Medicine Center Research Articles

Analysis of prenatal diagnosis and pregnancy outcomes for rare autosomal trisomies detected by non-invasive prenatal testing in 33,079 cases

BackgroundNon-invasive prenatal testing is widely used for screening common fetal aneuploidy disorders such as trisomy 21, trisomy 18, and trisomy 13. However, its ability to detect rare autosomal trisomies has introduced a new layer of complexity and clinical uncertainty.MethodsA retrospective analysis was conducted on the prenatal diagnostic results and pregnancy outcomes of cases identified as high-risk for rare autosomal trisomies through non-invasive prenatal testing at the reproductive medicine center, Renmin hospital, Hubei university of medicine, from 2015 to 2023.Results66 cases identified as high-risk for rare autosomeal trisomies, yielding a detection rate of 0.20% (66/33,079). 7 declined amniocentesis, while the others underwent the procedure. Prenatal diagnostic procedures did not confirm the presence of the corresponding rare autosomal trisomy in any of these cases. Among the 66 cases of rare autosomal trisomies (RATs), 5 cases were lost to follow-up, and 1 case underwent termination of pregnancy (TOP) for personal reasons, leaving 60 cases with valid pregnancy outcomes. Of these 60 valid outcomes, 50 (83.33%) resulted in full-term births, while 10 (16.67%) experienced adverse pregnancy outcomes.ConclusionPrenatal diagnosis for high-risk rare autosomal trisomies typically reveals a normal karyotype with no detectable chromosomal abnormalities, and most cases can achieve full-term pregnancy outcomes. However, adverse pregnancy outcomes such as preterm birth, fetal demise, placental abnormalities, and intrauterine growth restriction are common and should be given clinical attention and consideration.

Electrocardiographic signs of cardiac ischemia at rest and during exercise in patients with COPD traveling to 3,100 m: data from a randomized trial of acetazolamide

IntroductionIn patients with chronic obstructive pulmonary disease (COPD), oxygen delivery to the heart may be impaired during travel at altitude. We assessed electrocardiogram (ECG)-derived signs of cardiac ischemia and the effects of preventive acetazolamide therapy in COPD patients traveling to high altitudes.MethodsPatients with COPD [Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grades 2–3] and a predicted forced expiratory volume in 1 s (FEV1) of 66 ± 11% (mean ± SD), aged 57 ± 8 years, and living <1,000 m were included in this analysis of secondary outcomes from a randomized placebo-controlled double-blind trial (www.clinicaltrials.gov, NCT03156231). Exercise electrocardiograms were recorded at the National Center of Internal Medicine and Cardiology, Bishkek (760 m) and on the day of arrival at the Tuja Ashu high-altitude clinic (3,100 m), Kyrgyzstan. Acetazolamide (375 mg/day) or placebo was administered 24 h before the ascent and during the stay at 3,100 m. The incidence of a post-exercise ST elevation (STE) ≥0.3 mm in aVR (J + 80 ms) was the main outcome.ResultsAt 760 m, 3 of 49 (6%) patients randomized to placebo and 3 of 50 (6%) randomized to acetazolamide showed a post-exercise STE. At 3,100 m under placebo, two (4%) new STEs developed and one (2%) disappeared compared to 760 m (P = 0.564, McNemar’s test). At 3,100 m under acetazolamide, one (2%) new STE developed and two (4%) disappeared compared to 760 m (P = 0.564). No treatment effect was detected (P = 0.242, Fisher’s exact test). The mean difference (95% CI) in STE between post-peak exercise between 3,100 m and 760 m was 0.22 mm (0.06 to 0.39) and 0.09 mm (−0.06 to 0.24) under placebo and acetazolamide therapy [treatment effect, −0.13 mm (−0.35 to 0.08, P = 0.230)], respectively.ConclusionsIn lowlanders with moderate to severe COPD ascending to 3,100 m, no ECG-derived signs of cardiac ischemia emerged neither at rest nor post-exercise and this was not modified by preventive acetazolamide therapy.

