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Leaves of Alchemilla mollis (Bauser) Rothm. were the subject of the study. The leaves were harvested early in the morning from the department’s ornamental plant collection. Selected leaves were fully-developed and showed no signs of damage or discolouring. Gibberellic acid (GA3), benzyladenine (BA), meta-methoxytopolin (MemT) and its riboside (MemTR) at concentrations of 25, 50 and 75 mg dm−3 were applied in the form of solutions to four-hour leaf-conditioning in the room at a temperature of 18-20°C. After conditioning, the leaves were placed in distilled water. Leaves put into distilled water immediately after cutting served as the control. The post-harvest longevity of leaves of Alchemilla mollis was 7.2-11.8 days. The conditioning of leaves in gibberellic acid solutions at concentrations of 25-50 mg dm−3, benzyladenine at concentrations of 25 mg dm−3 and meta-methoxytopolin and its riboside at concentrations of 75 mg dm−3 extended the post-harvest longevity of leaves by 10.1-81.9%. The conditioning of leaves in gibberellic acid at a concentration of 50 mg dm−3 inhibited the degradation of chlorophyll, as indicated by the highest SPAD index values.

Introduction: A solution for emergency department (ED) congestion remains elusive. As reliance on imaging grows, computed tomography (CT) turnaround time has been identified as a major bottleneck. In this study we sought to identify factors associated with significantly delayed CT in the ED.Methods: We performed a retrospective analysis of all CT imaging completed at an urban, tertiary care ED from May 1–July 31, 2021. During that period, 5,685 CTs were performed on 4,344 patients, with a median time from CT order to completion of 108 minutes (Quartile 1 [Q1]: 57 minutes, Quartile 3 [Q3]: 182 minutes, interquartile range [IQR]: 125 minutes). Outliers were defined as studies that took longer than 369 minutes to complete (Q3 + 1.5 × IQR). We systematically reviewed outlier charts to determine factors associated with delay and identified five factors: behaviorally non-compliant or medically unstable patients; intravenous (IV) line issues; contrast allergies; glomerular filtration rate (GFR) concerns; and delays related to imaging protocol (eg, need for IV contrast, request for oral and/or rectal contrast). We calculated confidence intervals (CI) using the modified Wald method. Inter-rater reliability was assessed with a kappa analysis.Results: We identified a total of 182 outliers (4.2% of total patients). Fifteen (8.2%) cases were excluded for CT time-stamp inconsistencies. Of the 167 outliers analyzed, 38 delays (22.8%, 95% confidence interval [CI] 17.0–29.7) were due to behaviorally non-compliant or medically unstable patients; 30 (18.0%, 95% CI 12.8–24.5) were due to IV issues; 24 (14.4%, 95% CI 9.8–20.6) were due to contrast allergies; 21 (12.6%, 95% CI 8.3–18.5) were due to GFR concerns; and 20 (12.0%, 95% CI 7.8–17.9) were related to imaging study protocols. The cause of the delay was unknown in 55 cases (32.9%, 95%CI 26.3–40.4).Conclusion: Our review identified both modifiable and non-modifiable factors associated with significantly delayed CT in the ED. Patient factors such as behavior, allergies, and medical acuity cannot be controlled. However, institutional policies regarding difficult IV access, contrast administration in low GFR settings, and study protocols may be modified, capturing up to 42.6% of outliers.

Tomato is a widely cultivated and economically important crop worldwide. This study aimed to test the effect of light spectra used in indoor cultivation on the growth, biochemical profile, and resistance of Solanum lycopersicum ‘Bawole Serce’ seedlings against Alternaria alternata, Alternaria solani and Botrytis cinerea. During the phase of first leaf emergence, the seedlings were transferred to a semi-sterile growth room with a controlled environment (20°C, 18-h photoperiod, 50 μmol · m−2 · s−1 PPFD, 65% RH) for a 3-week cultivation period. Five light treatments differing in red/blue (R/B) light ratio were tested: I (LED tube; R/B 5.55), II (fluorescent tube; R/B 0.72), III (fluorescent tube; R/B 1.19), IV (LED panel; R/B 0.51), V (LED panel; R/B 0.20). The best parameters in terms of shoot length, shoot fresh and dry weights, and number of leaves were obtained in treatment I, in contrast to IV and V. Plants from treatments IV and V had the smallest leaf area, perimeter, vertical length, and horizontal width. As for the root system, the highest fresh weight, area, length of the longest root, total length, and the number of root tips and forks were found in treatments I and II. The least developed root systems were observed in IV and V. The greatest chlorophyll, carotenoids and anthocyanins accumulation was enhanced by treatment II. Treatments I−III stimulated the biosynthesis of phenolic compounds. The highest superoxide dismutase activity was detected in plants from treatments I and II. As for A. alternata and A. solani, the level of disease symptoms was significantly higher for treatments IV and V than for I-III. The highest/lowest level of B. cinerea infection was found in treatments II/I, respectively. The least susceptible to infection by all tested pathogens were leaves from treatment I. Light spectrum composition is of practical importance for tomato seedling production.

