Instrumental Methods Research Articles

The smarter the city develops, the healthier the child grows? Evidence from China

This paper examines whether implementing the smart cities initiative (SCI) can effectively uphold children's right to healthy growth. Using a time-varying difference-in-differences model and a data set collected from 2638 counties in China from 2005 to 2018, we empirically examine the causal relationship between SCI and child growth for the first time. The results show that SCI has a beneficial impact on mitigating the prevalence of stunting and wasting. This conclusion remains valid after various robustness checks, including propensity score matching, placebo testing, and instrumental variable method. Further heterogeneity analysis reveals that SCI substantially reduces the risk of growth failure in children, particularly in the eastern region and cities with higher administrative levels, and boys are more positively affected than girls. Finally, we find that SCI can facilitate the healthy growth of children through three primary effects: economic development, reduced pollution exposure risk, and optimized public service quality. This study provides valuable insights into the impact of SCI on safeguarding children's health and establishes a foundation for informed decision-making to promote child-friendly growth spaces in China and other developing countries.

Kinematic upper limb analysis outperforms electromyography at grading the severity of dystonia in children with cerebral palsy

BackgroundSeverity of dyskinesia in children with cerebral palsy is often assessed using observation-based clinical tools. Instrumented methods to objectively measure dyskinesia have been proposed to improve assessment accuracy and reliability. Here, we investigated the technique and movement features that were most suitable to objectively measure the severity of dystonia in children with cerebral palsy. MethodsA prospective observational study was conducted with 12 participants with cerebral palsy with a predominant motor type of dyskinesia, spasticity, or mixed dyskinesia/spasticity who had upper limb involvement (mean age: 12.6 years, range: 6.7–18.2 years). Kinematic and electromyography data were collected bilaterally during three upper limb tasks. Spearman rank correlations of kinematic or electromyography features were calculated against dystonia severity, quantified by the Dyskinesia Impairment Scale. FindingsKinematic features were more influential compared to electromyography features at grading the severity of dystonia in children with cerebral palsy. Kinematic measures quantifying jerkiness of volitional movement during an upper limb task with a reaching component performed best (|rs| = 0.78–0.9, p < 0.001). InterpretationThis study provides guidance on the types of data, features of movement, and activity protocols that instrumented methods should focus on when objectively measuring the severity of dystonia in children with cerebral palsy.

Risk factors and the possibility of predicting late premature birth

In the structure of preterm labor, more than half of the cases occur in late preterm labor. Many aspects of this problem remain unexplored. The article analyzes the literature sources from 2018 to 2023 (domestic and foreign scientific studies, meta-analyses, and systematic reviews) devoted to late premature birth. Risk factors, prognosis, and management strategies for preterm birth in the period from 34 to 36 weeks of pregnancy are considered. Understanding risk factors and predictive capabilities are important to prevent late pregnancy and improve pregnancy outcomes. For ease of use, risk factors and prognostic criteria are summarized in tables with references and OR. Based on the analyzed data, an approximate portrait of a patient with late premature birth was compiled and the value of biochemical markers (PAMG-1 and fibronectin), as well as instrumental methods - cervicometry and elastography ultrasound examination of the cervix, as the most informative predictor tests of the onset of late preterm birth was confirmed. It seems optimal to assess risks using several methods for predicting the onset of premature birth. The information provided in this article allows for a correct assessment of the risks of premature birth, including late delivery, and to determine management tactics based on the use of informative and "fast" tests for threatening deliveries, which will improve their outcomes.

Revisiting the resource curse hypothesis from the viewpoint of green growth: The role of Fintech as the de-cursing agent

Conventionally, the resource curse hypothesis highlights the economic growth-inhibiting impacts that are often associated with the expansion of natural resource-based industries. However, not much focus has been given to assessing whether natural resource consumption hinders green growth establishment, as well. Hence, this study makes a novel attempt at evaluating the validity of the resource curse hypothesis from the viewpoint of green growth in the context of selected Sub-Saharan African countries. Notably, this study focuses on whether natural resource abundance upholds green growth in the concerned Sub-Saharan African nations, especially by reducing their annual carbon emission-adjusted economic growth levels. More importantly, this study ascertains whether Fintech development, via the channel of Fintech-based startup financing, can promote green growth in these countries and thereby act as a de-cursing agent for tackling the possible economic and environmental curses imposed by their natural resource sectors. Accordingly, by employing a recently developed two-stage instrumental variable regression method, the resource curse hypothesis is verified from the perspective of green growth establishment. On the other hand, Fintech development is found to not only promote green growth on its own but also act as a de-cursing agent that partially offsets the green growth-impeding effects associated with natural resource consumption. Furthermore, capital accumulation is identified as a green growth-restricting factor while institutional quality improvement is observed to stimulate green growth across the selected Sub-Saharan African countries. Therefore, considering these major findings, a couple of green growth-promoting policy suggestions are put forward.

