Specialized Centers Research Articles

Real-world persistence of multiple sclerosis disease-modifying therapies.

Treatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real-world rates of persistence on disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation. Treatment data on 4366 consecutive people with relapse-onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan-Meier survival analyses were used to express DMT persistence. In 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1-4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate. Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.

Digitalization as a determinant of transformation of the real sector of the economy of the macroregion (using the example of the North Caucasus Federal District)

Purpose: is to study of the processes of digitalization and digital transformation of the real sector of the economy of the regions of the North Caucasus Federal District. Methods: the methodological basis of the study was the concept of the digital economy, the theoretical principles of supply-side economics, the systems approach, trend analysis and predictive analytics. The study is based on the use of the methods of economic and statistical analysis, scientifi c abstraction, analogies and scientifi c generalizations. The methods used are characterized by validity and show a high degree of eff ectiveness. Results: digitalization and digital transformation processes are underway in the North Caucasus Federal District, but the pace remains low. To accelerate these processes, it is necessary to solve two interrelated problems: fi rstly, to materialize the processes of digitalization and digital transformation in the real sector of the economy of the regions of the federal district, and secondly, to train personnel in certain specialties who can eff ectively operate digital technologies. In the fi rst case, it is possible to use the model of catch-up development at the regional level, which will make it possible to implement the principle of “advantage of backwardness” and use the accumulated global and regional experience in the transition to the modern trends in the operation of digital technologies. In the second case, it is proposed to organize special centers in the subjects of the district for retraining digital technologies specialists with the necessary competencies and/or advanced training with the issuance of the confi rming certifi cates. Such centers could train exclusive specialists at the request of enterprises or engage in refresher training and retraining of the necessary specialists. The creation of the centers is possible on the basis of public-private partnership. Conclusions and Relevance: the main task of the digital transformation of industry is considered to be the modernization of production process management, which will lead to the signifi cant increase in labor productivity. To implement such a scenario, the economic entities in the regions of the North Caucasus Federal District need to move away from the traditionalist approaches that take place in the organization and management of enterprises, and switch to the processes of digitalization and digital transformation of the real sector of the economy of the district.

The World Must Put Hunger to Shame: The Hidden Story of Homowo, Ngmayem and Ngma

This message calls our world to put hunger to shame using the revealed examples of Homowo and ngmayem, an original ethnic food systems in Ghana. The occurrence of hunger over the centuries can be understood from hunger’s proverbial mood. The results of hunger on humans due to its numerous causes and it associated lessons compelled early Ga-Adangbe settlers in Ghana to independently initiate the concepts of ‘Homowo’ (hoot at hunger) and ‘Ngmayem’ (celebrate life foods) as food systems. The hidden systems and basics in these unique food systems of ‘hoot at hunger’ and that of ‘celebrate life foods’ was studied. Some notable findings from the concept of ‘hoot at hunger’ involves a comprehensive layout of hooting at hunger using sustainable agriculture and the following principles: an appropriate food with or without therapeutic effect, applicable technology, basic knowledge in food and nutrition, building a suitable organizational system driven by skilled humans across several communities, by recalling historical records of hunger in society, a set day of remembrance, eating good foods all day, by the story of who we are and where we come from, with unity of purpose as a community lead by honest leaders, and also by proper symbols, designs and expressions. A remarkable outcome from ‘celebrate life foods’ norm was that it showed a notable historical record about a people, their decisions, actions, dealings and group effort in time during a hunger crisis. Once again, both concepts call for the establishment of specialized centers for advanced studies on unique food systems of old and hunger around the world with a museum chronicling the past stories of hunger challenges among a people, district, nation and the world, their probable causes and its impact on their health, and how they invented exceptional systems and products to solve those problems. All these concepts are intended to transform or strengthen food systems.

Extrapleural pneumonectomy for sarcoma: Outcomes of adult patients at a specialized center.

