School Hospital Research Articles

Self-care tendencies and their pain-relieving effects in patients with endodontic pain: a descriptive survey

OBJECTIVE: This paper aims to search for sociodemographic/ dental models predicting the self-care orientations in endodontic patients and to explore the effectiveness of the applied methods in relieving pain. MATERIALS AND METHOD: Patients with a history of endodontic pain presenting at the endodontic clinic of Gazi University were subjected to a survey. Their sociodemographic and clinical data were obtained. They were asked to select from a structured list whether they had used any self- or formal care methods. Pain relief was measured using a 5-point standard Likert scale. Statistical analyses were done using multivariate logistic regression, Wilcoxon and Kruskal-Wallis tests, and Benjamini-Hochberg correction. RESULTS: Among 356 patients, 90% applied self-care alone or in combination with formal care. Maximum pain level, age, and pattern of dental clinic attendance were the variables that predicted orientations to various subcategories of self-care behaviors, with the first two variables remaining statistically or marginally significant in all tested conditions (P < .05 or < .10). Among the home remedies, drinking or local application of alcohol and intraoral cold treatment by the patient provided significantly greater pain relief than the others (P = .001). Medication under the guidance of a professional was more effective than self-medication (P < .001; except for NSAIDs, which were similarly effective in both cases). CONCLUSION: Before applying to the dental school hospital, most of the patients used various self-care methods for relieving toothache. Maximum pain and age were the common covariates of various self-care orientations. Overall, formal care relieved pain better than self-care. Home remedies generally displayed little effectiveness.

Profile of female survivors of sexual violence in the first 6 months of the COVID-19 quarantine in the city of Campinas, Brazil: A cross-sectional retrospective study.

Describe the characteristics and changes in the profile of women who sought care after experiencing sexual violence (SV) during the first six months of the COVID-19 pandemic in a Brazilian city. This is a cross-sectional retrospective study. Data from emergency care and legal abortion requests of women assisted at the Women's Health Care Center Hospital (School of Medical Sciences, University of Campinas, Brazil) due to SV experienced between March 23 and August 23, 2020 (Quarantine Group, QG), were collected and compared with data from the same period of the previous biennium (Comparison Group, CG). χ2 and Fisher's exact tests were used to compare groups; the significance level was 5%. Data for 236 women were analyzed; 70 women were included in the QG and 166 in the CG. In the QG, there was a restriction in the area of origin of women, with a higher proportion of women who lived in Campinas (P = 0.0007) and a higher frequency of chronic SV (P = 0,035). There were no rapes associated with the use of social media or apps in the QG, but 9.8% of women in the CG experienced rape associated with the use of social media or apps. There were higher rates of domestic violence (P = 0.022) and intimidation through physical force (P = 0.011) in the first two months. The COVID-19 quarantine affected the profile of women who sought care after experiencing SV. The quarantine resulted in changes in the area of origin of patients, hindering access to health services and leading to higher rates of chronic and domestic SV, particularly in the first 2 months of the pandemic.

THE DEVELOPMENT OF THE VALUE-SEMANTIC SPHERE OF PRIMARY SCHOOL CHILDREN IN A NEW SITUATION OF GROWING UP

The paper examines the specifics of the value-motivational sphere of primary school children growing up in the digital age. The author presents the results of an experimental study on the features of value orientations and the orientation of the motivational and need sphere of children studying under standard conditions in comparison with children undergoing long- term treatment. There is a tendency to narrow the value-semantic sphere of children in hospital schools and a general tendency to strengthen the consumer orientation of the value-semantic sphere of younger schoolchildren.

«Fruit of Hope»: Recruitment of Kyiv Academy Students to the Hospital Schools in the Mid-18th Century Russian Empire

The article examines the choice of medical career as a way of social mobility by students of the Kyiv Academy, focusing on the first recruitment campaigns to hospital schools in Saint Petersburg and Moscow in the mid-eighteenth century. Researchers have long noted that students from the Hetmanate and Sloboda Ukraine were a valuable source for imperial domestic physicians. Lesser is known about possible motivations of the volunteers to study medicine in view of their social background. The article argues that a medical career was an active choice for social advancement made not only by clergy students, but Cossacks and commoners as well. Among those who wished to pursue a medical career were also towners. It was rarely attractive to representatives of the Cossack elite at the time under consideration. The article illustrates the process of educational integration of many students from the lower social ranks on their way to becoming participants in imperial project. First, the article examines how this trajectory of social advancement was shaped by the recruitment policy of the imperial medical administration, both declared and implemented. Then, it discusses the students’ travels to the capitals in light of the challenges they faced and the decisions they made on their way to join the medical ranks. The final part examines the social background of the students and their academic performance to understand what the choice of medical profession meant for different social groups and how inclusive this path of social mobility was.