Uterine hydatidosis: casuistry is possible

Introduction. Hydatidosis is a severe parasitic disease caused by tapeworm Echinococcus granulosus widely spread in some endemic areas all over the world that primarily targets liver, lung, bones, muscles well as pelvis in casuistic cases. Due to the lack of pathognomonic signs as well as low prevalence rate of hydatid cysts in such anatomic sites, a differential diagnosis for relevant gynecological pathologies may be substantially complicated. Compared with common gynecological disease such as uterine fibroids, ovarian cyst and malignancies uterine hydatidosis may be identified only in 0.16 % cases.Aim: to present a clinical case of uterine hydatid cyst in order to optimize algorithms for differential diagnosis of primary pelvic echinococcosis and gynecological pathology, which is necessary for successfully conducted timely surgical treatment.Clinical case. In 2023, patient K. complained of dysuric phenomena and a feeling of heaviness in the pelvic area. Based on the anamnesis, clinical picture, laboratory and instrumental research methods, it was decided to perform surgical treatment. The patient underwent laparoscopic hysterectomy and removal of ¾ hydatid cyst. The obtained material was used for histological examination to verify the diagnosis.Results. Differential diagnosis of uterine echinococcosis is most often carried out with cystic or dysembryogenetic tumors, purulent or tuberculous abscesses, ovarian cysts, ovarian tumors, and uterine fibroids. Features of the MR picture, such as a thick compacted wall, the lack of internal septa, parietal and papillary outgrowths, as well as a solid component, allowed to suspect parasitic genesis of the neoplasm.Conclusion. While treating patients with cystic neoplasms of the pelvic area referred from endemic areas, echinococcosis should be included in the list of differential diagnostic searches.

Characteristics of the colonic crypts in inflammatory bowel diseases

Purpose: to characterize changes in the colon crypts in colitis and to assess their significance in the morphological diagnosis of inflammatory bowel diseases (IBD). Materials and methods: colon biopsies were retrospectively reviewed in patients with IBD (30 patients with ulcerative colitis (UC) and 30 patients with Crohn's disease (CD)) and in 30 patients where the diagnosis of IBD was not confirmed (self-limiting colitis not related to IBD (non-IBD)). The age of the patients ranged from 19 to 53 years. In all cases, the diagnosis was established based on a combination of clinical, laboratory, and instrumental diagnostic methods. Multiple biopsies were obtained from all patients during colonoscopy. The processing of the material was carried out according to generally accepted methodology. All cases were scanned using the Aperio TC histological preparation scanner (Leica, Germany) and re-examined with an emphasis on crypt changes. Results: the crypt characteristics found during the study were divided into the following groups. The most frequently detected changes included inflammatory and destructive changes (98% of cases of IBD and 80% of cases of non-IBD). Atrophic changes in crypts were more often found in patients with non-IBD colitis compared with cases of IBD (30% in IBD and 53.3% in non-IBD; p=0.03). Significant differences in frequency were observed when dysregenerative changes in crypts were detected (76.7% of cases of colitis in IBD and 13.3% of cases in non-IBD; p&lt;0.001). Crypt budding was more pronounced in patients with UC compared with CD (92% in UC versus 70% in CD), and a special variant of crypt changes, which we termed "serpentine," was found exclusively in patients with CD. Conclusion: crypt changes found only in patients with IBD, such as budding crypts, can serve as an important differential diagnostic criterion for the diagnosis of IBD. In the IBD group, the discovered serpentine crypts can help in making a differential diagnosis between UC and CD. Inflammatory and destructive changes are found with equal frequency in both cases of IBD and non-IBD colitis and therefore cannot be considered specific diagnostic signs.

