Modern research indicates that cancer patients exhibit certain clinically significant psychological characteristics. These psychological constructs can significantly impact treatment adherence and the dynamics of the disease. An analysis of current literature on the clinical and psychological characteristics of cancer patients has identified the most significant ones: neuroticism, irritability, shyness, extroversion, emotional lability, and an external locus of control. Many studies have also noted anxious, ergopathic, and hypochondriacal attitudes toward the disease. All of these psychological characteristics of cancer patients lead to vulnerability to stress and contribute to the development of maladaptive behaviors in this group of patients. Intense emotional experiences can transform various aspects of the immune response, thereby influencing tumor development. Current research also points to the influence of mental disorders on tumor progression; however, actual data on the impact of both stress and psychosocial support on cancer processes necessitate further study.
Background. Glutamate plays a key role in excitatory neurotransmission and neuroplasticity, as well as in addiction. While the isolated effects of ethanol and morphine on its levels in the brain are well known, the combined effects of these psychoactive substances on glutamate concentrations in the central nervous system have been poorly studied. Objective. To evaluate changes in the functional relationships of glutamate with neuroactive transmitters in various brain structures of rats following a single combined administration of ethanol and morphine. Material and methods. Albino male rats (n=43) divided into five groups were used in the experiment. A single intragastric administration of ethanol and intraperitoneal administration of morphine were performed, as well as their combined administration in varying orders at 12-hour intervals. Neurotransmitter and neurotransmitter amino acid concentrations were determined in the cerebral hemispheres, striatum, hypothalamus, midbrain, and cerebellum by ion-pair high-performance liquid chromatography with fluorescence detection. The relationships between glutamate levels and other neuroactive substances were assessed using Spearman correlation analysis. Results. In acute alcohol intoxication, a statistically significant positive correlation was found between glutamate and the inhibitory neurotransmitter amino acids gamma-aminobutyric acid (GABA) and glycine, despite a significant decrease in glutamate levels in the cerebral hemispheres. Of particular interest were the experimental groups with combined psychoactive substance administration: morphine followed by ethanol resulted in increased glutamate levels in the hypothalamus and a strong glutamate/aspartate correlation, as well as a glutamate/dopamine correlation in the striatum and cerebral hemispheres. In the ethanol+morphine group, glutamate concentrations remained stable, but there was a positive correlation with aspartate in the cerebellum and striatum, with GABA and aspartate in the hypothalamus, as well as with glycine and aspartate in the cerebral hemispheres, while a strong negative correlation with norepinephrine was observed in the striatum. Conclusion. Despite relatively stable glutamate levels in the brain following a single combined administration of ethanol and morphine, significant changes in its correlations with other studied neurotransmitters were detected in various areas of the central nervous system. This may indicate functional dysregulation of the glutamatergic neurotransmitter system, as well as an imbalance between excitatory and inhibitory amino acids in the brain following combined administration of ethanol and morphine.
Objective. To determine the prognostic value of lesions of the main arteries of the lower extremities and the results of their correction in diabetic foot syndrome (DFS). Material and methods. A total of 452 patients with DFS were examined. Hemodynamically significant disturbances of the main blood flow in the lower extremity arteries were detected in 53.3% of cases. Reconstructive surgery on the lower extremity arteries was performed in 22.6% of patients. The surgical activity in the sample was 60.0%. Local interventions on the foot were performed in 48.2% of patients, of which 14.7% required a series of additional local interventions, and 6.4% ultimately required high amputation of the lower extremity (HALE). Primary HALE was used in 11.7% of cases, in 26% of these cases stump complications occurred which required additional surgery. Results. Risk factors for additional foot surgery after local interventions in the surgical treatment of DFS include lesions of the iliofemoral segment as well as combined lesions of the femoropopliteal segment and crural arteries. Combined pathology of the iliofemoral segment and crural arteries is associated with the risk of performing HALE after local interventions on the foot. The risk of performing primary HALE is associated with lesions of the iliofemoral segment, femoropopliteal segment, crural arteries, and combined lesions of the femoropopliteal segment and crural arteries. The risk of performing HALE during surgical treatment correlates with the presence of lesions of the iliofemoral segment, femoropopliteal segment, and crural arteries. Following reconstructive surgery on the main arteries of the lower extremities, the risk of additional foot surgery after local interventions and the risk of performing HALE after local foot interventions increases during subsequent treatment, while the risk of performing primary HALE and HALE during treatment decreases. Initial hemodynamically significant lesions of the main arteries of the lower extremities and performing reconstructive surgery on them do not affect the incidence of local complications after primary HALE. Conclusion. The obtained information can be used to predict results and determine rational tactics for surgical treatment of patients with DFS.