Comparison of the Efficacy and Safety of Thyroid Microwave Ablation and Radiofrequency Ablation versus Open Surgery for the Treatment of Benign Thyroid Nodules: A Propensity Score Matching Study.

With the advantage of preserving thyroid function while minimizing intervention-related morbidity, minimally invasive thermal ablation techniques such as microwave ablation (MWA) and radiofrequency ablation (RFA) have emerged as alternatives to traditional open surgery. This study compares the efficacy and safety of MWA and RFA with that of open surgery for the treatment of benign thyroid nodules by utilizing a propensity score matching study design to improve comparability. This retrospective study included patients with benign thyroid nodules treated at the North China Electric Power University (Baoding) School Hospital between May 2020 and May 2023. Following propensity score matching, the patients were equally divided into three treatment groups: MWA, RFA, and open surgery. Data on demographic characteristics, thyroid function, treatment outcomes (including nodule size reduction, postoperative pain, cosmetics, hospital stay, and quality of life (QoL)), and postoperative complications were analyzed. A total of 160 patients, including 55 patients who received MWA, 58 patients treated with RFA and 47 patients operated with open surgery, were initially included. Propensity score matching, aimed at minimizing baseline differences among the groups, was conducted, leaving behind 105 patients, who were equally distributed with 35 persons per group. Compared to open surgery, both MWA and RFA significantly reduced intraoperative blood loss, operation time, length of hospital stay, and pain scores (p < 0.05). The incidence of complications, such as hypothyroidism, hematoma, wound pain, and incision adhesion, was also significantly lower (p < 0.05). In addition, the MWA and RFA were superior to open surgery in terms of cosmetic satisfaction and overall QoL scores (p < 0.05). No significant differences were observed between the MWA and RFA groups in terms of treatment efficacy, complication rates, cosmetic satisfaction, and QoL scores (p > 0.05). At the 6-month follow-up, no significant differences in thyroid function were observed among the three treatment modalities (p > 0.05). MWA and RFA exhibit comparable outcomes, in terms of efficacy and safety, for the treatment of benign thyroid nodules, with advantages over open surgery including shorter hospital stays, lower level of postoperative pain, better cosmetic outcomes, higher QoL scores, and lower rates of certain complications.

Application of comprehensive nursing combined with ISBAR handover approach in the nursing of patients with placental abruption.

The research for this paper was conducted to unveil the effect of comprehensive nursing combined with the Identification-Situation-Background-Assessment-Recommendation (ISBAR) handover approach in the nursing of patients with placental abruption. The 40 cases of placental abruption patients admitted to the Women's Hospital School of Medicine Zhejiang University from May 2021 to May 2022 were subjected to conventional basic nursing combined with traditional handover tool intervention, which was recorded as the control group; the 40 cases of placental abruption patients admitted to the Women's Hospital School of Medicine Zhejiang University from June 2022 to June 2023 were subjected to comprehensive nursing combined with ISBAR handover tool intervention, which was recorded as the observation group. Maternal and infant outcomes, the quality of nurse handover, and the psychological burden [State Anxiety Inventory (S-AI), Trait Anxiety Inventory (T-AI), Distress Thermometer (DT), and General Self-Efficacy Scale (GSES)] were observed in the two groups, and the satisfaction with nursing was also assessed by using a self-administered satisfaction scale in the two groups. The rate of normal delivery of patients in the observation group was higher and the rate of cesarean section and the total incidence of complications were lower than that of the control group. The 1- and 5-min Apgar scores of the newborns in the observation group were higher and the total complication rate was lower than that in the control group. Nurses in the observation group had higher scores for nurses' shift handover quality. S-AI, T-AI, and DT scores were lower in both groups after the intervention and were lowest in the observation group; GSES scores were higher and were highest in the observation group. Satisfaction with nursing was higher in the observation group than in the control group. Comprehensive nursing combined with the ISBAR handover approach applied to the clinical care of patients with placenta abruption can effectively improve the outcomes of mothers and infants, enhance the quality of nurses' shift handovers, reduce the psychological burden of patients and increase nursing satisfaction.