Satisfied? Examining Focus of Attention in Self-Directed Practice

In a series of three video-recorded assignments over a 6-week period, undergraduate music education students ( N = 16) enrolled in an instrumental methods course described aloud what they were thinking about as they practiced a three-note melody on a secondary brass instrument. Later, I completed a content analysis of the students’ practice verbalizations (PVs) captured in their assignment videos. Brass primary students ( n = 3) described thinking about predominantly external components of performance (the effects their physical actions produced). Non-brass primary students ( n = 13) described thinking about internal (parts of the body) and external components in relatively equal proportion, often focusing their attention on paired action-outcome (i.e., internal–external) relationships. After the final assignment, non-brass students reported higher levels of satisfaction with their progress than the brass primary students and expressed confidence in their ability to guide their own practice independently and effectively toward the accomplishment of meaningful goals.

Quaternion-Based Attitude Estimation of an Aircraft Model Using Computer Vision.

Investigating aircraft flight dynamics often requires dynamic wind tunnel testing. This paper proposes a non-contact, off-board instrumentation method using vision-based techniques. The method utilises a sequential process of Harris corner detection, Kanade-Lucas-Tomasi tracking, and quaternions to identify the Euler angles from a pair of cameras, one with a side view and the other with a top view. The method validation involves simulating a 3D CAD model for rotational motion with a single degree-of-freedom. The numerical analysis quantifies the results, while the proposed approach is analysed analytically. This approach results in a 45.41% enhancement in accuracy over an earlier direction cosine matrix method. Specifically, the quaternion-based method achieves root mean square errors of 0.0101 rad/s, 0.0361 rad/s, and 0.0036 rad/s for the dynamic measurements of roll rate, pitch rate, and yaw rate, respectively. Notably, the method exhibits a 98.08% accuracy for the pitch rate. These results highlight the performance of quaternion-based attitude estimation in dynamic wind tunnel testing. Furthermore, an extended Kalman filter is applied to integrate the generated on-board instrumentation data (inertial measurement unit, potentiometer gimbal) and the results of the proposed vision-based method. The extended Kalman filter state estimation achieves root mean square errors of 0.0090 rad/s, 0.0262 rad/s, and 0.0034 rad/s for the dynamic measurements of roll rate, pitch rate, and yaw rate, respectively. This method exhibits an improved accuracy of 98.61% for the estimation of pitch rate, indicating its higher efficiency over the standalone implementation of the direction cosine method for dynamic wind tunnel testing.

At an appointment with a patient with diarrhea: the doctor’s algorithm of actions

Diarrhoea is one of the most common gastroenterological complaints made by patients who seek medical attention. It can be a manifestation of the whole range of different diseases, although not exclusively of the digestive tract, which requires a thorough examination of the patient and often is a challenge for the clinician, especially in the limited time settings during an outpatient visit. The cause of diarrhoea should be identified early to begin treatment of the patient in a timely and rational manner. In managing a patient with diarrhoea, a diagnostic search must begin with the following actions: working out complaints in detail, identification of symptoms of anxiety and taking a medical history, including epidemiological, pharmaceutical, hereditary, allergic, as well as analysis of dietary preferences. A physical examination is an integral part of the patient management; it allows to assess the general health condition, identify signs of dehydration and clinical stigmas of the underlying condition, which may manifest itself as diarrhoea. After an initial examination and exclusion of anxiety symptoms, a number of laboratory and instrumental examination methods is prescribed to determine the cause of diarrhoea. Given the polyetiology of diarrhoea syndrome, the range of methods for examining the patient can be quite wide, therefore the choice of area for the diagnostic search and the scope of the necessary diagnostic procedures is carried out on an individual basis, taking into account the features of the clinical picture, history data and physical examination findings. Treatment of a patient with diarrhoea at the pre-examination stage must include rehydration, timely detection and correction of electrolyte disturbances and other possible complications. Once the cause of diarrhoea has been established, the patient is treated due to the identified etiological factor in accordance with the current clinical guidelines. The article presents a step-by-step algorithm for making a differential diagnosis in a patient with diarrhoea, and also presents our own clinical observations.

Does fiscal decentralization reduce environmental degradation through mitigating resource mismatch and digital transformation? Evidence from China's resource-based cities

Fiscal federalism grants local governments a certain degree of fiscal autonomy and stimulates their motivation. This study analyses the impact of fiscal decentralization on urban carbon emission reduction using the double fixed-effects model and the mediated-effects model using data from 187 resource-based cities in China from 2011 to 2020. It is found that fiscal decentralization significantly promotes energy saving and emission reduction, which is reflected in the significant negative correlation between fiscal decentralization and the size of urban carbon emissions and the positive correlation with carbon emission efficiency. These results are still robust after replacing the carbon emission scale and carbon emission efficiency and using the instrumental variable method. Heterogeneity analysis reveals that fiscal decentralization significantly suppresses the carbon emission scale and positively contributes to carbon emission efficiency in the country's east-central part and resource-based cities with lower marketization. Mechanistic analyses suggest that mitigating land resource mismatch and enhancing the degree of government digital transformation are critical factors for fiscal decentralization to reduce carbon emissions. This study provides empirical support for how policymakers can balance the relationship between economic development and environmental protection when formulating local fiscal policies.

