Functional Assessment Research Articles

Neuromuscular Phrenic Nerve Ultrasound versus Nerve Conduction Study of Phrenic Nerve in Amyotrophic Lateral Sclerosis

Abstract Background Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disorder that is, characterized by progressive loss of the upper (UMNs) and lower motor neurons (LMNs) at the spinal or bulbar level. In the most advanced stages, ALS patients will develop symptoms of dyspnea due to weakness of respiratory muscles and subsequently death in ALS. Objective To compare between neuromuscular ultrasound and nerve conduction study of phrenic nerve in the assessment of pulmonary function in Amyotrophic lateral sclerosis patients. Patients and Methods This was a case control study performed in Ain Shams University Hospitals in the period from 2/2022 to 8/2022. The study included 15 patients diagnosed with Amyotrophic lateral sclerosis according to El Escorial revised criteria and 15 healthy people served as controls. Patients were randomized by a simple computer generated method into two groups: A study group (n = 15) and a control group (n = 15). Results This study showed that PNCS is more sensitive than CSA in the assessment of respiratory affection in ALS. PNCS is simple and easy to do and doesn’t need a highly equipped device. Also PN amplitude has a normal value and many studies were done about it. To our knowledge no research studies this correlation between PN CSA and PN amplitude in the assessment of respiratory affection among ALS patients. Conclusion Electrodiagnosis and Neuromuscular ultrasound have a valuable role in the diagnosis and monitoring ALS patients. This study showed that PNCS is more sensitive than PN CSA by NMUS in the assessment of respiratory affection in ALS. PNCS is simple and easy to do and doesn’t need a highly equipped device. Also there were well established reference values as many researches studied electrophysiology of phrenic nerve.

Renal Assessment in the Setting of Pediatric Living Related Liver Transplantation

Abstract Background Liver transplantation in the pediatric age group has become the last resort and yet the preferred option for many end stage liver disorders. This field shows a great improvement and is considered a breakthrough achievement for previously fatal liver diseases. Renal functions are not thoroughly studied in pediatric patients undergoing liver transplantation. Aim of the Work To determine the prevalence and risk factors of renal dysfunction among pediatric living related liver transplantation (LRLT). Patients and Methods This was a cross sectional retrospective and prospective cohort study in which a pilot study for a six-month duration is estimating the incidence of renal dysfunction among LRLT. A total of 40 patients were enrolled during the duration of the study from Ain Shams University, pediatric hospital and Dr. Yassin Abdel Ghaffar charity center for liver disease and research. Full history and clinical examination was performed as well as base line investigations preoperatively including: Serum Creatinine, Urea, Na, K, PO4, Ca, corrected creatinine clearance and urine analysis. Post-operative assessment was done to same parameters in addition to: Serum Mg, Cl, HCO, uric acid, drug trough level of used immunosuppressive drugs, 24 hours’ urinary proteins, and 24 hours’ assessment of electrolytes (Na, K, Ca, PO4, HCO3) in case of lowered serum levels. Moreover, pre and postoperative pelviabdominal U/S to check kidney status (size, echogenicity, RI of renal arteries) was assessed. Results Forty patients were analyzed of which 70% of the patients were males. The mean age at transplantation was 6.84±3.3 years. The commonest diagnosis of the studied group was high gamma-glutamyl transferase (GGT) cholestasis (35%) followed by Biliary atresia (22.5%). Of the enrolled patients, 50% were CHILD-B score, the median of the CHILD Score prior to transplantation was 8 and the median of the PELD score was 7.4. 87.5% of the patients had normal urine analysis, and normal proteinuria in 100% of the patients. The postoperative laboratory investigations were within the normal ranges. Mg was low in 67% of patients while Ca was low in 42.5%.The mean of creatinine, K and Ca levels are significantly elevated after LT (P < 0.05). After a mean duration since transplantation of 4 years, we found that 82.5% of our patients were CKD G1. S. creatinine was positively correlated with the patient age, duration of transplantation, s. uric acid, and average Fk level over the past year(P < 0.05 for all). Conclusion Renal dysfunction is a common, yet may be an underestimated, problem after pediatric liver transplant. Renal impairment was limited in our patients probably due to favorable perioperative conditions. Our pediatric recipients require mandatory and planned nephrologic evaluation to early detect any renal impairment which may develop into an end-stage renal disease and eventually increase the patient mortality rate. Further studies with larger cohort of patients and more advanced methods of assessment of renal functions are recommended.