Human Papillomavirus Genotype Attribution and Integration in High-Grade Vaginal Intraepithelial Neoplasia.

The aim of the study was to investigate the distribution and association between human papillomavirus (HPV) genotypes and integration as well as their correlation with cervical lesions. Two hundred seven patients diagnosed with high-grade vaginal intraepithelial neoplasia (HG-VaIN) were recruited from the Women's Hospital School of Medicine Zhejiang University between 2015 and 2021 and assayed for HPV genotyping. HPV integration sequencing analysis was conducted using tissues from 53 patients with HG-VaIN and 4 patients with invasive vaginal carcinoma (IVC), along with paired cervical lesion specimens. A total of 207 patients with HG-VaIN were categorized as having cervical lesions unrelated to HG-VaIN (group A, 71 patients, 34.30%) or cervical lesion-related HG-VaIN (group B, 136 patients, 65.70%). With an average follow-up of 42.19 months, 12 of 153 patients progressed to IVC and were all from group B. HPV16 infection and the presence of cervical lesions were the 2 main factors associated with disease progression, with cervical lesion coexistence being an independent factor. Compared with group A (5/20, 25%), group B (17/33, 51.52%) showed a higher rate of HPV integration, as demonstrated using HPV integration sequencing analysis, with HPV16 being the most integrated genotype (72.73%). The integration analysis of 4 patients with IVC paired with cervical lesion specimens showed that 3 of the 4 pairs exhibited the same HPV infection and integration sites, indicating a high degree of homology in HPV integration between cervical lesions and HG-VaIN-induced IVC. Patients with HG-VaIN associated with cervical lesions exhibited a higher risk of malignant transformation, necessitating more proactive treatment approaches.

Surgical outcomes of a low-cost adapted sacrospinous fixation for apical prolapse repair

Objective: To assess surgical outcomes of women submitted to the adapted sacrospinous fixation (SSF) at a school hospital in northeastern Brazil for apical prolapse repair. Methods: Retrospective study with medical records of women submitted to the adapted SSF at a reference center in Brazil (2015 to 2019). All women submitted to this SSF were included, and those with pelvic organ prolapse (POP) recurrence, repair using other techniques, or unavailable medical records were excluded. The anatomical result, surgical characteristics, and associated complications and recurrence were evaluated. The chi-square and Fisher's exact test were used for statistical analysis, using a significance level of 5%. Results: A total of 198 medical records were included. The mean age was 65.1 ± 8.2 years; most had less than eight years of education, were menopausal, multiparous, and with urinary incontinence. The postoperative POP stage significantly improved at all compartments. The complication rate was 15.7%, especially due to de novo urinary incontinence (n = 12; 6%). Five cases of mesh-related complications (5%) were observed. The median follow-up was nine months, with 8.4% of POP recurrence and reoperation. POP recurrence or mesh-related complications were not associated with sociodemographic, clinical, or surgical characteristics.[...]

Влияние детско-родительских отношений на эмоциональное состояние детей с онкологическими заболеваниями, находящихся на длительном лечении

&lt;p&gt;This study is devoted to identifying the interrelationship of child-parent relations and emotional state of children with cancer who are on long-term treatment. The research methodology includes a complex of psychodiagnostic methods for studying the emotional state of children and child-parent relationships: questionnaire &amp;ldquo;Parent-child interaction&amp;rdquo; by I.M. Markovskaya, family sociogram, projective technique &amp;ldquo;Non-existent animal&amp;rdquo;, &amp;ldquo;Train&amp;rdquo; by S.V. Velieva, anxiety test by A.M. Prikhozhan for younger schoolchildren and anxiety test by R. Temml, M. Dorki and V. Amen for preschoolers. Children aged 5&amp;ndash;10 years and their parents participated in the study. 30 children and 30 parents were interviewed on the basis of the hospital school of the &amp;ldquo;TeachKnow&amp;rdquo; project at the Federal State Budgetary Institution National Medical Research Center of Oncology named after N.N. Blokhin, Ministry of Health of Russia. The results obtained indicate a correlation between the specifics of child-parent relations and the emotional state of children with cancer.&lt;/p&gt;

Conformational Flexibility in Capsids Encoded by the Caliciviridae.