ВЛИЯНИЕ КОРМОВОЙ ДОБАВКИ С СОРБЦИОННЫМИ СВОЙСТВАМИ И ФИТОКОМПОНЕНТОМ НА РАЗВИТИЕ ВНУТРЕННИХ ОРГАНОВ ПЕРЕПЕЛОВ

The purpose of research is to study the effectiveness and safety of using active carbon feed additive (ACFA) when raising young quails. The object of the study is Texas white quail. Objectives of the study: to determine the effect of the studied feed additive on the main zootechnical indicators and the development of internal organs of quails. The studies were carried out according to standard methods for production studies of poultry feeding. We studied young Texas white quail, which were raised for meat, in the vivarium of the Krasnodar Scientific Center for Animal Science and Veterinary Medicine. The duration of the experiment was 42 days. The first group (control) received complete feed produced by Yuzhnaya Korona LLC without additives. The second received ACFA in a percentage of 0.1 % by weight of the feed during the entire experimental period, the third received the first 28 days of cultivation. Based on the results of the studies, it was revealed that the live weight of quails increased relative to the control by 6.9 (P < 0.001) and 4.5 % (P < 0.01); safety – by 2.5 and 1.3 % according to the sequence of groups. Feed costs per unit of production were reduced by 6.5 and 3.9 %, respectively. The internal organs of all groups of birds developed within normal limits; significant differences were noted in the length of the cecum in the second group of the experiment – this indicator decreased by 17.2 % (P < 0.01). In the third group, there was a downward trend of 1.6 %. Intestinal length decreased significantly by 15.0 % (P < 0.001) and 17.4 % (P < 0.01), respectively. The data obtained during the experiment indicate that the use of ACFA with sorption properties and a phytocomponent has a positive effect on the main zootechnical indicators. The use of the studied additive did not have a negative effect on the development of internal organs of quails.

Improving Post-Surgical Management of Rhinoplasty: A Comprehensive Review of Existing Literature.

Introduction Rhinoseptoplasty addresses both nasal deformities and functional issues. Effective postoperative care is essential for optimal recovery, as complications such as swelling, bruising, and pain can adversely affect healing and patient satisfaction. Proper postoperative care emphasizes the significance of comprehensive management strategies. Materials and Methods A systematic literature review was performed utilizing the PubMed and Cochrane databases to identify articles published between 2014 and 2024 that specifically addressed postoperative care following rhinoplasty. Of 191 articles, 22 met the pre-established inclusion criteria. We assessed the quality of evidence according to the Oxford Centre for Evidence-Based Medicine's Levels of Evidence. Results Seven key studies were analyzed, exploring a range of post-operative care interventions, including administering corticosteroids, elevating the head during and after the procedure, using alternative therapeutic approaches, and applying cooling techniques. Discussion Post-surgical recovery after rhinoplasty involves managing pain, swelling, and bruising, among other complications. Educating patients about expected outcomes and the healing process helps alleviate their anxiety and uncertainty. Corticosteroids have proven effective in controlling swelling and bruising. Antibiotics are generally not recommended. Silicone septal splints provide support, particularly when stabilization of an injured mucous membrane or septal cartilage is required; however, nasal packing is not recommended. Adhesive strips can help reduce edema in the dorsal and supra-tip areas. Positioning patients in a 20° reverse Trendelenburg position during surgery, followed by maintaining the head elevated at a 90° angle postoperatively, has significantly reduced edema and ecchymosis. Using a cannula for drainage and cooling techniques has been shown to reduce postoperative morbidity effectively. Conclusions Rhinoplasty is a common facial plastic surgery, yet there is no consensus on optimal post-operative care. Key strategies include silicone splints, subperiosteal drainage, nasal taping, cooling, corticosteroids, and intra and postoperative head elevation. However, further systematic trials are necessary to refine these strategies and improve patient outcomes.

The complex lived experience of women with infertility in Ethiopia: An interpretative phenomenologic analysis.

To explore the lived experience of women living with infertility in Ethiopia. We used interpretative phenomenologic analysis with open-ended semi-structured questions, focusing on what living with infertility looks like and what that means to the women. Participants included women who had experienced infertility and were following treatment at St. Paul's Hospital Center for Fertility & Reproductive Medicine in Addis Ababa, Ethiopia. We purposefully recruited 13 women living with infertility and used NVivo version 12 software for data analysis. The study generated six themes: (1) the reason for wanting a child, (2) the financial sacrifice of accessing treatment, (3) infertility and marriage, (4) estrangement and ostracization in social life, (5) psychological despair and support, and (6) faith and resilience. Further analysis identified the superordinate themes: the meaning of a child; lineage and continuity of life; togetherness; marital discord; reduced social participation; being left out of the world, psychological suffering; support and relationship with healthcare providers; helplessness, acceptance, and hope. A child in the Ethiopian context has significant meaning for women and the community. Being unable to accomplish motherhood brings numerous challenges. The far-reaching consequences of infertility substantially affect women's psychological, financial, sociocultural, and spiritual lives. However, despite the difficult journey of infertility, women develop coping mechanisms and resilience. Professional psychosocial support is necessary to alleviate the consequences of infertility, yet access to and utilization of these services are inadequate. Infertility needs to receive better attention in the Ethiopian healthcare system as it has significant implications for couples' lives.