Pilot study: Measurement of first phase ejection fraction in a sample of Egyptian people

Abstract Background Left ventricular dysfunction (LVD) constitutes the final common pathway for a number of cardiac disorders. Ischemic heart disease (IHD) is the dominant cause of heart failure (HF). The remaining etiologies include cardiomyopathy, hypertension (HTN), valvular heart diseases (VHD) and myocarditis. Data from the Framingham heart study shows that it develops in approximately 16% of men and 18% of women who had diabetes; 12% of men and 8% of women who had HTN; and 30% of both sexes who had myocardial infarction (MI). Aim of the Work to measure the first phase ejection fraction (EF1) in a sample of Egyptian population and to determine its normal value and to assess its reliability in assessment of systolic function. Patients and Methods This study is a prospective and observational clinical that was conducted at El- Mokattam health insurance & Ain Shams University hospitals from October 2019 to March 2022. Results we found that mean EF1 was 35.41 ± 4.16 %, its minimal value was 26.9% and its maximal value was 43.4%. We found that EF1 was reliable and reproducible as there was no statistically significant intra observer nor inter observer variabilities (p-value was 0.547 & 0.602 respectively). We found that there was no significant statistical correlation between EF1 and gender or heart rate or other demographic or clinical data. Conclusion EF1 is a simple and reproducible measurement of LV systolic function that is easily measured by transthoracic echocardiography and is considered comparable to other indices that measure LV systolic function.

Impact of Pressure Targeted Modes of Ventilation on Diaphragmatic Function as Assessed Using Ultrasonography in Critically Ill Patients with Cerebral Insult

Abstract Background Mechanical ventilation (MV) causes diaphragmatic atrophy and reduces diaphragmatic efficiency. Patients with diaphragmatic dysfunction (DD) have longer MV durations and intensive care unit (ICU) stay. There is currently a scarcity of data on the effect of different modes of MV on diaphragmatic function and ultrasound-guided assessment of diaphragmatic efficiency. Methodology Sixty mechanically ventilated patients were randomly divided into four equal groups (15 each), patients were ventilated using either Assist Control Pressure Controlled mode (ACPC group)(Group A), Synchronized Intermittent Mandatory Ventilation Pressure Controlled mode (SIMV)(Group S), Bi-level Positive Airway Pressure mode (BiPAP)(Group B), or Pressure Support Ventilation mode (PSV)(Group P). The primary outcomes were diaphragmatic motion & structure in terms of Diaphragmatic Excursion (DE) & Diaphragmatic Thickness Fraction (DTF) respectively. The duration of the ICU stay was the secondary outcome. Results The PSV group had the highest DE indicating better diaphragmatic function. In addition, MV for longer durations led to diaphragmatic thinning and decreased DTF resulting in DD. Conclusion Among the various modes of ventilation employed in the study, PSV was found to be the mode with the lowest risk of DD. Trial Registry PACTR202112653971335.

Cognition trajectory in Duchenne muscular dystrophy

BackgroundDuchenne muscular dystrophy (DMD) is an X-linked recessive disease brought on by genetic changes that alter the dystrophin (DYS) protein. There has been growing evidence that children with DMD have been at higher risk of developing symptoms of neurodevelopmental disorders. We aimed at defining the cognitive difficulties and their categories in patients with DMD, compared to healthy controls, and assessing their relation with the functional severity. This work was a multi-center, observational, case–control study conducted on DMD patients. Age and sex-matched healthy subjects with no neurologic, psychiatric, or medical comorbidities were included as normal controls.ResultsThere was a statistically significant difference in cognitive patterns between the studied groups. We have observed a significant relationship between cognitive difficulties and functional severity assessment in our patients. There was a statistically significant difference between the studied cases regarding basic characteristics and correlation between cognitive functions and demographic data.ConclusionsThe decline in cognitive functions in DMD patients compared to healthy controls was established. Education was the most affected domain in patients, with more speech delay and dropping out of school. Therefore, it was recommended to establish cognitive screening as a routine in the evaluation and follow-up of DMD children.

The Efficacy of a Home-Based Functional Skills Training Program for Older Adults With and Without a Cognitive Impairment

Abstract Background and Objectives The performance of everyday technology-based tasks, such as online banking or shopping, can be challenging for older adults, especially those with a cognitive impairment. Technology-based tasks are cognitively demanding and require learning new skills. This study explored the efficacy of a technology-based functional skills assessment and training program (FUNSAT) among aging adults with and without Mild Cognitive Impairment (MCI) in home settings. Research Design and Methods One hundred and eighty-four racially/ethnically diverse male and female adults aged 65+ participated in the study. The sample included 75 non-cognitively impaired (NC) older adults and 109 older adults with mild cognitive impairment (MCI). The FUNSAT program includes medication and money management, transportation, and shopping tasks. The MCI participants were randomized to the FUNSAT training or FUNSAT training combined with computer-based cognitive training (FUNSAT/CCT). The non-impaired adults received the FUNSAT training only. Using alternative forms of the assessment component of the FUNSAT program, assessments occurred at baseline, post-training, and one-& three-months post-training. This paper reports the post-training results. Results The findings indicated that the performance of both the non-impaired and MCI participants improved significantly for all six tasks post-training. Specifically, training resulted in improvements in task completion time and task errors. Participants also reported greater confidence when performing the tasks in the real world. Discussion and Implications Non-impaired aging adults and those with MCI can learn to perform technology-based everyday tasks. Further, home-based technology training protocols are feasible for aging adults with and without a cognitive impairment.

