Objectives The initiation of reimbursement for intermittently scanned continuous glucose monitoring (isCGM)/ continuous glucose monitoring (CGM) for those 26 and older could greatly benefit people with type 1 diabetes (PwT1D). The aim of the study was to assess changes in quality of life, metabolic control, fear of hypoglycemia and selected psychological parameters after 3 months of implementation of the isCGM/CGM in PwT1D aged 26 and above. Methods The study involved 57 PwT1D from five diabetology centers. To be included in the study, each participant had to be at least 26 years old, have a minimum of two years of diabetes history. Participants completed a set of validated questionnaires including the FSH-II, DDS, PSS10, DTSQs, WHO-5, PAID, DBQ, and a sociodemographic survey. They also downloaded pump/glucometer data and underwent HbA1c measurement at the beginning and again at the end of the study. Results PwT1D reported higher treatment satisfaction measured by DTSQs. Well-being assessment according to WHO-5 was also higher, and the level of diabetes burnout measured by DBQ, fear of hypoglycemia assessed by HFS-II significantly decreased. Diabetic distress measured by means of total score of DDS lowered. Participants scored also lower on PAID upon follow up. The HbA1c level after three months of using the CGM system was significantly lower. Conclusions The use of isCGM/CGM, even during relatively short observation, leads to improved quality of life, reduced fear of hypoglycemia and diabetes burnout, and lower HbA1c levels in PwT1D over the age of 26 who were naïve to this technology.
Szumy uszne to słuchowa percepcja fantomowa występująca w jednym lub obu uszach przy braku bodźca akustycznego w otoczeniu. Dolegliwość ta stanowi istotny problem społeczny i kliniczny ze względu na dużą częstość występowania, brak w pełni skutecznej metody leczenia oraz towarzyszące jej problemy emocjonalne u pacjentów. Pomimo prowadzenia wieloletnich intensywnych badań nad etiologią wciąż nie jest rozstrzygnięte, jaki czynnik bezpośrednio odpowiada za percepcję szumu. To z kolei skutkuje brakiem właściwej metody terapeutycznej opartej na działaniu przyczynowym. Klasyczny podział kliniczny obejmuje szumy uszne subiektywne i obiektywne. Szumy subiektywne (inaczej prawdziwe), podmiotowe występują w większości przypadków, natomiast obiektywne (rzekome), przedmiotowe spotykane są znacznie rzadziej. Podstawą diagnostyki szumów usznych powinien być wywiad lekarski i przeprowadzenie odpowiednich badań audiologicznych (audiometrii tonalnej oraz impedancyjnej) w celu dokonania oceny stanu narządu słuchu. W szczególnych przypadkach zaleca się również wykonanie badania rezonansu magnetycznego oraz ultrasonografii, tomografii komputerowej, angiografii rezonansu magnetycznego czy konwencjonalnej angiografii. Autorzy dokonali oceny efektywności leczenia szumów usznych z zastosowaniem różnych metod terapeutycznych: farmakoterapii, wykorzystania aparatów słuchowych, generatorów szumu, metody TRT (Tinnitus Retraining Therapy), terapii poznawczo-behawioralnej, stymulacji nerwu błędnego, stymulacji bimodalnej, prototypowego urządzenia do elektromagnetostymulacji ucha, aplikacji mobilnych. W opublikowanych w październiku 2014 roku przez Amerykańską Akademię Otolaryngologii Chirurgii Głowy i Szyi wytycznych do postępowania z pacjentami z szumami usznymi w praktyce klinicznej umieszczono rekomendację przeciw stosowaniu farmakoterapii w początkowym etapie leczenia przewlekłych, uciążliwych szumów usznych. Do najnowszych metod wykorzystywanych w terapii szumów usznych należą: stymulacja nerwu błędnego tVNS oraz stymulacja bimodalna łącząca stymulacje słuchową i somatosensoryczną oraz nowatorska metoda elektromagnetostymulacji ucha z wykorzystaniem prototypowego urządzenia własnej konstrukcji.