Prenatal diagnosis of vasa praevia in routine clinical practice: Prevention of stillbirths and impact on perinatal outcomes.

Vasa praevia (VP) is defined as the presence of unsupported fetal blood vessels in close proximity of the internal os of the cervix. There is robust evidence from observational cohort studies and meta-analysis that prenatal diagnosis of VP is associated with excellent perinatal outcomes. We have previously proposed a two-stage strategy for prenatal diagnosis that can be implemented in routine clinical practice leading to effective prenatal diagnosis and prevention of fetal and neonatal mortality and morbidity. To demonstrate the feasibility and effectiveness of a two-stage screening strategy for prenatal diagnosis of VP in routine clinical practice and to estimate the potential impact on prevention of stillbirths and perinatal deaths. This was an observational retrospective cohort study carried out at the Medway Fetal and Maternal Medicine Centre between January 2010 and June 2022. We examined the feasibility and effectiveness of this policy in terms of identification of a high-risk cohort and prenatal diagnosis of VP through routine 11-13 and 20-22weeks' ultrasound assessments based on the two-stage protocol. We also examined the impact on maternal, neonatal and perinatal outcomes in pregnancies with a confirmed diagnosis of VP. Absolute risks (95%) were calculated based on rates of events in the two groups. Logistic regression analysis was used to estimate independent contribution from maternal and pregnancy characteristics in prediction of VP. The study population of 53,648 singleton pregnancies included 45 pregnancies with VP (0.83 per 1,000 pregnancies or an incidence of 1 in 1,192 pregnancies). VP was suspected in 56 cases and were resolved in 11 cases (19.6%), thus leaving 45 pregnancies with a confirmed diagnosis of VP. The main findings that predicted VP included a low-lying placenta at 20-22weeks', placenta praevia, bilobed placenta and a velamentous cord insertion. In our study population, pregnancies with a prenatal diagnosis of VP had a livebirth rate of 100% and an intact perinatal survival rate of 97.8%. Our study demonstrates that effective prenatal diagnosis of pregnancies with VP can be achieved in routine clinical practice with good perinatal outcomes.

Correlations among hope, fertility quality of life and negative emotions for couples undergoing their first in vitro fertilization–embryo transfer: a cross-sectional analysis

BackgroundThe global incidence of infertility is increasing, and infertility has become an important medical and social issue. With the widespread application of in vitro fertilization-embryo transfer (IVF-ET) technology, the mental health problems of patients undergoing this treatment have gradually attracted widespread attention. The purpose of this study was to explore the relationships among the level of hope, the fertility quality of life and negative emotions of patients who underwent IVF-ET treatment for the first time to provide a scientific basis for subsequent psychological support interventions.MethodsThis study was a cross-sectional survey conducted at the Reproductive Medicine Center of Renmin Hospital of Wuhan University. From February 2023 to October 2023, 1425 patients who received IVF-ET treatment for the first time participated in the questionnaire survey. The survey content included the General Information Questionnaire, the Fertility Quality of Life (FertiQoL) Questionnaire, and the Herth Hope Index (HHI). Pearson correlation analysis was used to examine the relationships among the level of hope, fertility quality of life, and negative emotions.ResultsThe survey included 805 women and 620 men representing 603 couples. The level of hope in patients undergoing IVF-ET treatment for the first time was positively correlated with fertility quality of life (r = 0.247, P < 0.01), and the level of hope was negatively correlated with negative emotions (stress: r = − 0.135, P < 0.01; anxiety: r = − 0.105, P < 0.01; depression: r = − 0.189, P < 0.01). Fertility quality of life was negatively correlated with negative emotions (stress: r = − 0.609, P < 0.01; anxiety: r = − 0.533, P < 0.01; depression: r = − 0.591, P < 0.01). Among couples undergoing IVF-ET treatment for the first time, the husband’s level of hope (r = 0.131, P < 0.01), fertility quality of life (r = 0.372, P < 0.01), and negative emotions (stress: r = 0.181, P < 0.01; anxiety: r = 0.163, P < 0.01; depression: r = 0.210, P < 0.01) were positively correlated with those of his wife.ConclusionsIn patients undergoing their first IVF-ET treatment, there is a significant correlation among hope, fertility quality of life, and negative emotions. Moreover, within couples, the levels of hope, fertility quality of life, and negative emotions of husbands and wives mutually influence each other. Enhancing the level of hope in this population is conducive to alleviating negative emotions and improving their fertility quality of life. The mutual influence of spouses should not be overlooked in clinical practice, and psychological support for both partners should be emphasized.

