrix metalloproteinase (MMP)-2, and MMP-9 levels in peripheral blood of GC patients and healthy donors, assessment of association of these markers with clinical morphological characteristics of the disease, and prognosis of overall and relapse-free survival. \u0000Materials and methods: Sixty (60) primary treatment-nave GC patients (38 men, 22 women) aged 29 to 81 years and 90 healthy donors compatible with their age and sex were included into the study. Galectin-3 was measured in EDTA plasma, MMP-2 and MMP-9 in serum with standard direct enzyme immunoassay kits \"Human MMP-2 (total)\", \"Human MMP-9 (total)\", \"Human Galectin-3\" (RD Systems, USA). \u0000Results: Plasma galectin-3 concentration in the GC patients was significantly higher than in the healthy controls (median 12.9 and 10.6 ng/ml, respectively; p 0.0001). No difference in serum MMP-9 levels between GC patients and control subjects were found, while MMP-2 level in the control group was significantly higher, than in the GC patients (p = 0.039). No association between galectin-3, MMP-2, and MMP-9 blood levels in the GC patients could be identified. In contrast to GC patients, there was a positive correlation of plasma galectin-3 with age in the control group (rs = 0.51, p 0.005). No associations between the biomarkers levels in blood and clinical and morphological characteristics of GC were established, except MMP-9 being higher at Т4а invasion depth as compared to the earlier Т2 level. Marked differences in the overall survival depending on plasma galectin-3 levels were found, with the cut-off level of 12.9 ng/ml: the 5-year overall survival in the patients with low galectin-3 was better, than in those with its higher level (50 and 43%, respectively; however, the difference was non-significant, р 0.1). Both overall and relapse-free survival of the GC patients was higher in those with low ( 212 ng/ml) serum MMP-2: the 5-year overall survival in this group comprised 60% versus 23% in the patients with higher MMP-2 (p = 0.018). The difference in relapse-free survival was non-significant. Serum MMP-9 levels had no significant impact on the survival of GC patients. \u0000Conclusion: The ambiguous data on the clinical role of galectin-3, MMP-2, MMP-9 in GC obtained in this study indicate the necessity of further investigation of their possible utility for the diagnostics and prognosis of treatment results.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75905301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of obesity on COVID-19 outcomes in hospitalized patients","authors":"T. Markova, Anastasia A. Anchutina, Angelina A. Bodranets","doi":"10.18786/2072-0505-2022-50-060","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-060","url":null,"abstract":"Background: Obesity is recognized as a risk factor for adverse outcomes in patients with COVID-19. However, a number of studies, including an analysis of the Federal Registry of Diabetic Patients (Russian Federation), have not identified any significant effect of obesity on mortality in COVID-19. Therefore, the role of obesity, assessed by body mass index (BMI) and waist circumference (WC), as a risk factor for an unfavorable course of coronavirus infection remains disputable. \u0000Aim: To assess the impact of obesity on the severity and outcomes of coronavirus infection in the Russian population of hospitalized patients. \u0000Materials and methods: This was a single center, retrospective, observational study in 367 patients with the polymerase chain reaction (PCR)-confirmed diagnosis of COVID-19 hospitalized to the in-patient department from April 2020 to November 2021. The first group included 185 patients with obesity (BMI 30.0 kg/m2); the second group consisted of 182 patients without obesity (BMI 30.0 kg/m2). Prevalence of comorbidities, clinical and laboratory parameters, and computed tomography results were assessed in both groups. WC was measured in 100 patients. \u0000Results: In this Russian population of hospitalized patients with COVID-19, obesity (BMI 30.0 kg/m2) didn't increase the probability of death both in the general sample (odds ratio (OR) = 1.31; 95% confidence interval (CI) 0.901.92, p = 0.164) and in the patients with type 2 diabetes (OR = 1.0; 95% CI 0.591.7, p = 0.997) or without diabetes (OR = 1.3; 95% CI 0.712.39, p = 0.392). However, obesity was associated with a 1,7-fold increase of the risk of severe COVID-19 (95% CI 1.132.59, p = 0.010). Morbid and abdominal obesity (according to World Health Organization and International Diabetes Federation criteria) had no significant impact on the death rate. WC of 101 cm, regardless of the patients gender, was associated with a 4,9-fold increase of the risk of death (95% CI 1.4516.42, p = 0.012). \u0000Conclusion: Obesity didnt show any significant effect on mortality, but increased the chance of severe course of COVID-19 infection. Abdominal obesity (WC 101 cm) was a more significant factor in predicting of a fatal outcome, than BMI.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77099686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of three endocrinopathies under nivolumab therapy","authors":"Anastasia A. Glibka, N. Mazurina, D. Gridnev, K. A. Sarantseva, E. Troshina","doi":"10.18786/2072-0505-2022-50-056","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-056","url":null,"abstract":"Active implementation of immune checkpoint inhibitors into oncology practice leads to an increase in numbers of observed immune-mediated adverse events, including various endocrinopathies. The focus is on multiple endocrine gland involvement because their predictors are unclear. \u0000The paper describes a clinical case of a patient with central cancer of the right lung, who had been administered immune therapy with anti-PD-1 monoclonal antibody (nivolumab). Under this treatment, three endocrine immune-mediated adverse events developed without any concomitant problems from other organs and body systems. The most interesting was the occurrence of adrenal insufficiency and fulminant diabetes mellitus, while, unlike hypothyroidism, which also developed in this patient, those two have been significantly less often described and up to now their incidence, prevalence and association with a certain subgroup of immune checkpoint inhibitors have not been identified. Despite multiple endocrine organ involvement and taking into account positive effects of the anti-tumor treatment, as well as titration of the corresponding hormonal replacement therapy, treatment with nivolumab was continued. \u0000Patients treated with immune checkpoint inhibitors require a multidisciplinary team approach including an endocrinologist, because of the potential multiple endocrinopathies, including life-threatening.