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INTRODUCTION: Disorders of glucose metabolism in children with obesity are less common than in adults. There is also evidence that they may be transient. The aims of this study were to determine the prevalences of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (DM2) and its reversibility in pediatric patients with obesity and to define the factors determining the reversibility of prediabetes or progression to diabetes. METHODS: Retrospective analysis included of young patients with obesity. Patients presented and were treated between 2000-2022 at a single center. RESULTS: The study included 573 (316 girls; 55.15%) Caucasian patients with median body mass index (BMI) Z-score of 3.95 (range 2.0-9.9) and median age 13.9 (2.9-17.1) years old. OGTT results were normal in 90.8% (n=520) and signs of prediabetes occurred in 9.2% (n=53); IFG 17%, IGT 88.7%, DM 0%. Among those who underwent OGTT twice (n=53), impaired glucose regulation was present in 9.3% (n=5) (IFG 40%, IGT 80%, DM 0%) at baseline and in 14.8% subject (n=8) (IFG 25%, IGT 50%, DM 25%) at follow-up after lifestyle modification only. After 12-36 months of follow up, in those with a history of IGT, 60% reverted to normal glucose tolerance, while IFG and IGT persisted in 20% and 20%, respectively, and none progressed to DM. The risk factors for progression of glucose metabolism disorders were increase of BMI Z-score, higher insulin levels and elevated homeostatic model assessment-insulin resistance. DISCUSSION AND CONCLUSION: IFG and IGT are common in pediatric patients with obesity, while the progression to DM2 is rare. Disorders of glucose metabolism have reversible character.

Background and objectivesMyasthenia gravis (MG) is an autoimmune disease characterized by dysfunction at the neuromuscular junction. Treatment frequently includes corticosteroids (CSs) and IV immunoglobulin (IVIG). This study was conducted to determine whether immune globulin (human), 10% caprylate/chromatography purified (IGIV-C) could facilitate CS dose reduction in CS-dependent patients with MG.MethodsIn this randomized double-blind placebo-controlled trial, CS-dependent patients with MG (Myasthenia Gravis Foundation of America Class II-Iva; AChR+) received a loading dose of 2 g/kg IGIV-C over 2 days (maximum 80 g/d) or placebo at week 0 (baseline). Maintenance doses (1 g/kg IGIV-C or placebo) were administered every 3 weeks through week 36. Tapering of CS was initiated at week 9 and continued through week 36 unless the patient worsened (quantitative MG score ≥4 points from baseline). CS doses were increased (based on the current CS dose) in patients who worsened. Patients were withdrawn if worsening failed to improve within 6 weeks or if a second CS increase was required. The primary efficacy end point (at week 39) was a ≥50% reduction in CS dose. Secondary and safety end points were assessed throughout the study and follow-up (weeks 42 and 45). The study results and full protocol are available at clinicaltrials.gov/ct2/show/NCT02473965.ResultsThe primary end point (≥50% reduction in CS dose) showed no significant difference between the IGIV-C treatment (60.0% of patients) and placebo (63.3%). There were no significant differences for secondary end points. Safety data indicated that IGIV-C was well tolerated.DiscussionIn this study, IGIV-C was not more effective than placebo in reducing daily CS dose. These results suggest that the effects of IGIV-C and CS are not synergistic and may be mechanistically different.Trial registration informationThe trial was registered on clinicaltrialsregister.eu (EudraCT #: 2013-005099-17) and clinicaltrials.gov (identifier NCT02473965).Classification of evidenceThis study provides Class II evidence that IVIG infusions in adult patients with MG do not increase the percentage of patients achieving a ≥50% reduction in corticosteroid dose compared with placebo.

Obesity is currently one of the most significant public health challenges worldwide due to the continuous increase in obesity rates among children, especially younger children. Complications related to obesity, including serious ones, are increasingly being diagnosed in younger children. A search was performed from January 2023 to September 2023 using the PubMed, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases. The focus was on English-language meta-analyses, systematic reviews, randomized clinical trials, and observational studies worldwide. Four main topics were defined as follows: disorders of glucose metabolism; liver disease associated with childhood obesity; the relationship between respiratory disorders and obesity in children; and the effects of obesity on the hypothalamic–pituitary–gonadal axis and puberty. Understanding potential complications and their underlying mechanisms can expedite the diagnostic process and enhance the effectiveness of treatment. We aspire that this study will bring insight into the often-overlooked complications associated with obesity.

