Radioligand therapy with 177 Lu-Prostate Specific Membrane Antigen is a very promising treatment option for patients with prostate cancer. In the past ten years it started to be used as one of the final options in patients with metastatic, castration resistant prostate cancer, after previously exploiting all the common treatments. In Slovakia, this treatment has been available since the beginning of the year 2020. In this time, we have been able to adopt many of the recommendations from the European guidelines and adapt the rest to the clinical and national legislative requirements. In the time period between February 2020 and June 2024, we treated 104 patients and administered total of 362 cycles of the radioligand therapy with 177 Lu-Prostate Specific Membrane Antigen. Although the numbers of our patients suitable for systemic evaluation are for now rather small, our result has so far showed the correlation with some of the largest multicentric trials. More patients will be included in the further evaluation with upcoming months, and more precise data will be available.

Metastatic castration-resistant prostate cancer (mCRPC) remains a lethal disease due to the absence of effective therapies. A more comprehensive understanding of molecular events, encompassing the dysregulation of microRNAs (miRs) and metabolic reprogramming, holds the potential to unveil precise mechanisms underlying mCRPC. This study aims to assess the expression of selected serum exosomal miRs (miR-15a, miR-16, miR-19a-3p, miR-21, and miR-141a-3p) alongside serum metabolomic profiling and their correlation in patients with mCRPC and benign prostate hyperplasia (BPH). Blood serum samples from mCRPC patients (n = 51) and BPH patients (n = 48) underwent metabolome analysis through 1H-NMR spectroscopy. The expression levels of serum exosomal miRs in mCRPC and BPH patients were evaluated using a quantitative real-time polymerase chain reaction (qRT-PCR). The 1H-NMR metabolomics analysis revealed significant alterations in lactate, acetate, citrate, 3-hydroxybutyrate, and branched-chain amino acids (BCAAs, including valine, leucine, and isoleucine) in mCRPC patients compared to BPH patients. MiR-15a, miR-16, miR-19a-3p, and miR-21 exhibited a downregulation of more than twofold in the mCRPC group. Significant correlations were predominantly observed between lactate, citrate, acetate, and miR-15a, miR-16, miR-19a-3p, and miR-21. The importance of integrating metabolome analysis of serum with selected serum exosomal miRs in mCRPC patients has been confirmed, suggesting their potential utility for distinguishing of mCRPC from BPH.

Dumping syndrome is a common post-operative complication following gastric surgery. Clinically, severe dumping can be a serious medical condition with a negative impact on the patient's life. In our case report, we present a case of refractory dumping syndrome which developed after laparoscopic subtotal gastrectomy with gastrojejunoanastomosis due to massive gastroptosis with stomach evacuation problems. Conservative gastroenterology treatment was not successful. Due to the progression of weight loss and life-threatening hypoglycaemia, the decision for surgical treatment was made. After the corrective gastro-duodenal and jejuno - jejunal anastomoses, all clinical symptoms resolved completely. With regard to the presented case, we discuss the common treatment options for dumping syndrome: the standard recommendations for dietary habits, pharmacological treatment and finally the surgery and its pitfalls. Due to the absence of randomized trials and guidelines, every patient should be treated in a personalized way.

In the global context, the epidemic of breast cancer (BC) is evident for the early 21st century. Evidence shows that national mammography screening programs have sufficiently reduced BC related mortality. Therefore, the great utility of the mammography-based screening is not an issue. However, both false positive and false negative BC diagnosis, excessive biopsies, and irradiation linked to mammography application, as well as sub-optimal mammography-based screening, such as in the case of high-dense breast tissue in young females, altogether increase awareness among the experts regarding the limitations of mammography-based screening. Severe concerns regarding the mammography as the golden standard approach demanding complementary tools to cover the evident deficits led the authors to present innovative strategies, which would sufficiently improve the quality of the BC management and services to the patient. Contextually, this article provides insights into mammography deficits and current clinical data demonstrating the great potential of non-invasive diagnostic tools utilizing circulating miRNA profiles as an adjunct to conventional mammography for the population screening and personalization of BC management.