Caliciviruses are a diverse group of non-enveloped, positive-sense RNA viruses with a wide range of hosts and transmission routes. Norovirus is the most well-known member of the Caliciviridae; the acute gastroenteritis caused by human norovirus (HuNoV), for example, frequently results in closures of hospital wards and schools during the winter months. One area of calicivirus biology that has gained increasing attention over the past decade is the conformational flexibility exhibited by the protruding (P) domains of the major capsid protein VP1. This was observed in structure analyses of capsids encoded by many species and is often a consequence of environmental cues such as metal ions, changes to pH, or receptor/co-factor engagement. This review summarises the current understanding of P-domain flexibility, discussing the role this region plays in caliciviral infection and immune evasion, and highlighting potential avenues for further investigation.

Effect of monoclonal gammopathy in the progression of acute kidney injury and chronic kidney disease: a retrospective observational study.

The involvement of monoclonal immunoglobulin (MIg) in renal damage in patients with haematological disorders and renal biopsy-proven monoclonal gammopathy of renal significance is well established. However, no epidemiological studies have been conducted on the effects of MIg on renal function in other patients. We aimed to evaluate the renal prognosis of MIg-positive patients and the effects of MIg on renal function. This retrospective observational study was performed using clinical data from all outpatients and inpatients who underwent MIg measurements at the time of enrolment at Kochi Medical School Hospital between 1 January 2017 and 31 December 2021. The primary outcomes were the occurrence of acute kidney injury (AKI) and a decline of > 30% in the estimated glomerular filtration rate (eGFR). Among the 1362 patients, 750 were included in our cohort. The number of MIg-positive and MIg-negative patients was 119 (15.9%) and 631 (84.1%), respectively. In addition, the MIg-positive patients were significantly older than the MIg-negative patients. The survival probability of the MIg-positive group was significantly lower than that of the MIg-negative group during the 2year observation period. The risk factors for the primary endpoint were positive MIg, female sex, lower eGFR, and lower albumin level. Our study showed that the presence of MIg was an independent risk factor for renal damage. Therefore, we suggest that MIg-positive patients require careful follow-up of their renal function, even in the absence of a clear underlying disease, such as multiple myeloma.

Characteristics of Japanese teenage suicide attempters: a retrospective study comparing suicide attempters with young adults

BackgroundTeenage suicide-related behaviors have been highlighted in Japan in recent years, but the background factors and characteristics of these behaviors have not been clarified. Therefore, we investigated the characteristics of teenage suicide attempters who were admitted to an emergency room.MethodsThe subjects were suicide attempters in their teens and twenties who were admitted to the Critical Care Medical Center of Nippon Medical School Hospital between January 1, 2010 and December 31, 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives for suicide attempts were retrospectively examined from medical records. Teenage suicide attempters were compared to those in their twenties in regard to the acquired data, and logistic regression analysis was conducted to evaluate the influence on teenage suicide attempts by the aspects that have been shown to be closely associated with teenage suicides.ResultsAmong 860 suicide attempters between 2010 and 2021, 59 (6.9%) were teenage suicide attempters and 216 (25.1%) were suicide attempters in their twenties. The large number of females, the history of self-harm, the great number of drug overdoses as a means of attempting suicide, and the large number of individuals with psychiatric disorders, especially with mood disorders and personality disorders, were commonly shared by suicide attempters both in their teens and twenties. On the other hand, family problems, school problems and autism spectrum disorder significantly influenced mostly teenage suicide attempters.ConclusionsIt was suggested that teenage suicide attempters may have attempted suicide due to environmental difficulties and conflicts about not being able to escape from them. It has become clear that teenage suicide attempters have unique characteristics and background factors, and that it is important to take these into account when taking measures to prevent teenage suicides.

Experience in the Management of Genitourinary Syndrome of Menopause With Fractional CO2 Laser at Dr. Alejandro Dávila Bolaños Military Teaching Hospital in Nicaragua.