OBJECTIVE:To investigate safety and explore efficacy of efgartigimod (ARGX-113), an anti-neonatal Fc receptor immunoglobulin G1 Fc fragment, in patients with generalized myasthenia gravis (gMG) with a history of anti-acetylcholine receptor (AChR) autoantibodies, who were on stable standard-of-care myasthenia gravis (MG) treatment. METHODS:A phase 2, exploratory, randomized, double-blind, placebo-controlled, 15-center study is described. Eligible patients were randomly assigned (1:1) to receive 4 doses over a 3-week period of either 10 mg/kg IV efgartigimod or matched placebo combined with their standard-of-care therapy. Primary endpoints were safety and tolerability. Secondary endpoints included efficacy (change from baseline to week 11 of Myasthenia Gravis Activities of Daily Living, Quantitative Myasthenia Gravis, and Myasthenia Gravis Composite disease severity scores, and of the revised 15-item Myasthenia Gravis Quality of Life scale), pharmacokinetics, pharmacodynamics, and immunogenicity. RESULTS:Of the 35 screened patients, 24 were enrolled and randomized: 12 received efgartigimod and 12 placebo. Efgartigimod was well-tolerated in all patients, with no serious or severe adverse events reported, no relevant changes in vital signs or ECG findings observed, and no difference in adverse events between efgartigimod and placebo treatment. All patients treated with efgartigimod showed a rapid decrease in total immunoglobulin G (IgG) and anti-AChR autoantibody levels, and assessment using all 4 efficacy scales consistently demonstrated that 75% showed a rapid and long-lasting disease improvement. CONCLUSIONS:Efgartigimod was safe and well-tolerated. The correlation between reduction of levels of pathogenic IgG autoantibodies and disease improvement suggests that reducing pathogenic autoantibodies with efgartigimod may offer an innovative approach to treat MG. CLASSIFICATION OF EVIDENCE:This study provides Class I evidence that efgartigimod is safe and well-tolerated in patients with gMG.

Objective: Gestational diabetes mellitus (GDM) is related to many complications of pregnancy. The aim of the study was the assessment of cervical colonization in GDM patients and its correlation with inappropriate glycaemic control and gestational weight gain (GWG). Materials and methods: The study included 483 women with GDM in a singleton pregnancy who delivered at term. Cervical smears samples were collected >35th week of gestation and cultured for aerobic and aerobic bacteria, and fungi. The patients were divided into two groups on the basis of cervical culture test results: women with negative and positive cervical culture results. Gestational weight gain was estimated in both groups as inadequate, adequate or excessive based on pre-gestational body mass index (BMI) according to the Institute of Medicine (IOM) guidelines. GWG and need of insulin therapy were used as an indicator of complying with dietary recommendations. Results: Patients with positive cervical culture results more frequently had pre-pregnancy BMI >35kg/m2 (4.9% vs 9.5%, p = 0.0508) than patients who had negative cervical culture results. One third (32.1%) of patients had one, and 9.3% had at least two microorganisms in their genital tracts. The most frequent bacteria species isolated was Streptococcus agalactiae (20.1%). Fungi were present in 14.1% of the cervical cultures. Patients with GDM with inadequate GWG more often had genital tract's colonization with Enterococcus spp. (6.83% vs. 1.19% vs. 1.83%, in group with inadequate GWG vs. adequate GWG vs. excessive GWG respectively p = 0.007). Conclusion: Insulin therapy in GDM patients was not correlated with the presence of microorganisms in genital tracts. Inadequate GWG in GDM may be linked to genital tract colonization with Enteroccocus spp. Genital colonization during pregnancy among patients with GDM is more often among patients’ with pre-pregnancy BMI >35 kg/m2.

Introduction and objective Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis. Material and methods Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2–40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p < 0.05 was considered significant. Results Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p < 0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p < 0.001) or positive (p = 0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p = 0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012). Conclusions SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation.

Background: Although approximately half of myasthenia gravis (MG) patents achieve remission, for the remaining group MG is often a life-long disease. Better understanding of the determinants of Quality of Life (QoL) in MG is needed to optimize treatment goals in chronic cases.Materials and Methods: We performed a single center cross-sectional study in 339 MG adult patients (64.9% women), with ocular or generalized disease. SF-36 and a structured questionnaire was administered, including information on previous and current MG severity, medications, comorbidities, education, occupation and BMI of the patient. Mean disease duration was 7.5 + 9.3 years. Current age was 51.6 + 18.3 years, 55% had Early-Onset (