Extrapleural pneumonectomy (EPP) is a complex surgical procedure involving en-bloc resection of the parietal and visceral pleura, lung, pericardium, and ipsilateral diaphragm. Small case series of pleural-based sarcoma of predominantly pediatric patients suggest EPP may be a life-prolonging surgical option. We aimed to describe the characteristics and outcomes of adults who underwent EPP at a specialized sarcoma center. Clinicopathologic variables, surgical details, and follow-up information were extracted for patients undergoing EPP for pleural-based sarcoma between August 2017 and December 2020. Primary outcomes were event-free survival (EFS) and overall survival (OS) from the date of EPP. Secondary outcomes were disease-free interval (DFI) prior to EPP, and early and late postoperative complications. Eight patients were identified, seven with soft tissue sarcoma and one with bone sarcoma. Patients had either localized disease with a primary thoracic sarcoma, sarcoma recurrent to the thorax, or de novo metastatic disease. All patients underwent resection of their pleural-based sarcoma by an experienced cardiothoracic surgeon, and some patients had pre or postoperative treatment. The perioperative morbidity was comparable with previously published reports of EPP performed in mesothelioma patients. At median follow-up of 22.5 months, median EFS was 6.0 months and OS was 20.7 months. Six patients (75%) had disease recurrence; five (62.5%) died of progressive disease. Two patients (25%) had not recurred: one died of a radiation-related esophageal rupture, and one was alive with no evidence of disease at 37.0 months. Characteristics of those with the longest EFS included low-grade histology and achieving a metabolic response to preoperative chemotherapy. In adults with pleural-based sarcoma, EPP is rarely curative but appears to be a feasible salvage procedure when performed at specialized centers. Patient selection is critical with strong consideration given to multimodal therapy to optimize patient outcomes. In the absence of a confirmed response to neoadjuvant treatment, long term survival is poor and EPP should not be recommended.

Sexual dysfunction in cystic fibrosis

BackgroundSexual dysfunction (erectile dysfunction in males, sexual dissatisfaction, sexual interest/arousal disorders, and dyspareunia in females) has not been the subject of indepth research in people with cystic fibrosis (CF). This study aimed to determine the prevalence of sexual dysfunction in adults with CF, factors associated with sexual dysfunction, and the impact of sexual dysfunction on quality of life. MethodWe conducted a multicentre study in adults with cystic fibrosis followed in specialist centres in Western France. We assessed erectile dysfunction and its severity using the IIEF5 self-questionnaire (International Index of Erectile Function); the FSFI (Female Sexual Function Index) was used to assess sexual function in females, and we evaluated quality of life in both sexes using the CFQ-R14+ questionnaire. ResultsIn total, 77 males and 74 females completed the sexual function questionnaire (mean age 32+/- 10 and 25+/- 8,5 years respectively). Among them, 21 % of males and 30 % of females reported sexual dysfunction. CFQ-R14+ score was significantly lower in males with erectile dysfunction than those without (p < 0.001). Faecal incontinence was associated with more frequent sexual dysfunction in females and higher severity of erectile dysfunction in males. ConclusionThe prevalence of sexual disorders is relatively high in males and females with cystic fibrosis. Therefore, it seems important to train specialist teams to address the issue of sexuality without embarrassment, and to encourage them to seek out and treat faecal incontinence, which is associated with greater severity or frequency of these symptoms.

Suicidal behavior in homeless population and its relationship with experienced aggressions: A seven-year longitudinal study.

IntroductionSuicide is a serious and complex public health issue that affects millions of people worldwide. Among the most vulnerable populations are homeless individuals (HIs), whose suicide rate is significantly higher than that of the general population.ObjectivesThe aim of this study was to analyze mortality and suicidal behavior in a cohort of HIs during a seven-year follow-up. Additionally, the study sought to identify variables linked to mortality in this population.MethodsThe study was conducted in the province of Girona, Spain, and included 154 HIs who were literally experiencing homelessness. Self-report questionnaires were used to gather sociodemographic data, assess suicide risk, and measure the severity of substance dependence. The follow-up was carried out between 2015 and 2022, collecting data on mortality, suicide attempts, episodes of overdose, and violence experienced from public health services (psychiatric and primary health care services).Results During the seven-year follow-up, 23 individuals (14.3% of the sample) passed away, with an average age at the time of death of 52.6 years. The main causes of death were cancer, suicide (excluding overdose), and accidental overdose. Methods used for suicide included drug overdose, jumping, and vein slashing. All deceased individuals had scores above the threshold on the Plutchik Suicide Risk Scale and had reported previous suicide attempts.Individuals who experienced violence during the follow-up period exhibited more severe suicidal ideation, more suicide attempts, and more non-lethal overdose episodes. Substance dependence, particularly cocaine dependence and dual pathology, was significantly associated with higher mortality.ConclusionsThis study reveals a high mortality rate among HIs, especially due to suicide and accidental overdose. The most significant variables related to mortality were suicidal ideation, the number of previous non-lethal overdoses, and substance use disorders, with cocaine dependence being prominent. The results underscore the need for specific prevention and treatment programs to address suicide risk factors and improve the mental health of homeless individuals. The importance of conducting interventions in specialized centers that detect and address suicide risk in this vulnerable population is also emphasized.Disclosure of InterestNone Declared