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"137 6‐8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91418790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The results of systemic thrombolytic therapy for acute ischemic stroke in women and men depending on the stroke risk factors","authors":"S. Kotov, S. N. Belkina, E. Isakova, A. S. Kotov","doi":"10.18786/2072-0505-2022-50-058","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-058","url":null,"abstract":"Background: Systemic thrombolytic therapy (STLT) with alteplase is the method of choice in all patients with acute ischemic stroke (IS) within the first 4.5 hours after the symptom onset. There is a noticeable difference between men and women in the clinical characteristics and results of stroke treatment; however, results of studies have been contradictory. \u0000Aim: To evaluate the efficacy of STLT with alteplase in women compared to men, depending on the presence of some risk factors for stroke. \u0000Materials and methods: This open-label prospective observational non-interventional cohort study of STLT in IS included 209 patients (102 women, the main group, and 107 men, or the comparison group) aged 32 to 86 years. All patients received STLT with alteplase within 4.5 hours from the onset of IS symptoms. The primary endpoint of the study was 28-day survival, and the secondary endpoint was the achievement of mobility independence (0 to 2 points by the modified Rankin Scale (mRS)). \u0000Results: The demographic and clinical patient characteristics of both groups were comparable, but women were on average 5 years older than men (p = 0.003). The index IS was not the first one in 31.4% of women and 23.4% of men (p 0.05). There were no significant differences in the severity of stroke and the timing of STLT. Men had a high mortality rate in the acute period of IS, but the difference was non-significant. PST-STLT hemorrhagic transformation was more common in men, with the difference being non-significant (2 0.743, p = 0.389). Women were more likely to have type 2 diabetes mellitus (DM2) (37.3% and 20.6%, respectively, 2 7.111, p = 0.008). In women, there was a trend towards better symptom regression by about 1 point (p = 0.129). The women with DM2 had a 13% higher survival than men (p = 0.038). The numbers of patients achieving independence (02 points on the mRS scale) by Day 28 was not different (56 women and 52 men). No between-groups differences were found in the numbers of patients with arterial hypertension and atrial fibrillation. Only 13 women (12.75%) and 21 men (20%) had a normal body mass index, while 56.3% of women and 46.7% of men had obesity 2 or 3 grades, with the gender differences being non-significant. \u0000Conclusion: In women, who have received STLT in the acute period of IS, the death rates and the functional outcomes were non-inferior to those in men, despite their older age, hyperglycemia in the acute period and past history of DM2. The risk factors for stroke in women, compared to men, could be the potential cause of more frequent IS recurrence (every third case in women and every fourth in men was recurrent). Despite a number of negative factors (age, obesity, metabolic syndrome, hyperglycemia, DM2, atrial fibrillation), there was a trend towards better outcomes of STLT in women.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90091818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic glomerulonephritis and pregnancy: predictors of preterm birth","authors":"D. V. Gubina, E. Prokopenko, I.G. Nikol’skaya","doi":"10.18786/2072-0505-2022-50-059","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-059","url":null,"abstract":"Background: Chronic kidney disease (CKD) in pregnant women, with one of its most important causes being chronic glomerulonephritis (CGN), increases the incidence of adverse perinatal outcomes and gestational complications, including preterm birth (PB). Being the main cause of infant morbidity and mortality, PB has serious medical and social significance. \u0000Aim: To identify clinical predictors and develop a predictive model of PB in pregnant women with CGN. \u0000Materials and methods: A retrospective/prospective study included 122 CGN patients, whose 128 pregnancies resulted in childbirth from January 2009 to November 2022. Eighty-eight pregnancies were in the patients with CKD stage 1, 15 in stage 2, 21 in stage 3a, 3 in stage 3b, and one in stage 4. One hundred and nine (109) patients (115 pregnancies) delivered on term (at least 37 weeks of gestation) and were included into the group of term deliveries, whereas 13 women with 13 pregnancies had PB within the range of 22 weeks to 36 weeks 6 days. In the patients of both groups, we assessed nephrological and obstetric history, proteinuria and arterial hypertension at baseline and during pregnancy, complications of the index pregnancy, such as preeclampsia (PE) and severe PE, anemia, urinary tract infections, acute kidney injury, placental insufficiency, and cervical insufficiency. Binary logistic regression was used for prediction modeling of PB in women with CGN. \u0000Results: The proportion of PB in total cohort of the CGN patients was 10.2%. PB was spontaneous only in 2/13 (15.4%) cases, while in the rest of 11 pregnancies (84.6%) the delivery was induced due to maternal and fetal indications. Six independent predictors of PB were identified: body mass index, CKD stage, history of non-developing pregnancies, proteinuria during pregnancy 1 g/day, PE and placental insufficiency. The predictive model had sensitivity of 76.9%, specificity 99.1%, diagnostic efficiency 96.9%, positive predictive value 90.9%, and negative predictive value 97.4%. \u0000Conclusion: Predicting PB and targeting modifiable factors associated with PB may improve pregnancy outcomes in patients with CGN.