We evaluated the quality of life improvements in patients with genitourinary syndrome of menopause (GSM) who received fractional CO2 laser therapy at the Gynecology-Obstetrics Department of "Dr. Alejandro Dávila Bolaños" Military School Hospital (HMADB) in Managua, Nicaragua, from June 2022 to October 2023. This descriptive cross-sectional study included 25 GSM patients with contraindications or insufficient response to local estrogen therapy. Each patient received two sessions of fractional CO2 laser therapy targeting the vaginal canal, vestibule, and labia minora, with a six-week interval between treatments. The Vulvovaginal Symptom Questionnaire (VSQ) was administered pre-treatment and at three and six months post-treatment. Statistical analysis was performed using the paired t-test. Most patients were between 56 and 68 years of age (80%), and 56% were in active sexual relationships. Prior to CO2 laser therapy, 100% of participants reported vulvar symptoms, 92% experienced impacts on daily life, and 72% had difficulties in sexual life. Six months post-treatment, these percentages dropped to 40%, 16%, and 8%, respectively. Overall, 52% of patients became asymptomatic, while 48% reported mild symptoms. Paired t-test analysis indicated statistically significant improvements (p < 0.05) between pre- and post-treatment scores. Mild and transient adverse effects included pruritus (40%), pain (28%), dyspareunia (24%), and erythema (16%). Fractional CO2 laser therapy is a safe and effective non-hormonal option for GSM management, with minimal and transient side effects, providing a valuable alternative for patients who cannot use estrogen-based treatments.

Transbronchial lung cryobiopsy for interstitial lung disease: early experience, learning curve, and the impact of sedation on complication rates at a single centre in Japan

BackgroundTransbronchial lung cryobiopsy (TBLC) has emerged as a promising diagnostic tool for interstitial lung disease (ILD). This study aimed to assess the initial experience, procedural learning curve, and influence of sedative medications on complication rates, particularly bleeding and pneumothorax, in the implementation of a TBLC program for ILD diagnosis.MethodsIn this retrospective cohort study, we analysed 119 patients who underwent TBLC at Nippon Medical School Hospital from April 2021 to March 2024. Procedural times, complication rates, and histopathological outcomes were evaluated. The learning curve was assessed using cumulative sum (CUSUM) analysis, focusing on procedure time and biopsy yield. The association between sedative medication dosages and bleeding risk was also examined.ResultsThe overall diagnostic yield was high, with alveolar tissue obtained in 97.5% of cases and a definitive pathological diagnosis achieved in 81.5% of patients. CUSUM analysis revealed a proficiency threshold at approximately 56 cases, with improved efficiency and biopsy yield in the consolidation phase. Fentanyl dosage was significantly associated with reduced bleeding complications (odds ratio 0.51, 95% confidence interval 0.27–0.97, p = 0.041).ConclusionsTBLC is a safe and effective diagnostic tool for ILDs, with a manageable learning curve for procedural efficiency. Sedation, particularly fentanyl dosage, may plays a crucial role in minimizing complications, but further research is needed to clarify this relationship. These findings support the adoption of TBLC as a standard diagnostic approach for ILD and highlight the importance of adequate training and optimized sedation protocols to ensure safety and efficacy in clinical practice.

Impact of Home-Based Rehabilitation on Renal Prognosis in Patients with Chronic Kidney Disease.

The increasing prevalence of chronic kidney disease (CKD) requires effective preventive measures, particularly due to an aging population. This study aimed to assess the effectiveness of home visit rehabilitation in preventing renal function decline among patients with CKD. In this retrospective study, patients with non-dialysis CKD undergoing home visit rehabilitation were compared with those receiving outpatient care at the Nippon Medical School Hospital between August 2017 and August 2023. Patients' backgrounds were matched using propensity scores derived from a logistic regression model. The primary endpoint was the annual change in the estimated glomerular filtration rate (eGFR), and the secondary endpoint was the annual change in blood parameters (Δblood urea nitrogen, Δcreatinine, Δtotal protein, Δalbumin, ΔC-reactive protein, Δhemoglobin, and Δhematocrit). Furthermore, the incidence of clinical outcomes, including mortality, hospitalization rate, and dialysis initiation rate, were analyzed within the additional 1-year observation period. Overall, 128 patients (64 matched pairs) were analyzed. After a mean follow-up period of 12.7 ± 4.6 months, there was no significant difference in the eGFR between both groups (40.1 ± 13.7 vs. 37.8 ± 13.8 mL/min/1.73 m2, p = 0.36), but the annual decline in eGFR (%/year) was significantly lower in the rehabilitation group (-1.1 ± 29.8% vs. -11.8 ± 27.7%/year, p = 0.037). The annual change in the level of each blood test parameter and clinical outcomes were not significantly different between the two groups. Home-based rehabilitation interventions may mitigate the progression of renal impairment in patients with CKD.