Dissecting the impact of the three E, S, G pillars on credit risk

This study explores the impact of Environmental, Social, and Governance (ESG) scores on the credit risk of Chinese A-share listed companies. Based on the empirical study, we analyse both the individual and combined effects of E, S, and G scores. Our findings indicate that improvements in ESG scores significantly reduce credit risk, particularly among green companies and those with high transparency. This conclusion remains robust after accounting for potential endogeneity bias through the application of the instrumental variable method. Furthermore, our study delves into how ESG scores impact credit risk. An increase in ESG scores reduces a company’s debt default risk by decreasing the negative ESG-related news sentiment, enhancing stock liquidity, lowering financing costs, and improving the quality of internal controls. These insights contribute to a deeper understanding of ESG factors in risk management and offer practical guidance for companies seeking to enhance their ESG performance in relation to credit risk.

Directors' and Officers' Liability Insurance and the Digital Transformation of Enterprises: Based on the Empirical Evidence of Listed Companies in China from 2011 to 2021

Amidst the wave of the digital economy, numerous enterprises have commenced the process of digital transformation to address market challenges and fluctuations, as well as to pursue sustainable growth. Directors' and officers' liability insurance (D&amp;O insurance), being an essential instrument of corporate governance, necessitates an empirical investigation to unravel its influence on enterprises' digital transformation. This study selects Shanghai-Shenzhen A-share listed companies from 2011 to 2021 as research subjects to examine the impact of D&amp;O insurance procurement on enterprises' digital transformation and its underlying mechanisms. The findings reveal that the procurement of D&amp;O insurance significantly fosters the progress of enterprise digital transformation, and this conclusion remains robust after employing a series of robustness tests, including the instrumental variable method and DIGT. The mechanism analysis indicates that by elevating the risk-bearing capacity of enterprise managers, the management efficiency of enterprises can be enhanced, thereby motivating supervisory executives to augment the quality of internal control and facilitate the digital transformation of enterprises. Further examination discloses that executive equity incentives and executive responsibility insurance possess complementary effects in promoting enterprise digital transformation, making the subscription of executive responsibility insurance a pivotal factor in enhancing the effectiveness of enterprise digital transformation and fostering high-quality economic development.

Interaction of Mechanical Characteristics in Workpiece Subsurface Layers with Drilling Process Energy Characteristics

The performance properties of various types of parts are predominantly determined by the subsurface layer forming methods of these parts. In this regard, cutting processes, which are the final stage in the manufacturing process of these parts and, of course, their subsurface layers, play a critical role in the formation of the performance properties of these parts. Such cutting processes undoubtedly include the drilling process, the effect of which on the mechanical characteristics of the drill holes subsurface layers is evaluated in this study. This effect was evaluated by analyzing the coincidence of the energy characteristics of the short hole drilling process with the mechanical characteristics of the drilled holes’ subsurface layers. The energy characteristics of the short-hole drilling process were the total drilling power and the cutting work in the tertiary cutting zone, which is predominantly responsible for the generation of mechanical characteristics in the subsurface layers. As mechanical characteristics of the drill holes’ subsurface layers were used, the microhardness of machined surfaces and total indenter penetration work determined by the instrumented nanoindentation method, as well as maximal indenter penetration depth, were determined by the sclerometry method. Through an analysis of the coincidence between the energy characteristics of the drilling process and the mechanical characteristics of the subsurface layers, patterns of the effect of drilling process modes, drill feed, and cutting speed, which essentially determine these energy characteristics, on the studied mechanical characteristics have been established. At the same time, the increase in the energy characteristics of the short-hole drilling process leads to a decrease in the total indenter penetration work and the maximum indenter penetration depth simultaneously with an increase in the microhardness of the drilled holes’ subsurface layers.

