Category Of Patients Research Articles

INTENSIVE TREATMENT OF SEPTIC SHOCK IN PEDIATRIC PRACTICE

In pediatric practice, septic shock (SS) is a serious, urgent condition with a high incidence and increased risk of death. Intensive therapy in this condition is based on provision of volume-expansion fluid management, prescription of antibiotic medications, and vasopressor support. Urgent care for children is provided in an intensive care unit and includes mandatory determination of the aetiology of SS (by inoculation of blood samples for sterility), provision of venous access and continuous monitoring of vital signs with measurement of lactate levels. The intensity of respiratory support changes according to the following stepwise logic: oxygen therapy – non-invasive ventilation – mechanical ventilation. When providing fluid management to a patient with SS, preference is given to crystalloid solutions. Antibacterial therapy is devised empirically and must be administered within the first hour of ICU admission. If fluid management proves insufficient to ensure stable hemodynamic parameters, vasopressor support is provided by administering inotropic agents, vasodilators and inodilators (norepinephrine, epinephrine, dopamine and dobutamine). Evidence on the effectiveness of corticosteroids in children and adolescents with SS is lacking. Knowledge of the latest algorithms of intensive treatment of SS in pediatric practice will enhance the quality of care and improve the therapeutic prognosis in this category of patients.

Total neoadjuvant therapy for locally advanced rectal cancer: a literature review

The problem of locally advanced rectal cancer (LARC) treatment has not lost its importance and relevance over the past decades, due to the steady increase in the incidence. For a long time, neoadjuvant chemoradiotherapy (nCRT) before total mesorectal excision (TME) and followed systemic chemotherapy was widely accepted as the standard therapy for locally advanced rectal cancer. Although local control is more than satisfactory using this approach, the same cannot be said of distant metastases, which rate reaches 30 % or more and is mainly the cause of death of this category of patients. One of the reasons for this lack of improvement may be the rate of patients who complete the planned adjuvant chemotherapy, which is approximately 50 %. The reasons for that may be postoperative complications, long-term recovery after extensive surgical procedures, etc. Total Neoadjuvant Therapy (TNT) is an emerging approach for the treatment of LARC aimed at improving distant metastasis. This review will outline the main steps in the evolution of LARC treatment and the formation of the stages of total neoadjuvant therapy.

Exploring the relationship between accommodation and intraocular pressure: a systematic literature review and meta-analysis.

To investigate the relationship between accommodation and intraocular pressure (IOP). Systematic literature search and meta-analysis following PRISMA guidelines was conducted on studies analyzing the relationship between accommodation and intraocular pressure. After removal of duplicates, title and abstract screening, full-text analysis was performed to select relevant articles and meta-analysis was then conducted as well. Of the 1357 records identified, 17 met the selection criteria and were included. Overall, all studies showed that accommodation can influence IOP levels and meta-analysis indicated a significant IOP reduction of 1.10 mmHg (95%CI, -1.77; -0.42) following accommodative stimulus in healthy individuals, albeit with high heterogeneity among studies. Differences in IOP changes between emmetropic and progressing myopic individuals were not significant. Controversial results were obtained in patients with glaucoma with significantly lower IOP fluctuations being noted in eyes with previous trabeculectomy; however, the clinical heterogeneity of enrolled patients among studies made it not possible to combine results. Type of accommodative task, extraocular muscle contraction, head and body position all could potentially play a role in the measured IOP changes with, interestingly, near reading on a smartphone suggesting IOP increase. Accommodation has an impact on IOP measurements and, overall, determines IOP decrease in healthy individuals. While such variations might not hold clinical significance for individuals in good health, their impact in patients with glaucoma should be considered. Further studies focused on specific components of such relationship are required to elucidate their individual impact and to define their potential role as non-pharmacological strategies to reduce IOP levels in selected patient categories.

Are there any benefits from prescribing a cardiac cytoprotector to enhance the quality of life in patients with coronary heart disease and chronic heart failure?