Effects of Physical Exercise on Neurofilament Light Chain and Glial Fibrillary Acidic Protein Level in Patients with Multiple Sclerosis: A Systematic Review and Bayesian Network Meta-Analysis

Background: The prognosis of people with multiple sclerosis (MS) has improved substantially in recent decades due to advances in diagnosis and treatment. Due to the unpredictable course and heterogenous treatment response in MS, there is a clear need for biomarkers that reflect disease activity in the clinical follow-up of these patients. We conducted a systematic review with Bayesian network meta-analysis with the aim of analyzing the effects of physical exercise on neurofilaments (NfL) and glial fibrillary acidic protein (GFAP) levels in patients with MS. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, starting with a PICO (patient/population, intervention, comparison, and outcome) question: what are the clinical effects of physical exercise (with independence of the type) on NfL and/or GFAP levels in patients with MS compared with other interventions or no intervention whatsoever? A systematically comprehensive literature search was conducted from January to March 2024 to identify original studies that answered the PICO question, using the main data sources. The quality of the studies included was assessed using the Quality Index of Downs &amp; Black. For studies included in the systematic review that followed a randomized controlled trial (RCT) design, the methodological quality of each paper was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Risk of bias was also explored by two independent reviewers. Finally, all articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. For continuous outcome measures with enough comparisons and a methodological quality greater than or equal to good according to the PEDro scale, a Bayesian network meta-analysis (NMA) was applied. The statistical analyses were performed in R (version 4.1.3, R Core Team 2023) using the “BUGSnet” and “gemtc” packages. Bayesian NMA can be used to obtain a posterior probability distribution of all the relative treatment effects, which allows us to quantify the uncertainty of parameter estimates and to rank all the treatments in the network. Results: Eight studies were included in this systematic review and six articles in the NMA, and they were appraised for quality. The characteristics of the included studies, types of training and described protocols, methodological quality, risk of bias, and clinical effects on the studied biomarkers were outlined. Qualitative synthesis, effects of different exercise modalities in NfL with the Bayesian NMA, selection of the final model and model assessment, and ranking of interventions are also shown. Conclusions: Our findings indicated that moderate-intensity exercise is more likely to reduce NfL concentration compared to high-intensity exercise, and, in turn, high-intensity exercise is more likely to reduce NfL concentration than low-intensity exercise. However, the effects of high-intensity exercise on GFAP levels were inconclusive.

Out of pocket costs and financial hardships among breast cancer patients in Egypt: a pilot study

ABSTRACT Breast cancer shows high global prevalence with high mortality rates and hence high financial burden specifically in low and middle-income countries (LMICs). This pilot study took place in Egypt to quantify the out-of-pocket expenses and analyze the financial burden faced by breast cancer patients under the governmental reimbursement system. The study took place at the Center of Clinical Oncology and Nuclear Medicine, Cairo University. We collected data on out-of-pocket costs, subjective financial burden and disease coping strategies through an interviewer-administered questionnaire. Then, we used descriptive statistics and Pearson correlations for analysis and the results were presented in Egyptian pound (EGP) and dollars (USD). The study included 60 breast cancer patients from Cairo University's oncology center, aged 27–75 years. The average direct medical costs, including medications, diagnostics, and medical care outside the center was 1096 EGP (35.47 USD) per month. Non-medical costs, such as food and travel, cost an average of 381 EGP (12.33 USD) per month and indirect costs of 1160 EGP (37.47 USD) per month. The total out of pocket costs of breast cancer showed an average of 2637 EGP (85.34 USD) per month. Around 32% of patients experienced catastrophic financial burden. Coping strategies included medication adjustments and lifestyle changes due to financial constraints. There was moderate positive correlation (r = 0.7) between the perceived financial burden and the number of adopted strategies. Breast cancer patients face financial challenges that may lead to impoverishment due to the excessive direct and indirect expenses associated with treating the disease. Therefore, we recommend disease screening, early detection, and facilitated access to subsidized healthcare.