Muscle Ultrasonography in Relation to Motor Function in Children with Duchenne Muscular Dystrophy

Abstract Background and Aim Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy of childhood and affects 1 per 3600 male births. Electromyography and muscle biopsy were a commonly ordered invasive diagnostic procedure, used to evaluate children with weakness suspected to be caused by muscle disease. Recently, neuromuscular imaging is used as non-invasive diagnostic tool for various muscle diseases. Muscle ultrasonography is increasingly used for the diagnosis and follow up of children with DMD. Aim of the Work The aim of this study was to describe the pattern of ultrasonographic thigh muscles involvement, and to correlate the US findings with motor functional status. Patients and Methods Functional motor assessment was the functional performance protocol (GSGC score) Gait (G), Climbing stairs (S), Gower's maneuver (G), and Arising from a chair (C). Sonographic assessment of quadriceps rectus femoris muscles. Results Twenty-four genetically confirmed ambulatory DMD children were enrolled in this cross- sectional study. Their mean age of 7.46 ± 1.82 (4.5–11 years). The Rt and Lt Quadriceps muscles positively correlated with the age. The Rt. and Lt. Quadriceps muscle assessment significantly related to the scores for gait, stairs, chair arising, GSGC total score, time to walk 10 m, Time to rise from the floor. Conclusion Ultrasonography could be used as a non-invasive method to assess progressive muscle hypertrophy in boys with Duchenne muscular dystrophy. Furthermore, Quadriceps muscle US correlates with the motor functions in ambulant DMD boys below the age of 12 years.

Online awareness is associated with superior performance on assessments of functional cognition.

Intact awareness facilitates an individual's adoption of strategies to support community living skills. However, most studies have not examined awareness during ongoing complex task performance. Objective: To examine whether community-dwelling adult's Accuracy and Strategy use on the Weekly Calendar Planning Activity 17-item version (WCPA-17), Total Cues on the Performance Assessment of Self-care Skills Checkbook Balancing and Shopping Task (PCST), and scores on the self-report Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale (ADCS-ADL) differ between groups who do and do not demonstrate awareness of performance difficulties on the WCPA-17. Using data collected as part of a larger study we performed a cross-sectional analysis of 274 community-dwelling adults aged 55 to 93 years. Two methods classified participants into groups aware or unaware of their performance. Independent sample t-tests examined group differences on four dependent variables: Accuracy and Strategy use on the WCPA-17, PCST Total Cues, and score on the ADCS-ADL. Using one classification method, aware individuals showed superior Accuracy (p < 0.001), used more Strategies (p = 0.002), needed fewer PCST Total Cues (p < 0.001), and reported greater independence on the ADCS-ADL (p < 0.004), similar trends were observed with the other method in Accuracy (p < 0.001) and PCST Total Cues (p < 0.001) but Strategy use and ADCS-ADL differences failed to reach significance after Bonferroni correction. Groups categorized as aware performed better on all measures. Intact awareness is critical to performance on complex everyday activities and can be evaluated with functional cognition assessments.

P-095 Towards deciphering the molecular architecture of the human sperm connecting piece