The aim of this work was to optimize the algorithm for managing patients withlocally advanced breast cancer, taking into account the problem of developing therapeutic chemoresistance. Material and methods. The first stage included 187 patients with a verified diagnosis of primary locally advanced breast cancer (T3N2,T4N0-3). In the neoadjuvant chemotherapy regimen, all patients were treated according to the AC regimen (doxorubicin 60 mg, cyclophosphamide 600 mg/m2 i), taking into account the immunohistochemical subtype: a) patients with the luminal variant additionally received paclitaxel 175 mg/m2 for a total of up to 4 courses, or paclitaxel 80 mg/m2 weekly for 12 administrations; b) patients with triple-negative cancer received paclitaxel 175 mg/m2 for a total of up to 4 courses,or paclitaxel 80 mg/m2 in combination with carboplatin AUC2 weekly for 12 administrations. The effectiveness of treatment was assessed by calculating the frequency of the overall objective response (OR) and complete pathomorphological tumor regression (pCR). At the second stage, based on the obtained results, patients with luminal and triple-negative breast cancer were divided into groups with a complete therapeutic response (n=10) and resistant course (n=10). The control group consisted of patients with fibroadenoma (n=10).In order to study the characteristics and mechanisms of formation of therapeutic resistance in patients with different histological subtypes of cancer, an assessment of the expression of immunological markers CD4, CD8, CD20, CD68 and angiogenesis markers HIF-1α, VEGF, ANGP2 in breast tissue was carried out using immunohistochemistry. Results. In the case of luminal, Her2/neu-negative, and triple-negative subtypes, it was shown that weekly administration of taxanes in mono regiment either in combination with platinum drugs (after anthracycline therapy) does not statistically significantly improve the rates of partial objective response and the degree of therapeutic pathomorphosis of the tumor. In the tumor tissue of drug-resistant patients, an increase in the number of CD68+cells was noted compared to the tumor tissue of patients with a complete response to therapy (p<0,001) and the control group (p=0,045); as well as a decrease in the number of cytotoxic CD8+cells in relation to patients with non-resistant cancer (p=0,032) and the control (p=0,001). When assessing the expression of angiogenesis markers in the tumor tissue of patients with no response to therapy, an increase in the number of HIF-1α-positively stained cells was recorded compared to tissue samples from the control group of patients (p=0,004); an increase in the degree of VEGF expression compared to the group with non-resistant cancer (p=0,021) and the control group (p<0,001); as well as a slight increase in the degree of ANGP2 expression compared to the control group (p=0,05). These markers are points of application of targeted therapy and immunotherapy. Conclusion. Thus, knowledge about the molecular basis of breast tumor resistance to neoadjuvant chemotherapy allows us to optimize the algorithm for managing patients, improve the quality of medical care, and improve treatment outcomes.
Treatment of high-risk soft-tissue sarcoma (STS) of extremity or trunk wall involves neoadjuvant chemotherapy (NACT) followed by surgery. Histopathological response could estimate patient outcomes. To characterize morphological changes in surgical specimens of patients treated with NACT with or without radiotherapy (RT) to identify histopathological features that stratify risk of recurrence and ultimately estimate the benefit from neoadjuvant treatments. This was a preplanned prospective secondary analysis of the ISG-STS 1001 clinical trial, a study with both a randomized clinical trial (conducted between 2011 and 2016) and a nonrandomized patient cohort (included between 2016 and 2020) at 32 centers across Italy, Spain, France, and Poland. Participants were patients with STS randomly assigned to receive either anthracycline plus ifosfamide or histotype-tailored (also termed histology tailored) NACT. Data analyses were performed from January to June 2023. Participants received 3 cycles of anthracycline plus ifosfamide or histotype-tailored NACT with or without RT followed by surgery. The primary outcome was disease-free survival (DFS). Histopathological features considered included the proportion of stainable tumor cells, tumor necrosis, hemorrhage, fibrohistiocytic reaction with hemosiderin, sclerosis or fibrosis, and sclerohyalinosis. The proportion of stainable tumor cells was classified according to the European Organization for Research and Treatment of Cancer–Soft Tissue and Bone Sarcoma Group categories