Comparing myocardial perfusion scan findings in patients with and without Covid-19

BackgroundCovid-19 is a pandemic viral disease that directly or indirectly affects multiple organ systems, including the cardiovascular system. SPECT GATED MPI is a non-invasive nuclear imaging modality used to assess myocardial perfusion and function. The aim of this study was to evaluate the effect of Covid-19 pandemic on myocardial perfusion imaging in ischemic heart disease.MethodsThis was a cross-sectional (descriptive-analytical) study of 750 patients requiring myocardial perfusion imaging (MPI) who were referred to the nuclear medicine center of Kowsar Hospital, a teaching hospital in Sanandaj, the center of Kurdistan Province in north-western Iran. Data collection was performed during the Covid-19 pandemic, between 6 April 2020 and 21 March 2021. Data analysis was performed in SPSS using independent samples t-test and chi-squared.ResultsA total of 750 patients, including 328 (43.7%) Covid-19 positive and 422 (56.3%) Covid-19 negative, were included in the analysis. Although Covid-19 infected obese patients had a significantly higher rate of abnormal MPI (P < 0.0001), no significant difference in abnormal MPI was observed between the two groups (p = 0.551).ConclusionThe lack of a significant difference in the incidence of abnormal MPI between the two groups suggests that there may be Covid-19 patients with potentially abnormal MPI who have gone undetected. In addition, Covid-19 patients with pleural chest pain, myalgia or dyspnea may have been misdiagnosed as having chest pain secondary to heart disease.

ИСПОЛЬЗОВАНИЕ ДОБАВКИ НА ОСНОВЕ ПЕРЕРАБОТАННОЙ ПИВНОЙ ДРОБИНЫ В КОРМЛЕНИИ СЕЛЬСКОХОЗЯЙСТВЕННОЙ ПТИЦЫ

Brewer's grain is a by-product of beer production, has a high biological potential due to dietary fiber and beta-glucan, which help animals to modulate the balance and activity of microbial populations in the intestine, so its use in combination with a mineral complex can increase the productivity of poultry. The paper discusses the effect of feeding complex feed additives based on processed brewer's grains as part of complete feed on the productivity, safety and control slaughter of quail-laying quails of the Texas white breed. The experiment was carried out in the vivarium of the Federal State Budgetary Scientific Institution Krasnodar Scientific Center for Animal Science and Veterinary Medicine on Texas white laying quails from 42 days of age to the 222nd day of rearing. The content of the bird was cellular in one tier. The conditions of detention corresponded to generally accepted zootechnical standards, the groups were formed by the method of pairs-analogues of 20 animals each. The first group was the control group and received a balanced complete feed (CF). For feeding the second group, CF was used with the addition of 1.5 % of the developed complex feed additive № 1 by weight of the feed. The third group received a complete mixed feed with the addition of 1.5 % complex additive № 2 by weight of the feed. It has been established that the use of the studied additives has a positive effect on the egg production of birds, increasing the gross collection of eggs by 3.17 and 3.82 % in the groups that received the studied additives. In the experimental groups, the slaughter qualities of laying quails improved. Thus, the weight of the gutted carcass increased by 8.30 % (P≤0.01) in the second group, and by 9.08 % (P≤0.001) in the third experimental group in relation to the control one. The use of complex additives based on processed brewer's grains contributed to an increase in production profitability by 3.22 and 3.24 % and additional profit per head by 11.9 and 12.6 % in the second and third groups, respectively, compared with the control group.