Semaglutide Effects on Metabolic Outcomes in Diabetes Mellitus Patients - Real World Study.

Diabetes is a public health problem that requires strategies to impact glycemic control and reduce the risk of long-term medical complications. Pharmacological management is a necessary treatment for this disease. Therefore, semaglutide is an essential tool to achieve the treatment targets. The present study aimed to evaluate the semaglutide effects on a cohort with type 2 diabetes mellitus (T2DM) in Colombia. The cohort included 49 patients with T2DM that have been treated in a specialized care center. Their glycemic outcomes, weight, renal function, and adverse events were evaluated through a 3-, 6- and 12-month follow-up. Significant differences were observed in the outcome evaluation: reduction of glycated hemoglobin levels (MD -2.74 CI -1.95 to -3.52 in 6 months), fasting plasma glucose levels, body weight (MD -7.11 CI -5.97 to -8.24), and the albumin-to-creatinine ratio. The results were maintained throughout the treatment period. The adverse event rate was 16.3%, predominating gastrointestinal events. This real-world evidence shows the efficacy of semaglutide in achieving treatment goals in patients with T2DM.

784 Effects of Optimal Versus Suboptimal Median Household Income on the Operative Traumatic Brain Injury Population: A Propensity Score-matched Analysis

INTRODUCTION: Median household income is a useful metric for healthcare disparity assessment. New England holds a highly diverse, densely populated metropolitan area with one of the highest living wages in the US. To our knowledge, there is no published data on the effects of optimal vs. suboptimal median household income on the operative traumatic brain injury (TBI) patients. METHODS: Demographic, clinical and outcome data of operative TBI patients between 2015 and 2021 were collected and stratified based on optimal (80 000$ or more) and suboptimal (less than 80 000$) median residential household income. 1:1 tight caliper (0.01) propensity score matching was performed to balance the groups for comparative analysis. RESULTS: From the initial 91 patients in the optimal and 102 patients in the suboptimal income groups, 62 patients were included in each group after propensity matching. There were significantly more ethnic minority patients in the suboptimal as compared to the optimal income group (66.1% and 35.7%, respectively; p=0.002). Optimal income group patients presented as transfers from other hospitals significantly more frequently than the suboptimal group (52.5% and 30.7%, respectively; p = 0.02). There were no significant differences in post-operative Glasgow coma scale scores (p = 0.15), modified Rankin scale scores at discharge (p = 0.92) and upon follow-up (p = 0.1), mortality (p &gt; 0.999) or disposition destination distribution (p = 0.3). CONCLUSIONS: While the suboptimal income group is significantly more ethnically diverse, optimal versus suboptimal median household income does not seem to affect TBI outcomes and disposition. Optimal income group patients are more frequently presenting as transfers from other facilities indicating fair high-level care at a specialized high safety-net burden trauma center adapted to an ethnically diverse population.