or as absent or present. The continuous variable of sclerohyalinosis, expressed as a percentage, was categorized based on the second tertile of its distribution (20%). Tumor necrosis, hemorrhage, fibrohistiocytic reaction with hemosiderin, sclerosis or fibrosis, which were also expressed as a percentage, were classified as absent or present. A total of 388 patients (201 in randomized cohort, 187 in nonrandomized cohort; median [IQR] age, 50 [41-60] years; 245 males [63.1%]) were evaluable for histopathological response. In the randomized cohort, after a median (IQR) follow-up of 86 (70-99) months, 115 of 201 patients (57.2%) developed a disease recurrence. The proportion of stainable tumor cells (>1%) was not associated with DFS (hazard ratio [HR], 1.47; 95% CI, 0.36-5.98; P = .59). Necrosis (>1%) was associated with shorter DFS (HR, 3.11; 95% CI, 1.36-7.14; P = .007), while sclerohyalinosis greater than 20% was associated with longer DFS (HR, 0.51; 95% CI, 0.28-0.94; P = .03). Exclusion of patients who received preoperative RT did not alter these associations. In patients randomly assigned to anthracycline plus ifosfamide (n = 98), sclerohyalinosis greater than 20% remained associated with longer DFS (HR, 0.24; 95% CI, 0.09-0.67; P = .007). These findings were confirmed when a broader cohort (n = 187) was included. In this secondary analysis of a randomized clinical trial, the proportion of stainable tumor cells, currently considered as the most relevant posttreatment change, did not stratify patient risk. The findings support consideration of the presence of sclerohyalinosis (>20%) to identify patients with the best outcome after NACT.
Introduction. The increasing interest in the use of bacterial cultures and complex microbial products in medical treatment has become more and more noticeable. Each year, a growing number of such products are introduced to the pharmaceutical market. With the development of methods for isolating and culturing specific bacterial strains, numerous concepts have emerged on the potential benefits of supplementation. We agree that probiotic supplementation yields scientifically proven positive effects in certain medical conditions. However, our attention is drawn to the tendency to expand the use of probiotics to vulnerable populations. This raises important questions concerning the safety, efficacy, and potential risks associated with probiotic use among the most sensitive patient groups. In our work, we focused on reviewing the current scientific literature, and we would like to propose several insights into safe probiotic administration among different groups of patients. Materials and methods. We reviewed the literature from early 2000 to 2025 for articles on the probiotics in different groups of patients. The review of the available literature was conducted by searching official databases such as PubMed and Google Scholar using the following keywords: probiotics, prebiotics, antibiotics, microflora, sepsis, acute diarrhea, preterm infants, SIBO, IBS, acute pancreatitis etc.. We also queried references cited from original research, meta-analyses, and reviews in both Polish and English language, published in scientific journals and articles. Results. Probiotics demonstrate therapeutic benefits in preventing antibiotic-associated diarrhea and reducing necrotizing enterocolitis in preterm infants. They may also support treatment of ulcerative colitis, pouchitis, travelers’ diarrhea and acute childhood diarrhea, as well as possibly prevent atopic dermatitis when taken maternally. However, the evidence remains inconclusive for several other conditions, including IBS and Crohn’s disease. Probiotic use remains not recommended in immunocompromised states, such as ICU settings, due to the risk of sepsis. Safety concerns include antibiotic resistance and microbiota disruption, which requires thorough data from high-quality clinical trials, including strain-specific assessments. Finally, the available data suggests that synbiotics may offer enhanced benefits, while postbiotics are emerging as safer alternatives. Conclusions. The available data and existing studies do not provide sufficient grounds to unequivocally support the use of probiotics and related products in clinical treatment. There is a lack of robust evidence based on well-designed clinical trials. Current recommendations regarding the use of probiotics for the management of travelers’ diarrhea and antibiotic-associated diarrhea remain in place, as do contraindications for their use in individuals with sepsis or compromised immune function. However, for other medical conditions, stronger evidence and formal guidelines from scientific societies are still awaited.