The Current Status of Comprehensive Genomic Profiling in the Management of Metastatic Castration-Resistant Prostate Cancer: A Study from a Cooperative Hospital for Cancer Genomic Medicine in Japan.

Several effective treatment modalities against metastatic castration-resistant prostate cancer (mCRPC) are available; however, an unmet clinical need persists for mCRPC treatment because resistance to these therapies is inevitable. This study aimed to evaluate the status of comprehensive genomic profiling (CGP) and its impact on subsequent treatments for patients with mCRPC at our hospital. Between December 2020 and August 2023, we assessed 41 patients with mCRPC who underwent CGP testing at the Nippon Medical School Hospital. The testing comprised FoundationOne® CDx for 30 patients and FoundationOne® Liquid CDx for 11 patients, following the procedures outlined by the Japanese Urological Association. CGP testing was successfully conducted in 40 out of 41 patients (97.6%), which resulted in the identification of 140 actionable genomic alterations. The most common alteration was TP53 in 12 patients (30.0%). Twenty-three patients (57.5%) with druggable gene alterations were identified; 21 were recommended for clinical trials, four for patient-proposed healthcare services, and six for insurance-covered drugs. Consequently, genotype-matched therapy with insurance-covered drugs was administered to five patients (12.5%) with a BRCA2 mutation. Notably, none of the patients underwent clinical or prospective trials based on patient-suggested medical services. Our results offer insights into the real-world application of CGP testing for patients with mCRPC at a cooperative hospital for cancer genomic medicine in Japan. Thus, urologists require a comprehensive understanding of the current status of CGP testing to enhance mCRPC management.

A-100 Clinical Utility of Measuring Creatine Concentration in Erythrocyte

Abstract Background Shortened erythrocyte lifespan characterizes hemolytic anemia and impacts HbA1c values. Recently, erythrocyte creatine concentration (EC) measurement emerged as a new method to assess erythrocyte lifespan. However, literature reports conflicting findings regarding the association between erythrocyte lifespan and EC concentration. In our study, we noted low EC concentrations in renal diseases, typically linked to short erythrocyte lifespan, while iron deficiency anemia exhibited high EC concentrations. This contradicts established relationships, prompting a reevaluation of EC concentration assessment. The aim is to evaluate the clinical utility of EC concentration measurements by correlating them with various clinical parameters, including hematopoietic status. Methods EC concentrations were measured in 522 subjects (252 females, 270 males) aged 19 to 95 at Kawasaki Medical School Hospital. Medical records and laboratory test results from around one month before and after blood collection were used to create a database. Box-and-whisker plots illustrated EC concentration distribution for each disease, and scatter plots compared EC concentrations with laboratory parameters. Results EC concentrations were lower in renal diseases like Diabetes and Chronic Kidney Disease but higher in iron deficiency anemia (Fig. 1). Moreover, EC concentrations rose as hemoglobin concentrations declined, unaffected by CKD grade (Fig. 2). Conclusions While conventionally, high EC concentrations imply a short erythrocyte lifespan, our study noted the opposite trend. EC concentrations might not indicate erythrocyte lifespan but instead reflect hemoglobin synthesis. Investigating EC concentration's relationship with factors like iron and vitamin B12 involved in hemoglobin synthesis may unveil new clinical applications.

Differential diagnosis of non-molar gestational trophoblastic neoplasia with ectopic pregnancy by clinical-pathological features.