Transformation of Traditional Oriental Medicine in the Modern World

The article examines one of the most important modern issues concerning the development of traditional medicines: their transformation into TMS — traditional medical systems. It is known that in some Asian countries (China, India, Vietnam, etc.) such TMS legitimately exist since the middle or end of the XX century; they are institutionalized and structured similarly to the conventional/biomedical healthcare system. TMS operates there in parallel with and in close interaction with the main medical system, with biomedicine as the primary educational basis for specialist training. Healthcare in these countries includes in its unified system a parallel with a second ministry or department, a complex structure of university training of specialists, specialized hospitals and clinics of various kinds — either separate or organized on the basis of complementarity, different pharmaceutical bases. At the same time, TMS, primarily from India and China, have long since spread to many other countries of the world and, as complementary or alternative forms of medicine, strive to form global forms (for example, the concept of “global Ayurveda” is already being used). The article first of all considers the specifics of the terminological apparatus associated with non-conventional medicine. Further the author analyzes the current situation of TM and TMS as it has developed to date in foreign countries, and compares it with what has been happening in the last three decades in the Russian Federation, primarily in the Republic of Buryatia and the Zabaykalsky Krai. Traditional medicine was initially introduced there with the practice of Buddhist lamas and with written sources from Tibet through Mongolia; later the Buryats on the basis of translated sources developed a relatively independent branch of Buryat-Tibetan medicine, which back in the XIX century spread first to St. Petersburg, and then to other cities and regions of the Russian Empire. Nowadays, in the main centers of traditional medicine in Buryatia and the Zabaykalsky Krai, the institutions of a medical system have been formed, making it possible to create a full-fledged TMS — a parallel, but closely intertwined with biomedicine branch of healthcare, which can easily become an alternative branch of healthcare in the Republic of Buryatia, where the traditional Buryat-Tibetan medicine has been institutionalized within the healthcare system since the 1980s. Currently, the Center for Oriental Medicine and its units are receiving a significant number of combatants for rehabilitation and are actively working in the field of restorative medicine.

A Systematic Review of Micropulse Laser Trabeculoplasty (MLT) in Primary Open-Angle Glaucoma (POAG) Management: Efficacy, Safety, and Future Perspectives.

Micropulse laser trabeculoplasty (MLT) is gaining attention as a non-invasive treatment option for primary open-angle glaucoma (POAG), offering an alternative to traditional surgeries and medications. This systematic review evaluates the effectiveness, safety, and potential of MLT in glaucoma management. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, following the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. We identified 79 articles, and after removing duplicates and screening abstracts, 56 articles were eligible for further review. A detailed full-text analysis was conducted on 26 articles, of which 15 met the predefined inclusion criteria. MLT shows promise as a primary or adjunctive treatment for reducing intraocular pressure (IOP) in glaucoma and ocular hypertension patients. Current evidence supports its efficacy and safety; however, additional long-term studies are needed to confirm its durability and compare its effectiveness with traditional surgical and pharmacological approaches. Standardizing treatment protocols and refining patient selection criteria could enhance MLT's clinical value and support its broader adoption in glaucoma care.

Consensus evidence-based clinical practice guide for the diagnosis and management of osteoporosis in childhood and adolescence

BackgroundThe incidence of osteoporosis in children has increased dramatically during the last decade. This has been attributed to better survival rates of children living with chronic disorders, the increased use of medications known to have a negative impact on the children’s bones, and the increased preference for indoor activities and sedentary life in healthy children. Recent advances in pediatric osteoporosis definition, along with a lack of management recommendations or national consensus on its diagnosis and treatment, have led to a wide range of approaches being implemented to manage this illness. The aim of this work was to develop an optimal evidence-based consensus, target-oriented, on-steered therapeutic approach for children with osteoporosis. Based on 15 key clinical questions, a qualitative literature evaluation was conducted to provide evidence-based recommendations for the treatment of pediatric osteoporosis. An expert panel of 14 pediatric osteoporosis specialists conducted a Delphi survey. The level of evidence for each element was assessed using the Oxford Centre for Evidence-based Medicine (CEBM) System, when available, and/or based on the expert panel’s personal experience. All recommendations with an agreement rate of 75% or higher were included.ResultsThirty-six recommendations, categorized into 13 domains, had evidence 4 or 5 and consequently were included in the Delphi survey. This was assessed online and a response rate of 82.4% was achieved. Delphi 2 round revealed that all the recommendations achieved 75% or more level of agreement and therefore have been accepted and included in this management recommendations. Based on that an algorithm showing an approach to pediatric osteoporosis management and maintenance of therapy has been developed.ConclusionFor the management of children with osteoporosis, consulting a pediatric bone specialist is strongly advised, either by referral or by advice. This is extremely relevant because children are uniquely capable of recovering spontaneously or with the assistance of medication. This includes also vertebral fractures reshaping. Consequently, there is a huge opportunity to improve bone mass accretion and thus musculoskeletal health in children with osteoporosis.