Abstract Study question How can we make the human sperm connecting piece accessible for structural analysis by cryo-electron tomography (cryo-ET)? Summary answer Preparation of sperm by chemical thinning or production of lamellae via cryo-focused ion beam (cryo-FIB) milling allows direct imaging of the human sperm connecting piece. What is known already Previous studies from our group and others have demonstrated the versatility of cryo-ET to advance our understanding of sperm biology. Structures of macromolecular complexes have been resolved in vitro and in situ, enabling a functional assessment at molecular or even atomic level. Resolving structures at high resolution further allowed identification of proteins previously not known to have a role in mediating male fertility. Such insights are instrumental to further improve diagnosis and treatment of male infertility. Study design, size, duration In our research study we use sperm samples from patients undergoing IVF treatment or donor material, which we receive through an ongoing collaboration with the Division of Woman and Baby, University Medical Centre Utrecht (UMCU). These samples are processed in our own laboratory and subsequently imaged by cryo-ET at the Electron Microscopy Centre of Utrecht University. Participants/materials, setting, methods Due to its thickness, the connecting piece cannot be directly analyzed by cryo-ET. Thus, we designed two strategies to achieve thinning of this area and allow collection of tomograms for structural analysis. While the first approach involves incubation of sperm with a detergent, a reducing agent and heparin, the second approach utilizes cryo-FIB milling to produce thin lamellae of the connecting piece. Main results and the role of chance Both strategies developed to access the connecting piece with cryo-ET are effective and allowed us a glimpse of the molecular landscape of the link between sperm head and tail. Chemical thinning of the connecting piece enabled imaging of the proximal and distal centriole while still embedded in the segmented columns or outer dense fibers, respectively. Furthermore, electron density within the microtubules of both centrioles indicates that they are decorated by microtubule inner proteins. Data obtained from lamellae produced by cryo-FIB milling complements these findings, displaying regular densities along the microtubules extending from the proximal centriole. Analyzing tomograms collected from cryo-FIB lamellae we further found a regular protein density that appears to be connecting the nuclear envelope to the base plate. Moreover, cryo-ET of lamellae allowed a detailed view of nuclear pore complexes and the postacrosomal sheath in their native environment. Limitations, reasons for caution Altering the native state of the sperm cell by chemical preparation is a limitation of this approach. Cryo-FIB milling retains the native state of the cell but is limited in throughput. To improve our cryo-FIB milling approach, we will implement automated milling procedures. Wider implications of the findings Chemical preparation and cryo-FIB milling of sperm enable the in-depth analysis of the connecting piece by cryo-ET. These strategies can now be applied to provide structural details at the molecular level and thus advance our understanding of male infertility related to defects of the head-tail junction. Trial registration number not applicable

Spexin inhibits excessive autophagy-induced ferroptosis to alleviate doxorubicin-induced cardiotoxicity by upregulating Beclin 1.

Doxorubicin is widely used in the treatment of malignant tumours, but doxorubicin-induced cardiotoxicity severely limits its clinical application. Spexin is a neuropeptide that acts as a novel biomarker in cardiovascular disease. However, the effects of spexin on doxorubicin-induced cardiotoxicity is unclear. We established a model of doxorubicin-induced cardiotoxicity both in vivo and in vitro. Levels of cardiac damage in mice was assessed through cardiac function assessment, determination of serum cardiac troponin T and CKMB levels and histological examination. CCK8 and PI staining were used to assess the doxorubicin-induced toxicity in cultures of cardiomyocytes in vitro. Ferroptosis was assessed using FerroOrange staining, determination of MDA and 4-HNE content and ferroptosis-associated proteins SLC7A11 and GPX4. Mitochondrial membrane potential and lipid peroxidation levels were measured using TMRE and C11-BODIPY 581/591 probes, respectively. Myocardial autophagy was assessed by expression of P62 and Beclin1. Spexin treatment improved heart function of mice with doxorubicin-induced cardiotoxicity, and attenuated doxorubicin-induced cardiotoxicity by decreasing iron accumulation, abnormal lipid metabolism and inhibiting ferroptosis. Interestingly, doxorubicin caused excessive autophagy in cardiomyocyte in culture, which could be alleviated by treatment with spexin. Knockdown of Beclin 1 eliminated the protective effects of spexin in mice with DIC. Spexin ameliorated doxorubicin-induced cardiotoxicity by inhibiting excessive autophagy-induced ferroptosis, suggesting that spexin could be a drug candidate against doxorubicin-induced cardiotoxicity. Beclin 1 might be critical in mediating the protective effect of spexin against doxorubicin-induced cardiotoxicity.

P-582 Analysis of assisted reproductive outcomes for gynecologic cancer survivors: a retrospective study