This article describes benefits of the application of zinc oxide submicron particles (ZnO SMPs), zinc oxide nanoparticles (ZnO NPs) and ZnO NPs combined with silver NPs (ZnO + Ag NPs) in chrysanthemum micropropagation. Single node explants of Chrysanthemum × morifolium (Ramat.) Hemsl. ‘UTP Burgundy Gold (UBG)’ and ‘UTP Pinky Gold (UPG)’ were inoculated on the Murashige and Skoog (MS) medium and treated with 100 mg · L−1, 200 mg · L−1, or 400 mg · L−1 ZnO SMPs, ZnO NPs (1.5% H2O), ZnO NPs (6% H2O), ZnO + 0.1% Ag NPs (1.5% H2O), ZnO + 0.1% Ag NPs (6% H2O), ZnO + 1% Ag NPs (1.5% H2O) and ZnO + 1% Ag NPs (6% H2O). Generally, the tested materials stimulated the growth and development of plantlets. In ‘UBG’, the most prominent treatments affecting increases in the number of leaves, micropropagation coefficient, shoot length and shoot FW/DW weight included 400 mg · L−1 ZnO SMPs and 100 mg · L−1 ZnO NPs (6% H2O). In ‘UPG’, the treatments with 200 mg · L−1 ZnO + 0.1% Ag NPs (6% H2O) and 200 mg · L−1 ZnO + 1% Ag NPs (6% H2O) were the most successful. The latter treatment stimulated an intensive development of root systems in the two studied cultivars. High values of leaf area, perimeter and width were reported in both cultivars for 400 mg · L−1 ZnO + 1% Ag NPs (6% H2O). As compared to the control, the treated plants were characterised by a similar or, most often, lower content of chlorophylls and carotenoids. The randomly amplified polymorphic DNA (RAPD) and start codon targeted polymorphism (SCoT) marker system analyses of the 400 mg · L−1 ZnO SMPs/ZnO NPs/ZnO + Ag NPs-treated chrysanthemums confirmed their genetic fidelity with the control plants. The obtained results can be implemented in the commercial large-scale production of chrysanthemums.

Introduction: A solution for emergency department (ED) congestion remains elusive. As reliance on imaging grows, computed tomography (CT) turnaround time has been identified as a major bottleneck. In this study we sought to identify factors associated with significantly delayed CT in the ED. Methods: We performed a retrospective analysis of all CT imaging completed at an urban, tertiary care ED from May 1–July 31, 2021. During that period, 5,685 CTs were performed on 4,344 patients, with a median time from CT order to completion of 108 minutes (Quartile 1 [Q1]: 57 minutes, Quartile 3 [Q3]: 182 minutes, interquartile range [IQR]: 125 minutes). Outliers were defined as studies that took longer than 369 minutes to complete (Q3 + 1.5 × IQR). We systematically reviewed outlier charts to determine factors associated with delay and identified five factors: behaviorally non-compliant or medically unstable patients; intravenous (IV) line issues; contrast allergies; glomerular filtration rate (GFR) concerns; and delays related to imaging protocol (eg, need for IV contrast, request for oral and/or rectal contrast). We calculated confidence intervals (CI) using the modified Wald method. Inter-rater reliability was assessed with a kappa analysis. Results: We identified a total of 182 outliers (4.2% of total patients). Fifteen (8.2%) cases were excluded for CT time-stamp inconsistencies. Of the 167 outliers analyzed, 38 delays (22.8%, 95% confidence interval [CI] 17.0–29.7) were due to behaviorally non-compliant or medically unstable patients; 30 (18.0%, 95% CI 12.8–24.5) were due to IV issues; 24 (14.4%, 95% CI 9.8–20.6) were due to contrast allergies; 21 (12.6%, 95% CI 8.3–18.5) were due to GFR concerns; and 20 (12.0%, 95% CI 7.8–17.9) were related to imaging study protocols. The cause of the delay was unknown in 55 cases (32.9%, 95% CI 26.3–40.4). Conclusion: Our review identified both modifiable and non-modifiable factors associated with significantly delayed CT in the ED. Patient factors such as behavior, allergies, and medical acuity cannot be controlled. However, institutional policies regarding difficult IV access, contrast administration in low GFR settings, and study protocols may be modified, capturing up to 42.6% of outliers.