Factor VIII Intron 22 Inversion Mutation in Samples of Iraqi Patients with Hemophilia A

Abstract Background: Hemophilia A is an X-linked recessive inherited bleeding illness characterized by a lack of procoagulant factor VIII; the factor VIII gene has more than 3000 different mutations, and the most frequent molecular changes in severe hemophilia A are intron 22 and intron 1 inversions (Inv 22 and Inv 1). Objectives: To detect intron 22 inversion mutation in samples of Iraqi patients with hemophilia A and reveal its role in inhibitor production. Materials and Methods: Eighty patients with hemophilia A were enrolled in this study from two Iraqi centers. The specialist centers for hemophilia in Babil Teaching Hospital for Maternity and Children and Welfare Teaching Hospital. Genetic analysis of the Inv 22 mutation was done by real-time thermal cyclic quantitative PCR (qPCR). Mixing study and Bethesda assay were used for the detection of inhibitor development. Results: Eighty patients with hemophilia A were partitioned into 22 (27.5%) with inhibitors and 58 (72.5%) without inhibitors. Most patients (48.8%) were diagnosed at age 6–9 months; according to the disease severity, patients were divided into severe hemophilia 76.25%, moderate hemophilia 16.25%, and mild hemophilia 7.5%. Among all patients, positive Inv22 mutation was detected in 83.7%. Conclusion: the results of inversion 22 are consistent with overall reports, being a significant major genetic transformation in severe hemophilia A. q-PCR is a basic, fast method for the detection of inversion 22. The mutation is detected in 74.6% of severe cases and is considered an important risk factor for inhibitor production.

External Validation of the Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH) Classification for Predicting Outcome in Periprosthetic Joint Infections: A Cohort of 653 Patients

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication in hip and knee joint arthroplasty. The “Joint-Specific Bone Involvement, Antimicrobial Options, Coverage of the Soft Tissues, and Host Status (JS-BACH)” classification system was developed in 2021 to stratify the complexity of PJI, and more importantly, to act as a tool to guide referrals to specialist centers. The “JS-BACH” classification has not been validated in an external cohort. This study aimed to do so using a large prospective cohort from Australia and New Zealand. MethodsWe applied the JS-BACH classification to the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort. This prospective study of newly diagnosed PJI collected 2-year outcome data from 653 participants enrolled in 27 hospitals. The definition of PJI treatment failure at 24 months was any of the following: death, clinical or microbiological signs of infection, destination prosthesis removed, or ongoing antibiotic use.Individual cases were classified as per JS-BACH into “1: uncomplicated” (n = 268), “2: complex” (n = 330), and “3: limited options” (n = 55). This cohort was similar to the original JS-BACH population in terms of baseline characteristics. However, there was a difference in complexity, with more debridement, antibiotics, and implant retention procedures, fewer revision procedures, and a higher proportion of uncomplicated patients in the PIANO cohort. ResultsThe risk of treatment failure correlated strongly with the JS-BACH category, with odds ratios (95% confidence interval) for category 2 versus 1 of 1.75 (1.24 to 2.47) and for category 3 versus 1 of 7.12 (3.42 to 16.02). ConclusionsDespite the PIANO study population being less complicated than the original derivation cohort, the JS-BACH classification showed a clear association with treatment failure in this large external cohort.

Empowering Minds: A Comprehensive Study of ECT Treatment in a Reference Mental Health Center in Portugal

IntroductionElectroconvulsive Therapy (ECT) is one of safest and most effective treatments for severe mental illnesses. The ECT Unit of Centro Hospitalar Universitário de Santo António – Magalhães Lemos Hospital (CHUSA-HML) is a reference center for this treatment modality, providing support to the northern region of Portugal.ObjectivesThis study aims to characterize patients undergoing ECT treatment from April to June 2023, at the ECT Unit of CHUSA-HML.Methods Retrospective study from April to June/2023. Social, demographic, epidemiological and clinical data were evaluated.ResultsAmong the 55 patients who were treated there was a predominance in male sex (56%), the average age was 53 years old and only 9 completed higher education. Half of them were in a long-term relationship. Around 67% of patients are retired, predominantly (62%) due to psychiatric disability. Most patients (78%) were referred through psychiatric consultation and the remainder came from psychiatric hospitalization (only 3 were never hospitalized). 41 patients were under maintenance treatment and 14 under acute treatment. Concerning the type of treatment 30 were submitted to bilateral ECT. For 33% it wasn’t the first ECT treatment. Almost all patients improved their symptoms, only one patient had complications related to the procedure (tooth loss).According to the international classification of disease (ICD11) the most frequent primary diagnosis was Schizophrenia or Other Primary Psychotic Disorders (58%). Neurodevelopmental disorders and substance use disorders were the most frequently comorbid diagnoses.The results presented are preliminary, and other data that may be relevant are being collected and processed.ConclusionsSevere mental illnesses profoundly impact patients, often imposing substantial limitations and suffering. These findings support the safety and effectiveness of ECT as treatment for severe mental disorders. Founding more specialized centers represents an important step toward enhancing mental health treatments. Access to controlled studies is crucial, fostering a deeper understanding of the ECT technique and long-term benefits.Disclosure of InterestNone Declared

