Scilit

Genome editing has transformed the fields of biotechnology, medicine, agriculture, and synthetic biology by allowing for targeted modifications of genetic material. Despite the simplicity and efficiency of CRISPR-Cas systems making it the dominant genome editing platform, their off-target effects, PAM sequence dependence, delivery challenges and unwanted genomic alteration have spurred the development of advanced editing technologies beyond the conventional CRISPR systems. In this chapter, we summarise the design principles, optimization strategies, and applications of next-generation genome editing tools, such as base editors, prime editors, RNA-guided transposases, and epigenome editing technologies. The molecular mechanisms, advantages and limitations of these platforms are discussed with special emphasis on improving editing precision, efficiency, delivery and bio-safety.

Precision pharmacotherapy is a paradigm shift in managing vitiligo that has shifted from a one size fits all approach to a stratified, mechanism based approach. This chapter introduces an integrated approach addressing clinical phenotype, immune endotype, and therapeutic mechanism to maximize the use of both topical and systemic, as well as targeted Janus kinase inhibitors. Potency-stratified topicals, pulse systemic immunomodulators and selective JAK1 or JAK1/JAK2 or JAK3/TEC inhibitors fit into a step-up algorithm based on disease activity, anatomical location, age and comorbidity. The discussion highlights emerging enablers like lesion mapping using artificial intelligence, digital phenotyping, digital twins, and pharmacogenomic prediction as tools for response prediction on extent scoring and decision support for durable, personalized repigmentation with balanced safety.

Retroperitoneal sarcomas (RPS) are rare and complex malignancies for which management in specialized multidisciplinary centers is recommended [1]. Contemporary Sarculator nomograms enable individualized survival prediction following primary RPS surgery and account for institutional case volume [2]. This retrospective single-center study evaluated patients undergoing primary surgery for retroperitoneal sarcoma at Kauno Klinikos between January 2017 and August 2025. Clinical, pathological, and survival data were collected from the institutional electronic health record (HIS). Overall survival was estimated using the Kaplan–Meier method. Observed survival was compared with individual 5-year overall survival predictions generated using the Sarculator nomogram. Among 35 patients, median age was 64 years (IQR 53.5–75.5), and median tumor size was 14 cm (IQR 10–24). Leiomyosarcoma was the most frequent histological subtype (40.0%), followed by dedifferentiated liposarcoma (34.3%). Disease recurrence was documented in 17 patients (48.6%), and 13 patients died during follow-up. Median follow-up was 45.7 months. The observed 5-year overall survival was 62.9% (95% CI 43.8–82.1%). Mean Sarculator-predicted 5-year overall survival was 57.1% for low-volume and 67.3% for high-volume centers. Observed 5-year survival was consistent with Sarculator-predicted outcomes, falling between estimates for low- and high-volume centers.

Small bowel bleeding is a rare clinical condition that remains difficult to diagnose and manage. Due to its recurrent nature and limited accessibility, identifying the bleeding source may require complementary diagnostic investigations [1,2]. This study aimed to present a challenging case of recurrent small bowel bleeding and highlight the role of repeated multimodal diagnostic evaluation. A literature review using the PubMed database and analysis of a clinical case were performed. We included English-language articles published in the last decade. A 72-year-old woman with recurrent severe anaemia and suspected gastrointestinal bleeding underwent repeated endoscopic, radiological, and surgical investigations. Capsule endoscopy and SPECT/CT indicated a possible bleeding site in the ileum, however, angiography and diagnostic laparotomy failed to identify the source. A loop ileostomy was created to facilitate further localization and endoscopic access in case of recurrent bleeding. When bleeding recurred, enteroscopy via the ileostomy identified a bleeding ileal angiodysplasia, and successful endoscopic haemostasis was achieved with clips. In conclusion, recurrent small bowel bleeding may remain undetected despite repeated diagnostic investigations. When clinical suspicion persists or bleeding recurs, repeated and multimodal evaluation is necessary [3,4]. In this case, enteroscopy through the ileostomy enabled identification and treatment of the previously unconfirmed bleeding source.