Abstract Study question Do women diagnosed with gynecologic cancer have worse pregnancy and neonatal outcomes of assisted reproductive technology (ART) ? Summary answer Decreased live birth rate was observed in female gynecologic cancer patients undergoing ART, particularly in endometrial cancers and cervical cancers. What is known already Gynecologic malignancies comprise approximately 13% of female cancer diagnoses, and oncological treatments such as surgery, chemotherapy, abdominal or pelvic radiotherapy, and hormonotherapy may induce infertility, premature ovarian failure, or early menopause, resulting in a loss of reproductive potential. ART has emerged as an important option for cancer patients undergoing treatment, but the reproductive outcomes of ART among cancer survivors remain poorly understood. Limited research exists regarding the impact of a history of gynecologic cancer on reproductive outcomes of ART. Study design, size, duration 136 women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were retrospectively enrolled in this study. 241 infertile women without any history of cancer were matched to the cancer group. Participants/materials, setting, methods Women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were included. Infertile women without any history of cancer were matched to the cancer group. The primary outcome was the cumulative live birth rate. A propensity score-based patient-matching approach was adopted to ensure comparability between individuals with and without specific cancer type. Main results and the role of chance A total of 136 patients with a history of gynecologic cancer and 241 healthy infertile controls were included in this study. Endometrial cancer constituted 50.70% of the cases and cervical cancer constituted 34.60% of the cases. The cancer group exhibited significant shorter duration of stimulation, lower levels of estradiol, lower number of retrieved oocytes, day-3 embryos, and blastocysts compared to the control group (P &amp;lt; 0.05). The cumulative live birth rate of the gynecologic cancer group was significantly lower than that of the control group (36.10% vs. 60.50%, P &amp;lt; 0.001). Maternal and neonatal complications did not significantly differ between the groups (P &amp;gt; 0.05). The endometrial cancer and cervical cancer groups showed significantly lower cumulative live birth rates than their matched controls (38.60% vs. 64.50%, P = 0.011 and 24.20% vs. 68.60%, P &amp;lt; 0.001, respectively). Limitations, reasons for caution Our study was limited by the retrospective design in nature and small sample size of its patient cohort. In addition, the effect of cancer treatments was not evaluated specifically in the current study due to the limited number of patients and possible inconsistency in surgical operations. Wider implications of the findings Our study provides data support for further exploration of the effects of endometrial cancer, cervical cancer, and other gynecologic cancers on fertility. Comprehensive ovarian function assessment, detailed counseling, individualized fertility guidance, and close follow-up after ART therapy are recommended for patients with gynecologic malignancy history. Trial registration number Not applicable

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

P-334 Hysterosalpingo-Contrast-Sonography: a key step in the female infertility workup?

Abstract Study question The main objective of this study is to estimate the possibility of offering Hystero-Salpingo-Contrast-Sonography (HyCoSy) as a first-line diagnosis test in the female infertility exploration Summary answer HyCoSy represents a key step in decision-making regarding subsequent steps in infertility diagnosis and treatment What is known already In this age of rising rates of infertility; the evaluation of the fallopian tubes and the endometrial cavity in an essential part of the infertility investigation. Traditionally hysterosalpingography has been used to evaluate tubal patency; but it has many disadvantages; laparoscopy and hysteroscopy are at present considered as the gold standard techniques for tubal and endometrial cavity assessment, respectively. Hysterosalpingo- Contrast –Sonography or HyCoSy was introduced over 20 years ago since 1981; it allows to gynecologist to evaluate the fallopian tubes the uterus and the ovaries with only one ultrasound in the office. Study design, size, duration During two years, one hundred and sixty-seven patients with a context of female infertility with normal spermogram were included in our prospective and descriptive study, Participants/materials, setting, methods Our patients underwent: a Hysterosalpingography (HSG), a Hysteroscopy, a Laparoscopy and as part of our study: a Hystero-Salpingo-Contrast-Sonography (HyCoSy), a comparison was made between the tubal and uterine parameters found by the HyCoSy with those of the HSG after comparison with the data shown by the Gold Standard techniques: Laparoscopy and Hysteroscopy, also we evaluated the failure rate, its duration, its tolerability, its cost, its complications, its limitations and the rate of post-HyCoSy pregnancies. Main results and the role of chance The technique was impossible in 4 patients, so a failure rate of 2.4%, the average duration of the procedure was 17+/-1 min (10-30 min), generally well tolerated, pain assessment found an average of 3 on the VAS (2-4), the rate of all minor complications was 8.85% at 5 min and 3.06% at 15 min, no case of allergy to the contrast product was noted. Following the 4 cases of failures the comparison was only possible in 163 patients, after comparing the data with the GOLD STANDARDS For the tubal permeability we noted almost perfect concordances between the three techniques HyCoSy, HSG and laparoscopy, with a concordance of 0.87 between HyCoSy versus laparoscopy (p value at 0.34) and 0.85 between HSG versus laparoscopy (p value at 0.18), For the uterine cavity evaluation the comparison of hydrosonography(step one of our technique) to hysteroscopy finds an almost perfect agreement at 0.88 (p value at 0.71) in contrast to a low agreement at 0.27 between the HSG and the gold standard (p value &amp;lt;0.02). Our technique also allows us to carry out a morphological and functional assessment of the ovaries as well as a study of the peritoneal cavity. Limitations, reasons for caution A disadvantage of this technique is the rate of false results, regardless of the contrast product used. However, it is important to note that these errors also occur when using an HSG, or during a Laparoscopy.A review of the literature allows us to identify the causes and identify solutions. Wider implications of the findings It is important to work more on improving exploration techniques by working to ensure that they are as precise, tolerable, of certain safety and as economical as possible and why not with a therapeutic effect. Trial registration number not applicable

Ambulation after in-utero fetoscopic or open neural tube defect repair: predictors for ambulation at 30 months.