Organizational and legal foundations of the introduction of uniform standards of training in tactical medicine for police officers under martial law: problematic issues and solutions

The article clarifies the organizational and legal principles of the introduction of uniform standards of training in tactical medicine for police officers under martial law, identifies problematic issues and ways to solve them. It was established that, despite the ongoing armed aggression on the territory of Ukraine since 2014, which leads to the death and injury of defenders of Ukraine, only in 2017 did a military accounting specialty related to tactical medicine officially appear in Ukraine (the «combat medic» specialty was officially recognized as an order Ministry of Defense), while there are still no uniform standards for training in tactical medicine and medical support for soldiers. It is noted that one of the important issues at the moment is the adoption of organizational measures to ensure appropriate training of police officers on duty, as there is a shortage of trained professional instructors in pre-medical care and even more so in tactical medicine, as well as the creation of appropriate legal support for their activities. It has been proven that there is an urgent need to create uniform standards for tactical medicine training and uniform standards for tactical medicine instructors and to create standards for equipping police officers, taking into account the needs of the latter in providing self-help and pre-medical assistance to the population. It is proposed to carry out the training of tactical medicine specialists by levels, in accordance with the needs and performance of tasks during tactical training to ensure the capacity of service and combat units. According to the levels, tactical medicine instructors can be persons who have basic knowledge of tactical-special and fire training (military, police officers, both active and those who have retired or commissioned due to health conditions), have received a certificate or instructor certificate from pre-medical care and/or, have a medical education (this condition is mandatory for a tactical medicine instructor for combat medics) and have passed the exam for a tactical medicine instructor at emergency medical aid and disaster medicine centers, educational training centers, qualification centers, higher military educational institutions, institutions of higher education with specific study conditions.

The effects of growth hormone on the outcomes of in vitro fertilization and embryo transfer in age-grouped patients with decreased ovarian reserve: a prospective cohort study.

Growth hormone (GH) could improve the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in patients with decreased ovarian reserve (DOR), but which age group will benefit the most has remained controversial. This study aims to explore the outcome of IVF-ET among differently aged patients with DOR treated with GH. A total of 846 patients with DOR undergoing IVF-ET from May 2018 to June 2023 at the Reproductive Medicine Center of Sichuan Provincial Women's and Children's Hospital were prospectively enrolled. The patients were divided into group A (< 35 year old, n = 399), group B (35 ~ 40 year old, n = 286), and group C (> 40 year old, n = 161). Each group was sub-divided into the GH part and the control part, with the former receiving pretreatment with GH 4 IU/day on day 2 of the previous menstrual cycle before the injection of gonadotrophin (Gn) until the trigger day. The ovarian stimulation protocol was gonadotrophin-releasing hormone antagonist (GnRH-A) or long-acting GnRH agonist protocol. The quality of oocytes and embryos and the outcome of pregnancy were compared. In group B, the number (1.16 ± 0.12 vs. 0.74 ± 0.09) and rate (34.27% vs. 23.90%) of high-quality cleavage embryos, rate of implantation (32.37% vs. 22.35%), clinical pregnancy (48.98% vs. 33.67%), and live birth (44.90% vs. 29.59%) were significantly higher, whereas the canceled oocyte retrieval rate was significantly lower (1.49% vs. 6.58%) in the GH part than those of the control part (P < 0.05). In group B, the duration and dose of Gn, number of oocyte retrieved, and rates of normal fertilization, cleavage embryo, blastocyst, high-quality blastocyst, and early miscarriage were not significantly different between the GH and control parts (P > 0.05). In groups A and C, no significant difference was detected in the quality of embryos and outcomes of embryo transfer with or without pretreatment (P > 0.05). GH could improve the quality of embryos and live birth rate for patients with DOR aged 35-40 years old.

Evaluation of five questionnaires for obstructive sleep apnea screening in the elderly

Obstructive sleep apnea (OSA) often leads to complications in the elderly. This study compares the usefulness of five screening tools for OSA in elderly patients. Data from elderly patients diagnosed with OSA, collected from the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from January 2012 to June 2017, is analyzed. The sensitivity, specificity, predictive values, area under the curve (AUC), and diagnostic odds ratio (DOR) of the five screening tools are computed and compared. 273 elderly patients with suspected OSA are included, of whom 189 are male (69.2%). The Berlin Questionnaire has an AUC of 0.670 (95%CI: 0.611–0.725) at different cut-off points. The sensitivity and specificity of the Berlin Questionnaire are noticeably high at 0.653 (0.587–0.719) and 0.608 (0.497–0.719), 0.699 (0.621–0.776) and 0.533 (0.449–0.616), and 0.803 (0.713–0.892) and 0.503 (0.433–0.572) when the AHI is 5, 15, and 30 times/hour, respectively. The GOAL Questionnaire has the highest DOR at AHI cut-off points of 5 and 15 times/hour, while Berlin has the highest DOR at an AHI cut-off point of 30 times/hour. Comprehensive use of these five screening questionnaires for suspected OSA in elderly patients aged 60 years and older is valuable and worth promoting among the elderly population.