Aim: To evaluate the appropriateness of empirical antibiotic therapy and antimicrobial susceptibility patterns in patients with acute complicated diverticulitis (ACD). Methods: This retrospective cohort study included 61 patients who underwent surgical intervention with intra-abdominal microbiological sampling for ACD between 2021 and 2023. Culture and antibiogram results were analyzed to identify the most frequently isolated pathogens and assess the concordance between empirical antibiotic therapy and antimicrobial susceptibility. Results: Empirical cefuroxime plus metronidazole therapy was microbiologically appropriate in 39 patients (63.9%) and inappropriate in 22 (36.1%). The most frequently isolated pathogens were Escherichia coli (73.8%), Enterococcus faecium (18.0%), Klebsiella pneumoniae (14.8%), Pseudomonas aeruginosa (13.1%), and Klebsiella oxytoca (8.2%). The presence of E. faecium or P. aeruginosa was significantly associated with inappropriate empirical therapy (p < 0.001). Both pathogens demonstrated 100% resistance to the empirical regimen in the respective cases. Conclusions: Empirical cefuroxime plus metronidazole therapy provided adequate antimicrobial coverage in only 63.9% of patients with ACD. E. faecium and P. aeruginosa were significantly associated with inadequate empirical coverage and may represent important considerations when selecting initial antibiotic therapy.

Approximately 700,00 people in Europe live with stoma [1]. In Lithuania, approximately 1,400 new cases of colorectal cancer are diagnosed annually [2]. Despite advances in surgery, stoma formation may lead to complications affecting quality of life. We aimed to evaluate stoma-related complications and quality of life using OAI-23 and DLQI questionnaires. A prospective study included 219 patients who underwent primary stoma formation. Early complications were evaluated using the Clavien-Dindo Classification, the psychosocial adaptation using OAI-23 and dermatological impact by DLQI questionnaire. Among 219 patients, 58 (26.5%) had stoma-related complications. Parastomal hernia and relaparotomy were the most common events. The mean DLQI score was 4.4 ± 4.9, indicating a small dermatology-related impact on quality of life. OAI-23 score decreased from 74.8 ± 11.4 at 2 weeks to 63.8 ± 14.1 at 2 months postoperatively, indicating improved adjustment. Urgent surgery was associated with higher OAI-23 scores at both 2 weeks and 2 months. Overall, 26,5% developed stoma related complications. Dermatology-related impact on quality of life was low. OAI-23 scores improved over time, indicating better psychosocial adjustment. Urgent surgery was associated with poorer adjustment.

This article discusses approaches to improving the biological stability of tuberculin preparations used for the allergic diagnosis of animal tuberculosis and outlines перспективes for the development of next-gene-ration differential diagnostic methods. The study focused on formalin-stabilized tuberculin, whose character-ristics were compared with those of conventional purified protein derivative (PPD) tuberculin preparations used in veterinary practice. Previous investigations evaluated the physicochemical, biological, and allergenic proper-ties of tuberculin produced from Mycobacterium bovis cultures using different concentrations of formalin as a stabilizing agent (0.1–10%). Among the tested formulations, a 3% formalin concentration demonstrated the most favorable balance between biological activity, storage stability, and the absence of local irritant reactions. Field clinical trials conducted in livestock farms of the Karaganda region (Kazakhstan) compared the formalin-stabilized tuberculin with two commercially available reference preparations: Mammalian PPD Tuberculin 1 (Kursk Biofactory, Russian Federation) and Mammalian PPD Tuberculin 2 (Republic of Kazakhstan). No false-positive reactions were observed in tuberculosis-free herds following administration of any of the tested pre-parations, confirming their high diagnostic specificity and biological safety. In herds affected by bovine tuber-culosis, however, the formalin-stabilized tuberculin produced more pronounced delayed-type hypersensitivity reactions, suggesting improved diagnostic sensitivity and enhanced detection of infected animals. As a promi-sing direction for further research, the development of next-generation differential diagnostic methods based on the ESAT-6 and CFP-10 antigens encoded by genes within the RD1 region has been proposed. The use of these antigens will enable the implementation of the DIVA approach (Differentiating Infected from Vaccina-ted Animals), allowing infected animals to be differentiated from those vaccinated with BCG, which is of considerable interest for improving animal tuberculosis control and eradication programs.