To compare the ambulatory status of a cohort of children who had undergone prenatal repair of an open neural tube defect (ONTD) using one of two different methods (fetoscopic or open hysterotomy) with that of a cohort who had undergone postnatal repair, and to identify the best predictors of ambulation at 30 months of age. This was a retrospective review of a cohort of children who underwent ONTD repair either prenatally (n = 110), by fetoscopic surgery (n = 73) or open hysterotomy surgery (n = 37), or postnatally (n = 51), in a single tertiary hospital between November 2011 and May 2023. The cohort comprised a consecutive sample of cases who had undergone ONTD repair in-utero following Management of Myelomeningocele Study (MOMS) trial criteria and cases who had undergone postnatal repair, meeting the same criteria, which were also followed up after birth at the same institution. Motor function assessment by ultrasound was recorded at referral, 6 weeks after prenatal repair, or after referral in postnatally repaired cases, and at the last ultrasound scan before delivery. Clinical examinations to assess motor function at birth and at 12 months were retrieved from records. Intact motor function was defined as first sacral myotome (S1) motor function. Ambulatory status data at each follow-up visit were collected. The proportion of children who were able to walk independently after 30 months of age was compared between those who had undergone fetoscopic vs open prenatal surgery and between prenatal (by either fetoscopic or open surgery) and postnatal ONTD repair. Logistic regression analyses were performed to identify predictors for independent ambulation. After 30 months, the proportion of infants who were able to walk independently was higher in prenatally vs postnatally repaired cases (51.8% vs 15.7%, P < 0.01), and there was no difference between those with fetoscopic (52.1%) vs open (51.4%) prenatal repair (P = 0.66). In the prenatally repaired group, having intact motor function at 12 months (adjusted odds ratio (aOR), 9.14 (95% CI, 2.64-31.63), P < 0.01) and at birth (aOR, 4.50 (95% CI, 1.21-16.80), P = 0.02) were significant predictors of independent walking at 30 months; an anatomical level of lesion below L2 at referral (aOR, 1.83 (95% CI, 1.30-2.58), P = 0.01) and female gender (aOR, 3.51 (95% CI, 1.43-8.61), P < 0.01) were also predictive for this outcome. Prenatally repaired cases of ONTD have a better chance of being able to walk independently at 30 months than do those who undergo postnatal repair. In patients with prenatally repaired ONTD, ambulatory status at 30 months can be predicted by observing a low lesion level at referral (below L2) and intact motor function postnatally. These results have implications for parental counseling and planning for supportive therapy in pregnancies affected by ONTD. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Efficacy and safety of acupuncture for cognitive impairment in Alzheimer's disease: a systematic review and meta-analysis

ObjectiveTo systematically evaluate the efficacy of acupuncture in the treatment of cognitive impairment in Alzheimer's disease (AD) by meta-analysis, in order to provide evidence-based evidence for the application of acupuncture therapy in the clinical process of AD.MethodsFrom the establishment of the database to December 31, 2022, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), VIP database, WanFang Database, Pubmed, Embase and Cochrane Library Database were systematically searched. To collect published randomized controlled clinical trials (RCTS) of acupuncture in the treatment of cognitive impairment in AD. The subjects in the intervention group were given acupuncture alone or combined with other treatments the same as the control group; the control group received conventional Western medicine treatment. The main outcome indicators of the study were cognitive function assessment of subjects, including: Simple Mental State Examination Scale (MMSE), Assessment of daily Living Ability Scale (ADL), Alzheimer's Disease Cognitive Function Assessment Scale (ADAS-Cog), TCM syndrome score (SDSD), Montreal Cognitive Test (MoCA), Secondary outcome indicators were the occurrence of adverse reactions. Literature screening, data extraction, and quality evaluation of the included literature were performed independently by two researchers, according to bias risk assessment tools recommended in the Cochrane manual. Data were analyzed by RevMan5.3 software. Dichotomous variables were represented by risk ratio (OR) and 95% CI, and continuity variables were represented by mean difference (MD) and 95% CI. For heterogeneity analysis, when P &amp;gt; 0.1 and I2 ≤ 50%, fixed effect model was applied. When P ≤ 0.1 and I2 &amp;gt; 50%, the random effects model is applied.ResultsA total of 1,172 eligible subjects were included in 18 RCTS, including 595 in the intervention group and 577 in the control group. The results of meta-analysis are as follows: acupuncture intervention group improved MMSE [MD = 1.67, 95% CI (0.94, 2.41), P &amp;lt; 0.00001], ADL [MD = −1.18, 95% CI (−3.09, 0.72), P = 0.22], ADAS-Cog [MD = 3.31, 95% CI (5.84, 0.78), P = 0.01], SDSD [MD = 2.40, 95% CI (3.53, 1.26), P &amp;lt; 0.0001], MoCA [MD = 4.80, 95% CI (3.74, 5.86), P = 0.04] were better than the control group. No serious adverse reactions related to acupuncture were observed in the intervention group, and the incidence and severity of adverse reactions were lower than those in the control group, with statistical significance [OR = 0.17, 95% CI (0.04, 0.67), P = 0.01].ConclusionExisting data show that acupuncture therapy has certain advantages in improving cognitive dysfunction and improving self-care ability of patients with Alzheimer's disease. However, due to the small number of RCTS and cases evaluating the efficacy of acupuncture, and the possibility of measurement bias and selectivity bias in included studies, it is still unable to conduct high-intensity demonstration on its effectiveness. Further large-scale, high-quality randomized, double-blind controlled trials are needed to evaluate its efficacy.Systematic Review Registrationhttps://inplasy.com/inplasy-2021-12-0125/, identifier: INPLASY2021120125.

