Search

To evaluate treatment outcomes, survival, and predictive factors in patients ≥70 with advanced epithelial ovarian cancer (AEOC).A retrospective single institution cohort study of women ≥70 with Stage III-IV AEOC between 2010 and 2018. Patients had either primary cytoreductive surgery (PCS), neoadjuvant chemotherapy (NACT) with interval cytoreductive surgery (ICS), chemotherapy alone, or no treatment. Demographics, surgical outcome, complications, and survival outcome were compared between groups.Among 248 patients, 69 (27.7%) underwent PCS, 99 (39.9%) had ICS, 56 (22.5%) had chemotherapy alone. Twenty-four (9.6%) remained untreated. Optimal cytoreduction (≤1 cm) was achieved in 72.4% of PCS and 77.8% of NACT/ICS (p = 0.34), without difference in grade ≥3 postoperative complications (15.9% vs. 9.1%, p = 0.37). Progression-free survival (PFS) was 23.5 months in PCS and 15.0 months in ICS patients (hazard ratio [HR]: 1.4, p = 0.041). Patients in the surgical arms, PCS or ICS, had better 2-year overall survival (OS) compared to chemotherapy alone (79%, 68%, 41%, respectively, HR: 3.58, p 0.001). In a subgroup analysis, patients ≥80 had improved 2-year OS when treated with NACT compared to PCS (82% vs. 57%) and a trend toward improved PFS. Age, stage, and CA-125 were determinants of undergoing PCS.In patients ≥70 with AEOC, surgery should not be deferred based on age alone. Fit, well selected patients ≥70 can benefit from PCS, while patients ≥80 might benefit from NACT over PCS.

Introduction: Hydronephrosis is one of the most commonly diagnosed urinary tract defects in children. It is characterised by various degrees of dilation of the renal pelvis and calyces with concomitant thinning of the renal parenchyma. The dilation is caused by a ureteropelvic junction defect obstructing the outflow of urine from the kidney. Extreme hydronephrosis can lead to a complete lack of function of the affected kidney. The treatment of hydronephrosis involves restoring normal urine outflow from the kidney and depends on the cause of the condition. The decision to perform surgery depends on the rate of progression of abnormalities observed in the renal parenchyma, among other aspects. Aim of the study: The paper presents the experiences of a single centre in the surgical treatment of hydronephrosis in children aged up to 18 years. Materials and methods: In 2016–2020, 77 children underwent surgery for hydronephrosis at the present authors’ department. In 40% of cases, hydronephrosis was diagnosed on antenatal screening, in 31% it was observed on abdominal ultrasound performed due to abdominal pain, in 17% the condition was detected incidentally when the causes of other diseases were being investigated, in 9% urinary tract infection led to the discovery of hydronephrosis and in 3% of cases abdominal trauma was the reason the patient was examined in the first place. In 58% of the subjects, the cause of hydronephrosis was intramural stenosis of the ureteropelvic junction, in 22% it was the presence of accessory vessels and in 20% various other causes were found. In all patients, Anderson–Hynes ureteropyeloplasty was performed. Results: Surgical outcomes were assessed 12 months after the procedure, and in 97.4% of cases they were considered good. A repeat operation was performed in only 2 cases due to a lack of improvement after the original hydronephrosis surgery. Conclusions: Surgical treatment of hydronephrosis caused by ureteropelvic obstruction is an effective and safe method with a low risk of early and late complications.

Aim: To evaluate treatment results in advanced/metastatic melanoma patients treated with anti-PD-1 immunotherapy in routine practice in oncology centers in Poland. Methods: Multicenter retrospective analysis included 499 patients with unresectable/metastatic (stage IIIC–IV) melanoma treated with anti-PD-1 in first-line therapy. Results: Estimated median overall survival (OS) and progression-free survival (PFS) were 19.9 and 7.9 months, respectively. Multivariate analysis confirmed that ECOG 0, no brain metastases, normal lactate dehydrogenase level and occurrence of immune-related adverse events (irAEs) were statistically significantly associated with improved OS and PFS. Any irAE occurred in 24% of patients. Grade 3 or Grade 4 irAEs occurred in 6% of patients. Conclusion: Analysis revealed a slightly worse OS in real-world treatment in comparison to clinical trials (KEYNOTE-006 and CheckMate 066). Polish population treatment results are similar to other studies of real-world data. PFS and ORR are similar in our research and clinical trials.

Pomimo 30 lat (simwastatyna została dopuszczona w 1991 przez FDA do stosowania klinicznego [1]) starań ekspertów, towarzystw i organizacji pacjenckich zaburzenia lipidowe wciąż stanowią wyzwanie diagnostyczne, ale przede wszystkim terapeutyczne. Dotyczy to zarówno właściwej oceny ryzyka pacjentów, włączenia odpowiedniego leczenia, problemów z jego adherencją, ale także problemów z tak ważnym leczeniem niefarmakologicznym – dietą, redukcją masy ciała czy regularnym wysiłkiem fizycznym [2]. Nie można także umniejszać znaczenia inercji terapeutycznej, czy to polegającej na niewłaściwie dobranej terapii (najczęściej brakiem intensywnego leczenia statynami czy jeszcze rzadziej leczenia skojarzonego), czy wręcz na błędach polegających na zmniejszeniu dawki czy odstawieniu terapii po uzyskaniu celu terapeutycznego. Właśnie dlatego w Polsce mamy wciąż prawie 20 milionów osób z hipercholesterolemią, z czego większość osób nie zdaje sobie z tego sprawy [3], to właśnie dlatego dotychczas rozpoznaliśmy tylko około 5% pacjentów z rodzinną hipercholesterolemią z prognozowanych nawet 140,000.

Immunotherapy with anti-programmed cell death-1 (PD-1) agents is an effective treatment for metastatic melanoma. Octogenarians and nonagenarians represent a significant cohort of melanoma patients. This multicenter retrospective analysis enrolled 499 patients treated with nivolumab or pembrolizumab. Seventy-three patients were aged 80-100, 218 patients were aged 65-79, and 208 patients were