STABILITY AND POTENTIAL OF COMMUNITIES IN THE CONDITIONS OF WAR: THREATS AND COUNTERMEASURES

Goal. In the conditions of war, the stability of the community becomes a decisive factor for its survival and further development. War exacerbates existing threats and creates new ones, requiring communities to rapidly adapt and develop resilience. The main goal of this article is to identify the key threats to communities in war conditions and to develop countermeasures. Method. A combination of quantitative and qualitative methods was used for the research, including case studies of local communities that have already faced military actions, as well as methods of comparative analysis, systemic-structural, generalization, economic-statistical, abstract-logical, monographic, methods of analysis and synthesis. The results. The invasion of the Russian army on the territory of Ukraine on February 24, 2022 caused terrible destruction, including the civil infrastructure of Ukraine. Significant damage to civil infrastructure has a negative impact on the functioning and development of the national economy, regions and communities. Russia's armed aggression today is also the main threat to the stability and security of the country in general and its regions and territorial communities in particular. This requires an immediate response at various levels of state administration and public activity. In addition to military action and political diplomatic pressure, an important aspect of countermeasures is economic stability. The stability of the economy, in particular, requires the strengthening of internal capacities capable of compensating for the economic and social losses that may arise as a result of military operations and require an understanding of countermeasures against threats. The main areas of sustainability are: Social cohesion: Threats: Division of communities, loss of trust, spread of fear and uncertainty. Countermeasures: Formation of mutual aid networks, provision of clear and truthful communication, organization of social events to preserve the community. Economic stability: Threats: Decrease in economic activity, increase in unemployment, drop in local budgets. Countermeasures: Creation of support funds for local enterprises, development of alternative sales channels, promotion of domestic and foreign investments. Psychological endurance: Threats: Spread of stress, injuries, mental disorders among the population. Countermeasures: Provision of psychological assistance, creation of specialized support centers, conducting trainings on psychological stability. Local self-government: Threats: Destruction of management infrastructure, loss of control over territories. Countermeasures: Development of local authorities, involvement of citizens in decision-making processes, creation of high-speed communication networks for communication between different levels of government. Scientific news. An analysis is made of how strategies to counter threats can be integrated into the daily functioning of the community and increase their recovery potential and resilience in the long term. Practical significance. The conclusions and suggestions of the article can be useful in optimizing community resources and developing strategies for their recovery and development in the post-war period.

A Pediatric Cardiology Outreach Clinic in a Local Hospital: An Experience Review from South A'Sharqiyah, Oman.

Specialized pediatric cardiology clinics conducted in local hospitals are an important part of delivering specialized care to patients close to their homes. This study aimed to review our experience with a specialized pediatric cardiology outreach clinic at Jaalan Bani Bu Ali Hospital, South A'Sharqiyah, Oman. Patient records for each individual, seen in the outreach clinic between March 2018 and June 2022, were reviewed to determine demographic information, reason for referral, underlying diagnosis, and clinic visit outcomes. Over the study period, 29 clinics were conducted, with 360 patients seen. Of these, 200 (55.6%) were male with a median age of 13 months. The majority of patients (n = 271; 75.3%) were referred due to a cardiac murmur. Most patients had a normal cardiac evaluation (n = 177; 49.2%). The most common congenital heart diseases detected were mild pulmonary valve stenosis (14.8%) and moderate to large secundum atrial septal defects (13.7%). Significant cardiac lesions detected included severe pulmonary hypertension (2.2%), tetralogy of Fallot (1.6%), and cor triatriatum sinistrum (0.5%). Overall, 70 (19.4%) patients were referred to tertiary care hospitals, and 179 (49.7%) were reassured and discharged. Conducting specialized pediatric cardiology outreach clinics in overpopulated areas is effective and well-received by families. It reassures many families and reduces the need for unnecessary travel to specialized centers. These clinics also play a crucial role in detecting patients with significant cardiac defects requiring urgent care. Implementing specialized clinics in primary and secondary health centers could be beneficial for other subspecialties in reducing long waiting lists.