This study was presented to investigate the clinical-pathological characteristics of gestational trophoblastic neoplasia (GTN) following non-molar pregnancy and differentiated with ectopic pregnancy (EP). The clinical data of 83 patients who were admitted for suspected GTN after non-molar pregnancy at the Women's Hospital School of Medicine Zhejiang University from January 2015 to September 2022 were selected for analysis. In total, 41 cases were confirmed non-molar GTN, including 31 choriocarcinoma, 9 PSTT (placental site trophoblastic tumor), and 1 ETT (epithelioid trophoblastic tumor), while 42 cases were confirmed EP. Compared with ectopic pregnancy, non-molar GTN patients had lower levels of serum progesterone compared with EP (3.81nmol/L vs 17.70nmol/L, P = 0.001). Based on the ultrasound, the thickness of the endometrium was thinner in patients with non-molar GTN compared with EP (0.565cm vs 0.70cm, P = 0.018). By histopathologic examination, the endothelium of non-molar GTN showed less decidual-like changes compared with EP (64.3% vs 14.6%, P = 0.001). A combination of serum progesterone levels, endometrium thickness, and histopathologic features of the endometrium can help to differentiate non-molar GTN and EP. Surgeries including hysteroscopy with curettage and/or laparoscopy are needed.

Is occlusal contact re-established within 6 months after bonding of a fixed anterior bite plane in adolescents with a Class II division 2 incisor relationship? A randomised controlled trial.

To determine if re-establishment of occlusal contact was achieved within 6 months after insertion of a fixed anterior bite plane in individuals with Class II division 2 incisor relationship, and to evaluate the occlusal and vertical skeletal changes and acceptance of the intra-oral scanner and bite plane. Single-centre two-arm parallel group randomised controlled trial with 1:1 allocation to intervention and control groups. Dundee Dental Hospital and Research School, UK. A total of 38 participants aged 9-16 years (11 males, 27 females) with Class II division 2 incisor relationship and increased overbite (greater than one-third incisor overlap). Participants were randomised to intervention (n = 19) and control (n = 19) groups using block randomisation. The intervention group had a fixed anterior bite plane, and the occlusion and vertical facial dimensions were monitored with intra-oral scans, lateral cephalograms and photographs. The control group received no treatment and occlusal and vertical facial dimensions were monitored with scans and photographs. Questionnaires were completed by participants and parents/carers. An intention-to-treat analysis was planned. The overbite reduced in all participants in the intervention group (mean initial overbite: 5.07 mm, 95% confidence interval [CI] = 4.15-6.00; mean overbite after 6 months: 2.45 mm, 95% CI = 1.93-2.96). There was a mean incisor intrusion of 0.29 mm (95% CI = 0.17-0.42) and mean eruption of the first molars of 0.23 mm (95% CI = 0.09-0.37). There was no significant change in incisor inclination or vertical skeletal change. Feedback from participants and their parents/carers were generally positive. Fixed anterior bite planes effectively reduce an increased overbite in adolescents with a Class II division 2 incisor relationship, due to a combination of incisor intrusion and molar eruption with no change in incisor inclination or vertical skeletal change. Intra-oral scanning and fixed anterior bite planes are acceptable in adolescents.

Effect of age, sex, and chronic kidney disease on urinary creatinine excretion in Japanese patients.

Urinary creatinine levels are used to estimate the excretion rates of certain analytes from the respective analyte-to-creatinine ratios. We clarified the influence of age and sex on estimated daily urinary creatinine excretion (eUCrE) based on the urinary creatinine level and daily urine volume. All inpatients aged ≥ 18years who attended the Kochi Medical School Hospital with serum and urinary creatinine measurement results were enrolled. Serum and urinary creatinine concentrations were extracted from the database and fluctuations with sex and age were investigated. The eUCrE was calculated for patients with early morning spot urine protein excretion (UPE), and daily urine volume was measured on the same day. Overall, 643 participants (322 men, 321 women) were enrolled. The eUCrE levels of men and women aged 18 - 64 and 18 - 44years, respectively, significantly exceeded 1g/day. Those of women aged 65-74 and ≥ 75years were significantly lower than 1g/day. Each age group was further categorised into Groups A (patients with eGFR ≥ 30mL/min/1.73 m2 and UPE < 0.5g/gCr), B (eGFR ≥ 30mL/min/1.73 m2 and UPE ≥ 0.5g/gCr), and C (eGFR < 30mL/min/1.73 m2 and UPE ≥ 0.5g/gCr). The eUCrE levels were the highest in Group A, followed by Groups B and C. This study revealed age-, sex-, and renal function-related biases in adjusted values using urinary biomarkers, including proteinuria and creatinine ratio.