Introduction. Type 2 diabetes (T2D) increases the risk of developing cardiovascular diseases, which leads to a high mortality in this category of patients. Issues regarding the prevention of the onset and progression of coronary heart disease (CHD) and chronic heart failure (CHF) in patients with T2D and/or metabolic syndrome (MS) are still not fully understood. The use of metabolic drugs with cardioprotective effects, in particular Mildronate®, is one of the possibilities to improve the effectiveness of combination treatment of CHD and CHF.Aim. To study the effect of Mildronate® on the quality of life (QoL) of patients with CHD and CHF, suffering from T2D and/or MS.Materials and methods. A total of 2.084 patients with co-occurring two (or more) disorders: obesity, type 2 diabetes, angina pectoris, CHT, and CHF were included in the INDICOR observational study conducted in real-life clinical practice settings. Group 1 received therapy with disease-modifying agents prescribed due to CHD and T2D; Group 2 received Mildronate® at a dose of 1000 mg per day in addition to the same therapy. The studied lab test results were assessed at baseline and 42 days of therapy.Results. A 42-day course of therapy in patients receiving Mildronate® at a dose of 1000 mg per day in addition to disease-modifying therapy (DMT) contributed to a percentage increase in the number of patients with CHD, FC (functional class) I angina pectoris (Δ,% + 63%, p < 0.001 ) as compared to the control group with no significant changes (Δ,% + 7%, p > 0.5). A significant increase in the number of patients with FC I CHF was recorded in Group 2 (from 23.5 to 42.1%, Δ,% + 79%) as compared to Group 1, where no significant changes were detected (22.7 to 23.7%, Δ,% + 4%). The QoL in patients with CHF based on data collected using the Minnesota Questionnaire and QoL in patients with CHD based on data collected using the Seattle Questionnaire significantly improved in the groups that received Mildronate® in addition to DMT, as compared with the group of patients who were only on DMT.Conclusion. Results from the Seattle and Minnesota questionnaires showed that the use of Mildronate® as part of combination therapy in patients with CHD and CHF, suffering from T2D and/or MS, contributed to a significant reduction in the frequency of angina attacks and lowering angina FC, CHF FC, and also enhanced the quality of life in this category of patients.

Intensive care unit-acquired infections more common in patients with COVID-19 than with influenza

Intensive care unit-acquired infections are complicating events in critically ill patients. In this study we analyzed the incidence, microbiological patterns, and outcome in patients with COVID-19 versus influenza in the intensive care unit (ICU). We included all adult patients treated with invasive mechanical ventilation due to (1) COVID-19 between January 2020 and March 2022, and (2) influenza between January 2015 and May 2023 at Sahlgrenska University Hospital, Sweden. Of the 480 participants included in the final analysis, 436 had COVID-19. The incidence rates of ICU-acquired infections were 31.6/1000 and 9.9/1000 ICU-days in the COVID-19 and influenza cohorts, respectively. Ventilator-associated lower respiratory tract infections were most common in both groups. In patients with COVID-19, corticosteroid treatment was associated with an increased risk of ICU-acquired infections and with higher 90-day mortality in case of infection. Furthermore, ICU-acquired infection was associated with a prolonged time in the ICU, with more difficult-to-treat gram-negative infections in late versus early ventilator-associated lower respiratory tract infections. Further research is needed to understand how the association between corticosteroid treatment and incidence and outcome of ICU-acquired infections varies across different patient categories.

Awareness of Post-COVID-19 Syndrome Among the General Population of the Kingdom of Saudi Arabia.

Background Post-COVID-19 syndrome (PC19S) is an emerging pathological entity characterized by the development or persistence of a spectrum of symptoms and signs 12 weeks after the original disease. Most COVID-19 patients showa variety of persistent symptoms after recovery that impact their quality of life and professional performance.The prevalence of PC19S is found to be high among many populations hence, the need for knowledge and understanding of its risk factors, symptoms, and the awareness of the population about them to improve the provided health and medical care. Aim This study aims to assess the level of awareness of post-COVID-19 syndromeamong the general population of the Kingdom of Saudi Arabia (KSA). Most studies have focused on hospitalized patients and those with severe disease, but PC19S can exist in other categories of COVID-19 patients; hence, the need for total population coverage. Methodology A cross-sectional study was conducted during the period between June 2023 and August 2023using a structured self-administered online questionnaire. The online questionnaire in addition to the demographic characteristicsconsists of two main parts, one is about the awareness of the Saudi population of symptoms of PC19S and the other is about awareness of its risk factors. Results The majority of the participants (1558;72.4%) showed low awareness of PC19S symptoms while only about one quarter (595; 27.6%) showed satisfactory awareness. Also, the awareness of the participants toward risk factors was low, as 1738 (80.7%) of them showed low awareness. We categorized the results into three levels of awareness to simplify and facilitate interpretation. The findings showed that 1380 individuals (64.09%) had low awareness of PC19S, 536 individuals (24.89%) had moderate awareness, and only 237 individuals (11%) had high awareness. The study reported that the highest awareness toward symptoms was of smell disturbances (1206; 56.0%) and the least was of hair loss (506; 23.5%) while among the risk factors, the highest was found toward old age 1326 (61.6%) and the female sex was the lowest 194 (9.0%). Conclusion The study revealed that the majority of the participants demonstrated low awareness of symptoms and risk factors, which needs a continuous effort to raise the population's awareness of this health-threatening condition.