Isolation and Identification of Oral Bacteria and Characterization for biofilm formation and antibiotics resistance

In this study, 100 bacterial isolates were obtained from tooth surface swabs of male and female patients with different ages who visited specialized centers and dental clinics in Baghdad city after they were clinically diagnosed with oral (dental) infections by specialist doctors for the period from 1/10/2022 to 1/3/2023. The methods employed to identify the bacterial isolates were the Vitek system, as well as highest isolated rate was among Streptococcus mutans species (48%). Isolates of S. mutans and their drug sensitivity was tested against 10 antibiotics using the disc diffusion process, showing that the separators’ Antibiotic resistance was larger than their sensitivity to these antibiotics. The resistance rate of the isolates to erythromycin was (98.21 and 94.64%), to amoxicillin (85.71)% for each of them, to ampicillin (80.35 and 83.92)%, to Nalidixic acid (80.35 and 87.50)%, to cefotaxime (69.64 and 75.00)%, and to chloramphenicol (69.64 and 89%), to amoxicillin–Clavulanic acid (58.92 and 76.78)%), to gentamycin (57.14 and 78.57)%, and to tetracycline the resistance rate was (55.35 and 66.07)% for each of them, respectively, while it showed high sensitivity to the antibiotics amikacin (25.00 and 48.21)% and trimethoprim sulfamethaxyl (7.14 and 19.64)% for each of them respectively.

Examination of Academic Human Resource Management Policies of Private Special Education Institutions and Rehabilitation Centers

This research aims to examine the human resource management policies of private special education institutions and rehabilitation centers based on the managers’ views. The basic qualitative research design was adopted in the research. The participants of the study consisted of managers of private special education institutions and rehabilitation centers operating in the province of Adıyaman. Criterion sampling technique was adopted in determining the participants. In this context, semi-structured interviews were conducted with 15 managers of private special education institutions and rehabilitation centers. The data obtained from the interviews with managers has been analyzed through content analysis. In the research, the opinions of the institution managers regarding the teacher employment process of their institutions were discussed under the themes of "employment criteria“, “employment process," and "problems encountered in the employment process." Policies for teacher development were examined under the themes of "personal development" and "professional development", while policies for teacher integration were examined under the themes of "rewarding". Policies for teacher evaluation were studied under the themes of "in-house evaluation" and "external evaluation". According to research results, the policies that shape the employment process are related to the nature of pre-service education and the professional and academic qualifications of teacher candidates. Additionally, based on the views of school administrators, it has been concluded that the shortage of subject experts is one of the problems encountered in the human resources management process of teacher employment. However, it has been stated that career planning and policies for professional development are insufficient in the process of teacher training and development, and teacher evaluation policies are shaped within the framework of internal and external evaluation criteria.

Optimization of biological heart valve prosthesis "UniLine": new tools for improving function

According to various estimates, more than 9,000 artificial heart valve implants were performed in specialized medical centers in Russian Federation in 2020 19.1 % of these implants were based on animal tissues. Such devices have high biocompatibility, but after 10–15 years from one third to one half require reoperation due to the development of various dysfunctions. Despite the advantages of biological prosthetic heart valves and the prevalence of their use in the clinic, there is a need for their optimization and refinement to improve postoperative hemodynamics and increase life spin. In this work, we applied an improved method to create the geometry of a leaflets and its evaluation to the commercial prosthesis «UniLine» (Kemerovo, CJSC «NeoKor») 23 standard sizes. An approach is demonstrated that includes a screening study of a large number of geometries (N = 6766) and detailed modeling (N = 4) of selected designs as part of the final product, taking into account interaction with the composite frame. The results obtained demonstrate the ability of the proposed method to optimize existing commercial models of prosthetic heart valves. An expanded set of construction parameters allowed us to select a design with peak maximum principal stresses of 1.89 and 0.68 MPa, as well as providing an open area of 233.08 and 267.34 mm2 with a maximum possible 314 mm2 for detailed and screening studies, respectively. At the same time, the area of the lumen in the diastolic phase in the prosthesis does not exceed 0.4 mm2 for the models shown. The presented results show the possibility of the method to create and evaluate "optimal" designs of flap devices according to a number of critical metrics for ensuring better hemo- and biomechanics – stresses occurring during the cardiac cycle, the presence of a twisting effect in the diastolic phase, as well as the ability to ensure maximum orifice area and locking quality.