Langerhans cell histiocytosis (LCH) is an orphan disease that belongs to a group of histiocytic and dendritic cell neoplasms. The group of histiocytoses is very heterogeneous, both clinically and histochemically. The incidence of the disease is 1 per 1 000 000. LCH with isolated lung involvement comprises about half of all single-focal form histiocytoses and differs nosologically from LCH. Pulmonary Langerhans cell histiocytosis has its own histological characteristics, its own development and treatment strategies. Today, there are possibilities of immunohistochemical verification of the diagnosis with the detection of CD1a+, CD207+ antigens, but the range of clinical manifestations and differential diagnosis is wide: random clinical and radiological findings will not always lead to the correct diagnosis. In addition, there are no generally accepted standards for the treatment of adult patients with LCH due to the lack of a strong evidence base. Recently, mutations in the RAS-RAF-MEK-ERK pathway have been found, which has expanded the possibilities of targeted therapy. The diagnostic algorithm taking into account clinical features, diagnostic criteria analysis and choosing the optimal management strategy for the patient with isolated pulmonary histiocytosis is a clinical challenge for an internist.
Background. Cervical cancer (CC) has become a common malignancy, significantly contributing to the rising mortality rate among women worldwide. The vaginal microenvironment plays a key role in the development of the human papillomavirus (HPV) infection, thereby contributing to the development of CC. Objective. To characterize the main indicators of vaginal microecology in HPV-associated cervical dysplasia. Material and methods. The study involved 102 women of reproductive age (18-49 years). The study material consisted of posterior vaginal fornix swabs and cervicovaginal secretion samples. Vaginal swabs were cultured. The vaginal microbiome was assessed based on the number of microorganisms grown. All lactobacillus isolates were assessed for their functional activity, including their ability to produce hydrogen peroxide, form biofilm, and exhibit antagonistic activity against test strains of opportunistic microorganisms. Results. In HPV-associated dysplasia, there was a significant increase in the pH of the vaginal discharge (p<0.034) and a significantly higher incidence of vaginal dysbiosis (80%), with severe dysbiosis detected in 73.3% of patients. Antagonistic activity and hydrogen peroxide production in lactobacilli of the compared groups did not differ. Biofilmforming capacity was significantly reduced in lactobacilli isolated in the cervical dysplasia group. Thus, the ability to form the main substance was low in all lactobacilli isolates in this group (p=0.02), and the ability to form biomass was absent in 60% of isolates (p=0.003). The study of the parameters characterizing local vaginal immunity did not reveal significant differences between the groups. However, a trend towards an increase in proinflammatory cytokines, regulatory IL-2 and a decrease in sIgA was noted in the group with cervical dysplasia. Conclusion. We detected significant changes in several vaginal microecological parameters in a group of women with HPV-associated cervical dysplasia. It was found that dysplasia was associated with vaginal dysbiosis, and vaginal pH was elevated. Changes in the properties of the resident vaginal microbiota were also observed, including decreased antagonistic activity and the ability to form a physiological biofilm on the vaginal mucosa, leading to decreased colonization resistance of the vaginal biotope. These parameters may indicate a progressive course of HPV-associated dysplasia and can be used as additional markers in assessing the risk of developing precancerous pathology and cervical cancer.