Prognostic efficiency of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy

BACKGROUND: A feature of the disease course in patients with spastic cerebral palsy is a combination of motor neurological disorders with contractures in extremity joints. Neurosurgical methods are currently the main treatment for correcting the pathological tone of the “spastic hand.” However, the decreased tone does not affect secondary (fixed) contractures; therefore, the effectiveness of this type of treatment is extremely dependent on the accurate selection of a certain category of patients. Presumably, diagnostic blockade of the median nerve can create a reversible model for planned neurosurgical treatment. The inclusion of this technique as a standard for examining a patient with spastic cerebral palsy before invasive tone-lowering treatment can radically promote treatment effectiveness. AIM: This study aimed to assess the prognostic effectiveness of diagnostic blockade as a method of modeling the result of selective neurotomy of the motor branches of the median nerve in patients with cerebral palsy. MATERIALS AND METHODS: A longitudinal prospective study enrolled 39 children (aged 5–18 years) with spastic cerebral palsy. Before neurosurgical treatment, each patient underwent a diagnostic n. medianus under electrical stimulation and ultrasound control. After a diagnostic blockade, only patients who had a good functional and goniometric response were selected for the study, which served as an indication for selective neurotomy of the median nerve, and orthopedic treatment was performed in children with a negative event. Patients referred for neurotomy underwent a standardized examination before treatment during the diagnostic blockade and after neurosurgical treatment. The examination included the assessment of the amplitude of passive and active movements in the joints of the upper extremities, muscle tone, and functional capabilities of the upper extremities and dynamometry. RESULTS: In comparison with the initial data, a significant increase in the amplitude of passive and active hand extension, passive and active abduction of the first finger, and upper limb functional capabilities according to the MACS classification and the Miller scale was determined both after the diagnostic blockade and after selective neurotomy of the motor branches of the median nerve. CONCLUSIONS: Based on the results of the study, the effect of the diagnostic blockade and neurosurgical treatment outcomes are unidirectional, which allows the use of blockade as a method for modeling the possible result in clinically complex cases of spastic hand. The use of diagnostic blockade in clinical practice makes it possible to adequately assess the severity of fixed contractures and reduce the pathological hypertonicity of the target muscles. Diagnostic blockade allows for the collection of sufficient information to make an objective decision about which type of treatment is most preferable for each patient – neurosurgical, orthopedic, or sequential use of both methods.

Sodium glucose transporter 2 inhibitors: Will these drugs benefit non-diabetic veterinary patients with cardiac and kidney diseases?

Sodium glucose transporter type 2 (SGLT2) inhibitors have been introduced into human medicine where their beneficial effects go beyond the expected improvement in blood glucose control. These drugs appear to prevent progression of both cardiovascular and kidney diseases, not only in diabetic but also in non-diabetic human patients. As these drugs have received conditional approval for use in diabetic cats and are being used in other veterinary species, the intriguing question as to whether they will have similar cardioprotective and nephroprotective effects in dogs and cats is being asked. The primary mechanism(s) by which SGLT2 inhibitors are cardio- and nephroprotective remain to be fully characterized. This paper reviews these suggested mechanisms in the context of the pathophysiology of progressive cardiovascular and kidney diseases in dogs and cats with the goal of predicting which categories of non-diabetic veterinary patients these drugs might be of most benefit.

To study the features of vegetative homeostasis in patients with ankylosing spondylitis with anxiety-depressive spectrum disorders

Objective: study of indicators of vegetative homeostasis and psychosocial functioning in patients with ankylosing spondylitis (AS) with anxiety-depressive spectrum disorders (RTDS).Materials and methods: the study involved 112 patients with AS in whom the presence of RTDS was assessed according to the Taylor, Hamilton, Spielberger scales, autonomic disorders by testing according to the methods “Wayne-patient” (VP) and “Wayne-doctor” (BB), heart rate variability (HRV), quality of life (QOL) and clinical and laboratory activity of the disease.Results: the majority of patients with AS showed signs of RTDS, while this category of patients showed signs of autonomic dysfunction, lower indicators of vital activity, the ability to adapt social functioning and the level of mental health. The HRV indicators obtained in this category of patients indicate an imbalance of sympathetic and parasympathetic influences with the dominance of the sympathetic link of regulation, which confirms the correlation analysis.Conclusions: patients with AS with RTDS are characterized by low vital activity, reduced adaptation to social functioning, depletion of antioxidant potential. They are characterized by a deterioration in HRV indicators with a predominance of the sympathetic link of the ANS, low resistance to psychoemotional stress with a predominance of the defensive component in the structure of vegetative security.