Revealing the impact of individual income inequality on different types of charitable giving in China through social interactions

AbstractObjectiveThis study delves into the correlation between individual income inequality as measured by the relative deprivation index and charitable giving, while also examining urban–rural heterogeneity. Additionally, it further explores the mechanisms by which online and offline forms of social interaction operate in this context.MethodsUtilizing data from the 2014–2020 China Family Panel Studies, we employed several methodologies including Probit regression models, cross‐model average marginal effects difference testing based on bootstrap method, instrumental variable method, and the Karlson–Holm–Breen (KHB) effect decomposition method.ResultsThe findings reveal that individual income inequality measured by the relative deprivation index significantly reduces charitable giving among Chinese households. The inhibitory effect of individual income inequality on social charitable giving is higher than that on charitable giving directed toward friends or colleagues. Furthermore, this impact exhibits some heterogeneity between urban and rural areas. Mechanism analysis indicates that the adverse effect of income inequality on charitable giving operates through reducing social interaction, including both online and offline forms.ConclusionOur results demonstrate that income inequality has distinct adverse effects on two types of charitable giving and explain the mechanisms underlying these effects through social interaction. A pattern of the differential mode of association similar to “ripples” in Chinese society is beneficial for understanding these differentiated impacts. We believe it is necessary to improve economic inequality conditions and enhance the enthusiasm of the Chinese public for participating in charitable donations by promoting various forms of social interaction.

Effect of membrane properties on the odor emanating from training aids for explosive-detecting canines.

Canines are widely used for real-time detection of explosives and have proven to be on par with instrumental methods. Canines are thought to rely largely upon detection of volatile chemical constituents of the explosives, though not necessarily the explosive itself. Hence, it is crucial to understand the odor available to them as generated by training aids. Previous studies have established that the Training Aid Delivery Device (TADD) developed by SciK9 is a reliable training aid that reduces cross-contamination and doubles as a storage device. A TADD comprises a standardized container, a synthetic membrane, a membrane holder, and a lid. In the work presented, activated charcoal strips were placed above and below the TADD membrane to determine the relative amounts of volatiles emitted by dynamite (i.e., ethylene glycol dinitrate (EGDN) and trinitroglycerin (NG)). The strips were eluted and the extracts tested using gas chromatography-mass spectrometry in negative ion chemical ionization mode. A series of t-tests at 95% confidence level were performed to determine any differences in vapor composition above and below the membranes. Nine synthetic membranes and six glass fiber membranes were tested in this study. It was expected that the relative concentration of volatiles would remain the same on both sides of the membrane; however, selective removal of nitroglycerin by some membranes was observed. Synthetic membranes with larger pore sizes showed no alteration in the vapor composition. Both synthetic and glass fiber membranes did not show a significant change in relative concentration of the other volatile compound in dynamite, i.e., EGDN. Out of all the membranes tested, three synthetic membranes and four glass fiber membranes showed selective alteration in odor availability of nitroglycerin in dynamite. For training purposes, membranes that do not alter the vapor composition should be used in the training aid.

Impact of online communication on the ambidextrous innovation investment of enterprises

With the rapid progress of China's information technology and digital economy, investors, especially retail investors, can communicate directly with enterprises on online platforms of stock exchanges. In this paper, using crawler means to collect all the question-and-answer (Q&A) logs on online platforms and taking A-share listed firms in 2010∼2020 as samples, we explore the effect of online communication between investors and enterprises on corporate ambidextrous innovation investment. The results show that such online interaction can greatly encourage developmental and exploratory innovation investment and play a more significant effect in the latter; the quality of communication is positively related to ambidextrous innovation investment, but excessive attention to investor returns in the interaction process restrains ambidextrous innovation investment. We take various approaches, such as the entropy balancing test, the instrumental variable method, and the Heckman two-stage method, to confirm the validity of the results. The mechanism test shows that interaction can increase ambidextrous innovation investment mainly by alleviating corporate financing constraints and improving corporate governance. Furthermore, we find that this effect is more evident in state-owned firms than in non-state-owned firms and that the promotion effect of interaction on ambidextrous innovation investment eventually helps improve firm value.

Likelihood-based instrumental variable methods for Cox proportional hazards model

Likelihood-based instrumental variable methods for Cox proportional hazards model

Safety and effectiveness of SGLT2 inhibitors in a UK population with type 2 diabetes and aged over 70 years: an instrumental variable approach.