Randomized, controlled, multi-center phase II study of postoperative enoxaparin treatment for venous thromboembolism prophylaxis in patients undergoing surgery for hepatobiliary-pancreatic malignancies.

Postoperative venous thromboembolism (VTE) risk is pronounced after abdominal cancer surgery. Enoxaparin shows promise in preventing VTE in gastrointestinal, gynecological, and urological cancers, but its application after surgery for hepatobiliary-pancreatic malignancy has been under-evaluated due to bleeding concerns. We confirmed the safety of enoxaparin administration in patients undergoing curative hepatobiliary-pancreatic surgery for malignancies in a prospective, multi-center, phase I study. The study was conducted from April 2015 to May 2021 across eight specialized centers. Patients (n = 262) were randomized to enoxaparin prophylaxis given postoperatively for 8 days (n = 131) or control (n = 131). The primary endpoint was the efficacy in reducing VTE. Secondary endpoints examined safety. The full analysis set included 259 patients (131 control, 129 enoxaparin). The per-protocol population included 233 patients (117 control, 116 enoxaparin). Most cases were hepatic malignancies (111 control, 111 enoxaparin). The median administration duration of enoxaparin was 7 days, with 92% receiving 4000 units/day. Despite a reduction in the relative risk (RR) of VTE due to postoperative enoxaparin administration, the results were not significant (control: four cases, 3.4% vs. treatment: two cases, 1.7%; RR 0.50, 95% CI 0.09-2.70; p = 0.6834). No significant difference was found in the incidence of bleeding events (control: five cases, 4.3% vs. treatment: five cases, 4.3%, RR 1.00, 95% CI 0.53-1.89; p = 1.0000). The perioperative administration of enoxaparin in hepatobiliary-pancreatic malignancies is feasible and safe. However, further case accumulation and investigation are necessary to assess its potential in reducing the occurrence of VTE.

A comparative study on fundamental movement skills among children with autism spectrum disorder and typically developing children aged 7-10.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition with unique differences in social interaction, communication, and a spectrum of behavioral characteristics. In the past, motor disturbance in individuals with ASD has not been considered a significant core deficit due to the predominant focus on sociability and communication issues. However, recent studies indicate that motor deficits are indeed associated with the fundamental symptoms of ASD. As there is limited research on the motor behavior of children with ASD, particularly in China, the objective of this study is to investigate the development of fundamental movement skills (FMS) in children with ASD and compare them to typically developing children. The study recruited 108 children with ASD (87 boys, 21 girls) aged 7-10 years from two special education rehabilitation centers in Wuhan, China. For comparison, a control group of 108 typically developing children, matched by age and gender, was randomly selected from three local primary schools. FMS were assessed using the Movement Assessment Battery for Children - Second Edition (MABC-2), which evaluates manual dexterity, aiming and catching, as well as static and dynamic balance. Group differences on MABC-2 percentile scores were analyzed using descriptive statistics and Mann-Whitney U test. Effect sizes were also calculated for practical significance. Findings from the study showed that a significant majority, around 80%, of children with ASD either displayed motor challenges or were at risk of developing such delays. When comparing to their typically developing peers, children with ASD scored notably lower in areas of manual dexterity, ball skills, and both static and dynamic balance (with all these findings being statistically significant at p < 0.001). Interestingly, gender did not show a significant influence on these results (p > 0.05). In addition to addressing the other skill development areas outlined in the diagnostic manual for ASD, clinicians diagnosing and treating children with ASD should also assess the presence of motor skill development. For individuals with ASD who have co-existing motor difficulties, it is essential to offer evidence-based interventions tailored to their specific needs.