Magdalena Bosak,1 Wojciech Turaj,1 Dominika Dudek,2 Marcin Siwek,2 Andrzej Szczudlik1 1Department of Neurology, 2Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland Purpose: The aim of this study was to assess the prevalence of depression among patients with epilepsy and to establish the risk factors of depression in that group, with special focus on the use of potentially depressogenic medications. Patients and methods: We studied 289 consecutive patients who visited epilepsy outpatient clinic (University Hospital of Krakow) and met inclusion criteria. All patients were screened with Beck Depression Inventory (BDI), and those with BDI score ≥12 were further evaluated by a psychiatrist. Results: Mean age of patients was 35.7 years, and mean duration of epilepsy was 14.7 years. Idiopathic generalized epilepsy was diagnosed in 63 patients (21.8%), focal epilepsy was found in 189 subjects (65.4%), and unclassified epilepsy was diagnosed in 37 patients (12.8%). Frequent seizures (>1 per month) were reported in 107 patients (37.0%). Thirty-five patients (12.1%) reported an ongoing treatment with one or more of the predefined potentially depressogenic medication (ß-blockers, combined estrogen and progestogen, corticosteroid, or flunarizine). In a group of 115 patients (39.8%) who scored ≥12 points in BDI, depression was finally diagnosed in 84 subjects (29.1%) after psychiatric evaluation. Only 20 of those patients (23.8%) were treated with antidepressant. Independent variables associated with the diagnosis of depression in the logistic regression model included frequent seizures (odds ratio [OR] =2.43 [95% confidence interval, 95% CI =1.38–4.29], P=0.002), use of potentially depression-inducing medications (OR =3.33 [95% CI =1.50–7.39], P=0.003), age (OR =1.03 [95% CI =1.01–1.05] per year], P=0.005), and use of oxcarbazepine (OR =2.26 [95% CI =1.04–4.9], P=0.038). Conclusion: The prevalence of depression among consecutive Polish patients with epilepsy reached 29.1%. Less than quarter of them received antidepressant treatment at the moment of evaluation. Independent variables associated with depression included age, frequent seizures, and the use of oxcarbazepine or predefined depressogenic medications. Keywords: epilepsy, depression, medication, seizures, risk factors, side effects

Objective: A number of studies on gait disturbances have been conducted, however, no clear pattern of gait disorders was described. The aim of the study was to characterize the gait pattern in HD patients by conducting analysis of mean angular movement changes the lower limb joints and trunk (kinematics parameters).Methods: The study group consisted of 30 patients with HD (17 women and 13 men). The reference data include the results of 30 healthy subjects (17 women and 13 men). Registration of gait with the Vicon 250 system was performed using passive markers attached to specific anthropometric points directly on the skin, based on the Golem biomechanical model (Oxford Metrics Ltd.). The research group and the control group were tested once.Results: Statistically significant (p < 0.05) angular changes in gait cycle for HD patients were observed in: insufficient plantar flexion during Loading Response and Pre-swing phases; insufficient flexion of the knee joint during Initial Swing and Mid Swing phases; excessive flexion of the hip in Terminal Stance and Pre-swing phases and over-normative forward inclination of the trunk in all gait phases. It should be noted that the group of patients with HD obtained, for all the mean angular movement changes higher standard deviation.Conclusion: A characteristic gait disorder common to all patients with HD occurring throughout the whole duration of the gait cycle is a pathological anterior tilt of the trunk. The results will significantly contribute to programming physiotherapy for people with HD, aimed at stabilizing the trunk in a position of extension during gait.

Aleksandra Klimkowicz-Mrowiec,1 Pawel Wolkow,2 Malgorzata Sado,3 Anna Dziubek,3 Joanna Pera,1 Tomasz Dziedzic,1 Andrzej Szczudlik,1 Agnieszka Slowik1 1Department of Neurology, Jagiellonian University, School of Medicine, Botaniczna, 2Department of Pharmacology, Jagiellonian University, School of Medicine, Grzegórzecka, 3Department of Neurology, University Hospital, Botaniczna, Krakow, Poland Background: Recent data indicate that the rs1080985 single nucleotide polymorphism of the cytochrome P450 (CYP) 2D6 gene may affect the response to treatment with donepezil in patients with Alzheimer's disease. There is also evidence that the common apolipoprotein E (APOE) polymorphism may affect the response to treatment with donepezil in Alzheimer's disease. We investigated the association between response to donepezil and the rs1080985 single nucleotide polymorphism, the minor allele (G) of which was previously reported to be associated with a poor response to this drug in patients with Alzheimer's disease. The common APOE polymorphism was also assessed for its relevance to the outcome of this treatment. Methods: Analysis of CYP2D6 and APOE polymorphisms was undertaken in 88 naive Caucasian patients with Alzheimer's disease. All patients received treatment with donepezil for at least 10 months, and the response to treatment was then assessed according to the National Institute for Health and Clinical Excellence criteria. Results: No significant differences were observed in distribution of the CYP2D6 rs1080985 single nucleotide polymorphism or common APOE polymorphism between responders (68.2%) and nonresponders (31.8%) to treatment with donepezil. Conclusion: Our results suggest that neither the CYP2D6 nor the APOE polymorphism influences the response to treatment with donepezil in a Polish population with Alzheimer’s disease. Keywords: Alzheimer’s disease, CYP2D6, APOE, donepezil, pharmacogenetics, single nucleotide polymorphism