The aim of this study was to analyse students' knowledge and adherence to nutrition as a risk factor for the prevention of cardiovascular diseases at the Lithuanian University of Health Sciences. Methodology. A quantitative study was employed to collect data from 107 students enrolled at the Lithuanian University of Health Sciences. Anonymous questionnaires were distributed to students in the Nursing, Occupational Therapy, and Physiotherapy study programmes. The survey comprised questions from two prior established questionnaires: The Disease Risk Factors Knowledge Level (CARRIFKL) and the Mediterranean Diet Knowledge/Adherence Questionnaire. Written permission for the use of both questionnaires was obtained from the original authors via e-mail. Participants were asked to provide demographic information, including gender, age, and educational level. The collected data were subsequently analysed using appropriate statistical methods. Results: A high level of knowledge was observed regarding cardiovascular risk factors, while an average level of knowledge was noted regarding the Mediterranean diet. However, the level of adherence to the Mediterranean diet was found to be low. Furthermore, a weak, insignificant correlation with a positive, direct linear relationship was identified between knowledge and adherence. Conclusions: Although participants demonstrated adequate knowledge of cardiovascular risk factors and the Mediterranean diet, a discrepancy between knowledge and actual dietary adherence was observed. This risk factor should be addressed to promote healthier behavioural practices and improve cardiovascular disease prevention.

Background: The role of renal artery revascularization in the management of renovascular hypertension remains controversial, particularly regarding its long-term clinical benefits. Objective is assessing early and long-term outcomes of renal artery revascularization in patitents with renovascular hypertension. Materials and Methods: This retrospective single-center study included 40 patients who underwent renal artery revascularization. Early outcomes focused on changes in blood pres~ 'sure and renal function, while long-term outcomes included restenosis rates and overall clinical improvement. Results: Revascularization was associated with a marked and statistically significant reduction in both systolic and diastolic blood pressure (p < 0.001). Renal function improved, as demonstrated by increased eGFR and decreased serum creatinine levels. During follow-up, most patitents maintained clinical improvement, and the rate of restenosis remained relatively low (15.0%). Conclusion: Renal artery revascularization is associated with substantial early improvement and favorable long-term outcomes in carefully selected patients with renovascular hypertension.

Background: Cardiovascular diseases remain the leading cause of mortality worldwide, accounting for more than 30% of all deaths. Traditional transvenous pacemakers are widely used; however, the complication rate after implantation reaches 10–15%. Leadless pacemakers significantly reduce the risk of complications, with rates of approximately 0.46% within 90 days and 1.77% within one year. Therefore, this technology is considered a promising direction in modern cardiac pacing. The aim is analyzing current scientific evidence on the use of leadless pacemakers. Materials and Methods. For the preparation of this literature review, contemporary scientific publications devoted to the clinical application, efficacy, safety, and future prospects of leadless pacemakers were analyzed. The literature search was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases for the period from 2015 to 2026. Original studies, meta-analyses, systematic reviews, and clinical guidelines published in English and Russian were included. Publications without full-text access, duplicate data, and studies lacking clinical relevance were excluded. Results. The literature analysis demonstrated that leadless pacemakers show high efficacy and safety, characterized by a low rate of complications and stable pacing parameters. Their use reduces the risk of infections, thrombosis, and lead dysfunction compared with traditional transvenous systems. Conclusions. Leadless cardiac pacing is a promising direction in modern cardiology. Further technological development and expansion of indications will improve the effectiveness of arrhythmia management and clinical outcomes in patients.