Introduction. The development of a new class of drug — checkpoint inhibitors has changed the prognosis of cancer patients. A particular class of drugs are antibodies against the programmed cell death type 1 receptor/ligand of the programmed cell death type 1 receptor (nivolumab and pembrolizumab). There are, however, no trials with a random selection of the patients which directly compare nivolumab and pembrolizumab. Because of the development of immunotherapy and many new drugs registered as anti-PD-1, it is important to determine whether there are differences in respect to effectiveness and safety in using nivolumab and pembrolizumab. Material and method. 499 patients with non-resectable or metastatic melanoma treated in the years 2016–2019 in five oncological reference centers in Poland (Cracow, Gliwice, Lublin, Poznan, Wroclaw) were included in the analysis. The criterion for inclusion in the analysis was first-line treatment with anti-PD-1 (nivolumab or pembrolizumab). Results. Median OS and PFS in the whole analyzed group were 19.9 and 7.9 months, respectively. Estimated median OS and PFS were 20.1 and 18.1 months and 8.5 and 6.0 months for nivolumab and pembrolizumab, respectively. No statistically significant difference was observed in median OS and PFS in the group of patients receiving nivolumab and pembrolizumab (respectively P = 0.6291 [HR = 1.06; Cl 95% 0.8–1.4] and P = 0.0956 [HR = 1.20; Cl 95% 0.97–1.48]). The percentage of grade G3 or/and G4 irAEs was similar in both groups treated with nivolumab or pembrolizumab, 5.8 and 5.2%, respectively. Conclusions. No differences in the range of OS, PFS and ORR was observed between therapy with nivolumab and pembrolizumab in previously untreated patients with advanced/metastatic melanoma. No differences were found in the frequency of irAEs of grade G3 or G4. The treatment with a specific preparation should be based on the preferences of the patient and the clinician.

Purpose The aim of this study was to analyze the severity of changes in cardiovascular risk factors (hypertension, overweight and obesity, carbohydrate metabolism disorders, burdened family history) and to assess the risk of a cardiovascular incident according to the Systematic Coronary Risk Evaluation (SCORE) algorithm in the same group of patients over a five-year interval. Patients and Methods The research method was analysis of medical records of patients from the area of West Pomeranian Province, Poland, included in the Cardiovascular Disease Prevention Program of the National Health Fund five years after the first examination (2012/2013 vs 2017/2018). We collected data on changes in the levels of selected cardiovascular risk factors over five years and calculated the SCORE values. Results In the second measurement (after five years), the odds of obesity were about 2.5 times higher. The repeated BMI measurement showed that after five years more respondents were classified as overweight and obese compared with the first measurement (p = 0.000; η2 = 0.056). The repeated SCORE measurement indicated that after five years the SCORE values significantly increased compared with the first measurement (p = 0.000; η2 = 0.588). Statistically significant differences (p < 0.05) were also found between the first and the second measurements of arm circumference, waist circumference, BMI, diastolic blood pressure, heart rate, and triglycerides. The risk of visceral obesity was statistically significantly higher for men than for women (RHM = 1.47). Conclusion In the group of patients examined twice over five years, the incidence of obesity, including abdominal obesity, significantly increased. Furthermore, five years after the last examination, the risk of a cardiovascular incident significantly increased. The participants had higher values of such parameters as: arm circumference, waist circumference, BMI, diastolic blood pressure, heart rate, and triglycerides.

Introduction. One of the most important achievements of contemporary oncology is the discovery of new therapeutic possibilities: targeted therapy and immunotherapy associated with checkpoint inhibitors. It has not been unequivocally determined so far which therapy should be used as first-line treatment in patients with advanced/metastatic melanoma with the BRAF mutation. Material and methods. 137 patients with advanced/metastatic melanoma with the BRAF mutation were analyzed. They received anti-PD1-1 therapy (IT) or molecularly targeted therapy iBRAF ± iMEK (TT) as first-line treatment in the scope of the national drug program. IT and TT therapies used as first-line treatment were compared. Results. Median OS and PFS in the group were 14.0 and 7.3 months. Unfavorable prognostic factors for OS and PFS were metastases to the central nervous system, increased LDH levels and performance status > 1. Metastatic sites in > 2 locations were only unfavorable prognostic factors for OS. A statistically significant difference was found between TT and IT for OS (p = 0.0011; median for TT was 12.6 months and was not reached for IT). It should be noted that the group treated with TT was characterized by a worse prognostic factors. No differences in PFS were observed (p = 0.292, medians 7.2 and 9.0 months, respectively). Conclusion. In patients with advanced/metastatic melanoma with a BRAF mutation without rapid progression, IT should be considered as first-line therapy.

The following elaboration presents positions of experts from various, mainly European scientific societies regarding utility of postprandial hypertriglyceridemia (HTG) in predicting cardiovascular (CV) risk. New studies and different categories of patients have been included. The following text has been based mainly on 2019 European Society of Cardiology and European Atherosclerosis Society guidelines regarding the management of dyslipidemia, as well as the 2019 international expert panel document. The position of Polish experts on using oral fat tolerance test in clinical practice has also been presented. Remaining problem is to assess potential usefulness of postprandial HTG in estimation of CV risk and to determine whether performing the oral fat tolerance test, that involves consumption of a standard high-fat preparation followed by blood collection at indicated time intervals, can improve CV risk assessment. Although importance of postprandial HTG in the assessment of atherogenic risk is increasingly well documented, there is still need for further research.

Elevated circulating concentrations of lipoprotein(a) [Lp(a)] is strongly associated with increased risk of atherosclerotic cardiovascular disease (CVD) and degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies. Everybody should have their Lp(a) concentration measured once in their lifetime. CVD risk is elevated when Lp(a) concentrations are high i.e. > 50 mg/dL (≥100 mmol/L). Extremely high Lp(a) levels >180 mg/dL (≥430 mmol/L) are associated with CVD risk similar to that conferred by familial hypercholesterolemia. Elevated Lp(a) level was previously treated with niacin, which exerts a potent Lp(a)-lowering effect. However, niacin is currently not recommended because, despite the improvement in lipid profile, no improvements on clinical outcomes have been observed. Furthermore, niacin use has been associated with severe adverse effects. Post hoc analyses of clinical trials with proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors have shown that these drugs exert clinical benefits by lowering Lp(a), independent of their potent reduction of low-density lipoprotein cholesterol (LDL-C). It is not yet known whether PCSK9 inhibitors will be of clinical use in patients with elevated Lp(a). Apheresis is a very effective approach to Lp(a) reduction, which reduces CVD risk but is invasive and time-consuming and is thus reserved for patients with very high Lp(a) levels and progressive CVD. Studies are ongoing on the practical application of genetic approaches to therapy, including antisense oligonucleotides against apolipoprotein(a) and small interfering RNA (siRNA) technology, to reduce the synthesis of Lp(a).