COMPUTER PRODUCTION OF FACIAL EPITHETS

BACKGROUND: The issue of rehabilitation of patients with facial defects is extremely acute. In addition to the annual increase in the number of patients with cancer of the maxillofacial region, in recent years the number of people with shrapnel and gunshot wounds to the face has increased as a result of local wars and conflicts. Traditional methods of orthopedic rehabilitation of patients and the manufacture of facial epitheses are quite a complex and lengthy process. In the postoperative period, there is a sharp decrease in the quality of life of this category of patients, a violation of the basic body functions necessary for vital activity and poor social adaptation. Direct prosthetics of the face in the postoperative period was impossible due to the lack of necessary digital modeling technologies and structural materials for additive or subtractive production methods. The production of temporary or permanent facial epitheses using digital technologies is an urgent task that can improve the social and functional living conditions of patients. AIMS: Development of 3D modeling technology for additive manufacturing of facial epithets. METHODS: To achieve this goal, the first task was to develop specialized three-dimensional software for modeling defects in the facial area. The functionality of the program should allow you to virtually simulate the missing parts of the face (ear, eye, nose, orbit). To create a digital platform together with IT specialists, it was decided to use the following programming languages: C++ - Writing the software core, writing UI/UX interaction modules, interacting with the Windows operating system; C# - Complex assembly of the entire project; Python is an automated assembly of virtual library modules; OpenGL HSLS is a shader language for graphical visualization of objects; C is the creation of functions for interacting with shaders that require high speed. RESULTS: A specialized computer program has been developed for 3D modeling of prostheses in patients with defects in the middle zone of the face using combined facial scanning and computed tomography data (Computer program. Apresyan S.V., Stepanov A.G. "A program for 3D modeling of facial epitheses. Registration number (certificate) 2023663490, Registration date: 07/04/2023). Instead of obtaining analog impressions with plaster or silicone material, the developed technology uses a special 3D facial scanner, which greatly eases the suffering of patients. A virtual three-dimensional database of ears, noses, orbits, and zygomatic bones of patients of various ages and gender is integrated into the developed program. This allows the specialist to select the most adaptive part of the face to make up for the defect. Built-in modeling tools allow you to personalize a 3D model of a part of the face, based on the structural features of the maxillofacial region of a person. The finished three-dimensional model of a part of the face can be exported in various formats CONCLUSIONS: The developed 3D program for modeling defects allows to avoid invasive prosthetics approaches, to coordinate the shape of future structures with the patient. The built-in library of structures with a database provides remote manufacturing of the prosthesis without the presence of the patient, in case of a need to replace it. Among the undeniable advantages of the technology, it is important to include the fact that prostheses can be made directly on the day of surgery to remove part of the face, completely restoring lost functions and providing rapid social adaptation.

Fluorescence Diagnostics and Photodynamic Therapy in Cytoreductive Surgical Treatment of Peritoneal Carcinomatosis Patient

Introduction. Peritoneal carcinomatosis, one of the most aggressive forms of metastasis, is recognized as a serious clinical problem. Conventional therapies, including cytoreductive surgery and systemic chemotherapy are limited in their efficacy. New approaches, involving photodynamic therapy and fluorescence diagnostics, obtain great potential for improving the outcomes of complex treatment for this category of patients. Materials and methods. The paper presents a clinical case of a female patient with peritoneal metastases of ovarian cancer complicated by small intestinal obstruction and tumor necrosis. The case demonstrates the results of implementing photodynamic technologies in combination with staged cytoreductive surgical treatment. The first stage of cytoreductive surgical intervention was mainly focused on elimination of life-threatening complications and involved fluorescence diagnostics and photodynamic therapy in order to control the completeness of cytoreduction as well as to assess the nature of suspicious tumor foci and to treat the residual tumor. The second stage of surgical treatment included completing cytoreduction under fluorescence diagnostics, and intraabdominal hyperthermic chemoperfusion. The paper evaluates the results of using fluorescence diagnostics for determining the tumor lesion of the peritoneum in order to objectify the choice of the peritonectomy volume. Results and discussion. The implementation of the described approach resulted in increased efficiency of cytoreductive intervention due to intraoperative diagnostics and targeted antitumor treatment of residual tumor foci. Assessment of the quality of life using the SF-36 survey in the postoperative period demonstrated a significant improvement in both physical and psychological components of health during three months of follow-up. Conclusion. The innovative approach, involving integration of phototheranostics into the cytoreductive surgical treatment of patients with peritoneal carcinomatosis, can potentially improve the accuracy of intraoperative diagnostics of tumor prevalence in the peritoneum and, moreover, enhance the efficiency of cytoreductive interventions. However, further clinical studies are required to fully evaluate the therapeutic potential and prove the efficacy of the proposed treatment.

Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios.

The aim of this consensus was to develop evidence- and expert-based patient-focused recommendations on the appropriateness of intra-articular platelet-rich plasma (PRP) injections in different clinical scenarios of patients with knee osteoarthritis (OA). The RAND/UCLA Appropriateness Method was used by the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), as well as the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories combining best available scientific evidence with the collective judgement of a panel of experts. Scenarios were defined based on first treatment vs first injective treatment vs second injective treatment, age (<50/50-65/66-80/>80), tibiofemoral vs patellofemoral involvement, OA level (Kellgren-Lawrence/KL 0-I/II-III/IV), and joint effusion (dry knee, minor-mild or major effusion). Out of 216 scenarios, in 84 (38.9%) the indication was considered appropriate, in 9 (4.2%) inappropriate and in 123 (56.9%) uncertain. The parameters associated with the highest consensus were PRP use after failed injective treatments (62.5%), followed by PRP after failed conservative treatments and KL 0-III scenarios (58.3%), while the highest uncertainty was found for PRP use as first treatment and KL IV OA (91.7% and 87.5% of uncertain scenarios, respectively). This ESSKA-ICRS consensus established recommendations on the appropriateness or inappropriateness of PRP injections for the treatment of knee OA, providing a useful reference for clinical practice. PRP injections are considered appropriate in patients aged ≤80 years with knee KL 0-III OA grade after failed conservative non-injective or injective treatments, while they are not considered appropriate as first treatment nor in KL IV OA grade. Level I.

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.

Evaluation of masticatory muscle function in the treatment dynamics of patients with myofascial pain syndrome

Relevance. Myofascial pain syndrome (MPS) often progresses to a chronic form that is challenging to treat with established methods. This issue is well known to dentists and frequently leads to frustration despite significant efforts to advance knowledge in the fields of etiopathogenesis, diagnosis, and therapy. Most treatment protocols focus on normalizing physiological parameters, such as restoring masticatory function, achieving stable occlusal relationships, alleviating pain, and enhancing the psychological well-being of these patients. Therefore, the need for non-invasive diagnostics to assess functional activity and monitor the condition of masticatory muscles during treatment is crucial. This study aims to address this need.Materials and methods. The examination and treatment of 64 patients with myofascial pain syndrome were conducted in two stages—clinical and electromyographic. During the clinical examination, tenderness of the masticatory muscles during palpation and the degree of mouth opening were assessed. The electromyographic research was also conducted in two stages. The first stage assessed the average amplitude and total biopotential of the masticatory and temporal muscles on both the right and left sides. The second stage evaluated the symmetry index of the masticatory muscles, as well as torsion and masseter indices. The first group received conventional treatment combined with laser therapy, while the second group received ozone therapy and kinesiology taping in addition to the conventional therapy.Results. In the short-term observations over 14 days, both groups achieved positive results. However, patients undergoing ozone therapy and kinesiology taping showed statistically significant improvements in their parameters by the third day of observation compared to their baseline values.Conclusion. For diagnosing this pathology, it is advisable to incorporate electromyography into the examination protocol to allow non-invasive evaluation of the functional activity of the masticatory muscles. For treating myofascial pain syndrome, minimally invasive methods with anti-inflammatory, analgesic, and muscle relaxant effects are recommended. While all treatment methods yielded favorable results, ozone therapy combined with kinesiology taping effectively eliminated both subjective and objective symptoms in this patient category.