Evaluation of prenatal-postnatal outcomes and risk factors in fetal jejunoileal atresia

Aims: The aim of the current study is to reveal ultrasonographic and clinical features, evaluation of prenatal-postnatal outcomes and risk factors of fetal jejunoileal atresia. Methods: This retrospective study evaluated all cases of fetal jejunoileal atresia identified between 2018 and 2024 at a tertiary centre of maternal-fetal medicine. In all cases, the pediatric surgery team confirmed the definitive diagnosis of jejunoileal atresia during the postnatal period. The cohort was divided into two groups, the "poor outcome" and "good outcome", in order to compare and evaluate risk factors determining the outcome. Results: During the study period, a total of 18 cases were recorded. All cases in the cohort managed to reach live birth. 15 (83.3%) neonates survived after the surgical procedure, whereas 3 (16.7%) neonates were deceased during the post-operative period. Short bowel syndrome was diagnosed in 2 (11.1%) living cases during postoperative follow-ups.

Study of the feasibility of polar body transfer combined with preimplantation genetic testing for blocking the intergenerational transmission of mitochondrial genetic diseases

To assess the feasibility of first polar body transfer (PB1T) combined with preimplantation mitochondrial genetic testing for blocking the transmission of a pathogenic mitochondrial DNA 8993T>G mutation. A Chinese family affected with Leigh syndrome which had attended the Reproductive Medicine Centre of the First Affiliated Hospital of Anhui Medical University in September 2021 was selected as the study subject. Controlled ovarian hyperstimulation was carried out for the proband after completing the detection of the mitochondrial DNA 8993T>G mutation load among the pedigree members. Mature MII oocytes were inseminated by intracytoplasmic sperm injection (ICSI), cultured in vitro for 5 to 6 days to the blastocyst stage, and trophoblastocytes were obtained by microbiopsy. Mitochondrial DNA testing (PGT-MT) and chromosomal aneuploidy (PGT-A) analyses were carried out after whole-genome amplification, and the embryos with zero mutation load were selected for transfer. Amniotic fluid and umbilical cord blood samples were collected during middle pregnancy and after birth respectively for mitochondrial DNA testing to verify the reliability of embryo screening. As an attempt, PB1 with good morphology of MII oocytes was selected for transfer into the enucleated oocytoplasm from healthy donors, followed by ICSI fertilization, blastocyst culture and PGT of embryos using the same procedure. This study has been approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (No. 2021zhyx-B12). An antagonist protocol was used for ovarian stimulation, and a total of 19 oocytes were obtained, of which 14 MII were fertilized by ICSI, and 2 had developed into blastocysts. PGT-MT was carried out on biopsied trophoblastocytes, in which the mitochondrial DNA 8993T>G mutation load was not detected in one embryo, the other was 100% mutated, and the mutation loads of the remaining unfertilized eggs and developmentally arrested embryos ranged from 0% ~ 100%, presenting a clear biased distribution. With fully informed consent, one PGT-MT zero mutation load blastocyst was transferred and clinical pregnancy was achieved. Mitochondrial DNA and chromosomal testing of amniotic fluid cells during middle pregnancy had revealed no abnormalities. The proband had delivered a healthy boy through Caesarean section at 39+5 weeks of gestation, and no mutation was detected in the cord blood sample. Five well-formed PBs from 14 eggs were selected for PB1 transfer, followed by ICSI and culture, and two of the reconstituted embryos had formed blastocysts, with none of the above mutations detected in the biopsied samples. The PGT-MT technology can help families affected with mitochondrial diseases to have healthy offspring. PB1 transfer in combination with ICSI and PGT-MT holds the promise of turning waste into treasure and providing an alternative means of fertility for such families.

The Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study.

To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births. A retrospective cohort study. A tertiary fetal medicine centre (London, UK). All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment. Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M. SGA < 10th centile and extreme PTB rates (< 28 weeks). In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0-66.0) and CRL-L was 63 mm (IQR: 58.4-68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (p = 0.275 and p = 0.419); SGA at birth (p = 0.132 and p = 0.325); or extreme PTB (p = > 0.999 and p = 0.765 respectively). Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.