The purpose of this study was to analyse both negative results of bacteriological cultures and the coexistence of several pathogens at the same intramammary inflammatory focus within bovine udder parenchyma in order to compare the health status of cows’ udders in 1985 and 2021. Mastitis was diagnosed on the basis of anamnesis, clinical inspection of the udder, milk quality, and somatic cell counts (SCC on the Fossomatic 5000-FC). In 1985, joint bacteriological and mycological diagnosis was based on the guidelines established for bovine mastitis by FIL-IDF (1971), while for 2021, it was based on the National Mastitis Council (NMC) laboratory Handbook on bovine mastitis (Hogan et al., 1999). In the first study (1985), mainly the genus Staphylococcus was isolated, but at present other species may be involved in cases of mastitis. In both periods, both subclinical and clinical cases were registered. In addition, the milk yield of cows was observed to increase over time, with concomitant deterioration of mammary gland immunity. The phenomenon of biofilms was documented in the study, which may be explained not only by the low efficacy of antibiotic therapy against udder disease but also by impaired immunity in cows, as the lymphocytes trapped in the biofilm matrix were inactive with respect to both cellular and humoral responses.

Analyses were conducted on extracts from the fruits of P. pyraster and P. ×myloslavensis. Extraction with 80% methanol was performed at room temperature. The total phenolic content was determined by spectrophotometry using the Folin–Ciocalteu reagent, with gallic acid as the reference standard. Phenolic compounds and organic acids were identified on a liquid chromatograph. The antioxidative activity of the extracts was tested in relation to linoleic acid incubation of the emulsions for 19 h based on the neutralization of the DPPH radical (2,2-diphenyl-1-picrylhydrazyl) and the ABTS cation radical (2,2′-azino-bis[3-ethylbenzothiazoline-6-sulfonic acid]) as well as by the ferric reducing antioxidant power (FRAP) assay. The analyses showed that the extract from P. pyraster fruits is characterized by a higher content of phenolic compounds and a higher antioxidative potential compared with that from P. ×myloslavensis. In extracts of both pear species, seven phenolic compounds and four organic acids were identified. The total fiber content in pears of P. pyraster and P. ×myloslavensis was determined at 36.45 g and 24.74 g/100 g d.m. of the pear fruits, of which most comprised the insoluble fraction (32.49 g and 20.86/100 g, respectively). The results of the conducted research are highly significant, as they confirm that pears contain many valuable nutrients and biologically active compounds, including antioxidants and dietary fiber. Adding pear extracts to food products may offer a way to boost their health benefits while also broadening the variety of items that have appealing sensory characteristics. Moreover, research has shown that fruit extracts can help to prolong the shelf life of food products by safeguarding them against lipid oxidation and the decline in their nutritional value.