Sargassum horneri extract fermented by Lactiplantibacillus pentosus SH803 mediates adipocyte metabolism in 3T3-L1 preadipocytes by regulating oxidative damage and inflammation

Sargassum horneri (S. horneri), a brown seaweed excessively proliferating along Asian coastlines, are damaging marine ecosystems. Thus, this study aimed to enhance nutritional value of S. horneri through lactic acid bacteria fermentation to increase S. horneri utilization as a functional food supplement, and consequently resolve coastal S. horneri accumulation. S. horneri supplemented fermentation was most effective with Lactiplantibacillus pentosus SH803, thus this product (F-SHWE) was used for further in vitro studies. F-SHWE normalized expressions of oxidative stress related genes NF-κB, p53, BAX, cytochrome C, caspase 9, and caspase 3, while non-fermented S. horneri (SHWE) did not, in a H2O2-induced HT-29 cell model. Moreover, in an LPS-induced HT-29 cell model, F-SHWE repaired expressions of inflammation marker genes ZO1, IL1β, IFNγ more effectively than SHWE. For further functional assessment, F-SHWE was also treated in 3T3-L1 adipocytes. As a result, F-SHWE decreased lipid accumulation, along with gene expression of adipogenesis markers PPARγ, C/EBPα, C/EBPβ, aP2, and Lpl; lipogenesis markers Lep, Akt, SREBP1, Acc, Fas; inflammation markers IFN-γ and NF-κB. Notably, gene expression of C/EBPβ, IFN-γ and NF-κB were suppressed only by F-SHWE, suggesting the enhancing effect of fermentation on obesity-related properties. Compositional analysis attributed the protective effects of F-SHWE to acetate, an organic acid significantly higher in F-SHWE than SHWE. Therefore, F-SHWE is a novel potential anti-obesity agent, providing a strategy to reduce excess S. horneri populations along marine ecosystems.

Functional assessment of differentiated therapeutic approach effectiveness in ovarian cancer treatment: impact on qol and survey results

Background. Ovarian cancer presents a formidable challenge, primarily due to the high prevalence of resistance to platinum drugs, which hampers treatment success. Despite notable strides in chemotherapy regimens, over 40% of patients remain unresponsive to initial treatment. Delving into the underexplored realm of functional assessment regarding treatmentʼs impact on patientsʼ quality of life emerges as pivotal for refining therapeutic outcomes and enhancing their well-being. The absence of standardized evaluation methods and limited data underscore the imperative for further investigation into understanding how different treatment modalities influence patientsʼ quality of life. Leveraging questionnaires such as the EORTC QLQ-C30 and FACT-G proves invaluable in gauging this aspect of healthcare. Integrating the findings of quality of life assessments into clinical practice promises to catalyze the development of optimal therapeutic strategies tailored to enhance the well-being of ovarian cancer patients. Purpose – is to investigate how a tailored therapeutic approach influences the quality of life among patients grappling with platinum-resistant ovarian cancer. Our focus extends to considering the degree of pharmacoresistance alongside the utilization of varied chemotherapy strategies. Materials and methods. The study was conducted at the University Clinic of the Odessa National Medical University spanning from 2014 to 2024. A cohort of 350 patients diagnosed with stage III-IV ovarian adenocarcinoma, who had undergone cytoreductive surgeries, formed the basis of our research. This investigation adhered to the clinical protocol approved by the Ministry of Health of Ukraine. The methodology of our differentiated treatment strategy involved predicting patientsʼ responses to platinum-based therapy, classifying them as platinum-refractory, resistant, or sensitive. Subsequently, patients were categorized into four clinical groups based on the treatment regimens employed. To assess the quality of life, we utilized hierarchical clustering methodology along with the EORTC QLQ-C30 and FACT-G questionnaires. Evaluations were conducted at 6 and 12 months post-treatment completion. Results and discussion. Patiens of different groups had different symptoms and side effects: those who received standard chemotherapy had leukopenia and other side effects; those who received doxorubicin complained of nausea and stomatitis. Patients with comprehensive metabolic support had a smaller number of subjective complaints. During the catamnestic follow-up, we detected changes in parameters of quality of life, which may be associated with treatment of ovarian cancer. The differentiated treatment approach led to improvement of quality of life, decrease in side effects, and better well-being of the patients. These changes remained stable for a long period of time after cessation of active treatment, thus encouraging the use of a similar approach in the future. The results confirm the importance of an individualized treatment with metabolic support for achieving better clinical results and improving quality of life of patients with ovarian cancer. Conclusions. Our study underscores the effectiveness of a differentiated therapeutic approach in managing ovarian cancer, considering both pharmacoresistance levels and diverse chemotherapy strategies, thereby enhancing patientsʼ quality of life. Notably, cytoreductive surgeries and varied chemotherapy regimens yielded distinct side effects and symptoms among patients, contingent upon the treatment modalities applied. Encouragingly, post-active treatment phases witnessed a consistent amelioration in patientsʼ quality of life, underscoring the pivotal role of individualized approaches complemented by metabolic support in fostering superior clinical outcomes.