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91002724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Langerhans cell histiocytosis as a clonal disease of mononuclear phagocyte system","authors":"E.F. Khynku, Maria K. Monaenkova, O. Tamrazova, A. V. Taganov, Мarina А. Gureeva, G. E. Bagramova, A. Molochkov","doi":"10.18786/2072-0505-2022-50-057","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-057","url":null,"abstract":"Langerhans cell histiocytosis (LCH) belongs to histiocytic proliferative diseases, which are rare in clinical practice; however they pose significant challenges both for their diagnosis and choice of therapeutic strategies. Histiocytic proliferative diseases are the scope of oncology; nevertheless, at the diagnostic stage the patients are referred to pediatricians or dermatologists. That is why the interdisciplinary interaction of various specialties and common approaches to their classification, diagnosis and treatment are important for the management of patients with histiocytic proliferative disorders. \u0000Accumulation of the studies on the LCH pathophysiology has promoted the development of new diagnostic algorithms and treatment methods. After the fact of MAPK signal pathway activation had been established, the potential target for therapy was identified. Neoplastic nature of LCH has been hypothesized. If confirmed, we can expect actual diagnostic algorithms being elaborated, in particular, the potential to predict the disease depending on the tumor clone mutation type. The unique characteristics of LCH including proliferate clonality (presumable of neoplastic nature), the disease course with spontaneous regression and frequent relapses and tropism to certain tissues (target organs) make up the grounds for further in-depth studies of the disease.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73196026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential diagnosis of inflammatory bowel diseases by endoscopic ultrasound","authors":"A. A. Budzinskaya, E. Belousova, Larisa P. Orlova, E. S. Vakurova","doi":"10.18786/2072-0505-2022-50-055","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-055","url":null,"abstract":"Rationale: At present, there is no established standard for the differential diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). Five to 15% of the patients have clinical, endoscopic, morphological, and radiological signs both of UC and CD and are therefore diagnosed with indeterminate colitis. However, the timely and correct diagnosis is essential for the choice of treatment strategy. \u0000Aim: To evaluate the potential of endoscopic ultrasound examination (EUS) for the differential diagnosis of UC and CD and to identify the most pathognomonic criteria for each of the disorders. \u0000Materials and methods: This was a prospective single center controlled study including 50 in-patients who were treated in the Department of Gastroenterology for inflammatory bowel disease (IBD) exacerbation. The inclusion criteria were an established diagnosis of IBD, absence of strictures, colon tumors, and infectious diseases. The control group consisted of 15 patients without IBD. In all patients, colon EUS with a radial ultrasound sensor and measurement of the intestinal wall thickness, assessment of the degree of intestinal wall vascularization by color Doppler mapping and measurement of the wall density by compression elastography were performed. \u0000Results: From 50 patients of the study group, 28 (16 men and 12 women aged 18 to 49 years) had CD of the colon and 22 (8 men and 14 women aged 22 to 60 years) had total UC. In CD, the colon wall thickness was 2-fold higher than in the control group (5.66 0.36 vs 2.62 0.11; р 0.001) and 1.5-fold higher than in the UC patients (5.66 0.36 vs 3.96 0.13; p = 0.002). In UC, the intestinal wall was thickened mainly due to its mucosal and submucosal layers (in 82% of the cases, р 0.001 compared to that in the CD patients; diagnostic sensitivity 82%, specificity 93%). In CD, transmural thickening of the intestinal wall was more common (in 68% of the cases, p 0.001 compared to that in UC; sensitivity 68%, specificity 91%), as differentiation of the intestinal wall layers was absent (in 68% of the cases, p 0.001 compared to UC, sensitivity 68%, specificity 100%). The intestinal wall in most cases of UC was less well vascularized that in the control group (54.6% of the cases, p 0.001), whereas in CD, on the contrary, the vascularization was increased (71.4% of the cases, р 0.001); the sensitivity and specificity of this parameter being 54.6 and 82%, for UC vs 71.4 and 77.3% for CD, respectively). Compression elastometry showed that in CD, type 2 staining (E. Ueno classification) was more frequent (45%) compared to UC (22%) and the control group (6%; p = 0.002), which indicates a more dense structure of the intestinal wall in CD patients. \u0000Conclusion: The differences in the intestinal wall structure (its thickness, density and degree of vascularization) identified by EUS UC and CD can be the differential diagnostic criteria between these diseases.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83105541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}