Despite considerable progress made in the treatment of patients with advanced melanoma, the majority of the patients treated with BRAF and mitogen-activated protein inhibitors (BRAFi and MEKi) experience a disease progression due to acquired resistance. Currently, ongoing studies explore the possibility to overcome or reverse this process. Our multicenter retrospective analysis included 51 patients with metastatic BRAF-mutated melanoma who had previously progressed on BRAFi/MEKi than had progressed on immunotherapy (anti-progression disease-1 or anti-cytotoxic T-lymphocyte-associated protein 4) and next were rechallenged with BRAFi/MEKi. Median age at BRAFi/MEKi rechallenge was 56 (range: 31-82 y/o). Median overall survival from the start of the first BRAFi/MEKi therapy and from rechallenge BRAFi/MEKi treatment was 29.7 and 9.3 months, respectively, whereas median progression-free survival was 10.5 and 5.9 months, respectively. Six-month, annual, and 2-year overall survival rates on both treatments were: 98% and 55%, 92% and 29%, and 69% and 2%, respectively. A response rate to treatment was higher in the group receiving BRAFi/MEKi for the first time as compared with the group receiving BRAFi/MEKi rechallenge and was overall response rate 72% and 27%; disease control rate 92% and 63%. Time interval between the end of the first BRAFi/MEKi treatment and the beginning of BRAFi/MEKi rechallenge did not influence median overall survival or progression-free survival. A lower toxicity rate was noted with BRAFi/MEKi rechallenge. BRAFi/MEKi rechallenge treatment remains clinically important and is associated with the lower toxicity. BRAFi/MEKi rechallenge efficacy is higher in patients who are in good performance status, with normal lactate dehydrogenase, and without brain metastases.

The storage of plant sample as well as sample preparation for extraction have a significant impact on the profile of metabolites. However, this parameter is often overlooked during experiments on plants. It was hypothesised that parameters such as sample storage (freezing) and sample pre-treatment methods, including the comminution technique or applied enzyme inhibition methods could significantly influence the extracted volatile metabolome.Significant changes were observed in the volatile profile of broccoli florets frozen in liquid nitrogen and at -20oC. Those differences were mostly related to the concentration of nitriles and aldehydes. Confocal microscopy indicated some tissue deterioration in the case of slow freezing (-20oC), whereas the structure of tissue, frozen in liquid nitrogen, was practically intact. Myrosinase activity assay proved that the enzyme remains active after freezing. No pH deviation was noted after sample storage - this parameter did not influence the activity of enzymes. Tissue fragmentation and enzyme-inhibition techniques applied prior to the extraction influenced both qualitative and quantitative composition of the volatile metabolome of broccoli.

Introduction When speaking of behavioral addictions (especially to the Internet and social media), it is emphasized that it is not the environment that is the main contributor to addiction, but rather certain behaviors and personality traits. Objectives The aim of this study was to assess the level of Internet and social media addiction on the example of Facebook with regard to psychological and social factors. Methods This survey-based study involved a group of women representing the female population in the West Pomeranian Voivodeship, Poland (N = 556). Research instruments were a self-developed questionnaire concerning sociodemographic data, the De Jong Gierveld Loneliness Scale, the Beck Depression Inventory, the Internet Addiction Test, and the Bergen Facebook Addiction Scale. Results Age, depressive symptoms, loneliness were the variable contributing to Internet and Facebook addiction among the studied. Available studies confirm the results of their own research. Employed n = 496 Unemployed n = 60 p BDI 4.0(1.0 – 10.0) 6.5 (1.5 – 12.5) 0.20 DJGLS 34.1 ± 3.7 33.0 ± 5.0 0.09 IAT 32.0 (24.0 – 44.0) 24.5 (20.0 – 32.0) < 0.001 BFAS 8.0 (6.0 – 12.0) 6.0 (6.0 – 7.5) < 0.001 Conclusions Depressive symptoms and dependence on the Internet and Facebook were more common among single women. In the employed women, we only observed higher levels of Internet and Facebook addiction. The level of dependence on the Internet and Facebook was higher among younger women. Loneliness correlated with Internet and Facebook addiction, and more severe depressive symptoms entailed higher levels of Internet and Facebook addiction. Disclosure No significant relationships.

There is a strong evidence that more marked lowering of low-density lipoprotein cholesterol (LDL-C) leads to progressively lower risk of cardiovascular disease (CVD) events. The evidence on validity of this hypothesis comes from epidemiological, genetic and clinical studies. The hypothesis "the lower the better" has been recently strongly supported by the results of secondary prevention trials with PCSK9 inhibitors. The combination of PCSK9 inhibitors and statins has resulted in achieving extremely low LDL-C levels with additional reduction of CVD events in secondary prevention. However, despite large clinical benefits, the safety of aggressive LDL-C lowering should be always taken into consideration, and there is still an ongoing discussion on whether very low LDL-C might result in some non-CVD adverse events. However, based on the available knowledge, so far the serious adverse events associated with achieving of very low LDL-C levels or intensive drug therapy have not been noted. These positive clinical effects were reflected in current ESC/EAS Guidelines (2019) for dyslipidaemia management. The experts strongly recommended the LDL-C lowering to levels that have been achieved in trials of PCSK9 inhibitors. In this state of the art review, we aimed to finally justify the critical need for LDL-C reduction to very low levels in secondary prevention patients in order to be as low as possible, as early as possible, and preferably lifelong.

Poultry waste is increasingly used as a substrate for the methane fermentation process in a biogas plant. However, not all waste materials processed in the meat industry meet the criteria for optimal process management and cost-effective methane efficiency. An example may be centrifuged biological sludge, etc. Treatment of such material used as a substrate by introducing new metabolically and enzymatically active strains of bacteria could be beneficial for the fermentation process in a biogas plant and provide increased energy efficiency. The aim of the study was to compare the amount and quality of biogas obtained from biological sludge from the processing of poultry vaccinated with metabolically diversified bacterial inoculum after initial incubation of the batch before the actual process in a biofermenter. Laboratory tests were carried out in accordance with the guidelines contained in the DIN 38 414-S8 and VDI 4630 standards. Based on the obtained results, it was found that the optimized biological sludge can be used as a substrate in the methane fermentation process in a biogas plant. The material processed by the combination of bacterial strains marked with the symbols A/C, E/G, and F/H showed a significantly increased efficiency of biogas, including methane, compared to the non-grafted material. This is a good predictor for industrial applications, process feasibility, economic viability, and environmental sustainability that should be compiled based on the results obtained from this study.