A systematic literature review on patient-reported outcome domains and measures in nonsurgical efficacy trials related to chronic pain associated with endometriosis: an urgent call to action.

Endometriosis, a common cause for chronic pelvic pain, significantly affects quality of life, fertility, and overall productivity of those affected. Therapeutic options remain limited, and collating evidence on treatment efficacy is complicated. One reason could be the heterogeneity of assessed outcomes in nonsurgical clinical trials, impeding meaningful result comparisons. This systematic literature review examines outcome domains and patient-reported outcome measures (PROMs) used in clinical trials. Through comprehensive search of Embase, MEDLINE, and CENTRAL up until July 2022, we screened 1286 records, of which 191 were included in our analyses. Methodological quality (GRADE criteria), information about publication, patient population, and intervention were assessed, and domains as well as PROMs were extracted and analyzed. In accordance with IMMPACT domain framework, the domain pain was assessed in almost all studies (98.4%), followed by adverse events (73.8%). By contrast, assessment of physical functioning (29.8%), improvement and satisfaction (14.1%), and emotional functioning (6.8%) occurred less frequently. Studies of a better methodological quality tended to use more different domains. Nevertheless, combinations of more than 2 domains were rare, failing to comprehensively capture the bio-psycho-social aspects of endometriosis-associated pain. The PROMs used showed an even broader heterogeneity across all studies. Our findings underscore the large heterogeneity of assessed domains and PROMs in clinical pain-related endometriosis trials. This highlights the urgent need for a standardized approach to both, assessed domains and high-quality PROMs ideally realized through development and implementation of a core outcome set, encompassing the most pivotal domains and PROMs for both, stakeholders and patients.

Data-Driven Smart Assessment for Enterprise Audit Risks Based on Radial Base Function Neural Network and Grey Correlation Analysis

In the era of big data, audit risk assessment is facing increasing business volume. Hence, it is important to develop automatic audit risk assessment methods for enterprises with the assistance of intelligent algorithms. As a consequence, this paper proposes data-driven smart assessment for enterprise audit risks-based radial basis function (RBF) neural networks and grey correlation analysis (GCA). First, evaluation data are collected and analyzed to understand the characteristics and influencing factors of enterprise audit risks. Secondly, RBF interpolation is introduced to establish the network structure for RBF neural networks. Then, GCA is integrated with RBF Interpolation (RBFNN) to formulate the automatic audit risk evaluation method, and the proposal is named RBF and GCA. Such a combined methodology can improve audit risk assessment efficiency. Finally, we make some experiments to evaluate the proposed TBF-GCA on a real-world dataset, and some evaluation indicators are specified based on the actual audit risk situation of the enterprises. The obtained results reveal that RBF–GCA has high accuracy in identity precision and can effectively identify audit risks for enterprises.

Falls in people with mobility limitations: a cross-sectional analysis of a US registry of assistive device users

Purpose of the Article: To (1) summarise the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall. Materials and Methods: This study was a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS. Data are collected during a user’s initial evaluation for a new mobility device. The sample is intentionally general to be inclusive of all mobility device users. The primary variable of interest was a patient-reported fall within the 3 months leading up to their evaluation for a new mobility device. Subpopulation characteristics were stratified by this binary fall variable. Results and Conclusions: This study provides descriptions of PwDs being evaluated for a new mobility device. There were 11,084 PwDs with 31 different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson’s disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction. Implications for rehabilitation 52.2% of persons with disabilities (PwDs) seeking a new wheelchair evaluation reported at least one fall in the last 3 months. Persons with progressively acquired disabilities (i.e., Parkinson’s disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). Earlier interventions for fall prevention including professional wheelchair evaluations may be warranted, but further research is necessary to explore long-term effectiveness.