Coronary risk factor profiles according to different age categories in premature coronary artery disease patients who have undergone percutaneous coronary intervention

Many studies have investigated the coronary risk factors (CRFs) among premature coronary artery disease (PCAD) patients. However, reports on the proportion and CRFs of PCAD according to different age cut-offs for PCAD is globally under-reported. This study aimed to determine the proportion of PCAD patients and analyse the significant CRFs according to different age cut-offs among percutaneous coronary intervention (PCI)-treated patients. Patients who underwent PCI between 2007 and 2018 in two cardiology centres were included (n = 29,241) and were grouped into four age cut-off groups that defines PCAD: (A) Males/females: < 45, (B) Males: < 50; Females: < 55, (C) Males: < 55; Females: < 60 and (D) Males: < 55; Females: < 65 years old. The average proportion of PCAD was 28%; 9.2% for group (A), 21.5% for group (B), 38.6% and 41.9% for group (C) and (D), respectively. The top three CRFs of PCAD were LDL-c level, TC level and hypertension (HTN). Malay ethnicity, smoking, obesity, family history of PCAD, TC level and history of MI were the independent predictors of PCAD across all age groups. The proportion of PCAD in Malaysia is higher compared to other studies. The most significant risk factors of PCAD are LDL-c, TC levels and HTN. Early prevention, detection and management of the modifiable risk factors are highly warranted to prevent PCAD.

O-243 Promoting family building strategies - a global call to action

Promoting family building strategies - a global call to action Study question Are there any strategies that can be improved or implemented to promote family building and slow down the global decline in fertility rates? Summary answer Fertility rates are dangerously decreasing worldwide, therefore current strategies need to be improved and new ones should be developed to face present-day challenges. What is known already Although to different extent, almost half of the countries in the world are below replacement level due to generalized fertility decline. Through the years, many of them have put in place policies to promote natality, with variable results depending on the kind of strategy adopted, on socio-cultural factors and on other local peculiarities. Most commonly used policies include prevention and education, plans aimed at allowing couples to have children (ensuring work stability, financial stability, housing stability), benefits and incentives for families and implementation of childcare services and facilities. Assisted Reproduction Techniques (ART) have also been considered a potential tool to boost fertility rates. Main results and role of chance Quite surprisingly, however, even countries who have been adopting high-quality family-friendly policies are experiencing a decline in fertility rates (e.g. Finland) and strategies that have been effective in the past century may be even counterproductive nowadays. In fact, cultural, psychological, biological and cognitive factors should also be taken into consideration (alongside social and economical ones) and it should not be forgotten that attitude towards having children is not stable and may be subject to sudden, unpredictable changes (e.g. war in Ukraine and Middle East). With specific reference to ART, it has been undergoing tremendous scientific and technical development in the last few decades, fueling the unrealistic expectation that it might solve all fertility problems and allow people to have children at any age. Actually, however, ART success rates are relatively low, especially in specific categories of patients. On the other hand, costs of these treatments are particularly high, which also affect accessibility for some of the patients in need. Financial, physical and emotional toll even of a single ART cycle can be burdensome for most couples, who tend to give up after a couple failed attempts. However, data in literature show that in specific categories of patients, repetition of up to 5-6 cycle can importantly increase success rates. Based on this assumption, the scientific community worldwide should start considering an ART treatment not as a single cycle, but a succession of more cycles, as deemed appropriate based on the patients’ characteristics. Number of cycles offered, planning and pricing should of course be adjusted accordingly. This paradigm shift might be difficult to instill in both professionals’ and patients’ minds, but it might turn out to be tremendously useful for ones as well as the others. Limitation, reasons for caution Although a global intervention in favour of family building is required, individual countries should design multidisciplinary strategies taking into account local and regional peculiarities. The above mentioned paradigm shift might initially encounter resistance from couples and professionals until its benefits are clearly documented. Wider implications of the findings Data show that it is essential that policymakers, healthcare professionals and other institutional stakeholders team up to raise awareness on infertility and to develop long term plans aimed at inverting this insidious trend that is already affecting all society and is destined to get even worse if not immediately tackled in a determined and cooperative way.

P-053 Comparative analysis between microfluidic sperm sorting and Swim-up technique to select spermatozoa with better characteristics in hyper viscous samples