Optimizing care for children with difficult-to-treat and severe asthma through specialist paediatric asthma centres: expert practical experience and advice

Severe asthma in children carries an unacceptable treatment burden, yet its rarity means clinical experience in treating it is limited, even among specialists. Practical guidance is needed to support clinical decision-making to optimize treatment for children with this condition.This modified Delphi convened 16 paediatric pulmonologists and allergologists from northern Europe, all experienced in treating children with severe asthma. Informed by interviews with stakeholders involved in the care of children with severe asthma (including paediatricians, nurses and carers), and an analysis of European guidelines, the experts built a consensus focused on the gaps in existing guidance. Explored were considerations for optimizing care for patients needing biologic treatment, and for selecting home or hospital delivery of biologics. This consensus is aimed at clinicians in specialist centres, as well as general paediatricians, paediatric allergologists and paediatric pulmonologists who refer children with the most severe asthma to specialist care. Consensus is based on expert opinion and is intended for use alongside published guidelines.Our discussions revealed three key facets to optimizing care. Firstly, early asthma detection in children presenting with wheezing and/or dyspnoea is vital, with a low threshold for referral from primary to specialist care. Secondly, children who may need biologics should be referred to and managed by specialist paediatric asthma centres; we define principles for the specialist team members, tests, and expertise necessary at such centres, as well as guidance on when homecare biologics delivery is and is not appropriate. Thirdly, shared decision-making is essential at all stages of the patient’s journey: clear, concise treatment plans are vital for patient/carer self-management, and structured processes for transition from paediatric to adult services are valuable. The experts identified the potential for specialist paediatric asthma nurses to play a significant role in facilitating multidisciplinary working.Through this project is agreed a framework of practical advice to optimize the care of children with severe asthma. We encourage clinicians and policymakers to implement this practical advice to enhance patient care.

Surgical Treatment of Coronary Heart Disease Against the Background of Coagulopathy of Unknown Etiology. Case Report

Coronary heart disease (CHD) is one of the most common cardiovascular diseases and one of the leading causes of death in the world. Diet is the first step in the prevention of CHD. Vegetarians have significantly lower risk of death from CHD, but also have changes in the hemostasis system due to a deficiency of blood clotting factors. Cardiosurgical intervention for patients with hemostatic disorders should be performed in specialized centers with the necessary support.&#x0D; Case description. A 73-year-old patient G. was hospitalized to the National Amosov Institute of Cardiovascular Surgery with angina pectoris, weakness and edema. From the past medical history it is known that the patient has been following a diet with complete exclusion of meat and dairy products for 20 years, rarely eats fish; in addition, he smoked for 20 years at a young age. After coronary angiography, the patient developed bleeding from the oral cavity of unknown origin, which resolved on its own. According to the examination, the patient was found to have a multivessel lesion of the coronary arteries, and cardiosurgical intervention was indicated: coronary bypass surgery. At a case conference with cardiovascular surgeons, anesthesiologist and cardiologist, a decision was made to perform salvage cardiac surgery. The predicted mortality risk was 7.0% by the EuroSCORE II. The early postoperative period was complicated by bleeding with subsequent revision of the pericardium to identify the source of bleeding. Coagulopathy of unknown origin was suspected. Replacement hemostatic therapy was started, which included massive blood transfusions. The pace and level of exudation significantly decreased, the operation was completed. After surgical interventions and hemotransfusions, thromboelastography was performed and plasma hypercoagulation was detected. The patient was discharged for continued cardiopulmonary rehabilitation, and outpatient treatment was prescribed.&#x0D; Conclusions. This case report describes successful treatment of multivessel coronary artery disease by bypass grafting in a vegetarian patient with a coagulation disorder. Studies of the effects of a vegetarian diet on the hemostatic system indicate that vegetarians may have lower concentrations of hemostatic factors and that thrombin time is also prolonged due to the nutritional guidance provided by this diet. In addition, timely detection of a deficiency of blood coagulation factors in the plasma of a patient with such history can facilitate the diagnosis of the hemostasis system.