Abstract Objectives One of the most pivotal decisions an emergency physician (EP) makes is whether to admit or discharge a patient. The emergency department (ED) work‐up leading to this decision involves several resource‐intensive tests. Previous studies have demonstrated significant differences in EP resource utilization, measured by lab tests, advanced imaging (magnetic resonance imaging [MRI], computed tomography [CT], ultrasound), consultations, and propensity to admit a patient. However, how an EP's years of experience may impact their resource utilization and propensity to admit patients has not been well characterized. This study seeks to better understand how EPs’ years of experience, post‐residency, relates to their use of advanced imaging and patient disposition. Methods Ten years of ED visits were analyzed for this study from a single, academic tertiary care center in the urban Northeast United States. The primary outcomes were utilization of advanced imaging during the visit (CT, MRI, or formal ultrasound) and whether the patient was admitted. EP years of experience was categorized into 0–2 years, 3–5 years, 6–8 years, 9–11 years, and 12 or more years. Patient age, sex, Emergency Severity Index (ESI), and the attending EP's years of experience were collected. The relationship between EP years of experience and each outcome was assessed with a linear mixed model with a random effect for provider and patient age, sex, and ESI as covariates. Results A total of 460,937 visits seen by 65 EPs were included in the study. Over one‐third (37.6%) of visits had an advanced imaging study ordered and nearly half (49.5%) resulted in admission. Compared to visits with EPs with 0–2 years of experience, visits with EPs with 3–5 or 6–8 years of experience had significantly lower odds of advanced imaging occurring. Visits seen by EPs with more than 2 years of experience had lower odds of admission than visits by EPs with 0–2 years of experience. Conclusion More junior EPs tend to order more advanced imaging studies and have a higher propensity to admit patients. This may be due to less comfort in decision‐making without advanced imaging or a lower risk tolerance. Conversely, the additional clinical experience of the most senior EPs, with greater than 9 years of experience, likely impacts their resource utilization patterns such that their use of advanced imaging does not significantly differ from the most junior EPs.

Objectives: To assess whether time-to-disposition is significantly different when a patient is seen by a provider during the early half or late half of a shift.Background: Time-to-disposition is an important metric for emergency department throughput. We hypothesized that providers view the shift end as a key timepoint and attempt to leave as few dispositions as possible to the oncoming team, thereby making quicker decisions later in the shift. This study evaluates disposition distribution relative to when patients are assigned a provider during the course of a shift.Methods: 50,802 cases were analyzed over the one-year study interval. 31,869 patients were seen in the early half of a shift (hours 1-4) and 18,933 were seen in the later half (hours 5+). We ran a linear mixed model that adjusted for age, gender, emergency severity index score, time of day, weekend arrivals, quarter of arrival and shift type.Results: Median time-to-disposition for the early group was 3.25 hours (IQR 1.90-5.04), and 2.62 hours (IQR 1.51-4.31) for the late group. From our mixed model, we conclude that in the later parts of the shift, providers take on average 15.1% less time to make a disposition decision than in the earlier parts of the shift.Conclusion: Patients seen during the latter half of a shift were more likely to have a shorter time-to-disposition than similar patients seen in the first half of a shift. This may be influenced by many factors, such as providers spending the early hours of a shift seeing new patients which generate new tasks and delay dispositions, and viewing the end of shift as a landmark with a goal to maximize dispositions prior to sign-out.

Objectives: In this study, we examine APP productivity to determine if a similar pattern applies to that of residents and attendings, with the hypothesis that hourly productivity decreases after the first few hours of the shift.Background: APP productivity follows a similar pattern to previously described behaviors in both residents and attendings. This further confirms the results of prior studies that productivity is a dynamic process that needs to be considered when adjusting staffing models. Additionally, this pattern by APPs at a community hospital provides additional validation of this model outside of academic institutions or training environments.Methods: This is a retrospective cohort study from 7/1/21 through 6/30/21 at a single suburban community hospital in the northeast. APPs work ten hour shifts from 10AM to 8PM, nearly every day. APPs also provide coverage for approximately 5 shifts per month from 3PM to 11PM. Timestamps of initial patient contact are automatically logged by the electronic health record, and then analyzed to determine in which hour of the shift this occurred. A mixed linear model was performed with the hour as a categorical variable, and day of the week, month and year as covariates. Data was grouped by individual shifts.Results: A total of 345 10-hour shifts were worked by five APPs over the one year studied. There were 64 additional afternoon shifts which were excluded due to the shorter length and lower frequency. Two APPs worked the vast majority of the shifts, and the other three provided per-diem coverage. A mean of 13.3 patients (SD 2.7) were seen per shift. In the first hour, APPs saw an average of 2.67 patients (95% CI 2.59-2.76). Each hour demonstrated a statistically significant decrease relative to the first hour (p< 0.001), with the highest magnitude over the second (-0.58 (95% CI -0.69 — -0.47)) and third (-0.98 (95% CI -1.09 — -0.86)) hours. This downward trend continued throughout the rest of the shift; however, the magnitude of this difference after the sixth hour was not significant. There was no effect by day of week, month or year.Conclusion: APP productivity follows a similar pattern to previously described behaviors in both residents and attendings. This further confirms the results of prior studies that productivity is a dynamic process that needs to be considered when adjusting staffing models. Additionally, this pattern by APPs at a community hospital provides additional validation of this model outside of academic institutions or training environments.