Older adults are under-represented in trials, meaning the benefits and risks of glucose-lowering agents in this age group are unclear. The aim of this study was to assess the safety and effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in people with type 2 diabetes aged over 70 years using causal analysis. Hospital-linked UK primary care data (Clinical Practice Research Datalink, 2013-2020) were used to compare adverse events and effectiveness in individuals initiating SGLT2i compared with dipeptidyl peptidase-4 inhibitors (DPP4i). Analysis was age-stratified: <70 years (SGLT2i n=66,810, DPP4i n=76,172), ≥70 years (SGLT2i n=10,419, DPP4i n=33,434). Outcomes were assessed using the instrumental variable causal inference method and prescriber preference as the instrument. Risk of diabetic ketoacidosis was increased with SGLT2i in those aged ≥70 (incidence rate ratio compared with DPP4i: 3.82 [95% CI 1.12, 13.03]), but not in those aged <70 (1.12 [0.41, 3.04]). However, incidence rates with SGLT2i in those ≥70 was low (29.6 [29.5, 29.7]) per 10,000 person-years. SGLT2i were associated with similarly increased risk of genital infection in both age groups (incidence rate ratio in those <70: 2.27 [2.03, 2.53]; ≥70: 2.16 [1.77, 2.63]). There was no evidence of an increased risk of volume depletion, poor micturition control, urinary frequency, falls or amputation with SGLT2i in either age group. In those ≥70, HbA1c reduction was similar between SGLT2i and DPP4i (-0.3 mmol/mol [-1.6, 1.1], -0.02% [0.1, 0.1]), but in those <70, SGLT2i were more effective (-4 mmol/mol [4.8, -3.1], -0.4% [-0.4, -0.3]). Causal analysis suggests SGLT2i are effective in adults aged ≥70 years, but increase risk for genital infections and diabetic ketoacidosis. Our study extends RCT evidence to older adults with type 2 diabetes.

Do the types of agricultural socialized services and their diverse suppliers matter to farmland renting in rural China?

Based on the nationally representative panel data collected in 2000 households in 100 villages of 5 provinces in 2016 and 2019, this study analyzed the impact and potential paths of different types of agricultural socialization services (labor-intensive, technology-intensive, marketing) on farmland rented-in from the perspectives of accessibility and diversity of suppliers. The consistent results yielded from OLS, fixed effect model, and instrumental variable method showed that labor-intensive services had positive and significant effects on the probability and size of renting in farmland and it was much larger for the households without off-farm employment or with rich farmland endowment. However, neither technology-intensive nor marketing services had such effects . The substitution effect of different type of services on labor force, the attributes of service providers, and the characteristics of service buyers contributed to the difference. These findings imply that the government should pay more attention to the development of technology-intensive and marketing services, especially for smallholders, while keeping to encourage and support various suppliers to provide labor-intensive services.

Delivery and organ-preserving surgery in a woman with high-risk uterine myoma

This article presents a clinical case from the practice of the State Budgetary Healthcare Institution of the Republic of Belarus "GKPTs" in Ufa regarding organ-conserving surgery in a woman with high-risk uterine fibroids of isthmus localization with transition to the posterior wall of the uterus. In May 2023, at 39 weeks of pregnancy, patient T. was scheduled for planned surgical delivery by cesarean section, with subsequent expansion of the scope of the operation to conservative myomectomy. The indication for surgery was uterine fibroids of gigantic size and isthmus localization with transition to the posterior wall of the uterus, as a result of which delivery through the natural birth canal is impossible. Uterine fibroids in this patient were discovered during pregnancy. Instrumental research methods used during the examination: ultrasound, magnetic resonance imaging (MRI). During routine ultrasound screenings, uterine fibroids of isthmus localization measuring 123x99x112 mm without disruption of the node's nutrition were diagnosed. According to MRI, the diagnosis of large uterine fibroids was confirmed. A transverse suprapubic laparotomy was performed. The first stage of the combined operation was a cesarean section in the lower segment. As a result, a live full-term boy weighing 3480 g, 53 cm, with 7-8-9 points on the Apgar scale was recovered. Then, during an inspection of the pelvic organs, a myomatous node was discovered in the isthmus area with a transition to the posterior wall of the uterus measuring 10x12 cm, without signs of necrosis. A conservative myomectomy was performed without penetration into the uterine cavity. The bed is sutured with separate sutures. Hemostasis has been achieved. The weight of the myomatous node will be 570 grams. Our clinical case shows that a favorable full-term pregnancy with high-risk, large size, atypical localization uterine fibroids is possible. Also, organ-preserving, combined operations are currently being carried out, which enable a woman to preserve the organ and further realize her reproductive potential.