Multiple sclerosis (MS) is a disease characterized by overlapping processes of neuroinflammation and neuro-axonal degeneration. Disturbances of the hypothalamo-pituitary axis in MS are supposed to modulate neuroinflammatory circuits, however, there is insufficient knowledge about the hypothalamic metabolism alterations in early MS. This 1H MRS study performed on a 1.5 T MR-scanner was focused on the hypothalamus of 31 pre-treatment patients after their first clinical MS episode/s, compared to 31 healthy controls. The metabolite ratios of N-acetyl-aspartate & N-acetyl-aspartyl-glutamate (tNAA), glutamate & glutamine (Glx), myo-Inositol (mIns), choline- and creatine-containing compounds (tCho, tCr) were further correlated with the Expanded Disability Status Scale (EDSS). In the hypothalamus of early MS patients compared to controls, we found decreased tNAA/tCr and increased tCho/tNAA, mIns/tNAA, Glx/tCr, and Glx/tNAA. In addition, tCho/tNAA, Glx/tNAA, and mIns/tNAA were positively and tNAA/tCr was negatively correlated with EDSS. Results suggest that the decline of the tNAA ratio, indicating neuro-axonal dysfunction in the hypothalamus, may be linked with glutamate excitotoxicity. Excessive glutamate concentrations may cause microglial activation and myelinated tracts degradation with subsequent gliosis, paralleled by increased mIns and tCho ratios. This indicates that glutamate excitotoxicity can play an important role in MS from its earliest stages.

Objective.In multiple sclerosis (MS), deep grey matter (DGM) atrophy has been recognised as a crucial component of the disease that presents early and it has been associated with disability.Although the precise mechanism underlying grey matter atrophy is unknown, several hypotheses have been postulated.Our previous research pointed to correlations of hypothalamic metabolic alterations with clinical outcomes of MS, therefore we decided to further test the relationship of these alterations with DGM atrophy.Methods.We used 1 H-Magnetic Resonance spectroscopy ( 1 H-MRS) of the hypothalamus to test its metabolites in 26 patients with RRMS and 22 healthy age-matched controls.DGM atrophy was evaluated by simple planimetry of third ventricular width on the hypothalamic level (3VW) in T1 weighted MRI pictures.Metabolite ratios of N-acetyl aspartate (NAA), choline (Cho), glutamate and glutamine (Glx), myo-inositol (mIns) and creatine (Cr) were correlated with Multiple Sclerosis Severity Scale (MSSS) and 3VW.Results.Metabolite concentrations were compared between patients and controls using multiple regression models allowing for age, 3VW and metabolites.It revealed that the only relevant predictors of MSSS were 3VW and Glx/NAA.At a significance level of P<0.05, a unit increase of 3VW was associated with a 0.35 increase of MSSS, for a typical value of Glx/NAA; P value 0.0039.A unit increase of Glx/NAA was associated with a 0.93 increase of MSSS, for a typical value of atrophy; P value 0.090.There were significant linear correlations between Glx/Cr and MSSS, Glx/NAA and MSSS, and between mIns/NAA and 3VW.Conclusions.The results suggest that both NAA and Glx are associated with neurodegeneration of hypothalamic DGM and severe disease course.Glx related 1 H-MRS parameters seem to be superior to other metabolites in determining disease burden, independently of otherwise powerful 3VW planimetry.Significantly increased mIns/NAA in MS patients compared to controls point to gliosis, which parallels the atrophy of hypothalamic DGM.

Echinococcosis is a serious parasitic disease that ends lethally in 95% of untreated infected patients. It was first diagnosed in Slovakia in the year 2000. It is caused by the larval stage of a tapeworm belonging to the genus Echinococcus, which was assigned to the group "A" of zoonoses in the year 2004. The number of new infections is rising because of increasing percentage of infected red foxes (Vulpes vulpes). Early and accurate diagnosis of infections with this parasite is essential for proper initiation of adequate therapy. Thanks to professional multidisciplinary efforts and new laboratory procedures, the number of correctly diagnosed cases has increased. Antimicrobial therapeutic approaches can lead to improved quality of life and better prognosis even if radical surgery is refused by the patient.

Abstract Objectives: Disturbances in the hypothalamo-pituitary axis are supposed to modulate activity of multiple sclerosis (MS). We hypothesised that the extent of HYP damage may determine severity of MS and may be associated with the disease evolution. We suggested fatigue and depression may depend on the degree of damage of the area. Method: 33 MS patients with relapsing-remitting and secondary progressive disease, and 24 age and sex-related healthy individuals (CON) underwent 1H-MR spectroscopy (1H-MRS) of the hypothalamus. Concentrations of glutamate + glutamin (Glx), cholin (Cho), myoinositol (mIns), N-acetyl aspartate (NAA) expressed as ratio with creatine (Cr) and NAA were correlated with markers of disease activity (RIO score), Multiple Sclerosis Severity Scale (MSSS), Depressive-Severity Status Scale and Simple Numerical Fatigue Scale. Results: Cho/Cr and NAA/Cr ratios were decreased and Glx/NAA ratio increased in MS patients vs CON. Glx/NAA, Glx/Cr, and mIns/NAA were significantly higher in active (RIO 1–2) vs non-active MS patients (RIO 0). Glx/NAA and Glx/Cr correlated with MSSS and fatigue score, and Glx/Cr with depressive score of MS patients. In CON, relationships between Glx/Cr and age, and Glx/NAA and fatigue score were inverse. Conclusion: Our study provides the first evidence about significant hypothalamic alterations correlating with clinical outcomes of MS, using 1H-MRS. The combination of increased Glu or mIns with reduced NAA in HYP reflects whole-brain activity of MS. In addition, excess of Glu is linked to severe disease course, depressive mood and fatigue in MS patients, suggesting superiority of Glu over other metabolites in determining MS burden.