Objectives: The purpose of this study is to determine Emergency Medicine (EM) resident productivity (as measured by patients per hour) over the course of the COVID-19 pandemic compared to the prior training environment.Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted medical education throughout the United States. As a result, many EM residents began residency with atypical clinical experiences. In addition, Emergency Department (ED) patient volumes decreased during the early months of the pandemic.Methods: This is a retrospective observational cohort study conducted at an urban, academic medical center with an established EM residency program. Data was collected from electronic medical records between July 1, 2017 and October 31, 2021. EM residents completing full, consecutive years of residency were included in the sample. Classes prior to 2020 were defined as a control group. Due to the structure of the residency, only shifts at the academic medical center during first and second year of residency (PGY1 and PGY2) were included. Productivity was defined as total primary patient encounters divided by aggregate scheduled shift hours. To allow comparison of the most recent data, analysis was performed on the first four months (July-October) of each academic year. The data was analyzed using descriptive statistics, including standard deviation and t-tests.Results: A total of 63 residents were included in this analysis of the first four months of each training year from 2017-2021. Prior to COVID-19, PGY1 residents evaluated 0.75±0.23 patients per hour and PGY2 residents evaluated 1.46±0.11 patients per hour (p

Objectives: To validate and expand upon prior data suggesting that visits shared with a midlevel or resident influence EP behavior as measured by resource use and propensity to admit a patient.Background: Variability exists in Emergency Physicians’ (EP) resource utilization as measured by ordering practices, propensity to admit patients, and whether a visit is shared with a resident or midlevel provider (nurse practitioner or physician assistant).Methods: This is a retrospective study of routinely gathered operational data from two community, suburban hospitals within an academic emergency network. We analyzed 34 EPs with 141,433 patient visits from July 1, 2016 to June 30, 2019. We collected individual EP data on advanced imaging (CT, US, MRI), admission rates, and whether a visit was shared with a midlevel or resident for each patient encounter. To investigate whether there might be distinct groups of practice patterns relating these resources, we used a Gaussian Mixture Model (GMM), a classification method used to determine the likelihood of distinct subgroups within a larger population. The total number of groups and covariance structure were determined by Bayesian Information Criteria.Results: Our GMM revealed three distinct groups of physicians based on their ordering practices. The largest group is characterized by a homogenous pattern of neither high or low resource utilization (n=19, 58% female, median years’ experience: 9 [IQR 2-16]; rates of Advanced Imaging: 44%, Admission: 21%, Midlevel/Resident staffing 35% with a modest group of low-resource users (n=10, 0% female, median years’ experience: 7 [IQR 5-11]; rates of Advanced Imaging: 31%, Admission: 17%, Midlevel/Resident staffing 32%), and far fewer members of a high-resource use group (n=5, 20% female, median years’ experience: 15 [IQR 5-16]; rates of Advanced Imaging: 49%, Admission: 22%, Midlevel/Resident staffing 35%) [Figure 1]. This variation suggests that use of advanced imaging and propensity to admit may be influenced by whether a patient visit is shared with a midlevel or resident provider.Conclusion: At two community EDs, three distinct subgroups of EP ordering practices exist based on advanced imaging use, propensity to admit a patient, and whether a visit was shared with a midlevel or resident. This data validates prior work showing that resource utilization and admission rates are related, while demonstrating that more nuanced patterns of EP ordering practices exist based on whether a visit is shared with a midlevel or resident provider. Further investigation is needed to understand the impact of EP characteristics and behavior on throughput and quality of care.