Introduction The treatment outcomes of patients with advanced/metastatic melanoma were poor before the use of new therapeutic options. Material and methods A retrospective analysis was conducted among 287 patients with unresectable stage III and stage IV melanoma treated at the Maria Sklodowska-Curie National Research Institute of Oncology Cracow Branch, from 2013 to 2019. All enrolled patients were treated with immunotherapy (IT; consisting of pembrolizumab/nivolumab, or ipilimumab) or target therapy (TT; consisting of vemurafenib ±cobimetinib or dabrafenib ±trametinib) in at least one treatment line. Results mutation was detected in 152 (55%) patients. In general, the majority of patients (92%) were in very good or good condition (Eastern Cooperative Oncology Group [ECOG] 0 or 1). Brain metastasis was detected in 64 (22%) patients. Median OS and PFS in the experimental group from the beginning of the first-line treatment were 14.9 and 6.7 months, respectively. Across the study population, as a first-line treatment patients received IT, TT as well as CHT, and the median OS was 19.2, 12.6 and 15.9 months, respectively. Multivariate analysis confirmed that normal LDH levels, no brain metastases, ECOG 0, and objective response to the treatment were strong predictors of longer OS. For PFS, absence of brain metastases, ECOG 0, and treatment response were found to be predictive factors on multivariate analysis. Conclusions The administration of new therapies for the treatment of patients with advanced/disseminated melanoma significantly prolonged survival in this group of patients. Nevertheless, further studies should be conducted to assess the effectiveness of various sequences of treatment.

The aim of the research was to assess the quality of milk from mountain sheep used for the production of traditional cheeses, taking into account the influence of the breed, the month of milking, and the content of somatic cells. Milk for the study was obtained from sheep of three mountain breeds: Podhale Zackel (PZ), Polish Mountain Sheep (PMS), and Coloured Mountain Sheep (CMS). The sheep were grazed in mountain pastures after lamb weaning, in the period from May to October in the traditional system. No influence of the breed on the examined parameters was found, except for urea content. Mountain sheep milk was characterized by a content of 19.68% solids, 8.48% fat, 6.63% protein, in which almost 76% was formed by casein (4.99%), and the average lactose content was 4.15%. Other milk parameters also did not differ between breeds: density was 1034.04 g/L, acidity 11.34°SH, and mean somatic cell content was 982.13∙103∙ml−1 (log10SCC = 5.68). The highest urea content was recorded in the milk of Coloured Mountain Sheep (280.69 mg/L) and the lowest urea content was recorded in the milk of Zackel sheep (200.97 mg/L). The month of milking influenced the content of most milk components, but no changes in SCC content during lactation were found. Significant correlations between fat content and other milk parameters were recorded. In the case of urea content, negative, statistically significant correlations with the majority of examined parameters were found.

The aim of the study was to evaluate the drug resistance of Enterococcus faecalis and Enterococcus faecium isolated from different types of poultry waste. The study material consisted of feather samples (duck, turkey, chicken), sludge and centrifuge sediment, originating from three poultry farms. The study was conducted in two stages; isolation and identification of Enterococcus bacteria from the waste and evaluation of their drug resistance using Kirby-Bauer method. Contamination of the poultry waste with Enterococcus isolates included E. faecium species (79 %) and E. faecalis (21 %). The most contaminated were sludge and sediment from the centrifuge as well as chicken feathers, irrespective of the place and time of sampling. Tested isolates showed multiple resistance and similar reaction to all antibiotics used in the study and E. faecalis strain was more resistant. Enterococcus isolates showed the highest resistance to streptogramins, carbapenems, fluoroquinones, aminoglycosides and penicillins, and the lowest for nitrofurantions and phenicols.

Irritable bowel syndrome is a common and recurrent disease occurring at all geographical latitudes. The prevalence in the northern hemisphere is estimated at 11%, with more women affected than men (2:1). The symptoms usually develop in the third or fourth decade of life. The aetiology of the disease is complex and not fully explained. Genetic factors, gastrointestinal motor dysfunction, visceral hypersensitivity, psychological stress and intestinal infections are believed to contribute to the etiopathogenesis. Irritable bowel syndrome reduces life quality and work productivity as well as is a considerable financial burden for both health care system and patients themselves. Despite its arduous course, it does not lead to the development of a serious disease with excessive mortality. Irritable bowel syndrome is characterised by recurrent abdominal pain related to defecation, change in bowel habits and/or stool consistency. The diagnosis of irritable bowel syndrome is currently based on the Rome IV diagnostic criteria published in 2016. These criteria are the latest update of the diagnostic criteria for gastrointestinal functional disorders now defined as disorders of gut–brain interaction. Irritable bowel syndrome is currently defined as abdominal pain that has occurred on average at least 1 day per week during the previous 3 months, which meets at least 2 of 3 criteria: 1) is related to bowel movement, 2) is related to a change in stool frequency, 3) is related to a change in stool consistency. The paper presents the main changes introduced in the Rome IV criteria, their rationale and implications for clinical practice.

People use their voices to communicate not only verbally but also emotionally. This article presents theories and methodologies that concern emotional vocalizations at the intersection of psychology and digital signal processing. Specifically, it demonstrates the encoding (production) and decoding (recognition) of emotional sounds, including the review and comparison of strategies in database design, parameterization, and classification. Whereas psychology predominantly focuses on the subjective recognition of emotional vocalizations, digital signal processing relies on automated and thus more objective vocal affect measures. The article aims to compare these two approaches and suggest methods of combining them to achieve a more complex insight into the vocal communication of emotions.

Melanoma is a malignant neoplasm with a very high rate of growth in the number of cases. In Poland, in the years 1980–2010, the number of cases of melanoma increased threefold. Although the incidence rates of melanoma are rising, the mortality rate due to melanoma is falling. In recent years, the treatment of patients with melanoma has changed to a great extent. Thanks to the development of molecular research, the presence of specific mutations in melanoma cells was discovered. The progress in understanding the molecular mechanisms occurring in this neoplastic cells and the interaction between the immune system cells and melanoma cells contributed to the development of new classes of drugs: immunotherapy and targeted therapy. With the use of checkpoint inhibitors, long-term remission of the disease can be achieved, which has been confirmed in many clinical trials that have shown improvements in overall survival (OS) and progression free survival (PSF). However, the predominant problem is the low response rate to checkpoint inhibitors and the time between the initiation of therapy and the response to treatment. This is not the case with targeted therapies, where the response rate is high and the response time is very short. Therefore, a promising treatment strategy can be a combination of these two classes of drugs, so that one can try to achieve a quick and long-term response to the treatment. The paper discusses the current treatment options for melanoma patients in the spreading phase of the disease and analyzes the benefits of combined and sequential treatment.