Abstract Study question What is the best technique to select spermatozoa in hyper viscous semen samples? Summary answer Microfluidics is the best technique that allows to select spermatozoa with better seminal characteristics and hyperactivated motility, and less sperm DNA fragmentation. What is known already Density gradient centrifugation and Swim-up (SU) are the two traditional selection methods used during assisted reproduction techniques (ART) to collect the highly motile sperm fraction. Many studies reported that centrifugation increase sperm DNA fragmentation and oxidative status which could affect reproductive outcomes. To overcome the limitations of centrifugation, an alternative approach by using microfluidic-based devices was recently designed. In microfluidic protocol, sample is applied to the device’s inlet port, connected to a lower chamber. This chamber consists of a microporous filter, where the most motile spermatozoa migrate upward through the filter. Study design, size, duration An observational study was conducted on 29 semen samples from patients undergoing routine semen analysis for couple infertility in the Andrology Laboratory of Careggi University Hospital of Florence from January 2023 to January 2024. In these samples we compare two different methods for sperm selection: indirect SU technique and microfluidic devices (MSS). Participants/materials, setting, methods We evaluated seminal parameters (sperm progressive and total motility, viability, and concentration), sperm kinematic parameters by Computer-Assisted Sperm Analysis (C.A.S.A. system), sperm DNA fragmentation by TUNEL/PI assay and sperm oxidative status by CellROX® Orange (which we have recently shown to identify a fraction of viable oxidized spermatozoa with better characteristics (Traini G., et al. 2022)) in 29 normozoospermic and 18 hyper viscous semen samples selected by SU and MSS. Main results and the role of chance In normozoospermic samples, sperm selection with both indirect SU technique and microfluidic devices, ameliorated sperm characteristics compared to not selected samples. Spermatozoa selected by MSS showed statistically significant higher progressive and total motility, viability and concentration compared to those selected by indirect SU. Moreover, an increase in most of kinematic semen parameters (like VAP, VCL and VSL) and hyperactivated motility was observed in MSS selected samples. Also, sperm DNA fragmentation was significantly reduced after MSS selection compared to indirect SU. We evaluated the percentage of viable oxidized spermatozoa by using CellROX® Orange. A significant increase of the percentage of CellROX® Orange positive spermatozoa was observed in most of MSS selected samples. In all 18 hyper viscous samples, the results obtained in normozoospermic samples were confirmed. Indeed, an overall improvement of sperm progressive and total motility, viability and concentration together with an increase in most of kinematic semen parameters and in hyperactivated motility were evidenced in MSS selected spermatozoa respect to those selected by indirect SU. Again, a significant decrease of sperm DNA fragmentation and an increase of the percentage of CellROX® Orange positive spermatozoa, were observed after MSS selection. Limitations, reasons for caution The number of semen samples included in the study is not very elevated. Results obtained in hyper viscous semen samples should be confirmed in a greater number of samples. Wider implications of the findings Our data indicate that MSS selects the sperm fraction with better characteristics and less DNA fragmentation. These results suggest that MSS could improve ART outcomes, particularly for specific categories of patients, including hyper viscous semen samples, for which the selection by SU does not always guarantee good yields. Trial registration number not applicable

P-681 LH priming before ovarian stimulation in POSEIDON-4 patients: effects on oocyte recovery and post ICSI/IVF pregnancy rates