Abstract Background Workflow interruptions are common for emergency physicians and are shown to have downstream consequences such as patient dissatisfaction, delay in clinical response, and increase in medical error. However, the impact of passive interruptions on physician productivity is unclear and has not been well studied. We sought to evaluate if the number of pages received per hour significantly affects the number of patients seen per hour. Methods Retrospective data was collected on resident physician (RP) emergency department shifts from July 1st, 2021 to June 30th, 2022 at an academic medical center with an annual census of 55,000 patients. A total of 2865 RP shifts were collected among the 26 postgraduate year (PGY) 1 and PGY2 residents. For each RP shift, we identified the number of pages received per hour and the number of new patients seen per hour. Pages consist of any transmitted message that was sent to the RP's personal pager, which includes both automatic (eg, bed assignments, abnormal lab values) and personalized pages from other healthcare practicioners (eg, nursing, consultants). Data were analyzed using Poisson regression controlling for clustering at the physician level to determine if the number of patients seen per hour is significantly affected by the number of pages (divided into quartiles) received. Results We found the number of pages received per hour did not decrease the number of patients seen per hour. Contrary to our hypothesis, there was a strong positive relationship between the number of pages received per hour and the number of patients seen by RPs in that hour and subsequent hours. During the middle of a shift (hours 3, 4, and 5), RPs receiving pages in the third and fourth quartile (top 50% of pages) saw significantly more patients during that same hour and the next hour (p

The main aim of this study was to investigate the association between 5 polymorphisms of the interleukin 10 (IL10) gene and body composition parameters in physically active young men. A cohort of 131 young men was enrolled and the following IL10 single-nucleotide polymorphisms (SNPs) were analysed: rs1518111, rs1878672, rs3024496, rs3024498 and rs3024505. The subjects were divided into groups depending on obesity parameters: body mass index (BMI) and percentage of body fat tissue (fat %). Statistical analysis was conducted for alleles, genotypes and haplotypes, and an association between SNPs and body composition parameters was analysed using four genetic models: dominant, recessive, codominant and overdominant mode of inheritance (MOI). The only statistically significant result in polymorphisms was found for rs3024505 in the over-dominant model with BMI (p = 0.04) and with fat % (p = 0.02). The haplo.score function showed an association between BMI and CCGTA (respectively) haplotype in the additive model (score = -2.00, p = 0.04) and in the dominant model (score = -2.30, p = 0.02). The obtained results indicate a statistically significant contribution of selected IL10 polymorphisms in the regulation of body weight in physically active individuals.

Although obesity in the domestic dog (Canis lupus familiaris) is known to decrease well-being and shorten lifespan, the genetic risk variants associated with canine obesity remain largely unknown. In our study, which focused on the obesity-prone Labrador Retriever breed, we conducted a genome-wide analysis to identify structural variants linked to body weight and obesity. Obesity status was based on a 5-point body condition score (BCS) and the obese dog group included all dogs with a BCS of 5, along with dogs with the highest body weight within the BCS 4 group. Data from whole-gene sequencing of fifty dogs, including 28 obese dogs, were bioinformatically analyzed to identify potential structural variants that varied in frequency between obese and healthy dogs. The seven most promising variants were further analyzed by droplet digital PCR in a group of 110 dogs, including 63 obese. Our statistical evidence suggests that common structural mutations in or near six genes, specifically ALPL, KCTD8, SGSM1, SLC12A6, RYR3, and VPS26C, may contribute to the variability observed in body weight and body condition scores among Labrador Retriever dogs. These findings emphasize the need for additional research to validate the associations and explore the specific functions of these genes in relation to canine obesity.