Introduction and objective. Lymph node involvement is a strong predictor of disease recurrence and patient survival in vulvar cancer. The aim of the study was to evaluate the feasibility of sentinel lymph node (SLN) screening, the incidence of skip metastases, and lymph node lymphangiogenesis. Materials and method. Fifty-five patients participated in this prospective, single centre study. A double SLN screening method was employed using radiocolloid (technetium-99 sulfur colloid) and 1.0% Isosulfan Blue. Immunohistochemistry, using a mouse monoclonal antibody against D2–40, was used to evaluate lymphatic vessel density (LVD). All calculations were performed using STATISTICA software v. 10 (StatSoft, USA, 2011); p<0.05 was considered significant. Results. Using both methods of SLN detection, 100% accuracy was achieved, and skip metastases were diagnosed in only one woman (1.82%). Peri-tumour median LVD was significantly increased compared with matched intra-tumour samples (p<0.001), while median LVD was significantly lower in negative, compared with positive SLN, regardless of whether matched non-SLN were negative (p<0.001) or positive (p=0.005). Metastatic SLN exhibited significantly higher median LVD compared with matched negative non-SLN (p=0.015), while no significant difference in median LVD was detected between positive SLN and matched positive non-SLN. However, negative SLN had a significantly higher median LVD compared with matched negative non-SLN (p = 0.012). Conclusions. SLN detection is a safe and feasible procedure in vulvar cancer. In patients without nodular involvement, SLN, compared with non-SLN, exhibited significantly higher median LVD, which may be an indication of its preparation to host metastases, and thus requires further investigation. [ABSTRACT FROM AUTHOR]

The 19th Congress of the Chinese Communist Party marked the completion of the first term of the fifth generation of leaders. Xi Jinping announced that China entered "a new era of socialism with Chinese characteristics," which is a new slogan, a symbol of Xi's second term. Contrary to some expectations, the Congress was not a political breakthrough, as the party's goals-to hold its power, maintain stability in the country and regain a superpower status- remain unchanged. New means of achieving these goals will be employed, however, including new technologies in economic and social management, while in foreign policy China will be more active globally, proposing or even exporting solutions based on Chinese standards. [ABSTRACT FROM AUTHOR]

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In the last two decades, Central and Eastern Europe (CEE) have not played an important role in China's foreign policy and vice-versa. EU membership did not change China-CEE relations remarkably. The situation started to change once the global financial and economic crisis hit. CEE began to notice that China is an economic and political partner to be reckoned with. Meanwhile, despite the crisis, the PRC started to look at CEE as a stable region -- especially in economic terms. At the beginning China decided to strengthen bilateral ties with CEE countries. But in mid-2011 Beijing took the first step to launch cooperation with CEE as a region. [ABSTRACT FROM AUTHOR]

Systemic Lupus Erythematosus (SLE) is autoimmunological disease of connective tissue which is characterized with clinical symptoms of many systems and organs injury. There are often neuropsychiatric symptoms. Psychotic disorder is the least frequent syndrome. Neuropsychiatric symptoms are important because they deteriorate the quality of life and are poor prognostic factor. Aim. The aim of the study is to present the patient with chronic, lasting for many years, skin lesions and laboratory tests results characteristic for SLE, who had psychotic disorder diagnosed as schizophrenia and in the next few years there were observed other neuropsychiatric symptoms including cognitive impairment and mood disorder. Conclusions. Psychotic disorder is rare syndrome of neuropsychiatric SLE (NPSLE). It may primarily originate from SLE or be secondary either to the therapy or the complications of the disease. It is not possible to define if the psychosis is the primary schizophrenic process or secondary to the autoimmune disease in presented patient. However the clinical picture pays attention to the significance of careful diagnostic process, including neuroimaging. In head CT of presented patient there were revealed massive, bilateral, calcifications of subcortical structures which probably substantially enhanced neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]