ObjectivesTo assess outcomes and patterns of recurrence in patients with high-grade serous ovarian/tubal/primary peritoneal cancers with radiographic supraclavicular lymphadenopathy at diagnosis.MethodsWe evaluated all patients with newly diagnosed high-grade serous ovarian cancers treated at our center between January 1, 2008 and May 1, 2013 who had supraclavicular lymphadenopathy (defined as ≥1 cm in short axis) on radiographic imaging (either computed tomography or positron emission tomography) at the time of diagnosis.ResultsOf 586 patients with high-grade serous ovarian cancer receiving primary treatment during the study period, we identified 13 (2.2%) with supraclavicular lymphadenopathy diagnosed on pre-treatment imaging. The median age at diagnosis was 52.0 years (range 38.2–72.3). Five (31%) had clinically palpable nodes on physical examination. Four (31%) had a known BRCA mutation. All 13 patients underwent neoadjuvant chemotherapy, followed by interval debulking surgery. Each patient received a median of four cycles of neoadjuvant intravenous chemotherapy (range 3–7). At interval debulking surgery, complete gross resection was achieved in nine (70%) patients, and optimal resection (0.1–1 cm residual disease) in four (30%). Eleven patients (85%) recurred; however, only one (8%) recurred in the supraclavicular lymph nodes. Median follow-up time was 44.3 months (range 22.4–95.0). Median progression-free survival for the cohort was 11.7 months (95% CI 9.2 to 14.1). Median overall survival was 44.3 months (95% CI 41.5 to 47.1). In patients obtaining complete gross resection at interval debulking surgery, median progression-free survival and overall survival were 13.9 months (95% CI 8.9 to 18.9) and 78.1 months (95% CI 11.1 to 145.1), respectively.ConclusionsIn our study, approximately 2% of patients with high-grade serous ovarian cancer presented with radiographic evidence of supraclavicular lymphadenopathy. Supraclavicular lymphadenopathy at diagnosis did not portend an unfavorable outcome when complete gross resection was achieved at interval debulking surgery.

Immune checkpoint inhibitors (ICIs), including anti-cytotoxic T-lymphocyte antigen 4 (anti-CTLA-4) and anti-programmed death receptor-1/ligand-1 (anti-PD-1/anti-PD-L1) caused a breakthrough in oncology and significantly improved therapeutic outcomes in cancer patients. ICIs generate a specific reaction in T cells, directed against antigens on cancer cells, leading to their damage and death. Through similar or the same antigens, activated lymphocytes may also have a cytotoxic effect on healthy cells, causing development of specific adverse effects – so-called immune-related adverse events (irAEs). We present the case report of a 56 year old patient with disseminated melanoma. During treatment with immunotherapy (anti PD-1), neutropenic fever and pancytopenia occurred. Trepanobiopsy of the bone marrow was performed to determine the cause of pancytopenia. Histopathological assessment of bone marrow combined with immunophenotype investigations may explain the cause of hematological disorders occurring in the course of treatment with ICIs, and support the choice of an appropriate treatment, directly translated into positive outcomes.

Objective Endometrioid ovarian carcinomas (EOCs) comprise 5–10% of all ovarian cancers and commonly co-occur with synchronous endometrioid endometrial cancer (EEC). We sought to examine the molecular characteristics of pure EOCs in patients without concomitant EEC. Methods EOCs and matched normal samples were subjected to massively parallel sequencing targeting 341–468 cancer-related genes (n = 8) or whole-genome sequencing (n = 28). Mutational frequencies of EOCs were compared to those of high-grade serous ovarian cancers (HGSOCs; n = 224) and EECs (n = 186) from The Cancer Genome Atlas, and synchronous EOCs (n = 23). Results EOCs were heterogeneous, frequently harboring KRAS, PIK3CA, PTEN, CTNNB1, ARID1A and TP53 mutations. EOCs were distinct from HGSOCs at the mutational level, less frequently harboring TP53 but more frequently displaying KRAS, PIK3CA, PIK3R1, PTEN and CTNNB1 mutations. Compared to synchronous EOCs and pure EECs, pure EOCs less frequently harbored PTEN, PIK3R1 and ARID1A mutations. Akin to EECs, EOCs could be stratified into the four molecular subtypes: 3% POLE (ultramutated), 19% MSI (hypermutated), 17% copy-number high (serous-like) and 61% copy-number low (endometrioid). In addition to microsatellite instability, a subset of EOCs harbored potentially targetable mutations, including AKT1 and ERBB2 hotspot mutations. EOCs of MSI (hypermutated) subtype uniformly displayed a good outcome. Conclusions EOCs are heterogeneous at the genomic level and harbor targetable genetic alterations. Despite the similarities in the repertoire of somatic mutations between pure EOCs, synchronous EOCs and EECs, the frequencies of mutations affecting known driver genes differ. Further studies are required to define the impact of the molecular subtypes on the outcome and treatment of EOC patients.

OBJECTIVES: To assess outcomes after secondary surgical resection in patients with recurrent uterine leiomyosarcoma (uLMS). METHODS: We retrospectively identified all patients who had no evidence of disease after initial surgery for uLMS, who underwent surgery for a first recurrence at our institution between 1/1991-10/2013. We excluded patients who received any therapy for recurrence prior to secondary resection, and patients who underwent surgery soon after morcellation [of presumed benign fibroids] showed widespread disease. Overall survival (OS) was determined from time of first recurrence to death or last follow-up. RESULTS: We identified 62 patients: 29 with abdominal/pelvic recurrence only, 30 with lung recurrence only, 3 with both. Median time to first recurrence was 18 months (95% CI: 13.3-23.3): 15.8 months (95% CI: 13.0-18.6) abdominal/pelvic recurrence; 24.1 months (95% CI: 14.5-33.7) lung-only recurrence (p=0.03). Median OS was 37.7 months (95% CI: 25.9-49.6) abdominal/pelvic recurrence; 78.1 months (95% CI: 44.8-11.4) lung recurrence (p = 0.02). Complete gross resection (CGR) was achieved in 58 cases (93%), with gross residual ≤1cm in 2 (3.5%) and >1cm in 2 (3.5%). Median OS based on residual disease was 54.1 months (95% CI: 24.9-83.3), 38.7 months (95% CI: NE), 1.7 months (95% CI: NE), respectively (P

The deteriorating condition of the environment and the increasing emission of pollutants into the atmosphere intensify the greenhouse effect. Energy production in power plants results in emissions that affect the increase of global temperatures. According to the Research Institute for Global Climate Change in Berlin there are just over 7 years to cross the critical point, which will start chain reactions associated with irreversible changes in the climate. In order to reduce the climate changes, exhaust emissions must be reduced. One of the steps is to reduce electricity consumption. In the case of roads, electricity is most related to the technical infrastructure. First steps has been taken to reduce the demand for electricity by using lighting systems equipped in the energy saving solutions. The next step should be to use renewable energy sources. There are many solutions to generate electricity that can be used directly on roads or nearby. There are many sides in the area of the road junction that can be used for producing energy. The authors, based on a review of the literature and the first usage of energy generating devices, describe the possibilities of obtaining energy and indicate the devices with their classification.