Abstract Study question Can a seven-day long LH priming treatment preceding ovarian stimulation (OS) improve follicular responses, oocyte yields and ICSI/IVF outcomes of POSEIDON-4 patients? Summary answer A seven-day long LH priming can substantially increase pregnancy rates through specific benefits in different subgroups of POSEIDON-4 patients. What is known already The combination of advanced maternal age (AMA) with diminished ovarian reserve (DOR) has become one of the most relevant and complex topics in the field of reproductive medicine. AMA/DOR patients appear to be refractory to increased gonadotropin dose and may benefit from strategies specifically capable of increasing the population of FSH-responsive small follicles before the onset of ovarian stimulation (OS). Androgen mediated LH intra-ovarian activity stimulates early follicular development. Pre-treatment with LH has been suggested to improve ICSI/IVF outcomes in normal responders but has not been assessed in AMA/DOR patients, despite the prevalence and relevance of this population. Study design, size, duration Retrospective cohort study from 2022 to 2023, including 235 POSEIDON-4 patients stimulated with FSH+LH in a flexible antagonist protocol with oestradiol pre-treatment (n = 129) or with the same stimulatory treatment preceded by a seven-day LH priming (150 IU/day) combined with GnRH agonist downregulation (n = 106). Follicular responses, oocyte recovery and ICSI/IVF outcomes were compared between treatment-groups in overall POSEIDON-4 patients and in a subgroup of patients with AMH &amp;lt;0.75 ng/mL (n = 77/Control, n = 59/LH priming). Participants/materials, setting, methods All participants were POSEIDON-4 caucasian patients aged 35 to 44 years undergoing a single homologous ICSI/IVF cycle in our clinic. Outcomes in the form of percentages were compared with the Fisher’s exact test, whereas differences in continuous variables were assessed with the Wilcoxon sum rank test. A multivariate analysis was performed to control for the interference of unequal variations in maternal age, AMH, insemination method and presence of male subfertility. Main results and the role of chance Patients in different treatment groups did not differ (p &amp;gt; 0.05) regarding maternal age (39.2±2.5 vs. 39.3±2.5), basal FSH serum concentrations (11.0±4.6 vs. 10.1±4.3) and antral follicle count (6.3±3.0 vs. 6.4±3.3, for patients stimulated with and without LH priming, respectively), but patients treated with LH priming presented slightly lower AMH serum levels (0.56±0.3 vs. 0.63±0.3; p = 0.05). Nevertheless, patients treated with LH priming achieved a twice higher clinical pregnancy rate per cycle (19.8% vs. 9.3%; p = 0.02), accompanied by a 40% reduction in cycle cancellation (32.1% vs. 45.0%; p = 0.03) and increased production of viable embryos (transferred fresh + frozen) per cycle (1.22±1.09 vs. 0.94±1.07; p = 0.02) and per oocyte inseminated (48.3% vs. 38.5%; p = 0.01), but did not differ regarding follicular outputs or oocyte yield. The multivariate analysis indicated a robust association between LH priming and pregnancy achievement, independently of potential confounding variables (OR = 2.52; p = 0.02). A two-fold increase in pregnancy achievement was also observed in severely restricted POSEIDON 4 patients (AMH &amp;lt;0.75 ng/mL) subjected to the LH priming (p = 0.05), which in this case was accompanied by higher oocyte yields per cycle (3.3±2.8 vs. 2.2±2.0; p = 0.04) and per pick (3.9±2.6 vs. 2.3±2.0; p &amp;lt; 0.01). Limitations, reasons for caution This study is limited by its retrospective nature and the data may be potentially influenced by the use of different downregulation strategies in the treatment-groups, even if the literature indicates equivalent performance for these strategies in the population under analysis. Wider implications of the findings The present data strongly suggest that a seven-day LH priming preceding OS can markedly improve ICSI/IVF outcomes of POSEIDON-4 patients, while indicating that this strategy benefits in different ways subgroups of this increasingly prevalent patient category. These findings thus represent new valuable parameters for the progress of ovarian stimulation. Trial registration number NA

Benign metastasizing uterine leiomyoma. A case series. Systematic review

Uterine leiomyoma (ULM) is one of the most common gynecological pathologies in women of reproductive age. The prevalence of this pathology varies across different age groups, with approximately 10% in the 20–35 age range, increasing to 40–45% after the age of 35. ULM metastasis is an extremely rare phenomenon, with only 411 cases reported in the literature, including our 3 observations. Several definitions exist, with the most common being benign metastasizing ULM, found in both domestic and foreign literature. Each observation is crucial, as there are currently no clear treatment algorithms for this patient category. The study presents 3 cases of successful treatment of patients with metastatic ULM in two institutions. A systematic review of domestic and foreign literature on this pathology is conducted. Twenty-two clinical observations in the Russian Federation and neighboring countries are analyzed. Analysis of foreign literature revealed records of 386 clinical observations of benign metastasizing ULM. Benign metastasizing ULM of the uterus represents a rare nosological form. Systematization is advisable for determining the optimal treatment and observation tactics.

FEATURES OF PHYSICAL THERAPY FOR SCOLIOSIS

Introduction. The article analyzes contemporary domestic and foreign publications regarding the effectiveness of physical therapy (PT) in scoliosis treatment. Physical therapy is one of the key methods in treating scoliosis, a condition characterized by abnormal curvature of the spine. Scoliosis is a common problem that can occur at any age, but it is more frequently detected in children and adolescents. However, despite its prevalence, many people have a limited understanding of the effectiveness and importance of PT in treating this condition. Therefore, highlighting the importance of PT in scoliosis treatment, including its role in improving the patient's condition, preventing the progression of spinal curvature, and enhancing the quality of life of patients, is relevant. The aim of the study. The aim of the study is to investigate the effectiveness of physical therapy in scoliosis to determine optimal approaches to treating this condition and improving the quality of life of patients. Conclusions: Scoliosis is a common problem, especially among children and adolescents, and its treatment is an important medical issue. Since scoliosis can lead to serious health consequences, including pain, spinal deformity, and functional limitations, the search for effective treatment methods is crucial to ensure optimal outcomes for patients. Physical therapy is one of the potentially effective methods for treating scoliosis, as it aims to strengthen the back muscles, improve flexibility, and maintain proper spinal alignment. However, despite several studies confirming the effectiveness of PT, further scientific research is needed to establish its optimal parameters, such as types of exercises, duration, and intensity of training loads, as well as the impact of PT on different categories of patients with various degrees and forms of scoliosis.