Introduction and objective CNS malignancies account for about 1.6% of all diseases today. In people diagnosed with a brain tumor with a poor prognosis, we often see disorders from the psychiatric spectrum, most often depressive disorders. In this paper, we want to focus on whether depression occurs as a sequel to cancer or perhaps is the first of the symptoms of a CNS tumor. Review methods For the analysis, the PubMed medical database was searched, and articles containing studies and case reports of people with CNS tumor and depressive disorders that occurred either before diagnosis or at any time during the course of the disease were selected Abbreviated description of the state of knowledge CNS tumors produce symptoms such as epilepsy, visual disturbances, paresis, but also behavioral disorders. This is determined by the location of the tumor. Depression is a mental disorder manifested mainly by lowered mood. This disorder can coexist with tumors occurring in the frontal lobe or be present regardless of the location of the tumor, in people diagnosed with a tumor with a poor prognosis. Summary Analyzing the selected articles, we see that in people who were diagnosed with a tumor located in the frontal lobe, often the first symptom was depressive disorders, which even preceded neurological symptoms. When depression is diagnosed, appearing suddenly and refractory to treatment, one should consider whether there is an underlying pathological lesion in the CNS. Unfortunately, there are no specific guidelines for imaging studies in depressive disorders. People who suffer from malignant tumors with a poor prognosis should be cared for by a psychologist, because as the disease progresses, the symptoms worsen, affecting the prognosis.

Introduction and aim of the study. Long-gap esophageal atresia (LGEA) is a congenital anomaly in which the gap between both ends of the esophagus exceeds three intervertebral spaces and is an esophageal atresia without air in the abdomen. The defect is both therapeutic and surgical challenge. This review aims at providing an overview of the most recent literature on the effective methods for treatment of LGEA, and the most frequent complications and experts’ recommendations on this subject. Material and methods. The systematic review was based on available data collected using PubMed database and the Google Scholar web search engine. Analysis of the literature. There is no consensus on the ideal technique for surgical treatment of LGEA. There are two possible approaches for opening the thorax – thoracotomy and thoracoscopy. The techniques stimulating esophageal elongation include external and internal traction techniques, magnetic compression anastomosis and intramural botulinum type A toxin injection. Replacement methods are a viable option when it is impossible to preserve the native esophagus. Decellularized matrices seem to be promising in developing an esophageal substitute. Regardless of the surgical approach a common complication of surgical treatment is anastomotic stenosis which requires further surgical interventions. Conclusion. Elongation techniques are effective in approximation of the proximal and distal esophagus. The future lies with tissue engineering and inventing an off-the-shelf esophageal substitute. The centralization of treatment is recommended. After discharge from hospital interdisciplinary outpatient assessment and care is required. Further prospective studies are needed to determine the optimal mode of treatment and prevent complications associated with LGEA.

Introduction and purpose: This article will discuss the relationship between nutrition deficiency, focusing on folic acid and vitamin D3 and autism spectrum disorder (ASD). Research suggests that nutrient deficiencies play a role in the development and progression of autism. This article will investigate causes of nutrient deficiencies in ASD, like dietary constraints, food choice, and environment exposure, and their impact on ASD and related symptoms. The purpose of this article is to provide an overview of the research examining the relationship between folic acid and vitamin d3 supplementation and autism. Materials and methods: A broad search was conducted using the PubMed database in order to identify relevant studies published between 2010-2020 using keywords such as “folic acid”, “folinic acid”, "vitamin d3", "autism spectrum disorder". A brief description of the current state of knowledge: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that in recent years has been increasingly diagnosed among children. Only between 2016 and 2014 measured prevalence in the United States has increased by 10%. [1] The exact etiology of ASD in not known. In this review we will examine a role of folic acid and vitamin D3. Research suggests that folic acid supplements can help improve verbal skills in people with ASD. Research also shows decreased levels of vitamin d3 in ASD patients. Clinical trials involving vitamin d3 present inconclusive data but lean towards positive impact of supplementation. Both folic acid and vitamin d3 supplementation is safe. Dietary changes and oral supplementation may be beneficial for patients. Conclusions: Studies with larger participant numbers should be done to prove the significance of folic acid and vitamin D3 supplementation as it shows potential in being a safe and not expensive complementary therapeutic option.