ObjectivesOpioids are routinely prescribed after minimally invasive gynecologic oncology surgery, with minimal data to inform the ideal dose. The aim of this study was to evaluate the impact of a restrictive opioid prescription protocol on the median morphine milligram equivalents prescribed and pain control in patients undergoing minimally invasive surgery.MethodsA restrictive opioid prescription protocol was implemented from January through December 2020 at a single tertiary cancer center in Ontario, Canada. Consecutive patients undergoing minimally invasive hysterectomy for suspected malignancy were included. Simultaneously, we implemented use of multimodal analgesia, patient and provider education, pre-printed standardized prescriptions, and tracking of opioid prescriptions. Total median morphine milligram equivalents prescribed were compared between pre- and post-intervention cohorts. Patients were surveyed regarding opioid use and pain control at 30 days post-surgery.ResultsA total of 101 women in the post-intervention cohort were compared with 92 consecutive pre-intervention controls. Following protocol implementation, median morphine milligram equivalents prescribed decreased from 50 (range 9–100) to 25 (range 8–75) (pConclusionsImplementation of a restrictive opioid prescription protocol led to a significant reduction in opioid use after minimally invasive gynecologic oncology surgery, with over 50% of patients requiring no opioids postoperatively.

BACKGROUND Endometrioid epithelial ovarian cancer (EEOC) is rare, and its management poorly defined. We examined factors associated with 5-year progression-free survival (PFS) after surgery for EEOC. METHODS Retrospective study: treatment and outcomes of all EEOC patients undergoing initial surgery at, or presenting to, our institution within 3 months of initial surgery, 1/2002-9/2017. RESULTS In total, 212 patients were identified. Median follow-up, 63.9 months (range, 0.7-192); median age at diagnosis, 52 years (range, 20-88); disease stage: I, n = 145 (68%); II, n = 47 (22%); III/IV, n = 20 (9%); FIGO grade: 1, 127 (60%); 2, 66 (31%); 3, 17 (8%); unknown, 2 (1%). One hundred twenty-eight (60%) had endometriosis; 75 (35%), synchronous endometrioid endometrial cancer (80%, IA); 101 (48%), complete surgical staging; 8 (5%), positive pelvic lymph nodes (LNs); 6 (4%), positive para-aortic LNs; 176 (97%), complete gross resection; 123 (60%), postoperative chemotherapy; 56(28%), no additional treatment. Five-year PFS, 83% (95% confidence interval [CI]: 76.6%-87.8%); 5-year overall survival (OS), 92.7% (95% CI: 87.7%-95.8%). Age, stage, and surgical staging were associated with improved 5-year PFS, and younger age at diagnosis with improved 5-year OS (p

High-grade serous tubo-ovarian carcinoma (HGSC) is a major cause of cancer-related death. Treatment is not uniform, with some patients undergoing primary debulking surgery followed by chemotherapy (PDS) and others being treated directly with chemotherapy and only having surgery after three to four cycles (NACT). Which strategy is optimal remains controversial. We developed a mathematical framework that simulates hierarchical or stochastic models of tumor initiation and reproduces the clinical course of HGSC. After estimating parameter values, we infer that most patients harbor chemoresistant HGSC cells at diagnosis and that, if the tumor burden is not too large and complete debulking can be achieved, PDS is superior to NACT due to better depletion of resistant cells. We further predict that earlier diagnosis of primary HGSC, followed by complete debulking, could improve survival, but its benefit in relapsed patients is likely to be limited. These predictions are supported by primary clinical data from multiple cohorts. Our results have clear implications for these key issues in HGSC management.

The first cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were identified at the end of 2019 and, in the next few months, coronavirus disease (COVID-19) spread throughout the world. Initially, it was believed that this disease mainly affected elderly individuals with comorbidities, in whom respiratory failure often occurs. It was believed that children fell ill from the infection more often, although the course of infection in the vast majority of pediatric cases has been asymptomatic or mildly symptomatic. In April and May 2020, the first report of a rapidly progressing disease, similar to Kawasaki syndrome, was found in children who had been infected with SARS-CoV-2. Shortly thereafter, children with symptoms of pediatric inflammatory multisystem syndrome (PIMS-ST [temporally associated with SARS-CoV-2 infection]) began presenting to pediatric hospitals around the world. The syndrome has a mortality rate of up to 2%. Symptoms of PIMS-TS include those that may suggest the need for surgical treatment (severe abdominal pain with the presence of peritoneal symptoms, ascites, high levels of inflammatory markers, intestinal inflammation, and appendages revealed on ultrasound examination). However, there are few reports addressing surgical cases associated with this condition. The authors present a case involving an 11-year-old boy who was admitted to hospital with severe abdominal pain and underwent surgery for symptoms of peritonitis and was diagnosed with PIMS in the post-operative period. Due to the large number of illnesses caused by SARS-CoV-2 infection in recent months, the diagnosis of PIMS-TS/MISC should be considered in the differential diagnosis of acute abdominal symptoms, especially in atypical courses and interviews indicating exposure to SARS-CoV-2.

The aim of this systematic review was to assess if cadmium and lead levels are linked to anxiety and depression. A systematic literature search was conducted to identify observational trials evaluating the impact of cadmium and lead on the incidence and phenotype of depression and anxiety. The search identified 1059 records. Overall eighteen studies comprising 28,304 participants with a female predominance (n = 19,483; 69%) were included. Cadmium and lead levels were analyzed in eight and thirteen studies, respectively. Five studies found an association between blood cadmium levels and depression, among them three trials which reported that individuals in the highest quartile of blood cadmium had higher odds of showing depressive symptoms. Sex and smoking status were found to be potential confounders of cadmium impact on the depressive phenotype. None of the studies found association between the level of anxiety and blood cadmium levels. Nine studies demonstrated association between depressive symptoms and blood lead concentration. High lead levels may be associated with anxiety and neurobehavioral deficits. There are many factors that influence both the levels of cadmium and lead, and the severity of depression and anxiety in the respondents. There is no clear evidence for the impact of cadmium and lead levels on the development of depressive symptoms but a lot of indirect evidence points to this.