Background: Preoperative location of a non-palpable breast lesion is a standard diagnostic tool helping surgeon to localize the breast lesion in a breast during operation, minimizing the local breast structure damage. The spectra of used approaches vary and depend on local experiences, preferences and conditions. The most frequent used is a wire-based technique when a specific guiding wire is placed under the radiologic control into/close to the breast lesion. Objective: To describe the specific case of lost wire-guided hook located in the chest cavity by using a 3D CT enhanced approach after failed mammography/X-chest detection scan in a woman with non-palpable breast lesion. Methods: Case report describing a modern approach of CT scanning for a localization of lost guiding wire in a 46-years old woman with BIRADs 4c lesion in her breast. Results: The use of 3D reconstructed enhanced computer tomography for a localization of lost guiding wire prior breast surgery is a highly sensitive and specific method, which by applying its planar scans allows detailed and more precise assessment of the case than conventional X-chest or mammography scan. Conclusion: The 3D CT scanning is a specific sensitive diagnostic tool which can be used for a localization of lost guiding-wire inserted into the breast prior surgery for the non-palpable lesions. Study was supported by grants UK 243/2012, VEGA 1/0243/12 and VEGA 1/0475/12 from the Ministry of Education of the Slovak Republic.

The authors report an interesting case of dangerous complications during dental hygienist treatment. Soft tissue emphysema during, and after stomatological procedures is described in several works. Such a complication after „airflowing“ has not yet been published in literature.

Purpose:The aim of the study was to evaluate the risk factors for CAS with cerebral protection and the incidence of complication in patients with severe carotid stenosis.Materials and Methods: Overall, 95 consecutive patients with an average age of 64.67 years (28 -83) (16 women (17%) and 79 men (83%)) were enrolled in the prospective monocentric study.Indication for CAS was symptomatic carotid stenosis ≥70% (n = 60 (63.16%)) or asymptomatic stenosis ≥80% (n = 35 (36.84%)) according to the NASCET criteria on DSA, which were not suitable for surgery.Results: From the selected risk factors, the most frequently found were arterial hypertension in 87 patients (91.6%), ischemic heart disease in 70 (73.7%),hyperlipidemia in 61 (64.2%), history of stroke in 43 (45.3%),diabetes mellitus in 35 (36.8%), smoking in 13 (13.7%),and age more than 75 years in 9 (9.5%).Significantly more frequent complications in elderly patients (more than the age of 75 years) were experienced: TIA (p = 0.049), early death (p = 0.049), restenosis (p = 0.04), and overall mortality (p = 0.04).Conclusion: Among the studied risk factors, only patients more than the age of 75 years were affected by the incidence of serious complications.

Introduction: There still is some debate about the relationship between handedness and speech in healthy subjects. We used focal transcranial magnetic stimulation (TMS) as a non-invasive method to determine hemispheric dominance and compared our results with several neuropsychological tests. Methods: 91 healthy subjects (age 26 +/- 4.6) underwent neuropsychological testing for handedness, TMS mapping of cortical representation of abductor pollicis brevis (APB), repetitive TMS (rTMS) to determine language lateralization with Number-counting paradigm - rTMS(1), and Verb-generation paradigm - rTMS(2). Results: There was a significant correlation between cortical asymmetry of the left/ right APB and all the used neuropsychological tests of handedness (p < 0.001). Laterality of speech arrest using rTMS(1) correlated with the majority of tests for handedness. When rTMS(2) was used, there was significantly longer reaction time in 29/42 subjects but we found correlation with only one of the tests. Conclusion: Handedness is associated with asymmetry in cortical motor representation. Right-cerebral dominance for language in healthy right-handers is not as rare as it was supposed (9.5%). Stronger left-handedness is associated with higher probability of language dominance in the right hemisphere (9.5-33%). When using rTMS, we found that: a) speech production can be influenced by 2 different areas in the gyrus frontalis inferior, b) pars triangularis is involved in verb production only in some subjects, c) motor threshold is significantly higher for cognitive processes than for motor functions. TMS with focal magnetic coil can be used as an objective method for mapping cortical motor asymmetry of handedness and language functions.