Introduction and purpose: Gluten-free diet have gained immense popularity in recent years, both as a treatment for coeliac disease and as a lifestyle choice for those who believe it is healthier. However, concerns have been raised about potential nutrient inadequacies resulting from the elimination of gluten-containing grains. The purpose of this review is to assess the state of knowledge regarding the impact of a gluten-free diet on nutritional status. Materials and methods: A comprehensive search was conducted using electronic database PubMed to identify relevant studies published between 1999 and 2022. Keywords such as "gluten-free diet" and "nutritional deficiencies" were used in combination with Boolean operators to refine the search. A brief description of the state of knowledge: Analysis of studies revealed that individuals adhering to a gluten-free diet may be at risk of nutritional deficiencies including micronutrients such as vitamin D, vitamin E, vitamin B complex along with minerals, in particular iron, zinc, calcium, magnesium as well as fibre. Furthermore, higher levels of fat and sugar were observed in the composition of gluten-free products. Conclusions: Based on the current body of literature, it is evident that a gluten-free diet results in certain nutritional deficiencies. Individuals following gluten-free diet should be aware of potential risks and take appropriate measures to ensure a well-balanced and nutrient-rich diet. Nutritional guidance should be provided to individuals to address specific nutrient deficiencies associated with a gluten-free diet.

Introduction and purpose: Ischemic stroke is one of the leading causes of death and disability worldwide. There is an urgent need to develop new treatments and diagnosis. The aim of this review is to gather current knowledge on the potential use of exosomes in the diagnosis and treatment of ischemic stroke. This review was based on available data collected in the Pub Med database and Google Scholar web search engine, using the key words: „Exosomes”, „ischemic stroke” Description of the state of knowledge: Currently, thanks to the development of knowledge about molecular processes, many studies are conducted on drugs that could limit neurodegenerative processes and support repair processes. Many of the drugs that could be used in treatment show poor penetration through the blood-brain barrier. In studies, exosomes show good penetration through the blood-brain barrier, limit neurodegenerative processes and show neuroregenerative effects. Exosomes are characterized by low immunogenicity and toxicity, and the proteins contained in them are involved in neurogenesis, anti-apoptotic processes and synaptic transmission. In addition, studies have shown exosomes inhibit autophagocytosis and reduce neuronal damage. ​ Summary: Studies performed on animal models have shown the effectiveness of exosomes in the diagnosis and treatment of ischemic stroke. Further studies are needed to determine the efficacy and safety profile of exosomes in humans.

Opioid therapy plays a crucial role in the management of acute and chronic pain, with opioids being widely prescribed worldwide. However, alongside the analgesic benefits, the use of opioids is associated with a range of adverse effects, including opioid-induced bowel dysfunction. Opioid-induced bowel dysfunction refers to a constellation of gastrointestinal symptoms caused by the effects of opioids on the gastrointestinal tract. These symptoms primarily manifest as constipation, but can also include abdominal pain, bloating, nausea, and vomiting. Opioid-induced bowel dysfunction poses a significant clinical challenge, as it can severely affect patients' quality of life. Non-pharmacological approaches alone are rarely sufficient to counteract the adverse effects of opioid therapy. The primary pharmacological agents used in opioid-induced bowel dysfunction management are laxatives, which should be chosen according to individual patient needs. Patients with poorly controlled symptoms can benefit from new pharmacological approaches, particularly peripheral mu-opioid receptor antagonists. By better understanding the underlying mechanisms, clinical manifestations, diagnostic criteria, and management strategies, healthcare professionals can optimize patient care, minimize complications, and improve patients' overall well-being.

Introduction and aim of the study: Osteoarthritis (OA) and depression are leading causes of disease burden worldwide and important public health problems. A number of recent studies reported depression as a comorbidity of OA and its impact on reduced quality of life and worse treatment outcome of OA patients. The clinical management strategies of those patients still haven’t been developed, which is a challenge of future research on this topic. The aim of this review is to shed a light on important aspects of depression relationship with OA including its prevalence among OA patients and its influence on course and treatment of OA with a purpose of increasing awareness of this problem among physicians which may subsequently lead to a better overall medical care of patients with OA and depression. Methods and materials: This literature review is based on articles published in the PubMed database, GoogleScholar, ScienceDirect, and available medical textbooks. Conclusions: Recent literature reports a higher prevalence of depression among OA patients when compared to general population and its impact on osteoarthritis course, both on psychological and biomolecular level. Future research may lead to a better understanding of molecular background of depression and OA interrelation and to more complex and individualized management strategies which may result in a better outcome of treatment and improved life quality of osteoarthritis patients. Therefore, in order to optimize management of OA patients, physicians should pay more attention to depression and use multidisciplinary approach including assessment of mental health status to develop a more effective strategies of medical care in osteoarthritis.