The relationship between immune related adverse events (irAEs) and efficacy is not definitively proven, and data on the relationship between irAE and treatment efficacy are contradictory. Five hundred ninety-three consecutive patients with unresectable or metastatic melanoma treated in the first line with anti-PD-1 (nivolumab or pembrolizumab) between January 2016 and December 2019 were enrolled in the study. Statistically significant differences were demonstrated between the group of patients without and with irAE in median OS and PFS (p < .0001 both) and also in OS between the group of patients without irAE and patients with irAE within 3, 6, and 9 months from the start of anti-PD-1 therapy (p = .0121, p = .0014, p < .0001; respectively) and PFS (p = .0369, p = .0052, p = .0001; respectively). A statistically significant relationship was demonstrated between the occurrence of irAE and the location of the primary tumor (skin vs. mucosa vs. unknown; p = .0183), brain metastasis (present vs. absent; p = .0032), other locations (present vs. absent, p = .0032), LDH (normal vs. elevated; p = .0046) and stage according to TNM (p = .0093). The occurrence of irAE was associated with longer OS, PFS, and more frequent response to treatment. IrAE occurred statistically significantly more often in patients with mucosa primary tumor, with normal LDH levels, without brain metastases, stages III, M1a, and M1b.

Introduction Increased serum cholesterol levels constitute one of the main risk factors for cardiovascular diseases. Statins are a major method for reducing the levels which also lower the risk of cardiovascular events. However, these valuable drugs cannot be used in all patients who need them due to contraindications and intolerance. In such cases, help can be sought from nutraceutics that reduce the serum cholesterol concentration. Since there are numerous products of this type available at drugstores, registered as supplements, there seems to be a need to demonstrate their effectiveness in preventing cardiovascular diseases induced by atherosclerosis. In literature, increasingly more attention is drawn to red yeast rice, Armolipid, berberine and bergamot. Brief description This article presents knowledge about these nutraceutics based on clinical studies and expert statements relating to their use. The results of clinical studies and metaanalyses have shown that nutraceutics with cholesterol lowering properties, red yeast rice and Armolipid are the most favourable for reducing cardiovascular events. However, the evidence of benefits of berberine and bergamot is not so conclusive. Results Conclusions Red yeast rice products and Armolipid may be used as an alternative treatment in statin intolerant patients, especially in combination with ezetimibe. These nutraceutics can be also considered, as an adjunct to diet therapy in primary prevention of cardiovascular diseases in patients with mild and moderate hypercholesterolaemia. The opinion of experts on berberine and bergamot is ambiguous.

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.

Despite the increasing body of research on Attention Deficit Hyperactivity Disorder (ADHD), the results of the studies assessing the relationship between executive function deficit and the risk of obesity in people with ADHD are incongruent. Our study aimed to assess the relationship between measures of executive functions and body weight and Body Mass Index (BMI) in children and adolescents with ADHD and control subjects. The study group consisted of 58 subjects aged from 8 to 17 years with ADHD. The Control group consisted of 62 healthy age and sex-matched participants from primary and secondary schools. Weight, height, and BMI measurements were standardized. The Sustained Attention to Response Test (SART) and the Attention Network Test (ANT) were used to assess executive functions. Based on the analysis of the correlation and analysis of moderation, we found that subjects with higher weight in the study group presented a lower efficiency of the inhibition processes and gave more impulsive and incorrect answers. The occurrence of impulsive reactions might contribute to the risk of excessive weight in children and adolescents with ADHD.

Background: Due to the rarity of osteosarcoma and limited indications for radiotherapy (RT), data on RT for this tumor are scarce. This study aimed to investigate the utilization of RT for osteosarcomas in the recent 20 years and to identify factors related to patients’ response to radiation. Methods: We performed a retrospective analysis of patients irradiated for osteosarcoma treatment. We planned to assess differences in the utilization of RT between the periods of 2000–2010 and 2011–2020, identify the risk factors associated with local progression (LP), determine whether RT-related parameters are associated with LP, and calculate patients’ survival. Results: A total of 126 patients with osteosarcoma who received 181 RT treatments were identified. We found a difference in RT techniques between RT performed in the years 2000–2010 and that performed in the years 2011–2020. LP was observed after 37 (20.4%) RT treatments. Intent of RT, distant metastases, and concomitant systemic treatment affected the risk of LP. Five-year overall survival was 33% (95% confidence interval (26%–43%)). Conclusions: RT for osteosarcoma treatment has evolved from simple two-dimensional palliative irradiation into more conformal RT applied for new indications including oligometastatic and oligoprogressive disease. RT may be a valuable treatment modality for selected patients with osteosarcoma.

Introduction Polyunsaturated n-3 fatty acid preparations containing eicosapentaenoic acid (EPA) and docosahexanaenoic acid (DHA), or EPA only, have long been recommended in the management of hypertriglyceridaemia, especially when severe (triglyceride levels ≥500 mg/dL), at the dose of 2-4 g/d, mostly for the prevention of acute pancreatitis. Material and methods The presented article reviews clinical trials and their metaanalyses which evaluated the effect of n-3 fatty acids on cardiovascular disease risk, and regulatory agencies' and cardiac societies' positions regarding their use. Results The findings indicate that only EPA is effective. Particular clinical benefit (25% reduction of cardiovascular events) was observed in the recently published REDUCE-IT trial which evaluated EPA (icosapent ethyl) at the dose of 4 g/d for 4.9 years (median), compared to placebo, in hypertriglycerydaemic patients at high or very high cardiovascular risk. This positive effect has been reflected in the expert opinions which recommend eicosapent ethyl (4 g/d) in patients similar to those participating in the REDUCE-IT trial. Additional data in favour of the above position have been provided by the EVAPORATE trial results which showed reduced progression of coronary atherosclerosis with EPA at the dose of 4 g/d. Conclusions The clinical studies and metaanalyses strongly point out that only EPA (icosapent ethyl), especially at dose of 4 g/d, is effective in reducing cardiovascular events in very high and high risk patients with hypertriglyceridemia. The use of EPA + DHA preparations in doses up to 1 g/d does not prevent recurrent cardiovascular events.

Menopause is an important event in a woman&rsquo, s life associated with hormonal changes that play a substantial role in the functioning of her body. A decline in the level of estrogens contributes to depressive symptoms and mood disorders during this period. The severity of depressive symptoms experienced by middle-aged women depends on many factors, including sociodemographic data (e.g., menopause, employment status, and marital status) and genetic variables (MAO-A and 5-HTT gene polymorphisms). In order to assess their influence on the development of depression in females, we analyzed 1453 healthy Polish women in different stages of menopause. Based on the results, we found that the l/l + l/s inheritance model for the 5-HTT gene polymorphism was more common in women without and with moderate depressive symptoms according to the Beck Depression Inventory (BDI), while the l/s model was more often observed in women with mild depression. Moreover, the overdominant 3/3 + 4/4 genotype of the MAO-A gene polymorphism was more often found in respondents without depressive symptoms, while women with depressive symptoms had more often the overdominant 3/4 genotype.

Anthropogenic disturbances, such as habitat modifications and machines, are associated with increased levels of faecal glucocorticoid metabolites (fGCMs) in mammals, an indicator of a stress response. One human-caused process provoking incisive habitat alterations is harvesting arable crops. We investigated the effect of cereal harvest on fGCM concentrations in European hares (Lepus europaeus) in arable landscapes in lower Austria during the year 2018 by collecting 591 faecal samples before, during and after cereal harvest. fGCMs were analysed using an enzyme immunoassay, and data were analysed using linear mixed-effects models. We found that neither cereal harvest nor farming practice (organic vs. conventional) caused an overall increase in the hares’ stress level. Lower vegetation density and higher proportions of bare ground were negatively correlated with fGCM concentrations, whereas the proportion of stubble fields was significantly positively correlated with fGCM concentrations in European hares. A change to more open landscapes might decrease time spent avoiding predation, and fallen grains may provide a beneficial additional food source for the hares. This indicates that European hares are well adapted to an opening up of the landscape and short-term disturbances such as cereal harvesting. In conclusion, cereal harvest had no large impact on European hares’ adrenocortical activity in an arable landscape with small average field size and enough available non-farmed areas.

The aim of this study was to assess the effectiveness of hydrocolloid dressings in the treatment of grade I, II, III, and IV pressure ulcers in adult patients. We compared the therapeutic effects of hydrocolloids and alternative dressings in pressure ulcer treatment. We conducted a systematic review, using a literature search only in English, from database inception until 20 April 2020, to identify randomized trials comparing various types of dressings applied in the healing of pressure ulcers. The databases were PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The study selection was performed independently by two reviewers. Data were extracted based on the guidelines included in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The risk of bias in the included studies was assessed using a standardized critical appraisal instrument developed by the Cochrane Collaboration. Random-effect meta-analysis of data from three or more studies was performed using meta-analysis software (Comprehensive Meta-Analysis V3, Biostat, New Jersey, USA). A total of 1145 records were identified, of which 223 were qualified after further verification, of which eight were finally included in further analysis. Hydrocolloid dressings were not superior to control therapeutics (p = 0.839; Z = 0.203; CI 95%: 0.791–1.334). They were not associated with higher healing rates (p = 0.718; Z = 0.361; OR: 0.067; CI 95%: 0.297–0.431), nor did they decrease the incidence of adverse events compared with control therapeutics (p = 0.300; Z = −1.036; OR: 0.067; CI 95%: 0.394–1.333). In the above cases, Egger’s test also did not indicate publication bias (t value = 0.779, p = 0.465; t value = 1.198, p = 0.442; t value = 0.834, p = 0.465, respectively). The present meta-analysis shows that hydrocolloid dressings are not significantly better than alternative ones in the healing of pressure ulcers in adult patients.

Objective This study investigated age-dependent and subtype-related alterations in electroencephalography (EEG) power spectra and current source densities (CSD) in children with attention deficit and hyperactivity disorder (ADHD). Methods We performed spectral and cortical source (exact low-resolution electromagnetic tomography, eLORETA) analyses using resting state EEG recordings from 40 children (8–16 years) with combined and inattentive subtypes of ADHD and 41 age-matched healthy controls (HC). Group differences in EEG spectra and CSD were investigated at each scalp location, voxel and cortical region in delta, theta, alpha and beta bands. We also explored associations between topographic changes in EEG power and CSD and age. Results Compared to healthy controls, combined ADHD subtype was characterized with significantly increased diffuse theta/beta power ratios (TBR) with a widespread decrease in beta CSD. Inattentive ADHD subtype presented increased TBR in all brain regions except in posterior areas with a global increase in theta source power. In both ADHD and HC, older age groups showed significantly lower delta source power and TBR and higher alpha and beta source power than younger age groups. Compared to HC, ADHD was characterized with increases in theta fronto-central and temporal source power with increasing age. Conclusions Our results confirm that TBR can be used as a neurophysiological biomarker to differentiate ADHD from healthy children at both the source and sensor levels. Significance Our findings emphasize the importance of performing the source imaging analysis in order to better characterize age-related changes in resting-state EEG activity in ADHD and controls.

Mucosal melanoma is a rare disease epidemiologically and molecularly distinct from cutaneous melanoma developing from melanocytes located in mucosal membranes. Little is known about its therapy. In this paper, we aimed to evaluate the results of immunotherapy and radiotherapy in a group of patients with advanced mucosal melanoma, based on the experience of five high-volume centers in Poland and Italy. There were 82 patients (53 female, 29 male) included in this retrospective study. The median age in this group was 67.5 (IQR: 57.25&ndash, 75.75). All patients received anti-PD1 or anti-CTLA4 antibodies in the first or second line of treatment. Twenty-three patients received radiotherapy during anti-PD1 treatment. In the first-line treatment, the median progression-free survival (PFS) reached six months in the anti-PD1 group, which was statistically better than 3.1 months in the other modalities group (p = 0.004). The median overall survival (OS) was 16.3 months (CI: 12.1&ndash, 22.3) in the whole cohort. Patients who received radiotherapy (RT) during the anti-PD1 treatment had a median PFS of 8.9 months (CI: 7.4&ndash, NA), whereas patients treated with single-modality anti-PD1 therapy had a median PFS of 4.2 months (CI: 3.0&ndash, 7.8), this difference was statistically significant (p = 0.047). Anti-PD1 antibodies are an effective treatment option in advanced mucosal melanoma (MM). The addition of RT may have been beneficial in the selected subgroup of mucosal melanoma patients.

The aim of our study was to assess the impact of whole blood lead (Pb-B) levels on changes in peripheral blood morphology and selected biochemical parameters, and the severity of depression in peri-menopausal women at risk of metabolic syndrome (pre-MetS) or with metabolic syndrome (MetS). The study involved 233 women from the general population of the West Pomeranian Province (Poland) aged 44&ndash, 65 years. The intensity of menopausal symptoms and the severity of depression was examined using the Blatt&ndash, Kupperman Index (KI) and the Beck Depression Inventory (BDI). C-reactive protein (CRP), insulin, glucose, glycated hemoglobin (HbA1C), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglyceride levels (TG), cortisol, morphology of blood cells and homeostasis model assessment for insulin resistance (HOMA-IR) and Pb-B was measured. Women with MetS had higher levels of glucose, HbA1C, HDL, LDL, TG, cortisol, insulin and higher HOMA-IR. No significant differences in Pb-B were observed between pre-MetS and the control group, and between pre-MetS and the MetS group. A significant correlation was noticed between Pb-B vs. the percentage of monocytes in blood, and blood cortisol levels in women with MetS, Pb-B vs. lymphocyte count and HbA1C in the pre-MetS group, as well as in the BDI scores between the MetS and pre-MetS group. We cannot clearly state that exposure to Pb is an environmental factor that can be considered as a risk factor for MetS in this studied group.